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Distance issues after accommodating IOL implant

I am third day post op from a Crystalens premium IOL implant in right (dominant) eye. I expect the left eye replacement to occur next week.
Even on day one post op near vision was quite good and is improving. My problem is distance vision. I expected distance vision to be a non-event. The surgeon is first class at everything except bedside manner and had nothing to say about this. Is my experience anomalous or is this within the range of normal third day expectations especially with nearly excellent near vision?
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233488 tn?1310693103
MEDICAL PROFESSIONAL
Steroids (prednisolone) and NSAIDS do NOT promote healing of the wound, in fact both, especially the steroids, slow wound healing. They are used as anti-inflammatories and prostaglandin inhibition. So your information is wrong.

Over and out of this discussion.

JCH MD
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Avatar universal
One more question. They told me that the medicine that promotes healing of the surgical wound (the NSAID and Prednisone) works against the adjustment of the eye to the IOL. What physiological mechanism causes this?
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233488 tn?1310693103
MEDICAL PROFESSIONAL
Can't generalize. Depends on person age, vision without glasses, expectations, willingness to wear glasses. etc. You will need tow work out with  your surgeon
JCH MD
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Avatar universal
Doc, I see slow progress but  some of my research has raised questions. The price of my cataract surgery included LASIK or PRK for refractive or astigmatism adjustment. My concern is that as I get closer to my distance expectations that , still shy of excellent distance vision, that further surgical adjustments will overshoot the target. Some literature suggests no correction should be made for myopia of -1 or less. Others even suggest a higher level.

It makes me wonder if the surgical adjustment was a bit of a come on.

What are the typical standards to justify surgical correction of refractive errors?
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233488 tn?1310693103
MEDICAL PROFESSIONAL
More likely the healing process than the timing of the NSAID

CH MD
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Avatar universal
I take an NSAID (Ilevro) once a day. All the literature I have seen says that this is very important. I was applying it in the morning and recently switched to just before bed on the theory that it will stay in the eye longer. It may be my imagination(combined with continued progress) but it seems to be making a difference. Any thoughts Doc?
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
Went for my one week exam on the left eye. It is astigmatic and the doctor says just wait for it to heal.

He said that the IOL is correctly placed in the right eye (posterior) and it just needs time. There is small daily improvement. He did hand me a couple of lenses and asked me to evaluate them. They made big improvements and only small degradation of near vision. I believe that the difference is less than a diopter. (I forgot to ask but last week it was .75 diopters and I know I am better this week.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
This is more of a log to mark my progress than a question.  The right eye continues to progress. I can read most of the letters on the 20/20 line. I am using an ipad based program that provides a variety of charts and randomizes the letters so that I can't memorize the chart. I have measured the distance between my chair and the screen.

Interestingly, there is an effect for the orientation of my head/eye. My vision isn't uniform across my entire field of vision. Making my amateur inferences from the doctor's explanation of the fit of the IOL in the  lens capsule, I wonder if the "shrinking  to conform" aspect affects  the focus in different orientations.

There is definitely some latency in refocusing the eyes. It takes several seconds to move from close to far.

The left eye 5 days post op is still rather much weaker and even though I am amblyopic it pulls me down when I test myself with both eyes. I continue to recognize that it functions much more than I had thought.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
So now ninth day post op (OD) and I can read a few characters on the 20/20 line at  correct distance. Intermediate vision is super and near vision is shockingly good. I did go ahead with the left eye ( now third day post op). Good progress every day. Because it is the weaker eye it is set to be slightly myopic versus the dominant eye.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
Improvement in the right eye continues daily but it isn't always a continuous line up. The doctor says that the thickness of the lens (IOL) is much less than the lens capsule and that over time the capsule conforms to the IOL. When it does, the IOL becomes more responsive to the movement of the ciliary muscle. The prednisone acetate actually works against the conformance of the lens capsule to the IOL but is necessary for the surgical healing.

This makes a lot more intuitive sense to me if I was trying to improve near vision (which is very good) but I will talk to him again next week.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
Doc, it is hard to dispute what you are saying but hour by hour I see improvement. From the beginning I was told that fine print would require readers. That seems likely but it won't be anymore than 125 power. (I have some but I am avoiding using them during the adaptive period). I am typing this into my IPad with no assistance for my right eye.

If I had two bad knees and the replaced one at a time I really wouldn't know how well the first was working until the second was replaced as well. My gait would be effected by the bad knee and the good one would be making unnatural accommodations.

One of the funny things I notice is that when reading with both eyes (lens removed from the right eye of my glasses) I see better than with either eye alone (although the right eye is better alone than the left eye alone). This is very strange to me. This is also true with no correction for the left eye.

Another observation. I took an Alleve this afternoon. It is supposed to have muscle relaxing properties. I now find it easier to read the titles of books stacked about 10 feet away. Truly not statistically valid but interesting.

Based on your advice I will speak to my physician on Monday.

I notice that physicians tend to take a more hands off approach in lifestyle medicine and defer to their "patient counselors". I have observed it directly and indirectly for cosmetic procedures, hearing assistance etc. I think they want to avoid setting up unrealistic expectations (directly) so they rely on manufacturers' brochures, websites and referrals. The pre-op disclosures  are full of warnings and complications. To their credit there is a lot of patient psychology in these choices that precludes the prediction of an outcome.

In my case I was relying on the experiences of relatives who had single vision IOLs with more advanced cataracts.

Sometimes being a patient means being patient.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
You are at a robbing Peter to Pay Paul situation. If your distance vision without glasses gets better your near vision will get worse. You likely will need glasses for distance vision. You could have lasik to improve distance but again your near will worsen without glasses.

Generally the better eye is set for distance so if the other is amblyopia that will be a problem.

My advice goes.  Right now you only have one eye t complain about, after surgery on the other you may have two.

All I have to say.

JCH :MD
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Avatar universal
Good advice from Dr Hagan.  Don't rush the second surgery.  I have had a bad experience with the Crystalens and won't do it again in the second eye.
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Avatar universal
This is wise advice. My reluctance to wait is driven by my recognition that my "amblyopic" eye even uncorrected has an impact on the acuity of the implanted right eye.

If I do not proceed with the left eye what can the doctor do about distance post up?  I think I understand his near vision options. The price io surgery includes PRK surgery "as needed"
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233488 tn?1310693103
MEDICAL PROFESSIONAL
Any physician that is too busy to answer questions or re-assure patients after surgery is not first rate.

This forum is full  of unhappy people that were dissatisfied with their first eye then rushed into the second eye and were unhappy with both.

Our practice philosophy that has severed our patients well is not to do surgery on the second eye before the patient is happy and/or accepting of the surgery on the first eye.   DON'T BE IN SUCH A HURRY TO DO YOUR SECOND EYE IF YOU ARE DISSATISFIED WITH THE FIRST EYE.

JCH MD
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