astigmatism, diagnosis and treatment, cataracts

[notrub]

I went to a respectable eye doctor who eventually (long story, short) had me look through a pin hole and my vision cleared and was focused .  He diagnosed cataracts and proposed inserting a fixed focus lens in one of my eyes.  I have just read about astigmatism and how one symptom is flaring of lights at night.  I have this problem and I find it very hard to drive at night and avoid doing so if at all possible.  This experience is fairly recent and I have had good eyesight all my life (I am 71 now).

 

Here is my question:  If I have astigmatism will light flaring be cured by cataract corrective surgery of lens insertion?  (This is the important part for me.)  I don't have any need to improve my vision except for the light flaring problem and can drive in the daytime without difficulty.  I see dogs, children, oncoming traffic and potential hazards without any problems.  I read that astigmatism can be corrected by contact lenses that correct the shape of the eye, for example.  The tests (diagnosis) for this condition seem to be complicated and may require very special equipment.  Any comments please including where I might go for tests, if required.  Thank you very much in advance.  (BTW I am not insured for this sort of thing here in Thailand but can pay as req'd)

[Thainesss]

I can tell you this, I have astigmatism and it is an extremely common problem (30% of eye problems) and had all the problems you listed to the letter, most especially the driving part. 

 

All I did was go to a basic Optometrist and took a basic eye exam and got prescription glasses that completely resolved the problem. It is an extremely easy problem to fix, not complicated at all. I literally went to a Wal-Mart in the states and got the complete vision check done and walked away with a paper prescription that I used to buy glasses. 

 

5 minutes ago, notrub said:

had me look through a pin hole and my vision cleared and was focused

I had the exact same reaction when I looked through the pin hole thing. My vision was immediately cleared. 

 

You gotta go to a place that uses this thing:

 

 

I would say that you should see a professional and get a professional eye exam with a written prescription at the end and get glasses first before thinking about having surgery. Astigmatism is easy to correct with both glasses and contacts. Seems like they were just trying to sell you a surgery, but Im not a doctor. 

[Thainesss]

It would also be great if Sheryl could recommend an Optometrist who can perform the exams to the common western standard. Id be very interested in that as well for maintenance. 

[Sheryl]

If you are not experiencing any visual problem other than the light flaring then unlikely you need cataract surgery now.  Cataracts should be corrected only when they get to the point the impaired vision interferes with daily life.

 

Problems with glare from lights at night are common especially as people age. Cataracts and astigmatism can contribute but it is also frequently found in near sighted people even without astigmatism.

 

I have had problems with it most of my life and gotten worse starting around age 35-40

 

What I do for it which helps a great deal -- enough that I can drive if I have to - is just wear yellow tinted glasses, similar to the tint on ski goggles.  You will find some studies claiming they don't work. They do, at least for me. Cut the glare by about 75%.

 

You don't mention where in Thailand you are but I would recommend going to Rutnin Eye Hospital in Bkk if possible for general check up and accurate prescription. Opticians in Thailand are usually  not very good/reliable, big difference from the west. 

 

Once you have a prescription you are confident of, you may prefer to get it filled online (Zenni) to save money but wherever you fill it, get the yellow tint and if possiblealso  an anti-glare (or anti-reflective) coating.

[Thainesss]

Looking on their website, this is exactly the kind of exam I had in the states:

 

http://www.rutnin.com/en/services/step.php Under the "Examination" Tab.

Specifically the "Refraction Exam"

 

Quote

3.Refraction Exam

• A test which measures a person's prescription for eye glasses or contact lenses
• A test which measures if a person is near-sighted (myopic), far-sighted (hyperopic or presbyopic), or has an astigmatism
• Performed if a person's visual acuity has dropped significantly or the person requests a prescription for glasses
• Performed at Refraction rooms on the 2nd floor

 

[LosLobo]

The diagnosis for astigmatism is not complicated there are online charts where you can self check for this problem.

 

If you look at the moon and it appears egg shaped you definitely have astigmatism.

 

Any optometrist can easily test and develop a prescription for you.

 

The pin hole test shows an improvement in vision can be achieved with prescription glasses.

 

Previously you couldn't remove immature cataracts but with modern techniques removal at any stage is now possible.

 

That being said removal of overly mature ones can be problematic.

 

Removal is recommended when the cataract starts to affect your daily life not just because you have been diagnosed with one.

 

Cataract corrective surgery will not correct astigmatism per se, (additional though not entirely necessary surgery will be required).

 

 With an IOL you will lose that ability to flex your eye lens and therefore focus, so you need spectacles to perform this function for you.

 

And with the spectacles your astigmatism will be corrected.

Edited November 21, 2019 by LosLobo

[notrub]

1 hour ago, LosLobo said:

The diagnosis for astigmatism is not complicated there are online charts where you can self check for this problem.

 

If you look at the moon and it appears egg shaped you definitely have astigmatism.

 

Any optometrist can easily test and develop a prescription for you.

 

The pin hole test shows an improvement in vision can be achieved with prescription glasses.

 

Previously you couldn't remove immature cataracts but with modern techniques removal at any stage is now possible.

 

That being said removal of overly mature ones can be problematic.

 

Removal is recommended when the cataract starts to affect your daily life not just because you have been diagnosed with one.

 

Cataract corrective surgery will not correct astigmatism per se, (additional though not entirely necessary surgery will be required).

 

 With an IOL you will lose that ability to flex your eye lens and therefore focus, so you need spectacles to perform this function for you.

 

And with the spectacles your astigmatism will be corrected.

Thank you very much for your encouraging comment.  The eye doctor that I saw is a real doctor and also has a ' day job' at the local hospital.  He does not appear to be touting for business but who knows?  The only reason that I want to have my vision corrected is because of the flaring of lights at night.  It is dangerous to drive at night and so I rarely do so.  I am typing this without any problems and watching TV is OK but would like it slightly sharper.  

 

My eye doctor in France is the real McCoy but he is there and I am here.  I am in the north of Buriram province about 100km from Buriram city, Khon Kaen  and Korat.  I would go to a private, costly, hospital for tests but how to know the competence of who will be there testing?   I would prefer not to go to BKK if poss.

 

The optometrists, and the doctor too, went through the lens selection routine and not of them corrected my vision.  That is how the pin hole test came up and then the doctor suggested surgery. 

 

I have never needed glasses except in the last 10 years for reading.  Now I have a tablet E reader so I don't use them at all.  

 

Any ideas?  Thanks.  Kind Regards

[LosLobo]

46 minutes ago, notrub said:

Thank you very much for your encouraging comment.  The eye doctor that I saw is a real doctor and also has a ' day job' at the local hospital.  He does not appear to be touting for business but who knows?  The only reason that I want to have my vision corrected is because of the flaring of lights at night.  It is dangerous to drive at night and so I rarely do so.  I am typing this without any problems and watching TV is OK but would like it slightly sharper.  

 

My eye doctor in France is the real McCoy but he is there and I am here.  I am in the north of Buriram province about 100km from Buriram city, Khon Kaen  and Korat.  I would go to a private, costly, hospital for tests but how to know the competence of who will be there testing?   I would prefer not to go to BKK if poss.

 

The optometrists, and the doctor too, went through the lens selection routine and not of them corrected my vision.  That is how the pin hole test came up and then the doctor suggested surgery. 

 

I have never needed glasses except in the last 10 years for reading.  Now I have a tablet E reader so I don't use them at all.  

 

Any ideas?  Thanks.  Kind Regards

I am surprised that they weren't able to correct your vision.

 

Cataracts can tend to degrade your vision over time eventually needing glasses of increasing strength.

 

As Sheryl suggested fly down to Rutnin in Bangkok for a second opinion, they are the best in Thailand!

 

Phone them for an appointment they speak good English. Book some overnight accommodation nearby and be prepared to wait at least half a day.

 

Bonne Chance!

 

PS Reminds me when I flew from Buriram (Satuek) to Rutnin in 2006 when I had a retinal detachment.

Edited November 21, 2019 by LosLobo

[Thomas J]

I have the need for corrective lenses for distance, reading, and I have astigmatism.  When I was younger I had laser surgery to correct the astigmatism and the distance vision.  I can tell you I wish I had never done it.  Yes for a period of time, I did not need glasses to see distance.  However, immediately I needed glasses to read with.  When you are older Presbyopia causes you to lose the focus ability close up and the laser surgery to correct distance then unmasks the Presbyopia if you are near sighted.  You will get the same effect if you wear single vision glasses for distance.  You won't be able to read.  Now my corneas are flat and contact lens do not fit properly.  I can not use the new multifocal contacts.  If you have astigmatism and need correction for both distance and reading you can try the TORIC lenses.  Multi-Focal to correct both distance and close up.  Also, try mono vision.  One contact in dominant eye for distance, one in other eye with prescription for reading. The TORIC lenses correct for astigmatism and should help with the starburst effect at night. 

Regarding cataracts, my closes friend is a Ophthalmologist.  He said that you want to do cataract surgery only when the cataracts are so bad that they are impacting your life.  In the meantime stick with glasses or contacts.  He stated that though cataract surgery is very simple, getting the correct lens replacement is inexact and made more difficult if you have lasik surgery. He said that he would never recommend multi-focal lenses for cataract correction.  He said they are far too difficult to accurately fit.  He said when absolutely necessary do the cataract surgery but go with single vision and then rely on glasses to read.  The likelihood is that you will still need some glasses to make you 20/20, correct for the astigmatism, and have added power for reading. 

 

[BritManToo]

11 hours ago, notrub said:

I read that astigmatism can be corrected by contact lenses

I've had astigmatism all my life, it isn't something that suddenly appears with aging.

It's unlikely you have it, more likely you have cataracts.

Edited November 21, 2019 by BritManToo

[Sheryl]

He does have cataracts but they don't sound very advanced.

 

OP try the yellow glasses. They really help me.

[Thainesss]

11 hours ago, notrub said:

The optometrists, and the doctor too, went through the lens selection routine and not of them corrected my vision.  That is how the pin hole test came up and then the doctor suggested surgery. 

 

This statement right here leads me to believe there is some incompetence in the doctor or that he was trying to sell you something. 

 

When I did the pinhole test, and my vision was immediately cleared, the nurse and the doc both made the immediate comment that it was great news and that it confirms that it will be easily corrected with prescriptions. It was proof that my vision was easily cleared by mechanical means. 

 

10 hours ago, LosLobo said:

As Sheryl suggested fly down to Rutnin in Bangkok for a second opinion, they are the best in Thailand!

 

This is the only option that makes sense. There is no way I would allow someone to perform surgery on my eyeballs without a confirmed and recommended second opinion. 

[notrub]

Thank you.  I guess I'll drive down and face the dreaded TM.30.  I just tried 'stretching' my eyes from the corners towards the left and right last night and the sub titles became sharp and clear.  Normally they are a bit fuzzy.  Great news to think I can avoid surgery.  Thanks again.  Kind Regards

[sunnyboy2018]

Go to the eye hospital!

[Sheryl]

1 hour ago, notrub said:

Thank you.  I guess I'll drive down and face the dreaded TM.30.  I just tried 'stretching' my eyes from the corners towards the left and right last night and the sub titles became sharp and clear.  Normally they are a bit fuzzy.  Great news to think I can avoid surgery.  Thanks again.  Kind Regards

 

Defer not avoid. If you have cataracts and you live long enough they will eventually need to be removed surgically but it does not sound like they need to now.

 

You can do the TM30 online these days.  A small hassle initially to get registered but after that it is a piece of cake, do it in minutes from home.

https://forum.thaivisa.com/topic/1097420-tm30-online-are-people-using-it/

https://forum.thaivisa.com/topic/1093431-tm30-online/

https://forum.thaivisa.com/topic/1121896-tm30-online-questions/

 

 

[Jingthing]

You can choose astigmatism correctly lenses for cataract surgery. Somewhat more expensive but common. 

[Thomas J]

 90% not 100% will show improvement in vision with cataract surgery and that most patients will still require some form of prescription following surgery.  If you opt for monofocal lens, you will most likely need a prescription for reading. It you opt for multi-focal the lens fitting is more demanding and you may still need a prescription for both distance and reading.  These may increase the starburst effect of light at night.  If you opt for a toric lens for astigmatism the surgery is not more complex but its alignment is paramount.  If misaligned a toric implant will cause blurry vision that can not be adjusted with glasses. 

Edited November 22, 2019 by Thomas J

[notrub]

Thank you, thank you, thank you.  I am going to Rutnin Eye Hospital next week.   It will be good to find out what the problem is and have confidence in the doctors doing the assessment.  Thanks for the information and encouraging me to go.

 

I see on their web site that there is a full eye examination special price for 11,000 baht but the fellow at their phone centre in said a simple exam would be around 2 to 3,000 baht.  Any comments?

 

Also, if I have small cataracts I would be inclined to have them removed immediately.  What do my fellow Thai Visa members think?   

 

Thanks again for the help.  I am very happy to be going to this hospital.  

 

Kind Regards

[Sheryl]

Cataracts do not need to be removed unt they seriously interfere with your daily life.

[anterian]

On 11/21/2019 at 8:06 PM, Sheryl said:

He does have cataracts but they don't sound very advanced.

 

OP try the yellow glasses. They really help me.

I would think polarised glasses would also help with night driving.

[LosLobo]

39 minutes ago, anterian said:

I would think polarised glasses would also help with night driving.

I would think not!

 

Polarised glasses are also tinted and would reduce the amount of available light and be dangerous.

 

At night, you want to be able to use the full sensitivity of your eyes.

 

I would even change the normally ridiculous level of window tinting on the average thai car to european standards.

 

ie no front windscreen tinting except for only uppermost 10% of windshield, 35% tint frontside 20% backside and 20% rear.

Edited November 23, 2019 by LosLobo

[ivor bigun]

I know that this will not help you ,but anyone living in the Pattaya area ,go to the queen Sirakit hospital in Satahip ,i get all my tests done every 6 months ,i have  a cataract and they found i had raised eye pressure which can lead to glaucoma ,excelent hospital ,for my tests i pay falang price ,350 baht . drops are extra ,they do all tests ,i had that one with the small dots only a week ago .

[LosLobo]

1 hour ago, notrub said:

Thank you, thank you, thank you.  I am going to Rutnin Eye Hospital next week.   It will be good to find out what the problem is and have confidence in the doctors doing the assessment.  Thanks for the information and encouraging me to go.

 

I see on their web site that there is a full eye examination special price for 11,000 baht but the fellow at their phone centre in said a simple exam would be around 2 to 3,000 baht.  Any comments?

 

Also, if I have small cataracts I would be inclined to have them removed immediately.  What do my fellow Thai Visa members think?   

 

Thanks again for the help.  I am very happy to be going to this hospital.  

 

Kind Regards

Likely you will only need :

vision acuity test and prescription (if required)

check for cataracts

glaucoma pressure test.

 

I had cataracts for 15 years before I needed to have them removed. 

 

Wait until they become a problem. Any changes in the cataract will happen over years so you will have a long time to make a go/no go decision.

 

Edited November 23, 2019 by LosLobo

[Jingthing]

3 hours ago, notrub said:

Thank you, thank you, thank you.  I am going to Rutnin Eye Hospital next week.   It will be good to find out what the problem is and have confidence in the doctors doing the assessment.  Thanks for the information and encouraging me to go.

 

I see on their web site that there is a full eye examination special price for 11,000 baht but the fellow at their phone centre in said a simple exam would be around 2 to 3,000 baht.  Any comments?

 

Also, if I have small cataracts I would be inclined to have them removed immediately.  What do my fellow Thai Visa members think?   

 

Thanks again for the help.  I am very happy to be going to this hospital.  

 

Kind Regards

It's not about small or large. It's about whether they interfere with your life activities.

[how241]

6 hours ago, Sheryl said:

Cataracts do not need to be removed unt they seriously interfere with your daily life.

People can be funny.  You have given him good advice 3 times and even offer a possible fast/easy/cheap fix( yellow glasses) and yet that is ignored and he chooses to spend a lot of money to go to Bangkok for something that he most likely does not need at this time. As with any surgery there is a possibility of less than desirable results.  Unless it was critical,  I would not take a chance with my eyes. 

[Langsuan Man]

13 hours ago, Sheryl said:

Cataracts do not need to be removed unt they seriously interfere with your daily life.

Words to live by

 

Sheryl lives by the Ann Lander's life rule:

 

If it ain't broke, don't fix it 

[notrub]

Thanks how241.  I got it about the glasses etc. but I was used to having an eye examination every year by a fantastic doctor in France.  It takes 1 year to make an appointment unless it is an emergency (he is a surgeon too) and so I have not been able to see him for some time.  My father had glaucoma and it is one of the things he checked as I understand that it can be hereditary (I think that's the one).  

 

So yes, it will cost perhaps 10K baht (including travel and hotel) and involve driving to and in BKK and back but I would like to be sure that my sight will be OK.  

 

Different subject.  My partner (soon to be wife) and I live a simple life in rural Isaan.  I mentioned to Pim that the hotel&hospital are near the train line and we could go into BKK centre and she just said 'why(?)'.  I said maybe a bit of shopping and she said 'what for(?)'.  What a lucky guy I am not to be dragged from shop to shop all the time (as some are).  Sorry if this comes across as being sexist, I don't mean it to. 

 

So, thank you all again.  Whether or not to trust the local doctor has been on my mind for some time.  I am not wealthy and I don't have insurance for this sort of thing so the money spent is gone for good (as I don't have a job to earn some more).  I needed a nudge and some information and that is what you all have provided.  Good.  I go on Tuesday next.

[lopburi3]

1 hour ago, notrub said:

My father had glaucoma and it is one of the things he checked as I understand that it can be hereditary (I think that's the one).  

In that case you likely should have a CVFT done and Rutin can do that (many hospitals can not) - (takes about 30 minutes) and cost is likely about 1,500 baht (but have not had there for some years).  You will have eye pressure test as routine and if CVFT shows indication of glaucoma they will want to keep it low and may have to start taking medications for that (eye drops).  Glaucoma is something you will not normally notice so if you need be sure to take medication (which may be a bit expensive and/or require cool storage).  Once known you can use a local doctor/facility to buy medications and if CVFT is periodically required go to another facility to obtain (it will be a print out test that any good doctor can understand).

[notrub]

23 hours ago, lopburi3 said:

In that case you likely should have a CVFT done and Rutin can do that (many hospitals can not) - (takes about 30 minutes) and cost is likely about 1,500 baht (but have not had there for some years).  You will have eye pressure test as routine and if CVFT shows indication of glaucoma they will want to keep it low and may have to start taking medications for that (eye drops).  Glaucoma is something you will not normally notice so if you need be sure to take medication (which may be a bit expensive and/or require cool storage).  Once known you can use a local doctor/facility to buy medications and if CVFT is periodically required go to another facility to obtain (it will be a print out test that any good doctor can understand).

Thank you.  My mother had a vision problem and I have forgotten what it is called.  Her vision failed from the centre out and she said that there was just a grey blob in the centre of her view or line of sight or whatever.  It meant that she could not recognise people because there was just this blob where their head was.  Is that glaucoma?  My sister just wrote and what my mum had was macular degeneration. 

[atyclb]

keep in mind there is something known as congenital cataract, present from birth that often cause no visual degradation.