Help with choice for second cataract surgery

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I think i have made a terrible mistake with my cataract surgery. I am 56 years old and have been mildly myopic with a rapidly progressing cataract in my right eye, and another in the left which is bad but not quite  as severe.I have a history of central serous retinopathy in the right and for that reason was told I was not a good candidate for a multifocal lens. I had a monofocal distance lens placed   in my right eye 4 days ago and noticed an immediate improvement in clarity; however I cannot see ANYTHING up close with the new lens. Fortunately, for now, my left eye allows me to see up close, although it is a bit uncomfortable. I truly cannot see up close with my right eye at all.

I have been reading these forums and now wish I had gone with a more intermediate type lens, as I cannot imagine needing reading glasses for everything up close, and an inability to focus AT ALL very close. How do you drive and read the dashboard? I am now scheduled to have the other eye done in two weeks, and am going to wait ( I think) Will the near vision in my right eye improve? I realize that it has only been 4 days, and my pupil, for whatever reason, is still slightly dilated.

What are my options? Can I use contacts?I do not like the idea of having one eye set for distance and the other for near vision. It is sort of what I have now and it is uncomfortable. Having said that, my far vision in the left eye is not horrible.In retrospect, I would rather have to wear glasses for distance and driving , than to not be able to see up close at all.

Hopefully the eye will adjust, and I will at least be able to see ( if not read clearly) up close?

Thanks in advance

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14 Replies

  • Posted

    First of all, I am happy for you that while you are surprised by not being able to see well at near distances, you seemed to have had an uncomplicated surgery and achieved good distance vision.

    Actually, your desire to be able to be read at the car dashboard etc can be achieved easily by getting your left eye set for the best focus at about 32 - 40 inches (that is, to end up with a prescription of about -1.0D or -1.25D in that eye). You will essentially be using mono-vision or blended vision, which most people adapt easily to. You will be then be able to see well down to about 20 -25 inches, depending on where you end up. You will still need to use reading glasses, but that should be much easier to deal with.

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    • Posted

      Thanks for the reply. I think I have that power in my left eye now. I think my L eye is to about -1.5 uncorrected, but since I have a cataraact in that one as well ( although not nearly as bad as the right), it seems somewhat cloudy.I am not crazy about the difference in my vision, as it feels a little off but if the right eye's near vision will not improve any more than this, I would gladly take the trade off, especially if I will acclimate to this. I know I would be very upset not to be able to see anything up close ( to about 3 feet) If i close my left eye now,everything is blurry to 5 feet or so.

      even 4 days out, I am amazed at the clarity in my new lens, but it is really disconcerting not to be able to see anything up close. I guess my old lens was able to accommodate, and this one is not?

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    • Posted

      Hi Joe:

      Has your doctor given you an opinion about the possibility of your near vision in your right eye improving in a few weeks?

      Many patients report that their vision does improve during the weeks after surgery.  Everyone is different, but sometimes it can weeks for the eye to heal and adjust.

      Depending upon what your doctor suggests and how your right eye progresses, you might want to wait a bit and consider all of the possible options for your left eye.

      Good luck to you!

      Ed

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    • Posted

      Thanks for the reply. I am only 4 days out of surgery. My post op appointment was 24 hours out and my distance vision was 20/30. They did not comment on the near vision, but at that time my pupil was still super dilated ( it is normal today)

      I am scheduled for the second eye  in 11 days but am probably going to wait to see what happens with my near vision. 

      I am also going to call them tomorrow to discuss my options. When I was younger and wore contacts. I definitely needed reading glasses but could at least see some close up. Post surgery my right eye is truly awful to 5 feet or so. 

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  • Posted

    Your first order of business should be to find out what your vision is in your right eye. Hopefully, it has not been over-corrected to far-sightedness. When will be your next post-op checkout?
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    • Posted

      I’m going to call the office tomorrow. I don’t think they were planning another exam prior to the next surgery.
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  • Posted

    I agree with Robert.  If your vision was "over corrected" and you are far sighted then the doctor should be able to "bring it in a little" with a laser correction.  I had the exact same problem you did where I was not use to everything being "flipped around."  However, my mid range vision was fine as well as distance and yes everything was super clear.  I would go out at night and the moon was a super bright white color. When I covered my right eye, the moon was a hazy yellowish color in my left eye (with a cataract).  After a few weeks, I decided to have the left eye done and my doctor recommended to bring it in about 1/2 diopter from distance  (biased to near).  Maybe I lucked out a bit but now I see well at all ranges.  I did have to "retrain my brain" to hold the phone and books and other things about 12-18 inches away to read them clearly.  I find the "mini mono vision" worked out very well for me because I see better at all ranges when both eyes are working together rather than full mono vision.  But, I would definitely first check to see if your eye is over corrected.

     

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    • Posted

      It is great that you are very happy with your vision.

      However, I am curious about what your prescription for the second eye actually is. Even though your surgeon may have aimed for -0.5D, you may actually have -1.25 D or -1.50 D.

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    • Posted

      I don't recall exactly what it was at my last exam but I know I see (just barely) 20/20 in my left eye even though he aimed for -0.5.  I usually see slightly better at all ranges in my left eye than my right.  I would think if my left eye is seeing 20/20 then my correction would be almost 0 or -0.5D at the most.

       

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  • Posted

    Since you mentioned contacts, I figured I'd bring this up. Have you used contact lenses in the past? If so this will be relatively easy for you to try. Obviously, the first thing would be to make sure that the surgery got very close to the target. If so (and once you are healed), then give multifocal contacts a try. I wrote about this in another post. In my case, the cataract was very severe in my right eye but not yet causing any issues in my left. I wanted to see if I could "simulate" the nighttime halo effects of a multifocal IOL and, although I realized it wasn't perfect, I tried multifocal contacts to see if it would give me any idea of what the halos would look like.

    My test failed completely in that regard but what I did discover is that multifocal contacts worked quite well for me (at least for distance + intermediate I didn't try a high ADD). The first two trials didn't work at all - they wrecked my distance vision - but the third one work beautifully (20/13 at distance and the equivalent of 20/20 in the 18" to 36" range). For a totally non-scientific rating, I'd rate the distance clarity at 95% of what I get with a distance-only contact.They work so well, in fact, that I'm probably going to delay the second eye and stay with the multi-focal contact in my left eye, paired with a multifocal IOL in the right eye.

    One set up I had considered for surgery was a monofocal IOL set for distance with a multi-focal contact worn over it (with 0D for distance + the ADD for intermediate). You'd have to wait until the surgery fully healed, of course, but this might work for you. Let's say you get 90% of the distance quality and the good intermediate vision with the contact. You wear this most of the time, but if you need perfect distance for a long drive or maybe at night lying in bed watching TV, you take out the contacts and just use the IOL.  

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    • Posted

      Thanks for all of the replies.  I am curious as to whether a multifocal ( or two) contact(s) is an option. The problem  I have is that while the left eye’s cataract is not nearly as severe as the right, it still is noticeable enough as to cause poorer vision. 

      I know that people say that the brain adjusts to monovision, but it is annoying thus far and really hard to see well ( with both eyes) either near or far. Having said that, I can at least read now with my left eye.  

      I will update this thread after I speak to my ophthalmologist’s office tomorrow, but at the very least I think I am going to postpone the surgery in the other eye

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    • Posted

      Lots of people are frustrated with multifocal lenses. Those don't often provide clear vision and definitely have more night vision issues than multifocal lenses.

      If you were going to have the second eye set for reading at 16 inches, that will be monovision., to which some people had difficulty adjusting to (although it took me less than 5 minutes to adjust to, when I first tried it with contact lenses about 30 years back.). If you aim for the second eye set for 32 to 40 inches, that is mini-monovision or blended vision, which most people get easily used to (actually, easier than adjusting to multi-focal lenses)

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  • Posted

    Joe62700

    Give yourself a little more time, everyone adjust different and we all heal different.  Stay in touch with your Dr.  It has been a long processing time for me, but I am slowly improving. (not to discourage you but I am going on 8 months come valentine day) Before my cataract surgery I had always used my right eye for close and my left for distance with bi-focal's  for over 30 years.  I wanted my right eye to stay as close, but was told since my right eye was my dominant eye I would have to have it for distance.  I have a great doctor and he has worked with me and also I see a cornea specialist since my dr no longer couldn't figure it all out.  I am improving.  It has been a struggle and can be frustrating.  Just talk and be open with your eye dr.  If need you can always get another opinion.  Good luck and let me know how it goes.  Prayers for you.  Don't give up!  

    Charlene

     

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  • Posted

    After my first (right) eye was done, I tried some test contacts in my left eye at around -1.5 and -2.0 to test mono vision so that I could see better up close  (fully corrected at that time before surgery was about -3.5).  The problem I found was even with those test contacts at -1.5 and -2.0 which would give me mono vision, I still had a hard time reading my phone (I could do it but it was not easy).  I thought if I did this then as time went on I might have trouble with both up close and distance at some point in the future.  So, my doctor and I decided to set my left eye for distance but just slightly biased to near about -0.5.  I figured I would just have to use reading glasses in the future but I thought it would be better than mono vision. Also, I didn't want to compromise my depth perception. To my surprise, I saw better at ALL ranges (near, mid range and distance) with my left eye post surgery with an IOL set to -0.5 than with a test contact lense at -1.5 and -2.0.  The only explanation I have is that the (toric) contact lens is not a good indicator of how the IOL will be because the cataract makes it harder to see at any range.  Also, maybe something about the IOL just gives better vision.

     

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