Cataract surgery for glaucoma - have Vivity in non dominant eye, confused about IOL for dominant eye
Posted , 6 users are following.
I have narrow angles and high pressure in both eyes. I had my first cataract surgery in May this year in my right eye which had the higher pressure. Pressure in right eye went from 39 to 16 post surgery so definitely successful on that front.
My surgeon chose the Vivity toric lens. I am 52 years old and have always had excellent vision. My new lens is set for distance but my distance vision is not as clear and sharp as my natural lens in my left eye.
It turns out my left eye is my dominant eye. I have been postponing my second cataract surgery out of fear of losing my beautiful distance vision. I am not seeing colour the same way with the Vivity lens. It's paler and kinda drab.
My surgeon has offered to do an explant if I'm still unhappy with the Vivity but after speaking with the Alcon consultant he said I probably wouldn't be any happier with a different lens. Basically I am coming to terms with the fact that the surgery is not for vision correction, it is to create more space in my eye chamber and reduce the pressure in my eyes. The right eye looked like I had had an angle closure episode when he extracted the lens. So he is recommending I get my left eye done soon. I realise there is no perfect IOL. It's just hard to accept I'll be saying goodbye to my natural good vision.
I feel like I should have maybe gotten a monofocal lens in my right eye set and the Vivity in my left eye? My surgeon wants to put another vivity in my left eye set slightly short sighted. I'm so scared because that means the distance vision I have in my right eye now will be as good as it ever gets. Not sure if I can live with that. Although the knowledge I can never have a closed angle glaucoma episode would be a big relief. Also the need for glasses will be minimal.
My surgeon does not think I will be happy with a monofocal in my left eye.
My night vision is ok. I do see lights brighter with the vivity eye but the flickering has settled down a lot as has the black disc in my peripheral vision.
Any suggestions would be much appreciated. Anyone else had cataract surgery for glaucoma prevention? Anyone successfully mixed a vivity lens with monofocal lens? Can dominant eye switch after cataract surgery? Thank you.
0 likes, 17 replies
trilemma silke111
Posted
I don't think the dominant eye ever switches, but I could be wrong.
What prescription does your right eye have, if you get refracted for glasses? That should be an easy test. The same test you would get if getting some new eyeglasses.
What distance does the your right eye see/focus best at?
silke111 trilemma
Posted
My right eye is still testing in the 20/20 range. It's just not as sharp as my left eye. Like the very smallest line is quite blurry but can kind of make it out. With left eye that last line is clear.
silke111 trilemma
Posted
The right eye focuses best at intermediate distance. I can read my computer screen too. Just light reader needed for close up.
trilemma silke111
Posted
Sounds like that secondary cataract would explain things, don't you think?
I wonder what the prescription is, and by prescription, I am wondering what numbers they would prescribe if you were to get a new set of distance glasses.
silke111 trilemma
Posted
I never needed distance glasses and would like to avoid them. I also do not have cataracts. I'm not sure what secondary cataract means. I'm going to go speak to my surgeon again.
silke111 trilemma
Posted
I just read about secondary cataract. I guess it's possible but sense it is the lens itself. I'll ask my surgeon anyway.
RonAKA silke111
Edited
Have you had a refraction test done to see where you ended up with the Vivity lens?
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I don't have glaucoma but I'm sure that is not a good situation to be in. I think with your options and priority for improved distance vision I would choose a Clareon monofocal in your left eye with a distance target of -0.25 D. Since both eyes are technically set for distance I don't think the dominant eye makes any difference. And, since your first eye with the Vivity did not work out that well, there is no reason to get another one.
silke111 RonAKA
Edited
Thank you. I will look that one up. Yes I'm extremely hesitant to get another vivity. I ended up still in the 20/20 range but the quality of the picture is just not as good. If I was 20 years older I'd probably be over the moon with it but because I still have the comparison eye it's just not making me happy.
Also I don't mind using glasses for close up as it's what I am used to.
RonAKA silke111
Edited
The Clareon is a standard monofocal from Alcon that has been updated slightly from their AcrySof IQ lens.
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The increased depth of focus for the Vivity comes at a cost of somewhat reduced visual acuity at distance. If you look at the defocus curves in the pdf document below and in particular at figure 5 you can see how the Vivity compares to a standard monofocal. 0.0 D on the horizontal axis is infinity distance. You can convert the other D values to distance by dividing 1 meter by the D value. -1D is 1 meter. -2 D is 1/2 meter and so on. The vertical LogMAR axis is visual acuity. You can google a chart to convert to snellen 20/20 type scale, but 0.0 is about 20/20 with above that better. I recall 0.2 is about 20/32. In any case at distance the standard monofocal can be expected to deliver 20/20+, but he Vivity a bit less than 20/20. So you are getting what is expected out of the lens. As you can see as you go to closer distances the Vivity outperforms the standard which is why you are able to get some reading out of it.
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Vivity P930014 Package Insert PDF
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The other issue to look at is contrast sensitivity. This has most impact in lower light conditions like night driving, but it may be the reason you are seeing less colour saturation at distance in the Vivity eye. See figure 4 in this document. It show how much contrast sensitivity (MTF) is reduced at distance compared to the standard monofocal lens. As some compensation MTF is higher at closer distances though.
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The bottom line is that in my opinion there are definite benefits to going with a standard monofocal like the Clareon instead of another Vivity. It will give you better visual acuity and contrast sensitivity at distance. And you will retain the benefits the Vivity is giving you at closer distances. My view is that only one Vivity should be used and the other eye should be a monofocal. That gives you the best of both lenses.
silke111 RonAKA
Edited
Thank you for the information. I am new to this site and don't see where the PDF is attached?
My surgeon is quite conservative and I don't think he has ever mixed lenses. I might be a first if he agrees to it. He told me he is more hesitant in prescribing vivity after my experience.
If he refuses I'll seek a second opinion.
RonAKA silke111
Edited
This site has some quirks. One is that they basically do not allow hot links. You have to copy and google the posted phrase to find the document:
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Vivity P930014 Package Insert PDF
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For sure if your surgeon will not do it, find one that will. It could be about money. Where I am, you have to pay $2,200 extra to get a Vivity. Should not be hard to find one that would put a monofocal in.
Emis_Moderator RonAKA
Edited
Hi Ron,
To clarify, and as per the T&Cs, we DO allow links if they are to a reputable, non-commercial website so feel free to post them. We tend not to allow links to specific practice sites if commercial but links to journals etc are fine. They will go for moderation but I try to approve as soon as I can depending on out of hours etc. If they are not suitable I will add a comment to the post saying as such.
Link for above:
https://www.accessdata.fda.gov/cdrh_docs/pdf/P930014S126C.pdf
Regards,
EMIS Moderator
RonAKA Emis_Moderator
Posted
I understand. The issue is that IOL manufacture and most cataract surgeons and clinics are commercial operations, and that is the main subject of this forum. Not being able to post images without moderation is also a significant limitation. The annoying part is that once you post something that goes into moderation, you essentially lose the post unless you think to copy it into memory first. Otherwise you have to retype it all over again if you want to remove whatever put it into moderation, or wait a day until the post appears (hopefully).
Emis_Moderator RonAKA
Edited
Hi Ron,
We have no choice but to check every link and image due to abuse of the forums in the past. There are some whitelisted sites that do not go to moderation like PUBMED, NEJM articles amongst others. I can add to this list as long as the sites are reputable, eg I've just added eyeworld .org so you can now post links to that site without moderation. Let me know if there are others that I may be able to add to the list (send me a PM).
In the meantime, all I can suggest if you don't want to wait for moderation is either:
Post the main content of your reply but leave the image/link out and put these in a separate follow on post. In the initial post you can add terms for users to google to find articles as you have been doing.
If it is an "urgent" reply you can use the Private Message service to contact individual users without limit on links but images can't be sent via PM, again due to abuse of the site.
I will try and be lenient with clinic sites in this group, as long as it doesn't turn in to users promoting specific clinics etc which has also been an issue around the forums previously.
Hope this helps.
Lynda111 Emis_Moderator
Posted
It was good to hear from the moderator. Thanks for your advice about posting.
silke111 RonAKA
Posted
I'm going to see my surgeon today. Fingers crossed. Thanks again for your help.