Still need glasses after Cataract surgery
Posted , 7 users are following.
I had cataract surgery done for both my eyes by the same surgeon. For both I had opted for Monofocal lenses for the distance. First it was the left eye done about a year ago. My vision was not clear first 3/4 days after the surgery and then very unstable for about a month. Fortunately it settled down and I could see things in the distance clearly without needing glasses.
Then I had the right eye done about 6 months ago. This time I could see things better from the 2nd day but it was a bit blurry. The surgeon said it would improve after a few days. It never did. In the end I have to wear prescription glasses for my right eye. It is not very much but I need it. The sphere value on my right eye in -0.75. Even with this correction I have somewhat of a blurry vision.
My surgeon gave me this reason for the blurriness. She said the IOLs are not custom made to be precise and it is made for a range. In my case it fell somewhere in the middle of the range for which the IOL was chosen. That is the reason I am not seeing as well I should.
I am trying to understand it this is the case or do I have any other recourse.
0 likes, 23 replies
RonAKA raj0813
Posted
Your complete eyeglass prescription including the cylinder for both eyes would be helpful if you can share it. An eyeglass refraction is the gold standard measure of how successful the surgeon was in giving you the best vision possible.
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From what you say based on sphere only the surgeon has had a significant miss to leave you at -0.75 D. A miss of 0.25 D is common, a miss of 0.5 D is much less common. And, a miss of 0.75 D especially on the second eye should happen only rarely. A good surgeon will learn something from your first eye and be more accurate on the second eye, IF they look at what they targeted and compare it to your actual refraction after surgery. They can then correct the power calculation formula for you specifically.
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I am afraid I cannot buy the middle of the range excuse. It is true that IOLs are not made in quite as fine of steps as eyeglass lenses. The commonly available step is 0.5 D which as measured by a refraction is about 0.75 D compared to the standard 0.25 D steps available in eyeglass lenses or contacts. It is not a good reason to miss by 0.75 D. However if there is astigmatism (cylinder) involved then the steps in IOLs can be much larger and your need can fall in between steps. Your full eyeglass prescription would be helpful in determining if that could have been an issue. Did you get a toric lens to correct for astigmatism?
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Blurry vision not corrected by eyeglasses can be caused by other things such as PCO. You could ask your surgeon if they can see any. Another reason sounds wild but sometimes an IOL can be installed inside out so the light is going through the IOL in the opposite direction it was intended to. You could ask the optometrist if both lenses were inserted correctly. Also, sometimes the lens can be tilted or off center in the eye.
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To correct the refractive error if that is the main issue the choices are to explant the lens and put a new different power one in. Another option is to do Lasik on the cornea. A third option is to implant a correction lens outside of the capsule to make an adjustment of 0.75 D in your case.
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Hope that helps some,
raj0813 RonAKA
Posted
Thank you for your reply. Here are my prescription. I have put is as sphere, cylinder, axis and add respectively
Right -0.75, +0.50, 161, +2.00
Left -0.25, +0.25, 62, +2.00
There is also of Vertex number of 14 for both eyes. I do not think I got a Toric lens because it was never mentioned to me.
Guest raj0813
Posted
So your spherical equivalents are -0.5D Right and -0.125D Left (basically bang on 20/20 distance). Some formulas for the predicted outcomes use spherical equivalent and others don't but regardless, if the prediction was 0 or very close to 0, the right eye outcome was off the mark. I'd expect maybe 20/32 distance in that eye or maybe a little worse? With both eyes open though your uncorrected distance should be quite good and you might even be getting a slight intermediate boost from the right eye?
RonAKA raj0813
Posted
That appears to have been written by an ophthalmologist that uses positive cylinder. I have to convert it to negative cylinder to get my head around what it means. In negative optometrist format:
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Right -0.25, -0.50, 71 deg SE -0.50 D
Left 0.00, -0.25, 152 deg SE -0.125 D
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The overall outcome is best expressed as the spherical equivalent or SE. That is the sphere plus 50% of the cylinder. You got an excellent result on your left eye with an SE of -0.125. It does not get much better than that. Your right eye is not quite so good, but not all that much worse. It moves from a miss to it happens sometimes. In retrospect the surgeon should have probably used a lens 0.5 D lower in the right eye which would have increased the sphere to about +.125 D, and the spherical equivalent to -.125 D or the same as your left eye.
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This all said a miss of 0.5 D usually gets you close to 20/20 vision. Have they tested visual acuity and given you a rating?
raj0813 Guest
Posted
Your observation is correct. Without my glasses on, I seem to be seeing better with my right eye at a range of 2 to 3 feet or so. I was always wondering why that was. But beyond that it gets blurry and glasses correct the blurriness though not as good as they are with the left eye. Thank you.
raj0813 RonAKA
Posted
I am not sure what I had were visual acuity tests. I thought tests were for prescription glasses. During the tests I was sitting at about a distance of 8 feet or so and asked to read letters on a chart.
But they did mention 20/30 or so for the right eye. I am not sure if that is the rating. Thank you.
RonAKA raj0813
Posted
Yes, that is the Snellen visual acuity test with the different sized letters and typically the large E at the top. 20/30 is off the standard of 20/20, which is a bit surprising for a SE of -.50 D. What is the brand and model of your lens? It should be marked on a card that they give you after the surgery. It makes me wonder if there is something else not quite right with the eye beyond the miss of -0.50 D SE. You could consider Lasik or PRK, but that is not a very large amount of error and the outcome could be unpredictable.
raj0813 RonAKA
Posted
Sorry about the late reply. The lens brand is Johnson and Johnson
Right eye: Model DCB00 Diopter: +23.5D
Left eye: Model ZCB00 Diopter: +23.0D
Other than that the rest of the numbers on both eyes are the same.
Theta symbol T: 13 mm
Theta symbol B: 6 mm
I am not considering doing LASIK at this point. Thank you.
RonAKA raj0813
Posted
The DCB00 in the right eye is the Tecnis 1 packed with the injector. The ZCB00 in the left eye is the same Tecnis 1 but is the model number without the injector. Both are the same model lens. The power would suggest you were likely a bit far sighted before surgery. This is the basic J&J monofocal lens and there would be no reason to blame the lens for the issue.
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It remains a bit surprising that vision would be 20/30 with a 0.5 D miss. I would have expected 20/25 or even 20/20. When these lenses are right on, they can achieve close to 20/15.
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I guess the good news is that combined you should have 20/20 vision with both eyes, and the right eye may give you a little better near vision.
raj0813 RonAKA
Posted
I very much appreciate all the information and help. The surgeon did not do a perfect work. There is a likelihood this could have been worse. With both eyes, it seems near normal vision. I am thankful for that.
soks raj0813
Posted
you were plano before cataracts for distance and needed +2 readers.
your surgeon set both your eyes for near vision.
is that what you asked for????
you will need glasses for distance. about -1.75 both eyes. your near reading vision should be glasses free.
normally plano folks like yourself are made plano for distance as you were used to readers anyway. its an unusual choice.
RonAKA soks
Posted
@raj0813 has the following outcome after surgery.
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Right -0.25, -0.50, 71 deg SE -0.50 D
Left 0.00, -0.25, 152 deg SE -0.125 D
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That is slightly myopic in the right eye, and essentially plano in the Left eye.
soks RonAKA
Posted
i thought that was his precataract refraction so found it strange that he got 23D iol.
raj0813 soks
Posted
My pre-cataract prescription was following:
OD: Sphere +2.25, Cyl +1.0, Axis 179
OS: Sphere +1.25, Cyl +0.25 Axis 024
Add of +2.25 for both eyes
Thank you.
RonAKA raj0813
Posted
Yes, your IOL powers would indicate you were far sighted before surgery.
soks raj0813
Posted
u did a good thing by going plano on both eyea.