Suitability for Monovision

[MandaCope]

I do envy most of the members of this forum who live in the USA as they all seem to be given much more information and are much more clued up about their vision.  I don't know about 20/20 or 20/50.

This is my before op test result (two years before) I had cataract surgery on left eye which was:

R - Sph +3.75  Cyl -0.75 Axis 10  (near add +1.50)
L -  Sph +3.75  Cyl -0.80 Axis  5  (near add +1.50)

After the op:

R - the same as before except near + 2.50
L - Sph -2.00  Cyl -0.50 Axis 90.0 (near +2.50)

The contact lens I am wearing in my right eye just says +4.25   8.6  CT 0.171 DIA 13.8

Would this indicate whether I might get a good result with monovision or not?    Thankyou.

[John C Hagan III, MD, FACS]

You cannot tell whether you would or would not do well with monovision. If you chose to do so then your Right eye should be targeted about PLANO (0.00)  If you can wear that contact and use your eyes together you would likely do well with monovision as that is a huge difference in the two eyes not

JCH MD

[JodieJ]

Are you saying that you now wear a contact lens in your right eye only, and you are comfortable with your vision?  In this case, you already have monovision.

I'm not an eye care professional, but it seems to me that a +4.25 contact might be little strong if your glasses script is +3.75 -.75 x10.  Since you are only using your right eye for seeing distance, you'd want to get the very best correction possible with that contact lens.  Your distance vision might be noticeably sharper with a toric contact.

[MandaCope]

Yes, I am managing with the contact lens in my right eye only at the moment as I was mistakenly given such short sight in my left eye after a cataract op, leaving me with severe anisometropia.  Our great NHS has agreed to correct this by whatever means I want, i.e. re-do left eye to distance, do right eye to short sight and wear specs for distance but as I'm happy with monovision I want to go for that option if I could get as good a result as I have with the lens.

I say managing because I'm not happy with using a lens permanently.  Although I see fine initially my eye gets sore and gritty after a few hours and blurring occurs in the evening.  I have to make a decision what I want and I'm scared of doing the wrong thing.

My consultant just said it's up to me.  I have to see him in December and let him know what I've decided.  

[JodieJ]

If you're happy with monovision (which you seem to have adjusted to already), perhaps your best bet would be to correct your right eye for distance, either with laser vision correction (e.g., LASIK) or cataract surgery.  You would want to get as close to plano as possible.  You have only mild astigmatism in your right eye, but your vision would be noticeably sharper if this could be reduced or eliminated.

Which of the 2 procedures to choose might depend on the following:  Are you likely to develop a cataract in your right eye in the near future?  (Then cataract surgery might make more sense.)  Are you a good candidate for LASIK (or a similar refractive procedure)?

Do you know what went wrong with your left eye surgery?  What might be done to prevent this from happening to your other eye?

I learned most of what I know about vision correction and eye problems by reading about it online.  This forum is excellent, and there are also a few very good informational websites.  Having more information before proceeding is always a good thing.    

[MandaCope]

Thankyou for your help.  I had my cataract surgery in our eye hospital in Worthing last May, saw the surgeon for a few minutes before the op and thought I had asked for distance vision.  He also said I had a small cataract in my right eye.  I never saw the surgeon again after but was discharged into the post op care of my local hospital.  The consultant there shrugged and said he had no idea what went wrong as he didn't have the notes to hand!!  He also said that I don't have a cataract in my right eye???

I trotted off to the optician to get specs and was then informed that I couldn't have them because of the vast difference.  It was only by searching this helpful forum that i found out about anisometropia and using one contact lens for monovision.  Luckily I had some daily disposables that I had used occasionally and was delighted to be able to see again so I went back to optician and asked for some new ones as mine were just out of date.

On my final check up at local hospital I was told "that's all fine - see you in 6 months".  I pointed out that I didn't want to be left dependant on contacts for the reasons above so I was told that they would do whatever I wanted to correct it.  I opted to have the right eye made short sighted because I was worried that I wouldn't get a good result with distance again.  4 months later I got to the top of the list for surgery and they offered me 10th November but during the phone call from Worthing I asked if I could see the surgeon and discuss what went wrong.  He's now left but the nurse there said that according to my file I had ASKED to be made short sighted in that eye!!  Well, no, I didn't.  Why would I?  I was hoping for maximum distance vision in both eyes and just wear specs for reading.  Surely if I HAD asked they should have told me about anisometropia.  It was then that I thought maybe monovision would be a better option but I was told to make an appointment to discuss it with the local consultant and he can't see me til December.

I think I've been treated quite badly to be honest, with lack of information and an uncaring attitude but that's nothing new with our NHS.

I'm desperate not to make a wrong decision on something as vital as my eyesight and that's why I'm constantly scouring these forums so as to be armed with as much information as possible.

Thanks again for your help.

[corks100]

HI.  I understand where you are coming from.  

You will be in my prayers.  Just dont give up.  

[JodieJ]

Reading your post makes me remember why I'm SO ambivalent about nationalized health care.  It makes me cringe to think that any competent doctor would target -2.00 for a patient whose fellow eye was +3.75, so the explanation that this was done at your request strikes me as absurd.  Perhaps mistakes were made in either your eye measurements taken before surgery or in the IOL power calculations, or maybe you just got an IOL that was meant for another patient!  (Usually IOL power calculations are within .5 diopters of the target.)  It might be a good idea to repeat the measurements of your right eye.  

Your best defense is to educate yourself about cataract surgery in general and your options for correction.  Having your right eye set at -2.00 to match your left eye might not be your best option.  Either monovision (right eye at distance vision/plano) or modified monovision (right eye set for intermediate vision) would greatly reduce your dependence on glasses.  Monovision would give you vision similar to what you now have with the contact lens.  Modified monovision would give you good intermediate and near vision (used for grooming, computers, cooking, reading, etc.)  There's lots of good information about these options on this forum.

Your right eye has slight astigmatism.  Dr. Hagan has posted information about how the placement of the surgical incision can eliminate most of your astigmatism.  This would noticeably sharpen your uncorrected vision.  (If you can't find the information, ask about it in a new thread directed to Dr. Hagan.)  It would definitely be worth discussing it with your surgeon beforehand.

Once you know more about cataract surgery and have chosen the type of correction that you want, make sure that the hospital and staff are aware of your preferences.  It would be a good idea to know the power of the IOL to be used beforehand  (and verify it in the OR.)  Hopefully, you won't be meeting your surgeon for the first time in the OR.  It would be excellent if you could at least talk to your doctor at a prior appointment, review what will be done, and ask about incision placement to reduce astigmatism.

You'll have more questions, so don't hesitate to post again.  By posting each question as a new thread, you can get feedback from a forum ophthalmologist as well as former patients like me.

[MandaCope]

Thankyou so much for all your helpful information.  It is so comforting to talk to someone who listens and understands what I'm saying, bless you.

I'm afraid that in the UK we are treated as if we have no right to question anything and consequently we tend not to but because I have raised questions and need to know these things I think I'm regarded as "difficult".   This is especially the case when one reaches Senior years when they feel obliged to raise their voice and talk in words of one syllable, insinuating that I'm both deaf and suffering from some form of dementia!  This is insulting when I am neither of these.

I distinctly remember that no measurements were taken at my pre-op assessment which was simply a list of questions relating to current medications and a BP check.

I assume that measurements were done in the brief consultation immediately prior to the operation?  How then would they have the exact lens for my needs?  I would have thought this would have to be pre-ordered to my requirements, or do they just get one off the shelf on the day of the op?  Can this be normal procedure, I wonder.

This was further brought home to me when the phone call regarding my second op (which I put off) was just to check that my medication hadn't changed and would save me coming in for a pre-op assessment!  So, again, my only contact with the surgeon would be the few minutes he spent explaining the risks, looking into my eyes, and getting me to sign the consent form prior to surgery!  Off the shelf lens then, I presume?

I've also found out from reading these forums that it's not advisable to wear a contact lens for (some say 3 weeks and others say 3-4 days) prior to the operation.  Nobody has mentioned this to me and had I not read it on here I would have worn my lens right up to the day of the operation.  There seems to be a serious lack of communication between doctor and patient here.

Thanks to you and this forum I feel I now know what questions to ask when I see the doctor in December and hopefully he will spare me the time to discuss them and not be as dismissive as on previous occasions.

Thankyou again. x

[JodieJ]

I'm absolutely stunned by what you are saying!!  I cannot believe that the treatment you received is standard in the UK (or anywhere else in the world, for that matter.)  Please tell me that you can have the surgery for your second eye done at another facility (and maybe in a different city, if this is the standard of care in your area.)  Do not let these quacks touch your right eye!

Eye measurements are absolutely necessary in order to chose the correct IOL power.  These numbers are inserted into a complex formula to determine which power IOL would get you close to the target you're seeking (e.g., plano/good distance vision).  An IOL Master is state-of-the-art for obtaining accurate measures, and an experienced surgeon can often get within .3 diopters of the refractive target.  Rules for contact lenses vary, but even soft contacts can affect the corneal measurements.  I was told to leave my contacts out for 2 weeks before I had my measurements done; some doctors think that 5 days are enough.  It may be necessary to leave hard contacts out for a longer period.  (In view of your current unbalanced vision, perhaps less time without contact lenses would suffice.)

Meanwhile, you'll have to make do with the contact lens.  In that regard, I have to repeat that your glasses script (+3.75 -.75 x10) seems to be inconsistent with a +4.25 contact lens.  If it is possible for you to get your eyes re-checked, please do it.  That gritty feeling in your eye is because your contact is too drying.  You might be more comfortable with a one-day contact made for dry eyes, such as 1-Day Acuvue moist or the new 1-Day Acuvue TruEye.  There are also astigmatism-correcting toric contacts made for dry eyes.  You may need to try out different brands of contacts to find which works best for you.  What you have now is not working well.      

[MandaCope]

Hi again and thanks for taking to time to help me.

I'm afraid there is no choice of having the surgery anywhere else. :(  I'm very nervous, in view of what you say, about the procedures followed (as well I should be I understand).

May I clarify?  These essential measurements - would they need to be done some time in advance of the operation to ensure the correct IOL?  Are they supposed to be made to measure before the operation takes place?  It did puzzle me at the time that no specific tests or measurements appeared to be taken but in my ignorance I assumed that it was done during the operation.  This doesn't now seem to be the case and I wonder just how they decided what I needed.  I'm not even 100% convinced that it was down on my file that I asked for short sight in my operated eye now.  Sounds more likely that I just got a bad result through lack of care, or wrong lens, but I will never know for sure I guess.

With regard to my contact lenses.  The ones I had been using when my eyes were lined up prior to the op were actually +4.75 and I never had a problem with them for occasional use and was quite happy with the result of using just the one.  As they were out of date and I had to get tested for new ones my optometrist did reduce it to +4.25 as she felt it was more appropriate.  I'm really happy with my vision I must say.  I can read close up, use the computer and drive with confidence and I don't have any middle distance problems or blurring or fuzziness.  I wasn't given a choice of lenses even.  They just gave me their own brand Specsavers Easyvision daily disposables.   I've just bought another 2 months supply as it seems I won't now get my operation this side of Christmas.  From what you have told me I'm having serious doubts as to whether to have it at all.

To have it done privately would cost about £2,000 (over $3,300) and I don't have that amount.

I will definitely follow your advice and ask if they have the lenses you suggest so that at least I am comfortable in the meantime.  Thankyou so much for all your help.

[JodieJ]

Yes, the eye measurements and IOL power calculations are done in advance of the surgery.  That way, it's certain that the correct power IOL (and back-up IOLs) will be available for you in the OR.

Frankly, I'm just about 100% sure that there is nothing in your file indicating that you requested that your left eye be made short-sighted.  (And even if you had made this request, no surgeon in his/her right mind would have complied with it, given your right eye was +3.75!)  I can't imagine what process was used to choose the IOL power for your left eye.

You are doing very well with monovision, and I think you'd be wise to continue with it.  This would involve a target of around plano (0.00) for your right eye.

I cannot advice you about dealing with your health care system.  I will try to get you some help in that regard from other UK residents.    

[MandaCope]

Thank you again Jodie.  I now feel armed with a lot more information and a list of questions I will ask at my appointment in December and if I'm not satisfied with the response I get then I will seriously think about cancelling it and soldiering on with the contact (a more comfortable type).  I'm indebted to you for all the help you have given me xx

[JodieJ]

I started a new thread about Cataract Surgery in the UK, hoping that it would generate some helpful advice for you about dealing with the NHS.  Unfortunately, it seems that several people have had negative experiences with the NHS.  You can read them for yourself.

It's my belief that no one choose an IOL power without doing eye measurements!  You'd want your target to be close to plano.  (I'm assuming that the astigmatism-reducing technique I had suggested won't be feasible.)

Meanwhile, it might be helpful if you could try out other brands of contact lenses made for people with dry eyes.

[MandaCope]

Hi again.  Thanks for trying but as you say, people aren't exactly clamouring to defend our NHS.  When it goes well then the system works, but get any sort of complication and they really don't want to know and just don't give the information we require.

I've taken your advice about the contact lenses.  Phoned to make appointment to discuss my needs but was told no need, they are ordering me some 14 hour lenses (apparently mine were only 8 hour so no wonder I was getting discomfort but again, why wasn't I given a choice?)  It's all so hit or miss over here.

They're going to let me know when they're in the store so I can try them.  That's a good result anyway, thanks to your advice.

I will talk to the consultant in December and hopefully get the answers to my questions re the first op and the measurements etc.  I'll post back when I have some answers. xx