Distance vision is poor post cataract surgery (5 days)

Hi Jon

I seem to be having same symptoms as yourself. 42 yr old, had my left eye done oct 1st. on day 2 i found that distance was pretty good but hard to stare outside for long as bright skies were dazzling. Had a check-up on day 3 and read from the board pretty well but for the last week everything from arms length to about 10 feet is good, so sitting around a table i can see everything fine but beyond that it gets out of focus. I'm using my old glasses for reading and working but their not perfect. I will be contacting my surgeon if i don't see improvement by Friday as i wanted to at least give it 2 weeks. I have seen people here mention the drops could be causing it which perhaps it is, i am on maxitrol 4 times a day the 1st week and 3 times a day 2nd week which im on now. I am due to have my right eye done oct 29th, but was hoping that the left eye would be better for distance by now. This might be not much help but i seem to be having the similar post op affects. I did try a pair of my wifes glasses and the left eye definitely had more focus with them not perfect but better. My current glasses only make distance worse.

regards

colin

Hi Colin,

I am on the same drops as you and also 4 times a day, I at first thought it was the drops but I think around 2 days ago I took my drop in the evening and then did not take one the following day until around 11am to see if my vision improved without taking a drop for a while but there was no improvements for me at least.

It could be the drops for you and I hope it is! I can see better than 20/20 with the correct prescription for distance I found out today bit without any aid I just cannot see.

Were you given an eyeglass prescription number as to what it would take to correct your short sighted vision? The reason I ask is that if it is a reasonable amount, then it would not rule out getting distance vision in the non dominant eye. I have crossed monovision where my dominant eye is my close eye at about -1.4 D. My other eye gives me 20/20 at -0.25 D. While crossed monovision may not be the ideal way, it still works fine for me.

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If you do go for distance in the other eye, it would be prudent to explore why the surgeon missed on the first eye, and how they will make sure it will not happen with the second eye. In other words, what did they learn from the first eye that could be used to get a better outcome in the second eye. Keep in mind that a small amount of myopia or short sightedness is good. The normal target is -0.25 D.

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The good news here is that it is much better to be left short sighted than far sighted. Being short sighted allows you to see better closer up. Being far sighted means both your distance vision and close vision is negatively impacted. That is the reason for targeting slight myopia.

If I were you I would defer the second eye surgery until you get a full eye refraction exam at 6 weeks. That will more accurately tell you where the first eye ended up. The results will be helpful in making a decision as to what to do with the second eye, and also should help the surgeon refine the power selection to avoid another "surprise" with the second eye.

funnily just in the last 30mins the appointment team for my surgeon rang to see if i wanted a cancellation appointment for this saturday. I told them i would prefer not to until my left eye has stabilised and in explaining the issue they will contact me again tomorrow to discuss as surgeon is in theatre for the evening. So i might be popping into them in the coming days for a review of my current distance issue. Will keep the forum updated.

Hey Ron, to answer your question:

-From the optician I saw today I didn't get the numbers for now but I know that I can see well with my old glasses for distance I was using which are 0.75 in left, I am pretty certain my right eye is close to 0 if there was no cataract, certainly no more than -0.5

My optician said today if I get my right eye done for distance it will really mess with me as my left eye is dominant and will just see a blurry image at distance with which I actually agree with him because I have found my left eye does most of the work for me and even before I had issues with cataracts.

Right now with my right eye being cloudy I am very aware of the difference in vision between my eyes and I feel as though for me personally monovision will really annoy me which leaves me to think, If I was to keep the left eye the way it is, I will need to aim similar for my right eye.

I am starting to think my best action to take here is to get the left one replaced again and find out how he got it wrong, I am just not sure if there are any serious additional risks doing this and when he can do it. I feel as though I would have been happier with a standard monofocal lens as what I have now is extremely frustrating.

If you are saying that you need a -0.75 D correction in your left eye that now has the IOL, that is not too bad. If it stays that way and you get distance in the right eye that would be called micro-monovison. It is typically the least amount of monovison, and reading could be marginal. However, if you wait until the eye is stable, then you will know how much monovision reading it could provide.

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I don't agree with the comment that monovision would mess everything up based on my personal experience, and the studies I have read. My right eye is non dominant just like you. I had it done first for distance and it came out very close with a spherical equivalent of -0.25 D. I see 20/20 with it without glasses. My left eye was done after about 1.5 years, and ended up with a spherical equivalent of -1.40 D. I can read quite well with it down to 12" and it has not interfered with the distance vision in my right eye.

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Have a look at the study below. It found essentially no difference in satisfaction when conventional monovision was compared to crossed monovision. They were using groups that averaged about -1.2 D, which is a little less than what I have.

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Crossed versus conventional pseudophakic monovision: Patient satisfaction, visual function, and spectacle independence Fuxiang Zhang 1, Alan Sugar 2, Lisa Arbisser 2, Gordon Jacobsen 2, Jessica Artico 2

Thanks, I will take a look at it. I also need to see why my surgeon says about this too. I will post an update on Tuesday after I have my appointment with him.

An explant has all the risks of cataract surgery plus all the additional explant risks. I did a forum search a while back saw some success stories and also stories of new problems after the explant. One person had multiple instances of retinal swelling after. Another had light streaks do to capsule wrinkles after the explant. Another ended up with their pupil no longer being circular in shape after the explant. If the vision problems leave no choice but to explant then you have no choice but to except the risks. If there's a good and workable option to solve the vision problems then personally, I'd avoid going for an explant.

I'm right eye dominant and never had the best vision from my left eye. It was almost like lazy eye. It was undiagnosed when I was young. I knew I couldn't see well out of that eye when I was growing up but I never had eye exams. I only found out it was a real problem when I tried to get my first drivers license and they said I needed correction for that eye. After that I used one contact lens for a few years until eventually needing correction for both eyes.

As my cataracts progressed my best vision started coming from my left eye because the cataract in my right eye was worse. I had no trouble adapting as it just happened automatically. After cataract surgery in both eyes, my left eye has great distance vision. It's actually bit better than my right eye. When I occasionally do temporary monovision with a contact lens or glasses now I make my dominant right eye be the near vision eye.

If you are at +0.25 D for refraction that is not much of an error. You should be seeing distance very well. Based on my experience with two Lasik consults if you are at +0.25 they will not be able to reduce that to 0.0 D. It really wouldn't be worth it in any case with that minor of an error.

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The refraction is not going to be accurate enough to get glasses until you get to 6 weeks post surgery. I also would not consider giving the go ahead for the second eye until you get the refraction result from your exam at 6 weeks. At that point you should have all the information you need to make a decision. I would expect you will ask for distance, and if it turns out the surgeon missed on the first eye, you should also ask what will be done to improve the accuracy on the second eye. You can't have that discussion until you have the results of your full eye test at 6 weeks.

The condition you describe of not being able to see clearly past arms length, does not match up with a refraction of +0.25 D (very slight far sighted). It sounds more like you are significantly near sighted. Even slight myopia of -0.25 should give you excellent distance vision.

Sorry Ron I have messed it up again, its -0.25 (I think), I keep forgetting the -!!!

and with that I cannot see distance, I mean I can kind of see but its just blurry and only becomes sharp once wearing my old glasses which are not the perfect prescription, they are -0.75. I almost thinking the -0.25 is incorrect but that is what I saw on the paper. I might need to double check this, its possible this is what my right eye is.

And yes, he has told me we will have a proper discussion at my next appointment which is on the 14th November, I will update then also. Also to mention he told me to only take the drops twice a day now rather than 4 times as that can mess with the vision a bit and my eye has healed nicely.

If you have a cataract in your right eye and you cover the eye that has the IOL, it makes sense that you would see glare when you cover your left eye. You are being forced to look through the cataract in your right eye.

oh sure that makes sense of course, maybe I didnt make much sense of what I mean.

I am feeling my left eye is very dominant at the moment, when looking at light with both eyes open, I see hardly any glare even though my right eye on its own is see's a lot of glare.

So my concern at the moment is if I get right eye for distance, my left eye will still just be superior and not make use of the extra distance if that makes sense.

The brain automatically selects the best image it can get. That is basically how monovision works. When one eye is giving good vision it uses it. When the other eye is giving good vision it uses that one. And when both eyes are giving good vision it uses both.