Can no longer see well intermediate without glasses after cataract surgery. Would like opinion
Posted , 6 users are following.
I have 2 questions. One has to do with vision change and the other is about how they determine you no longer need drops after cataract surgery.
I am 78 and had cataract surgery at Critical Care Clinic at a hospital (right eye Oct 16/2019 and left eye Nov 13/2019. I have open angle glaucoma and macular hole in my left eye and exfoliation (developed just before cataract surgery) glaucoma in my right eye. I had vision correction laser PRK back in 2001 which made it difficult for exact measurements. The doctor recommended lenses for distance for the left eye and intermediate for the right eye. At first, my intermediate was very good and but gradually has decreased and at my next visual test appointment I was told my eyes now are both for distance 20/30. Although I'm very glad I had no complications, I am very disappointed that I'm still left struggling with 2 sets of glasses (for reading and pc). Even if I have a bit better vision, they're still glasses.
My vision laser doctor had made my dominant eye (right eye) for distance which gave me full monovision. This time, because of the exfoliation in the right eye which I developed just before the cataract surgery which made it the weaker eye now so the cataract doctor chose to do this eye first but chose to make it intermediate and made my left eye for distance -- the reverse of what I had before. Wouldn't it have been better to make my right eye for distance like I had it before? What I think happened is that because my right eye is dominant and was for distance for many years, it has now taken over for distance and so I lost my intermediate. I just want to know if anyone would be of the same opinion as myself. The weird thing is I can still see the text on my pc without glasses but a bit blurry and not comfortable. It's frustrating because it's there, but just not good enough and I can't have it, grrrrrrr. We were vying for glasses for reading only which was ok with me.
Also would like to know if anyone knows how the experts determine a person doesn't need glaucoma drops anymore or a lower dose. Cataract surgery can sometimes release pressure. Do they go by the numbers of the pressure, e.g., I understand that 24 is high? Or just stop the drops altogether, wait a couple of months, check your eyes, and determine from that whether you still need them? Sorry for the length of this.
0 likes, 16 replies
RonAKA micheline16004
Posted
I am coming up to my first of probably two cataract surgeries. One is not bad enough to do yet, but I am scheduled to have the bad one done in 6 months. The surgeon wants to monofocal distance on the first eye, and then consider some undercorrection on the second eye so it can be used for intermediate vision and larger print reading. I have tried this with contacts a few years ago, with somewhat mixed results. Not sure how much was due to the monovision and how much was just due to wearing contacts. I don't particularly like them. In any case if we proceed as he has recommended, my non dominant eye will be corrected for distance, and my currently dominant eye corrected for closer up. He says it can be done and is done. I have done some checking and discovered it is called "Crossed Monovision". I found one report that you likely can find on a search as well if you search for the report title below. It basically concludes crossed monovision can work as the brain will learn to use the eye that works for the distance that it needs. I'm still slightly skeptical, but am going to consider it. I have probably a year plus to think about it. I still have 20/20 in my good eye, but a cataract is developing.
Crossed monovision may be as effective as conventional monovision
micheline16004 RonAKA
Posted
Thanks Ron for your reply. I never knew there was such a thing about crossed monovision. I'll look it up. That's very interesting. I'm still wondering though why she didn't make it for distance since it is my dominant eye. I guess she must have had a reason. I just wish doctors would explain more. Some do, but too many of them don't. Thanks.
Chris53317 micheline16004
Posted
Micheline, your particular case sounds complicated, so asking non professionals in this forum may not provide accurate opinions, and at worst could be misleading. That being said, I have read that some level of training or disciple in adapting to monovision is necessary. Is is possible that you were not give advise about this?
Have you considered getting progressive lenses in your glasses? This would eliminate the 2 sets of glasses, and should you good vision for all distances.
Treatment for glaucoma is usually based on eye pressure. Mine was high, not sure what the reading was, before cataract surgery and was on drops twice per day as preventive measure for a few years. I did not actually have glaucoma. Post surgery the pressure is down to 12 and I have been reduced to drops once per day. This will continue to be assessed at my next appointment. Do not take the chance of just stopping unless advised to do so as this could cause irreversible damage.
You have to be assertive with your optometrist and surgeon, and keep asking questions until you are satisfied with the answer. Many seem to tell you as little as possible.
micheline16004 Chris53317
Posted
Hi Chris,
Thank you for your reply. Yes, I agree it is complicated and so I knew it was a long shot. But it did bring out your opinion which helps. I knew about progressive glasses but I haven't thought about them because 1) I don't like them, and 2) I haven't lost complete hope about my intermediate vision yet. Still hoping it will return. One of the surgeons told me I wouldn't lose it. I'm still trying different things e.g., different drops for dry eyes which I have, omega 3, trying to get a humidifier. So here's hoping. But if, at the end, it doesn't return, then I will consider your recommendation of the progressives.
As to my question on glaucoma, the surgeon who performed the cataract surgery would not answer any of my questions on glaucoma and pressure relief after surgery, because it's not her field. Her field is cornea and refractive surgery and she handles only critical care cases and I was to return to my previous ophthalmologist who had referred me to her. When I returned to him who is in the same field as she is, I asked him the same question and he seemed unsure about it. He said it was done by process of elimination, i.e., he said stop the drops for the left eye completely, wait 3 months, come back and see him then and he would see if I can either eliminate the drops or some of them or lower the dosage. My right eye has exfoliation syndrome so it's out of the question for that eye. ButI am leery about it, and I see from your comment that they simply used the numbers to determine to reduce your dosage which is what I wanted to know. Again, glaucoma is not his field and I asked him to refer me to a glaucoma specialist but that won't be easy. There are not that many of those around apparently.
Thank you.
tamarinda micheline16004
Posted
It sounds like your lens settled in to a diopter different than the target, which is indeed frustrating, but not uncommon. My ophtho said up to 1 diopter difference is within standard of care. Mine started out someone off, and then settled back to 20/20, which was the goal.
It also sounds like you have some intermediate anyhow, since they settled at 20/30 for distance (and not 20/20), and you have blurry intermediate vision, enough to read your screen.
One thing that occurred to me as I read your post was the trick where the reading glasses are just slid down the nose...that will change where they focus. Could that difference be enough to allow you to use one pair of glasses for both near and intermediate?
micheline16004 tamarinda
Posted
You know that's a very interesting reply. Thank you. Right now I'm using drugstore reading glasses. I have to book an appointment with an optometrist. How long did yours resettled to 20/20? I am using 1.50 strength for the PC sometimes because some days are better than others. The days that are clearer without glasses are still a bit blurry but I keep trying. Just tried what you suggested. Oddly enough the ones I use for reading at 2.50 I can see clearer on my PC than the 1.50. So I can use both glasses for the PC. I don't understand that. I'm hesitant to use my reading glasses for the PC before I find out what's happening. I don't know what I'd be forcing my eyes to do. Before my cataract surgery, I had to use 3.25 for reading and 2.50 for PC. I was high myopic. It's true what you are saying about the distance. It is shorter than before. She took from the distance to give me intermediate and that was good. I'm 78 so I don't need very far and fine distance vision. I was really pleased at first when the intermediate was good. I was in awe actually. I could read on my PC and prepare meals without glasses. She said she gave me a mini-monovision RE + 22.00 and LE + 20.00. It's frustrating because it's there just a tiny bit blurry but just enough though to keep it from being comfortable. The thing is it's so easy to get dependent on the glasses. The next thing you know you're reaching for them all the time. I was supposed to need them only for reading.
RonAKA micheline16004
Posted
I have looked ahead to consider what I will do if I end up with distance monofocal lenses in each eye. There is OTC reading glasses of course, but I have found that Foster Grant makes what they call multifocus reading glasses. The claim to have three progressive zones to cover from close up reading to intermediate distance. Those might work for you. I have worn prescription progressives for 20 years or so. I had no problem at all adapting to them, and if push comes to shove and I don't get 20/20 distance, I am not afraid of just getting prescription progressive to take care of what the IOL does not do. The biggest secret with progressives is to not look down when you are on stairs. Trust yourself. "Use the force Luke!"
micheline16004 tamarinda
Posted
Hi Tamarinda,
May I ask you, how long did it take for your eyes to resettle to 20/20 vision?
Thank you.
micheline16004 RonAKA
Posted
Hi Ron,
I have looked up the title but didn't find any articles on it, but I understand what you mean. Yes, the brain can do wonders. Yes, that's what I have Foster Grant glasses but not multifocus. It is something to consider. Thinking back, I was told they couldn't guarantee anything because my problem stemmed from the surgeon not being able to get and use exact measurements due to my vision laser surgery PRK done 20 years ago. It was ill-advised and shouldn't have been done. How doctors just go ahead and do these surgeries without warning the patients about this is appalling. I was 60 at the time. Cataract surgery should have been done instead. I was high myopic and could no longer tolerate contact lenses. Thank you for your response.
RonAKA micheline16004
Posted
Try a search on the following. I have no trouble finding the article, but as I have found it before the cookies saved may be helping me. Just copy and paste the following exact phrase in to your Google search field including the " symbols.
Healio Ocular Surgery News "Crossed monovision may be as effective as conventional monovision"
micheline16004 RonAKA
Posted
Hi Ron,
Thanks for coming back. Yes, this time I was able to read about it. It mentioned that it is used mostly for people with presbyopia which is the opposite of what I had high myopia, and for people with mild degree of anisometropic pseudophakic. I don't have that. Instead I have pseudo exfoliation syndrome. She did the right eye first. Although it had been my strongest dominant eye before, the exfoliation had rendered it the weaker one. So I don't think she had a choice. They do the weaker eye first usually so that you can function with the stronger eye after surgery. At least that's what I understand. Makes sense, but what I'm wondering is why didn't she make it for distance like it was before? That's what I'm left wondering about. I'll never know I guess. I understand about crossed monovision but it didn't work in my case. It could be because 1) I had full monovision before for 20 years which is so long that my brain couldn't handle the switch and my dominant right eye just took over. Or 2) it could be because she couldn't get precise measurements and because of that it just didn't come out right on target. I tend to think it was the former because my intermediary was very good at first. Or then again if it's supposed to be off a bit at first to then settle into the right target, then it's the latter (no. 2) that is probably what happened. What a dilemma! Nothing can be done I guess.
tamarinda micheline16004
Posted
You know the other hitn
tamarinda
Posted
Oh bother. Could it be PCO?
micheline16004 tamarinda
Posted
Hi Tamarinda,
You know I just looked up the symptons of PCO and it's quite possible. It says the following:
What are the symptoms of posterior capsule opacification?
A gradual decrease of vision.
Vision that is blurry.
Glare around lights.
Sensitivity to sunlight.
Halos around lights.
Yes I have all those. There definitely is a gradual decrease in vision. Thank you so much for pointing this out to me. I will be asking my ophthalmologist to check for that next time I see him. I will come back to let you know if it is. I will be making an optometrist appointment also. Maybe they will be able to tell me. Thank you.
Guest micheline16004
Posted
Hi
Non of us in here are experts, so off course this is only my personal opinion, based on what I have learned.
As Tamarinda says, pco could very well be possible.
The lenses often do shift a little during healing, I am not sure if this is the case, but if the lens have settled to the quite myopic side, this can also give you 20/30 vision at far, and then worse vision the closer things gets.
On thing is certain, you can NOT damage anything with reading glasses, no matter what powers they have. You should use the readers that give you the best vision, if your +2.5 gives you best pc vision, then it is fine, no need to worry. Eyes will heal the same way, lenses will settle the same place, you can not change anything in your eyes no matter what reading glasses you are using.
I believe your brain should get used to the dominant/nondominant eye thing. In my case left eye have been dominant for 45 years, and then within 3 weeks right eye became dominant after the surgery.
Glaucoma is a hole different story, I have a couple of friends with glaucoma. What pressure our eyes can tolerate varies from person to person.
24 is high, but some can tolerate it, others would need to have it lowered to not damage the optic nerve. I suppose your eye doctor is aware of this, and taken this into account.
I believe the eyes drops for glaucoma in most cases lowers the pressure, and in most cases the pressure determine, if and when you can stop with the glaucoma eye drops. This is something you should do together with your eye doctor, to not risk damage of the optic nerve.
micheline16004 Guest
Posted
Hi Danish,
Thanks for your reply. Yes opinions is what I am looking for. This is an excellent site not with experts but very knowledgeable people to get suggestions and share ideas from experiences. I'm taking down notes and bringing those to my ophthalmologist to get answers. I had completely forgotten about PCO which is possible. It's weird. It's there. The letters I look at without glasses are not blurry themselves per say but this fluctuates. Instead it's like having to look through a patchy haze or fog to get to see them. I instill lubricating drops about 4 times a day and when I do, things are better but it doesn't last and it's not enough.
No, I didn't mean using reading glasses would damage my eyes. I was more thinking of inciting dependency on them, making my eyes used to them. I was of the idea that if the brain can adjust the vision for monovision, can it not adjust the vision to certain power of glasses if you wear them all the time? I guess I'm wrong, but since I'm fighting having to wear glasses at all for intermediary vision, I don't want my eyes to get used to wearing them, at least not until it's confirmed that I've lost that vision for good and will have no choice but to wear them. Yes, cross-monovision is possible apparently. I'll be more certain after tests to see what is the problem whether it worked for me or not.
I have seen many comments about the change in drops after cataract surgery. People saying I've had the surgery and now I don't need drops anymore or only once a day. So, I wanted to know if anyone knew how this is determined, by process of elimination meaning stopping the drops and waiting a couple of months and then checking the pressure which was suggested by my doctor, but I am leery about this. According to Chris, they went by the numbers and I think that's much more reliable and less risky. Now, I'm going to insist on seeing a doctor specializing in glaucoma.
The optic nerve in my right eye is already damaged. I was unaware what was happening. My vision was getting very blurry in that eye but I thought it was my cataract getting worse. I didn't even know pseudo-exfoliation-syndrome existed. This disease chokes the eye and makes the pressure rise. I was waiting for cataract surgery. I wasn't being monitored and so my doctor was also unaware. So, yes you have to rely on doctors, but you can't always just rely on them. There is a lot of time between appointments. You have to be aware, read a lot, and yell bloody murder if something happens. I didn't and this is the result. I agree with Chris that you have to be assertive and push to get answers, even if that works only sometime, keep pushing.