Good, not Great -- 5 Months After Cataract Surgery
Posted , 8 users are following.
My wife, age 60, had cataract surgery in both eyes five months ago. Both of her lenses were quite cloudy. She also had substantial astigmatism in both eyes.
Five months later, her vision is clear and bright, but she still requires corrective lenses for BOTH distance vision and for reading. Without glasses her vision is sharp only between about 3 and 10 feet. Her doctor said the goal was for good distance vision without glasses, but that has not happened. Thus, she must still wear eyeglasses most of the time, except at her computer.
Overall, her vision is much improved. She previously required heavy, thick eyeglass lenses. Now her glasses are light and comfortable. This is a welcome change.
However, she expected not to need glasses for distance vision. At this stage -- five months removed from her cataract surgery -- is her distance vision likely to further improve? Or is this as good as it's going to get?
Thanks,
Jeff
1 like, 20 replies
peter1110 jeff5158
Posted
Sadly, doubt she'll see much if any improvement after 5 mos.
michael74313 jeff5158
Posted
It might be possible to do a laser tweek to get improvement near and mid range so as to see clearly without glasses further out than 10 ft.
Sue.An2 jeff5158
Posted
Hi Jeff with 5 months past I wouldn't be confident that much would change.
I assume from your comment that the target was for good distance that your wife had monofocal lenses implanted (these provide good vision for one distance and expectation is one wears glasses for other 2 distances unless a mini monovision is done where 2nd eye is targeted for .50 to .75 diopter nearer than the first surgery that was targeted for distance.
Ir sounds like the distance target was missed a bit and complicating that is the astigmatism which depending on the amount can really blur one's vision at all distances. She likely would want glasses even to correct the astigmatism.
She could have laser to tweak a bit - but that would come at an expense. Most people opting for monofocals don't usually undergo that given they knew and are comfortable wearing glasses at times.
Is she ok with the results or bothered and wants to see what else can be done? she could seek out another opinion. At 5 months there is possibility of a lens exchange (if no YaG was performed to treat PCO).
All the best to your wife.
michael74313 Sue.An2
Posted
Sue you made a good point that I had overlooked. She has an astigmatism and if she DID NOT get a Toric lens to correct the astigmatism then she would need glasses at almost all distances. He didn't say what kind of iol lens she has.
It's possible that a laser might be able to correct this. She should check with her doctor. If she did get a toric lens, then it would have had to have shifted quite a bit but she could still ask her doctor about a laser tweek.
Sue.An2 michael74313
Posted
Wishing her luck. If her lens isn't a toric one hoping she recalls if it was at least offered to her. Would have provided better vision.
Sometimes a wallet size card is provided after the surgery - it should list the lens type used.
Hope it all turns out for her.
jeff5158
Posted
Thanks everyone for your comments.
The lenses my wife received are mono-focal. I do not know if she received toric lenses.
What I can say with certainty is that she has excellent vision -- without glasses -- between 3 and 10 feet. She can use her computer without glasses, which is a big benefit.
She is not regretting having cataract surgery; the cloudiness of her natural lenses had become extreme. It's simply that she expected -- based on the doctor's comments -- that she would need only reading glasses after the procedure. She has worn glasses most of her life and was really looking forward to glasses-free distance vision.
We're now wondering if a different doctor might have yielded a better outcome.
Sue.An2 jeff5158
Posted
Hi Jeff - if your wife has very good vision at 3 to 10 feet that is normal for monofocal lenses and what doctors explain at consult and ask if you want to see better for near, intermediate or distance (I misunderstood your original post thinking her vision wasn't particularly good at any distance but better at 3 to 10 feet). Some with monofocal lenses get more range but doctors don't promise you will only need glasses to read - unless mini monovision is discussed and planned.
It is doubtful with monofocal lenses the outcome could be better unless she got toric lenses for the astigmatism or different targets for RE and LE.
Premium lenses were have given her more range if focus but they ate expensive and one has to accept that night vision isn't as good as a monofocal.
jeff5158 Sue.An2
Posted
Thanks for your comments. Perhaps we should have asked more questions of the doctor in order to better manage our expectations.
Overall, she views her outcome as a success but with a tinge of disappointment. With glasses her vision is very good. She no longer needs thick, heavy lenses. And of course her vision is not clouded by cataracts.
michael74313 Sue.An2
Posted
The mono focal is usually set to a specific range such as for distance, mid range or near. Hers might have been set to near rather than distance. It's only normal if she requested "NEAR" for both mono focals. I can't imagine many people wanting that. If anything at all, one might request near for one mono focal and mid range for the second (so as to have mini mono vision).
I had my mono focal toric lens set to distance and the second one set to distance but 1/2 diopter in so as to have "mini mono vision" and I see great at all distances. In general, one will see worse at all ranges with an astigmatism unless they get a toric lens.
With that said, she should check with her doctor to see what she has and whether a laser tweek might help. Otherwise, there's always glasses and / or contacts.
Lens exchanges can be risky and more is involved. I've also read about lens piggybacks which might be less risky than a lens exchange. Either way, the laser tweek might be able to fix the astigmatism and is more accurate than an iol so it can fine tune things. I think every time they go in and mess with the lens or change it out, etc., there's always more risks involved including infection, retinal detachment, etc. She should discuss with her doctor.
Sue.An2 jeff5158
Posted
As Michael said sometimes messing about with vision isn't best course of action. If she is generally pleased if it were me I would leave it alone.
Side note - wish doctors would take more time at consult to explain options, lens types and dig into what distances would be best for their patients based on their hobbies etc. A simple questionnaire while sitting in the waiting area would be helpful to determine this.
unless you do a little searching on your own you pretty much are dependent on doctor to provide advice.
michael74313 Sue.An2
Posted
Agree - If I were in her situation and I did want to do something, I would look into a laser tweek because I think it's more conservative/safer than a lens exchange but I don't think they can tweek it as far (ie: from near all the way to distance). However, if she doesn't have a toric lens, then the laser might be able to resolve the astigmatism which should sharpen vision at all ranges.
Night-Hawk jeff5158
Posted
I'd suggest you post the eyeglasses Rx that now provides good distance vision and we can see how close they got. Cataract surgery isn't exact due to the IOLs come in 0.5D steps and there is always the unpredictability of how the incision heals. If you get within 0.5D of the target that is considered very good, thats where my eye after surgery ended up plus about 1D of residual astigmatism so I get about 20/25 or so distance vision with that eye, but glasses can correct it to 20/15,
Sue.An2 Night-Hawk
Posted
Good points Night Hawk. Haven't seen you post in awhile. Trust all is well with you (my original account was deactivated - although posts still all here. Had to create a new account under Sue.An2).
Mike - depending on current prescription (and assuming both your wife's eyes same prescription) tweaking one to see distance may be too much depth perception/balance wouldn't be good. IE Moat people can handle .50 to .75 diopter difference but greater than that could be problematic. It is one of the reasons I chose Symfony lenses. I didn't think due to migraines I could even tolerate .50 diff. If my cataracts were do bad I would have experimented with contact lenses.
michael74313 Sue.An2
Posted
Sue - I agree that most can't tolerate mono vision and it affects depth perception which can increase probability of slip/falls. I was thinking both eyes would be within .75 diopters and the laser would be done on both so as to target vision further out than 10 ft.
jeff5158 Night-Hawk
Posted
I'll try to get my wife's distance Rx and post it here. Maybe her distance vision is within the margin of error for cataract surgery.
BobDob Sue.An2
Posted
When I was researching mini-monovision for my eyes, I found opinions that suggested up to a 1.50 difference was easily tolerated, although I wonder if that would leave a gap between distance and near. For myself, I was okay with targeting a 1.25 difference.
My vision currently is at -1.00 with .25 astigmatism in the left eye and near plano in the right eye (3 weeks out of surgery), although I currently have ,75 astigmatism possibly due to (unnoticeable by me) corneal swelling in that eye. My surgeon recommended not getting a prescription for glasses for a month, giving time for the swelling to subside.
The mini-monovision I have provides seamless vision from intermediate to distance, as well as a degree of near vision. I have no problems with depth perception at all and haven't had any headaches from the monovision.
Sue.An2 BobDob
Posted
Lots of people have good success with mini monovision strategy. Glad it is working well for you. Wish I could have experimented with contacts. I seem to get nauseas driving backwards in a car so didn't want to chance that I'd be dizzy with mini monovision. I have mentioned to friends to experiment with contacts before they get cataracts.
Waiting a bit before getting prescription glasses (unless you can get them cheaply) is best. Sounds though you are fine except for reading tony print. Astigmatism changes. My RE had a bit at 6 week check up and at last checkup there is zero astigmatism. LE has a little more astigmatism than 6 week check up. I assume though that measurement can change depending on time of day of one's eye exam. Evening is worse than morning and also dependent on light conditions.
Glad all turned out well for you.
michael74313 BobDob
Posted
I think 1.5 might be pushing it a bit especially when you figure there can be an error factor of .5 which might leave some with 2D difference. Me personally, I wouldn't want to go more than .75. Mine are 0.5D difference and it has worked out great for me.
BobDob michael74313
Posted
Good point about the error factor. My eye surgeon advised me that the results could be .25 off, but it was more than that for my left eye. I originally planned to target near vision at -2.50, but he convinced me to target -2.00 instead. After the surgery, he told me he targeted -1.80 (I wasn't happy about that) but I ended up at -1.50. Two months later, my optometrist measured the eye at -1.00 with .25 astigmatism. At that point, I decided I would be better off going for distance and targeted -.25 in my right eye. So far I seem to have reached close to plano in that eye.