Myopic iol confusion and conflicting consultations for cataract surgery.
Posted , 6 users are following.
I'm new to the forum, forgive me but I don't have the same technical understanding as I see many do, on this forum.
I have myopia -6.75 and have had two consultations. One said they suggested an iol of -2.00 and the other said plano.
I am quite confused with it all to be honest. I don't really feel I had very much explained.
I have astigmatism and will require glasses post surgery to correct that unless I paid private for toric iol.
NHS monofocal lense I believe, I just don't know which I should be listening to.
I have always worn glasses since young child so not desperately wanting to be glasses free.
I'm late 40s and not currently wearing varifocal glasses.
if I go to plano for the iol I'm worried the interim between surgeries between a plano eye and a -6.75 eye will be awful.
I'm also aware fixed at distance I won't be able to see to do makeup or crafts.
Similarly with a -2.00 iol will I be able to manage between surgeries and post recovery driving is very important to me.
if anyone has any advice on this, I would be grateful.
my cataracts have worsened in quite short period of time and I know I need to get on with it,
0 likes, 8 replies
trilemma lilo58391
Edited
I think you are implying that both doctors are looking for the both eyes to be targeted to be about the same. Targeting one eye for plano and the other eye for -1.5D or -1.75 has its merits, and would be my preference. Have you expressed to your doctors that certain activities are more important to you than for many? e.g., reading, needlepoint, television watching, driving?
Regarding glasses, I think that even if you wear glasses sometimes, lighter glasses will be less of a burden.
You mention your current sphere number or numbers. You mention toric. But you don't mention your current cylinder (astigmatism) numbers. If 3/4 D or more, I would go toric. However I don't know how tight your finances are. But I would prioritize toric.
The target is just that-- a target. I suspect when they say to target plano, they build in some margin.
How long between surgeries are you envisioning? If a week or two, close one eye if it bothers you. I suspect the difference during the interval would bother you less than you fear. A contact lens will be another possibility for the interval, but I think it is important that the eye measurements be taken before you wear a contact that could alter measurements.
There are special "makeup readers" or "makeup glasses" that let you flip the lens in front of one eye or the other. The eye without the lens is left accessible.
Bookwoman trilemma
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If a week or two, close one eye if it bothers you.
Perhaps, but I found it much more disorienting than that. I had a 2 week period with a 6D discrepancy (-2 IOL and -8 in my unoperated eye), and couldn't leave the house on my own. I suppose an eye patch would have worked, but I was fortunate that my husband was able to drive and do errands, because I certainly couldn't. Even reading was difficult.
That said, the main thing to decide is what you want to be able to see without glasses. If you drive a lot, or do sports, etc., and don't mind putting on readers for close-up vision, then targeting plano for your first eye, with perhaps mini-monovision for the second, makes sense. If near vision is important, then start with a -2 target for the first eye, see where you actually wind up (after 6 weeks), and adjust for the second eye accordingly.
RonAKA Bookwoman
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If one has a cooperative optometrist they usually have free trial contact lenses that they will give you to manage an issue like this. If you reuse daily ones (which can be done if one is careful with them) it is an option to manage the interim at no to little cost. It is also an opportunity to trial mini-monovision before doing it for real.
RonAKA lilo58391
Edited
Welcome to the forum. Your issues are common and I agree that surgeons and clinics in many cases do not explain the options very well. Some more information would be helpful to give a full answer though. Do you have cataracts in both eyes or just one? Have they taken the detailed measurements of your eye and determined what the residual astigmatism (cylinder) will be if you go with non toric lenses. Your eyeglass cylinder is a hint at whether or not you will have residual astigmatism, but to know for sure you need the prediction from the clinic. Some residual astigmatism can be tolerated if it is not too high. Keep in mind that it will only impact your vision when you are without glasses, and may not impact it much.
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Correcting to plano is the most common choice that people make. A second option as you have been offered is to correct both eyes to leave some myopia. About -2.0 to -2.5 would be a good choice, and remember you get too chances at it, if there is a bit of a miss with the first eye. A third option that is not often explained is to have one eye corrected for distance and the other eye corrected to leave mild myopia. Common targets would be -0.25 D for the distance eye, and -1.50 D for the near eye. This can be good enough to be eyeglasses free almost all of the time. And you always have the option to wear glasses and make the full correction.
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Managing the time when one eye is operated and the other is not, is always an issue and especially when myopia is getting up there. A -6.75 is getting up there into the moderately high range. If accuracy of the power post surgery is important it is worth waiting 5-6 weeks between surgeries so the first eye fully heals and you can have an eyeglass refraction done to see where it really lands. Power accuracy for cataract surgery is not perfect and is generally in the +/- 0.5 D. If you determine the accurate outcome of the first eye, the surgeon can make adjustments to the power calculation for the second eye, if there is a miss. The best way to manage this interim period is to use a contact in the non operated eye. Second best would be to take an old pair of glasses and have the lens removed in the operated eye side. Compromising your target in the eye having surgery first is not a good option to manage it - short term gain for long term pain.
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If you target for distance (plano) keep in mind that vision does not drop off a cliff as you get closer. Most people can see well down to 2-3 feet before vision starts to get progressively worse. It may not be quite good enough to do makeup though. Targeting one eye for near and one for distance (mini-monovision) could solve that problem though as long as you can do it with both eyes open.
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And most important keep in mind that all you are doing with your choices is determining what you can see WITHOUT glasses. It does not impact vision with glasses on, as that fixes any errors in sphere and astigmatism. In other words your vision without glasses does not have to be perfect, as long as you are happy with it. You are not painting yourself into a corner. About the only difference it makes is how thick the lenses will be in your glasses. In general the more you correct with the IOL the thinner the eyeglass lens will be.
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Hope that helps some
Bookwoman RonAKA
Edited
Second best would be to take an old pair of glasses and have the lens removed in the operated eye side.
If only it were that simple. I did this, and it was worse than not using glasses at all. Perhaps I just have a non-adjustable brain!
RonAKA Bookwoman
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I did it for a while but my differential was much less. I didn't like it, and it was not a workable solution as I went 18 months between eyes, and needed a much more permanent solution. I actually had new lenses made for my glasses and that worked ok. But contacts worked the best for me and it gave me a long trial of mini-monovision.
Guest RonAKA
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Glasses with a 0 sphere and -4 sphere works for -4 isn't as big a difference and my brain has had a long time to adapt to it because I had complications that delayed the second eye. That said, as others have mentioned, using a contact lens should work well. I wouldn't make a target decision (which is for the rest of your life) based on the differential between surgeries (which if for a couple weeks).
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As for -2 vs. plano that is up to you. It depends on what is most important for you to be able to do without glasses after surgery. Some surgeons recommend a myopic target for myopic patients as it's closer to what they are used to. Others always recommend plano. Neither is right or wrong, it's just a personal choice. I chose plano and that is what most people choose. But some people choose a myopic outcome and are quite happy with that.
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Bear in mind that the issue with glasses isn't about wearing glasses, its about how often you have to switch focus depending on what you're doing. Grocery shopping is a good example (switching from walking / browsing to reading labels / prices). If I'm doing an activity that is in a fixed, known location for am extended period though (reading in bed or using the computer) the glasses are a non-issue because I just keep readers beside the bed / computer and I'm in reading or computer "mode" for an extended time so it's not a pain.
Bookwoman Guest
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That's why progressive glasses are so good: just about perfect vision at all distances when you're out and about.