+0.75 post op on dominant eye :-( ... what to do with my other eye?
Posted , 5 users are following.
First of all, thank you to all who have responded to my previous post. I have learned a lot and I really appreciate you taking your time because it's been a stressful period—made worse by not having good enough vision to do proper work.
Update:
Well, it's been 3+ weeks and even my dr agrees that I am dealing with a refractive surprise: +0.75 with a Vivity lens. The dr. mention that the Ora system sometimes gets it wrong.
I was hoping for good distance, OK intermediate, with the possible bonus of decent near, and now I have OK intermediate (just OK, not really good due to some fuzziness), poor near, and poor distance.
Since I could not really function postop with just intermediate, I had to get progressive prescription glasses which, thanks to Costco, I had in 5 days and for $160 (since they used my previous frame.)
The good news is that with the glasses, I am getting 20/25 distance on the operated eye—which I am very happy with. But near and intermediate are still a bit on the blurry side.
Here's my question?
What should I do with my other, non-dominant, eye?
Lens type:
I am reluctant to go with another EDOF like the Vivity, or any fancy lens—I don't want to risk another refractive surprise of this magnitude. So I am thinking basic lens (and also save some precious $$$.) Am I wrong to assume that going with basic lenses minimizes the chance of a major error and also give me some clarity which I am not getting with the Vivity.
I was also thinking of going for distance (plano, perhaps?)
Will a +0.75 + distance combination give me some kind of mini-monovision?
Reading is important to me, but if I can handle with drugstore reading glasses I am OK.
What would you do if you had +0.75 in one eye and had to pick a lens for your other eye?
Thank you in advance for any suggestions.
0 likes, 8 replies
RonAKA RandallG
Posted
That is an unfortunate situation. When you are left with a +0.75 D eye, the optimum distance for it is further away than infinity. That distance does not exist, so there is no ideal distance that it works at. But, it should generally give you better distance than near. Also unfortunately it may be harder to correct with eyeglasses as it is an EDOF and does not have a definite peak in visual acuity.
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I think you are wise to stay away from another EDOF or MF. Stick with a basic monofocal like the Clareon. Your surgeon should have learned something from the suprise with the Vivity and be able to refine his power calculation for the second eye. If you want to double check things, ask for the IOL Calculation page from the IOLMaster 700 measurement so you can see your actual eye measurements. With that information you can check what the power calculation is with different formulas. Ask for it for the eye that brought the "surprise" to see what formulas the surgeon used. Compare it to what the actual result was. And also compare it to what other formulas would have predicted. The Hill RBF 3.0, Barrett Universal II, and Kane formulas are all on line, and are quite easy to use, once you have the measurement data. I guess the overall objective would be to determine what went wrong with the first eye, and make sure it did not happen with the second one.
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Is there anything unusual about your eyes that would make things difficult to get an accurate prediction? Prior Lasik can be an issue. Also if your eyes are much longer or much shorter than average that can be an issue too.
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As for a kind of monovision, I guess that is kind of possible. If you can get excellent distance vision with your second eye, and you have OK intermediate with the Vivity, then that is some kind of monovision. You would be left with needing reading glasses for close reading.
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Hope that helps some,
RandallG RonAKA
Posted
Hi Ron,
Thank you for your quick reply.
You are great at explaining things!
That is what I am learning. With a -0.75 prescription I am getting good (20/25) distance (although blurry).
I don't think so. The surgeon certainly did not mention it before or after. He just "blamed" the Ora machine.
At this point, I would be delighted with that outcome—especially if I can read clearly with glasses. It's what I was used to prior to my myopic shift (pre-surgery.)
It helps me more than I can tell you, Ron. I appreciate you sharing your knowledge.
So, thank you!!!!
greg59 RandallG
Edited
When you say your eye is +0.75D, does that mean you need a +0.75D concave glasses lens to correct farsightedness or does it mean you need a -0.75D convex lens to correct nearsightedness (as indicated in this reply?)
If you were left farsighted, then an explant might be worth considering. If it were me, I wouldn't hesitate since you vision doesn't seem to be acceptably correctable. It seems odd that your distance vision would be bad if the only problem was a +0.75D miss. I don't think that would have been the case with a monofocal. Contrast sensitivity may be the problem and is likely an issue with Vivity hyperopic misses (hence the FDA warning) and that's why you can't get corrected to 20/20.
I parted ways with a surgeon who wanted to use Vivity over the contrast sensitivity issue. If all goes well, it probably isn't a problem but if there are hyperopic misses or if future eye problems exacerbate contrast sensitivity issues, Vivity seemed to me to have a much higher risk of ending up with uncorrectable vision problems. I'd get rid of it if possible.
If you are left nearsighted, I'm not sure why your near is bad and intermediate is only mediocre unless there is an uncorrectable contrast sensitivity issue.
I'd go for the monofocal explant before having the 2nd eye done. Target something more near than plano to make sure the best vision of the lens isn't lost as happened with the Vivity. I wouldn't target anything closer to plano than -0.75D. Even with a 0.75D miss in either direction, you'd have much better correctable vision than what you have now. If you hit -0.75D with a monofocal, you'll probably be able to drive without glasses.
RandallG greg59
Posted
Hi Ron,
sorry I was not clear. The ophthalmology lingo is still a bit confusing to me.
I am left farsighted ("the implant is too powerful by 0.75" the doctor said).
If there wasn't risk of further complication from surgery I would consider the explant—even with the additional expense since I don't think that the insurance would cover it.
I have two other consults scheduled with different drs to get their thoughts.
I was not aware that there was an FDA warning. I just saw it. I wish the dr had mentioned it.
On the GOOD NEWS front. Yesterday, upon waking up my vision was considerably better. To the point that I could see 20/25 or 20/32 without glasses—and I saw better in the distance with middle of my progressive glasses prescription than the top. And I assume that in the middle, the correction is close to 0.0.
Sadly, it did not last for long, maybe an hour or so but I took it as a sign of progress/adjustment.
Also, with my prescription glasses, I am seeing more clearly now—at least at the right time and in the right conditions.
Bottom line: If I had 100% certainty that the explant and replacement would fix the problem and not introduce further complications—I would definitely go that route. But if with the second surgery (from another dr (probably) and a with a monofocal) gives me decent distance vision and I need glasses for computers and reading, I would probably stay put.
I have my 4th followup with the original surgeon next week. It's possible that my #s have improved a bit—perhpas +0.5 with less fuzziness.
I will keep you posted and thank you again for taking the time to reply to my posts. It sounds like you have a lot of know-how and experience and they help A LOT!
Sue.An2 RandallG
Posted
That is unfortunate. I don't suppose you would want to exchange the lens to a basic lens? More risk you may not want to take. Might mean a different surgeon if considering. But outcome with a basic lens better than what Vivity
Only other thing I can think of that would throw a curve ball in calculations is if you wore contact lenses and didn't remove them 2 weeks prior to having measurements taken.
hard decision and one you might want a 2nd opinion on before doing anything.
rwbil RandallG
Posted
What was the reason for the refractive miss, was your cataract dense and they could not get a good reading? I had that issue.
My suggestion is to get different IOL Master readings on the latest and greatest machine on different days and make sure your reading are consistant and keep a copy of the readout.
The fact he is blaming the ORA machine is concerning, as he is supposed to be the expert that knows how to use the machine and IMHO that machine is for verifying and fine tuning, unless there was a problem getting your measurement or you have a particular eye issue like long eyes.
My best advice is to make sure you use a top Opthmalogist and get more than 1 measurement taken and keep the results for your record.
If you have some issue that makes it difficult to get an accurate measurement you could consider the LAL, which can be adjusted post op.
RandallG rwbil
Posted
Thank you, for the reply.
How did you resolve your issue?
I will follow your advice. As I wrote in my "measure twice, cut once" post, I am surprised that the drs don't DEMAND multiple measurements.
Will do. Thank you for the recommendation. I don't have long eyes or had particular pre-op problems. At least as far as I know or as far as the dr told me.
Besides getting multiple measurements, any suggestions for what lens to go with in other (non-dominant) eye given the +0.75 (with EDOF) in my operated eye?
Thank you again for taking the time to share your experience and advice.
rwbil RandallG
Posted
When I had my right eye done they took measurement for both eyes. I had procrastinated on the left eye and by the time I had it done the cataract was to dense to get an accurate measurement with the IOL Master machine so they went to some blue light in the eye method, which was not consistent. So they had to go back and dig up their old records out of storage and we used the measurement taken years before, which worked out well.
As for doctors, I recommend using the top Opthmalogist even if you have to travel to them. PM me for suggestions.
As for IOL recommendation only I can say is learn the risk and tradeoffs of each and make the best decision for you. I personally have one of the highest risk IOLs and I also have mix and match, with Tencis Low add and a Tecnis Synergy IOL. My advice is go to a top Opthmalogist and discuss what happened and their recommendations.