DIY post cataract surgery custom glasses
Posted , 9 users are following.
After getting a not-too-satisfactory surgery and IOL implant (Vivity) on my left eye, I have blurry intermediate vision on my IOL and "cataracted" near vision on my other eye–not a great combination.
Here's how my vision was left:
If I don't wear my old glasses, I see OK with my IOL eye and really bad with my non operated upon eye.
If I do wear my old glasses, I see really poorly with my IOL eye and OK with my non operated upon eye.
I wanted the best of both worlds (or the least bad of both worlds) so I popped one of the lenses off my old glasses—so now I am somewhat functional until my next surgery ... which may be several weeks or months off because I am uncertain of what to do with my other eye since if I get stuck with intermediate vision in the first IOL eye.
Have any of you done something similar? How do you manage the time between cataract surgery without an appropriate prescription?
0 likes, 20 replies
Guest RandallG
Posted
You may have better luck using a contact lens in the unoperated eye. Using glasses will make the images from each eye different sizes, which can be disorienting.
RandallG Guest
Posted
Oh no! I did not know that that would ALSO be a problem. Ouch. I was OK wearing glasses to correct the disparity until I had identified how to proceed with the second lens.
RonAKA RandallG
Posted
I went about 1.5 years between surgeries. Initially I just did the same as you and took the lens out of the eye that had the new IOL. I had a basic monofocal and got 20/20 vision so there was no need for a lens for distance. That kind of worked until I broke the frame. I then ordered a new pair of progressives with an updated prescription for both eyes. At the same time I started to get more serious about doing a trial of monovision with a contact in my non operated eye. I found some that were comfortable and I liked (Costco Kirkland 1 day). I got to the point where I was going without glasses for 15+ hours a day with the one contact and no glasses. The contact solution was better than the eyeglass correction in one eye, and essentially nothing in the other. I think there is a difference in the image size presented to the eye depending on whether the correction is made at the eyeglass plane or right on the eye. Then after the second cataract surgery I had permanent monovision with my left eye at -1.4 D and my right at -0.25 D. 95% of the time I go without glasses. I occasionally use some +1.25 OTC readers. And I got the lenses exchanged in my new frame glasses. So now I have three options to choose from; No eyeglasses at all, +1.25 readers occasionally, and prescription progressives very occasionally. I don't bother to take the readers or progressives with me when I leave the house. I have only really used the progressives to drive at night out of the city (once in 6 months).
RandallG RonAKA
Posted
Hi Ron,
Thank you again for your replies to my posts. As you can probably tell, I am more than a little stressed and confused about what happened.
If I could end up with your outcome after my second IOL implant I would be delighted.
If my current IOL settles at intermediate vision, as I fear will happen, I am not sure what my best option would be for the second implant. Perhaps experimenting with contact lenses is the best way to find out ... and then hope that my second measurements and IOL selection and surgery go as planned.
freddi23948 RandallG
Posted
I also have not yet had the second surgery. I popped one lens out of my progressive glasses and it works reasonably well except for reading. So I have now had prescription reading glasses made and that is working reasonably well. If you have an older pair of glasses that you don't need to use, you can use that frame for the reading glasses. For me the reading glasses are worth the expense as I cannot read without them, though they are not great.
RandallG freddi23948
Posted
Thank you for the advice Freddi.
Agreed. But what do you mean when you say "they are not great"—in terms of giving you good vision or in terms of convenience?
Thank you for sharing your experience.
freddi23948 RandallG
Posted
They are not great because it seems that each eye sees the best (each with correct prescription for near vision) at a different vision from what I am reading. So one eye or the other usually is doing most of the reading because the vision is much less clear with the second eye. But if I move closer to or farther from the iipad screen, then the second eye sees very clearly and the other eye sees a lot less well. I think this is related to the difference in prescription between the 2 eyes. If so logic suggests that this will be less of a problem when the second eye has surgery. So I can read but not well.
jimluck RandallG
Edited
I have made a series of future appointments for scleral contact lenses (I can't wear any other kind), in part so that I will have them and be used to them by the time I go for surgery. That way, the non-IOL eye will have a contact lens. Since I don't plan to go for distance with the IOL, I will also order glasses ahead of time for the target refraction of the IOL eye and any residual myopia I have built into the contact lens prescription ( I'll probably have it under-corrected for intermediate).
My other goal in doing contacts is to experiment with under-correction amounts and minimonovision. But I am realizing such experiments are probably not very valid for me. I seem to have a lot of accommodation left. I recently had new lenses put into an old frame that have my full prescription except the myopia is intentionally undercorrected by 0.75d. I find I can do everything with these glasses. I can tell by the shape of the leaves on a distant tree whether it is an oak or a maple. I can use the computer. I can read my phone with a normal bent elbow position. In fact, I could read it at 12 inches. I can read a book in my lap with normal size print. How is this possible? I am 73 with cataracts! Realizing this, makes me want to put off surgery as long as I can. Accommodation is a wonderful thing.
The docs say, looking at my cataracts, I should be wanting surgery. I do see wonderful colorful halos around lights at night that didn't used to be there. But I have no trouble driving at night. My chief complaint has been lack of sharpness in the right eye for computer vision. Playing with my new set of trial lenses I found a lens that sharpens that eye -- it is a 2 diopter cylinder lens and I have to hold it at about a 50-degree axis over my glasses (my glasses have 8.25 cylinder at about 90 degrees). When I get the axis on that just right, the improvement in vision over what I see with glasses alone is dramatic. I looked up the equations for converting this bicylinder lens combination to a simple sphere plus cylinder and I'm not sure I can solve them right -- lots of trig in them. So, I made an appointment with my optometrist and will bring the lens, show her how I hold it, and ask her to duplicate that in a new prescription. She can just put the two lenses on her lensometer and not have to do the trig, I expect.
I've been hampered in my explorations with the trial lens set because the cylinder lenses max out at 6d and it gets awkward stacking 2 cylinder lenses over one eye to get to 8.25, along with the sphere I need, and then getting both cylinder lenses to the right starting orientation, and then keeping them aligned with each other while experimenting with changing the axis. I found a place online that offers 7d and 8d cylinder trial lenses, so I have those on order.
I feel the usual way they do refractions ("which is better, one or two?") is sub-optimal. If they would tell me what they are working on -- sphere power, cylinder power, or cylinder axis -- I would know what to pay attention to and be able to give better feedback . For axis, it would be better to put a knob or a lever in my hand and let me find the right axis. What I am learning from my trial frame and lenses is the axis is SO critical with 8 diopters of cylinder. A very few degrees makes a big difference. It does not portend well for the chances of complete success correcting that eye with a toric IOL. I expect there will be residual astigmatism, since most of the astigmatism is in the cornea.
RonAKA jimluck
Posted
"What I am learning from my trial frame and lenses is the axis is SO critical with 8 diopters of cylinder. A very few degrees makes a big difference."
.
Yes, angle would be critical with that much astigmatism. You may have considered it, but my understanding is that they can mark the eye with a laser before surgery to get the angle of the toric as exact as possible. The normal practice is to do it by hand with a marker, and for your situation that may not be accurate enough.
RandallG jimluck
Posted
Thank you for your thorough reply Jim.
Based on my experience, it is VERY wise to do the kind of experiments and research you are doing before surgery—and not assuming that "it's the thing to do and no big deal."
If I had been PROPERLY (not casually) warned about the possibility of an IOL miscalculation of this magnitude, I would have asked for multiple tests on different days and at least two calculations.
Best wishes to you for whatever you decide, JimLUCK!
LUCK definitely plays a role in this—as with so many things in life!
greg59 jimluck
Posted
Long ago, an optometrist was concerned that no matter how he refracted me on a machine that could change astigmatism corrections one degree at a time, I'd always stop him at the exact degree of astigmatism. Finally, he let me turn the knob by myself that changed the degrees - and it was easy to find the same correction. One degree to either side and the image looked substantially worse.
I didn't realize it at the time but he knew that most lens manufacturers wouldn't be able to make a lens with axis accurate to one degree and even if they could by the time they were put into frames and placed in front of my face, the result wouldn't be accurate to 1 degree. The optometrist encouraged me to get premium lenses (Zeiss, at the time) to have the best vision possible.
For cases like jimluck's (8D cylinder), the IOLs should be custom made. I don't know if anyone does this but you can't be off by 10 degrees and expect a decent outcome. I'd ask the surgeon if anyone makes custom IOLs. I think off-the-rack toric IOLs are available in 10 degree increments or so for common cylinders - and it probably works ok for moderate astigmatism.
jimluck greg59
Posted
I think the lens maker is only responsible for the sphere and cylinder. It's up to the surgeon to put it in at the right axis. There's lots of stuff written by ophthalmologists for ophthalmologists emphasizing how important axis is. The inference I draw is that they mark the eye and line up the lens with the mark. For example, from the American Academy of Ophthalmology EyeWiki "It is possible for a Toric IOL to rotate from its initial position as the eye heals following the surgery and the capsule contracts around the IOL. For every degree the lens is rotated off axis, there is a 3.3% reduction in toric IOL power[18]. The higher the cylinder power the more significant is this effect. If vision becomes unsatisfactory it may become necessary to return to the OR for lens repositioning[14]"
Aside: My perception is there is much more than a 3.3% reduction in visual acuity per degree!
When I was investigating European venues for my surgery, there were options for custom IOLs -- HumanOptics and Teleos .
My Canadian and US surgeons have recommended a Zeiss to me, which is available in Canada at the necessary cylinder power. That's off-the-shelf in 0.5 d increments up to 12 d for cylinder. Sphere is also 0.5d increments. I need about a 9d cyl at the IOL plane.
It would be a miracle if they got it perfect. For one thing, astigmatism changes, or can change, due to the surgical incision and healing.
RonAKA greg59
Posted
Unlike a lens in eyeglasses, or contacts, I don't believe there is any angle associated with a toric IOL. The cylinder correction is made in 4 symmetrical quadrants 90 degrees apart around the 360 degrees of the lens. The lens will be marked, but it is up to the surgeon to put it in your eye at the right angle. The tricky part is marking the eye accurately, and a laser can help with that. And the even more tricky part is having the lens stay at the correct angular position. That comes down to the surgeon's technique, and the design of the toric lens, as to whether or not it stays put.
greg59 jimluck
Posted
I rejected my surgeon's toric recommendation for one eye with -1.4D corneal astigmatism (-0.5D eyeglass correction) because of these concerns. I will hopefully need the IOLs to last another 25 years or so. There wasn't much research on long-term (10 years +) stability of corneal astigmatism but it seemed to me that it would change enough to render the toric worthless within a few years. My axis has changed at least 10-15 degrees in the past, even when the cylinder was stable and in the last couple of years even the cylinder has changed (perhaps due to lens changes rather than cornea but I have no way of knowing.)
I decided to use the limbal relaxing incisions, repurpose the eye for near duty, and try to use the projected residual astigmatism to extend my depth of focus on near tasks. It's only been 8 days since that surgery but it seems to be working out reasonably well. The optometrist co-managing my case (fairly common in the US) thought I might have a "touch" of astigmatism (I'm guessing that means -0.75D to -0.5D) that might go away as the eye heals. I could see 20/20 both at distance and near at the 1-week follow-up. Not a sharp 20/20 but decent at both ends of the spectrum.
I wonder if the "light-adjustable" IOL might be useful in your case and other hard-to-fit patients. You would get several chances to adjust the IOL with UV light before locking it in. Once locked in, you wouldn't be able to change it if the eye changes.
RonAKA greg59
Posted
If you have healthy corneas most of the sphere and cylinder changes are a result of changes in the lens. And, when a cataract starts to grow inside the lens the changes can be dramatic. Sometimes they make the vision worse, and other times it can make vision better. My refractive vision got better as my cataracts progressed. The normal practice if there is a desire to correct astigmatism is to consider a toric if predicted eyeglass cylinder is 0.75 or greater. The first toric is with a cylinder of 1.0 D which is about 0.75 D at the eyeglass plane. But, if there is no desire to be eyeglass free there is less value in having a toric, as astigmatism can be accurately corrected with glasses.
greg59 RonAKA
Posted
You are correct about the lack of axis in the torics. I'd asked my surgeon about how the toric would stay in place if I got one and he talked about haptics. I'd always thought the haptics were place somewhat horizontally within the bag and the axis was built into the lens but I suppose that haptics could support the lens in any direction and then would be no need to have a fixed axis in the lens. Still, most research indicates that torics commonly end up 5-10 degrees away from their targets (at least a 16.5% loss of visual acuity according to Jim.) Then, you can stick a needle in and rotate the toric back to where it should have been but I'm not sure how well that works.
I wonder if the light-adjustable IOLs (RxSight) might be a better option for high cylinder correction. Not sure how much astigmatism these lenses can treat but if you waited until the lens became stable in the bag, it seems like you could at least get the cylinder power correct. Evidently, the surgeon is still responsible for aligning the axis correctly.
jimluck greg59
Edited
No, on the LAL. It's only good for up to some low ceiling on cylinder -- I want to say 3d or 4d. I need 9.
With the right eye now, I can't even see my phone well enough to read it, at any distance. In bed, I close that eye and read it at 4 to 6 inches quite comfortably with my left. But if I try to do that with my right it's a smeary mess. The left has 2.25 cylinder (-5 sphere), but phone vision is perfect at 4 to 6 inches. If they get the right to give useful glasses-free vision at some distance -- any distance -- it will be quite an improvement and I'll be grateful for it.
I should say, glasses correct the right to 20/40 and I'm very grateful for that. It's amazing, actually. Used to be better than that.