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How to choose the right IOL after complications

I am in my later 50's  and my history has involved retinal detachments in both eyes with first one in right in 2008 requiring a scleral buckle and lasering, the second in left eye just lasering. Have had to wear progressives since the first detachment in the right eye. With glasses my vision in right eye was 20/40 but vision got progessively worse and ended up 20/80-2. Surgery subsequently for removal of epiretinal membrane in right eye with vitrectomy. Vision did not improve after surgery and 4 months later is at 20/400 (with glasses) in right eye, apparently due to cataract forming. Now candidate for cataract surgery in right eye and looking at monofocal lens as it seems multifocal would not be a good option for me?  Comments?

My left eye is 20/20-1 (with glasses). But I do need to wear corrective vision for that eye for distance for driving and watching TV. I can't read very small print with it. If I am to consider the monofocal lens I am wondering whether to go for the near vision lens in the right eye as I am quite near sighted in both eyes (although not sure if this means I would end up not seeing with that eye beyond arms length) or the intermediate lens, as I would enjoy being able to cook, use the computer, see the car dash, shopping, see things on shelves and read menus or signs without wearing glasses.
However as I am active, I also would like to be able to see people in a room without glasses or see where I am going eg when cycling or dancing. I am wondering what the depth perception would be for engaging in a sporting activity if I opt for the near or intermediate lens and what the lens power range should be.

The second option would then be selecting for intermediate /distance but not sure how near or far I would see with this option in distance foot measurement or what the optical power should be. Also to try and balance it with the good eye if this would be a good choice bearing in mind I do need correction for driving etc for the other eye.

In sum, I would love to be able to not wear glasses for either close or distant vision but would not want to have to end up wearing glasses for both!   I would really appreciate comments or suggestions from anyone with a similar experience and from eyecare professionals.
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Avatar universal
Now I am confused!  I am soon to have this IOL cataract surgery on my right eye which is the vitrectomy Erm/ buckle eye in the next few days.
My surgeon has recommended setting a target for my right eye, to about -175 which is similar to the left eye presently. I would not then have a great discrepancy between the two eyes assuming the surgery goes well.  I am wondering if this is a near vision or intermediate vision target?  As I am having a monofocal lens, would I see well enough for nearer tasks and then on the other hand would I only see up to about arm's length with the right eye before things get blurry, so would I then be able to walk around the house and see reasonably without glasses for detail and see the ground/stairs when looking down with the right eye?  

Would it be a better option for me to have correction to a more intermediate range and what target would that be? About -150 or -125? I am used to wearing glasses for distance correction for the left eye but I can see well even without glasses with the left eye from a range of about 12 inches to about 10 feet away and just not see finer detail such as TV or read signs without glasses. Eventually my left eye may need cataract correction too although not in the near future. With the surgeon's present recommendation I hope that a nearer target will not leave me feeling too restricted in the intermediate range with my right eye and yet I can still do tasks in arms reach.

Your comments would be very much appreciated. Any other comments appreciated.

Also, is the Alcon Acysof lens a good one?
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Avatar universal
Thank you Dr. O very much for your comments re multifocal and for yr suggestions re distance correction, as I had been considering the near option (as I have been near sighted and now post- ERM and with cataract can only see some detail with right eye about 6 inches from the eye and not nearer or further than that).  It also seems from what you suggest to use progressives I cannot realistically expect to go without glasses for any range.

Yes I do have some distortion in the right eye from ERM surgery but it was worse before surgery.  I have not been able to guage improvement of vision after this surgery because vision in the right eye has been blurry since possibly from the cataract developing so quickly after the vitrectomy which I did not expect (surgery 4 months ago).


I had an anterior segment assessment done and the potential acuity meter of Pam and visometer result was 20/30-1. I suppose this is not an absolute especially in my case.
An IOL formula was given with Holladay and SRKT. I am not sure if that is special formula for scleral buckle taken into account.



Helpful - 0
711220 tn?1251891127
MEDICAL PROFESSIONAL
Do you also want to be 30?  Your expectations may not be realistic.

A multifocal IOL is NOT an option.   I doubt your right eye will do well at near.  I would suggest you correct this eye for distance and use glasses with a progressive add.  Even after a successful ERM surgery the retina will not see normally.  There will frequently be some distortion if that eye if used by itself.  However with both eyes used together the distortions in the poor eye will be minimized and not noticed in most situation.

Also, the calculations for the IOL in the scleral buckle eye is much more difficult than a normal eye.  A special formula must be used.  Therefore, it is very unlikely you will hit an exact refraction target.

Dr. O.
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