Predicting results

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I had both eyes done last December, they put monofocals in both eyes. I was very nearsighted and had astigmatism.

After the surgery I'm happy with my far and night vision,  but without readers I can't see anything closer than two feet or so..feel like I'm a blind man when trying to see closer than 6 inches things that were never talked about in the surgical workup

My buddy just had his left eye done two days ago. He did not have astigmatism and had a very low correction on his glasses. He is very very happy with the results, he has both near and far vision after the surgery. We are both Vets so I assume the VA used the same lens manufacturer for both of us eliminating the possibility of the lens being different.

So I'm thinking that the predictor of how successful the cataract surgery will be is how bad your eyes were to start with.

It seems to me that the cataract surgeons don't inform their patients that the outcome is very dependent on your eyes pre surgery and give the impression that everyone will have good results at all distances.

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  • Posted

    Hi:

    Both you and your friend should have received documentation describing the lenses used.  Perhaps you could compare notes with your friend.

    Since you were myopic and had an astigmatism and your friend had neither condition, perhaps the lenses were quite different.

    If you are unhappy with your near vision maybe you should visit your doctor.  He might have a solution -- just a wild guess, but 1.25 diopter readers might help.

    Good luck to you!

    Many thanks to both you and your friend for your service!

    Every good wish to you!

    Ed

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  • Posted

    Hi jwrhn1951

    I am no expert but I think there are many variables involved in outcomes.

    The fact that you have astigmatism (perhaps your buddy had none or little) may mean your IOLs were different toric IOLs to correct astigmatism are generally considered premium lenses and there is an upcharge for them.  If you got regular monofocal lenses the astigmatism would need to be corrected with glasses.

    Also in reality biometric measurements are not perfectly accurate and it is not physically yet possible to measure all of the physiological variability between eyes.  The measurements and IOL prediction algorithms rely on a number of assumptions.  IOLs themselves come in increments of .50 diopters and due to the fact the IOL is not as thick as the eyes natural lens there is slight movement back and forth before it settles.  This too makes an exact target difficult to achieve.

    If you had prior lasik surgery and surgeon didn’t have your pre-lasik scan can also account for unpredictability in results.

    All to say there is more than one factor to consider.  And just because 2 people have same IOL and surgeon doesn’t mean the end result will be the same.

    Sounds though you have great clarity for distance and no night vision issues.  That is the main thing one hopes for with monofocals targeted for distance. You can gain mid and near with progressive glasses or with contact lenses.

    Just wonder if there was time between your surgeries.  Did you discuss a bit of mini monovision for second eye to address the intermediate vision with IOL?

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  • Posted

    "After the surgery I'm happy with my far and night vision,  but without readers I can't see anything closer than two feet or so..feel like I'm a blind man when trying to see closer than 6 inches things that were never talked about in the surgical workup"

    Not being able to see things closer than 6" is to be expected(unless the eye is intentionally corrected to >-2.00D nearsightedness), whereas not being able to see anything closer than 2' is not. I can see how that can be debilitating. There are two possible reasons for this to happen: one your eyes could have been overcorrected to farsightedness and two your eyes have become unusually less "accommodating" over the years as you get older. The former can be confirmed via simple eye exam by an optician. The eye accommodating is the result of aging, varied from person to person, similar to having presbyopia. 

    If one targets plano during cataract surgery, there is a good chance you will end up in farsightedness. My own surgeon kept telling me the variation could go either way by as much as 0.50D. I don't think there is a way to predict which direction the variation will go. In my case, I was targeting -1.00/-1.75 but ended up with -1.25/-1.50. It turned out that way because both eyes were off the same 0.25D but in different directions.

    It is unfortunate that many patients are not aware of the possibility of losing near vision due to eye surgeon's negligent. 

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    • Posted

      Sounds like it might be more advantageous to target slightly nearer than plano unless one spends most of their time driving.  I think I spend more time needing intermediate and near vision than distance - varies with individual preferences I suppose.  

      Time and again seems a lot of surgeons don’t want to engage in conversation with patients - time factor or setting expectations and having patients disappointed afterwards.  More so if these are done under national healthcare and no extra $ in it for surgeons.

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