Post Cataract Op Question

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Hi all,

My first post here so apologies if this isn't the correct place to post.

I had cataract surgery two months ago in my right eye, my pescription was -5 SPH, -250 CYL & AXIS 4. This changed to -4 SPH, -1.25 CYL & 155 AXIS post op. I had a monovision IOL fitted and set for reading distance, meaning I still need glasses for distance.

My question & problem is I can see pin sharp at 25 / 30 cm (without glasses) and also pin sharp in the distance (with glasses) but there is a gap between the both where my vision is blurry (about 10 feet!) I can't even see the computer screen.

It is vital for my work this this 'gap' is sharp as I need to be able to see clearly at mid range distances (either with or without glasses).

Can anyone offer advice, I'm really reluctant to get the second eye done until I get the first one useable for work.

Thanks.

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  • Posted

    Hi IrishPol, I am no help to you but you are on the right page, I had a bad time with my first eye which was done last June, I too had doubts about getting my second one done but as my first eye became OK I got the other one done last Aug, there are a lot of factors when your eye isnt right, two months should make it OK but you have to speak to either the surgeon or the optician you have to get medical advice regarding why your eye still isnt OK so please do that.  You will get loads of advice on this site but speak to the professionals.  Please let us all know the outcome

    Regards Agnes

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    • Posted

      Thank you for the advice Agnes, 

      I'm wondering would varifocal glasses bridge the vision gap i currently experience.. I'm being driven mad with the imbalance between the two eyes at the moment. 

      i'll do as you suggested and contact the optician for advice and possibly the consultant if I still can't get answers.

       

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    • Posted

      I forgot to mention in my post I was told glasses won't work well between surgeries. It was explained to me they set too far away from the eye and make the vision gap very anoying. Speak to your doctor about a temporary contact lense for your distance eye.

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  • Posted

    Hi,

    I had my first eye (right eye) done the 18th of December. Like you i had it set for near. Also like you my vision is perfect in that eye at about 30cm or about 12 inches.

    I did not use glasses after I instead wore a distance contact lenses for two weeks in the other eye which helped simulate what I would have after my second surgery. I had my left eye done December 5th. It fills in the void very nicely. It is the eye i use for computer screens at arms length and also have amazing distance vision.

    I hope this helps put your mind at ease.

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    • Posted

      Hi Cart, thank you for your reply.. have you one eye set for distance and the other set for near? my surgeon is looking to set my left eye for near also, hense my concerns,. He said that's what I'm used to my whole life and changing that would be unfair on me. However if the focus distance gap remains and I cannot see the computer screen either with or without glasses, im basically screwed. 

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    • Posted

      Yes that is correct one eye is near and the second eye is distance. With my near eye I have 20/20 reading vision and 20/50 distance (basically everything about 3 feet out is blurry)

      My distance eye is 20/20 distance and I cand read perfectly with it at arms length.

      I researched extensively what kind of vision was best. My mother had both eyes set for close years ago and has to wear trifocals. I did not want to be dependent on glasses. I do not have to wear glasses for anything.

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  • Posted

    The problem is that a monofocal IOL doesn't provide much of a range of vision. When your best vision is focused at a particular distance, you only have a small range of distances further in or out from that which are in good enough focus.  Wearing single vision distance glasses is essentially like having gotten a monofocal focused best at distance. A typical guideline I'd heard is that with a monofocal set for distance, that vision 6 feet in will start to get blurry. However the range of good vision varies for each person, some will find vision blurry at 10 feet as you do, while some lucky few can even do some reading (though that isn't to be expected).

     

    What you'd need now would be a pair of glasses focused at some intermediate distance for your computer, or a pair of progressive glasses that give good vision at a range of distances (or bifocals or trifocals, or multifocal contacts). When you have your 2nd eye done, you could choose to have it focus at intermediate distance to have a chance of being able to use that eye for the computer without glasses, or set it to match your other eye and use glasses for intermediate as well as distance.

     

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    • Posted

      I should add that you mentioned you had a "monovision IOL", and I assumed that you meant a "monofocal IOL". Monovision is where you get each eye set to focus at a different distance, e.g. one focused for distance and the other focused a little bit nearer in, say for intermediate. The brain can only adapt to a limited   amount of difference in focal point between the two eyes, how much varies depending on the person.  In your case since your first eye is set to focus very near, you wouldn't be able to get your second eye done for perfect distance vision since a > 4 diopter difference is more than anyone can adapt to. You'd merely be able to set it to slightly less near, or very close in intermediate, possibly closer in than you use the computer at.

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    • Posted

      Perhaps I should add that the focal distance of an eye with a particular refraction power in centimeters is -(100 / lens_power_in_diopters). So if someone has a refrection of -2 their eye is focused at -(100 / -2) = 50 centimeters.For  -4 its 25 centimeters. 

      Astigmatism tends to add blur at any distance, but it increases the range of focuses you can see a bit. It  means is that the lens power of your eye isn't constant. In your case what it means is that your lens power is -4D at one part of your eye (focusing best at 25 cm), and at another angle it is -4D plus the astigmatism of -1.25D = -5.25D which focuses best at 19cm). The average lens power of your eye is called the spherical equivalent, which estimated to be the sphere plus half the cylinder correction. In your case that is -4 + -0.625 = -4.625D. That means the average best focal point for your eye is 21.6 cm = 8.5 inches.

      You can also   get the diopters needed to focus at a particular distance, diopters=-(100/distance_in_cm).  So if your computer is located at 66.7 cm=26.2 inches that would be about -1.5 diopters your eyes would need to be focused at (rather than 0 for distance). 

       

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    • Posted

      Thank you for all this information softwaredev, you are correct is it a monofocal lens I got fitted. I can only focus on one point about 20 - 25 cm away before my vision blurs. I have single vision glasses which does give me sharp distance vision, better than I had before. But as I mentioned earlier there is a gap, and it's that gap where I use my vision the most.

      I'm beginning to wonder if the surgeon fully understood my needs with line of work. 

      You have given me a lot of information and if I'm honest it's a lot to take in. 

      The surgeon, talked about multi-focal lens and how I wasn't suitable due to the 'halo'. I was reading earlier about trifocal lens, the info and reviewsall seems very positive, they weren't mentioned to be by the surgeon but now I and am wondering if it might be an option for the left eye.. or at the very least will vari focal glasses will solve my problem if I get the left eye set the same as the right.

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    • Posted

      Varifocal glasses are an option. I'd referred to them as "progressive glasses" in my post above since that is what we call varifocals here in the US.  The easiest option might   be merely a pair of dedicated computer distance glasses, or  lined bifocals or   to give you computer&reading vision, or trifocals to add far distance.  

      Unfortunately although in my first post I referred to the idea that your 2nd eye might be set at rather close in intermediate distance,  I guess I'd label it more as merely not quite as near. It seems likely unlikely it could be far enough out for good computer vision. I don't know what the maximum difference they would go for is, I think its usually 2D to 2.5D difference between the eyes at most, 3D might be possible but its not a good bet. I seem to recall that even 2D difference between the eyes is a lot and there is some risk of adaptation problems. It is a shame they didn't fully go through all your options with you before surgery.

       They can also correct astigmatism during surgery, and usually that is useful since it causes blur at any distance. (though it can  provide a bit larger range of vision, it won't be as crisp).

      Most people choose monofocal IOLs since that is what insurers or the government will pay for, premium lenses like trifocals cost extra money. If you are willing to pay out of pocket for better vision, then a trifocal would be an option (or another premium lens, I chose the Symfony lens as a better bet since intermediate vision was more important to me and its a better bet for that, but it doesn't give as much near as a trifocal).  

      An added question though is whether you'd be willing to pay even more out of pocket to have a laser correction to your first eye to have it set a bit further out. Or you could see  if they think its viable to do a lens exchange for your first eye to give it a trifocal or at least a different power monofocal that will  focus it out further. 

      The problem is how near your first eye is.  I'm uncertain  how well it would work to combine a near eye set that far in with a trifocal. Usually the distance target for the 2nd eye again wouldn't be able to be too much further out than where the first eye is at, though I don't know if with a trifocal you could adapt if the near focus point is close enough to where your first eye is at, its seems a bit of a risk. 

       

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  • Posted

    Thanks everyone, I'm .. I have an appointment with my local opticial later today, I'll see what they say.

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  • Posted

    You may like to see an optician who can check your middle distance vsion and prescribe spectacles to help you to cope until you adjust. I do not think you should worry because the surgeons would never attempt surgery until your vision improves in the already operated eye. That is why they only do one eye at a time then wait before operating on the other eye.
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