Cataract Surgery for 76 YOM 20/30 Vision Fuchs Dystrophy Guttata 1100 Corneal Thickness 560 MM

May 20, 2009

I would appreciate an opinion regarding undergoing cataract surgery with the following criteria:

1. I am 76 years old.
2. Have Fuchs Dystrophy.
3. Corneal thickness of approx 560 Microns in each eye.
4. Guttata count at 1100. No morning edema.
5. 20/30 vision

I have all the symptoms of cataracts.




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37 Responses to “Cataract Surgery for 76 YOM 20/30 Vision Fuchs Dystrophy Guttata 1100 Corneal Thickness 560 MM”

  1. Dr. Weitzner on May 20th, 2009 10:53 am

    those corneal numbers are not bad. if your surgery is done very carefully by an excellent surgeon, chances are very good your cornea won’t fail and you’ll see well. if the cornea fails, you won’t see well.

    With 20/30 vision, do you really want to take chances? i suppose that is something you have to think carefully about- how unhappy you are with your vision, and whether it’s the worth the small risk. if you decline surgery for now, make sure you are followed closely, for we don’t want the cataract to become too dense, as that will increase the surgery’s risk to the cornea. also, with time, your fuch’s might get worse, increasing the risk of surgery.

    Your general health and life expectancy play an important role, too.

    Lastly, if your corneal does fail, all hope is not lost- we now have much better cornea transplant techniques where recovery can take weeks instead of 6 months-year, and vision is much better than traditional techniques.

    i hope this helps!

  2. MD on May 20th, 2009 2:46 pm

    DSAEK concurrently with cataract surgery an option?

  3. ari weitzner on May 20th, 2009 7:25 pm

    i think dsaek concurrently is too aggressive. there is a very decent chance the cornea will remain clear. if the fuch’s were worse, then i would agree.

  4. Marielle on July 1st, 2009 11:21 pm

    I’m interested in your responses to cataract surgery if Fuchs’ is present. In what way does the “cornea fail” after cataract surgery ? And when you say that after cataract surgery “there is a very decent chance the cornea will remain clear,” how does surgery affect the corneal clarity?

  5. ari weitzner on July 2nd, 2009 7:35 am

    when the cornea fails, i mean it loses clarity (the cornea has to constantly pump out fluid to keep it clear; otherwise, it gets waterlogged and thus cloudy).

    any surgery in the eye, including cataract surgery, causes turbulence in the eye. the cells (endothelium) that act as water pumps of the cornea are in the innermost layer. any turbulence will cause some of those cells to fall off. the cornea requires a minimum number of those precious cells. fortunately, we have many more than we need, so if we lose, say 20%, the cornea still functions normally. but in fuch’s, the patient has lost many of those cells, and even losing 1% can cause the cornea to fail.

  6. Ginny on July 15th, 2009 9:50 pm

    I recently had cataract surgery in both eyes (6/11/09 and 7/9/09) and i have Fuch also. Prior to the surgery, at an office visit, the thickness was measured at 693 in the left eye and 694 in the right eye. When I went in at each surgery the thickness was measured at 994 each time. The nurses were alarmed but the doctor wasn’t worried. I have had floaters before but now they are worse. My vision is 20/30 and I can see through the floaters pretty well for distance. Close up it is bad. I have so many readers glasses now, trying to find the right strength. Do I have any reason to be concerned.

  7. Marielle on July 19th, 2009 2:20 pm

    Ginny, have you joined the help group called Fuchs’ Friends? It is not a medical site, but people with Fuchs’ share their information and it can be very reassuring and informative.

  8. Ginny on July 20th, 2009 9:53 pm

    Yes I am a member of both Fuch Groups. They are great.

  9. Dr. Ari Weitzner on July 23rd, 2009 6:11 pm

    hi ginny
    20/30 vision is a great result- you are lucky. the floaters often appear worse after cataract surgery because your contrast vision is better, so you can see them better- that is typical.
    your difficulty with near vision may be due to astigmatism- get a prescription instead of over-the-counter readers. otherwise, it may be dur to the fuch’s- try using muro-128 drops when you read, as it may clear up the cornea a little.

  10. Ginny on September 5th, 2009 9:13 pm

    Well after the cataract surgery on my left eye, I developed what the dr. called scar tissue which in reality was that the Fuch was upset. The dr. said he would do something about it when my vision got bad. Ny vision went wacky and I changed to a corneal specialist here in New Orleans. He said that there was so many things going on in my left eye that if I didn’t have surgery, I wouldn’t be able to drive. I had DSAEK surgery on my left eye Sept. 1, I am still dealing with that. I can hardly see out of my left eye, just globs. Hopefully eyerything works out. I go back next Tuesday and see if maybe the air bubble needs to be replaced or the whole procedure done over. We will see!

  11. carol opulski on December 27th, 2009 9:43 pm

    I have been told I have Fuchs. I have been followed by a Lasik eye surgon, from reading your articles, I can see that I need a new eye MD. Can anyone in NYC recommend a thoughtful, nice , excellent one?

    I have been totally afraid since my diagnosis, and stricken with panic attacks for fear of loosing my sight. Can anyone in my area help me? I also have diabeties, type ll and I am 51 years old woman.

    The MD I am currently being treated by says my Fuchs is not yet a problem, that the corneas are still normal.

  12. ari weitzner on January 2nd, 2010 7:16 pm

    hi carol- dont be so panic-stricken from fuch’s- the latest surgical procedures in dsaek and related ones are very sucessful, if you get to that point- and you live in nyc, where great cornea surgeons practice.
    im not sure why you think you need a new ophthalmologist- when you need surgery, you should simply get a second opinion. otherwise, as long as your vision is stable, there is nothing to do anyway- we dont do any cataract or cornea surgery if the patient is satisfied with her vision and/or the vision is stable. (one small caveat- dont wait until your cataracts get too dense- it makes the surgery more difficult. )

  13. Meg on March 1st, 2010 2:41 pm

    I was just told I have Fuchs’ dystrophy, & that once my cataracts are “ready” for surgery, that I will also need to have corneal implants, hopefully the newer surgery using just a partial cornea. (?) How can this crop up so suddenly? While I have symptoms it seems they mimic those of cataracts I thought, except for the eye pain, but my Dr. did extensive testing & said in 6 mos. she’ll do the same tests again to see if my cataracts are at the right stage for surgery. I will seek a second opinion in the meantime, but will they do both surgeries at same time (she indicated this) and will they do both eyes at same time? I was sort of shocked, and didn’t ask these questions then. I am nearly 62, & also am developing glaucoma. (I am beginning to feel extremely old…no fun at all!)

  14. MK on April 5th, 2010 4:18 pm

    I am 52 and have Fuchs dystrophy. I have striae of my left eye and intermitant haziness of vision on the left which can last hours. I can now afford LASIK surgery but since the Fuchs is at a noticeable point ( on the left anyway), is it OK to proceed? An optometrist has advised against it, but today I consulted with a LASIK surgeon who said that the surgery would not affect the Fuchs because the issue is the inner corneal layer, and not where the LASIK treatment would be occurring. He described my dystrophy as a stage 3 on the left and a 2-3 on my right. The optometrist descibed it as moderate dystrophy occuring midline to temporally in both eyes.
    What do you think? It would be so nice to go back to single vision glasses again. I was just thinking of having my right eye corrected and going with monovision.

  15. ari on April 8th, 2010 11:24 am

    mk- i would not advise lasik on a cornea that is already symptomatic from fuch’s. in fact, i think lasik on fuch’s without symptoms is bad. technically, its true that the lasik affects the superficial cornea, and the fuch’s affects the inner. but the whole idea behind lasik and spending $5000 is to get good vision without glasses. if your cornea is affecting your vision due to the fuch’s, the quality of your vision will still be affected regardless of the lasik.

    i strongly, strongly advise against the lasik.

    best bet is to consider dlek/dsaek when it gets worse.

  16. ari on April 8th, 2010 11:26 am

    the fuch’s can create symptoms suddenly- not so unusual.
    i advise doing cataract surgery first, then the partial transplant (dlek/dsaek), not doing them at the same time- unless the fuch’s is very bad.
    do the cataract surgey when your ophthal feels they are ready and will improve your vision.

  17. Adrienne on May 22nd, 2010 7:13 pm

    I had cataract surgery almost 2 weeks ago. I have Fuchs Dystrophy and so far my eyesight has not improved since the day of surgery. I am getting worried about this and wonder if it will come back. My eye surgeon tells me it will take 2 weeks – to one month, but I keep thinking it should gradually be getting a little better – – however remains the same every day. I can see big objects but no details at all – mostly light objects also. The blurriness is difficult to take and it makes me feel a little sick and also I have headaches from it.

  18. ari weitzner on May 23rd, 2010 10:42 am

    if the surgery was uncomplicated, then you should be seeing normally by now. so, either the cornea is swollen from the fuch’s- and there’s a chance it won’t get better (but i would wait about 2 months to see if the cornea gets clearer), or, the surgery was complicated, and the cornea got damaged and/or some other issue.
    ask your doctor if the delay is due to the fuch’s. if so, then consider dsaek or related procedures to improve your vision.

  19. Betsy Ray on July 9th, 2010 12:38 pm

    I am a 77 yr old female and I was told I had Fuch’s about 5 yrs ago. I have been told my cataracts are ready to be removed, but I fear that the operation will cause my eyesight to get worse. The opthamalogist tells me they are ready to be removed, but I am fearful of it causing my eyesight to get worse. I see well enought to drive, but sometimes driving at night is difficult. I have no other symptoms and still see to read, but the distance in my glasses is not as good ,and I do better taking them off. I am not sure where I should go to have it done. The Dr I am seeing claims to be a corneal specialist, but I have heard pro’s and con’s on his abilities. I live in NW Florida and would appreciate being given a name of someone who is qualified to do surgery on Fuch’s patients. I was told I have no swelling and he has been seeing me for yrs and did not find it until 5 yrs ago. Are there special instruments for causing less trauma to the eye, as I read an anticle that they have come up with an instrument to use instead of the ultra-sound “jack-hammer” method. It was called a torsional mode that removes the tissue by shearing. It said by reducing the ultrasound power, it caused less tissue damage.. I believe Alcon was the company who introduced it in 2006. Should I get a 2nd opinion in another location? Thank you for you time.

  20. Joy on September 9th, 2010 10:59 am

    I have Fuchs’ Dystrophy. My most recent cell count was about 1600 in my worst eye. I have cataracts. My vision worsens each year. Can’t read street signs; cars on the highway are fuzzy around the edges, etc. Definitely don’t drive at night. I’m seeing a reputable corneal specialist who says my corneas aren’t that bad, but the cataracts need removal. I’m pretty confident that he can remove the cataracts without too much damage to the endothelial cells. My confusion is his recommendation that I have premium (prescription) lenses implanted as opposed to the clear lenses. I’ve read about side effects of the premium lenses, and they are some of the same problems I have now. My reasoning is, If the cataracts are causing my poor vision, won’t just removing them and implanting clear lenses improve my vision? By the way, the premium lenses cost $2,500 each and I just can’t see that they’re worth it. Opinions please.

  21. Joy on September 9th, 2010 11:02 am

    Forgot to mention, I am 73 yrs old and was diagnosed with Fuchs about 5 years ago. My corneal specialist and retina surgeon (I’ve had a retinal hole repair) feel that I may not need corneal or endothelial transplants for 10 or more years, if then.

  22. ari on September 14th, 2010 10:48 am

    the torsional is simply a slightly different ultrasound. i use it and i think it is easier on the eye.
    the rand institute in florida has a good reputation. bascom palmer is a world-class eye hospital. consider those if you have second thoughts about surgery. waiting for the cataract to ripen may be a bad idea- requires more ultrasound to remove, and thus more risk to the fuch’s cornea.

    offering a fuch’s patient a multifocal is very aggressive, and i disagree with it. most ophthal’s dont want to implant multifocals (like alcon’s restor) in eyes with compromised corneas- the odds of you being unhappy are just too high. the crytalens works differently- would give you decent intermediate vision, but you will probably need glasses for reading. less controversial, but less bang for your buck. if you have astigmatism, i would get the toric lens.

  23. Jamesoh on November 27th, 2010 10:15 pm

    I went a few months ago to see why my vision was getting foggy. My opthalmologist says I also have some cataract. I was told I have Fuchs and have a thickness number of 625. I am a dentist and worried a little about how soon I will be able to work again after surgery. I have always had alot of floaters starting at around 35y/o. This is mostly my left eye that is in question at this point. I can get by working alright at this point but if I wait maybe they could do a corneal transplant at the same time? I think I generally heal kind of slowly too. Should I be seeing a corneal specialist or just a local guy that does 10 cataract surgerys a week?

  24. ari weitzner on November 28th, 2010 1:22 pm

    you have to ask your surgeon what percentage of your vision loss is due to fuch’s and how much to cataract. that will determine whether you should have cataract alone, first, or in combination with corneal transplant. if you need transplant, you need to go to someone who is familiar with the new technique of dsaek/dlek. a conventional transplant is inferior to this and should not be done. this technique has a difficult learning curve, and you need to go go to someone who is very familiar with it. for straight cataract surgery, you should stick to your regular ophthalmologist. after the transplant, the vision may be foggy for a few weeks- you know best how this may affect your dental procedures. after simple cataract surgery, you can go back to work in a couple of days, unless the cornea gets swollen from the fuch’s- then it can stay foggy for weeks, or even longer if the swelling doesn’t resolve.

  25. Penny on December 19th, 2010 11:39 am

    I am 53 years old. I was diagnosed with Fuchs in both eyes when I was 18. On the advise of Edward Isbey of Asheville Eye I had a combination surgery of DSAEK as well as cataract with an IOL implant. Prior to surgery my uncorrected vision in my left eye was 20/50 early morning; 20/40 late morning and 20/30 late afternoon. My surgery was on November 16, 2010. The following day my vision was 20/100. Two days later my vision was 20/80. During the surgery Dr. Isby found it necessary to place a contact in my eye. This contact was removed after the exam where my vision was 20/80. Since then my vision has declined. It has been 20/200. It has not improved since before Thanksgiving. My question is….does anyone know if this is unusual. Last Monday Dr. Isbey referred me to a retina specialist to see if I had developed fluid behind my retina due to the surgery. No fluid was found. My impression from Dr. Isbey is he is somewhat confused why my vision has not improved.

  26. ari weitzner on December 19th, 2010 12:42 pm

    if the cornea is nice and clear, and the retina exam was negative for fluid (was an oct done, or just angiogram?- angiogram could possibly miss subtle fluid), perhaps something happened to the optic nerve. do you have any risk factors for ischemic optic neuropathy like hypertension/diabetes/high cholesterol? do you have any glaucoma?
    you need to get a second opinion.
    i assume your surgeon is a cornea specialist and would detect subtle fluid between your cornea and the graft.- that could degrade the vision.

  27. Joy on February 18th, 2011 10:09 am

    See my post in September. I had the cataract only surgery on my left (worse) eye 2 days ago with an IOL implant. Wow is all I can say. My vision in that eye is so improved I find it hard to believe. I’m typing this without glasses. Everything is so clear, even colors are more pronounced. I have a lot of healing to come, but at this point I am overjoyed. Haven’t had my glasses on since the patch came off. Do close my right eye on occasion to focus. I’m so ready to have the cataract removed from the right eye. I realize the Fuchs’ is still there and will have its way with me, but am hopeful it will progress very slowly and I’ll never need DSAEK or corneal transplant. My doc here in San Antonio is wonderful. I’ll try to post again in 3 weeks after my check-up. Life is good.

  28. ari on February 18th, 2011 12:33 pm

    thats wonderful to hear!
    which iol did you choose?

  29. Joy on March 4th, 2011 2:06 pm

    Well, 2 weeks plus 2 days after my cataract surgery. I was so excited at my ability to see without glasses (surgery eye). But this past week, my vision seems to be gradually deteriorating. Big disappointment that my distant vision isn’t more improved. Can’t recognize characters on TV (I wear my glasses and cover the surgery eye so I can see). Follow-up in a week. Torn between calling dr and waiting for follow-up. Oh my. Is the Fuchs’ terrorizing me?

  30. ari on March 7th, 2011 2:41 pm

    again, which iol did you choose?

  31. Jeanne Adam on April 11th, 2011 1:10 pm

    I have just had cataract surgery on R. Eye by the DSAEK Specialist in FT. Myers…he is the innovator for DSAEK, Dr.M.Gorovoy. Surgery was 5 days ago, I cannot see anything but cloudiness in the eye. I have full confidence in him, I am going back for transplant of cornea lining in May…I pray I will see better after that heals. Fuch’s snuck up on me, I knew I had it but it caused blurry distance vision very quickly. His office is so efficient and the Dr. seems very knowledgeable. I will post after DSAEK surgery.

  32. Jeanne Adam on April 30th, 2011 11:56 am

    Now, 3 1/2weeks post-op for IOL implant. I have had lots of edema which led to blisters on the cornea, very painful. Still scheduled for DSAEK on 5/11. Muro is the only drop giving me relief from edema, also in between using other eye meds by doc’s advice. Will still post after DSAEK on 5/11.
    Great to hear from others on this subject!

  33. Betty Wilson on August 31st, 2011 5:39 pm

    I regret having cataract surgery in my left eye. NO diagnosis of Fuchs Dystrophy was made in that eye (that I was TOLD) until AFTER the surgery. If I could go back in time I would NOT have the surgery in my left eye. Now I am stuck with constant blurriness, discomfort…and even though I realize I have to “let it go” I am still angry with the eye dr’s for not making a diagnosis…AFTER the surgery and the blurriness continued, I was told by the surgeon that I had a ‘mild case’ of Fuchs Dystrophy. I am taking Muro128 drops and the ointment. If only I would have known that the surgery would ‘bring the Fuchs to life) ((before it never bothered me in the least)) I never, ever would have chosen to have the surgery. Now its like I am looking through several layers of white gauze with my Left eye. Please think TWICE before having cataract surgery…unless your cataracts are SO bad that you barely have ANY vision.

  34. ari on August 31st, 2011 8:05 pm

    subtle pre-fuch’s can be overlooked pre-op. typically, it would not cause problems after routine cataract surgery. it looks like you were not so lucky. you should definitely get dsaek cornea transplant consultation- very good chance you will get your vision back

  35. Betty Wilson on September 13th, 2011 3:02 pm

    Thank you, Ari, for your comment. I appreciate it. I realize that my ‘best bet’ is not to be ‘resistant’ against any more surgery and just go with the flow, intend my best, and know the best thing will happen with and for me. The more I stress or the ‘harder I try’ the worse my vision is.
    Again, thank, I have appreciated all the posts you have written.

  36. Maggie R on December 30th, 2011 10:41 am

    At 71, I have been diagnosed with Fuchs by two doctors, one wanting to implant Crystalens, and seeing what happens with Fuchs. Second doctor said I have “advanced Fuchs” (7 on 1-10 scale) and said my corneas would most likely never survive cataract surgery. The first doctor stands his ground. Which is the least riskiest?
    Even if I had the cataract surgery, is the corneal transplant probably inevitable in the long run?

  37. ari on January 1st, 2012 1:02 pm

    a crstalens in an eye with fuchs is, in my opinion, inappropriate. if your fuchs is a 7, there is a decent chance you will need a transplant sooner or later after surgery. but its kinda irrelevant- if you have significant cataract, what choice do you have but have it removed and hope for the best, and if you need dsaek (special corneal transplant surgery for diseases like fuchs), so be it- the prognosis is very good.

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