Cataract Post-Surgery Results

Hi Night Hawk - did you ever get those glasses you were waiting on?

How’s the eyesight.  Hoping it is much more stable now and close to that target you were aiming for.

I received my eyeglasses order a couple weeks ago, but unfortunately my right eye had changed by that time from one month after surgery when I went to an optometrist for an eyeglasses Rx.  I should have waited until about now (2 months after surgery) since my right eye has been better and more stable in the past few weeks. 

Now daily during the morning and early afternoon I'm seeing near 20/20 or better with my right eye with the toric IOL.  Only worse outside at night like while driving, I'd estimate then its probably 20/30 to 20/40 but doesn't appear to be a refraction error that can be corrected.  Fortunately my left eye works fine even at night corrected with eyeglasses to 20/20 or better and I don't do much night driving nowadays anyway.  Outside in sunlight the right eye's uncorrected vision is excellent now, close to my left eye's best corrected with eyeglasses and good indoors with light sources. 

I'd say the residual astigmatism must be down to 0.5D or less now compared to the 1.0D that the optometrist measured a month ago.  I've found some online astigmatism test patterns and they don't show any noticeable astigmatism effect with my right eye, same as my left eye with corrective eyeglasses. But I can see a noticeable effect on the test patterns with my left eye uncorrected since that eye still has about 2D cylinder without eyeglasses.

So what I did today is order a couple pairs of cheap eyeglasses, one for computer (intermediate) vision and another for reading (near) vision.  For the right eye I'm using no astigmatism cylinder value at all and just doing an add of +1D for intermediate and +2D for near, which I've tested with over the counter reader glasses of those values.  For the left eye I use the same old Rx thats worked fine for that eye for years.  I'm still using an old eyeglasses progressive pair with the right lens removed for general use.  I'll eventually order a new progressive eyeglasses pair when I'm certain my right eye is completely stable perhaps next month - either if its reliably near 20/20 just use plano for that eye or get yet another optometrist eye exam then which I'd expect would only show a very small cylinder value that may not be worth correcting since it may still vary or reduce in the coming months.

I also have a scheduled full comprehensive eye exam set for next month with a new opthalmologist I've selected for my future eye care maintenance for my right eye's glaucoma which requires extra visual field and imaging tests annually as well as eye pressure measurements 3 times a year. With the eye pressure lowering Rx eyedrops I've used for 4 years its remained stable. They usually do a simple auto-refraction at those eye exams, so I might be able to see what they get for the right eye's approximate Rx then too.

I was able to return the original eyeglasses I ordered a month ago and get 100% credit for future orders.  However that order got a 20% discount for the Black Friday week special, which I won't be able to have on future orders.

Good they refunded you- maybe get it in on that Black Friday deal next year!  

Nice the vision is settled.  Did optometrist say that it is normal that the night vision wouldn’t  be as sharp?  I assume you mean the contrast isn’t as good as your other eye without the cataract?

No, the optometrist only did the basic eye exam to get an Rx for eyeglasses.

I will have to ask the MD eye doctor next month about night vision issue.

Not sure if its a contrst issue, I just noticed on the freeway at night I had to get about half the distance with the right eye to read a road sign clearly compared to the corrected left eye. Whereas in the day with sunlight the right eye is close to the corrected left eye.

Might be unrelated to cataract surgery though since my right eye has glaucoma.

My right eye is still improving even after 2 months it would seem.

Today all morning I'm able to read down to the 20/15 and even at times the 20/13 line at 20feet!

Some of us need extra months to achieve the best vision and stability.

Thats why I'm waiting longer to order the more expensive progressive eyeglasses, but its looking more like I can just use PLANO (no distance correction) for my right eye.

Yes that is what I ordered in sunglasses.  Want d insurance to cover the expense of ‘Coach’ frames so ordered for slight astigmatism but no power either way - plano.  Just got them this week.  They are super cute.  Going to be great on cruise.

Yes healing is different for everyone.  For me it has been the night vision that took time and I expect still better in 6 months.  Big difference though between week 1 and now.

I had the dilated eye exam today I had scheduled a couple months ago for the new year with a new opthalmologist.  I asked to see the autorefraction results the tech did before the exam, and as I expected my right eye as measured by that showed only -0.50D cylinder residual astigmatism and PLANO power.  I got 20/20 in the visual accuity test with that eye today too.  So my right eye is ending up similar to your worse eye it would seem.

The doctor didn't see any problems while examing my dllated eyes, other than the known mild-moderate glaucoma I have in my right eye but its been controlled/stable for 4 years now with presssure lowing eyedrops.  I'll just have to continue the annual tests to make sure it remains stable.

I did bring up the night vision issue I've noticed in my right eye, in that it appears to be less clear vision at night driving compared to the left eye whereas in the day with good light both eyes are now very close. He didn't have an idea about that offhand, but might be related to the glaucoma in the right eye which I had guessed might be the case since it can reduce contrast sensitivity.  I noticed that on a dark clear night looking up at the stars, my left eye can make out a dimmer star easier than the right eye so that would indicate the left eye has better contrast at night than the right eye.  A bright object like the moon however appears brighter in my right eye than the left!

I also noted at home whlie my eyes were still fully dilated before it wears off, I see full circles with my right eye (with the IOL) around lights even indoors like the blue LEDs on my cable modem, etc.  Similar to what I remember when I was at home that day after the cataract surgery when my eye was also fully dilated.  But as the dilation starts to wear off now the light circles are disappearing.  Outside in dark night conditions with my right eye dilated at its maximum (without the dilation drops) I can get a half circle around some bright lights, but that goes away if my pupil size shrinks even slightly with enough background light which is more often the case with lights from cars, etc.  I asked about this as well, and might be caused by the outside edge of the IOL  reflections possibly, only visible when the pupil is open big enough which isn't often thankfully.  The half circles must be due to the pupil only normally opens big enough to let one half of the IOL's edge reflection to get thru, perhaps due to offset of the IOL center vs the pupil center. Anyway thats the best guess for that for now, fortunately its not a major issue since normally my pupil is small enough to not get that  effect.

Oh, my 2nd order of eyeglasses were delivered today - only took a week from when I ordered them, so way ahead of time from when I expected them!  I only ordered a computer/intermediate (+1D) vision pair and a reading/near vision (+2D) pair using no astigmatism/cylinder correction in my right eye and my regular Rx for my left eye.  They work just fine like that.  So I could order a progressive pair in the near future probably the same without any cylinder/astigmatism correction with the right eye or I could go for another optometrist exam but it would probably be too small an Rx for the right eye to bother with, since it still could get even better as time goes on since I'm getting 20/20 or better most days now with my right eye uncorrected at least with good light inside or especially outside with sunlight.

It certainly sounds like your eye is now pretty much stabilized.  Good results.  

I do think your vision  could still slightly improve - and reason results are gathered 6 months after cataract surgery.  Maybe has more to brain adapting (don’t know) but as time goes by I think we do adapt.  When it comes to actual visual results I find my optometrist better at accessing that.  She said she was surprised that the opthamologist did a 6 week checkup as he normally sees the patient within 24 hours and that is it.  I think the opthamologist checked for healing or any signs of complications - not so much with visual results whereas optometrist focused more on visual tests and results.  She even remarked she wished the opthamologist would have an iol implant so he could appreciate patient comments about sharpness colours halos etc.   Guess they are 2 different bodies that focus on 2 different aspects of vision.

You did receive those glasses fast!  I am guessing you’d like the progressive pair sooner vs later so that you don’t have to switch pairs of glasses for near and intermediate.  Assume TV is far enough nothing needed for that?

I am not sure if all IOLs give less contrast at night.  I recall when I had just one eye operated on I had trouble in dimly lit restaurant reading menu.  Unoperated eye with cataract could read it - operated eye need light from iPhone to read it.  I too recall first night home with glare around all lights even inside the house.  Thankfully that goes away or I would have a constant headache!

Had an odd drive home 2 nights ago. We have had extremely cold weather and it warmed up enough for storm.  Lots of fog and steam rising from manholes made driving difficult to see.  I am thinking in fog or whiteout snow conditions visibility will be hard.  All in all though I am pleased with results. As it sounds like you are too.  There are days now I don’t even think about my vision - seems normal.  After more than a year of worrying and not seeing well it’s kind of a relief not to think about it so much.  With most on these forums unhappy with Symfony lenses I don’t know if I just got lucky or most don’t post.  Will likely never really know.  I am just grateful I am able to do all the things I did before - maybe more.  Leaving for my cruise soon and looking forward to seeing through a snorkel mask for the first time ever!

Happy new year to you Hawk.  I am sure now with 2 functioning eyes things will be brighter for you too.  I assume you won’t have to have other eye done for years.  Spoke to a gentleman at my church who had one eye done 18 years ago and now looking at options for 2nd eye which now needs to be done.  He always wore glasses so I never knew he had an iol in one.  Funny the things you find out about others when you go through things. 

My TVs are about 6feet or further away, so distance vision is fine for that, my right eye is at its clearest and sharpest vision beyond 4-5 feet.  So I watch TV without glasses now or with my old progressive eyeglasses pair with the right lens popped out if I want good vision with both eyes.  The old pair is  also fine for general stuff, getting distance vision with both eyes and near with the left eye lens.  Progressive pairs don't give easy intermediate vision for computer use for a sustained period so I always use a separate pair just set for intermediate (2-3feet) for my computer use. The last weeks I used my old computer pair with the right lens popped out and that was fine, now I have both eyes corrected so its a bit better.  Same with my old reading glasses I just keep on the table next to my bed for reading my smartphone at night or early morning - one eye corrected was enough, but now I have two eyes corrected again.

My experience with my old pairs of glasses with the right lens popped out as shown me that if I do choose to get my left eye in the future with say a Symfony toric IOL that could work fine with my monofocal toric in my right eye set for distance for most things.  Of course that however could add night vision issues which I don't have with the eyeglasses, so I would have to decide between that tradeoff but not for several years probably.

Seeing the circles of light around lights yesterday for several hours in my right eye while it was still fully dilated after my eye exam was a bother, but I knew it would go away by later in the evening which it did as the eyes pupils shrank in size.   I know those circles I was seeing around lights were probably more obvious/opaque than what you describe from those with the Symfony IOL at night which are more like a thin spiderweb you can see thru?

I agree about the things an optometrist cares about more compared to an ophthalmologist.  I think that difference has gotten more extreme in recent years, nowadays its hard for me to find an ophthalmologist that does refraction for an eyeglasses Rx, they send you to an optometrist for that now.  That wasn't an issue with my old ophthalmologist, he did it all, but he retired 7 years ago. So now I go to an ophthalmologist for the medical eye issues and find a cheap optometrist just for a new eyeglasses Rx.

Also even with ophthalmologists, they are splitting nowadays into general "comprehensive" ophthalmologists and specialists.  I was going to a "glaucoma specialist" ophthalmologist the last few years and she seemed only interested in lowering my eye pressure above all things, not worrying about the side effects of some eyedrops that can worsen dry eye, etc.  But since my glaucoma has been stable not requiring surgery, I switched to start the new year to a general comprehensive ophthalmologist who deals with glaucoma maintenance as well as dry eye, cataracts, and overall eye medical checks.  He can always refer you to one of his specialist colleagues if ever needed, like a retina specialist ophthalmologist, etc.  One of his colleagues is the ophthalmologist who did my cataract surgery and he is a cornea specialist, doesn't do glaucoma maintenance so thats why I couldn't use him as my main eye doctor.  But for cataract surgery I though he was the best choice with his advanced near dropless technique and experience in all the Tecnis IOLs I was interested in.

That would be an accurate description.  The concentric circles are thin like a spider web and on some lights I have to  concentrate to see them.  Other times they are more vibrant.  Like cars when they brake.  Normal brake lights in front of me have no concentric circles but then when the driver applies the brakes I see all those concentric circles. Seems red lights are the most noticeable.  

Likely not an easy decision and thankfully you have time.  Perhaps there will be a better lens come along.  Or the glasses aren’t bothersome and you know another monofocal will not bring any negative night visions your way.

Are the concentric circles the color of the lights, like red for brake lights?

Another possible choice for my left eye could be an accomodating lens but it would need to be a toric version.  There is a relatively new toric version of the Crystalens IOL (Trulign) that came out a couple years ago, but the largest cylinder model available in the Trulign was way too small (1.75D) for my right eye which required over 3D cylinder correction. Even the largest cylinder Symfony (2.5D) wasn't enough for that eye, hence why I went with monofocal toric IOL for my right eye since they have models with even higher cylinder values available.  But the Symfony toric IOL is probably sufficent cylinder for my left eye so its still in play, the Trulign might barely make it but would probably leave some residual astigmatism and if its too much that wouldn't help eliminate eyeglasses. But the Trulign if it worked could achieve about a +1D range in focus so could provide computer distance viewing and perhaps smartphone viewing, but not as good focus range as a Symfony.  However the Trulign/Crystalens IOLs don't have any night vision issues more than monofocals.

Another alternative I might consider for my left eye in the future is a monofocal toric set for intermediate distance about +1D or so.  Then I would use a distance eyeglasses pair for driving to get good distance binocular vision, and since I would use sunglasses anyway during the day not a big issue. That would be a form of mini-monovision which Is pretty easy to get used to.  That could offer glasses free for most day to day things around the house, out shopping, etc.  Just put on a distance pair with sunglass shield for driving and have a weak pair of reading glasses available for fine print reading.

Yes the circles are same colour as light source.

Doctors tend to specialize and really hard to find one that does more than their specialty.  Same reason family doctors are fewer and fewer now too.  I am surprised by number of people that just see their surgeon / opthamologist after cataract surgery and do not check in with optometrist to see exactly what their prescription iis.

Sounds like you are considering a few options.  I  am sure in time you’ll work out best solution 

The circles only appear at a certain distance from light source - likely why one doesn’t see them inside.  I would say about 25/30 yards away.  As you get nearer the light source circles disappear 

Also since I figure I won't need cataract surgery for my left eye for several years, hopefully the available range of models even among the current IOLs like Symfony and Trulign will expand with higher value cylinder for example.  I doubt the "holy grail" IOL will appear in a few years though, that could offer full focus range like a young natural lens without any night vision issues at all!

Hard to say when the holy grail will come along.  Read an article recently that indicated lots of research going into that as a lot of lasik patients won’t be happy with wearing glasses after cataract surgery (reason why they chose lasik in first place).  And those patients have money and won’t bat an eye if paying for perfect eyesight.  

Will be interesting to see what comes along in next 10 years. 

Today is now 3 months since my right eye cataract surgery with the Tecnics toric monofocal IOL - thats a major milestone!

The chances of the toric IOL rotating from here on out is extremely small if its made it 3 months without any significant rotation which is the case since for the past month+ I'm getting 20/20 or better daily in the right eye. The residual astigmatism cylinder is 0.50D or less and the power is between PLANO and -0.25D which was the target.

Last Friday I ordered online a new pair of progressive eyeglasses just using essentially no correction (PLANO) for the right eye since trying to correct the tiny residual astigmatism is not worth it since it seems to still be reducing and the axis could move around when its that small a cylinder. With this pair of eyeglasses I should get the same distance vision I have now uncorrected in the right eye, but with intermediate and near vision correction thru the progressive lens.  I ordered a half-rim pair with the newer Trivex lens material that is more shatter proof than other materials.

Sounds like you got your desired outcome which is great.  How long till your glasses come in?  I have never ordered a pair online.  I suppose it’s easy enough by just plugging in your prescription?  I always used to like trying them on to see if I like the look of them first.

It takes typically about 2 weeks from the day I order the glasses until they are delivered, though last time it only took 1 week but that was just simple single vision glasses, this time its the progressive type (more complex).

Yeah you just can plug in your Rx for your eyes, thats nice because you can tweak them slightly if needed.  You need to know about what dimensions of frames will work for you too, since each frame usually only comes in one size, though I've found it can be within a couple mm and still fits OK. Where I order you have 30 days to do a return for any reason, so if you find you just don't like the look of the frame in person compared to the photos on the website, or a fitting or lens problem, its easy to do a return.  Thats what I did a couple months ago when I ordered the first pair with the optometrist's Rx which turned out to be wrong by the time they were delivered since my right eye apparently was still changing at that time. So I did a return back then for 100% credit which I'm using now to pay for most of the new order.  Alternatively you can return them for a 50% cash refund, but if you just want to switch to a different frame or Rx change, the 100% credit is fine, though you can't do that for a pair ordered using a previous credit.  The price thru this online vendor is so low though its worth the trouble I think since you can get several pairs for the same price as one pair locally...

My only remaining issue for my right eye is dim light/night vision is not as good as the excellent daytime (or good indoor lighting) vision.  The half circle artifact around some lights I see only outside in very dark conditions isn't happening as often so it hasn't been a bother, and I expect it will stop happening completely in the near future as my eye's max pupil size decreases a bit with more aging.  I do notice my right eye's visual accuity driving at night decreases from ~20/20 in the daytime to probably 20/30+ compared to my left eye that with glasses seems to stay the same day or night - my left eye corrects to about 20/15, so I notice a difference checking with each eye alone - but of course with both eyes open its fine, so not a bothersome issue.  I suspect  thats more because my right eye has early stage glaucoma that affects the optic nerve and reduces contrast sensitivity a bit, but its been controlled with eye pressure lowering eyedrops for 4 years and hasn't gotten worse in that time since it was diagnosed.  The eye surgeon had told me often after cataract surgery most people get about a 4 point drop in eye pressure in the eye with the IOL, but so far I haven't seen any or very little pressure drop.  At my full eye exam a couple weeks ago both eyes were measured with IOP at 15, which is simliar to what I've had the past couple years (14-16).

hello! can you give the vendors wen address? I would like to look into this esp since my first eye will be done in 2 weeks..second eye one week later..but im.so nearsighted I need something asap for intermediate and near. thanks