I had cataract surgery for my right eye at 9:00AM today. I'm home now and just removed the patch. My vision is very, very blurred. I sure hope it improves. It is still somewhat dialated. I'm to instill one drop of Pred Forte and one drop of Ofloxcin every three hours. My eye is also watering a bit. I was hoping to see better after I removed the patch. Maybe I'm just a little anxious.

Way too early to be concerned. First of all, you were aware of the difficulty with getting the IOP power correct, but that may not be the issue. There may be some temporary corneal swelling after cataract surgery that will reduce the vision, quite significantly at times, and this could persist for a few days. Also, immediately following IOL surgery the intraocular pressure is low and this could alter the corneal curvature on an RK eye. Some RK patients experience changing refractive error during the day.

No matter, this is what the post-op visits are to ascertain. I understand your anxiety but there is nothing to be overly concerned about this soon after surgery.

I too have had cataract surgery recommended on my post Rk eyes My RK was done in 1993 when my eyes were -9 and -7.5 respectively. I had the usual post op starbursting etc described many times on this forum. But after a year or so things settled down and I learned to compensate for some of the problems. But in the past two years my vision has changed for the worse. Depending on the time of day and lighting conditions my vision can be almost perfect. But much of the time I am plagued with difficulty reading, big changes in my vision as lighting changes (like walking into a building), glare, contrast problens, etc. The cataract in my right eye clouds that eye and is the focus of my present concern. I have consulted physicians at Wills Eye Hospital in Philadelphia for solutions to all these problems and they want to deal with the cataract problem first and then address the other issues. Do I have much to fear from cataract surgery on an RK eye? I know from the doctors' explanation that there is more involved in getting the right lens for me then for a non-RK eye. But since my RK in 1993 I fear any surgery on my eyes. Any comments would be appreciated. Phil

RK corneas can be unstable. There are a few considerations. It is difficult to determine prior to your cataract surgery what the IOL power should be. This means that the IOL could be too strong or weak. While no surgeon wants to re-enter the eye, it may be necessary to exchange the IOL for another power. So, one question would be to find out how this possibility will be handled by your surgeon.

It goes without saying that you want a surgeon who is somewhat "up" on doing cataract surgery on RK eyes. Incisions for cataract surgery can be made into the cornea, at the limbus or just outside the limbal zone. It would be important to stay as far away from the cornea as possible to avoid destabilizing the cornea.

Thanks so much, Dr Harzok for your reply!
I have some good news to report. I have scheduled the cataract surgery for mid November. The Doctor informed me that if the IOL power is incorrect an option might be correction using Lasic. He said it is ten times more difficult to replace a lens then inserting it in the first place. He also assured me that he was aware of the incision issues.
Recently in our local newspaper I read of a new multifocal cataract lens that offers some advantages over previous approaches to cataracts. Is this anything I should look into?
Finally, the reason for my happiness. My local optometrist always wanted me to try RGP lenses to correct my problems. Despite many tries, (even before my RK in 1993) I never could put a lens in my eyes due to extreme skittishness!!!. Finally, last week, after much work in overcoming this problem, I learned to insert RGP's into my eyes and WOW, the difference is dramatic. It still takes me some time to put them in and out, but I will live with it and hopefully improve as time goes on. I have had the lenses in over a week now and my left eye is 20/20, at least in the daytime. My night time vision is much better too, but I still have some problems with oncoming lights halos, etc. Hopefully, my right eye will be as improved after the cataract situation is resolved. Phil

What is your vision in your right eye with the RGP? An RGP is also diagnostic. If your vison is much improved, there is less indication for cataract surgery.

You have multifocal corneas following RK that is, as you are now aware, corrected by RGPs. Any aberrations created by multifocal IOLs (there is more glare with MF IOLs than single vision IOLS) will further complicate your vision in a way that RGPs cannot correct.

About half of what we read is advertising. The other half is fact skewed by marketing but the intention is still to sell something. MF IOLS like ReStor have limitations but I think, knowing those limitations, they are acceptable but ONLY for patients with perfect corneas. There was a time when drugs, medical devices and medical procedures were not permitted to be advertised and promoted to the general public. It is essential to not complicate an already complicated optical situation.

Adding LASIK to RK is another example. LASIK may adjust for an off-power IOL but it will compromise and destabilize the corneal optics further.

The vision in my right eye, even with the RGP is very cloudy. So I do need to do something. My surgery at Wills Eye Hospital is set for Sept 21. I am to have an ultrasound A scan in both eyes prior to the surgery. There is no similar A scan to compare from back in 1993 which I know would help. What are options other than Lasic if the lens chosen for my cataract turns out to not be such a good choice? Phil

Also I forgot to mention, the article on multifocal cataract lenses was written by Ann Wlazelek a reporter for the Allentown Morning Call on October 3 and seems to be well researched, running almost a full newspaper page in length. She interviewed lots of local eye professionals as well as the manufacturers. You could probably find it on that newspapers website. But thanks for answering my question as to suitability for my situation. Phil

The RGP has given you better vision than you had previously. Removing the cataract in the right eye, even if the IOL power is off, does not preclude wearing an RGP to adjust the power. If, on the other hand, LASIK over the RK is performed, fitting an RGP will not be easier. If a MF IOL is inserted, this is another complicating factor.

Optics conforms beautifully to the KISS rule - keep it simple. The optics of RK are not simple and all too often the procedure leaves the cornea distorted. LASIK has it own set of corneal optics issues. MF IOLs are stretching the optics out from distance to near, attempting to gain an extended focal range. There are visual compromises to all three. Combining all these is putting your vision at additional risk. Since your surgeon can't guarantee the power being dead-on with any IOL, a MF IOL will not be advantageous. In fact, your surgeon won't know until after the IOL procedure whether you are over- or under-powered, meaning a prescription adjustment could require myopic LASIK or hyperopic LASIK. The latter is even more likely to reduce the quality of your vision and eliminate any benefit the MF IOL was attempting to provide.

RS patients want to believe that their visual problems will be rectified, surgically, once and for all. The greater possibility, a very significant one, is that the vision will be further compromised by the complexity of multiple procedures. Your surgeon says explanting an IOL and inserting a different one is ten times more difficult than the original implantation. Explantation/re-implantation may be more difficult for HIM; there are risks but also rewards. LASIK will be easier for him but what about the visual risks? What may prove more difficult for YOU?

Thanks again Dr Hartzock for your input into my situation. I have taken the liberty of sending a copy of this thread to my eye surgeon at Wills for his comments. My surgery is set for Nov 21 so I have some time to explore options.
But I am delighted in how well the RGP's have corrected my left eye. I seem to tolerate them well with none of problems some on this forum have had with contacts. I do have some problems with light beam extensions from things like overhead streatlights when I go out at night. Hopefully the RGP's can be adjusted somewhat to deal with that type of problem. But I feel I am 90% there. I appreciate your skepticism regarding Lasik if my cataract lens turns out to not be exact. My over-enthusiasim for surgery got me into this mess back in 93!!! I wanted to get rid of my coke-bottle glasses and couldn't get contacts into my eyes. Everything then was about how the Russians had come up with this fantastic new surgery!!! I even recall a story told then about a Russian who had walked into a glass door, injured his eyes and when he recovered and his eyes healed his nearsightedness had disappeared. I will let you know what happens. Phil