Unexplained IOL Procedure & Post Cataract Astigmatism

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I am a 63 yr old female.Had cataract surgery on both eyes one week apart in March. Doc discussed various visual outcomes and I told him my current vision was acceptable with reading and computer vision and only wore glasses for driving with minor correction. I said I wanted the IOL's that insurance would pay for. He asked me then if I wanted monovision, but did not explain to me what this was. Not knowing the difference between monovision and monofocal, I agreed to the procedure. You can imagine my surprise post surgery when one eye was set for near and the other eye for distance! Had he explained what monovision was, I would have never agreed to this, having tried several types of contacts several years ago for near and far vision. My optomitrist told me I wasn't a good candidate for these type of lenses. In addition to the monovision IOL's, my vision now is quite unacceptable. Pre-surgery vision was RT: Sphere -0.75, Cylinder -0.50, Axis 020, Add +2.50. LT: Sphere -1.25, Cylinder -0.25, Axis 060, Add +2.25. Post-surgery vision is now RT: Sphere -0.50, Cylinder -1.75, Axis 005, Add +2.25. LT: Sphere -1.25, Cylinder -1.75, Axis 015, Add +2.25. You can imagine my concern when my astigmatism (Axis) increased -1.25 in right eye and -1.50 in left eye. My dr said that my cataracts were ptobably masking this astigmatism?? I now have uncorrected astigmatism and double vision in both eyes. His options to correct this are either PRK or trifocal glasses I would need to wear all the time! Both options I would have to pay for. My questions are: 1) Can cataracts 'MASK' astigmatism pre-surgery or is this bull? I have read a lot about surgically induced astigmatism, but dr seemed put off by this suggestion. I know any kind of cut in the eye can increase astigmatism, but this much? 2) Do I have any recourse due to his lack of explanation of the monovision procedure? If he had explained this procedure to me, I would have shared my prior experience and told him this was NOT acceptable.

Anyone else with a similar experience? I plan to get a second opinion from another opthalmologist this next week.

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  • Posted

    Hi, am 63 too and had cataract surgery in February. 

    There are a couple of differences between what our doctors conversations with us were.  First I was told that I had astigmatism and that would be corrected.  I was asked by what type of vision was important to me - and I said close.  Because I knit, I cook, I read and am on the computer.  If I had to wear glasses I would have preferred it for long distance cos then I could wear prescription sunglasses for long distance right?  Not that I was expecting to wear glasses because I was toldby the doctor  I would not need any.

    I'm not an expert.  Am on here to find answers too because I have terrible night vision problems.  My only advice would be to seek more opinions which is what I am doing now.

    Best of luck

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  • Posted

    Actually, I think that most of your bad vision issue is due to the high astigmatism introduced in both of your eyes due to the cataract surgeries. No, the cataracts would not have masked this much astigmatism. They could have masked a small part of the regular astigmatism, but may have even causing some irregular astigmatism which is not there any more.

    Actually, looking at your eye prescriptions, the difference in the 2 eyes is on the lower end of even mini-monovision (which can be a difference in the eye spherical prescription from -0.75 D to -1.75D) and monovision (from about -2.0D to -3.00 D). If he was really trying to achieve monovision, he failed on that account also (which is good for you). That much difference in the eye spherical prescriptions can be introduced even by a surgeon not trying to achieve any amount of difference. In any case, by itself (without the astigmatism), you probably would not have had any difficulty in adjusting to it.

    So, the main question for us is to figure out how to deal with your astigmatism. LASIK enhancement is one way to achieve it, but means more money to be spent.  The trifocal glasses is obviously another option (assuming that your corrected vision is good). But, you should at least consider trying a pair of bifocal glasses with the appropriate asigmatism correction in both eyes, a spherical correction of -0.50 in both eyes (instead of -0.50 and -1.25) and adding only +1.50 for reading (instead of +2.25). This will take advantage of your slight difference in the eyes (even though you did not want it). You may find that this is easier to live with.

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    • Posted

      Thank you for your thorough reply. My optometrist did prescribe some lined bi-focals for me for near and distance to wear so I can see to read and drive, but they won't be good for me long term, as I have nothing for my intermediate vision. Progressives prior to these glasses were worse. I will ask about the RX you suggested on my next visit to the optomotrist.

      I asked my doctor about LRI to correct the astigmatism and he said the results would be inconsistent at best. I've learned quite about about these procedures through reading, probably more than I'd ever want to know! I guess I just trusted his experience.

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    • Posted

      With your eye prescription, a LASIK enhancement will be a much better solution for your astigmatism than LRI. Even if LRI corrected your astigmatism perfectly, you would end up with a spherical correction of about -1.5D for the right eye and about about -2.25D for the left eye. Thus, you will be nearsighted with a good vision from about 16 to 32 inches (with a slight mini-monovision, but will need glasses for distance vision.

      A LASIK enhancement on the other hand, will not only correct the astigmatism, but also let you correct the spherical prescription to your desired value. Most of the LASIK surgeons would do further correction, if needed, free of charge. (just for your information, I needed LASIK enhancement in both of my eyes after cataract surgery  and am very happy with the results)

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    • Posted

      OK, so this morning my cataract surgeon's office called with their best-decision to remedy my poor eyesight.

      1) They would like to do YAG on my left eye (right eye done 2 wks ago), then

      2) PRK surgery both eyes for distance and to correct astigmatism. I would need glasses for near and intermediate vision.

      I am wondering if I should still seek a second opinion for correction options?

      Thank you in advance for your insight.

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    • Posted

      That is a good plan. PRK should give you results similar to those provided by LASIK. There are slight advantages and disadvantages of the 2 procedures depending on the individual, but the surgeon is in the best position to judge that.

      The only additional suggestion I have is not hold the bad experience which you had with monovision with the contact lenses (which required a difference of about 2 to 2.5 D between the 2 eyes) against trying a small amount of mini-monovision (with a difference of about 0.75 D between the 2 eyes). You can easily try that with the bifocal glasses per the prescription which I had suggested earlier. If successful, you can then similar difference with PRK, which will allow you to not require glasses for the intermediate distancess. You will then need them only for reading.

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