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Wrong Lens?
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Wrong Lens?

I had cataract surgery last October.  My vision was 20/40 in my eye before surgery.  After surgery my vision was 20/40.  I had a monofocal lens put in.  My prescription before surgery was -.25sph, +1.50 cyl, 17 axis in my right surgery eye.  My prescription 6 weeks later was -1.50 sph, +1.00 cyl, 40 axis.  I had an Acrysof SA60AT with 21.OD put in. 13.Omm, Optic 6.Omm.  Do you feel the outcome should have been better.  I question if the correct lens was used.  My near vision is +2.25

My left eye also has to be done.  My prescription in that eye presently is -.25sph, +.50cyl, 167axis.  What type of result can I expect in this eye with a monofocal lens?  Can you tell me if this eye is 20/30 or 20/40?  Doctor never said.

I requested my file from the doctor and it said on my first visit my vision was 20/40 in the right eye.  The day after surgery my file says it was 20/30.  On my 1 week visit the doctor said it was 20/30.   On my last visit at 6 weeks it was 20/40.  I differ with the 20/30 because I could not even begin to read the line.  I have read the 20/40 so much I knew which line I was reading.  Why would a doctor say I was 20/30 and then my eye was 20/40?  I was told right after surgery my eye would get better vision over time.  I feel the doctor falsified my vision regarding the 20/30.  He said I had to get glasses, the reason I got the surgery was I was told by him and another doctor that my vision problem was due to a cataract and I had a choice between the glasses or the surgery.  I went with the surgery because of very bad glare driving at night.

Are you aware of a prescription drug called Arimidex causing cataracts in both eyes?  I was diagnosed with cataracts after being on the drug for 6 months.  

I have an appointment with another surgeon in 2 weeks to get a second opinion on my right eye and talk about my left eye surgery.  Other than telling him how I feel and bringing in all my paperwork do I need anything else?

Thank you for any information.
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Dear 1voice46,

No one can guarantee that you will not require glasses following cataract surgery.  You had some astigmatism before surgery and now, have some nearsightedness with astigmatism.  I would recommend that you undergo a complete eye examination.  Does your vision improve with the glass prescription to 20/20?  I would also expect the night difficulties you experienced with your vision to improve following the surgery, although you might not notice it until you are corrected with the best glasses, contacts or laser vision correction.  

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California
11 Comments
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Avatar_m_tn
I would first ask myself, beyond the numbers, do you see better out of the eye after surgery with the appropriate glasses??  Nearly everyone after cataract surgery sees best with a light set of glasses.

Is there another diagnosis of the eye that doesn't give you 20/20 potential vision??

I would venture to guess that it wasn't your eye doctor that found the 20/30 vision after surgery, but actually one of his technicians.  If you have the record, and it isn't his handwriting, he didn't falsify it.

Good luck
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Avatar_n_tn
The doctor was the one who marked my chart.  It is his writing and he did the exams himself. He was the one that measured my eye for the surgery also. He told me right after the surgery that my eyesight would get better while I was still at the outpatient clinic at the hospital.  My husband heard him.  I also noticed in the chart that he said I was happy with the results.  I never told him that.

The next morning in the office he took off my bandage and asked me to read the chart.  I could barely read the 40 line but I did.  Everything was quite bright.  He asked me over and over again to read the next line down and I repeatedly told him I couldn't.  He seemed like he was very aggravated that I couldn't do it.  At my last visit he just said I needed glasses.  I was disappointed because I asked him before the surgery if he felt that my bad eyesight was due to the cataract and he said yes.

This doctor has an excellent reputation in the area, one of the top 100 doctors listed in a local magazine for several years.  I also told him I had a slight blur when I turned my head a certain way and his answer was he had a blur in his eye also.  I then knew I was dealing with someone who in my opinion would wish I would just go away.  Perhaps a second opinion will give me some answers.

The doctor I'm going to see in 2 weeks was recommended by a doctor at a local group health clinic.  She said she would go to this particular practice.  The doctor I'm seeing only does cataract surgery although there are quite a few doctor in the practice with their own specialty.

As to your question do I see better?  I can explain it as I see things as brighter, was going to paint my white walls but realized after the surgery that they did not discolor as I saw them with the cataract.   Do I see better as far as distance, no.  I still have some glare at night while driving.  

He said there was nothing wrong with anything else in my eye when he examined them before the surgery.  The eye looked good and to go ahead with the surgery.  My surgical report says the surgery went fine, no problems.

The cataract in my left eye is not as bad.  I'm hoping that I can bring in better vision having the cataract removed from that eye and a correct lens to compensate for the lesser vision in the right eye.

I haven't gotten my glasses yet because I was hoping that my vision might get better over time.  

My neighbor who had both cataracts removed was brought to 20/20 and 20/25.  She said she couldn't even read the 1st line on the top of the chart before the surgery.  I cannot go to her surgeon because he is a group health surgeon.  I'm not a member.
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Avatar_f_tn
Unfortunately, predicting the correct IOL power is not an exact science.  No cataract surgeon can promise 20/20 vision without correction.  Based on the numbers you posted, you are slightly nearsighted.  Some people actually prefer being slightly nearsighted after cataract surgery in order to boost their near/intermediate--but you are clearly unhappy with this.  I suspect that with glasses, you'll be able to read the 20/20 line.  Be sure to let your new surgeon about your wish for good distance vision in your second eye.  And please don't wait 6 months to get glasses if you need them after your second eye is done.  It's really your vision with glasses that counts.
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Avatar_m_tn
Your right eye had significant astigmatism before surgery, and still has it afterward (expected), so there was no way to reasonably expect to see better than about 20/40 without glasses based on this much astigmatism.  And it sounds like you would like to see well without glasses.  I would look into LASIK for this eye once healing is complete.  You would have had to pay out-of-pocket for astigmatism correction at the time of cataract surgery anyway, so you really haven't lost anything.

Your left eye doesn't have much prescription at all, and has always likely seen well in the distance without glasses.  As Jodie pointed out, choosing the correct IOL power is a best GUESS based on multiple measurements.  Hopefully you will have a very small prescription after this eye is done.

Good luck
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Avatar_n_tn
I did ask the doctor about Lasik or another surgery to get better vision and he said no that I would have to wear glasses.  His assistant told me that sometimes a laser would be needed to bring the vision in better.  He gave me a definite no which I really didn't understand why he wouldn't discuss it with me.  I know I would have to pay for it but I figured it would be worth it.  My son-in-law had to wear glasses all the time. He had some kind of laser surgery and it brought him to 20/20 and 20/15.  He's very happy with the results.

I'm aware of the astigmatism, noticed it when I did accounting work.  I will get my glasses after the second eye is done.  I'm just glad I didn't have any problems after the surgery.
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Avatar_n_tn
I know it isn't a precise surgery.  The doctor never said before the surgery that he would bring me to 20/20 without glasses.  We never discussed this.  Since he was the doctor and I was the patient I figured he would know the lens I needed.  I know more about it now so I can ask more questions and get the answers before surgery.  Thanks for answering.
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Avatar_n_tn
If the doctor had explained the astigmatism to me and told me what I could expect I guess I wouldn't be posting here.  I still have some glare in my right eye at night but it has gotten better.  I think he did bring me to 20/20 with my prescription for glasses.  I will decide after the left eye is done if I want to have laser surgery done.  I can discuss this with one of the doctor at the new clinic.  Thanks
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Avatar_f_tn
With a little luck, your surgeon can get your left eye close to plano and 20/20.  In this case, you might be able to go without glasses (except for reading).  Your left eye would be your distance eye, and your right eye would give you pretty good intermediate vision.  You could probably skip the laser vision correction, although you might consider getting a limbal relaxing incision (a much less expensive in-office procedure) to reduce your astigmatism.
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Avatar_n_tn
Thanks for the information.  It helps to know more when I see the doctor.  I had my eyes examined last June and the doctor who took over for my doctor that retired said my left vision was plano.  Then this new doctor said it was a minus 25.  Looking over my exams over the years I see the vision does change sometimes it's better, sometimes not. I was looking over all the reasons a person can get cataracts, besides aging, and I had none of them.  Never smoked.  I have been taking cancer medication for 4 years and this is known to cause cataracts.  I don't know if it would make my vision worse besides the cataracts.

I haven't posted here much but I noticed several of your posts.  Are you a physician or do you work for an eye doctor.  It's nice to know that people can share their experiences and give helpful information.  I wish I had checked this site out before having the surgery.

Have a great day!
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Avatar_n_tn
I saw the second eye surgeon and apparently I have a clouding in my right eye and I'm set up to have a Yag procedure.  He said if I did not get improved vision after my cataract surgery that there might be something else going on.  He said this could have developed very soon after the surgery.  My question is, why didn't the first surgeon find it when I last saw him.  I don't feel my vision has changed since then.

Between the assistant and the new doctor I was at the office an hour and half.  I took a copy of all my records including my surgery report.  I feel I was given enough time to ask the questions and get answers.  The doctor said I was given an IOL for intermediate vision.  I was told it was for distance.  Guess this is why I can't see distance well.  I don't understand why the doctor that did the surgery didn't tell me this.  Another thing, the morning after the surgery the first surgeon told me that before I was legally blind.  That I couldn't believe because I can see well enough to do whatever I want except for readers.  Asked the new doctor what legally blind meant, he said usually it's 20/200.  The old doctor said my vision before the surgery was 20/40.  That is not legally blind.  I don't understand why he would lie to me like that and then change the readings that I could see better than I can.  How can this man get to be one of the best in the city?  

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Avatar_m_tn
A related discussion, Post op vision changes was started.
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