Discouraged after first IOL surgery

Had my first cataract extraction/lens implant on September 13th in my weak eye (power 13.5D).  The implant is an Acrysof IQ.  I had to remove that lens from my glasses, but still cannot see very well with the new implant.  The operated eye does seem to have some good near vision.  My final implant (dominant eye) will be on Sep 27th.  I'm basically using my unoperated eye with glasses in order to see.  The two eyes are not working well with each other, so I'm covering up the newly operated eye for the most part.  My doctor has not discussed this with me, but I'm gathering from reading this forum that perhaps the next surgery will accommodate distance vision and between the two, I will have some sort of decent eyesight - maybe even be able to drive without glasses.  I also have bad astigmatism, and am not sure if my doctor has done limbic relaxing incisions. which I also learned about on this site.  I know it must be difficult to diagnose this, but could you please give me your opinion on what I might expect after the second surgery.

[John C Hagan III, MD, FACS, FAAO]

Sorry, I can not give you advice on how the first eye is doing or what the second eye will do. These are important questions but something you need to ask of your surgeon.

JCH III MD

[JodieJ]

After reading your post, it seems to me that you have a number of major questions/concerns to talk over with your surgeon, including whether your target correction is for near or distance vision and whether you will be getting limbal relaxing incisions at the time of your surgery.  In my opinion, these questions are much too important to get answered over the phone.  I suggest that you schedule an appointment with your surgeon BEFORE you get your second eye done.  You should not have to ask on a forum about what you might expect after the second surgery; your doctor should be giving you this information.  It might be helpful to make a list of all your questions and bring someone with you when you see your surgeon.

[Nearsited]

Thank you.  I didn't think to ask these questions before the first surgery (about a week ago).  I simply trusted that the doctor(s) would make the best decisions for my eyes.  It was after the first surgery that I began researching all of this on the Internet.  It's rather like visiting a country the first time and then becoming quite interested in its history, etc.  Part of the reason I began researching was that my expectations after the first eye surgery were not met.  I can see a little better, but nothing like what I thought would happen.  I know I will need glasses for reading and driving unless a miracle happens with the second surgery.

[JodieJ]

Unfortunately, cataract surgery alone cannot correct your "bad astigmatism," which might be at least partially the reason for the disappointing results of your first surgery (although your eye is still healing).  I've read that limbal relaxing incisions eliminates about 50% of astigmatism on average.  (My own results were a little better than average.)  Limbal relaxing incisions can be done at the time of surgery or afterwards, and some surgeons don't charge an additional fee.  (Having Lasik a couple of months post-cataract surgery is reported to be the most reliable way to eliminate astigmatism, although this would definitely involve an additional out-of-pocket expense.)

Your surgeon cannot be aware of your priorities unless you tell him/her.  Why don't you raise the possibility of getting limbal relaxing incisions on both eyes at the time of your second surgery?  Although it involves some pre-surgery measurements and calculations, it probably takes about a minute to do.  

[Nearsited]

Here is the Rx for the eye that had surgery:  -8.75  -2.25  +160  Here is the info on the lens implant for that eye:  13.5D,  length 13 mm, Optic 6 mm.  Does this make sense to you.  Should I just be glad to have somewhat better vision after surgery?  Thank you for the information that I could have further surgery to relieve astigmatism after the lens implants are completed.

[JodieJ]

Your pre-surgery prescription is not used in determining the power of your IOL  Instead, one of a number of complex formulas are used, plugging in the measurements of the length of your eye and the curvature of your cornea.  (Remember those eye measurements they did before your surgery?)  Unfortunately, the prediction process is not an exact science, and no cataract surgeon can guarantee the results.

I was also highly myopic with mild/moderate astigmatism before cataract surgery.  I consulted three reputedly "top" cataract/refractive surgeons in my area, and all three told me that my results probably wouldn't be very good, due to the combination of my myopia and my "steep corneas" (astigmatism).  One of the doctors actually told me that I'd probably be needing some Lasik enhancement post-surgery!  So don't be too hard on your surgeon if your post-surgery vision missed the target; you may also be in the same (unfortunate) group of patients as I was.  In my case, however, the Lasik wasn't necessary.  I ended up plano in both eyes with minimal astigmatism (thanks to LRI's), although this was not at all the mild myopia that I was hoping for.  BTW, I received the same implant as you (the aspheric AcrySof IQ), and I have found it to be problem-free (i.e., no halos, glare, ghosting, arcs, night vision problems, etc.)  And my vision is very crisp.

Please talk to your surgeon about all your problems and concerns before your second surgery.  And remember, if you're really unhappy with your results, both the spherical power and astigmatism can be corrected with some Lasik enhancement post-surgery.  Best wishes.
  

[Nearsited]

Thank you.