How long after surgery does it take to have distance vision?

[sandy214]

I had a toric iol implanted two weeks ago, and the results I have had so far are confusing to me. I can see very well at reading and computer screen distance, but beyond arm's length, about 24"-30", everything is fuzzy and blurry. I was told that I would have good distance vision and would need reading glasses, but what I am experiencing is just the opposite. Is it too early to know what my distance vision will be? How long does it take to know what the outcome of the operated eye will be? I don't want to have the second eye surgery until I know the results of this one, because if this eye doesn't get a lot better, I'm not paying for another toric lens.

[JoeBee]

I had a toric lens implanted in my left eye during recent cataract surgery. Now, using an Amsler grid, my central vision is "smudged", not "blurred", to sound like a martini recipe. The lines of the grid are not wiggled, as with macular problems. They remain straight-arrow, and the very center of the grid, the "dot", is crystal clear, as are the grid lines for a single square. All around the center, the grid looks as though it had been smeared, handled before the ink had completely dried. The grid lines remain visible, not obliterated.
The surgery on my right eye, normal lens implanted, is crystal clear. Unfortunately, when reading (new reading glasses in use), the smudging from the left eye pushes the clear right eye just a bit "off," resulting in eyestrain as my brain struggles to sort out the signals.
My surgeon, in whom I have great confidence, is puzzled by this. I think the smudged appearance rests with the toric lens, that my eye and the lens simply were not meant for each other, and I should have saved the $900 and settled for wearing bifocals. This condition did not exist before the implant, and has existed continuously since.
Your opinion? And what might be done? Might I consider a second procedure, to replace the toric with a regular implant and get new bifocals?

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

One of the most important elements of a doctor-patient relationship is mutual trust. If you are to continue with your present surgeon I would suggest you consider asking why the diagnosis wasn't mentioned ahead of time. Hopefully that would clear the air. If you don't trust your surgeon you would be doing both of you a favor by finding a new one.

JCH III MD

[sandy214]

I respect your opinion and know that what you say is true--that conditions may not be seen until a cataract is removed. But in my experience, the examining doctor *did* note macular degeneration, and this was recorded on my chart, I found out. Her knowing about this prior to surgery and yet not informing me is what I'm objecting to. If the problem had not been discovered until after the cataract was removed, I'd have a different perspective on this. I'll have surgery on the other eye soon, but my expectations will be considerably lower now.

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

I think your surgeon is being very generous in his offer of doing lasik or IOL exchange "for free". Certainly nothing binds him to do that and many other surgeons would not do that.

This is IMPORTANT for everyone. When you have a cataract its like a dirty window, its not only hard for the patient to see OUT of the eye but equally hard for the surgeon to see IN the eye. After the cataract is removed the surgeon, probably for the first time in years if not decades, can see the back of the eye through a clear IOL rather than a dirty brown cataract. Very frequently this is the first time that things like macular holes, cysts, membranes, macular degeneration, glaucoma damage to the optic nerve, optic nerve atrophy or palor can be seen for the FIRST time. It does not mean that your surgeon wasn't upfront with you.

Your choice of IOLs for the other eye is just that your choice. If you are not comfortable with your surgeon then get a second opinion. Sounds to me like you've not been done any disservice.

JCH III MD

[JodieJ]

I know little about macular degeneration, but your surgeon's explanation for your good near/intermediate and blurry distance vision doesn't make sense to me.  And if your problem were really retinal (as your surgeon claims), I don't see how LASIK or a lens exchange would help.  I'd be very interested in reading Dr. Hagan's comments about this.  You might want to get a second opinion before proceeding further.

[sandy214]

Just wanted to update this thread, although perhaps I will start another on the same topic. On Monday, I talked to the surgeon who did my surgery/lens implant and asked numerous questions. He said that the effectiveness of the toric lens was most likely compromised by some degree of macular degeneration in the eye--"not bad" in his description, but there.

No one ever mentioned to me any existing conditions other than the cataract prior to surgery. As I told him, if I had been told about this before surgery, if I had understood that a toric lens might not work as well because of another condition, I probably wouldn't have chosen it. I think I would have gone with a monofocal lens, wear glasses, and keep my $850 in the bank. This really concerns me, not being informed as well as I believe I should have been. The doctor said that he will do Lasix or another implant for free if I want to do either of them. I'm still thinking about that. But how can you be expected make an informed decision if you haven't been informed? The drama continues...

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

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[JodieJ]

Your point about spending $850 out-of-pocket for a toric lens for which you received no real benefit makes a lot of sense to me.  Obviously, there were no guarantees, but I still think that your surgeon might make some type of concession to you.  Many surgeons include the cost of a LASIK touch-up (if needed) in their premium lens fee.  Other possibilities include a reduced fee for the toric lens for your second eye, or even reduced fees for an IOL exchange.

Since the toric lens did a great job of eliminating your astigmatism, getting a second toric lens makes a lot of sense to me.  If I were in your situation, though, I might give some thought to seeing a different surgeon for my second eye (possibly someone more experienced at doing those toric IOL power calculations), especially if my surgeon refuses to make any concessions.

There's also another option to consider.  My own cataract surgery gave me 20/20 vision in both eyes.  This correction makes near and intermediate vision very blurry, so I wear either progressive glasses or bifocal contacts just about all the time.  It's possible that you'd actually be happier (and spectacle-free) with one eye set for distance and the other for near/intermediate.  

[sandy214]

Thank you for your post.  What I wanted most from this surgery was acceptable distance vision, and I'm very disappointed by the results.  The implant did correct almost all of the astigmatism in my eye, but that could have been corrected well enough with glasses, which I am now going to have to wear fulltime anyway.  I spent $850 for nothing.  Can you offer any explanation for why this surgery didn't work for me?  And what are my options for my other eye, which also needs surgery?  Should I try another toric iol and hope for better results, or just go with a monofocal implant?  I have an appointment on Monday with the surgeon who did this procedure and will definitely ask the same questions, but your opinion would be much appreciated.  Thanks again.

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

Everyone heals differently but at 4 weeks with a small incision IOL vision is usually stable. You likely will need glasses for distance just the opposite of what was planned.

If this is really disturbing you can consider LASIK down the road.

JCH III MD

[sandy214]

Thanks for your take on this. I have an appointment today and will certainly ask questions. I'm very disappointed with the results so far. I don't mind wearing glasses, but the possibility of good distance vision for driving and outdoor activities and art classes without them sounded so good to me.

[Occupant]

To answer your question, I would say: "Immediately" and it is not too early to tell what the vision in that eye is. I could, after the operation on the first eye, read the signs on the doors in the recovery area right away once they took the patch off, although the pupill stayed still dilated three days later. A week after the surgery the ophthalmologist did a vision test that showed 20/20 in that eye.

[JodieJ]

I'm not an eye care professional, but I suspect that your problem is not the toric lens.  (Residual astigmatism would impair your vision at all distances.)  You're saying that you now have good near/intermediate vision but your distance vision is poor, i.e., you are nearsighted.  If this were the case, your distance vision could be corrected with glasses/contact lens, LASIK, or an IOL exchange.  What does your surgeon think?  In your situation, I'd be asking my surgeon the questions you posted.