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Replacing IOL after cataract surgery- choices?
64yr fe glass/RGP contact lens wearer past 50 yrs for myopia. Rx increased from 4 to 6+ in past 15 yrs. astigmatism. Current readers 2.75 to 3.0 depending on task.

Past 3 yrs vision has been more out of focus due to cataract progression.

Had single focus lens inserted into left eye after cataract removal on Aug 29. No complications in recovery. At 10 day visit, distance vision needed 1.75 correction. Tried Accuvue and cannot adjust - spending 10-15 min to insert and same to remove. Eye irritated, red, itchy after 3rd day removal.

Second visit at 4 wks post op shows eye now needs distance correction of 2.5. Opthamologist is referring me to a specialist who will replace the lens and can offer LASIK. She has asked me to think about my options.

I have spent 5 hours online researching accomodative, multifocal, monofocal and LASIK as well as complications when lenses are exchanged/replaced. Very little is posted in the way of peer reviewed literature.

Here is the outcome I desire:
As near perfect distance vision as possible in daylight conditions. I am very willing to continue with reading glasses for computer work and sewing. I would also like to be able to see clearly about 8-12 feet away but that is not as important as clear vision 20+ feet away. I do not want to go back into RGP contact lenses. While the glass contact lenses gave me excellent vision and comfort for 2-3 yrs (1967-1994) the RGPs wear out after only 6-9 mo. At $100 per lens plus solutions this is more than I want to invest. I would rather invest in the correct IOL and/or LASIK.

Q: What lens would give me the best outcome? Does having a second surgery on the same eye present a higher risk than the first surgery? If so, for what? After the lens is exchanged, if my astigmatism is causing focusing problems, will LASIK correct that?Is LASIK a good option now for correcting the 2.25 distance instead of replacing the current IOL?
Do you think the wrong IOL strength was due to wearing the RPG? If so, how long do I need to not wear the RPG in my right eye to ensure a better pre surgery measurement.

I am not diabetic and have no other eye conditions. I am asthmatic with seasonal allergies and reflux and have been on inhaled steriods for 15 yrs (which I am told influenced the progression of cataracts.) I have no other medical conditions.

Thanks for your input. My referral apt is in 2 weeks so I would like to be prepared for the discussion of my options.
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177275 tn?1511758844
Start by reading this article and the many discussions that followed.  http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You
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After reading the discussions posted below the article, I read that you would prefer me to respond here so that others may benefit.

My desired outcome was much like the photographer's discussion. I would have liked to be able to evaluate landscapes and watch wildlife but also enjoy close sewing. I would have liked to walk into a store and be able to identify what items are at the end of an isle. I would have liked to be able to read street signs and house numbers while driving.

I THOUGHT before reading the article that I would just wear readers but now I see how inconvenient it might become to look up and observe wildlife/nature and then not be able to see the buttons on the camera or the book I am reading. Or to see fabric prints at the far end of an isle and then not be able to read the information on the bolts that identifies the fabric content/cost. Or to see the Instructor or video monitor across the room and not be able to see the pattern I am drafting on the table top 3-4 feet away nor being able to discern the ticks on the ruler. Or being able read street signs and not being able to bring my dashboard into focus.

These situations would mean I would continuously be taking readers on and off during the process of a single task. I can now understand why I would want to sacrifice some distance vision acuity in order to increase the ability to read or be able to bring items into focus in the closer ranges.

I think I will be pleased the most if the doctor I am being referred to can bring both eyes to a point where there is less diopter difference between the two eyes at close range so that both eyes can work together to bring the items into focus.

I have tried monovision contacts in the past and could not adjust. For the past 4 weeks (post lens implant) I am dealing with that again. The left eye can see only 2-4 feet clearly with the implanted lens. The right eye cannot see anything close with my RGP in place unless I wear readers at a strength of 2.5 to 3.0. I have resorted to wearing readers after removing the left lens from the frame. My world is now confined to seeing 2 feet with readers on (no left lens in the frame) and up to 4 feet with readers off and no contact lens (RGP) in right eye.

With the RGP inserted, my right eye sees 4-20 feet OK, while my left eye with the IOL sees 2-4 feet very clearly. My brain hasn't been able to adjust to that.

For example, I cannot read my weight on the bathroom scale with my left eye's IOL or without the RGP in my right eye. I cannot read a book anymore after removing my RGP because the uncorrected right eye sees print at 6-8 inches while the IOL in the left eye cannot see closer than 2 feet. The right eye sees the print as larger while the left eye sees it as smaller. I have read that some brains can adapt to this but mine does not seem to be one of them!

I am now thinking the outcome that I would prefer is to be able to see the world around me most clearly up to 8-12 feet and then wear glasses while driving or walking. That would mean not being able to enjoy my detailed views of nature across the lake without wearing glasses. Perhaps I will need to go back into RGPs after all. The joys of aging!

Your information has prepared me to discuss all this at my next visit and helped me reach a decision as to where I would be most willing to compromise when it comes to projected outcomes.

A heartfelt thank you. :)
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Much appreciated.
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Just finished the excellent article and am on to the discussions. Very greatful to have found this forum.

Nearly everything in previous searches were either by companies promoting a lens product or by offices explaining about cataracts and offering appointments to evalutate/correct.

Again, thank you for directing me to information about achieving desired outcomes and the trade-offs.
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Are you going to have the cataract in the other eye removed and replaced with an IOL in the near furture?  I had a monofocal placed in my left eye but have no need or intent at this time to have cataract surgery performed in my right eye.  That being said my eyes are both now myopic with +1.5 diopters difference in the two, and I use RGP contacts in both eyes again for distance correction and +1.25 readers for up close.  Like you I never liked monovision in the past so I did not want IOL in my left eye to correct for distance while doing nothing with my other eye.  
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How much residual astigmatism (cylinder) do you have now in the eye with the IOL?

I too wore old hard contacts when I was young and later RGP contacts for decades until about 4 years ago, and am having cataract surgery for my right eye next month.  I have nearly -3D cylinder astigmatism, so am planning for a Tecnis monofocal toric IOL in the right eye for good distance vision.  In the future, I would consider perhaps mini-monovision with a -1D target for my left eye, also with a monofocal toric IOL.
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My right eye has been diagnosed with a "pre-cataract" for a few years now plus it has had astigmatism most of my life.

I am not getting the clear distance vision that I used to get a few years ago, even after a new annual stronger RGP rx. I am not quite sure why but my regular opthalmogist seems to think I may get improvement in my right eye with cataract removal. My left eye cataract was definitely interferring but the right eye did not seem as bad to me. It is hard for me to evaluate it at this time as focusing on anything at any distance is a real challenge. I am not driving and I am not outside in daylight due to depth of perception issues where I bump into things or stumble. I have not left my house except for doctor appointments. Since she has referred me to a second opthalmologist I will be asking her for a second opinion.

I am comfortable either way at this point. Either waiting until the right eye cataract worsens or to have it removed or even to have LASIK or astigmatism correction although from what I have, trying to evalute the IOL after LASIK, further complicates things and astigmatism corrections do not offer permanent results.

I am a retired ARPN and understand this is not an exact science and may not give me the vision I desire. At the same time I am hopeful of someday being able to resume visually dependent activites that I enjoy but I can no longer do. Managing my  expectations is a big part of being satisfied with the end result.

I had read about and talked to so many fully satisfied friends that no longer depended on glasses or contacts so that was my initial expection. I am now at the point of accepting the need for RGPs in both eyes if that is how the problem will be resoleved so that both eyes can bring items into focus.

I am fairly convinced to stay with the monofocal lens and use the RGP to tweak the distance vision for driving. This would seem to return me to the same point where I was before cataract removal but theoretically my visual acuity would improve because it was the cataract(s) that caused the blurred vision, glares, pain with sunlight, and difficulty seeing outlines of objects.

I would think the first step is to get my left eye IOL rx corrected and then determine what visual problems, if any, that I have with my right eye.
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The cataract that I had in my left eye began to seriously affect my night driving due to the glare, and it got to the point where the best corrected vision I could get was 20/70.
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