Tecnis 1 and Eyhence results

Any dysphotopsia?

Same thing

Any dysphotopsia?

u r getting 20/20 distance due to binocular summation. what power readers do you need for close reading?

no

I don't remember. I don't use them that often. My dr said my uncorrected astigmatism and targeting intermediate gave me 20/20 vision because of where the axis fell.

You did really well in the way you handled this! 3 surgeons and I have only been to one!! That may inspire me to go to another one. I never knew about lubricating drops before the measurements! One learns a lot from this site!! It sounds like you have had excellent luck and it is encouraging to think that your hard work may well have contributed!

BTW, why did you pick Tecnis 1 ZCB00 and not Clareon or Eyhance?

1. My drs group only does Johnson and Johnson. 2. The Tecnis has a 10 year track record. Eyhance does not. 3. One dr told me my astigmatism would be easier to correct with a pure monofocal like the Tecnis if I had to wear eyeglasses, as my dr and I thought I would after surgery. But as it was, I really didn't need glasses after all.

10 year track record is meaningful. Thanks!

Are you aware how big is your night time pupil in mm ?

No

More or less?

My iolmaster 700 pupil size measured at 4.3mm, at first I saw cartwheel halos when my pupil was dilated much bigger than the lens itself, however those went away once the pupil went back to 'normal'. I was concerned about the size of the optics because i have cats eyes, but I haven't had any problems with that for the few days / nights i've had tecnis1 on my dominant eye. I'm 44 years old. Also the driving vision is pretty incredible and lights look great again.

Tecnis1 has been used for a very long time and it's a dependable lens. Our university hospital uses it pretty extensively.

I had my surgery on friday. Image was superhuman on the first night / day, but towards the afternoon of that day i started getting ghosting. I can't get a 100% focus anywhere without glasses, there's just a minor amount of ghosting, enough to make reading smaller things difficult.

With readers I get the sharp vision back, not 100% what's going on but the surgeon said it's probably swelling on the eye and that this is normal. It's only been a couple of days so i'll keep monitoring the situation. Other than that the image color and contrast are unbelievable, once i get the superhuman sharpness back it's going to be pretty incredible also.

Anycase, my symptoms don't have anything to do with the lens itself, just biology. Tecnis1 is a bit sensitive to great placement as it sets your spherical aberration to near zero, so hopefully mine is fully centered. Because my glasses vision is great i'm expecting it to be the case. Just hoping to heal quickly.

So you do have PD at night now or not?

at 4.6mm mesopic pupil i doubt he will have any PD.

Well, I think about a year ago when I was wearing eyeglasses and my optician was adjusting them, I think he mentioned I had small pupils. And they do look small to me in the mirror

No. Sometimes headlights on cars at night have streaks but it's doesn't bother me

Do you know for sure the iolmaster measurement is mesopic?

Anycase, if it's super duper dark I sometimes see minor cartwheels in bright leds etc indoors, but it never really gets that dark outside that to be an issue. Driving you'll see headlights of other cars that already constrict your pupils etc. But it was clear i was worried for nothing. And again, it's only been less than a week from my surgery.

One thing that is clear with these monofocals is that the image quality is absolutely incredible. I'm seeing deeper blacks and brighter whites i don't recall having seen in a long time.

my report says mesopic pupil size 5.6mm and 6.1mm.

how close can you see? what power readers do you need for intermediate and close up?

is dasboard clear for you?

I don't obviously have my final vision settled yet.

One reason why I was scared was that I thought I was going to be completely useless at close ranges, but that's not really the case. Things are out of focus nearby but I seem to have functional vision. The more light there is the better I can see closer even with a tecnis1. I haven't driven in full daylight yet. Dashboard is blurry, as expected, in the evening at least. The +1's bring it to great focus and i can still drive, but far distance quality goes down as well.

I have a box with text on it, some larger, some smaller. Here at my working desk it's blurry and i can sorta read the large text, however going to the kitchen where there's full blown bright spring winter sun the text becomes a lot clearer and i can read the smaller text also. Not with 100% clarity but I can read it. As the pupil constricts the depth of focus noticeably improves even with the pure mono-focal lens.

In normal light all text that's in my range is obviously very blurry. Larger text is legible, but all detail is gone. +1's seem to be great general use glasses but to read any smaller print you need stronger glasses. The closer the object is that you need to comfortably read and the smaller the print the more power the glasses obviously need. I got a bunch of supermarket readers. The thing is I don't quite know for sure what my prescription is yet. +1.5 seems to be pretty good for computer, i see my desk / keyboard etc pretty clear. I'm going to get some proper prescription glasses once this process is done.

I have now selected Tecnis 1 ZCB00 targeting -0.27 LE.

I am very interested in your posts as a result. I am hoping to target something like -0.75D or -0.1D in the RE for some untested monovision depending on what my doctor advises since I am waiting 7 weeks until the second surgery.

What did you target LE and RE?

I have in my possession some really good prescription +1 glasses and some cheaper +1.50 which I never use. From reading your posts it looks like I will be using them after the surgery which may be a difficult adjustment for me.

You may or you may not need eyeglasses, Spring, and if you do, you may adjust well. Remember all eyes are different. And refractive outcomes after cataract surgery vary from patient to patient. I think you made a good choice with the Tecnis 1 ZCBoo. Just don't second guess yourself now.

Interesting that you would say that. That is encouraging that my eyes might respond differently and even positively in not needing glasses as much.

I do think about Eyhance, however, which was my doctors choice (but we never really discussed it in any depth) but reminded myself that one study shows that Eyhance and the basic Monofocal are about the same for near and distance; Eyhance is slightly better with intermediate, however..... so what Spoo is experiencing with his near vision might be the same with Eyhance.

I have to remind that I'm only 4 days post-op and my vision will likely still change.

My doctor targeted plane, because the next refractive power available for the lens was targeting -0.5, My vision is currently not sharp at any distance because of just a hint of double vision. I'm seriously hoping this will go away because it's the only thing preventing me from enjoying my vision fully. Using my +1 readers brings everything back to sharp. I'm hoping it will fix itself as the eye heals, but it's causing me anxiety. What i'm also seeing with these +1 (previous prescription) reading glasses is that they give me very good vision within a pretty wide range, but not close reading.

Losing the ability to read without glasses really does suck, my natural lens will still compensate for the missing near vision for now. Obviously when this journey is done i'm planning to get bespoke varilux X glasses for general use. They should give a wide area of focus in the reading / intermediate range.

Also my left eye isn't done yet and I have not decided on the lens or the power for that yet. I have a bit of time to figure it out. That surgery is still ~3 weeks away so I can think of my options.

did you get laser cataract surgery?

if your distance vision gets clear with +1 then that is not good because that means they made you hyperopic. u want to end up myopic so you gain some near. hopefully it is temporary and fixes itself.

what r u thinking for the next eye?

It would seem that your distance double vision issue will clear up by 3 weeks. Reading without glasses is really a good thing, I agree, which I do on my computer; I do now have to wear glasses for books (but I like reading on my chromebook better and stopped with the books) I jotted down "bespoke varilux X" in case I will be running to the Optometrist for glasses after this is over.

Again, I guess you will see an improvement over time. Hang in there! These posts really help the rest of us as I know I would experience a lot more anxiety after surgery if I did not know about other's post-op experiences and the information they have about what to expect etc.

I was the opposite, the first night of my surgery (yesterday). My pupil was still really large even at midnight (surgery was around noon), so everything yesterday was distorted and fuzzy. When I woke up this morning though, my pupil was back to it's usual small size and everything was pretty sharp. I asked for a target of -1.0 D with an Eyhance, so my distance isn't great (around 20/40) but close is pretty good (around 14") and intermediate is freakishly sharp and clear from 2' to about 5'. I could even see the small print on the side of a large Tylenol bottle at 40". I've been decreasing the zoom on my laptop and decreasing the font sizes in the desktop's finder menus since everything is so clear -- no ghosting at any distance. I've had to use readers for a few minutes here and there for pill bottle types of things, but overall, I'm really impressed.

Eyhance is known for stronger intermediate than the other Monofocals in a study that I read. Your results sound excellent!

Any new feedback today? Hope all is going well!

I'm back to work, the diplopia hasn't yet gone away but I use readers, image is very clear with them. Glasses-free vision is better in good lighting than dim, which is expected.

My biggest issue is using the ski-mask eye shield at night because i can't really sleep with it. But if (when) my vision clears up of the minor ghosting that's causing my sharpness issues i'm expecting to be quite happy with my distance lens. I need to figure out my plan for the non-dominant eye next week. Eyhance is an option for it.

The eye is still healing, my distance vision is definitely exceptional. Everything in my apartment is out of sharp focus without glasses. In good light things look better. I wonder if i should've picked the eyhance afterall. I was hoping to have sharp vision from 3-4 meters forward which is a lot more useful but at least currently that's not the case.

I'm definitely interested in seeing where I landed, and Its likely have some astigmatism , but i'm hoping that will improve as the eye heals. Getting rid of the astigmatism would have a huge improvement to quality of vision.

It is frustrating to make these decisions and then end up with problems. Hopefully the diplopia will clear up soon. It will be interesting to see where you landed. I had my left dominant eye done with Tecnis 1 a week ago and although the first few days were a bit concerning, things have cleared up and my distance is great. I had my second eye done yesterday, also with Tecnis 1. My left eye was targeted for -.25 and my right eye was -.55.

Once your eye heals and the diplopia goes away hopefully you will probably notice a big improvement. Will you be able to find out where you landed before you have to make a decision on your other eye? I can't remember what the target was for your eye. This whole process is very stressful.

The target was ultimately set to plano because there wasn't a calculation in iolmaster that could've landed me to -.25 with the 0.5 powers available for that lens. My eye was very close to zero to begin with I think and no corneal astigmatism. I would've preferred a nearer target in case we run over, but -0.5 for the dominant eye would've been too much also. I've seen what the eye can look like in full sharp so I know what it should be. I'm also wondering if i ended up hyperopic and that's causing the out-of-focus experience. But i can't seem to get in focus no matter what I look so it's possibly astigmatism, also if the IOL has moved off-axis you'd think you'd have problems with glasses also?

Sorry, I put some incorrect information in my post. I wanted -.25 in my left eye, but the closest the surgeon could get with the power of lens was -0.1. My right eye was -0.55. I can see really clearly from 3 feet to distance. From 2 to 3 feet I can see clearly, just not any smallish print. I don't have a lot of knowledge on this, just from my experience and what you have said, being hyperopic could be what happened in your case. If distance is exceptional like you say, but it is just around your apartment where things are out of focus being hyperopic makes sense. If it is astigmatism wouldn't everything be out of focus without corrective lenses? I don't have any knowledge about IOLs being off-axis, but makes sense glasses wouldn't fix that. When do you see the doctor again? He/she should be able to check if that happened.

Can you find out what target the doctor hit? It would definitely be good to know before you decide on your next lens. Also, if he did miss the target and you are hyperopic, having an Eyhance lens wouldn't have made a difference in the outcome I don't think.

That sounds familiar, i think my residual refraction was -0.07 in iolmaster with the 20.00 lens. Why i'm also thinking it's minor astigmatism is because even when looking at a distance object and compare that to my natural eye there's clearly a minor ghost involved, which means it's not in perfect focus. Why the eyhance could've potentially been of help here is that lens had a target of -0.25-0.3 which could've prevented me from going over. But I had to make a decision as I was heading for surgery.

In any case, I'll get this eye refracted latest in 2 weeks when i'm going for my second eye and the checkup for this one. It's also still 'early' so it's perfectly possible my eyes are still in motion, but this experience hasn't really changed much in the last few days.

That's interesting to know about the Eyhance. I just assumed because the lenses were similar the targets would be the same based on the power of lens. No pressure trying to make that decision heading into surgery. It is still early days, so things could change. Once you speak with your doctor and have more information that will be helpful in making your decision. This is very frustrating and stressful for you. Keep me posted.

Also, not sure if you are allowed to use over the counter drops for dry eyes with your prescribed eye medication, but drops for dry eyes made a huge difference for me.

"Why the eyhance could've potentially been of help here is that lens had a target of -0.25-0.3 which could've prevented me from going over."

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The Tecnis 1 and Eyhance have an optical A constant that is exactly the same at 119.3. The IOLMaster should predict the same residual refraction for the same 20 D power of each of these lenses.

You really went for distance on both eyes. I guess you decided to wear glasses for closer in. How is your close in vision now?

With Tecnis 1 you set it to plano but wanted closer to -0.25? My doctor set my LE target with Tecnis 1 to -0.27. I am going to try to get something closer to -0.50 or -0.75 when I speak with her next.

If your LE -0.1 how is the vision in that eye?

I thought long and hard about what I wanted and what I did in my life and what vision would work best for each thing. I decided distance is what would work best for me. I see things clearly now that I haven't been able to see with glasses, even before cataracts. I have lived in my house for 20 years and just the other day looked out my front window and for the first time in 20 years I could see the house number on our neighbour's house across the street. I see clearly from 2 feet to distance. I can see my computer without reading glasses, but my eyes don't get as tired if I wear them right now, that might change once both my eyes are fully healed. Yes, I need reading glasses to read a book, but I can read larger print, like headlines on the newspaper or the title of the book from about arms length to 2 feet away. I picked up a mug today that has a saying on it and I could read it with no problem at arms length. I can get by on my cell phone because I have maxed out the font size, but it is easier if I put readers on. Everything I do inside and outside, except reading, are clear. I can put drops in my eyes without a magnifying mirror. There are things I know I will probably have problems with like seeing prices in stores, checking labels etc. but I will get used to making accommodations. When I wore glasses, even with bifocals, I could read better if I took my glasses off, so now it will just be the opposite.

I am a bit of a klutz, so when I walk, especially on uneven ground like during the winter months with all the snow, I have to look at the ground so I don't trip. One of my worries was I wouldn't be able to see the ground clearly, but I can see it better now than with glasses. I do a lot of walking, riding bikes and spending time on the water, all things I decided are important to have good distance vision. Site seeing, watching animals in the wild, etc. are better with clear distance vision. Driving is important to me, again having good distance vision for that is important. I have heard people say, "yes, but you can get glasses for distance". I have had glasses for distance for over 40 years and I have never been able to see this clearly with them.

Everyday my vision seems to improve a little bit more. I can see things clearer today, than I could yesterday. My second eye just had surgery yesterday and it is still blurry, but when I do get full vision in that eye, things will only improve even more I think. It was a hard decision, but I feel I made a well informed decision that works well for me.

"My second eye just had surgery yesterday and it is still blurry, but when I do get full vision in that eye, things will only improve even more I think. It was a hard decision, but I feel I made a well informed decision that works well for me."

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I think the most important thing in preparation for cataract surgery is to have realistic expectations as to what the outcome will be. I think sometimes when people are "sold" on a particular lens model that it will be magic and do all kinds of wonderful things, they end up being disappointed. They get fixated on the particular lens model and overlook the underlying optics of the lens. It is like shopping for a car and deciding that Ford is bad, and Chevy is good, or the reverse.

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There is no free lunch. Each lens has pros and cons. The important thing is fully understanding what they are.

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I think you made good informed decisions based on your situation.

I'm not still 100% sure what was going on here because the tecnis1 at 20.50 and the eyhance at the same power had a different outcome in the iolmaster., further we didn't have a 20.00 version of the lens ordered so i couldn't have picked the eyhance for plano. All the 'prep' and still didn't go completely as planned.

The IOLMaster 700 can be set up with various different formulas. Perhaps the same formula was not being used. Or the surgeon may have been picking different targets for each lens. Some seem to think the Eyhance should be targeted differently than a monofocal.

did you get a toric lems?

u might have hit the target but just didnt get enough near due to large pupil. get readings from autorefractor at optometrist.

My corneal astigmatism was practically none, so there wasn't any point in a toric IOL. I'll get a hold of my doc and get a checkup just to understand if it's just more healing needed or some other issue.

I bought myself a pair of cheap non prescription glasses to wear around to protect my eyes til at least they've completely healed, but I wear them to sleep also. I'm used to wearing glasses in general, and when I sleep cos I use the TV to help me fall asleep. I'd bought some of those plastic eye shields with the holes in them to sleep with so I didn't accidentally rub or knock my eye, but I could only see clearly with them at a certain angle -- not an easy angle either. So I returned them. The plain glasses work great and they're a lot more comfortable than those shields were. The frames are big enough that I can't reach under them accidentally or unconsciously.

I had my left eye targeted for -0.50 D five days ago with an Eyhance and the surgeon said he hit -0.36 D and the distance vision hasn't seemed to change much since the test four days ago that said I had 20/20 with it. Intermediate vision is getting better - I can read my laptop screen pretty clearly at about 36" Now that I know how it turned out, I think I would have gotten really good results targeting only -0.25 D in that eye instead with even better distance vision. But of course, hindsight...

Yes, but if you had targeted -0.25 you would have had more than -0.75 between the two eyes which might not be as good. Better to keep that number lower than -0.75, I believe.

Crossposting this from that other thread, but I just had my eye refracted at a nearby optician, S +0.75, C -0.25 A 77, that looks pretty hyperopic to me. I hope this settles to something more reasonable, but may explain the ghosting / why nothing's really sharp at any range. The surgery is less than 2 weeks ago so fairly early and i really really hope this won't be the final result.

I had my right eye done with Eyhance and the surgeon wants to do .5 for the left eye but I am thinking I want more near vision. He didn't even say what the right eye was but my distance vision is beautiful. I just wish he didn't do 40 surgeries week and had time to consult. It's very frustrating. I just want to know I made the best decision with all the information available. I don't know why they make me feel lie no one else asks these questions.

My eyhance research said intermediate vision was good to 26inches.I was thinking laptop distance, I really want to get away from holding a phone close to my face. How is your vision closer in than 36"? Is it very blurry or tolerable?

y dont you try out + contact lenses on your eyhance eye and see what your sweet spot is for decent near and tolerable distortion to distance?

is that with autorefractor? hold off on your other surgery. go to a place that has ORA.

The surgeon says that this should still improve when the healing continues, I'm pretty depressed until it does.

I went for a checkup today after ~2,5 weeks and planning for friday surgery. My dominant eye is now +0.50S -0.25C, it's slowly improving, but obviously still hyperopic. The doc says it should still improve and move closer to zero.

I also got my iolmaster 700 zcb00 sheets from last time and also re-measured for friday's operation of my left eye. The lens calculations with all 4 formulas check out pretty well, Barret Universal II and BU2TK both predict -0.07-8 for the 20.00 lens for me for the previously operated eye. Also the 20.50 lens prediction for the eye says -0.41-0.43 so that's definitely too much off mark assuming these calculations are correct. Using that lens would've had a big risk for a compromised distance vision in the dominant eye. zcb00 has been used for a long time so I would imagine these measurements should be pretty good.

Left eye targeting for a 20.50 lens for both measurements are hitting a range between to -0.31-0.19. a 20.00 would go a bit hyperopic in both cases. Surgically induced astigmatism is +0.25D on both eyes in this chart.

It's also cool to see iolmaster scan of the eye with an IOL in it. The system recognizes it as pseudophakic immediately and shows the cross-section of the eye with the iol in it.

Seeing these measurements and re-measurements + the change from last week to this week make me feel better about my right eye. I just need to give it some more time and try to take it easy. I'm a lot less anxious now than I was last week seeing these papers. I should've asked for the copies earlier.

"Yes, but if you had targeted -0.25 you would have had more than -0.75 between the two eyes which might not be as good. Better to keep that number lower than -0.75, I believe."

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Yes, that is true. Overall, I am very happy how both eyes over lap each other and work together. I wouldn't want to potentially lose that over such a small amount.

Yes, that's what I thought might have happened to you also. Sorry. Your symptoms matched those I'd read who ended up with a hyperopic result also. That is too bad. That's why I stayed safe into the near end of things. I was having similar results in my dominant eye after the retina tried to detach -- had to back off the distance vision in order to offset the "plus" factor the eye was giving me. Would you be able to use YAG or such to correct it down the road if it doesn't resolve on it's own?

You know, your surgeon should be able to pull what he thinks he got with your right eye off the ORA computer scans -- that's why you paid extra to have them done. That's what mine did before the second surgery when I asked him about it. It might end up a bit different when you go for your four to six week check up with your optometrist, but it will give you an idea. Isn't that why it is suggested to wait between surgeries, so the surgeon can "learn" from the first eye and apply it to the second surgery?

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Despite my dominant eye being targeted for -0.50 D and my surgeon thinks ended at -0.36 D, I'm not sure that I'm getting that great of a boost for intermediate with that eye. And no real near vision (closer than 34") -- I can see items around me, but the details aren't necessarily that clear. Of course it's hard to tell for sure as I have nothing to compare it to. I would say a minimum of 36" to 40" away before medium sized items get sharp. That being said, I can see the print on my laptop screen (15" display) pretty well, a little blurry, at about 32", but doable ( my "near" eye sees it perfectly from about 15" out).

different iol master scans give different results. i had a -0.2 with 16.5 and -0.02 with 16 at two different locations. ORA had -0.19 with 16.5. so at the -0.02 location the surgeon was selecting -0.37 with 16.5.

i think you shoukd go with 21 in your left eye if want go with plano. that will make you land between +0.12 and -0.72. most llikely around -0.25.

Your experience reminds me of a discussion I had with the surgeon just before my first eye was done for distance. At the time I was not smart enough to ask for the IOLMaster calculation sheet, and we were just discussing the options verbally, (by phone if I recall correctly). He said there are two options for lens powers. One will leave you perfectly at plano, and the other will leave you at -0.38 D. He said that while the plano option is tempting, it leaves a risk of ending up hyperopic. He said "Nobody ever thanks me for leaving them hyperopic", and recommended that I go with the -0.38 D option. I did and my stable long term outcome ended up at:

Sphere 0.0 D, Cylinder -0.5 D, for a spherical equivalent of -0.25 D

His advice was obviously good and I ended up with 20/20+ visual acuity.

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If I was in your situation I would not proceed with the second eye, until the first eye is stable and your surgeon has corrected his calculation method to ensure you do not get another refractive surprise on the second eye. See my post on dealing with refractive surprises.

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https://patient.info/forums/discuss/dealing-with-refractive-surprises-798224

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Have you used the Hill RBF-3.0 D formula on your right eye to recalculate what outcome it predicts for a 20, and 20.5 lens? The IOLMaster calculation sheet should have all the numbers you need to run the on line calculator. Do it with both sets of measurements to see if there are any differences. It seems virtually certain at this point that the 20 D was wrong for your distance eye and it should have been a 20.5 D. Keep in mind that these formulas when you are dealing with a non toric lens, use spherical equivalent for a predicted outcome, not just sphere. The other think to keep in mind is that while the steps in IOL power are in 0.5 D increments, the outcome is in 0.38 D steps.

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Once you determine what formula gives the best accuracy based on the first eye, then I would decide on the second eye, and even then a small adjustment may be needed between what is predicted and what is likely to be the result.

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I recall that your objective in vision was to have the best possible distance visual acuity. Assuming the first eye remains hyperopic, you may want to have a discussion with the surgeon on doing a lens exchange to the correct power. And for sure you don't want to miss on the second eye.

The other variable with the IOLMaster predictions is the formula used. The IOLMaster comes with some standard formulas, but others can be added. Different clinics may use the same machine, but different formulas.

I ran the numbers on some online tool for RBF3 at rbfcalculator and they seem to be in good alignment with the iolmaster 700 barret calculations for a target of -0.07. The 20.50 had a calculated target -0.41 which is in agreement with the iolmaster.

Also the left eye prediction looks pretty good and it's in agreement with this iolmaster sheet. I suppose this is a good thing overall, even though there's always a chance that biology will play tricks on you.

I guess i'll just have to patiently wait for my eye to heal, but my left eye is becoming so bad it needs to get fixed.

The calculations are suggesting a 20.50 lens for it with an outcome of -0.24. The 21.00 lens prediction is -0.59 but that has a risk of leaving the eye too myopic for my hobby use cases as well. I suppose the refractive surprise is generally closer to zero than away from it? This is scary stuff overall.

By the way, which A-constant should be used here: A-Constant (SRK/T): 119.3 or A-Constant†: 118.8

The iolmaster 700 sheet is using 119.3 for this lens? Looks like the 118.8 doesn't at least make a negative difference in the outcome using the RBF calculator. What's the difference between these values?

Also is the target refraction INCLUDING the surgically induced astigmatism, so that's the spherical equivalent you see in the formula results?

the formula is the same but the input parameters measured can vary based on cataracts and other things. thats why they say stop wearing contacts and other things.

-0.07 is too close to call. i had -0.02 so he went with -0.37 which was the next IOL and ORA said it is really -0.19. if i had gone with -0.02 inwould be +0.16.

For the A-constant there are sometimes two values given. One is for an ultrasonic measurement, and the other is for an optical measurement of the eye length. The IOLMaster uses the optical method, and if you are using the IOLMaster measurement the A- constant for the Tecnis 1 lens is 119.3. The 118.8 is for ultrasonic measurements.

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I would be interested in seeing what the predicted residual outcome on your first eye is with the original IOLMaster data (with an A-constant of 119.3) for the Barrett Universal II, Hill RBF-3.0, and the Kane formula, and of course what you actually got. They are all on line.

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One thing you can do is pick the most accurate formula and then adjust the A-constant by trial and error until it gives you what you actually got in your first eye. Then use that A-constant to do the prediction for the second eye with the measurements for the second eye. Or, you can just use the error from the first eye with the best formula and apply it to correct the prediction on the second eye.

The A-constants for both Tecnis 1 and Eyhance were recently updated by J&J to 119.39 and they now prefer doctors to use that in calculations for best accuracy. Also, the expected outcome is a spherical equivalent.

This is the RBF3 result for my operated eye

19.00 0.61

19.50 0.27

20.00 -0.07

20.50 -0.41

21.00 -0.76

Kane formula

22.5 -1.64

22.0 -1.29

21.5 -0.95

21.0 -0.61

20.5 -0.28

20.0 0.06

19.5 0.38

Original iolmaster

barret II (TK in parens)

21.00 -0.78 (-0.76)

20.50 -0.43 (-0.41)

20.00 -0.08 (-0.07)

19.50 +0.26 (+0.27)

19.00 +0.59 (+0.61)

19.88 0.0 (20.06)

They are pretty consistent. The doc says this should still change as the healing isn't complete. I found some studies done on corneal thickness during healing, there are also other factors but it takes about a month to get back to normal. I'll just sit tight and take it easy, It may not hit zero, but hopefully it will still be a lot better.

There's at least this study "Central corneal thickness changes following manual small incision cataract surgery versus phacoemulsification for white cataract ".

Looks like i had the wrong K1/K2 for the kane formula for OD, so it's predicting +0.1

22.5 -1.60

22.0 -1.25

21.5 -0.91

21.0 -0.57

20.5 -0.23

20.0 0.10

19.5 0.43

It would seem the Kane forumula was the closest to what you actually got. I make your outcome to be +0.375 D. Kane predicted +0.06 for the 20 D. So it is predicting 0.315 lower that actual. My thoughts would be to base the second eye on the Kane formula but with it, target 0.3 D lower than what you want to end up with. In other words target -0.3 D and hope for plano.

Would be useful to understand where the failure in calculation comes from to make useful conclusions about it.

I should've just ran with the original plan of 20.50 eyhance, but i said to the doc at the last minute the worst outcome is to need glasses for all my visual use cases so she picked the tecnis1 at 20.00 because it predicted closer to plano. So now i need glasses for every visual use-case because it's not sharp at any distance because it's hyperopic. Driving vision and general outside vision is ok, but smaller detail and indoors you can tell it's not quite up to snuff.

I'll just hope it still settles somewhere closer and then figure out what's the next plan for me. Once I get off the cortisone drops the eye probably also improves a bit. I have some fibrosis also on my capsular bag already visible on inspection, that may also affect my refraction somewhat as it possibly adds some thickness to the lens.

It is fairly common for surgeons to modify the A-constant to reflect their own personal experience. Each surgeon may have procedure factors that impact the front to back position of the lens in the capsule. That distance is critical to the actual outcome. Some formulas allow for a surgeon factor, while others leave it to the surgeon to enter a surgeon specific A-constant.

Which was used in your surgery, MSICS or phacoemulsification? And how advanced was your cataract? It is interesting that msics (manual small-incision cataract surgery) appears to create less damage than the ultrasound technology, at least in the short term. These findings support the various articles I have read about surgeons preferring to use MSICS. And if corneal thickness affects visual acuity in a normal eye, I wonder if this additional thickness post surgery contributes to better initial results compared to when the eye heals?

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The group who underwent phaco had significantly higher corneal thickness than the group who underwent MSICS (p< 0.008). Three months after the surgery, however, MSICS patients’ endothelial cell loss was 11.8%, while phaco patients’ endothelial cell loss was 15.8%, an insignificant difference (p< 0.111).

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A comparative study of MSICS and phacoemulsification on moderately hard cataracts found a 5.33% increase in corneal thickness (a 28 micron increase) and cell loss at 6.32% in the MSICS group and a 10.4% increase in corneal thickness (a 53 micron increase) and cell loss at 8.2% in the phaco group [15]. In addition, the white cataract patients lost endothelial cells at 11.8% and 15.8% post operation in the MSICS group and the phaco group, respectively. Cell losses were higher than those found in other studies due to the different degrees of white cataract hardness, ranging from moderate to high at NS 4+ levels. In cases of very hard cataracts, higher ultrasound energy is necessary, which can also result in higher corneal cell loss.

Good for you! Getting three estimates to fix a hopefully one-time (chance) problem is extremely important. I did it simply because I found that a lot of surgical centers and surgeons' partner with one lens company and only promote those products. Pure monofocal is the safest route to go for least amount of risk and best outcome.

These are calculations derived from a number of variables associated with outcomes over numerous cases. It still isn't exact science because those calculations do not factor for your individual variance or variability, yet. Yes, we each are truly unique! It also doesn't ensure that things go as planned in the surgery, implantation, or healing.

I am 3 days post eyhance surgery both eyes. Targeted plano in dominant eye and -1.00 in non dominant. My vision is incredible.

I read my ipad at about 12 inches, exactly as i did prior to surgery.

My intermediate vision is perfect. For the first time in years i am able to actually see my toes while i cut my toenails. I can see my face up close and also further away from a mirror. My distance vision is great. When i cover my dominant eye i can tell that my vision is not as clear in the minus 1.00 eye, as planned. When i try to read from the plano dominant eye, i need to hold my ipad in my fully outstretched arm (about 24" as i am tall with long arms) in order to read. I couldn't have asked for more.

I am still adjusting to what feels like a very strong new prescription first thing in the morning, but that feeling dissipates as the day goes on.

Prior to surgery my distance vision was 20/50 or worse and beyond further correction due to cataracts. I read without glasses as i have all my life. I have mild astigmatism 0.75 d corrected at least partially by lri at time of surgery.

Hope this helps others as i have been helped.

When I was discussing the target for my eye with the surgeon before surgery, he said that he was going to do his very best, but despite all of the scans and measurements, that it was not an exact science. Strangely enough, that comforted me.

I'm expecting phaco. The cataract was a PSC, bad enough that it needed surgery so some capsular bag polishing was also performed.

My left eye was operated on friday. 20.50 ZCB00 lens targeted about -20-30, it's now 3 days post-op +0.25S +0.25C, but like my previous eye i'm expecting sphere to drop by -0.25 to zero. My right eye is currently +0.50S +0.25C (was +0.75 post op). It's been stable for a bit over a week. I still have some corneal swelling on my right eye (which I can clearly see as a distortion) so the refraction can change for the better (I hope) while healing proceeds.

Both eyes are anycase done, any 'fixes' for my refraction until ~3 months are done using glasses. I'll then see where the right eye is and figure out what to do with it. If we'll do a lens swap then the doc said it can be done at 3 months. It's likely also possible i'll get a SMILE tweak on it, which is a lot safer and more precise than lasik. But that maybe best left done after a YAG if that's needed? Anycase, i'll ask about these during my final post-op in a month if there hasn't been any movement in my right eye.

expecting = suspecting, most likely

It has been a while since I have done my research and two laser clinic consults. But, my recollection is that SMILE makes larger corrections than Lasik, and it requires a thicker cornea. And the other issue is that it is much harder to increase the steepness (move you in the myopic direction) than it is to flatten the cornea.

Here's hoping!

You maybe correct. LASIK opens your cornea more i think which increases the chances for a dry-eye syndrome and I tend to have pretty dry eyes. I'm not also very enthusiastic of fixing this with a sulcoflex, which was something the doctor also offered as an option. I need to look at my options carefully. She's a pretty skilled surgeon, but i'm not liking my options. 0.5d of hyperopia is clearly too much. +0.25 is barely noticeable (which is my left eye 4 days post-op).

There is also PRK which I think may be more suitable for thinner corneas. It is also used for those in contact sports as it is less fragile than Lasik. There are a couple of other variations called Lasek and EPI-Lasik. It did not look into those.

Posting an update, my left eye was targeted for ~-0.24-0.31, it was hyperopic at +0.25 / +0.25 in post-op checkup, but it's been gradually improving and it's been occasionally visiting plano. Now it's been more stable at plano for a while and everything is sharp on the left eye. I hope it stays here and this is not just some dream or tease that will be yanked away.

Right eye is still hyperopic and doesn't seem like there has been much movement since it was last measured in the left eye post-op. The right eye feels strained, maybe it needs some further treatment. Having a call with the surgeon tomorrow.

The experience with the healing of the left eye has been quite different to the right eye, but it's still early in the game. I feel massively relieved that at least one eye seems to be turning out good.

It appears you are getting the refraction done by an ophthalmologist. They use positive cylinder for astigmatism. Converting to standard optometrist negative cylinder is a little tricky. This converter:

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Eyeglass Prescription Positive Cylinder Conversion calculator

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Would seem to convert your prescription to:

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Sphere: +0.50 D, Cylinder: -0.25 D

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That would be a spherical equivalent of +0.375 D

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Not ideal but it could be worse I guess.

It was done at the eye clinic. But just to be clear: that eye that refracted +0.5/-0.25 post op seems to be very close or at plano (by my own subjective measure) since everything's very sharp with it and there's a clear difference to earlier. It's been pretty stable there for the evening. It took ~3 weeks to go from that to what it is now.

Conversely, the right eye has been +0.75/-0.25 the whole time, not much has changed in 5,5 weeks. I'm wondering if there's actually something wrong with it that can be treated, since it's also a bit symptomatic. The left eye feels 'normal', while the right eye feels like 'it's there' in a way that is not normal. It's been a bit achy today. Not sure if it's tired eyes or something else.

You put "+0.25 / +0.25 " in your post. I read it as +0.25 Sphere and +0.25 Cylinder. Perhaps that was not what you intended?

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Yes being +0.75 sphere and -0.25 cylinder would be an issue. Perhaps a piggyback lens or a lens exchange....

0.25 / 0.25 was the original refraction i got from the surgeon post op for the left eye, which, as you said, converts to 0.5 / -0.25. I changed that notation in the second post. Sorry about the confusion.

And certainly the right eye is causing noticeable diplopia.

Your situation sounds very similar to mine. i thought plano was targeted in the first eye but with research, i found the target to be -.29 The surgeon is awful to communicate with and I am trying to determine the best lens for the second eye. I have a refractive exam set for next week.

This is just what I am experiencing now: that reading with one eye targeted at plano, I am only reading at about 24 inches. My distance vision is great, as good as I could ask for. But intermediate and close, I am not happy with.

Did you wear glasses prior to surgery?

How do you feel adjusting? Headaches, dizziness?

That's very encouraging to me that you are having great results!

Thank you.

My surgeon targeted plano for my dominant and I ended up hyperopic to a degree that causes my sight to be blurry at all distances in my dominant eye. I wish she would've targeted below plano. My non-dominant was targeted -0.3 and it's skimming plano, it's not there all the time but sometimes. I'm hoping that's where my sight settles but my left eye is very good, my right eye gives me anxiety as hyperopia is not easy to fix with laser surgery. Probably ending up a bit myopic would've been a much better outcome as there are more options for fixing it.

Targeting below plano is a lot safer procedure to do, so I wouldn't scold the surgeon for not taking chances with your vision. My non-dominant is cutting it too close and it was also hyperopic for ~3 weeks post-surgery.

I am not scolding the surgeon for the target, but for not discussing it with me, but there has been no follow up with the surgeon, and I haven't been able to discuss the second target with the surgeon who does the calculations, only third hand. I've only had one eye done and want a refraction so I can know if the target was hit, but basically, they are refusing to do the refraction and telling me they only do the refraction after both lenses are replaced. I was willing to pay out of pocket for the refraction but they just wont do one. The surgery office also will not give me my chart. I asked 4 times and it's been more than 30 days. With such poor after care (I had an eye infection too), it's hard to have any trust in the surgery practice. I don't, so I am having an independent test done.