Diary Post Surgery Mono-focal lens

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Hi All, 

As a few of you know I had started a diary with a title indicating it was being kept for the days  "prior to surgery".  But now that I'm post surgery, and thinking the other title might be misleading at this point, I'm creating a new one for anyone interested.  To recap,  my procedure involved only my left cataract affected eye with my unaffected right eye being still good for near reading (about 10-18 inches distance).  The surgeon recommended the left eye be set for distance with the strategy in mind of a mono-vision result.   So here it is T+1.  I've been taking my drops as instructed.  After surgery yesterday, my surgeon told me all went well.  I did notice for several hours after the procedure the vision in my operated eye remained a bit blurred.  I chalk that up to it still being dilated.   This morning I awoke to more clarity in my operated eye and it seems to have continued to improve throughout the day so far.  I have to say it's a strange experience to see out of my left eye now.  I do notice the colours are more vivid, the whites whiter, the blues not as purplish, than in my right un-operated eye.  Distance vision seems quite good.   Intermediate not as good, and of course reading not good (as expected).  Honestly, I was hoping for better intermediate vision.  I don't know if my intermediate vision will improve in the operated eye over the next few days (can it? I don't know) , or if some mono-vision magic will happen as it works along with my right eye... but my expectations aren't too high right now.   I was a bit nervous from the beginning that there might be a range in the intermediate where both eyes wouldn't cover. It seems this may have been realized. 

With all that said, I can probably go most of my day without needing glasses under today's conditions.   I think for computer work or long reading sessions I'd need some correction of some sort.   So depending on whether things settle in differently in the next couple of days or weeks and how motivated I am to want to change things up from here, I may explore what can be done with my right eye to get better intermediate without sacrificing too much of the near.   I would prefer to have reasonably good vision from, say 18 inches and beyond.

My surgeon called a few moments ago, too, just as I began this post to see how I was doing.  He seemed to suggest that my eyes will get "less cloudy" over the next few days, but I did tell him that things seemed quite clear as of right now.   I am to schedule a follow up appointment in the next week or two.   I intend to discuss strategies to obtain the intermediate distance I'm seeking.  It may be that I need a contact lens in my right eye...I don't know.    All in all, whilst not THE perfect situation at the moment, things are much better than prior to surgery.  

G

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  • Posted

    Glad you have clear distance vision.  That is the expected outcome for monofocals which give great clarity at one focal point.  I know some say you can get all round vision with a monofocal but I really think that isn’t what one can expect.

    Yes with just one day behind you you can experience small changes in vision.  That IOL remember is just 1mm thick whereas the natural lens is 4mm thick.  The IOL will move back and forth till it settles and adheres.  That can cause changes all the way till complete healing at 6 weeks which is why one is advised only to set up an appointment with their optometrist at 6 weeks to get an exact prescription.  In the interim you can get cheap readers from pharmacy/local stores that carry them. 

    This is just my opinion.  But you may want to consider a Symfony Lens for the other eye targeted for intermediate.  This will give you the intermediate and close reading distance desired.  Also with Symfony the concentric circles (halos) are seen when you are 50 yards from light source at night.  If Symfony is targeted for intermediate there is a good chance you won’t see (or very least see less) of these halos.   Your monofocal will also counterbalance the symfony’s night vision too.   Really think you should consider and discuss this option with your surgeon for his thoughts.

    Glad things are clearing up.   The other reason for the changes you may encounter in next few weeks is the drops you are taking.  For some people these blur vision.  I was ok with clarity throughout the drop regiment but I know for others clarity only came after drops were finished.

    Cataract surgery is a process (journey).  Don’t get discouraged.  Focus on the positive results.  It sure is nice colours were noticeably more vivid for you.  I remember how surprised (and thrilled I was).

    You are in very early days - and already you can see distance more clearly - that is fantastic.   Once a few weeks have gone by your surgeon will have options for you to have better vision for intermediate and reading.

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    • Posted

      Hi Sue.An, 

      Yes, I've been thinking a lot about the exact strategy you mention.  In fact, I was quite tempted to go with the Symfony in my left eye initially and my surgeon was okay with that.  BUT, he said I would need to go with the Symfony in my right eye as well if the "mono-vision" with the Symfony in the left didn't work out.  He seemed to want Symfony lenses in both eyes for the best chance of optimal results.  Yet, I've read of rather good results with a mono-focal in one eye and the Symfony in the other for that "blended" affect.  Indeed, seems to me that theoretically a diversified approach should work well.   I'll definitely mention this to him at my follow up on, as it turns out, the 29th of this month.  On this forum there was a gentleman who had the Symfony set for distance and the mono-focal for mid to near I think and while he was happy overall, he did complain of the halos on the Symfony side due to being set at distance.  As you say, the halos might be minimized or eliminated by setting the Symfony more towards mid to near.   Thanks again for your post! 

      Kind Regards, 

      G

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    • Posted

      I found that some eye surgeons don't like to mix different types of IOLs, but on this forum quite a few patients have had good results mixing a Symfony with a monofocal, or a Symfony with a mutifocal, etc.

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    • Posted

      You’re welcome.  Yes some surgeons don’t want to mix and match and yet those that have that setup here on the forums are quite happy with it.  Also I have met people who had to have cataract surgery many years ago on one eye and due to new lenses opt to have a different lens in 2nd eye anyways.

      My own surgeon too recommended to Symfony lenses.  And I am pleased with the result.  Gives me great all round vision and I am able to carry on just how I used to at work before cataracts got in the way.   

      Hope something can work out for you that way.  Likely if you suggest that to your surgeon he’d think it a good way to proceed to give you better intermediate and near vision.

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    • Posted

      The person you are likely thinking of is a201 - he had a monofocal in one eye and Symfony set for distance.  He does believe targeting Symfony for intermediate would give better reading distance and less night halos.  He is good with these calculations so could likely best tell you what ideal target should be if you opt to go that route but pretty sure he will want you to know where your first eye has settled.

      PS how has day 2 been?

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    • Posted

      Hi Sue.An... Yes, I think it was a201.   Hopefully I'll have a more or less settled measurement on my operated eye when I see my surgeon on the 29th.    Now, to answer your question, "How has day 2 been?"...Well, today (Tues) is what I'm calling "T+1", T (or T Zero)  being the day of the surgery (yesterday).  I'm not sure I was clear on that.    It's evening now in the UK whilst I'm writing this (still T+1)...and it was earlier today that I posted this new thread (ie.. "post surgery"wink.   Tomorrow, I'll post on what I guess would be 'day 2' (or T+2).   As of this evening, not much has changed for me.  My intermediate vision is still not very good in my 'mono vision' strategy which is unfortunate but not entirely unsurprising.   In addressing this possibility with my surgeon a few days ago, plus what he said was his inability to determine precisely which was my dominant eye (because of the cataract in my left eye), he wrote the following:

      "This is why we are setting your left eye for far because long term if it is your dominant eye then it will only tolerate distance vision correction and if your right eye does not tolerate remaining myopic then this can be easily corrected with laser and lens".    

      Now, I took that to mean that essentially he could tweak my right eye with either a laser or implant a lens for a slightly further distance (still in a mono-vision or mini-mono-vision context)  than my existing and quite near (10 to 18 inches) reading focus to achieve a more tolerated mono-vision if my initial mono-vision result was unsatisfactory.   While my current situation isn't "perfect", I can say that I'm reasonably functionally independent of glasses provided I don't need to sit at a monitor for extended periods.   It's a kind of "casual independence" at the moment.   I would prefer however a more "arm's length" clarity beginning at 18 inches and outward from there.   I'm in an "almost there" state if you know what  I mean.   Funny (or not funny) how I can get so particular about this... I suppose maybe I SHOULD be very well happy with the fact that all this wonderful technology (of the lens) along with the great skill of a surgeon have given me such clear vision from around 3 or 4 feet out to infinity.  And I am grateful for that... But at the same time, I'm finding myself looking for just that little...bit.....more I need for things to be so much better.   Apologies for rambling a bit! 

      Kind Regards, 

      G

       

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    • Posted

      Interesting what your surgeon mentioned about dominant eye and due to cataract can’t determine which it is.

      When my surgeon asked which eye I wanted done first (both needed surgery) I wanted right eye done as it was worse than left eye.  But then I asked if I should have the dominant eye done first.  I thought my left eye was dominant.  He said that wouldn’t matter.  As it turns out my right eye is my dominant eye but left eye learned to be dominant as my right eye’s vision was affected more by the cataract.

      I forget you are 5 or 6 hours ahead of us.  So must be after midnight there.

      I assume from 3 feet out then your vision is clear?  this is very god news.  Many don’t get clear vision till they finish the drops,  the iol will still settle and you could get slightly more nearsighted or farsighted by .50 diopter.  You won’t know for few weeks.  Once the 2nd eye is fine uou’ll Have that more blended vision.  Even though I went with Symfony lenses I had to wait 6 weeks for 2nd surgery.  Things were a lot more blended, clearer and reading ability improved a lot.

      So take it one day at s time.   Are you able to take time from work?   I took a week but wished I had more time.   2 would have been optimal.

      How’s your daughter taking it all in?   They are usually much more resilient than us adults at times.

      Take care.

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    • Posted

      Hi Sue.An,  Thanks again for your reply.  Yes, dominant eye thing had me a bit confused.   I honestly think I'm right eye dominant (as I read most people are).  I seem to sight a camera with my right eye.. but if I were to sight a rifle or do archery, it would be my left..but then again I'm more or less left handed (throw and write)...although I do golf and play hockey right handed.   I've also heard a person can be "cross dominant".    I hope that when things do settle, that my left eye settles nearsighted by 1/2 a diopter... I would think that might assist my situation..not positive though.   

      And yes, I seem to have reasonably clear sight in my operated eye.  I guess I thought that was normal to have at this point, but sounds like maybe not so much.  

      In terms of my work situation.. Well...I've been out of work for longer than I care to admit.  This vision issue I think has been hampering my confidence for some time and I didn't feel I could get back into work (as I've mentioned I do mainly Excel spreadsheet related work).  I'm MBA degreed along with a finance undergrad degree.   Again, this issue snuck up on me over time and I had no idea what was going on.. it was rather subliminal.   I already feel some confidence coming back though and I am starting to see myself going back out there and being capable, indeed driven, again.

      My little girl is taking things in stride.  I had been joking with her that "Daddy's going to get a new eye"..and she's be saying.."Noooooo!" as if she just couldn't believe it.   Then, I'd try my best to explain what was going on.. She doesn't quite understand the concept of such a procedure.. She's just 5 yrs old. 

      I'd better get off to bed now.. it's 1 am here. G'nite. 

      Kind Regards, 

      G

       

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  • Posted

    That sounds similar to what I get with my right eye with a distance vision monofocal toric IOL, gets good distance vision beyond about 4 feet, but I need at least +0.75D glasses for intermediate vision for computer monitor viewing at 2-3 feet.

    So when my other eye eventually needs cataract surgery probably in a few more years, I would seriously consider a Symfony toric IOL to get good distance and intermediate and maybe a little near vision too. For now I use an old pair of progressive eyeglasses with the right lens popped out, to get a good range of vision.

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  • Posted

    Hi G,

    We have similar situations. I went with monofocals in both eyes. LE was impacted and was done first and one week later the RE. Based on some comments here I was tempted to do both eyes for distance hoping to get decent intermediate vision for computer work and readers for extended reading. The cold math said otherwise. Finally, at my surgeon's advice, I decided to do a mini monovision with the RE settling at -1.25D (nearsighted).

    Now, two months post-op, I get by most of the day without glasses. Distance vision is excellent. Intermediate vision is not so good meaning at 32" from the computer screen I can read but blurred enough to make it a challenge if I need to work for extended time; the eyes are overburdened and tire quickly. Reading is similar.

    I can "make do" but if I wanted to read a long document or book I would prefer to have some correction. On my last post-op eye exam (5 weeks after the surgery) at the eye clinic, the optometrist gave me a prescription for "computer glasses" with only two zones - top half for intermediate vision (primarily for computer work) and lower half for near vision (primarily for reading). It is what it is. Not expecting any miracles where intermediate and near vision will improve past this point in time. Night time vision is generally good; some low level artifacts with car beams from approaching traffic and signals but quite manageable and not dangerous. I suspect multifocals would present more of a challenge in this respect and that is why I chose monofocals.

    I hope this helps you.

    S

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    • Posted

      Hi Polyphemos,  Yes, helpful indeed.   And yes, it seems like we are in very similar situations.  Although I've not spoken to my surgeon in detail as to next steps, I'm wondering if both you and I could benefit from laser surgery to help "blend" the vision of both eyes to the point where we would get some useful intermediate vision.  I'm a bit surprised that with your mini-monovision that you're not getting useable intermediate vision.  Seems some people on this forum have had rather good luck with that strategy.   Then again I suppose there are multiple variables that produce the final outcome that I'm not taking into account.    It's just unfortunate that the good vision we would desire is so close, yet so far sometimes. 

      G

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    • Posted

      Hi Polyphemus - you mention the second eye targeted for mini monovision at -1.25:  did you know if the first operated eye was at plano (confirmed by your optometrist)? There can be a difference between the target and where the eye winds up by as much as .50 diopters either way leaving you more farsighted in the first eye.   Guess what I am asking is there possibility there is more than a 1.25 between your 2 eyes which would account for things being blurry in the morning ntermediate vision.

      Glad you were able to resolve that and get clarity with computer glasses - although that likely was t your plan.

      Could you benefit from a bit of laser tweaking?

      Best of luck to you.

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    • Posted

      Hi Sue-An - the surgeon targeted for -1.50D for my RE (minimal 1.1D astigmatism) using a regular (non-toric) monofocal. The final outcome shows that it ended up at -1.25D with 0.50 astgmatism.  The LE was targeted for plano (with toric lens) and he hit the target - no myopia and no astigmatism. I am aware of LASIC option to reverse or blend for better effect but not plannng to do that. Wearing correction for long spells in front of the computer or reading does not bother me.  Wore glasses all my life previously.  As I said, at all other times I am functional without correction.
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    • Posted

      Yeah I would think twice about lasik too.  Someone I know - it ruined her eyesight and because they do both eyes at once she doesn’t have the other eye to see well with.  All because she wanted to lose distance glasses.   I know these cases are rare but being conservative by nature I just always stuck with glasses.  I guess I had the thought with cataracts I have to have this surgery anyways I went out of my little conservative nature with Symfony lenses.   But for whatever reason they are fine for me.

      But yeah if I were in your shoes I would stick with the glasses solution too.

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