Monovision - First eye for near vision

How good is your reading vision now, with the operated eye?

Maybe you will end up with a very good outcome. Good luck with the second operation!

Ouch, that is a significant "surprise". I assume you will now target the other eye for distance, and leave this one for near? Although it may be a bit early to come to a firm conclusion as to where it has settled.

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In this situation I would be asking the surgeon for a copy of the IOL Calculation sheet to see your eye measurements and predictions. Perhaps a remeasure of your other eye would be in order too. With the eye measurements you can do your own calculations with tools available on line. Hill RBF 3.0 is probably the best, with the Barrett Universal II very good as well as the Kane formula. Regardless you along with the surgeon need to figure out what went wrong with the first eye calculation and make adjustments with the second eye.

I just had my left (non-dominant) eye operated on for distance, with an eventual goal of both eyes in mini monovision fashion. It has now landed 2.5 weeks after surgery at around -1.25D given the surgeon targeted around -0.5D.

Jane, what are your plans for your dominant eye? I know what mine would be if it were practical.

You did not state the cyl of your current post-iol refraction, and I don't know if -1.25D is your sph or if it is your Spherical Equivalent. Spherical Equivalent is (sph+(cyl/2)) where cyl is a signed number.

For example, if the prescription on one eye were sph: -1.5 cyl:+ 0.50 , the spherical equivalent would be -1.25 D. If the prescription on one eye were sph: -1.5 cyl: - 0.50 , the spherical equivalent would be -1.75 D.

I would suggest waiting until the 6 week point and then get an accurate phoropter measurement of the sphere and cylinder before making a decision on the second eye. Ideally it should be done by an optometrist practicing independently of the cataract surgeon.

I can read a book comfortably in broad light at slightly bent arm's reach, and I'm quite short, 5'2 so short arms too. Face is clear in the mirror, but anything within especially text incl the phone is a mild blur. My astigmatism was also corrected with a toric, leaving behind about 0.25D.

I'm really hoping that the surgeon will hit the target for the second eye for distance, because the worse case would be a match in both eyes which gives me functional vision (everything important is visible) but not really what I'd optimise for.

Do you recommend changing surgeons? I assume the next surgeon will need the prior measurements and predictions to calibrate for the next eye. I'd expect the constants used for predicting this eye need to be adjusted to match the actual outcome and then applied for the right eye.

First I am not sure what you mean by "My astigmatism was also corrected with a toric, leaving behind about 0.25D." Did the cylinder come out at -0.25 D? That actually is a pretty good outcome with a toric lens.

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On changing surgeons there are pros and cons. On the con side, unless they the new surgeon takes new measurements, they could make a mistake too. You would have to, and should anyway ask for the IOL eye measurements. The new surgeon would have to diagnose what went wrong, and make corrections to the IOL power calculation process.

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Staying with the same surgeon has some advantages. They have the complete data and should be able to diagnose what went wrong with the power calculation and make an adjustment to the formula constant to not do it again. But, if they get defensive about it, and especially if they refuse to give you the IOL Calculation data, it could become a difficult situation. I think if that is the way it goes, then a new surgeon with new measurements will be a good idea. Legally they have to provide you with these measurements, but they can charge you for so called "out of pocket" costs, which really just consists of a click of the mouse and a few sheets of paper.

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What were your eyeglass prescriptions for each eye before surgery, and ideally before cataracts started to develop? Were there any other issues with the eyes, such as prior laser surgery? What IOL was used in your first eye?

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In any case I would start with a full phoropter exam at 6 weeks, and then go back to the original surgeon and see what they will do to prevent a miss in the second eye. Depending on how well that goes, then decide on whether a new surgeon is needed or not.

Do you recommend changing surgeons? I assume the next surgeon will need the prior measurements and predictions to calibrate for the next eye. I'd expect the constants used for predicting this eye need to be adjusted to match the actual outcome and then applied for the right eye.

I would. But waiting a while makes sense.

I would opt for an RxLAL /LAL (light adjustable lens) if practical. But if nobody close enough offers that, then that is not going to be practical. Figure 3 to 5 EXTRA trips. Similarly, if you cannot manage the cost premium, that would eliminate that.

And for a target, I would tell them plano. I think they probably build in some margin, but anyway, the LAL should let them get within 1/4 D of a target.

Correct, that is the CYL.

I am a very young patient in the 30s, with a prescription of -3.75D, CYL -2.25D AX 160. I do have dry eyes which I tried to treat a few weeks beforehand. No Lasik.

The astigmatism is a little higher, but overall should not be a difficult eye to measure and predict the IOL power needed.

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Apparently with dry eye it is important to treat it with drops for some time before the eye measurements are taken.

-6.0 sphere, -0.50 cylinder at 085 for eyeglasses, but it's nearly a year old prescription. Haven't got a more recent update.

-6 D sph is surprisingly nearsighted after Lasik. That would put your best focus at about 7 inches.

So clearly you don't have a problem with monovision, so I might even go -2 for your close eye.

I would also like to see your astigmatism adjusted, tho many think that less than 0.75D, or even 1.5D, is not worth doing anything about. If you are close to an RxLAL provider, consider that; it should be able to get astigmatism with about 1/4D. That is the resolution on their settings. I don't know why they cannot target smaller resolution. Yes, it is premium, but it is also about 4 extra visits, plus wearing UV blocking glasses until the day after your second lock-in.

I would google this sentence with the quotes:

"Obviously, there are benefits to correcting it, but there are sometimes benefits to leaving it alone.”

So there are different opinions, which that article discusses. The sentence I quoted is not the main suggestion of the article.

I read that some laser assisted cataract operation machines can do astigmatism treatment during the IOL implant. What I don't know is if this is done from within the eyeball or is done from outside of the lens.

Google:

"Femto laser-assisted surgery can also be used during the procedure to help correct a mild astigmatism by relaxing the cornea with limbal incisions"