Little pea has had her cataract operation

Hi, mine was the IOL monofocal for distance thats all i know im afraid. Had this done on NHS, but had Midland eye do my op who are the best in the country. If your concerned phone the clinic or hospital that done your op if only for reassurance purposes. The thing to remember is i had both eyes done 12 weeks apart as this is how long it can take to properly heal. Mne healed very quickly but we dont all heal at the same rate.

Its possible any initial blur may be due to the eye recovering from surgery still if its at all distances.

The odds are that blurry distance vision in this case, and for the poster who started this page, is due to either the lens power being off and leaving you somewhat nearsighted (which explains better near vision in the original poster's comments), or residual astigmatism which can blur vision at any distance with any IOL (though studies show the Symfony is more tolerant of that than multifocals or monofocals).

Even if the surgeon intends to target distance, unfortunately there is no guarnatee they will suceeed. The power of an IOL isn't determined by an exact formula, it is an estimate based on statistics of eye measurements of prior patients (they usually try a few different formulas based on different statistical studies to see how they compare). With most people who had fairly decent uncorrected vision before surgery the results are usually accurate.. but not always, and there is more of a risk of the lens power being off for those who had high prescriptions before they had their surgery (e.g. high myopes especially). 

The lens can move sligthly forward or backward during healing the first couple of months, changing how myopic you are for better or worse, though usualy the impact is minor. After vision is stabilized, any nearsightedness  can be corrected with glasses or contacts,  though those who get a premium IOL usually choose to have a laser correction to permanently fix the issue, LASIK or PRK or a variant of those. 

Unfortunately in the case of those with a toric lens (of any brand/model), the lens needs to be oriented in the right direction to accurately correct astigmatism, since if it isn't it can change how much astigmatism you have, and how nearsighted you are. They can rotate the lens after surgery, sometimes in the office and sometime its a very minor procedure (much more minor than the initial cataract surgery) but still done in an operating room.  Unfortunately I'd seen a meta-study that suggests perhaps 29% of people with a toric lens wind up with > 0.5D of astigmatism and that is enough most people wish it to be corrected. 

Any residual astigmatism left after trying to orient the lens correctly can also be addressed via laser correction if someone doesn't wish to wear glasses or contacts for it. 

 

I have not posted any comments until today...I just keep hoping this issue will resolve and I will wake up and be able to see at a distance.  My close vision appears to be ok.  I don't need glasses to use my computer or read on my ipad.  If I had a choice I would rather have good distance vision because tennis is a big part of my life.  What is a resonable amount of time to expect this to resolve?  Also is it common to be using eyedrops (antibiotic 1 week and 2 antiinflammatory meds for weeks after surgery)?

Even though your eyesight will take a few more weeks to stabilize completely, it probably won't change very much.

That does not mean that you can't have your eye corrected to get good distance vision to be able to play tennis (even if that results in poorer near vision). The first thing to do is to have your vision checked , know what your spherical as well as cylinderical correction (for astigmatism) is, and what the best corrected distance vision is.

If your best corrected distance vision with glassses is close to what you would like to have, you should consider having LASIK enhancement done to get rid of the astigmatism and bring the best focus distance to where you would like to have it. I have had LASIK enhancement done in both of my eyes and have been very happy with the results. Most of the reputable LASIK surgeons offer a follow-up correction free of charge, if the first one does not quite achieve the desired results.

If on the other hand, if you can't get good distance vision even with the glasses. then your surgeon needs to figure out the reason for that and take corrective steps before having LASIK enhancement.

I was given  eye drops to use for about a month after surgery. It may be that some prefer to check your eyes at postops to see if you need them longer rather than playing it safe upfront and prescribing them for a  longer time.  

As the other reply also mentioned, as I said it *might* change a bit, but likely not too much. They usually test your refration, your prescription, at postop visits so if you have one coming soon you can ask for it, or you can probably contact the staff at the doctor's office to get it from your file.

If your close vision is ok, that suggests you might be lucky and not have residual astigmatism, but not necessarily since the Symfony is fairly tolerant of that, but it still reduces visual quality compared to what youl could have. If you do have residual astigmatism, it depends on whether its the lens being rotated in which case sometimes they rotate it back righ away, other times  they may wait a bit before rotating it back  (a few weeks I think, but it may depend on the doctor it sounds like from what I'd read. 

Usually for those who need glasses/contacts the general rule is that they usually give people prescriptions at one month when most people's vision is fairly stable, though if it hasn't been they'll wait for 2 months. Usually with laser correction they wait  at least 2 or 3 months to be sure vision is stable before making a change on your eye like that.

 

Hi Rick,

I'm scheduled for my right eye to be done in July, also on the NHS. Did you have to go back on the waiting list after the first eye was done? I'm curious since you said you had to wait 12 weeks following the first op.

My consultant has also asked me to think about monovision for the 2nd eye, what choice did you make?

Cheers,

Jim

Hi, I noticed you mentioned in your reply that an astigmatism of 0.5D is noticable. I got a successfull retina detachment operation done in February which resulted in a cataract which is to be removed this July. I've also just found out that the Feb op has left me with -0.75D astigmatism in my eye with my consultant didn't mention but my optician noticed during a contact lens assessment recently.

Does this mean I will need a toric iol for this eye or can they correct it some other way, I've read that toric iols arn't as good as mono.

Cheers

Getting a toric lens just for -0.75D astigmatism will not be a good idea for many reasons. I think that the minimum correction is usually about -1.0D.  Part of your astigmatism may be due to the natural lens in your eye, which you won't have after the cataract surgery. Additional corneal astigmatism may be introduced or existing corneal astigmatism modified due to the cataract surgery itself. Also, if you get a toric lens, its rotation from its desired position may result in a different source of astigmatism. Because of all these factors, your astigmatism may not be any less by usin a toric lens than it would be using a standard lens.

If you do have a noticable astigmatism after your surgery, you can get it corrected by, for example, LASIK. That can also simultaneouly provide any spherical correction, which you may need.

(Just for information. I do have a toric lens, but needed LASIK enhancement to correct for the remaining astigmatism and spherical correctin.)

Usually small amounts of astigmatism like that are corrected via an incision, often called an LRI (limbal relaxing incision), though it may be located elsewhere on the eye. It causes the eye to reshape as it heals to try to reduce the astigmatism. Its not precise since not every eye heals the same, they rely on statistics about what incision has had what impact on prior patients. However usually it reduces it enough since small amounts of astigmatism aren't a big deal.

 

re: "you mentioned in your reply that an astigmatism of 0.5D is noticable. "

Actually the post said > 0.5D astigmatism remaining after surgery is what people usually wish to have further corrected via laser, LASIK or PRIK or some variation of those.  <= 0.5D doesn't have much impact on vision, and may even extend the depth of focus a bit. 

 Since this site moderates links, google for this quote to find a blog entry discussing work on the minimum amount of astigmatism to correct in surgery:

 

"Together with Eloy Villegas and Encarna Alcón, we recently performed a study to actually address this question. It will be published soon in the Journal of Cataract and Refractive Surgery, but I advance here some of the results relevant to Alberto’s question."

It suggests that a small amount isn't useful to try to correct. 

It isn't clear how much astigmatism you have in that eye since as the other poster indicated, the eye can have astigmatism in the lens as well as the cornea. Before surgery they will do a scan of your cornea, usually in a preop visit a day or few before surgery where they will determine the IOL power you need and order it.  

When the natural lens goes away, so does the  part of the astigmatism in the natural lens. The astigmatism in the natural lens might be in the same direction as the corneal astigmatism, in which case your corneal astigmatism is less than that astigmatism they found when fitting you for contacts, or if its opposite it cancels out some of the corneal astigmatism and the actual corneal astigamtism may be more than the -0.75D. Usually lenticular astigmatism is small, if there is any at all, so the odds are you will need about 0.75D corrected.

Toric lenses are comparable to spherical lenses. The main reason they might be viewed as "not as good" is that there may be extra steps involved to get it to work. Usually the lens is placed in the right position, but there is some chance it might be rotated, or rotate after surgery and they'll need to rotate it back again. Also as I posted earlier there is around a 29% chance with a toric lens that it won't eliminate enough of the astigmatism and  if so the odds are you'll want a laser touchup to fix the rest if you don't wish to need to wear correction.

 

Hi Jim, yeah after first op it was about 12 weeks from the time you go back for your checkup from the first op which is usually a month. I had monofocal in both eyes and I am very pleased with the results. Painless procedure and very quick. I chose Midland Eye as it's not such a waiting list and they are the best in the country. Good luck with your op.

Thanks for the reply. That is good to know and will probably mean I'll get a monofocal implant which should reduce any problems after surgery.

Cheers,

Jim

Thanks for the detailed reply, that was an interesting article. I think I was worried about this because my previous spectacle prescription prior to the retinal operation was -0.25D in my right eye and I assumed if they went to the bother of correcting this with my glasses then -0.75D would be worse.

I now realise that my glasses probably don't have any astigmatism correction at all, so why bother noting it in my prescription?

As you and at201 have pointed out I'll probably just get a monofocal lens for this eye, which is good news as there's less chance of things to go wrong.

I'm assuming the opthamologist will assess my eyesight after the eye has healed and any remaining astigmatism (hopefully <0.5) will be corrected with new glasses or lasik (although I'm not keen on laser correction TBH)

How are you getting on with your Symfony lenses?

Hi Rick, Midland is a bit far for me as I live in Glasgow. The surgeon said about 6 weeks to me but when I got the letter it was for the 11th July, can't be helped and I'm assuming the 2nd eye will be the same. I've seen some articles in the news claiming 15 months waiting for some parts of the country so 12 weeks isn't too bad.

I'm going through stages of being excited to be able to see at distances without glasses to apprehension, I also made the mistake of watching a cataract surgery video on YouTube lol.

In my case btw just before the cataract hit (it changed my astigmatism) one eye was showing -0.75D astigmatism in the prescription, but mostly  lenticular since the corneal scan only showed perhaps -0.25D then, -0.17D on a more accurate scan before surgery. The other eye was also rather different showing mostly lenticular astigmatism and not from a cataract, -1.5D astigmatism prescription, but only  -0.25D corneal scan, though oddly a couple of years later it was -0.63D on the more accurate pre-op scan.

re: "How are you getting on with your Symfony lenses?"

My results with the Symfony seem to be fairly typical, matching the studies.  I'm at least 20/15 at distance (that line is easy, and they didn't have a line below to check), 20/20 plus a bit at 80cm, and 20/25 at best near, plus a bit.  In my case I didn't have much astigmatism so I got spherical IOLs. Unfortunately due to being highly myopic there was more risk of the IOl power being off, and so my left eye wound up slightly farsighted at +0.5D but with 0D astigmatism postop. My right has usually been 0D and -0.5D astigmatism most checks, though last check, perhaps meaurement error or daily fluctuation, it was -0.25D and -0.25D astigmatism, but it has at least 20/15 at distance despite a slight bit of astigmatism.  If I do a laser tweak to my farsighted eye for micro-monovision  to bring it to -0.5D perhaps I can get to 20/20 at near, but it hasn't been worth the time&money to deal with since near is usable as is.

It's good to hear you are doing well with your surgery, you hear too many horror stories.

I just got a letter today offering me surgery on the 10th May with a pre-op the day before, this is because I ticked the option for cancellations - now it's getting scarily close lol.

keep up the good advice it's much appreciated 

Hi jim one thing i did not do is watch videos, not until after the op, but i am a bit squeamish anyway. Still the op for me is quick and painless and you will be surprised after and wondering what all the fuss was about. Like yourself was looking forward to no glassess, especially for driving and cant express enough how good it feels especially now i can drive with sunglassess on. Everything in HD. I could not even read the neighbors number plate on his car from across the road. Now i can see his number plate so much better and now have 20/20 vision in distance and less strength needed in reading glassess. Even watching the telly with no glassess is a luxury for me, especially when i am watching formula 1 and can see grid positions on the screen lol. Just remember its 97% success rate, thats only 1 in a thousand who have complications, and even then they can be corrected. You will be fine mate, i had all those feelings like yourself and now so glad i had it done.    

Thanks for posting your post-op experience. I have not been given a date yet. Likely some time mid to late June. Just mulling over lens options. Did u have both eyes done with monofocal?

re: " I also made the mistake of watching a cataract surgery video on YouTube lol."

Its understandably not for the squeamish. However when you go through it, I found the actual procedure to be less of a big deal than even the most minor dental work I've had done, no discomfort before or after in my case. Most places give you a sedative to help you relax and zone out during it. 

Hi Sue, yeah i had monofocal in both eyes for distance. Really pleased now with my vision. The only problem i have, that i would call it a minor problem, is in certain shades of light i get a ring of light. It does not bother me and i can easily drive at night time without any glare. When i consider how good my vision is, it is a minor thing to put up with. Good luck with your op. 

Sorry, I don't know what lens I had in, all I know it was a distance one.  I went private in the UK, had a really good surgeon.  I did ask the question at my post op appointment if you get a better mono lens going private than on the NHS (other eye has a small cataract).  He said that the NHS one is alright, it does the job, but there is more choice if you go private and he picks the one that he thinks is best.  

Did you get small cards after the surgery with the lens information on them, similar to what you get with a spectacle prescription?

No, nothing at all. Looked at all my paperwork and no information at all.

I got a card but it was not clear which Abbott lens it was so I contacted Abbot and they told me I have a Tecnis Symfony multifocal lens.  I am extreemly frustrated that my vision is worse than before my surgery 2 weeks ago.  Also I always feel like there is something in my eye.  I am religious about eyedrops both for inflammation and moisture.  Has anyone on this website had a similar experience?   

Susie do you have a multifocal lense or Symfony extended focus lens. From my understanding Symfony is not a multifocal

Some surgeons, including mine, refer to Symfony as a multifocal lens even though calling it an extended focus lens will be more accurate. This may be simply to make it easier for them to list their prices for the different types of lenses.

Tecnis multifocal.  I was given a print out page from my doctor and I just reread it and it is still not clear to me about which lens I have because he said he was using the Symfony lens.  I paid alot for the lens.  When I enquired Abbott about the lense I gave them the model number (actually letters) on the card I was given.  No mention of Symfony..

Thanks for clarification. Ian sorry to hear your eyesight has improved 2 weeks post op. Considering Symfony for myself but keep going back and forth with the decision.

If you post the model number we should be able to tell for sure which lens you have.  The comments you've posted so far however suggest problems that likely have nothing to do with the particular model of IOL. The post you made indicating poor distance vision but better closeup vision suggest the lens power is off  which could happen with any model IOL since they use the same formulas (merely with different constants plugged in depending on IOL model). It isn't clear if you might also have residual astigmatism which needs to be treated. The lens power being off and any residual astigmatism can be treated after the vision stabilizes with contacts/glasses, or a permanent correction via laser. (less commonly they migth consider a piggyback lens, or lens exchange).

The issue of feeling like you have something in your eye also has nothing to do with the particular IOL model since you have no nerves in there to feel anything, its a side effect of the surgery. It may have to do with incisions or inflammation, but the most likely explanation is that its a symptom of dry eyes (which the moisture drops should help with) which is sometimes a temporary side effect after cataract surgery due to the incisions cutting nerves that nead to heal back that inform the brain it needs to lubricate the eye.  

Its best to ask at a postop visit though about any symptoms to be sure it is something minor like that rather than some rare other cause.