Second Cataract Surgery

Teresa, could you provide a little more detail? What kind of lens did you have put in with you first surgery? Are you talking about having this lens taken out and replaced with another lens? Or are you talking about having the second eye done?

First, I would ask your doctor which IOL you had implanted. If you have enough astigmatism you probably have a toric IOL. If you do not know I am guessing a monofocal set for Plano, which means you should get good distance, maybe up to 3’ and then wear readers for close. But everyone’s results will vary, as so many conditions, to how well the doctor placed the lens and hit the mark.

I am assuming you are referring to having the other eye done when you say 2nd surgery. My advice is don’t rush into a second surgery until this eye heels and you can truly evaluate your Visual Acuity (VA) and before you get 2nd surgery learn about all the different IOLs (might want to do a mix to maximize VA) and Options like Monovision. And if you doctors is not telling you about the options get more than 1 opinion. Sadly money gets involved here as typically on a monofocal is covered by insurance in the US and by socialized medicine in other countries.

The other reason to read up on IOLs and even defocus curve is for you can ask the right question to your surgeon about the VA you are getting. I would start with what were the issues, if any, with my current eyes. Again there are so many possible issues with your eyes and past history, I can only be very very general to give you ideas on what to ask about. Maybe your astigmatism is an issue or past Lasik or past eye injury or you have short eyes and on and and on. Also you need to give time for your eye to fully heel. With 20/30 distance with monofocal it is possible the surgeon missed the refractive mark and you are myopic, but then you should have gained more intermittent vision if that was the case. If you do not get satisfactory answer then I absolutely would be looking for a 2nd opinion and I would do some research to find a top doctor in your area. I am talking a doctor that has written research papers and is involved in clinical trials, not some doctor your neighbor just recommended. If you are in the US, what state are you in, as I and others here might be able to make suggestions.

Just to give you a quick summary of options, I will give you my standard reply about IOL options below. Others that have read my standard reply can skip:

There is no perfect lens selection for everyone. You need to take your time and think about what activities are most important to you. Only you can decide what tradeoffs you are willing to accept. If your 100% sure you want to reduce the risk of halos, starburst and other dysphotopsias, below is my list of refractive IOL option in order of risk:

Non Premium Monofocals:

These are the most common Iols implanted. They will have the best contrast and the least issues of any lens (unless you consider close vision an issue). They have been around and tested for a long time. A Monofocal lens should provide great distance. In general close vision is reading your cell phone or a book, maybe 33cm-40cm. Intermediate is about 2 feet or so. A perfect example might be the dashboard on your car.

One comment on distance vision. Some people I think are confused by that term. If you look at the defocus curve on a monofocal you should get pretty good vision down to about 2' -3' or so (again it depends on many factors). As you get in closer; vision quality drops off rapidly. This is important, everyone Visual Acuity will vary as there are so many factors, such as short eyes, astigmatism, previous Lasik surgery, and on and on.

I also suggest just getting 1 eye done at a time and evaluating the results before getting the other eye done. Mix and Match is always a possibility to obtain the best vision possible.

Premium Monofocals:

LAL – If considering a monofocal I would recommend giving this IOL serious consideration. I have had Top Ophthalmologist highly recommend this lens. Having said that it has been around for a while now, but not as long as the standard monofocal so there is the test of time issue.

What makes this lens great is no matter what equipment Ophthalmologist use they don’t always hit the refractive mark and in a few cases can be way off by more than 1D. And let’s say you decide to do monovision. You want to hit those marks.

But it even gets cooler than that. From what I understand you can adjust the LAL more than once. So you decide on monovision, but not 100% sure how much monovison. So set 1 eye to plano and then try various settings with the 2nd eye to see which one works best for you. I would only consider micro-monovision like -0.75D, but if I had the option to adjust it you could try a different setting and see if you end up with a lack of stereopsis or other problems.

Crystalens Lens – You hardly hear about this lens anymore. This is the only FDA approved accommodating IOL. Many people did not get accommodation or much accommodation, so you were paying premium price for a monofocal lens that did not give the range of vision expected.

But from what I have read Crystalens at distance provides the same level of contrast as a standard monofocal and you are likely to get some accommodation. This lens could be a great mix and max with a PanOptic Trifocal IOL.

IQ Vivity and Tecnis Enhance - The newest hottest IOLs on the block. A refractive IOL that provides some EDOF. I think IQ Vivity is around .5D and Eyhance a little less. So not a lot but combined with micro-monovision you should get decent intermediate and some close up vision.

Now here is the part that is trick. I have read that Vivity gets EDOF by manipulating SA. So that means contrast sensitivity will not be as good as a standard monofocal. Could the average person notice the difference, I don’t know. But I suggest you get an Ophthalmologist who is an expert with these lenses so you can discuss that exact issue. And of course there is the test of time issue.

I tried mono-vision with contacts and I know it is not the same, but I hated it. I need good distance vision. That is why I say if doing mono-vison go with micro-monovision (<-0.75D). If you do that with Vivity you will be getting -1.25D of mono-vision, preferable in the non-dominate eye.

Enyhance is a little less clear to me as from what I read there is no CS lost, but you don't gain much EDOF. I am not even sure it is much better than some monofocals. But IMHO you have to be giving up something to get even that little bit of EDOF. So this one needs further research.

Vision accuity is more complex than it sounds. There are just so many environment factors and so many ranges to go with those conditions. Will you be able to see well indoor at a concert or basketball game vs seeing up close in dim light vs moderate light vs bright light.

Defractive IOLs

These IOL, which include Trifocal and EDOF IOLs, give you improved intermediate and close vision but they all come with tradeoffs (dysphotopsias & Contrast Sensitivity loss). This category is a paper in itself, so I will not go into details unless you are interested in a defractive IOL. I personally have a defractive lens. In the US the main defractive lens currently would be Panoptics and Symfony IOL. I actual have the Tecnis MF low add, which is a bit of older tech now.

Sounds to me that they gave you a regular monofocal lens for the cataract surgery, after up to 6 weeks of healing time after the surgery that should give you good distance vision (4feet and beyond) unless your astigmatism is significant (greater than a cylinder of 1.0D in the eyeglasses Rx)

So you may still need to use eyeglasses for best distance vision as well as for intermediate and near (reading) vision, though you would need to get a new eyeglasses Rx from an eye doctor after your eye has fully healed after 6+ weeks, since the vision can vary until then.

If you are used to wearing eyeglasses fulltime, then the cheaper monofocal lenses in both eyes would be fine if you don't mind continuing to use eyeglasses (just with a new Rx, the lenses in the glasses may be able to be a lot thinner than before)

I still am not clear on some issues. First exactly what IOL did you get. Provide a model number ZCT150. Maybe because I got a premium IOL, but the Opthmalogist gave me a card with all that information and I think it would surely help when getting a 2nd opinion.

You state you had extreme myopia and double vision. My question was this due to the cataract? What was your vision like before you had cataracts?

"My doctor says I will be able to see clearly after I get new glasses". Maybe if it is just a refractive issue. It is possible the issues with your eyes are so great 20/30 is the best that could be accomplised with an IOL. Again what was your corrected and uncorrected vision before cataracts. And do you know those numbers with cataracts before surgery?

Without knowing exactly what issue you had and what your eyesight was before cataracts it is hard to give opionions. I can only make guesses at best.

But I agree 100% with Ron and that placement especially if you got a toric IOl is critical. The doctor needs to dilate your eyes and make sure that IOL is properly placed.