Surgery scheduled, not sure what to expect
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Just over a year ago I had eye surgery to remove an epiretinal membrane in my right eye. After this surgery my vision was improved. Unfortunately a side effect of this surgery is that you will get a cataract in that eye. That's where I'm at now.
I saw an optometrist back in mid February because I noticed my vision was deteriorating and hoped that new glasses would fix it. The doctor said he was unable to correct my vision with glasses and that my vision problem was due to the cataract. An appointment with a cataract surgeon was set up for early April. Then of course Covid happened, and I finally saw him a few weeks ago.
I first saw his associate. An intern? A student? I'm not sure. (I go to a large University- affiliated medical center in the midwest US.) I explained to her that i could see pretty clearly with my glasses for distance (albeit with "ghosts") with my left (nonsurgical, and dominant) eye doing all the work, and that although I have progressive lenses, Ive always taken off my glasses for reading, even before the cataract. She said i was a perfect candidate for a iol to replace the cataract in my right eye. I'd use my right eye for distance, and my left eye for reading, and wouldnt need glasses. Sound great, I thought. Ive worn glasses since i was 14, (i'm 69 now) and looked forward to being able to get cool sunglasses.
Then the surgeon came in. I'd call his demeanor brusque. He asked if I agreed that my iol should be for distance. I said yes. He asked if i did much night driving. I told him I do a lot of driving, both day and night. He said ok, Im going to put in an Alcon, but a half (of ??) below optimum so there would be less difference with my left eye. No discussion of lens options. Although i have a slight cataract in the left eye he said it would probably be years, if ever, that i would need an iol in that eye. I mentioned that i was looking forward to not needing glasses. "You'll still need them for driving", he said as he walked out the door.
So, from what i've read here, it seems most people get iols in both eyes, either at the same time, or at least within a few weeks. Do many people only get them in one eye? How will that work? Right now my left, dominant, eye handles my distance vision with glasses. Will my brain swap over distance vision to my newly fixed eye? And what happens if i have to wear glasses for driving? Would i have my current prescription for my left eye and little to no correction in my right eye? Wont that confuse my brain when I'm not wearing glasses? And I assume when they fit me for glasses theyll also correct my vision in my right eye for reading, wont that be a huge discrepancy between my eyes, giving me headaches? My current vision in both eyes is -4.000 Add 2.50, so my left eye would have -1.50 for reading, while my right eye would have +something. I also have astigmatism in both eyes, dont know if that complicates things further.
They already scheduled me for the optometrist appointment for a month after the cataract surgery. For the month in between, how will i be able to see? With my glasses my left eye will be clear but my right eye will be wildly off, but without my glasses my left eye wont be clear, and i assume my right eye will not have yet taken on the distance load. Seems like i will be basically blind for a month.
Sorry for this very long message, but as my surgery approaches i keep getting more and more apprehensive, and hope the knowledgable folks here can give me some guidance.
Thanks!
0 likes, 12 replies
RonAKA miscrap
Posted
With the exception of the epiretinal membrane being the cause of your cataract in the right eye, your situation is quite similar to the one I was/am in. I was diagnosed with a cataract when I was 69, and now due to the wait time and COVID I got my surgery three weeks ago, just before my 71st birthday. I have a cataract developing in my non operated eye, but currently is not enough to justify cataract surgery in our Canadian health care system. With correction, I see pretty close to 20/20 with it, but I expect it will go downhill over the next couple of years. My right eye was operated on, and my left eye, like you is the dominant eye. I went for a full correction for distance in my right eye, and my surgeon says I should think about monovision when it comes time for the second eye. My surgeon says it is not necessary to correct the dominant eye for distance, and it can be reversed. The other bit of a difference between you and I, is that my correction is a little less. My non operated left eye considering a small amount of astigmatism is about equal to a -2.0 eyeglass correction.
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This said, this is my experience so far. I had Costco take the right lens out of my eyeglasses. Like you I have a +2.5 add for reading. I think that is pretty standard. My corrected vision in my right eye is 20/20 without glasses. When wearing glasses with the lens out, I find it a little odd. I can tolerate it, but it just does not seem right, and at times I almost feel dizzy. Not sure what that would be like with a difference of -4.0 D between the eyes, but it might be worse. The other thing I have done is wear a contact in my non operated left eye. This seems to cure the odd somewhat dizzy feeling. I have tried two contacts. One fully corrects my left eye and gives me pretty close to 20/20. It is quite natural and vision with both eyes is excellent for distance, but of course I can't read at anything less than about 20 inches. Now, I am trying a couple of different contacts that correct me to -1.25 and -1.50. I am still evaluating that, but so far the -1.5 residual seems to leave me with a bit of a fuzzy area about the same distance as a computer screen and I am not liking that so much. The residual of -1.25 seems better. When I tried them at Costco, they did not seem to compromised distance too much. With a -1.25 residual in my left eye and nothing with my right eye, I tested at a solid 20/20. I could read about half of the 20/15 line as well.
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That is where I am at. I hope that helps some. Some questions for you. What is your eyeglass astigmatism (cylinder on your prescription) in each eye? Did the surgeon tell you what the residual astigmatism would be just based on the cornea measurements? It quite likely will go down as the astigmatism in the natural lens is gone with the lens replacement. Was there any discussion about using a toric lens to correct for residual astigmatism?
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Hope that helps some
miscrap RonAKA
Posted
Hi RonAKA! Thanks for the detailed reply. To answer your first question, my astigmatism is R +1.000, L +0.750.
As far as astigmatism discussions with the surgeon...there were none. No mention of residual astigmatism, no mention of a toric lens. I just happened to overhear him say Alcon, and recognized the name from my research earlier this year. i have no idea which of their lenses he's planning to use. I guess im following his lead that he's the expert and knows best. The only thing he asked me was do i want it corrected for distance or closeup, and do i drive much at night. Other than him examining my eyes our discussion was probably about 3 minutes.
Ive also thought about the possibility of removing a lens from my glasses. Youve confirmed my thought that it would look and feel strange. Ive also considered the possibility of wearing a patch, although im not sure if i would wear with glasses covering my surgical eye, or without glasses covering my nonsurgical eye. Long term, i wondered about the possibility of getting lasik on the eye without the lens. One thing that scares me about that is, many years ago, my young niece was on my shoulders and thought she was going to fall. She wrapped her hands around my face and stuck her finger in my eye while i was wearing hard contacts. Cut my eye with the edge, i could never wear hard contacts again. Switched to soft lenses, all was good. Fast forward about 5 years. My daughter was on my shoulders. Youd think i would have learned my lesson, but no. Her uncle was taking her off, and tickled her under her arms. She kicked me in the other eye (im not sure which incident goes with which eye.) Major abrasion over a large portion of my eye. Doctor told me not to wear the soft lens for 2 weeks. When i went back to it it felt great while wearing it, but when i removed it it felt like i ripped my eye open, like it had stuck to a scar. Doc said wait a month. Same result. Wait 6 months. Same result. Wait a year. Same result. No more contacts. Although Ive had countless in depth eye exams between the membrane removal and the cataract, and no one has mentioned any issues with my corneas, ive always been extremely leery of getting cuts in my eyes.
Since youve just had the surgery youre a perfect person to ask a couple other questions. im having the surgery on a Tuesday morning. Im required to have someone there with me to drive me home. I have a follow up appointment with the surgeon the next day. The hospital is about 35 miles away. Do you think ill be able to drive myself there and back in Chicago rush hour traffic? i live alone, and i had a hard enough time getting someone to drive me the day of the surgery. Also that evening, i have the 2nd of 6 dog training classes. Id really hate to miss the class, but do you think it would be too strenuous? i know youre supposed to take it easy for a few days, but my 18 month old, 95lb boxer/mastiff mix really needs the training.
Thanks!
RonAKA miscrap
Posted
If those are cylinder corrections with an angle associated with them, that is quite low astigmatism. Likely after lens removal there is not enough to correct. 0.7 D is the minimum amount before they will consider a toric lens. With the detailed eye measurements they took, they should know whether you have that much or not. Suspect you don't as they did not discuss toric lenses.
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It sounds like you are no longer able to wear a contact in the other eye. That is too bad, as it seems to be a good solution especially for a shorter period of time. I would not consider Lasik without consultation with an eye surgeon first. It can cause complications in fitting a cataract IOL to that eye in future.
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I really don't like the idea of half correcting your cataract eye. It would seem they are going to leave you with a -2.0 D eyeglass correction. It would work I guess, but it is not going to give you distance or reading without glasses. Kind of leaves you in no man's land. I think I would get a second opinion before proceeding. Another thing to look into is your insurance or medical coverage. Some plans will recognize the split in correction between the two eyes to be a problem and will cover the IOL surgery for the second eye to eliminate that issue. If it is a choice that is the way I would go. Ideally get both eyes corrected for distance, or get the dominant eye corrected for distance, and the non dominant one under corrected by about -1.25. This is called monovision. This would give you good intermediate vision (computer and your car dash), and some reading when the light is good. If you get both eyes for distance then you will need reading glasses for sure. If you do monovision, you may get away with no glasses nearly all the time, and reading glasses only for small text.
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My appointment for my next day surgery was very early in the morning, and my travel was before sunrise. While the surgery was totally painless, and the eye was totally pain free that day. I slept well that night with the eye patch on. When I got up the next day and turned the lights on I thought my eye was going to explode in pain. The light causing my pupils to dilate and constrict was very painful. They gave me dark glasses to wear and until that moment I didn't know what they were for. However, I could not get them on fast enough with the lights on. My wife drove me to the appointment, but even with the dark glasses on every time the traffic lights changed, or someone in front stepped on the brakes, more pain. I think there is no way I could have driven safely. My doctor says it is not legal here to drive with an eye patch on in any case.
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My thoughts are that the dog training class on the evening of the next day would be pretty iffy. My instructions were to avoid any lifting or physical activity for the first week.
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Hope that helps some,
miscrap RonAKA
Posted
Thanks! Im really torn about what to do. I know the IOL can be replaced if necessary, but ive been told that it should be considered permanent. Youve got me thinking that i should cancel my appointment and get a second opinion. Thanks for the advice.
RonAKA miscrap
Posted
I would suggest thinking about how you want to end up with both eyes, and consider the option of having both eyes done. The one with the cataract first, and then the other one 8 weeks later or so. Perhaps your insurance will cover it, especially if you say you cannot live with the difference between the two eyes. Or, in the US you probably have the option of just paying for the second lens. In Canada we can't easily do that, but I think the cost of a monofocal lens is in the order of $1000.
miscrap RonAKA
Posted
Thanks again for the suggestions and advice. Im going to cancel my surgery and followup appointments and get a second opinion. I have Medicare and a supplemental plan so whatever i decide my out of pocket cost should be minimal. My current vision, with my left eye basically doing all the work, is not terrible, so no point in rushing into things.
RonAKA miscrap
Posted
I agree. Due to our Canadian health care system and COVID I waited 18 months for my first eye. It was getting bad toward the end, but I was still safe driving as one eye was still 20/20 with glasses. Getting an IOL is kind of a one shot affair. Yes they can be exchanged but it takes a specialist to do it right, and even then there can be complications. Best to get it right the first time.
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When I was at my 3 week follow up appointment this week with my optometrist I asked him what the criteria was for referring me to get the second eye done. I expected him to say that the vision has to be 20/40 or worse. He actually said in our Alberta system there is no cast in stone vision number. He said it is based on how well the person is adapting to having one eye done or not the other. He said some patients can't adapt and he refers them, and others try to stretch out the time for the second eye as long as they can. I think I will give it a year and see how it is going. If it were my choice alone, I would get the second eye done now, even though I am seeing a discolored somewhat fuzzy 20/20 with it.
robert80020 miscrap
Posted
If you go with the RxSight light adjustable lens, all this stomach churn/brain damage goes away and you get to try it before you "buy" it. I'm getting mine done by Codet in Tijuana, Mexico. They offer the edof enhancement that is not available in U.S or Europe yet.
miscrap robert80020
Posted
That lens sounds perfect! I see that theres a clinical study for it. With my luck i'd be in the 50% who receive the other lens.
robert80020 miscrap
Posted
Lens is available in U.S now. Edof enhancement is in trials.
lynnma miscrap
Posted
i am facing the same issues. i would love to wait for continued improvements with less comps in multifocal lens. i can see well with correction out of my left eye. right eye is 3/4 with severe myopia--11.0 . doctor claims i can wait but as lens size increases more of a surgical risk! currently opting for monofocal for distance. i haven't seen many multifocal patient experiences with PANOPTIX! it was just approved in AUGUST 2019 in US.
Sue.An2 miscrap
Posted
hi miscrap - I am in a similar situation except reverse. I had cataract surgery 3 years ago both eyes and this year diagnosed with epiretinal membrane. I am still awaiting to see the one specialist we have here - covid likely has delayed this. Not sure what to expect.