After reading all the posts found here at this wonderful site a few months ago, I decided to to choose blended vision (distance and intermediate) using a AMO Tecnis lens in my non dominant eye for my first surgery.
I am a 49 year old male and three years ago I was diagnosed with Cataracts. My vision has been getting worse so I chose to have Cataract surgery on my left eye, the left being worse than the right eye. I had the surgery this past Monday, October 17th.
On previous posts Dr. Hagen has recommended a target of +1.25 for intermediate vision. He stated that he would personally choose +1.0 for himself. I had asked for a target of a maximum of +1.25 for my intermediate vision.
My questions are: #1 I thought intermediate vision was approx 3 to 6 feet and a +1.25 should get you in that range. If not, am I within the +1 to +1.25 range for the focal length if my clearest distance is at 20 to 22 inches?
#2 At the follow up appointment, the doctor said I need time for Neuro-Adaptation to work. Could it be that my remaining Cataract eye is so bad that it isn't in a place to help with the adapting process? How long might it take?
While looking at a distant object, and alternating between the right or left eye or both eyes the view I see appears to be coming 100% from the surgical eye, with very little, if any, noticeable adapting done with my Cataract eye. I do notice that depth perception is still available when both are used together so I believe something is used in the remaining Cataract eye.
#3 Could it be that my other eye may need to be done near plano for the adapting process to work?
If the eye was left with -1.25 of myopia that would give you intermediate vision of about arms length for computer work for example (not 3-6 feet.) It would be best for you to look into cataract surgery for your dominant eye set for distance and that will probably help with your situation. Remember that your refraction should really be about -1.25 which would be sort of like wearing +1.25 reading glasses. I could go on and on about monovision and mini-monovision (my favorite.) I use it all the time, but generally do the distance eye first and do not make the non-dominant eye for near unless the distance eye is very good. Otherwise the patients might be dissapointed in their distance vision. I have to be honest, if this is done properly, I very rarely have to talk about neuro-adaptation. In my biased opinion, if things are done properly, it should be natural and quite easy for the patient to accept and they are usually quite happy right off the bat. I think the better you understand the basics of myopia and hyperopia, the better you will understand your situation and adapt as needed. Remember, if you have healthy eyes, you can always wears glasses if necessary to see well.
Cataract surgery, like all surgeries, requires a healing process. It takes time for your eye to fully heal as well as your brain to adjust to the resultant refractive error. It is important to communicate your concerns to your eyeMD as you heal so that he/she can guide you. It definitely takes up to three months for your brain to adapt to the vision that is present. Often, by targeting different prescriptions in the two different eyes, one can get a larger range of vision and it is definitely possible that this will be needed. Communication with your eyeMD is essential so that he/she can aim for the best for you! Each person is an individual and requires a different target offset.
Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California
Drs. I want to thank you for your replies. I am relieved to know I am in a good range now. I now am going to have my other eye done. I have toyed with the idea of a Crystalens only because of my apprehension towards the quality of the image I will see which lies between the two focal lengths after neuroadaptation. Am I worrying too much? Will I, for the most part, be happy with the image I will see after the neuroadaptation takes place? It is tough because I had excellent vision all my life in both eyes except for readers the last few years and not to see a focused world bothers me.
I had been told that my capsule had the fibrous tissue and cells that need to be polished away during the surgery and because of my age and the 3 year speed of development of Cataracts, I most likely will be a candidate for YAG lasering. Due to this possibility would you rule out the Crystalens because of the increased potential of a correctional surgery from Crystalens over a monofocal lens? Also, with the added risk of an open capsule surgery and inherent complications of such a surgery? Thank you both so much! Mitch
There will be no open capsule during surgery. The yag laser may need to be done a few months after the original cataract surgery due to the fact that you may have a PSC (posterior subcapsular cataract.) I think crystalens will just add one more layer of complexity to your situation and certainly no guarantee of satisfaction.
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