53 yo Acrysof Toric Monofocals Upcoming Surgery Questions
Posted , 6 users are following.
I am a 53 yo, high-myopia (-6D and -7D) with -2D astigmatism in both eyes. Moderate cataracts but have very little vision at all distances now. Will have toric Acrysof monofocals. The first surgery on the right eye set for distance, with the worse vision, is in three weeks and the left eye two weeks after. Healthy eyes, no previous lasik or other problems.
They are a world-famous hospital and the physician is eminent. I am however having trouble pinning him down on how he would adjust the second surgery in terms of the outcome of the first. This is what I have been told:
For distance vision, the target is between 0.00 and -0.50.
Because of how advanced my cataracts are, it's not possible to do a contact lens trial for monovision. However, between the surgeries you will walk around with mono-vision with one eye clear for distance and the other eye still myopic.
The second eye is planned depending on the outcome of the first eye.
When I ask what is the range of likely outcomes and what adjustments he would make, I was just told he would discuss it after seeing how the right eye turns out. Is this right, or are there tradeoffs I should be aware of and anticipate before the first surgery?
I am also doubtful about the fact that the second surgery comes only two weeks after the first one. I understand that for monofocals the post-sugery vision stabilization may take 1-3 months, or even six months in some cases. Given that the second one helps to adjust the overall vision, how can that scheduling make sense? Is there a way the physician to know for sure that your vision has stabilized?
I don't mind wearing glasses and contacts. However, optimizing my vision is obviously a priority.
I've been reading this wonderful forum, many thanks. It is so complex I am still trying to wrap my mind around it. Any thoughts would be much appreciated.
0 likes, 16 replies
Bookwoman jade37822
Edited
Yes, it normally takes about 6 weeks for your eye to heal after surgery and for your prescription to become stable, although some people do take longer. However, as a fellow high myope (-8 in both eyes before surgery), I can tell you that the discrepancy between your eyes after the first surgery will be very difficult to tolerate, or at least it was for me.
I had my surgeries done two weeks apart, and was fortunate to be able to stay home and have my husband do all the shopping, etc. during that time. The discrepancy made things quite disorienting, and I was very happy to have the second eye done ASAP.
Those with milder prescriptions obviously have much less of a problem, and can simply pop a lens out of their glasses on the operated side; I tried that and nearly fell over. And I was working with a -2 monofocal IOL, not one for distance!
jade37822 Bookwoman
Edited
Thank you. This is immensely helpful. Sorry to see the discrepancy was so hard to bear. I'll definitely keep that in mind. Best wishes for your vision!
jade37822 Bookwoman
Posted
May I ask why it wasn't possible to equalize the vision at least somewhat with glasses or contacts? I know I am being obtuse. And did it matter that you only had two weeks for the adjustment? I am asking because others are saying it takes six weeks for the vision to stabilize, so if the second eye were to serve the purpose of finetuning the vision to make up for whatever the first-eye surgery did not accomplish, that may not be possible in this instance. How did your physician account for that?
Bookwoman jade37822
Edited
To answer your last question first, I was always going to have the same -2 IOL put in both eyes (I didn't want to lose my near vision, which I use much more than distance), so there wasn't going to be any fine-tuning involved. I wasn't aiming for mini-monovision, but wound up with my second eye at -2.5. And therein lies the rub: you can aim for a certain outcome, but nothing is assured. In the end, I'm delighted with how things turned out, but it was serendipity.
As for your other questions: I wore contact lenses for 40 years, but by the time I was in my 50s I couldn't tolerate them any more. So I wore, and still do, progressive glasses very happily (although now I only use them for watching TV and driving). I was 61 when I had my surgeries.
So it's possible that a contact lens could have helped me, but I'll never know. I knew it was time for surgery precisely when changing my eyeglass prescription no longer did anything; I got to the point where I had to stop driving, that's how blurry the world was.
Perhaps in your case the discrepancy might be overcome with a contact lens, at least to an extent: this is something I'd definitely discuss with your surgeon. The difference in your vision after the first surgery will astonish you!
Sue.An2 jade37822
Posted
You could also try a contact lens vs popping a lens out of your glasses to cope with the in between surgery time.
mary27273 jade37822
Posted
Hi Jade. I am myopic too and currently have a -5.75 in unoperated eye and day after surgery had 20 /20 in operated eye. I can function go outside and shop with contact in to be operated on next week eye. But the difference is that my operated eye is so sharp colors so bright and images crisp that there is some contrast between eyes. With contact in i thought my vision was perfect even with cataract but it s not. so yes my vision is somewhat equalized and definitely functional between surgeries. Im not dizzy or not able to focus being able keep using contact in to be operated eye in a lifesaver for us myopics
RonAKA jade37822
Posted
"May I ask why it wasn't possible to equalize the vision at least somewhat with glasses or contacts?"
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You can correct the vision with a contact or eyeglass lens in the non IOL eye. I believe the issue that causes a problem is the axial location of the correcting lens. In a normal eyeglass situation you have refraction error in both the natural lens and cornea. You correct that with a lens in front of the eye in an eyeglass frame. That lens is a significant distance away from the lens in the eye, and especially if you have high myopia this changes the size of the image. It is sharp but smaller. If both eyes are about the same for needed correction this image size effect is similar in both eyes.
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The problem comes in when you use an IOL to correct the refractive error. The correction plane is now right inside the eye. If you correct the other non IOL eye for sharp vision it requires quite a strong lens well in front of your eye. Now you have a significant difference in image size between the IOL eye and the non IOL eye. A contact lens of course goes right on the cornea and is much closer to the natural lens. This provides a closer match to the image size of the IOL eye.
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I wouldn't be surprised if you do not have a problem with a contact in the non IOL eye and an IOL in the other. With the non IOL eye having a significant cataract, I also suspect your brain will be largely ignoring that image in favour of the new sharp and clear image from the IOL eye.
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I still think there is merit in having at least 4 weeks between eyes, with 6 weeks being better as long as you get a full eye exam to evaluate the outcome. This is most important if you are considering monovision. If there is significant error on the first eye, it may change which eye is best used for the distance eye.
jade37822 RonAKA
Posted
This is fantastic. Am most grateful.
jade37822 Bookwoman
Edited
Heartfelt thanks! I am so happy yours turned out so well. Hurray to serendipity for book lovers.
jade37822 Sue.An2
Posted
Thank you will do. Very helpful.
RonAKA jade37822
Edited
This surgeon sounds similar in some ways to the one I had, and my wife will have for surgery next week. She will get the same lenses you are getting. His preference is to do the worst eye first, and the reason he gives is that he says he always learns something on the first eye that can be used to refine the process for the second eye. It sounds like your two eyes are very similar and the surgeon will quite likely learn and be more accurate the second time. If you are considering monovision the normal practice is to do the dominant eye first, see what you get, and then do the second eye. While it is ideal to have the dominant eye set for distance, it can be reversed if for example the first eye ends up under corrected and is more suitable as the closer eye. With what they learn on the first eye, the hope is that they will get the lens correct for distance on the second eye.
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What does not make sense is to space the eyes only two weeks apart. You get a pretty good idea of outcome at 3 weeks, and normally the eye is fully healed and stable after 6 weeks. If it is possible I would try to hold off on the second eye and get your eye checked at 6 weeks, and then make a decision on the second eye. Yes, you will have to put up with one eye done, and the other not for longer, but you keep your options open until you know for sure what you have in the first eye. You will likely find it more tolerable to correct the non operated eye with a contact instead of an eyeglass lens.
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Those would be my thoughts. Hope that helps some,
jade37822 RonAKA
Posted
Thank you so much. The doc is so busy he has a fellow replying to me, since they have much harder surgeries to perform. So this really helps!
mary27273 jade37822
Posted
Hi Jade. I am myopic too and currently have a -5.75 in unoperated eye and day after surgery had 20 /20 in operated eye. I can function go outside and shop with contact in to be operated on next week eye. But the difference is that my operated eye is so sharp colors so bright and images crisp that there is some contrast between eyes. With contact in i thought my vision was perfect even with cataract but it s not. so yes my vision is somewhat equalized and definitely functional between surgeries. Im not dizzy and i can focus using contact in one ye. being able keep using contact in to be operated eye in a lifesaver for us myopics till second eye done
jade37822 mary27273
Posted
Thank you so much Mary for this really useful info. I am very happy it's worked out for you! How long do you think you would wait until your second eye surgery, and why?
Guest jade37822
Edited
Doing the two eyes separate is about removing the risk of cross contamination (i.e. if an instrument wasn't properly sterilized you don't want to end up with TWO eye infections and potentially lose sight in both eyes). If you do them at the same time (as private clinics do to maximize profits) they use separate surgical trays, separate instruments, lenses from different batches, and scrub up between eyes, etc. So there's almost no risk either way. But that's the reason for doing them separate. It removes all risk of cross contamination. It's not about tweaking refractive targets between eyes. So a week or so between eyes is typical and is what the vast majority of surgeons do when they do them one eye at a time.
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But as others have said full settling takes 6 weeks. So if the idea is to adjust the target on the second eye based on the first eye then you'd be better to wait 6 weeks.
jade37822 Guest
Posted
Thank you very much for the clarification! Do you have any thoughts on how to tolerate the high discrepancy during the wait period? The first poster who kindly responded said that was hard to bear.