“I had cataract surgery 6 months ago but I’m still having blurry vision.”  I see patients here at Miami Eye Center who come to see me for a second opinion totally distraught over the issue and in many instances their degree of concern is unwarranted. This could be you, if so there are several things to consider.  Firstly, what is the cause of the blurriness and secondly, can it be fixed?” 

We can start analyzing the problem from the front of the eye (cornea) and working to the back (retina).  Some of the issues are simple yet overlooked while others are complex.  If you have had a multifocal lens implant there is no margin of error as these lenses are unforgiving.  If your tear film is not good you could be losing vision.  I have many patients complain of poor acuity only to find that by putting a drop of artificial tears on their eye they recover substantial vision.  A long term program of tear film enhancement leads to continued excellent vision.

There could be residual nearsightedness, farsightedness and or astigmatism.  If this is the case and you have had a multifocal lens implant it is incumbent upon the surgeon to correct this.  If you have opted for a generic lens implant, eyeglasses is the answer.  However, with multifocals you should be offered LASIK correction which has the potential to completely correct the blurry vision.

The intraocular lens is placed into the eye on a clear membrane (like Saran wrap) called the posterior capsule.  On occassion this clear membrane becomes cloudy and impacts the vision potential.  This is easily treated with a Nd:YAG laser procedure which vaporizes the membrane and thus clears the vision.

Moving to the back of the eye there is the retina.  If there is a problem with the retina it is the same as taking a photograph with bad film in the camera.  In a small percentage of surgeries there could be swelling of the retina known as cystoid macular edema.  This has a profound effect in reducing the vision.  Fortunately, it is self limited to several weeks to months and often responds to therapeutic eye drops. 

While the point of this discussion is to inform the reader that all is not lost if at first glance the outcome of cataract surgery appears to be less than optimum, however, there are a number of complications which require extensive evaluation and complex repair.  One must keep in mind that if you lump all of the possible complications of cataract surgery into one, the risk is about 3%, one of the safest major surgical procedures performed today.

If you are currently under medical treatment for glaucoma you are well aware of the expense of the eye drops.  In addition, there is the hassle with the insurance company/drug store over which brand is available to you under your plan.  Many people find that the month is longer than the drug supply and have no ability to obtain a resupply.  There are folks who can afford their drops but find it an inconvenience and miss instilling the medication.  Then there are patients who are allergic to all drops and might require surgery for pressure control.

Something to consider; laser surgery to reduce the pressure and thus allow you to eliminate all or some of your drops.  ALT, argon laser trabeculoplasty which I began doing in 1982, has long been the standard for low risk laser reduction of eye pressure.  It has more recently been supplanted by SLT or selective laser trabeculoplasty. Patients with open angle glaucoma are candidates for the procedure.  The laser (Q-swithced Nd:YAG) fires a fine beam in 3 nanoseconds which is much faster than you can blink (1/10th of a second).  The patient is seated in front of the device, the eye is anesthetised with drops and approximately 100 laser spots are made taking about 10 minutes.  You can drive into the office and drive home; there are no restrictions.  There is a delay in effect so patients must use their regular drops for awhile following the procedure.  I have not experienced any serious complications; there might be a temporary rise in pressure or no effect at all.  In general, the pressure is reduced by about 4-5mmHg which may be enough to eliminate some or all of your medications.  In addition, the procedure can be repeated when necessary.

This approach may not be for everybody but with the spiraling cost of drugs and the availability of insurance coverage for SLT, this may be a new way of looking at your glaucoma management.  I might add that in many locales, patients are offered SLT when they are first diagnosed with glaucoma and thus avoid any drops from the get-go.