Eye Vision

[jasonleon]

As several of you know I am a candidate in need of cataract surgery (I am nearsighted and have astigmatism). I recently went to the optometrist and had a re-evaluation for my current vision since I have other more serious spinal surgeries I need to take care of first and to know my current status of how much my cataract has progressed, but I had a hard time interpreting it on paper.

I have attached my summarized evaluation, would appreciate some help in interpreting my current vision and my current astigmatism if listed.

[SoftwareDeveloper]

re: "less complications"

I assume he means less risk of visual artifacts than a multifocal. Studies show the Symfony has fairly comparable risk of halos to a monofocal, and fairly comparable contrast sensitivity to a monofocal.

[JohnHaganMD]

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[JohnHaganMD]

That is the -2.75 number indicate you are myopic. Your vision improved with a very strong lens but not to 20/20 I think the number was 20/50 moreover the new lens strength was so strong you likely could not adjust to it.

Go to my webpage and read the article on what you need to know before your surgery.  Multifocal may not be the best choice for you. they are much more expensive, the optics and night vision not as good, more complications, glasses often needed.  Just look through this Forum and you will see a lot of unhappy patients with multifocal IOLs.

This morning in clinic I saw 4 people that had standard aspheric monofocal IOLs and they were happy and delighted.  There are strong economic reasons for cataract surgeons to pressure patients to "upgrade" to multifocal IOLs, femtosecond laser surgery adn ORA technology.  I just posted a review article indicating that femtosecond laser technology has not be found to be worth the extra costs. Most people do not need ORA technology.  For most people a single vision aspheric IOL or a toric IOL give the best results and are the least expensive and least likely to have complications.

JCH MD

[jasonleon]

Well my main concern is of course the cataract; but as well I am currently nearsighted and only needed glasses for distant, while being able to remove them to see clearly near and intermediate, getting a monofocal would mean that I would have to adapt to a opposite lifestyle of having to wear glasses for near, but not for distance. Also with astigmatism if a procedure isn't added to correct it i'd be having to wear glasses for all focuses including distant unless my glasses correct them, so I am considering a multifocal if possible and whether the risks of halos/glares of a multifocal is worth it over a monofocal and if I am a suitable candidate for it. Of course I'd have to get the astigmatism taken care of too via a laser or incision procedure as well. If not I may wait for the Symfony/Symfony torics to come out in the U.S which I was told was about in 6 months (since they have less risks of complication), which is over the time limit of which the optometrist recommended me in getting the surgery (which was within 6 months). So again I am in the process of considering the pros and cons of the wait and to monitor how fast my cataract progress over time.

[JohnHaganMD]

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[jasonleon]

Dr. Hagan,

Is there a reason that surgeons prefer setting a monofocal to distance rather than near? This seems to be the typical assumption for most clinics compared to setting it for near. If I was to have it set for distant, I'd be adapting to an opposite lifestyle of having to wear glasses for near and intermediate vs. right now I only wear glasses for distant and take them off for the rest since I am nearsighted. I'm also assuming that they might be able to set it for some slight monovision, (but not necessarily monovision) to broaden my near/intermediate vision if I was to set it for distant, is this correct?

[teller4]

jasonleon:  What do you mean, Symfony/Symfony toric has less complications?  Less complications that what exactly?
Thanks and good wishes.

[jasonleon]

When you say the first number (sphere) on the "new" RX which number would that be indicating? And by new RX are you referring to my current prescription? Because I have not renewed a new prescription for 2 years which is why I think the optometrist said my prescription and my vision was off (with the cataract progressing). I did not have cataracts 2 years ago or it wasn't to noticeable degree.

So I am assuming with a new prescription my vision of 20/200 corrected would improved, is this correct? Nevertheless, the surgeons advised cataract surgery within 6 months as an estimate before it progresses too much?

I was told the more my cataract matures, it'll lower my chances of being able to use a premium lens since it needs to go in a bag. I was already told premium lenses (multifocals) may not be the best option for me so I will look into my best options for now.

[JohnHaganMD]

Your vision is 20/200 with your present glasses. Your cataract is making your more myopic that is why the first number (sphere) is so much larger on the new RX.  The definition of visual acuity is based on angles letter subtend but the easiest way to think about it is that a person with normal vision could see a letter at 200 feet you would have to walk up to 20 feet before you could tell what it is.

You can't get around the need for surgery on the RE and best to do it while your LE has useful vision.  

[jasonleon]

I'm not good at interpreting the eye chart the 20/200 was what someone had told me, if it is actually 20/200 is that with glasses or without as in would it be the corrected vision? I was told my prescription was way off as well, I believe I didn't update it for a year or so.

[jasonleon]

Thank you for the interpretation. Yes I am a smoker, but I've tried to cut down recently, hopefully that will my slow my progression of the cataract maturing even though it won't make it go away. And please disregard the comment about my left eye I was confused for a second, it is true that my right eye is the worse one, although I don't know how to interpret the numbers of the right eye equaling 20/200. I am 58.

[JohnHaganMD]

I don't see your age on any of these reports.

What you posted means you have a dense cataract in your right eye and you do need surgery  within 6 months at the longest.  Your tobacco use may have caused the cataract (and if you use alcohol excessively that may be a factor also). Smokers get cataracts at an earlier age.

So you need to see a cataract surgery eye MD ophthalmologist.

AND  stop smoking

JCH MD

[jasonleon]

Also I always thought my left eye was worse than my right, but the numbers say otherwise, is there a reason for this?

[jasonleon]

Will it be a concern if I don't get my severe eye corrected soon? Optometrist said within 6 months at the most.

[jasonleon]

These are the numbers that I got:

Astigmatism (lens and not residual astigmatism) is a minor factor at - 1.00 on the right and - 0.50 on the left.

Glasses prescription is :

OD - 2.75 - 1.00 x 66

OS - 1.25 - 0.50 x 70
Cataract OD ( right eye ) is very advanced, severely affecting your vision in that eye which is now only 20/200 with glasses on , the left is 20/40.

[jasonleon]

Any feedback you can provide when you get the time will be much appreciated.

[JohnHaganMD]

I won't have access to a computer to look at those till Monday

[jasonleon]

Photos didn't attach on initial post so I had to use image upload.

http://postimg.org/image/7o99yjn0b/

http://postimg.org/image/54w0neszf/

http://postimg.org/image/fco7aoawr/