Posted , 4 users are following.
Hello
I am not sure if i had asked this question already. I was wondering if anyone knows if its possible to have lasik to achieve optimal near vision after cataract surgery. I know I have heard about needing "touch ups" after. However I was wondering if I opted for the Vivity lens so I wont have a risk of glare and halos and then have lasik after to provide near vision?
Thank You
0 likes, 9 replies
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Guest Songirl
Posted
That is not a plan. Don't go into this PLANNING on Lasik. It can shift your optimal focus point if they overshoot but it comes with it's own risks and it won't give you near vision.
rwbil Songirl
Posted
If you have residue refractive or astigmatism error, there are things you can do to correct for them. And many times the doctors miss the mark.
Some eyes like short eyes and long eyes can be more complicated to hit the refractive mark.
My advice is do everything possible to hit the mark or be at least darn close.
That means first finding a top Opthmalogist; not someone a friend recommended. I would then make sure they are using the latest IOL Master machine, next get a few measurement on different days and preferable on different machine and make sure the reading are consistent. I can tell you my Astigmatism reading were not consistent so I went back for additional measurements.
And if hit the mark is top priority I would further look for a doctor using the ORA system.
I would add don't be afraid to ask you doctor what his results with similar patients have been in hitting the refractive mark.
I have mentioned in the past I went to several Opthmalogist before I found the one I used. One of the earlier ones I went to told me they offered free Lasik to fix any errors and I was like that is your plan. That was not the plan I wanted to hear and the last time I went to that doctor.
RonAKA Songirl
Edited
Yes, you can have Lasik after cataract surgery. My cataract surgeon says it is safe and reliable, especially if the amount of correction required is low. I am in fact considering it for a small astigmatism correction depending on what is required at the 6 week post surgery mark. If I go ahead with it, it will be with a Lasik specialist, not my cataract surgeon.
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That said it is obviously far better to not need or do Lasik after cataract surgery. I am aware that some surgeons include this as a "package deal" with the cost included up front in the cost of the cataract surgery. I would be more inclined to go with a surgeon that is more confident in getting the planned results with the cataract surgery. But cataract surgery is not a precise tool in every case. Studies have shown in only about 70% of cases does the surgeon achieve within +/- 0.5 D of the target. I would suggest if Lasik is needed then it is best to go to a Lasik specialist for that work. Specialists that do it accumulate 10 of thousands of procedure practice, with some over 100,000.
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Last there is no direct way to get close vision with Lasik. They can do monovision by under correcting one eye to around -1.5 D or so, but that is about it. It would be far better to target monovision by making the correction with the selection of the power of the IOL.
Songirl RonAKA
Posted
I had asked my doctor about mini mono and he said I will most definately needs readers.
RonAKA Songirl
Posted
My experience with mini-monovision with my near eye set to -1.5 D or so is that I can see as close as 12" or so without reading glasses. My interest in Lasik is only to correct some residual astigmatism. Without the astigmatism my near vision would be perfect. Yes, I do have some +1.25 D off the shelf readers, but I almost never need to use them. And, now even with this astigmatism I see very well close up.
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It is worth simulating monovision with contacts before you do it with an IOL though. Then you can see for yourself what it is like.
Songirl RonAKA
Posted
yes, I had plan on doing that. I did try it years ago. I had one set for distance and one for near. i could not tolerate it but I want to try it again. Is 1.5 the maximum difference I should do? Also can I ask what IOL you have?
RonAKA Songirl
Posted
I looked back into your earlier posts and see that you are dealing with very high myopia in the -10 to -12 D range. That deserves some extra care and consideration. I will have a look to see if I have any bookmarks on the specific considerations of dealing with high myopia. It is possible that when you start with myopia that high, there is a higher risk of missing on the selection of the correct power IOL.
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I you want to try to simulate monovision, yes I would suggest -1.5 D is the ideal amount of myopia. For example if you were -11.0 D in both eyes, I would suggest trying for full correction in the dominant eye, and 1.5 D less correction in the dominant eye. Those who sell contacts should have a formula to convert eyeglass prescriptions to contact lens prescriptions. An adjustment will be needed with powers that high.
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In my first eye which was fully corrected for distance I have an Alcon AcrySof IQ Aspheric monofocal. It gives me a bit better than 20/20 vision. In my second eye which was done about 3.5 weeks ago, I got an Alcon Clareon Aspheric monofocal targeted to -1.25 to -1.50 D. With it I can read J1 in bright sunlight, and J3 indoors with indoor artificial light.
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Will post again if I find anything which may be helpful in dealing with cataract surgery on high myopic eyes.
RonAKA Songirl
Posted
You can find the summary of a study on power calculation methods for high myopia eyes if you google the details below. Their conclusion was that the Hill-RBF v2.0 was the most accurate method.
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A Comparison of Intraocular Lens Power Calculation Formulas in High Myopia João Bernardes, Miguel Raimundo, Conceição Lobo, Joaquim Neto Murta
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The other factor is the quality of the measuring instrument. Measuring axial length of the eye (which is long with a myopic eye) is a critical factor in determining the power calculation. I would suggest finding a surgeon who uses the IOLMaster 700 instrument, and combined with the Hill-RBF v2.0 forumula should give you as good a calculation as you can get. I do not have high myopic eyes and was in the -2 to -3 range, but my surgeon used the Hill formula. The sphere calculation was exactly on with both my eyes and with my wife's eyes also.
Songirl RonAKA
Posted
Thank you for taking the time to studying my background. My cataracts are not really bad but I keep toying with the idea of getting them done already because I am so done with wearing glasses but dont want to make a hasty decision.