IOL Implant wrong power or will VA Improve

[SBM555]

Hello,

3 weeks ago had surgery to remove a dense posterior subcapsular cataract on LE. Distance lens was fitted,eye drops just about to be finished...recovery has been fine with no issues experienced.
On post op appointment last week was informed surgery went ok but will need YAG Capsulotomy,now just waiting for eye to completely heal before exposing eye to laser.If I'm honest I have been a little disappointed from day 1 about my VA with respect to distance...I was hoping I may get  away from wearing glasses for driving/golf etc but I fear not...Intermediate and near distances I accept glasses (Varifocals) will be needed.
I know its a little early for refraction but went to optician last week came away with the following
LE  Sphere +1.5   Cylinder -0.5    Axis  60     Reading addition 3.0  ( I deal with schematic drawings a lot,)
RE Sphere +1.25 Cylinder -0.00  Axis 0

Other factors are I suffer from Amblyopia...RE is amblyopic, also has dense posterior subcapsular cataract  ..pre op VA was count finger so I totally rely on LE for VA which was 6/12 pre op.
So
1) Could my IOL lens be the wrong power...today I put on a pair of reading glasses (+1.0/+1.25) and distance vision is excellent !! .....or is this in the expected widow regarding IOL targeting and expected VA.
2) Will the YAG laser procedure improve my Visual Acuity in LE....my optician seemed to think not...

Thanks in advance....
SB

[JohnHaganMD]

CBCT thanks for the comments.  JCH MD

[CBCT]

Although I understand your frustration, your surgery is quite recent and you should give time to heal.  I too wished to get away from glasses, but it is not guaranteed. Try verifocals for a month or two to see if you adapt.    I strongly encourage you to put off a YAG for the time being as it will certainly complicate lens exchange, should you choose that route.  Best wishes.

[JohnHaganMD]

You have some very difficult choices to make. LASIK does NOT correct hyperopia well its great for myopia.    There was obviously some error made in either taking readings from your eye, or data entry into the IOL formula. Error should be no larger than +/- 0.50 you are more than twice over that amount.

Well good luck
JCH MD

[SBM555]

Thank you for you prompt reply, it is much appreciated.

I'm in the UK and this procedure was done under the NHS.
Yes refraction at opticians was 6/6,I suspect I may also have a hard time in getting the IOL replaced, I waited long enough to get this one done.Does seem to be a larger error somewhere in procedures/ calculations etc..+1.5D...or I am just unlucky and do not fit in some bell curve....

I will have to ask my consultant if this amount of error is within acceptable limits,if not do I risk IOL replacement ? I don't want to push my luck as my life generally relies on this eye. So I gather my options are..
1) Carry on with my varifocals when they arrive. I was expecting to wear glasses for near/intermediate distances anyway.
2) Fund Lasik,PRK laser surgery myself as having now sampled 6/6 distance vision the experience without glasses is starting to appeal to me more...I suspect this will have to be considered when the YAG capsulotomy and the cataract in the RE is replaced... The fact I have a distance lens fitted would I still be suitable for Lasik ?

Regarding the YAG capsulotomy, Looks like the PCO is starting to give halos,light streaks etc from street lights....was clear the 1st week...so my VA may not be suffering but am starting to see early symptoms .this was also commented on by the optician....I am a little surprised it has occurred
so early.

Once again,thank you..
SB

[JohnHaganMD]

You might want to take a step back and hold off on the yag laser capsulotomy. If it was visually significant then wearing a +1.25 would NOT make it clearer. The fact it is excellent with it indicates the primary problem in a wrong IOL power. You do not give your visual acuity with the refraction the optician did but your comments would lead me to believe it should be 20/20 or better.

Find out what your visual acuity is with the refraction the optician did. If 20/20 its not likely you need a yag capsulotomy. You might also wish to consider and IOL exchange for a proper IOL. A distance RX target is 0.00 or -0.25 NOT any hyperopia and +1.25  means the IOL power is too low.  Opening the capsule with a yag makes a IOL exchange much more difficult and complication prone.

Discuss this with your surgeon. If necessary get a 2nd opinion from outside their office. The problem with being left hyperopic is that there is no distance (far, intermedicate or near) that is clear without glasses.

JCH MD