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How to correct vision after cataract surgery in only one eye
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How to correct vision after cataract surgery in only one eye

Hi,

I'm 52, and had cataract surgery 4 months ago to remove a mild cataract in my left eye - vision couldn't be corrected better than 20/40 and felt unsafe driving at night.  I was advised to have the cataract removed, but there was no discussion of possible visual problems with just one IOL.  I wish I had found this discussion group before surgery!  Even with a contact lens in my right eye and progressive glasses on top of all, I am still dizzy and feel as if my eyes are seeing different universes.  The optometrist feels he can do no more to improve my vision.  He and the ophthalmologist are recommending surgery to remove the even slighter cataract in my right eye, saying it is "probably" a difference in image size that is causing the visual distortion.  I have no intention of having surgery on a perfectly good eye on a "probably".  Before surgery, my left eye was Sph -5.50 and my right eye was -3.00 (both were Cyl -1.75).  After surgery, the left eye is Sph +.25 (Cyl -.75).  So, image size difference has indeed flipped from what is was pre-surgery.  (However, I have a -3.00 contact lens in the right eye, which I understand brings the image sizes pretty close.)

Because of significant astigmatism, they used a toric IOL in the left eye.  I recently saw a different optometrist who wonders if the the IOL is slightly "off", causing the distortion.  I don't know what to do now, and I'm looking for suggestions.  What are the chances that this is just a problem of image size?  If so, will my brain eventually learn to compensate, and how long will it take?  Or, have others given it time, only to finally have cataract surgery in the other eye?  Did that solve the problem?  Could it be a problem with the IOL and can that be diagnosed, or even corrected?  Should I see another ophthalmologist - does anyone have a recommendation (I live in the San Francisco Bay Area)?  I have Kaiser, but am willing to see someone outside the system.

Thank you for any suggestions!
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284078_tn?1282620298
If the cataract is minimal as you say, then cataract surgery would generally not be able to do anything that you couldn't get with a proper contact lens.  This type of imbalance between the eyes (anisometropia) is generally fixed either with contact lens, lasik or prk surgery, or cataract surgery.  They all will try to even out the refractive error between the two eyes - just accomplish it in different ways.  If the contact lens is not solving the problem that is curious expect if you just don't do well in contacts.  At present it sounds like your best choices are perhaps the contact lens with glasses on top of that or cataract surgery in the other eye.  Just some observations from afar, since I really don't know the whole story.  Just get a second opinon from an excellent cataract surgeon if you are still confused.  It is not that complex of a problem.
8 Comments
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Avatar_n_tn
I am 51 and had surgery to remove a cataract from my right eye nearly 3 weeks ago. I developed the cataract after having a vitrectomy. After the cataract was removed I too feel as if my eyes are seeing different universes. I had successful Lasik surgery to both eyes a number of years ago and both eyes were set for distance requiring reading glasses for up close. The cataract surgeon put a tecnis IOL set for distance and I just assumed that everything would be fine. I do see 20/20 in right eye but I feel crosseyed as if the eyes are competing with each other and I feel somewhat dizzy. I have noticed that the images from the IOL (rgt eye) appear slightly bigger than the left eye. I saw my optomertrist a few days ago he says that my left eye has amazingly dropped off a bit now requiring a sph.+1.25 adjustment. He ordered a sample contact lens to try for a month. I put it in today and I no longer see what I perceive to be crosseyed thank God. I do not see my cataract surgeon for another 1 1/2 weeks and I am curious as to why my left eye dropped off so suddenly as I had been hoping not to have to wear contacts again especially after having lasik. I have a very tiny aged cataract in my left eye but I was afraid that they may suggest having lens replacement to even them up but I, like you do not want to have surgery on a good eye for a "probably".
I hope you find a solution
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Avatar_f_tn
Thanks for sharing your experience.  It sounds like a contact lens in the other eye is going to solve the problem for you, which I know must be a great relief.  

Unfortunately, even with a contact lens in the other eye and glasses on top to fine-tune things, I still have the dizziness and "two universes" going on.  I had forgotten to mention that the glasses also now have 1 up prism in the left eye, which I had never had before.  The cataract in my right eye is really quite minimal (and vision is still correctable to 20/25), so it sounds like cataract surgery in that eye wouldn't make much difference to the situation.  I'm going to try to get a referral to a specialist for aniseikonia (image size differences).  If nothing else, hopefully I would have more information.  If anyone else out there had a similar problem and found a solution, I would love to hear about it.
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574673_tn?1234129578
I had one Restor IOL which I had explanted. I now have one natural eye with a mild cataract and one IOL torric eye set for intermediate distance. I wear a distance contact in my natural eye which is -7.5. For reading and computer work I use progressive no line prescription glasses over my contact.
This is working for me until I decide to have my other eye with the mild cataract done. I cannot wear glasses when I take my lens at as my eyes are too different, about 7 diopters apart. This does create some inconvenience, that some folks may be unwilling or unable to tolerate. So it is a personal decision.
It can work eventually to have one IOL and one contact.
Hope this helps. Good luck.
londonbridge
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Avatar_n_tn
I was wondering how you got on with trying to get in to see a specialist for aniseikonia (image size differences). When you look at say a glass on a table how much bigger do you think the image sizes are between the two eyes. I know it might be hard to measure but I am just curious.

I went into see my cataract surgeon yesterday and he was surprised when I mentioned that I feel unbalanced, dizzy, cockeyed. I mentioned about the image sizes I asked whether the IOL in right eye would make things bigger and after some testing etc. and as he had all my records way back from the Lasik he said (and I did not know this) that I was over corrected in the left eye back then and that would make the image seem smaller in my left eye. He did mention as I suspected that one way to fix the problem was to have my left eye done (IOL). I asked how bad was the cataract in that eye and he said very small in fact may not even class it as a cataract so I politely said "No thanks I'll pass" . I will get some glasses made up with plain glass in right eye and light prescription in the left for when not wearing the contact. I dropped the contact down to +1.00 as the IOL eye seemed to drop off slightly with too crisp vision in the left.

Interested to hear how you are getting on as I know this can be quite distressing just trying to manage daily business etc. there isn't alot of talk before hand about only having one IOL done as here in australia average age for most cataract patients would be 65 onwards and then they are usually getting both done within a short time.   You mentioned in your original post that with -3.00 contact  in your right eye it should have brought the image sizes pretty close it would be interesting to see what is going on.  Cheers
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Avatar_f_tn
Do you have any vision distortion when wearing the contact lens or the contact lens and glasses?  (I don't know what to call this distortion I have - like my eyes are just not seeing the same thing.)  Or did you have distortion that went away after some amount of time?

Like you, glasses without the contact lens doesn't work - even more distortion.  There's only 3 diopters difference for me, but it was 3 diopters in the opposite direction before surgery, so maybe that's part of my problem.  Still, it's been over 4 months since surgery, so thought the brain would have adapted by now!  
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Avatar_f_tn
I'm still waiting to hear back from my optometrist about seeing a specialist.  I think I'm learning to compensate for the distortion - and sometimes I just take the glasses off when I get too dizzy, which is usually when out walking (my vision is less clear, but the dizziness is less as well!).  I took a hard spill over the dog a couple of days ago, but overall I'm tripping and knocking things over less.

You asked about image size difference.  The image in the IOL eye is at least half again as large as the image in my other eye, and that's with contact and glasses on.  I'm still not convinced that's the problem, but hoping that's what a specialist could tell me. (As well as if my brain will eventually learn to compensate, or if there's some other solution.)  Maybe if they changed the glasses prescription for the IOL eye so that it made the image smaller (intermediate vision, instead of distance?)?  At this point, I'd be willing to try it!  Good luck with your new adjustments - sounds like you're on the right track!
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Avatar_f_tn
Hello  all,
  I ‘ve had an IOL for about one year now. The image in the IOL  (crystalens) eye has always been larger.  Is it the difference in diopters?  The IOL targeted for plano was off so it is now -1.50 (nearsighted, but less nearsighted than -4.00 before) and the natural lens in other eye is still nearsighted,  -3.75.  ( I guess that both eyes, uncorrected, are now  a little over 2 diopters apart).  However, what I perceive is that the smaller image size remains the same when a contact lens is worn in the -3.75 eye to correct it to plano (distance).  (now  plano and -1.50  so 1 ½ diopters apart., but maybe the diopters are considered unchanged?).

  What would make an image  as large as the IOL eye sees it.  I really can’t imagine that another IOL implant  would correct size difference if a contact lens doesn’t (unless all IOL’s make images larger than the natural lens).  I think the eye is more complicated than I can understand.

In addition to difference in size, my experience is that the image also jumps around when I change eyes..  At 7 feet, objects move to the right using the IOL eye and objects that are closer, 1 foot or so, move to the left.  The icons on the computer move to the left with the IOL eye.  Looking at the left edge of a round fan on my floor about 6 feet away, when I change to the IOL eye it moves to the right.  Not sure what that is all about.

Also, I had retina surgery, vitrectomy about 4 mos. ago,  to peel ERM and reduce CME,  I think the size difference was more pronounced before the vitrectomy, but I can’t be sure how much it has improved.  It is very hard to assess objectively.  .
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Avatar_f_tn
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