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Wrong iol implant for cataract surgery? Want my near vision back!

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Carolyn7171
Carolyn7171

A month ago I had cataract surgery for my right eye with a single focal implant for far vision.  I did not realize I would lose near vision focus until, alas after the surgery was over.  About 95% of my life consists of near vision work, computer, reading, artist work, etc. I never had to wear glasses for close up or computer work before whereas I have worn glasses for distance driving for 40 years and have no problem continuing to do so. (Now I am left with blurry vision for even the simplest close up chores.  I don't know what to do to correct this and what Imy options are for the  left eye which also needs cataract surgery. I was told I wasn't a candidate for multifocal in my right eye since I have a macular pucker but it is probably an option in my left eye.  Haven't been able to get a clear answer from the surgeon as to the alternatives so I am going to be researching finding a new surgeon for the 2nd eye and possibly to correct the first (before I go nuts trying to see my paperwork and computer!) Any insights most appreciated! Thanks in advance.

0 likes, 15 replies

15 Replies

  • Macjazz
    Macjazz Carolyn7171

    Posted

    I had cataract surgery this past summer. The doctor laid out the options beforehand, in particular the choice between correcting for good distance vision (at the expense of close-up vision) or correcting for good near vision (at the expense of distance vision).  With glasses to be worn for whichever distance would then be less good. I was not a good candidate for multifocal lenses, so I chose distance vision - the end result was that I now have very functional distance vision, and adequate near vision (I'm able to both drive and read without glasses for either).  So the doctor hit a nice happy medium there. I do have bifocals for reading and distance, but I almost never wear them.

    The third option he presented was to have one eye focused for distance and the other focused for reading.  He said that some people find this a good solution while others find it hard to adjust to. He suggested the possibility of a trial using contact lenses to see how it felt to me, if I were to chose that option (one near focused and one far).  So this could be one potential solution.  Good luck! 

    • Carolyn7171
      Carolyn7171 Macjazz

      Posted

      Thank you for this reply! I am glad for you that your surgeon found such a happy alternative you and thought it would be the same for me.  I don't know whether there are any sensitive gradiations between the intermediate and long distance lengths.  I've heard of the monofocal option, it's good one can try it out with contact lenses.  I'm wondering whether this surgery and IOL is ever exchanged, or whether an adaptation can be done.  I read that whereas the first surgery is easy, subsequent surgeries are much more risky. i so wish I could turn the clock back to before I had this done! Thanx again!
  • diane97793
    diane97793 Carolyn7171

    Posted

    its pretty sad that a doctor can't specifically say you have to choose whether you want close vision or distance you can't have both.   The same thing happened to my sister in law . She had to find out when its too late.  The secibd  eye you should tell the pysician you want close vision.   I have close vision in one eye ( it was suppose to be distance but didn't work out that way, so my second eye i went to another surgeon and got distance, they work well together. 
    • Carolyn7171
      Carolyn7171 diane97793

      Posted

      Thanks Diane. I have heard that combo can work together, but not for everyone.  I am glad to hear yours work well together. I've also heard fhat for some reason makes a difference which eye is distance and vice versa, most I've read saying the dominant eye should have the distance vision...but I don't know why. Or how to tell which is my dominant eye. And t if that's done in reverse, is that a big problem I wonder? (Guessing mine is in reverse but not sure, just beginning to research)
    • softwaredev
      softwaredev Carolyn7171

      Posted

      When one eye's vision is clouded by a cataract it can switch the dominant eye to be the clear one, regardless of which eye would be naturally dominant if both eye's were clear. I seem to recall reading that even though surgeons perfer to make the distance eye the dominant eye, that it really doesn't seem to be that bit a deal to do it either way, that most people can adapt. Its unfortunate that more doctors don't have patients try monovision in contact lenses before cataracts hit so they can decide if they like it, and to see which eye they prefer for distance and how much monovision to have. 

      Its too late now, but you mentioned your first eye wasn't a candidate for a multifocal. I suspect you could have considered a Crystalens as an option in the first eye since it is a single focus lens, but has the possibility of giving some better intermediate&near, although not as much near as a high add bifocal.

      There are many people who have one eye with a monofocal and the other with  a multifocal (or Crystalens). Your profile describes you just as living in the "northeast" so I'm going to guess you are in the US (this is a global site, it could for instance be the northeast in the UK, but the odds seem lower). That matters because there are more options outside the US that aren't approved here  

       The multifocals currently approved in the US are all bifocals. The older bifocals tended to give good distance vision and very close near, with a bit of a drop off in intermediate vision. Last year they approved new lower add bifocals that are focused more at intermediate distance, with not quite as good really near.  So you'll need to decide which distance is most important for you    if you consider a multifocal. The new lower add bifocals tend to have lower risks of visual artifacts like halos and glare when driving at night (though there is some risk even in a monofocal of those issues). Overall I tend to hear better things about the Tecnis lenses than the Alcon lenses, but which one is best may partly depend on what distance you prefer, they have different adds.

      Multifocals do split the light for different focal points, so there can be some reduction in vision in dim light. Ideally people would try multifocal contacts before they get cataracts to see if they work for them (though their optics aren't as good as a multifocal IOL), I was happy with them before I got my cataracts. The new low add bifocals seem to also have better contrast sensitivity (vision in lower light) than the high adds.

      To me intermediate vision was more important than really close near since it includes computer distance, most social distance, and household tasks, when out hiking/running the trail ahead of you (e.g. rocks/ice), etc. The new low add bifocals weren't available in the US when I had my surgery.  Thats why I initially planned to go to Europe for a trifocal which is good at distance, intermediate, and near and then just before I got my surgery the Symfony came out and I went to Europe  for that   (slightly better than a trifocal at intermediate, perhaps not as good at near, and low  risk of visual side effects comparable to a monofocal). They are available in Canada as well now. In my case I had my surgery at age 52 so I figured I have more decades to live with the results than the typical cataract patient so I decided it was worth the effort to travel to get a better lens.

  • peter1110
    peter1110 Carolyn7171

    Posted

    No expert, but I believe your options may be: have lasik done to modify the prescription or have a lens exchange performed. Also, as you may know, you could have the left done, so you can see up close, which would give you "mono-vision", one eye for distnace, one for close up. It's what my wife opted for and she's able to do without glasses.

    Glad to hear you don't seem to have any of the annoying visual aberations a lot of us on here are suffering with.

    Good luck. 

  • Macjazz
    Macjazz Carolyn7171

    Posted

    I've read that in some cases inserting  a second lens over the first one, as an adjustment, is an option - easier surgically, I think?  Don't know if that would apply to your situation.  Or - as mentioned - replacement is possible, or lasik surgery is sometimes done to further correct vision.  So at least options do exist, even if it's a big pain in the neck. 
    • softwaredev
      softwaredev Macjazz

      Posted

      That is often referred to as  a piggyback lens. There are different risks with piggyback lenses or lens exchanges, nothing is risk free. It   seems to vary with the surgeon and the patient what they recommend to change the focus of an eye after catarct surgery,  those options or   laser adjustment (PRK is preferred by some over lasik for post-cataract surgery minor tweaks).
  • georgia10706
    georgia10706 Carolyn7171

    Posted

    I am encouraged to hear that alternatives are available for someone unhappy with their cataract surgery.  I don't understand why doctor's tell their patients their eye sight will improve but don't ask the patient what their lifestyle needs.   Please let us know what you decide to do.  Thank you.
    • Carolyn7171
      Carolyn7171 georgia10706

      Posted

      That's a mystery to me, too, Georgia. I'm going to seek another surgeon for the second eye's cataract surgery and will ask advice about this one which was operated on at the same time. Thank you for your comment!
  • Carolyn7171
    Carolyn7171

    Posted

    Reporting back on second opinion for the cataract surgery Feb 3 which left me without near vision in right eye...saw second doc a couple days ago...she confirmed  I should have gotten intermediate and also confirmed my concern that there are risks with exchanging one implant for another. (Odd because the original doctor acted like it was a piece of cake. The  choices she suggested are 1) correct left eye (not yet done) for intermediate range with lens implant-toric monofocalcorrected for intermediate range) - with trial first with contact lenses. But could not schedule that try out till April 18. 2) Corneal Shaping surgery - suggested specialist and I made appt but can't get in till Mid-May. And of course #3 (progressive glasses.  As far as I'm concerned, driving glasses were never a problem cuz there's only one distance but reading/computer glasses with the varying distances are driving me nuts. So looking forward to improving this..can't read well now unless with magnifier and getting headaches that I never got before when I try to read for any length of time, so have to limit all the work I loved just two months ago.  I have another 2nd opinion scheduled March 29.
    • Carolyn7171
      Carolyn7171

      Posted

      Forgot to mention that doc#2 said I would be a good candidate for toric on the remaining eye and if first eye is redone, first eye too to correct the astigmatism.  Why wasn't it suggested by Doc#1? Don't know.  Still have the second eye to decide upon. 
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