Post-Cataract Surgery Discomfort: Causes and Treatment Options

Q: Post-Cataract Surgery Discomfort: Causes and Treatment Options

Hello： 1. <br>The most likely causes of the postoperative eye condition could be corneal edema, macular edema, or other underlying issues such as amblyopia or other pathologies. <br>2. <br>The choice of surgical combination techniques may need to be discussed with the surgeon, as

Possible reasons for discomfort after cataract surgery include inflammation, infection, or improper healing. It is also possible to perform different surgical techniques on each eye, but this should be discussed with your ophthalmologist to ensure the best outcomes for both eyes?

Hello Dr.
Gao! My father underwent cataract surgery on one eye three months ago, opting for femtosecond laser refractive surgery at a cost of NT$72,000, plus an out-of-pocket expense for the intraocular lens of NT$50,000 (which included correction for astigmatism).
However, he still experiences difficulty seeing clearly post-surgery (although there has been some improvement, it is significantly less than the immediate improvement seen by other family members who had surgery covered by national health insurance).
Here are some additional patient details for your reference: * The other eye has cataracts that have not yet been addressed (it is now at a stage that requires treatment).
* There is a difference of approximately 200 degrees in uncorrected vision between the two eyes.
* He has tried wearing glasses to correct his vision, but he feels uncomfortable after wearing them for a while.
* He has macular degeneration, but the doctor has indicated that it does not require treatment at this time.

I would like to ask Dr.
Gao:
1.
How can we clarify the cause of discomfort in the first eye? We want to identify possible reasons before proceeding with surgery on the second eye.
(1) The surgery was unsuccessful.
(2) The surgical method or lens type was not suitable for the patient.
(3) The untreated cataract in the second eye is causing issues.
(4) Other personal health conditions are contributing to the problem.
2.
For the second eye, can we consider different combinations instead of the femtosecond laser and out-of-pocket lens? For example, "national health insurance surgery + national health insurance lens" or "national health insurance surgery + out-of-pocket lens," or would you recommend using the same surgical method and lens type as the first eye? (My father feels that spending more money did not yield better results compared to others who had surgery covered by national health insurance, so he is hesitant to spend money on a second procedure.)
We are eager to seek a trustworthy second opinion from a reliable physician.
Thank you very much, Dr.
Gao, for taking the time to read and respond.
We appreciate your efforts!

Xiao Fang, 40~49 year old female. Ask Date: 2023/02/18

Dr. Gao Pilin reply Ophthalmology

Hello: 1.
The most likely causes of the postoperative eye condition could be corneal edema, macular edema, or other underlying issues such as amblyopia or other pathologies.
2.
The choice of surgical combination techniques may need to be discussed with the surgeon, as it is important to assess the patient's current condition.
Generally, using the same type of intraocular lens is considered more ideal for postoperative outcomes.

Reply Date: 2023/02/18

More Info

Post-cataract surgery discomfort can be a frustrating experience for patients, especially when the expected visual improvement does not occur as anticipated. In your father's case, three months post-surgery, he continues to experience difficulties seeing clearly, which raises several important questions regarding the potential causes and treatment options.

Understanding the Causes of Discomfort
1. Surgical Outcome: One of the primary concerns is whether the initial surgery was successful. Factors that can affect surgical outcomes include the skill of the surgeon, the type of lens used, and the patient's individual healing process. If the surgery did not achieve the desired refractive outcome, this could lead to persistent visual discomfort.

2. Lens Compatibility: The choice of intraocular lens (IOL) is crucial. In your father's case, he opted for a premium lens with astigmatism correction. If the lens is not properly aligned or if there are issues with the lens itself, it could lead to visual disturbances. Additionally, some patients may experience issues with multifocal lenses, such as halos or glare, which can affect their overall satisfaction with the surgery.

3. Unaddressed Conditions: The presence of other ocular conditions, such as macular degeneration, can complicate the visual outcome. Even if the cataract surgery was successful, underlying conditions may still hinder optimal vision. It is essential to monitor these conditions closely, as they may require separate treatment.

4. Refractive Error: The difference in refractive error between the two eyes (200 degrees) can also contribute to discomfort. If one eye is significantly weaker than the other, it can lead to visual imbalance, making it difficult for the brain to process visual information effectively.

5. Adaptation to New Vision: Post-surgery, patients often need time to adapt to their new vision. This adjustment period can vary significantly among individuals. Some may experience discomfort while their brain learns to interpret the new visual signals.

Treatment Options
To address your father's discomfort, several steps can be taken:
1. Comprehensive Eye Examination: A thorough evaluation by an ophthalmologist is essential to determine the exact cause of the discomfort. This examination should include assessing the position and function of the IOL, checking for any signs of inflammation or infection, and evaluating the overall health of the retina and macula.

2. Refraction Assessment: A refraction test can help determine if there is a need for corrective lenses. If your father experiences discomfort with glasses, it may be beneficial to explore different lens options or adjustments to his prescription.

3. Consideration for Second Eye Surgery: Regarding the second eye, it is crucial to weigh the options carefully. If your father is hesitant due to the experience with the first eye, discussing alternative surgical options with a trusted ophthalmologist is advisable. He may consider a standard cataract surgery with a basic IOL, which is covered by insurance, or a premium lens if he desires similar outcomes to the first eye.

4. Second Opinion: Seeking a second opinion from another qualified ophthalmologist can provide reassurance and additional insights into the best course of action for the second eye. This can help alleviate concerns about the previous surgery and provide clarity on the potential outcomes of the next procedure.

5. Follow-Up Care: Regular follow-up appointments are vital to monitor the healing process and address any emerging issues. If discomfort persists, further interventions, such as additional treatments or adjustments, may be necessary.

In conclusion, while your father's experience post-cataract surgery is not uncommon, it is essential to investigate the underlying causes of his discomfort thoroughly. By collaborating with a trusted ophthalmologist and considering all available options, you can help ensure that he receives the best possible care moving forward.

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