magnified vision after cataract

I had cataract surgery 9 days ago and everything is so clear, especially outside.  When I'm indoors though it seems as if I have too much correction.  I've developed a headache while grocery shopping- it seems as if I can't get far enough away from the shelves to see items clearly.  Is this something that may correct over time?

[John C Hagan III, MD, FACS, FAAO]

What rossagrant said is pretty much the case. Your may behaving problems related to your eyes learning to work together, or being unbalanced with one eye fixed, or your old glasses could be the problem.  Depending on circumstances some of these problems persist until the second eye is fixed especially if the surgery "unbalanced" your refractive error.

JCH III MD

[rossagrant]

Hi Jojo.
I'm no doctor but had cataract surgery in both eyes just over 3 weeks ago! Your symptons are EXACTLY what I have been suffering from pretty much since day one and please let me reassure you that these symptons really do settle down over time. I too find vision great outside but when moving from outside where daylight is good into a building with artificial light I have the same effects as you. I found I became slightly short sighted almost. I have found these symptoms less and less over time and now the change is becoming very minimal.
Which type of lenses did you have fitted? Monofocal, Multifocal or Accomodative?
Monofocal lenses set for distance may require reading glasses for more intermediate or near vision which may account for the shelves being out of focus.
I'm sure a doctor on here can reassure you too that these symptons will become less and less as the lens settles in and maybe a weak prescription for tasks like shopping may be needed, but 9 days since what can really be classed as MAJOR surgery is such a very short time, I am sure you will be very happy with the results.

[jojokiki]

thanks for your comments- they're very reassuring to me.
i had a monofocal lens implanted in my right eye (but my near vision at this point definitely requires reading glasses- Dr suggested 2.5 whereas the left eye which hasn't had the cataract removed yet can still read without any correction).  I'm now wearing a contact lens in my left eye (1.75)  to test whether I'd be able to have a lens to correct near vision implanted in my left eye after cataract is removed.  I've not been wearing my old glasses- even with the right lens removed, I couldn't focus.  Any thoughts on the monofocal lens- distance in one eye and near in the other eye?  thanks

[John C Hagan III, MD, FACS, FAAO]

If you've not been using it before with contact lens or if you find a trial of wearing a contact lens to simulate it troublesome then best avoid it. It works best with people that have done it with contacts and in people that absolutely,positively hate glasses and are willing to put up with less than perfect vision to shed the glasses.

Most monovision patients still wear no-line bifocals for some things. Remember with monovision and two eyes you have TWO clear points. Let's say one eye is for distance and one eye for reading (-2.00 to -2.75)  If you shop, use a computer, look at your speedometer or anything about 3-4 feet away it will be in the blurred image where you don't see well. (monovsion is like wearing bifocals). These distances you will have to wear glasses or get closer or further away from what you're trying to see.

JCH III MD

[jojokiki]

Thank you.  I've decided to have the left eye lens replaced with one I can read with.  What does the
-2.00 or -2.75 signify?  Is it the distance from the eye that the sight should be clear?  If so, what are the ranges (ie does -2.00 mean that vision should be clear 2 feet from the eye?).  My optometrist said that he can't legally consult with me since I'm already under the care of an opthalmologist (yet I want his input regarding this).  

Also, I've got astigmatism in both eyes.  Don't think it was corrected with the cataract surgery in the right eye.  Could it be done for the left eye and if so, would it negatively affect my vision (since it would be corrected in only the one eye?).  One last question/s- is astigmatism corrected by using a special lens implant or by laser directly to the eye?  If by laser, is it done at the same time as cataract removal or at a time later.

Thank you in advance for all your help- It's truly a privilege to have your responses!

[John C Hagan III, MD, FACS, FAAO]

1.  a -2.50 refractive error would mean that when you don't have your glasses on to correcst your vision at distance (> 20 feet) you would need a lens of that power. However for reading it equals a +2.50 diopter reading glass (sometimes called a magnifiying lens). That would good reading vision about 18-20 inches.  The diopters are defined in terms of meters so it doesn't directly correlate into feet.

2. Astigmatism would need to be corrected by: a toric implant (not used often), placing the incision in the axis of the steepest corneal meridion, making radial keratomies (cuts on the cornea that run parallel to the edge of the cornea (limbus) (sometimes referred to as limbal relaxing incisions). This is generally an extra procedure, often with an extra charge and you would need to ask the surgeon about it before the operation is done. Correcting the astigmatism on the eye to have surgery likely would not unbalance them. Ask the surgeon for clarification.

JCH III MD

3.

[jojokiki]

So my MD suggested implanting a  -1.75 lens in my left eye so I'll have monovision (I don't mind wearing glasses if necessary but for some reason cannot give up my ability to read occasionally without having to wear glasses).  Does -1.75 mean that I should be able to read items that are closer to me?
Is this a lens often used for monovision or is -2.50 ususally the lens of choice?
I guess I'm still confused about these numbers.

Thank you again!

[John C Hagan III, MD, FACS, FAAO]

You will need to review this with your surgeon. If you are left after surgery with a prescription of -1.75 in one eye and -2.50 in the other you should be able to read without glasses and use a computer without glasses assuming the rest of your eye is normal and the surgery is uncomplicated.

JCH III MD

[cay77]

I have been reading your posts with interest--I have upcoming cataract surgery next week.  I am nearsighted and have worn contacts for years.  I understand completely your reluctance to give up being able to do some reading without glasses. It's nice to be able to fall asleep reading without glasses on, it's nice to be able to see what's on the grocery shelves.  I have struggled mightily with the decision of whether to go monofocal iol or multifocal iol.  Multifocal sounds so ideal until you read about all the problems that people can have with them.  So I have decided to do what you are doing--modified monovision.  But hearing that you have had some adjustment problems makes me worry.  Right now, wearing my glasses, I have the same problem you are describing at the grocery store.  I think my glasses are not the right prescription (it didn't seem worth changing for a few months use), but I experience the same "whoa, everything looks too close" phenom.  But as they are glasses, I take them off.  If I have that feeling with an iol like you do, there's obviously no taking it off!  Please keep posting your progress, I am interested in hearing how it goes for you.  Good Luck!

[John C Hagan III, MD, FACS, FAAO]

I do not know any eye surgeons with cataracts that have had multifocal IOLs put in their eye, all I have known or read about choose monofocal, which I would use in my own eye if I needed cataract surgery now. Things may change in 3, 5, 10 years but for the moment the promise of multifocal IOLs is not matched by the technology.

JCH III MD

[jojokiki]

Thanks for your comments.  I may not have been clear but at this point, in my right eye (cataract was removed 13 days ago) I can see from 4 feet away from my eyes "to eternity".  I cannot read without correction in my right eye any more.  MD suggested I'll need glasses with 2.50 correction for the right eye.   He suggested that he would put a -1.75 lens into my left eye after removing the cataract (I'm still trying to decide).  I expect to wear reading glasses occasionally but insist on being able to read even minimally without glasses.  I shopped today and wasn't as "overwhelmed" as I was last week with the shelves seeming too close and magnified.

My night vision was never a problem- actually, vision was beautiful due to the pupil dilating and letting the light go around the cataract.  Signs, license plates etc. were crisp and clear.  Maybe not as much now (I'm wondering if there's a tint to the lens which might block minute amounts of light from aiding the vision).

Dr. JH, with the above lens info, does -1.75 seem like an appropriate lens to implant after removing the left eye cataract?
PS astigmatism has always been corrected with glasses yet hasn't been with this cataract removal.

[John C Hagan]

I'm sorry I cannot answer your question with the data you've given me.  To do so I need your distance refraction (example -1.75)  I need the distance refraction to determine your ability to see up close and mid-range.

If you want to see better at near on the second eye the IOL will need to be a stronger power and leave you with less uncorrected distance vision but better near vision.

Bottom line here is that you and your surgeon will need to work this out and I would never dream of telling surgeon what to put in your eye. All I can do is generalize.

JCH III MD