Prescription changes 15 months after cataract surgery

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Had an appointment today with the optometrist who diagnosed my cataracts. Saw her 3 months post op to get my prescription. At the time both eyes were plano for distance and i had slight astigmatism in both eyes (RE .25 & LE .50). Although I haven't used readers much I was given a prescription of 1.75.

I had EDOF IOLs (Symfony implanted summer of 2017).

Today from my visit glad to receive the news there is no sign of pco but my prescription changed. For the better in RE see 15/20 in RE and now no astigmatism. LE needs a bit of help at .25 for distance and astigmatism increased to .75

Reading prescription decreased to 1.25 although only time I used them this year was for extended reading or very tiny print.

I was surprised to find out my vision could still keep changing in next few years. Wondering if this is the nature of cataract surgery and IOLs or because I was diagnosed at 53 with cataracts vs the normal age for cataracts. Forgot to inquire with my optometrist.

Anyways wondering if difference between eyes will cause some headaches and RE will be working overtime. It may be helpful if I got glasses to use when driving to reduce the strain.

Anyone else still on the forums a year or more out from surgery experiencing fluctuations in vision?

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  • Posted

    Happy New Year, Sue Ann.

    Like a fine wine, your eyes are only improving with age.

    My cataract surgeries took place about 14 months ago; I haven't noticed any changes; I'm extremely pleased with both my surgeon and his choice of Symfony lenses for my stigmatisms.

    It's great not having to wear glasses, especially when I'm skiing or riding a bike.

    Please keep us updated about how your eyes are changing.

    Cheers.

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    • Posted

      Happy New Year to

      you too Ed. So far our Canadian winter has been extremely cold. Looking forward to escaping it for a bit soon.

      Nice to hear your vision is very stable. I was pleased a put RE improvement - couldn't have asked for anything better really. LE increased astigmatism - hoping it doesn't increase more. Thinking I may get glasses for driving so that RE isn't over taxed.

      Overall I am pleased with Symfony's results and no PCO for now on the horizon.

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    • Posted

      Enjoy your holiday, Sue Ann!

      I wonder if eye measurements can fluctuate and if the actual measuring is such that relatively small changes are not permanent. For example, do you think it's possible that if your eyes are checked next July, the "LE increased astigmatism" might have decreased?

      My vision seems to fluctuate a little bit according to my mood and how tired I am.

      The better I feel, the better my sight seems to be. That's rather subjective, but I wonder if you have had a similar experience.

      Stay warm, young lady.

      All the best,

      Ed

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    • Posted

      You may be right about that Ed. My appointment was in the morning. Often end of day when eyes more tired or dry vision is affected and results if tested likely would be different.

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  • Posted

    I've read that eyes Rx can typically move around 0.25-0.50D day to day, or different times within a day. Dry eye, etc can of course affect that too.

    I observe this myself at home day to day and from morning to later in the day with my own standard eye chart I check from 20feet away most days. At the last optometrist refraction check, my right eye with the monofocal toric IOL got an Rx of +0.25D power and 1.00D cylinder (astigmatism).

    But often in the morning that right eye can achieve 20/15 or better without glasses and sometimes the glasses make it the same or slightly worse than without - indicating that cylinder astigmatism value had reduced 0.5D or even a bit more! My vision tends to get a bit worse in the afternoon or evening where the glasses correction works best.

    So variations of 0.25D or even 0.50D between optometrist visits may not be a true change in your eye's Rx, just happened to get that natural day to day variation between the visits to the eye doctor. Not worth getting new glasses if the previous pair still working well in that case.

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    • Posted

      Thanks Night Hawk that does make sense. My optometrist lady visit was 13 months ago and I checked my calendar and it was an early evening appointment whereas yesterday's was 11:30am. Even at home I find daytime vision better than evening - thought it had more to do with lighting conditions (and likely a part of it). I always did find the reading prescription she gave me a year ago of +1.75 odd given I could read even J1 well and few times I put them on to read a novel extended period of time they seemed too strong. Since my insurance company (for husband and I) reimburse us with coordinated benefits 100% of expense to max $500 per family member going to at least new readers as +1.25 to my thinking would be more beneficial. On holidays do live to read novels as I have more time and it's easier on the eyes when reading hours at a time to use readers.

      How is your other eye doing - cataract still same and not progressed?

      Has the IOL eye been better for night vision now that time has passed?

      Hope you enjoyed a nice Christmas and New Years.

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    • Posted

      One thing that puzzles me though is that RE improved and LE bit worse unless conditions can affect eyes independently.

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    • Posted

      Re that 1.75D reading glasses Rx, some optometrists just prescribe a typical value for your age and that sounds right for typical mid 50s. But since you have Symfony IOLs you need a smaller correction for reading than someone the same afe with natural lens.

      I'm 64 so use +2.25 for reference with monofocal and natural lens. Of course less is needed with strong reading light vs low lighting.

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    • Posted

      My left eye with natural lens will probably take years before its early stage cataract affects vision. My right eye with toric monofocal iol has been fairly stable, most days 20/20-25 in that eye without glasses.

      At my eye doc checkup a couple weeks ago both eyes could read 20/15 with glasses and eye pressure down to 14, so excellent said the doc also no PCO so far,

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    • Posted

      Here is where things were confusing to me. Prior to cataract surgery the tests I did at home pointed to my LE being dominant. Although both eyes needed surgery right eye was worse - best corrected vision was 20/60 and LE was 20/50. Surgeon asked me which eye I wanted done first and I said RE as I knew it would be a 6 week wait for other surgery and RE was worse. At that time I said I thought my LE was dominant and should it be operated on first. My surgeon said it didn't matter (although from these forums seems it should matter?)

      Long story short now that both eyes are done and time has passed those same home tests point to my RE being dominant.

      So question I have - is it possible for dominance to change? Was it possible due to cataract worse in RE that LE learned to be dominant during that period of time (my cataracts developed very rapidly over the course of 1 year). Never a mention at my last optometrist that I had beginnings of them.

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    • Posted

      Sounds like you are doing well! Good that you are able to find a way to function with glasses so that you can wait on LE surgery. With time who knows better IOL may be approved in USA. atLARA sounds promising with more range than Symfony and less halos (hopefully there will be reviews of that lens here as I think to many of us the concentric circles were a surprise. Although thinking if it is just the circles it is not so bad (after this much time I know they are there but not something that jump out like the beginning). If less than optical day vision and glare experienced then trade off not worth it.

      My optometrist has a new machine (wish I'd asked the name of it) but took a scan of area between IOL and back of capsule from a sideways view. She showed me the gap between them - whereas a natural lens fills that entire gap. Quite amazing. She has all my scans going back to 2011 when I started seeing her. Been monitoring my optical disk area as it is larger than norm. Usually a sign of concern but it has always been same size so she thinks it is genetics. My daughter sees her now and she has same large optical disk so must be in my family.

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    • Posted

      The funny thing is I was yet into readers prior to cataracts - highly unusual but that played into my decision for IOL option. Was not wanting to lose my near vision. Oddly enough most surgeons really never discuss/suggest targeting for near with monofocals which is why I brought up premium lenses. If I hadn't my surgeon would never have offered or discussed them with me.

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    • Posted

      A definitive answer is way above my pay grade, but my best guess would be that your surgeries along with different rates of cataract development changed the dominance from LE to RE.

      This might be an explanation (albeit overly simple) to explain the different outcomes between your LE & RE, the latter perhaps receiving a lense more precisely attuned to that eye.

      Have you asked your eye specialists about this?

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    • Posted

      Are you saying that the power calculations and measurements are done more precisely and accurately with first eye surgery? My surgeon didn't seem to care or need to operate on dominant eye first (maybe he knew or tests reveal true dominant eye - he just never contradicted me when I assumed my request to operate on RE first even if I thought LE was dominant.

      I did read an article prior to my surgeries - wish I could find it - indicating 2nd surgery doesn't work out as well.

      I haven't asked the specialist and I would need a referral to see him again and unless I develop a complication or pco don't think I would get a referral. It may be a little different in Canada with national health care that foots the bill. They are so busy it takes months to get in (for some things we wait over a year - I am currently waiting to see an ENT and told 18 month wait!) Life in Canada I guess and we learn to accept we may not get answers. Just thankful this worked out well in the end. To struggle with vision would be very hard.

      I do think despite astigmatism in LE I can read closer. With both eye open I read at 11 / 12 inches away. But if I close RE I can bring iPhone closer and words only start to blur at 7 inches. Whether my surgeon planned that in his calculations or IOL settled that way I don't know. Just something my optometrist remarked on yesterday but her test with snellen chart was 14 inches away.

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    • Posted

      I think eye dominance can change after cataracts.

      My right eye was dominant before cataract but after a few years of blurry vision in that eye apparently my brain got used to relying on the left eye for the clearer image and has stayed left dominant even a year after surgery. I thought it might switch back but so far not.

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    • Posted

      Hi Sue Ann:

      My naive view is that eye surgery is contingent upon precision in each part of the process: from initial evaluation to the surgery to the final evaluation.

      Precision is the key element with respect to the machines which measure the eye, the techs that work the machine, the exactness of the lense, and the skill of the surgeon determine along with the unique characteristics of each patient not only the general outcome, but how that outcome is measured.

      As you have noted, your vision changes according to the time of day with eye fatigue and dryness affecting your vision.

      Techs and surgeons have good days (mostly), but some days they are off form. That will affect both the surgery and how it is evaluated.

      Measuring devices usually must be maintained and calibrated to be as precise as possible; the skill with which techs do this combined with the intrinsic precision of the machines help to determine both the surgery and its evaluation.

      Hence whether or not the surgery goes well depends upon a host of possible variable factors related to precision, not the least of which is possible variation in measuring precisely the outcome.

      It sounds as if the Canadian health-care system has given you an excellent outcome, although I certainly sympathize with your frustration about not getting the answers you want and having to wait in long queues for evaluation and treatment.

      By contrast with the US system, Canada, IMHO, does provide the major advantages of providing more people with a better standard of health care at an affordable cost than the US system does. Drugs are much more affordable in Canada; good preventative care is taught; and no one goes bankrupt in Canada trying to pay back medical providers for hideously expensive procedures -- eg $300K for quadruple by-pass surgery at a top cath lab.

      Additionally, litigation is such a key factor in US medical decisions that it drives health-care costs up significantly, thus further complicating both effective treatment and major US fiscal woes. Canada, thankfully, doesn't have that problem.

      Words blurring at 7" for the RE; both eyes at 11/12" seems to indicate that Canadian precision provided an excellent health-care outcome for you.

      Have a great day, Sue Ann!

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    • Posted

      With all that needed precision and skill required it's quite incredible that so much of the time it is successful.

      Yes pros and cons to Canada's healthcare system. I am not sure it is sustainable - time will tell. I suspect (and we see the beginnings of this now particularly in larger provinces) where private clinics offering variety of services (MRI, etc) are popping up.

      I am sure my surgeon was considerably skillful - although I could sense his relief at my 24 hour check up. I had so many questions that I am sure he thought I was going to be picky and difficult. But city where I Live neither hospital yet has ORA equipment and I didn't realize what and how instrumental that piece of equipment is in cataract surgery. So I credit him and his team for their knowledge and skill for my outcome.

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