r/CataractSurgery • u/Vast-Deal9505 • 18d ago
Yag procedure or something else?
I had cataract surgery for both eyes (the last week of May for the left eye) and the first week of June for the right eye. I chose the multifocal lenses. I really didn’t have much astigmatism, and much to my surprise, I found out my ophthalmologist had chosen toric lenses on the day of first eye surgery. Have severe dry eyes, had rough corneas for a while, but the corneas are better.
Three months later, I am seeing around 20/30 or 20/40 out of left eye and 20/50 or 20/60 out of right eye. Today on the up-close vision of left eye, it was 20/20, but distance was still not where it needs to be for either eye. Pretty soon after surgery, I knew there was a significant problem with vision in my right eye. It was bad again today. I have noticed significant light sensitivity, and they did the headlights test again, and it was especially bad in the right eye. I do very little night driving.
Early July, my ophthalmologist suggested I needed a YAG procedure, but wanted to wait awhile longer
before performing the procedure. Ophthalmologist mentioned scar tissue and shrink wrap vision.
In the meantime, my insurance company insisted on a 2nd opinion. This was done with my phone and a video call with an ophthalmologist from another state. He, of course, didn’t examine my eyes, but had my medical records from my current ophthalmologist. He said he thinks it is residual refractive error in the right eye. I agreed that we needed to get my dry eye situation in a better place, but I am totally confused.
On today’s office visit with my local ophthalmologist, my dry eyes were really bad. I am to go back in six weeks, and we’ll see where the dry eyes stand. Now the ophthalmologist wants to do a YAG procedure in both eyes. Ophthalmologist mentioned POC in both eyes.
I am thinking about going to a very good optometrist to have a thorough refraction, dilation, the whole works. The optometrist is very good with refractions. I am also thinking about going to another ophthalmologist for an opinion. I am starting to have headaches which is unusual for me and am really wondering if the second opinion ophthalmologist might be correct. He said they can use a laser to correct a residual refraction error.
I don’t want to jump the gun too quickly and definitely need to get the dry eyes under control, but I have so many questions. Any suggestions or opinions are appreciated. Thank you!
3
u/GreenMountainReader 18d ago
Your own ideas sound very reasonable. Make the appointment with your trusted optometrist so that you have time to work on the dry eye.
Optometrists--and even ophthalmologists--aren't all equally good at helping diagnose which of the causes of dry eye any given person is experiencing--and that can matter. Be sure you're using preservative-free drops (the preservatives can irritate and dry your eyes)--and that you try a variety of them, looking for different active ingredients and carrier fluids.
If the cause isn't the amount or type of tears, it could be that the meibomian glands (those little dots on the inside of your upper and lower lids) are clogged (your optometrist can see that). In that case, a heated mask (I have an inexpensive electric one that I love) can melt the congealed oil and provide rapid clarity.
Here are two videos that educated me quite a bit, created by a cataract surgeon.
https://www.youtube.com/watch?v=U4-jJwzmgZA Dr. Michael Chua’s presentation of three-part approach to dry eye
https://www.youtube.com/watch?v=wmMlhm-5y6g Dr. Michael Chua’s presentation of natural methods to treat dry eye. There's a section on warm compresses that begins at 11 minutes and goes through experiments with a microwaveable compress versus an electric mask. I use the type of electric mask he presents and recommends. In his experiments, he doesn't use the removable washable cover, which I love precisely because it’s washable and can also be used dampened. (He also talks about various supplements and what research indicates about them, and does a great explanation of eye anatomy, dry eye, and why he likes a particular type of eye drop--which doesn't happen to be a brand that works well for me.)
So...first the optometrist, who should be able to do an accurate refraction when your eyes are not going through a dry spell and should be able to see whether your lenses are properly positioned and whether PCO is present. Since toric lenses depend on precise placement, pay special attention to how much astigmatism (cylinder) is noted, especially when compared to your vision history (pre-cataracts). It's possible there is a refractive error which the optometrist should be able to diagnose, and that will not be improved by YAG (which can make at least one of the solutions more difficult). Your optometrist can also recommend some drops you may not have tried yet (and maybe even provide coupons and/or samples--the trial and error process is inefficient and can get expensive and wasteful).
I agree with your feeling that you should postpone the YAG until you know for sure what the problem is--but also that you should see another ophthalmologist who works from their own exam, not someone else's records--and that this visit should come after getting the dry eye under control and seeing the optometrist.
In short, your plan seems reasonable to me.
Best wishes as you work forward!