Depressing news from ophthalmologist - now what?

[CairoCarol]

Sorry for the long OP; it boils down to this: if you had lousy eyesight and could (barely) afford it, would you get lens implants? Now for the detailed version:

I'm a 53-year-old female in good health who has always had terrible eyesight - just ordinary but severe myopia since early childhood (minus 11 in one eye, minus 12 in the other). Between glasses and contacts and putting up with a little bit of frustration that other people obviously could see better than me, I've always managed.

Lately, though, my vision seems worse - to the point where I can't function effectively even with corrective lenses - so I just had it checked. The results: minus 13 in the right eye, minus 17 in the left.

The doctor here in Indonesia characterizes this as: "without corrective lenses you have 20% vision in your left eye and 50% in your right. Corrective lenses will get you to 30% in your left eye and 70% in your right."

I have no idea if this is a legitimate assessment, though it sounds pretty odd to me. I have never heard any eye doctor, and believe me I have seen my share, put it that way before, and obviously he's only talking about one aspect of vision - acuity, I assume - since I can see light and colors just fine.

He also says I don't have much in the way of cataracts yet (though those are in my future), and that I am at severe risk of retinal detachment - something I know the symptoms of, and am aware I need to be on the lookout for.

Then he goes on to the real kicker: "there is no point in getting new contact lenses or glasses, because your vision is so bad you cannot get any better correction than you have with your current glasses/contacts. Just learn to live with it, and try to lead a normal life." (This is consistent with what a doctor in Houston told me last year, although at that time my eyes had not deteriorated to where they are now.)

Well, s**t. For me, a "normal" life includes a lot of work events where I'm staring at Powerpoint presentations that I cannot even begin to read, even if I am at pains to sit in the front row. I'm expected to recognize people across the room, and I am unsure who's waving at me or how to identify someone later when my colleague says "see that guy over there - next week at the meeting, talk to him."

Things really have gotten to the point where I feel that my performance and my interpersonal skills are being compromised because I can't effing SEE. I do have a valid driver's license, but thank god I almost never have to drive. And I will not drive at night or without a GPS, as that feels downright hazardous to me and others on the road.

So, what now? Should I look into lens implants? They cost a fortune, I guess (I saw on CNN recently an estimate of something like $10,000/eye), and I doubt insurance would cover it. Technically I can afford it, I guess, but I hate to take that money from other things that would be helpful to our family - paying off the mortgage, a family vacation, sending my son to an enrichment program. On the other hand - not being able to see is frustrating in the extreme. And what if I'm in a situation where I DO need to drive regularly? Next time I need to get a license, I'm not sure how the vision test is going to go...

Anyway, I don't want to be melodramatic. For computing purposes I can see fine, since I can always enlarge things on the screen if I need to. I am a million trillion times less visually impaired than someone who is, in fact, blind.

Has any doper had lens implants? Why? How did it work out? Would you do it again? Would you do it in my situation?

[Lynn Bodoni]

I think that I'd want a second opinion before deciding anything. That's a pretty big chunk of change.

The cost of these procedures is going down, the success rate is going up, and they are developing new techniques all the time.

Having said that, I'm sorry your vision is so bad. I've asked a couple of opthamologists about getting corrective surgery for nearsightedness, and I've been told that even if everything goes perfectly, I'd still have to wear glasses, so what's the point?

[Broomstick]

OP, you are now visually impaired, meaning "corrective lenses" of the conventional sort will no longer give you normal vision. You seriously think being able to afford family vacations or pay off the mortgage a little sooner compares with being able to see properly?

My vision isn't as bad as yours, yet I have looked into surgical options, including lens implants. If I was in your shoes hell yes I'd get 'em. Yes, paying for them might be an issue, but there are ways to finance medical procedures, negotiate payment plans, and so forth.

Your decision, of course, and if I were you I'd also get a second (maybe even a third) opinion but provided the risks are minimal and benefits high I'd do it.

[not what you'd expect]

I think you should do whatever you can to improve your vision. Investigate your options, get more than one opinion and then do what you've got to do. My vision has gotten worse as I've aged and it is a pain.
Good luck.

[Shodan]

I had worse vision than you do - -13 in one eye, -12 in the other.

I developed cataracts, and got implanted lenses about four months back. I still have to wear bifocals, but my eyesight is now 20/20 in my left eye and 20/15 in my right (corrected).

Insurance covered it because of the cataracts.

I recommend a second opinion at least.

Regards,
Shodan

[Senegoid]

Wait... A year ago you got your eyes checked in Houston. This year, in Indonesia.

What are the options there? Do you have an medical plan that might cover this? Is it an American plan or an Indonesian plan? How might your medical options differ between Indonesia and America? Or between Texas and America? Do you travel regularly between America, Cairo, and Indonesia? These questions might help others who would like to suggest options for you to consider.

[Eureka]

My mother has had a procedure done twice this past year where they not just removed her cataracts and gave her new lenses but inserted some new cornea cells into her eyes.

Now, granted, that was to treat cornea dystrophy, which is not the same condition causing the OP's problems.

And yes, it was covered by insurance.

And she's not sure she sees as well now as she'd like to be able to.

But some of her stories of being able to judge whether to stop at the light by seeing rather than by watching the other cars, are scary.

And now she usually wears glasses out of habit, and because they do improve her vision slightly. She's a lot less beholden to her glasses than I am to mine (severe nearsightedness, some astigmatism, no cornea issues).

So when you say

Things really have gotten to the point where I feel that my performance and my interpersonal skills are being compromised because I can't effing SEE.

I think you should see an expert. Find out if lens implants will fix your problems or not--I'm more than a little concerned that lens implants may not actually be a fix for your issues. Lenses aren't the only part of the eye which can cause vision impairment.

My mother's eye surgeon told her that he almost never recommends surgery at the first appointment, but her situation was serious enough that he did so. She's got a couple of cousins with the same type of condition, and eye surgery didn't fix the problems for one of them--the cousin can't drive.

I'm sympathetic to the concern that it's a lot of money which you could find other uses for, but if I were on the fast track to functional blindness, I'd consider preserving my lifestyle a priority.

[Ferret Herder]

I work in ophthalmology, but more in retinal issues, not corneal/lens ones; IANAD/N.

That being said, I agree that your level of myopia is pretty extreme, compared to what I've seen before, and that you may indeed be reaching a limit of what conventional correction can do. I also share reservations about whether an implantable lens can help when standard glasses lenses don't, though again this isn't my area.

I also wonder whether something else might be at work too. Age-related macular degeneration is a very common cause of blindness/severe vision impairment after age 50, and since it takes place in the retina, vision correction methods don't really help. Have you had any imaging done? Fundus photographs, OCT, fluorescein angiography?

[CairoCarol]

Originally Posted by Senegoid

Wait... A year ago you got your eyes checked in Houston. This year, in Indonesia.

What are the options there? Do you have an medical plan that might cover this? Is it an American plan or an Indonesian plan? How might your medical options differ between Indonesia and America? Or between Texas and America? Do you travel regularly between America, Cairo, and Indonesia? These questions might help others who would like to suggest options for you to consider.

A full answer to your question would put us both to sleep, but the main points are:

I have an international insurance plan from Cigna. Meaning, they will cover whatever they deem to be necessary medical care anywhere in the world EXCEPT in the US - unless I am traveling in the US and have a medical emergency. Vision care is not covered - I guess if I had a tumor or something it would be, but corrective stuff is not. Of course, if I were to go ahead with surgery I would verify this in advance and try to get coverage, but as a veteran of battles with insurance companies, I have no illusions about whether I would succeed.

I would probably have the surgery down in Singapore, where medical care is cheaper than the US and certainly very good. I have already identified a good specialist there - I'll probably try to schedule an appointment with him soon.

[thatguyjeff]

I had a detached retina several years back. Have always had poor vision, though correctable with conventional lenses. Though I can't do contact lenses due to me being prone to infections - just another issue to add to my list.

I looked into refractive surgery (LASIK) a while back and was told my correction was outside the bounds of what that can correct, but was told I may be a candidate for intraocular lens implants.

I saw a specialist who does this and was told I could get it done, but yeah - too expensive. If I remember correctly though I think I was told in the neighborhood of $4,000 per eye though. I declined at that time.

As far as your insurance goes, it's worth taking a shot. Worst that can happen is that they tell you it's not covered. It will be some red tape though.

Get documentation from your optometrist, opthamologist, everyone - citing medical need and details regarding the limitations of conventional lenses. And if they turn it down on the first try, appeal it, and appeal again and go all the way through your available appeal options.

If I was in your shoes, I would at the very least try that route.

[cromulent]

It sounds like, from what you've said, you have myopic degeneration. I can tell you that lens implants are not going to do anything if you don't have a cataract. Actually, contact lenses might give you a line or two of improved acuity because they won't cause the minification that high powered spectacles can induce,but your doctor might not want to prescribe contacts to a patient with unequal vision in each eye.

For what it's worth, I have quite a few patients with myopic degeneration. (I'm an optometrist.) Let me know if you have any questions.

[Lasciel]

,but your doctor might not want to prescribe contacts to a patient with unequal vision in each eye.

Why is that?

I've always had a pretty noticeable difference in my eye prescriptions - nearsighted at -6.5 in one and nearsighted at -3 plus astigmatism in my other, and even before they had astigmatic-correcting contacts, my doctor was all about getting me into contact lenses. Once they had astigmatic lenses available, he practically danced with joy that I got to have TWO different totally accurate prescriptions (and for a while, two different BRANDS) that I wore at the same time. He had always been a little miffed that the astigmatism prevented things from working exactly right before.

Now I'm wondering if he screwed me over!

ETA - to address the OP - I really like seeing. I read and use computers as my life. I'd most assuredly get a few second and third opinions, and then I'd look into how best to structure a loan or handle the debt to get my eyes as fixed as possible. Anything that lets me keep seeing is totally worth being broke otherwise.

[cromulent]

Originally Posted by Lasciel

Why is that?

I've always had a pretty noticeable difference in my eye prescriptions - nearsighted at -6.5 in one and nearsighted at -3 plus astigmatism in my other, and even before they had astigmatic-correcting contacts, my doctor was all about getting me into contact lenses. Once they had astigmatic lenses available, he practically danced with joy that I got to have TWO different totally accurate prescriptions (and for a while, two different BRANDS) that I wore at the same time. He had always been a little miffed that the astigmatism prevented things from working exactly right before.

Now I'm wondering if he screwed me over!

Let me be more specific. It's not the unequal prescription that would be a contraindication for contact lens wear, but the fact that one eye has best-corrected visual acuity that is so much worse than the other. This can be an issue if doctors don't wish to risk contact lens wear in a person with one "good" eye. However, it sounds like CairoCarol is already using contacts.

[Lasciel]

Originally Posted by cromulent

Let me be more specific. It's not the unequal prescription that would be a contraindication for contact lens wear, but the fact that one eye has best-corrected visual acuity that is so much worse than the other. This can be an issue if doctors don't wish to risk contact lens wear in a person with one "good" eye. However, it sounds like CairoCarol is already using contacts.

Gotcha. Many thanks for the reassurance. I was thinking wild thoughts of switching eye doctors for a moment there!

[Siam Sam]

My eyesight has always been almost as bad as yours (the OP's), although it's stable. (But astigmatism prevents me from wearing contacts or having laser surgery.) And I'm pretty close to you in age. I agree with those who said to get a second opinion, and for something this serious I would get that second opinion in the US. If it's verified, then I would certainly start to consider it. I know that's a hefty chunk of change, but my eyesight is everything. Maybe I would procrastinate awhile until I could not stand it anymore, but I see (heh) myself going ahead and eventually doing it. In may case though, I have no family concerns, no members whom I feel I'd be taking money away from, but I think I would still go ahead and get it done even if I did. Again, eyesight is everything.

[CairoCarol]

Originally Posted by cromulent

I can tell you that lens implants are not going to do anything if you don't have a cataract.

Thanks for weighing in. (And, as you note in a later post, I am indeed already using contacts. From a cosmetic standpoint, I'm very fond of them; vision-wise, I'm just as happy with glasses.)

I do have a question: why won't lens implants help if you don't have a cataract? Of course, they won't cure any problems that aren't cataract-caused (cloudy or brown vision, haziness, halos, etc.) but after some Googling, I was under the impression that, while cataracts are the cause that often drive people to consider such surgery, it's actually "doable" even if you don't have cataracts. Here's a citation of sorts from the FDA.

Originally posted by FDA website:
Phakic intraocular lenses, or phakic lenses, are lenses made of plastic or silicone that are implanted into the eye permanently to reduce a person's need for glasses or contact lenses. [Bolding mine.] Phakic refers to the fact that the lens is implanted into the eye without removing the eye's natural lens. During phakic lens implantation surgery, a small incision is made in the front of the eye. The phakic lens is inserted through the incision and placed just in front of or just behind the iris.

Or, perhaps we're not talking about the same thing? My link is to the latest technology (I think) - is there another, older type of lens implants that don't work the same way?

[Nava]

CairoCarol, those prices you got from CNN are American prices. You may have access to better ones.

I don't know what's the going rate for lens insertion here, but back when I had Lasik, what I paid in Spain was 1200€ total; a friend in the US paid $2000/eye during the same period. Oanda says my 1200€ were worth about $1600 at that time.


Siam Sam, I had astigmatism - before I had laser surgery that corrected it as well as the myopia. You may want to ask again.

[cromulent]

Originally Posted by CairoCarol

Thanks for weighing in. (And, as you note in a later post, I am indeed already using contacts. From a cosmetic standpoint, I'm very fond of them; vision-wise, I'm just as happy with glasses.)

I do have a question: why won't lens implants help if you don't have a cataract? Of course, they won't cure any problems that aren't cataract-caused (cloudy or brown vision, haziness, halos, etc.) but after some Googling, I was under the impression that, while cataracts are the cause that often drive people to consider such surgery, it's actually "doable" even if you don't have cataracts. Here's a citation of sorts from the FDA.



Or, perhaps we're not talking about the same thing? My link is to the latest technology (I think) - is there another, older type of lens implants that don't work the same way?

Phakic IOLs, which you linked to, are used as a type of refractive surgery. That's one type, and LASIK is another. Just as LASIK can correct for your refractive error and ensure that you don't need to use specs (for distance vision at least) so too can phakic IOLs.

However, your vision is not 20/20 with spectacles, according to what you wrote above. That's because myopic degeneration is a problem related to the retina and not the refractive system ( lens, cornea) of the eye.

Now, I'm not your doctor and I'm only hearing what your doctor told you second- hand, and believe me when I tell you that it's easy to get confused about this stuff, so please don't take this as medical advice since I haven't looked at your specific eyes in an exam room. But I can tell you that very high myopes have thinner retinas and may not be capable of correcting to 20/20 vision even with glasses and contacts due to a retinal issue. Implanted lenses are not going to change that, even if they ensure that you won't need glasses.

[Siam Sam]

Originally Posted by Nava

Siam Sam, I had astigmatism - before I had laser surgery that corrected it as well as the myopia. You may want to ask again.

I've had multiple doctors tell me I'm not a candidate.

[Broomstick]

Cromulent, could you perhaps explain what myopic degeneration is? I am curious.

[cromulent]

Originally Posted by Broomstick

Cromulent, could you perhaps explain what myopic degeneration is? I am curious.

Generally, the more nearsighted or myopic an eye is, the longer it is in the front-to-back direction. Sometimes very nearsighted eyes are stretched to the point that the retina is thinned or scars over, and these patients are also prone to bleeding in the back of the eye and the growth of new, aberrant blood vessels, of the sort That are seen in the eyes of some diabetics.

Myopia, or garden variety near- sightedness, is corrected via glasses, contacts, or refractive surgery. But if an eye is stretched to the point that the retina is thinned or damaged in some way, that is known as degenerative myopia. Someone with this condition might have vision that can't be improved through glasses, contacts or refractive surgery. The reason I think lens implants will be of no use to the OP is that there currently are no lens implants that improve visual acuity beyond what's achievable through glasses or contacts. ( Except, of course, in the case of cataracts, where removing the old lens will improve vision.) A number of patients with this condition honestly don't understand why there are no glasses, contacts, or implantable lens that will help them see better. The reason is that degenerative myopia is a retinal condition, not a refractive one.

[Eureka]

cromulent,

Thank you, I think, for explaining degenerative myopia. It sounds scary.

I am taking comfort in the fact that my vision has been stable for the last dozen years, and the next change I expect to have to deal with is bifocals.

[redtail23]

I'd get another opinion, personally. And I'd ask for more info - why is it that your vision can't be corrected any more than that?

I'm not much younger than you and am also very myopic (-13 and -14 last checkup). My eyes had been stable at -12 for many years and then began changing again the last couple. My doc hasn't told me any such thing about my vision not being correctable. In fact, he agrees that I'm a great candidate for implanted lenses, if I'm interested. I've only been waiting because it looks like they've got some spiffy new stuff coming out, and I hate to be an early bird on medical stuff.

I am, of course, at risk for retinal detachment. And I'm going to have to ask him next visit about the myopic degeneration, because I've never heard of that.

But it sounds to me like you need to talk to the doc again and/or to another doc, because you're not getting the full story.

If implantables will help, then I'd do 'em if I were you. Check around on prices - they're not $10K each here in the U.S. last I looked. It may be about that for *both* eyes without insurance or discounts, but I'm pretty sure I've seen it for less. But lose my vision to afford a vacation? That's just bizarre. Hell, I wouldn't lose my vision to pay off my mortgage!

But if you truly can't get any improvement, then you need to start planning how you'll deal with your impaired vision. The problems you're having are all surmountable, but not if you just pretend they don't exist.

[phreesh]

As a data point on cost, I'm getting implanted lenses in the coming months. The cost for me is about $3500 per eye.

[VOW]

Here's a question:

What happens if you get implantable lenses (or LASIK surgery) and then later develop cataracts?


~VOW

[CairoCarol]

Originally Posted by VOW

Here's a question:

What happens if you get implantable lenses (or LASIK surgery) and then later develop cataracts?


~VOW

I'm wondering that myself. There's no way they can be sure you'll never get cataracts, but the site I linked to says that if you develop them you may need to have both your natural lens AND the implanted lens removed. And then .... ?

Since cataracts are fairly common and they are recommending the implants for people aged 25-45 (before you'd know whether you were likely to develop cataracts), there is obviously more to it than just, "Sure, have this surgery, and maybe you'll get cataracts and end up blind!"

[Broomstick]

Originally Posted by CairoCarol

I'm wondering that myself. There's no way they can be sure you'll never get cataracts, but the site I linked to says that if you develop them you may need to have both your natural lens AND the implanted lens removed. And then .... ?

Presumably, they'd then implant a new lens...?

[Ferret Herder]

That's my understanding, but like I said, this really isn't my area. Similarly, LASIK is just a reshaping of the cornea, so once you need cataract surgery, they just determine the appropriate lens and corrective power and insert that once they've removed the old lens.

[CrazyCatLady]

Originally Posted by CairoCarol

I'm wondering that myself. There's no way they can be sure you'll never get cataracts, but the site I linked to says that if you develop them you may need to have both your natural lens AND the implanted lens removed. And then .... ?

Since cataracts are fairly common and they are recommending the implants for people aged 25-45 (before you'd know whether you were likely to develop cataracts), there is obviously more to it than just, "Sure, have this surgery, and maybe you'll get cataracts and end up blind!"

They'd most likely just put in a different implant, same as they would when doing cataract surgery on someone who didn't have implants.

Although it looks like in some cases they pretty much use the same procedure as cataract surgery--open up the outer layer of the lens, remove the inner layers, and put the implant in the resulting bag. In that case, I'd think your risk of getting age-related cataracts would be decreased, since the most common type happens in the central layer of the lens.