Hai, y'all. I haven't written about my cataract journey since two days after the first surgery was done. That eye, my right one, had almost 20/20 distance vision immediately, and I was looking forward to the second surgery on June 2.
If you missed my previous diaries about cataracts, the first diary gave some definitions and described my history of cataract development. The second diary had a video of an actual cataract surgery and descriped pre-op preparations. I wrote the third diary to document my experiences on the day of surgery and my immediate post-op findings. I was happy with the first result and excited about getting my left eye done.
The second surgery went even smoother than the first. From arrival to discharge I was at the eye center for two hours. I went home, put antibiotic and steroid drops in my (hugely dilated) eye every two hours, and slept with the eye shield on. Thursday morning I removed the shield and fully expected a result similar, if not identical, to the first: close to 20/20 distance vision. I believe my first expression was, "Oh, shit." My result is nothing close to 20/20.
I got dressed and drove to my optometrist's office for my previously-scheduled 24-hour check. The pressure in my eye was slightly elevated from surgery, but that had been the case a week earlier with my right eye, and its pressure was now normal. I told Dr. Cummings I was upset about the result, but he cautioned me to be patient. "It's only been one day, Kelley. We'll check your vision again in a week. Keep using your drops as prescribed and I'll see you next week."
Every day for the next week my vision in both eyes was so cloudy upon awakening that I couldn't read for several hours. The haziness slowly cleared as the hours passed, leaving me with good distance vision in my right eye and fair distance vision in my left. The IOL's, particularly the right one, haven't adhered to the capsule (the capsule which contained the original natural lenses) so they're moving around as my eyes move, causing light to flash off their edges, particularly in bright light or sunlight. Every day I applied the two drops as prescribed, four times a day. I was extremely frustrated, and I was also dealing with a sick pet, having to drive up and down the mountain every day or every other day for his visits to the vet.
I last saw my optometrist on Tuesday. I tried asking my questions several different ways: Is this normal? Have you seen these problems before? If they're normal, how long will the symptoms last? If they're not normal, what should I do? Could the prolonged AM cloudiness be from corneal edema? What can/should I do to make things better? Could the drops be a factor? Why did the vision in my right eye, originally 20/20, drop to 20/25? Why is the result in my left eye so poor? Could it have been a simple mistake, like using the wrong IOL?
I got non-answers, no answers, and half-assed answers. I don't have much patience with practitioners who lack good communication skills, experience, empathy, and common sense, and if I decide to give this guy another chance, he and I will have to have a talk. He wouldn't answer my question about the possibility of the wrong IOL being implanted. He told me I could stop using the antibiotic drops after Wednesday, but to finish up the PredForte drops, then added, "Some of my patients stop using them." His best suggestion for the AM cloudiness was to apply a warm compress across my eyes, "as hot as you can stand it." The only time he gave what I felt was an effective response was after I inquired why my right vision, originally 20/20, had decreased some. When I asked that question - and remember, he didn't think to look into this without prompting - he examined that eye with an extremely bright light and said I have some capsular hazing.
WTF? I guess my jaw dropped on that last statement, because I got the first unprompted explanation or elaboration to date. Dr. Cummings explained that the lens capsule is opened on the front side to remove the cataract and place the IOL. Usually, the capsule heals and adheres to the IOL, eliminating flashing lights, but sometimes the back side of the capsule develops an opening which must be repaired with a laser before the IOL can provide optimal vision. He then shook my hand, told me to return in two weeks for my new prescription, and left on vacation.
Oy, vey. I went home and had a consultation with Dr. Google. Guess what the most common side effect of PredForte drops is? Cloudy vision. You'd think an optometrist would know that and share that, wouldn't you? No wonder some of his patients stop using them!!! The next day, this patient tried an experiment: I stopped using them in one eye, the right. When I woke up Thursday morning the vision in my right eye was as clear as the night before. I called my surgeon's office just before noon, anxious to report my symptoms and my findings and to ask how I should proceed. I stopped using PredForte drops entirely, pending a promised return phone call.
It's Saturday, I haven't gotten a return call from the surgeon's office, and I'm pretty frustrated. Stopping the drops helped a lot, but it's possible he'd ask me to use something else if we talked. The person I spoke with at his office said laser procedures aren't done until at least ninety days after surgery. Isn't that special?! I get to buy at least TWO sets of expensive lenses, one so I have optimal vision now, and the other after the laser improves my result.
Now y'all know why I haven't posted a follow-up. The gods saw I was blogging with a "teaching" tag and gave me a thicker textbook. Learn from my mistakes:
If at all possible, have your post-op care done by your surgeon. It may be much more convenient to see your neighborhood optometrist, but that should always be your second choice. I had good reasons for going that route, but I regret my decision.
Understand your insurance (if you have it). I assumed my optometrist would charge me for my post-op visits. When no one asked for immediate payment after the first visit, I should have inquired instead of assuming their policy was to send me an invoice. When the surgeon's office never called me back I realized they might have assigned their payments for post-op care to my local guy ... and not be too interested in sorting that out now.