1. Community
  2. Eyes
  3. Cataract

3 months out from 1st eye targeted for distance with a myopic surprise result- different readings

Posted , 7 users are following.

jane97874
jane97874

I was implanted with a monofocal toric, RayOne Toric. I did some digging and found the surgeon's target refraction was -0.30D. At the 2 month mark i was measured at the surgeon's office for -1D, -0.25D astigmatism. I've had a further refraction reading at an independent optometrist's fitting for glasses at -0.75D, -0.25D a few weeks later.

I'm a little surprised at the result and when confronting the surgeon, he was a little defensive. It's looking like I will be targeting for -2D in the second eye, as I don't have a great deal of hope for aiming for distance, (even with a calibration I don't have an appetite for risk to end up at -0.75D) nor do I see the value for gaining any more sharpness at the expense of my near vision.

My operated eye does give me decent enough vision to leave the house without glasses and have noticed that I tend to need to look at my phone very often when out and about, e.g. maps and texting, which has consolidated my decision to go for near in my second eye.

I thought I'd update here for the benefit of others to be aware of the refractive surprise (I should have been a home run as I didn't have LASIK prior, with healthy albeit dry eyes) and what sort of vision this result buys me.

2 likes, 10 replies

10 Replies

  • maura04015
    maura04015 jane97874

    Posted

    I'm glad it's working out for you in spite of the missed target. Refractive surprise is my biggest worry as it seems to be the most common less than desirable happening.

  • Guest
    Guest jane97874

    Edited

    That is very disappointing but a few things…

    1. The normal margin of error is .5D in either direction (not very good I know) so I hate to say it but a -.3 prediction with a -.75 result is actually just within the margin of error. It's a bit of a miss for sure though. Perhaps this result can inform what to do with the second eye so it's more accurate.
    2. I think RayOne has a slightly extended range like Eyhance. It's important with that kind of lens to "push plus" when doing the refraction with a phoropter otherwise the refraction can result in a more myopic result than necessary. I would trust your optometrist more for the refraction than the ophthalmologist, especially if they only use an autorefactor (the thing where you look at a road / balloon picture)
    3. Do you know what formula was used? Because some give a prediction of pure sphere (without taking astigmatism into account) and some give a prediction of spherical equivalent (which takes astigmatism into account). That said you have negative sphere and negative astigmatism so your spherical equivalent is going to be ever so slightly MORE negative anyway but it's just good to know if you are comparing apples to apples when judging how close you got to the predicted outcome. Barrett Universal outputs SE predictions.
    • jane97874
      jane97874 Guest

      Posted

      I managed to get hold of the IOL calculation sheet but am having a hard time reading it as they don't seem to measure up. It says the SRK/T formula was used, listing out the following for my left eye:

      Target refraction 0.00

      Power Refraction

      +15.50 -0.58

      +15.00 -0.24

      +14.50 +0.10

      +14.00 +0.43

      +13.50 +0.75

      But on the final surgical notes it reads that the target refraction was:

      Predicted SE refraction: -0.30D/+0.10

      +14.50D/+3.00 x 73deg

      So I'm not sure if it was actually used? I overheard the surgeon in the theatre saying he put the same numbers in the formula and it lined up....Any pointers @RonAKA?

    • RonAKA
      RonAKA jane97874

      Posted

      I can't say that I totally understand the numbers, but the best I can make of it is that a +14.5 D sphere and 3.00 D cylinder toric lens was used. I think, but I am not 100% sure that the predicted outcome was -0.30 D sphere and +0.10 spherical equivalent.

      .

      Your outcome for astigmatism is excellent at -0.25 D. However the spherical equivalent is -0.875, not +0.10 D, or a significant miss in the sphere component. On a rough basis it looks like you needed the +13.5 D sphere power lens not the 14.5 D sphere lens. That is a significant two power step miss.

      .

      For your second eye one of the things you could do is use the data for your IOL calculation sheet (if it is complete) and enter it into the Barrett Toric formula to see what it predicted for this operated eye. If it makes a better prediction it would be best to use the Barrett formula for the second eye, and not the SRK/T one. There may be other toric calculators, but the Barrett one is the only one I have used.

      .

      Google Barrett Toric Calculator V2.0 to find it.

      .

      If you need help with the Barrett calculator post again and I will try to help. I recall there are some issues running it with the Chrome browser, and I needed to use the Microsoft Edge browser to get it to work.

  • RonAKA
    RonAKA jane97874

    Edited

    How is your reading ability with your operated eye? If it is "good enough", you could also try again for distance. The surgeon should be able to refine his calculation method and come closer on the second try. You could also ask for your IOL Calculation data sheet and enter the numbers yourself in some of the better IOL calculation formulas. The one that predicts your actual outcome for your first eye, may be the most accurate in predicting the accurate results in you second eye.

    • jane97874
      jane97874 RonAKA

      Posted

      It's currently not good enough for any decent near vision. For desktop I have to move the screen a bit far back to make use of it or blow up my laptop font if it's on my lap. My phone is already on max font and I still have to hold it at arm's length; not all apps have this and I struggle to see. I don't really drive so it's decent enough to go about my day outdoors.

      I still have halos and glare though, something I'll just accept will hopefully disappear with time.

      Some interesting points on eye dominance though; I was right eye dominant prior to surgery and my left eye was corrected for distance. This dominance has now switched. I wonder if I aimed for right eye distance vision it would switch back?

    • RonAKA
      RonAKA jane97874

      Posted

      Not sure on the eye dominance thing. It seems to be stronger in some people. I have crossed monovision where my dominant eye is the near eye. It has not switched.

      .

      I guess you will have to make a decision on what your priority is, near or distance, and try again for that with your second eye. Dominance should not be a concern as to which eye you do for distance or near. I would investigate which IOL Formula is most accurate for your eyes, and refine the calculation so you get a more accurate outcome though.

    • phil09
      phil09 RonAKA

      Posted

      It's not clear to me that eye dominance has any relevance at all to cataract surgery. Maybe if you're a golfer or a photographer you would care a little bit and do something different in choosing lenses or focal targets for the dominant and nondominant eyes?

      .

      I have consulted four ophthalmologists about my cataract over the past year. Not one of them has even mentioned dominance.

    • RonAKA
      RonAKA phil09

      Edited

      Handgun and shotgun shooters may have to be a bit more concerned, as they are normally done with both eyes open. Especially with a handgun one needs to see the sights on the gun and the target well with the dominant eye. This may be a case of when a MF lens would work best in the dominant eye. Monovision may not work all that well.

      .

      Golfing should be OK though as the ball distance on the tee is in the range where vision is good in both eyes with monovision and depth perception should also be good.

      .

      Photography is different again depending on whether you use a TTL or backscreen viewfinder. But you don't need 3D vision, and not many cameras today are manual focus, so it should be fine.

    • phil09
      phil09 RonAKA

      Posted

      I see (no pun intended). I suppose tennis is the only activity of mine that could possibly be affected. But I expect it will be no problem, as the ball very rarely gets hit at closer than arm's length. Even on a backhand volley at the net, I would think a player with monovision really uses only the distance eye, whether it's theoretically dominant or not. Guess I'll find out soon enough.

Back to top

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.