Wrong correction Cateract surgery

Thank you for replying, my new perscription is od +1,75-1.25x0.80 in right untreated eye and OS -0.50 -0.25x120 in operated left eye. My unoperated eye is so much clearer than my operated left eye I am hesitant to get the other done now. I guess I thought my left eye would be set for distance. At least that is what we discussed, but didn't turn out to be clear for upclose or distance.

That is a bit puzzling. Technically without glasses you should be seeing better with your left treated eye than your right untreated eye. On a spherical equivalent basis which is an estimation of total correction converted to spherical only (by adding 50% of the Cylinder to the Sphere) you are at:

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OD Right: +1.125 (far sighted)

OS Left: -0.625 (near sighted)

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This should give you better vision at distance in the left eye only, compared to right eye only.

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Looking at sphere only, as I assume you got a non toric lens the -0.5 D near sighted outcome is not all that uncommon. Determining the correct power is not a perfect science. Statistics show that only in 70% of the surgeries is the outcome within +/- 0.5 D. You unfortunately ended up at the limit of that expected outcome. In hindsight an IOL power of +20.5 should have been used. That would have reduced your sphere error from -0.5 D to -0.125 D. The next lowest power of +20.0 D would have pushed you into the + zone where you do not want to be.

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All said this is not a terrible outcome. If your left eye remains stable at this degree of near sightedness you could get a Lasik touch up which should reduce the myopia to near 0.00. But, I am not sure I would jump into that as it is expensive, and it may contribute to a dry eye side effect. Instead I would get the other eye done but with the assurance from the surgeon that they will not miss the power on the second eye. They should have learned from your first eye what caused the "surprise" miss. And assuming they get you to the perfect window of -0.25 to 0.00 D, your vision should be as good as it gets with the second eye. You will want to ask about residual astigmatism predicted. If it is -0.75 D or more it would be worthwhile considering a toric lens. Your eyeglass prescription of astigmatism is not that high however, and with just a non toric lens it may well come down to a very low amount like your left eye did. Your surgeon should have an accurate prediction of what it could be.

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With one eye corrected for full distance and the other eye mildly myopic you should have a good outcome for distance vision and a somewhat improved nearer vision from the myopic eye. With a monofocal lens like the Clareon you will still need OTC reading glasses or progressive prescription glasses. Suspect you could get away with reading glasses only.

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It is unusual that you should be experiencing glare with the IOL eye. I would expect the cataract eye to have more glare. You should ask at your next visit for them to check the position of the IOL to make sure it is centered and not tilted. They should do that without you asking though.

Thank you for replying. It sounds like they missed it but not by much. I checked out at 20/25 the day of the surgery. I have had a stroke and am subject to balance problems so that might contribute to my discomfort. I will wait and see what the doctor says on follow up! Thanks

I'll agree with Ron that your prescription would be considered a fairly good outcome by most surgical standards. I'm wondering if it will take your brain a bit longer to adjust to being slightly nearsighted since you've been far-sighted your entire life. Give it another 6 weeks and see if it improves. If possible, I'd wait on the 2nd surgery until the issues/complications associated with the first one can be identified.

Most people wouldn't bother getting glasses with a prescription as low as in your left eye and they'd still be able to see clear enough to drive. I'm surprised the glasses make a big difference.

Thanks Greg, I had a stroke 3 years ago with no problem to my eyesight. I had to get glasses for my right eye anyway so I got a new perscription, since my stroke I am very cautious. I think the plan was to set my left dominant eye for distance and maybe the right for intermediate, I actually feel like I got the worse of both worlds, I don't see well close up and my distance is not great either. All of my friends talked about how colors now look vibrant, but everything is fuzzy to me. I am cautious now about getting the 2nd done.

Colours should be vibrant looking compared to the cataract eye. And with a -0.5 D outcome objects at distance should still be pretty sharp. It is certainly something to raise with the surgeon when you see them next.

If that eye glasses Rx is accurate for your left eye with the IOL thats actually a very good result since the IOLs come in 0.5D steps so it can always have an error up to 0.5D and they usually for distance target -0.25D rather than 0 since they want with that possible 0.5D error to avoid going positive farsighted. Also your cylinder result is excellent at -0.25D since often the residual astigmatism is higher than that like -0.50D to -0.75D. So that should give you very good distance vision uncorrected in the left eye, if not 20/20 at least 20/25 I would think. If not it may be due to some other issue only a full eye exam might detect or your eye still may need more time healing.

Thanks Nighthawk, I guess where I am confused is I was suppose to be able to see clearly at a distance. I can see much better at a distance with my right eye, which has not been operated on, but not as well close up. If the same thing happened on my right eye than I would have poor distance vision in both eyes. Maybe I should be happy with my right eye.

Remember that we can only estimate what you should be seeing based on your eyeglass prescription. Only you see out of your own eyes and that is what really counts. From what you are describing there must be something going on that is reducing your vision that is not the result of the lens power being slightly off. I think about all you can do is report what you are seeing to your surgeon and ask for an explanation. I agree with @Night-Hawk. You should be seeing at least 20/20 and perhaps a touch better with the operated eye. And for sure at distance you should be seeing better than the eye that is further off and has a cataract. Be sure to tell the surgeon about that.

I don't see colors as more vibrant with my surgery eye, just a bit more blue ish . So you can't count on vibrant colors.

That may vary from person to person based on the specific nature of their cataract. With my first eye I was seeing a very orangish colour instead of bright whites. When I had it done, it made so much of a difference that I found my TV to be too bright and so saturated it seemed unnatural. I switched the colour mode from Vivid to Normal and it looked much better. But, on my second eye, which was not as bad when it was done, I really did not notice much of a difference.

I am still confused, I started my surgery with +1.25 in each eye. After surgery I am -.50. Should I see better distance in the operated -.50 eye or the unoperated +1.25 eye. Thanks in advance, this is confusing to me!

Has the after surgery -.50D in each eye been confirmed at an optometrist? If not, that could be only the target, but the end result could be significantly off from that after healing of the eyes after 6-8 weeks. Also there could be new residual astigmatism as well that would complicate the result.

I had only the left eye operated on so far. I went from +1.25 in both eyes at first now -.50 in left eye only and still +1.25 in unoperated eye. I had two different optometrists cofirm that, they both reached the same conclusion. I didn't get toric lenses so I assume the doctor didn't see a problem. I am not sure what I gained from the surgery

Sorry I meant both eyes were +1.75 before surgery.

I am not sure what you are currently at in the un-operated eye? +1.75 or +1.25. But in either case a -0.5 D after cataract surgery should be better.

I think what I am confused about is should the-.50 be better for distance or the +1,75 is better for distance, I don't know anything about this except what I am reading, I read that a negative sign means nearsighted and a plus means farsighted. The optimitrist thinks I am 20/40 in my eye that was operated on. Should I be seeing distance better in my -,50 or my positive 1.75 unoperated eye? Thanks!

At the end of the day, only you can see what you see. All I can comment on is the numbers and what they should indicate. If your non operated eye needs a +1.75 D correction to see well in the distance, then you should not be seeing very well at all without that correction. I am think it would be about 20/125, especially if there is a cataract in play.

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On the other eye if you need a -0.50 D eyeglass correction to see well at distance, then you should be seeing not all that bad without any correction. I would estimate about 20/30 or so.

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That is a big difference between the eyes without eyeglass correction. You are comparing the eyes without eyeglasses I assume?

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I think perhaps what you may be asking is whether a +0.5 D (far sighted) prescription indicates an eye with better vision than an eye with a -0.5 D (near sighted) prescription. The answer to the best of my knowledge is that for distance vision, they will be essentially the same at about 20/30 on the Snellen scale. However, for closer distances the -0.5 D eye will be better than the +0.5 D eye.

Maybe I can get it. So even though I am farsighted in my +eye I am still getting a correction for distance not close up with my eyeglasses. My last eyeglasses got me to 20/20 on both +1,75 eyes. So it all refers to distance, not to reading. Thanks

I am afraid I am not quite following your thinking. The objective with glasses is to bring you to 20/20 or better for distance regardless of where you are without glasses. If you are of cataract age, most people will also be suffering from loss of close vision, and for that reason get progressive glasses to allow them to see at closer distances. When you are wearing glasses it does not really matter whether you were +1.75 or -1.75 before you put glasses on. Both will be very poor for distance without glasses, but both should be very good once you put the correct prescription glasses on.

Stupid question but does being far sighted mean you see better than 20/20 or does Snellen degrade the same way on either side of 20/20? Wondering if you're just used to 20/15 so 20/30 seems worse by comparison? Then again if you have cataracts I'm sure you're not seeing 20/15. And you got a monofocal so I'm sure it wasn't a refractive lens exchange. I wonder if there is some issue other than the refractive error that's causing the blur?

You can get a good idea of what being far sighted is like if you look an IOL defocus curve. A natural lens will have some accommodation if you are younger, but as you get older that fades toward what a monofocal IOL is like. Visual acuity drops off fairly quickly in both directions.

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Yes, I think if one compares +1.75 D and -0.5 D without eyeglass correction and you see better with the +1.75 D eye, then something else must be going wrong with the -0.5 D eye. It is possible that the +1.75 eye may see ok really far away, like looking at the moon at night, but not so much at the standard 20 feet distance for vision.

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I wonder about the origin of the term. A myopic person usually has a longer eye and the focal point falls short of the retina - short sighted? A hyperopic person usually has a shorter eye and the focal point falls behind the retina - far sighted? Not sure.

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In a natural lens perhaps hyperopia can be tolerated to the extent that the eye has accomodation and that ability reduces with age. Again - not sure...

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But for sure with an IOL the visual acuity drops off fairly quickly in both directions away from emmetropia.

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I also think the term far sighted may be coloured by the use of the term to describe someone that looks ahead into the future, and it is seen as a positive attribute. Not so sure it is, when it comes to vision.

Your post prompted me to dig a little deeper on visual acuity for a person that is far sighted or hyperopic. In my previous response I floated the idea that with "a natural lens perhaps hyperopia can be tolerated to the extent that the eye has accommodation and that ability reduces with age."

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I found some reference that suggest someone with as much as +2.0 D hyperopia up until the age 40, may see the 20/20 on a Snellen chart at 20 feet. As they get older and lose the accommodation ability they start to drop off on the 20 foot chart, and I suspect the near vision gets worse sooner than someone that is near sighted. So I learned something. My earlier estimates in this thread of vision being as bad as 20/125 with a +1.75 D eye, is likely way off, especially for a younger person. And, I am not sure how much that changes with age in an older person. Perhaps it could be reasonably good, but when one is old enough to need cataract surgery, I suspect it can't be close to 20/20.

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But with an IOL at -0.5 the snellen equivalent should be much more predictable and around 20/30 or 20/25.

I went for my post surgery checkup. I now have 20/40 on my operated eye. The nurse told the doctor I was unhappy with the outcome.The doctor proceeded to tell me in his experience only unhappy people are unhappy with their surgery. Also, it was my eyeballs fault that I didn't have great vision and I went with the cheap government issued IOL instead of premium. Anyway, I am not rushing to have the other eye done, since I have 20/50 in it, not a lot worse than the operated on eye.

That was very uncaring and unprofessional remark your doctor made. You should see someone else.

"The doctor proceeded to tell me in his experience only unhappy people are unhappy with their surgery. Also, it was my eyeballs fault that I didn't have great vision and I went with the cheap government issued IOL instead of premium."

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I would have walked out of the office at that point. Time to get a new surgeon. I would not let this one touch your second eye.

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The Clareon lens is not a cheap inferior lens. They are as good as IOL's get for a monofocal lens. If your vision is at -0.5 D that is a miss in power, but not a big miss. A +20.5 D lens would have brought you closer to 0.0 D and would likely have been the correct lens for you. However, you should be getting better than 20/40 vision with the lens you have, so there may be other issues at play. I would wonder if there is some astigmatism? Your optometrist should be able to tell you if you have any in this IOL eye now, and whether or not there is any in your other eye to be concerned about. If there is something to be found in your surgeon's comment, it might be that you needed a toric lens to correct astigmatism which would have a premium price, and it was not considered for some reason? I am not sure Alcon is making a toric in the Clareon line yet, but they have the AcrySof IQ Toric which is a good lens for astigmatism.

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I would suggest it is time to get some other opinions and select a new surgeon for your second eye. If distance vision is your priority there is nothing wrong with another Clareon lens for the second eye, but this time the surgeon needs to be more accurate with measurements and calculations. Just be sure you get a toric if one is required and you want to be eyeglasses free for distance vision. If you are going to wear glasses then a toric is not really necessary.

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Not sure how accurate or dependable it is, but Newsweek published a list of the highest rated ophthalmologists in America. Google this to find it, and see if there is one close to you. These are US only so, if you are not there, then it is of not much help.

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Newsweek America's Best Eye Doctors 2022

WOW. That is unbelievable. How incredibly unprofessional and insensitive. I would 100% be filing a formal complaint. In Canada doctors are regulated by something called Colleges… like… The College of Physicians and Surgeons of Ontario or whatever. I would look for the equivalent organization where you are and file a complaint. Treating patients like that is wholly unacceptable. It won't amount to anything since no physical harm was done but I'd still file a complaint. Also 20/40 is objectively not a good result. That's not just you being picky. And even if you ARE picky, doctors are supposed to LISTEN not insult and diminish.

I am in the US and the doctor was connected with the University here. I did find out that I have a small macular pucker in my 2nd eye and that might be helpful to tell the new surgeon. I will change surgeons for sure! Thanks for the response, now I know I am not crazy!

My surgeon and also my wife's is an Associate Professor at our provincial university. While I believe he did a good job on the first three of our combined eyes, I am not totally happy with my second eye. I feel I did not get sufficient time and information before making a decision on it. I would not recommend him if I was to be asked for a referral. On the other hand, I think one has to keep in mind that cataract surgery is a very small slice out of their time per patient. They handle a lot of patients and do not always allocate the necessary time to each, especially for the more complicated cases. Most also are only trying for vision with the assumption glasses will be used to cover for their misses. More time and care is required if one is trying to be eyeglasses free.

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On the macular pucker I think @Sue.An2 may have something similar. You may want to send her a message or check some of her posts. She may be able to give you some advice on what reasonable expectations are with the condition. It is something I have no experience with...

More time and care is required if one is trying to be eyeglasses free.

Hi Ron, what exactly would the surgeon (or his staff) do if they had the extra time and care? More measurements? Try different formulas? ???

If it can make a difference between glass free and glasses or—even more dramatically—between a decent outcome and a major refractive surprise I suspect that many would be pay for that extra care.

I am no Bill Gates, but the cost of glasses alone for the next 20-30 years would justify it for me.

Getting astigmatism corrected is not necessary if the plan is to use glasses full time. Correcting for astigmatism requires extra measurements, and ideally an estimation of surgery induced astigmatism. Extra measurements cannot hurt, but the cornea should be stable over time compared to a lens with a cataract. Yes, I think at least a couple of formulas should be used and the results compared. My brother is seeing a surgeon that seems stuck on using the TK version of the Barrett Universal formula. I am not convinced that is the best formula, and I think he missed by one power step on the first eye he did. The outcome may be worse for the second eye. In comparison I believe the Hill RBF 3.0, the non TK Barrett Universal II, and the Kane formulas are better. Hill RBF 3.0 may be a the best as it is based on artificial intelligence and is being updated as more and more data has been fed into the AI calculation. Ideally one would like to see them all giving the same recommended power. I used all three of those formulas with my brother's eye measurements and they recommended the same power lens, which was different than the Barrett TK. I think it is fair to ask the surgeon to show you the recommended power using different formulas and then justify which one they believe would be the best if they differ. This is fairly easy to do with the IOLMaster 700 instrument and software.

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In my case I don't think the surgeon spent enough time showing me what the toric lens could do for me compared to the non toric. He would not commit to it being of any benefit to me, but when I was seeing double images after surgery due to astigmatism he offered to exchange the non toric for a toric. I was not pleased. Why didn't he tell me that before the surgery?

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The ORA System may have some additional accuracy benefits but I have not done much research on it, as my surgeon did not offer it. One concern would be that it not only measures refractive outcome in real time, but it would also require a lens exchange in real time if the outcome was not correct...

I just noticed that you have said your eyeglass prescription for your operated eye has a -0.25 D cylinder (astigmatism). If that is correct there should be no astigmatism issues causing poor vision.

Cataract surgery still has a lot of variables like the IOLs come in 0.5D steps so there is up to 0.5D error just from that. Also each eye heals differently and can end up with some error especially residual astigmatism from that.

I think the only way to get a near perfect outcome for a particular target is with the new type IOLs that can be adjusted after surgery with UV light.

Ron

You are exactly right when you said cataract surgeons don't spend enough time with patients and they assume most patients will want distant vision and eyeglasses will fix everything else. That is also how it is in the USA. I have read that Medicare reimbursements (which most Americans over age 65 have) have decreased over the years, so many (but not all) doctors aim for a high volume of patients. For a patient to get that "extra time and care," a patient has to very assertive or find another doctor.

I looked at my operated eye's perscription from a year ago and I had about the same -0.25 before the operation. My right unoperated eye has more at -0.125. I will ask about a toric for my 2nd eye. I keep thinking about the phrase measure twice and cut once. I think they rushed the measurements.

Lynda I agree, I think the doctor was paid less than 500.00 by Blue Advantage for the surgery. I believe the doctors are already mad, thus the rude behavior.

Keep in mind that astigmatism required for eyeglasses prior to surgery is not necessarily a prediction of what you may have after cataract surgery. If the astigmatism is in the lens, that part will be removed during surgery, and the astigmatism caused by the lens will be gone. The measurements of the cornea that they take should tell them how much astigmatism can be expected after surgery. That amount is what you have to consider when deciding on a toric or not. In general predicted astigmatism of less than 0.75 D is not considered enough for a toric.

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Your outcome for your first eye with respect to astigmatism is very good. It is hard to get astigmatism down to as low as 0.25 D.