How long to get used to new IOL?

It's a dillemma because if my surgeon target -0.6 for my second eye and hot target, then my two eyes will have about -1.2 difference. So does it help to use a contact lens of -0.5 lower in power to get use to about -1.25 difference in eyes now before second surgery?

I think that is a great idea, because you will get to trial the mini monovision you are requesting before committing to it with the surgery.

However, if the vision imbalance is making you feel very bad, you may want to try balancing the eyes even more than that with contacts to alleviate your symptoms. I think if you have a few different contacts you can try in your unoperated eye to see what you feel good with and what gives you the most functional vision that would be great.

The nauseated feeling is quite normal and I think you might experience it even if both eyes were corrected to the exact same power, whether it's -0.5 or -1.75. The reason is because the operated eye is likely seeing everything as larger through the IOL than the unoperated eye through the contact lens. It's difficult for your brain to combine images of different sizes. You may get used to it with time, and if not, the second surgery should help balance and bring you relief.

That is correct. When one eye is done and not the other and you are trying to correct one eye with glasses while the other is being corrected with the IOL there can be image size differences. This is minimized by using a contact for correction instead of an eyeglass lens, but the contact will still sit further away from the natural lens, while an IOL is in the same position as the natural lens. This may be magnified to some degree by the higher power contact being used.

what if after second surgery, i have a difference of -1.25 between eyes? will i still feel nauseated?

I guess i am asking if the -1.25 between IOL and Contact lens or between two IOL matters?

Ron,

do you mean if i used a contact lens fully corrected to distance, the IOL eye will see bigger than if i would have to use a lower power contact lens?

Yes, it does matter. Because your high myopia requires you to wear a high negative powered contact lens in one eye and have a low powered IOL in the other, you are likely experiencing a vision imbalance called aniseikonia. In your unoperated eye, light passes through your contact lens, then your cornea and then your cataractous crystalline lens before hitting your retina. In the operated eye, the light passes through the cornea then the lower powered IOL before it hits the retina. Objects viewed by this eye should appear larger than in the other eye. Assuming you have a visually significant cataract in your unoperated eye, your vision may appear darker, blurrier and you may also see ghost images in that eye. All of this is making your brain work very hard to integrate the two different eye images into one seamless view of the world.

On top of all that, you have the operated eye corrected for intermediate to near vision and the unoperated eye corrected for distance vision as you trial mini-monovision. I do not know if you will have an adjustment period during which you will feel nauseated if you reach your target of -0.5D in one eye and -1.75D in the other eye, but I think that you would be able to adjust to your new vision with some time. And if you cannot, or don't like mini-monovision, then you could get a pair of glasses or wear contact lenses to get whatever amount of correction you desire.

I was told by two surgeons that a difference of less than a diopter between the eyes is not a big deal and is not even considered mini-monovision. I do not know how difficult it is to adjust to a 1.25D difference between the eyes, but I would be very surprised if you could hit any target so precisely, and think that whatever you do hit you most likely will be able to adapt to, so long as it's not severe hyperopia.

Personally, if I were to get -1.75D in one eye and -0.5D in the other I would be very happy. This would allow me to see a range of distances without glasses and to wear glasses for more perfect vision for any activities that require it. I have been so severely nearsighted for so many years that the only distance I could see clearly without glasses was very close to my eyes-- the activities that others might use a magnifying glass for. Now with cataracts I can no longer see clearly at any distance.

I personally think it is very lucky that you landed 1.15D more nearsighted than your refractive target. If you had missed in the other direction you would have +0.55D of hyperopia.

I'm sorry you are experiencing the miserable physiological effects of vision imbalance and hope that it will get easier for you with some time.

thank you Ka! i am also happy that i didnt become hyperopic. Doctor told me the fluctuation or deviation is usually plus/minus 0.5, so i thought -0.6 would be a safe target which surgeon suggested. Now after first surgery, that large deviation scared me because like you said, it could become +0.55D! So i am at a lost as to the target of my second eye!

my eyes after two weeks are still imbalanced. The imbalance is worst in bright light room like a flourecent lighted room or store like Costco. Under sunlight, even though imbalance , better than fluorecent loghted room! Why is that?

RonAKA has pointed out that once the first eye is done, how that eye behaved can improve the use of the numbers on the second eye.

Well technically your doctor was right, if you think 60% is "usually." I read that approximately 60% of high myopia patients land within 0.5D of target and approx 80% land within 1.0D of target. Which means that 20%, or 1 in 5 patients miss their target by more than 1D. In my opinion, 20% is a lot of patients. I think you are very lucky because -1.75D seems to me like a good place to land, especially if you don't need reading glasses for your phone. In sunlight your pupils get smaller so that would make the vision imbalance better than in Costco where your pupils will be larger. Larger pupils should amplify the vision imbalance.

Sam, when the image is corrected by an IOL vs a contact there is a small difference in the size of the image. I am not sure which one is larger or smaller.

Would my surgeon understand the imbalance i am experiencing? i will see him tomorrow and hope he can give me some suggestions to balance eyes!

Consider pasting the relent posts on this thread to a document, and print that out to take to your visit.

I think it may be better to prepare a short list of questions for the surgeon. Many surgeons will get offended if they figure out their competence is being questioned based on internet advice. The important thing to address with the surgeon is the reason for the miss and what will be done to not repeat it in the second eye.

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And I think the efforts to "balance the eyes" may be better addressed by an optometrist than an ophthalmologist. Surgeons typically don't want to be involved in eyeglass or contact lens corrections. The surgeon I went to will not even give out a copy of the refraction tests they do.

I am so glad you will have the opportunity to see your surgeon tomorrow to discuss your symptoms and get advice.

Vision imbalance is not the fault of the surgeon. Usually when this issue arises the medical advice is to proceed with the second surgery to balance the eyes. I think the refractive difference between the eyes is too big right now to be fully corrected with specialized spectacles or contact lenses. I have also seen suggestions online such as getting plenty of rest and/or using an eye patch over the unoperated eye to help with symptoms.

Nevertheless I think it was wise of you to space your surgeries apart so that you and your surgeon could learn from the results of your first surgery and apply those lessons to the second surgery in order to get the best possible outcome. If you had complications such as poor vision or dysphotopsias that were specific to the chosen IOL or surgical technique then it would be very good to use that experience to avoid those problems with the second eye.

But it sounds to me like your surgery was successful-- good vision in the operated eye with no major surgical complications. Remember this surgery is primarily done to restore vision by removal of cataracts, with refractive benefits being secondary to that.

Even so, the surgeon may have some good ideas for how to get closer to your refractive target when doing surgery on the second eye but in my experience surgeons will not make promises about meeting a specific target, they will only tell you what chance you have of getting within a certain distance of the target.

Good luck tomorrow!

When you see your surgeon tomorrow and assuming they do a refraction, be sure to ask what the sphere and cylinder is so you can get an update on where your operated eye is now. At 2 weeks it will not be fully healed, but it should be much closer to the final refraction than what was indicated right after surgery.

I am hoping the surgeon will give suggestions as to why my vision is imbalanced! and also hoping i will get another appointment in March to discuss the target for the second eye.

one thing i find is that even though the cataract in my second eye is not as severe as the first, but after the first surgery, the effect of the cataract in the second eye seems greater or magnified. I feel the glare or blinding effect from sun or bright light is a lot greater between one done and one undone eye as compared to two undone eyes. Is that possible?

Since that is your experience, then yes, it is possible that your perception of the cataract in the unoperated eye is greater now that you have one operated eye with no cataract. But if you are asking if the cataract is actually worse now, I have never heard that cataract surgery on one side could make the cataract on the other side actually worse. So I think you are just more aware of the cataract which is interfering with the good vision in your operated eye.

The other thing to realize is that since you were operated on your worse eye first, the unoperated eye was probably your dominant eye before the surgery. So your brain had learned to favor that eye over the other when selecting which information from each eye to use to see the world. Now your brain has to learn to favor the operated eye, since it is now your better eye. This process takes time-- your brain has to create new neural pathways, and in the interim it is not surprising that you are getting glare and blinding effect from the formerly dominant cataract eye being superimposed into the good image from your operated eye.

Imagine how difficult this learning process must be for your brain. You must be feeling very tired!

We are a lot better in detecting differences than we are in detecting the quality of a single image. I never realized my good eye that only had a minor cataract was giving me such a yellow cast on my colour balance until I had a new IOL eye to compare it to.