Aa
Too Farsighted following second surgery?
I am a photographer. I was nearsighted -6.75 ,astigmatic, long eyeball 28mm. Relatives who have had cataract surgery are in their eighties, are not active , rarely drive and are of absolutrely no use to me when I probe them about their satisfaction with our doctor. Since I wanted excellent distance vision to drive and do sports I opted for "plano" in both eyes. I expected that I would not have to wear glasses for distance or for television watching, only for close work at less than 6 feet. My Dr. , Dr. Mackool is an excellent surgeon and highly regarded. In 2006 the first surgery, with LRI to correct astigmatism left me +.75 D too farsighted and about 20/40 at best , correctable to 20/25 with glasses. Without glasses even the Moon is a bit blurry.The diopter correction in my cameras is set at +1 diopter and is fine. I waited almost two years, wearing a contact on the other eye till it no longer worked well. On 7/08 I had my second surgery with a Toric lens, but now I am +1.00 D far sighted in that eye, although it is easily correctible to 20/20 with glasses. +1.00 readers bring my vision right onto 20/20, perhaps better. This is certainly an improvement from my nearsighted days, but I wanted more. Is my Dr.'s Biometry inferior?? I wonder if he ever gets to see it.
So - I am not happy with my outcome since I need to grab reading glasses in various powers as soon as I wake. When I ski the tearing makes my vision more acceptable , perhaps 20/30. Now, I need +1.00 to watch TV, +3.00 to read. I'b like to get the eyeglass restriction removed from my drivers license - that would be nice. With both eyes I can read New York's DMV's eye chart, even now. The English license plate test is a breeze too.That one seems to be about 20/50 - as is New Jersey's.
What can I do? Is a lens exchange a good idea and is the procedure eligible for any insurance reimbursement? Is it too risky?? My Dr. does not think so. How much chance is there that with the "perfect" IOL power I may still get a worse result than I now have?
Glasses certainly do work right now - +1.25 sunglasses allow me to drive ,read gauges, gps, and see street signs a block away.
I CK a reasonable - that is , a highly accurate - way to correct about +.75D ??? I hate the way the positive eyeglass lenses make me look. Will contacts work for me in the future?
Are my expectations reasonable???
Thank you for bearing with me. Life can certainly be worse.
So - I am not happy with my outcome since I need to grab reading glasses in various powers as soon as I wake. When I ski the tearing makes my vision more acceptable , perhaps 20/30. Now, I need +1.00 to watch TV, +3.00 to read. I'b like to get the eyeglass restriction removed from my drivers license - that would be nice. With both eyes I can read New York's DMV's eye chart, even now. The English license plate test is a breeze too.That one seems to be about 20/50 - as is New Jersey's.
What can I do? Is a lens exchange a good idea and is the procedure eligible for any insurance reimbursement? Is it too risky?? My Dr. does not think so. How much chance is there that with the "perfect" IOL power I may still get a worse result than I now have?
Glasses certainly do work right now - +1.25 sunglasses allow me to drive ,read gauges, gps, and see street signs a block away.
I CK a reasonable - that is , a highly accurate - way to correct about +.75D ??? I hate the way the positive eyeglass lenses make me look. Will contacts work for me in the future?
Are my expectations reasonable???
Thank you for bearing with me. Life can certainly be worse.
In response to your question, contacts can definitely be worn after cataract surgery. You might even consider trying multifocal contacts or (modified) monovision.
You also mentioned that you hated the way plus glasses made you look, and I'm guessing that it's the magnification effect that bothers you. If you had your glasses made with aspheric lenses, it would eliminate this effect. Getting progressive glasses would eliminate the need for having different glasses for TV and reading. (There may be occasions when you want to do both at the same time.) Having your exact prescription and a good anti-reflective coating would probably eliminate problems with glare. The selection of comfortable, attractive frames is also a lot larger in an optical shop than it is at the drug store.
You also mentioned that you hated the way plus glasses made you look, and I'm guessing that it's the magnification effect that bothers you. If you had your glasses made with aspheric lenses, it would eliminate this effect. Getting progressive glasses would eliminate the need for having different glasses for TV and reading. (There may be occasions when you want to do both at the same time.) Having your exact prescription and a good anti-reflective coating would probably eliminate problems with glare. The selection of comfortable, attractive frames is also a lot larger in an optical shop than it is at the drug store.
Helllo,
touche...i had very same problem in my first eye op ...I went from -20....to +1 ...felt awful....couldnt see watch or anything close up....i had same feelings of dissapointment....however 2nd eye we went for -2 correction ...2 weeks now...and i am guessing ...ended up with -1 or-1.5...whatever the case ..whilst ...-0.25 and -1.25 is ideal...didnt happen surgeon aimed for -0.5 first eye and eneded up +0.75 ...but now the 2nd eye has given my near sight back and so am much happier.
Than i realised the biometric calculation is dificult and never 100% accurate and overall i should be grateful for such an excellent outcome.
All i can say is if you end up -0.75 to -1.25 ...for 2nd eye ...you should be ok...yes you will need glasses for ceartain situations ...but wont have to go for glasses as soon as you wake up ...In my case i only need for reading and minor correction when driving...otherwise i mostly dont need glasses throughout the day.
Surgery is always a risk ...given your result ... lens exchange seems a bad idea ...as my surgeon said to me ...aftr 1st eye op ...your expectation is too high...and there are no gurantees with the prescription if you do have lens exchange.
Good luck and i am quite sure if you get 2nd eye correct you will be fine...
touche...i had very same problem in my first eye op ...I went from -20....to +1 ...felt awful....couldnt see watch or anything close up....i had same feelings of dissapointment....however 2nd eye we went for -2 correction ...2 weeks now...and i am guessing ...ended up with -1 or-1.5...whatever the case ..whilst ...-0.25 and -1.25 is ideal...didnt happen surgeon aimed for -0.5 first eye and eneded up +0.75 ...but now the 2nd eye has given my near sight back and so am much happier.
Than i realised the biometric calculation is dificult and never 100% accurate and overall i should be grateful for such an excellent outcome.
All i can say is if you end up -0.75 to -1.25 ...for 2nd eye ...you should be ok...yes you will need glasses for ceartain situations ...but wont have to go for glasses as soon as you wake up ...In my case i only need for reading and minor correction when driving...otherwise i mostly dont need glasses throughout the day.
Surgery is always a risk ...given your result ... lens exchange seems a bad idea ...as my surgeon said to me ...aftr 1st eye op ...your expectation is too high...and there are no gurantees with the prescription if you do have lens exchange.
Good luck and i am quite sure if you get 2nd eye correct you will be fine...
Thank You! This is an honest answer. My outcome of around 20/40 uncorrectedis not the end of the world..
Certainly, my outcome is better than I once had. I was no longer correctible with expensive glasses to even 20/40 and needed my glasses to see anything further than a couple of feet away.
Now the residual astigmatism in my left eye does provide some increase in depth of vision , but there are some real issues with headlight glare. The Toric lens in the right eye is fine and glare is not an issue at all. Since it is only 10 days since that surgery, I hope that the vision will continue to improve. It improved dramatically once I stopped taking the dilating drops a few days ago.
The glare issue may make a lens exchange in my left eye worthwhile. Especially for night driving.
Certainly, my outcome is better than I once had. I was no longer correctible with expensive glasses to even 20/40 and needed my glasses to see anything further than a couple of feet away.
Now the residual astigmatism in my left eye does provide some increase in depth of vision , but there are some real issues with headlight glare. The Toric lens in the right eye is fine and glare is not an issue at all. Since it is only 10 days since that surgery, I hope that the vision will continue to improve. It improved dramatically once I stopped taking the dilating drops a few days ago.
The glare issue may make a lens exchange in my left eye worthwhile. Especially for night driving.
MEDICAL PROFESSIONAL
I think your expectations are un-reasonable. I think doing bilateral IOL exchanges is not a good option.
This is a recent post re: IOL power
Hello Garrett, Your mother's optical situation is not uncommon. Choosing an intraocular implant (IOL) power to give the best vision unaided by glasses is as JodieJ says not an exact science. It is much, much better than 5-10 years ago and it will be better 5-10 years from now. It will never be 100%. Like much of medicine we are sometimes a victim of our own success. There was a time in which patients were happy to go through a cataract operation without a major complications and wore regular glasses happily after surgery.
As we have been able to improve the vision without glasses some people expect to see perfect without glasses even though this is not possible for many people and something an ethical surgeon never promises or guarentees. There are many variables (radius of curvature of the cornea, axial length of the eye, position of the IOL in the eye, etc) that can cause the actual result of surgery to differ from the "theoretical" values used in the pre-operative calculations. There is not even one forumula that surgeons agree is "best" to use for the calculations. As eyes become longer than normal or shorter than normal the possibility of under/over correction increases significantly.
Some eyes, because of astigmatism, are not correctable with the standard monofocal implants used in most surgeries. Even with the new multifocal "premium" IOLs that are used to try and get away from glasses completely for all distances often require glasses for certain tasks and certain distances (use the search feature and look at all the complaints).
Of course it is possible to have gross miscalcuations due to error in data acquisition or data entry. These are rare compared to the normal "scatter".
Wearing progressive bifocal lens to achieve good vision is the expected and hoped for result of standard monofocal IOL surgery. Some people will see satisfactory at distance without glasses, others will see okay at near or mid range without glasses but this is a bonus not the expected result. We never tell our patients that they will be able to go without glasses. We tell them it often happens but we expect they will need glasses. Period.
There are certain circumstances in which if the difference is way to much to wear glasses (say a 4-5 diopter difference) that the information can be sent to a Medicare review or insurance review committee to authorize a LASIK procedure and have it paid for by insurance/Medicare (of course deductibles or co-payments would legally have to be collected). If glasses are feasible and wearable do not expect them to authorize the LASIK.
As to your physician's behavior, again Jodie J may be right. If you've gone to this ophthalmologist (Eye MD) for quite some time and he/she is generally even tempered and patient, I would cut them some slack. On the other hand if the physician is usually this way then I would seek not only a second opinion but a new ophthalmologist. I am a very patient physician and very even dispositioned but I have "lost it" on a few occassions with my patients. I always felt terrible afterwards and in most cases have called back to apologize the next day. More than one of these occured during a stretch where in addition to my professional responsibilities I was taking care of a sick parent and another member of my family was seriously ill.
Compared to some of the really serious sight threatening complications that are often posted here I think your mother has some really excellent options.
JCH MD
This is a recent post re: IOL power
Hello Garrett, Your mother's optical situation is not uncommon. Choosing an intraocular implant (IOL) power to give the best vision unaided by glasses is as JodieJ says not an exact science. It is much, much better than 5-10 years ago and it will be better 5-10 years from now. It will never be 100%. Like much of medicine we are sometimes a victim of our own success. There was a time in which patients were happy to go through a cataract operation without a major complications and wore regular glasses happily after surgery.
As we have been able to improve the vision without glasses some people expect to see perfect without glasses even though this is not possible for many people and something an ethical surgeon never promises or guarentees. There are many variables (radius of curvature of the cornea, axial length of the eye, position of the IOL in the eye, etc) that can cause the actual result of surgery to differ from the "theoretical" values used in the pre-operative calculations. There is not even one forumula that surgeons agree is "best" to use for the calculations. As eyes become longer than normal or shorter than normal the possibility of under/over correction increases significantly.
Some eyes, because of astigmatism, are not correctable with the standard monofocal implants used in most surgeries. Even with the new multifocal "premium" IOLs that are used to try and get away from glasses completely for all distances often require glasses for certain tasks and certain distances (use the search feature and look at all the complaints).
Of course it is possible to have gross miscalcuations due to error in data acquisition or data entry. These are rare compared to the normal "scatter".
Wearing progressive bifocal lens to achieve good vision is the expected and hoped for result of standard monofocal IOL surgery. Some people will see satisfactory at distance without glasses, others will see okay at near or mid range without glasses but this is a bonus not the expected result. We never tell our patients that they will be able to go without glasses. We tell them it often happens but we expect they will need glasses. Period.
There are certain circumstances in which if the difference is way to much to wear glasses (say a 4-5 diopter difference) that the information can be sent to a Medicare review or insurance review committee to authorize a LASIK procedure and have it paid for by insurance/Medicare (of course deductibles or co-payments would legally have to be collected). If glasses are feasible and wearable do not expect them to authorize the LASIK.
As to your physician's behavior, again Jodie J may be right. If you've gone to this ophthalmologist (Eye MD) for quite some time and he/she is generally even tempered and patient, I would cut them some slack. On the other hand if the physician is usually this way then I would seek not only a second opinion but a new ophthalmologist. I am a very patient physician and very even dispositioned but I have "lost it" on a few occassions with my patients. I always felt terrible afterwards and in most cases have called back to apologize the next day. More than one of these occured during a stretch where in addition to my professional responsibilities I was taking care of a sick parent and another member of my family was seriously ill.
Compared to some of the really serious sight threatening complications that are often posted here I think your mother has some really excellent options.
JCH MD
Have an Answer?
You are reading content posted in the Eye Care Community
Top General Health Answerers
Kansas City, MO
Grand Prairie, TX
San Diego, CA
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.
