urgent advice needed re cataract surgery on Monday (explant multi focal iol?)

[lulu888192]

Hi

I really hope someone can help. I am 40 years old and had PSC discovered several years ago, these are possibly related to my high myopia of -9 and -10 I also have very large eyes and mild astigmatism. Retina apparently unusally good for such high myopia, tons of floaters in -10 eye mild floaters in the -9.  

Three weeks ago I had cataract surgery on the first eye with a multo focus lens, i was told i might need glasses for PC or extended reading  - an Acri.LISA toric IOL was used (I'm in France).

The surgery itself went very well (i trust my surgeon and have a good eye hospital) after dilation wore off (three days) I was surprised to see that there's no ghosting, halos are tiny few and seldom even at night, very very rarely in certain lights i see the edge of the IOL but only for a second its no biggie. I can see to read at 30cm in a 'sweet spot' without glasses (but its quite a small sweetspot - although it is comfy reading distance) maybe more outside and see to watch tv fine. I can also see to type this (again using a sweet spot)  HOWEVER. Whereas vision outside is very good, intermediate vision indoors is not. My main problem is that in shops, I cant really identify what's on the shelves easily - i have to be about 30cm to see the wording on the packet..too close for comfy browsing in a shop. I appreciate vision will improve when 2nd eye is done but I am concerned that given my age, this poor intermediate vision may be a problem - I work 8 hours at the PC. I'm also slightly sad that i cant see  very close up anymore - I could probably apply mascara at a push but nothing more detailed like eyeliner.

Colours etc. were more vibrant before the operation - but i must admit it's wonderful to wake up and not to have to put in contact lenses. I can drive fine without glasses etc.As mentioned, the main problem is inside - but as a 40 year old who works...this is where I spend most of my time.              

It's only been the in the last week that I have experienced the problems shopping as I took it easy for two weeks after the first eye. My second operation is due on Monday and I am wondering whether or not to go ahead.  When I said I was disappointed in having no near vision, my surgeon did say he could explant the lens if i wanted (but to do it soon) i got used to no very close vision ( 10cm but for an ex-myope it's strange!!! ) but the trouble shopping is a bigger deal and i don't know if it warrants explanting the lens, or if, due to my realtivey young age, I'm expectiung too much. I also can't see clearly to slice vegetables, or see my plate very well - sufficiently to eat but a litle blurry. I can however, see peoples faces clearly as long as they are further than 10 cm away - see miles into distance, tv perfect etc.  From older people talking about IOLS i expected colours to be madly vibrant - however they are slightly less so.

I would be very grateful if anyone knows how risky it is to explant and exchange a lens 3 or 4 weeks after surgery.
Also - is it possible to have laser or PRK post multifocal to improve near and intermediate vision.
Finally - if I opted to have the lens explanted and had blended - would it be possible to see clearly within 2 metres or so with the near eye - and then the eye set for far would be 2 metres plus - is that how it works? I have absolutely no problem if i need glasses for driving and prolonged reading, but i  would like to be ab le to shop, cook, read in an emergency and possibly use PC without glasses.

Very grateful for any help.

[katie190]

Hi lulu,

What did you end up doing? I'm is a similar situation... facing cataract surgery at age 33.
I'm surprised you weren't able to see well enough to put on eye make-up with the multi-focal.
Were colours still dull even in full sunlight?

[lulu888192]

Thank you Dr O

I was minus -10 in the right eye (now has the IOL) and -9 in the left. I asked about having blended mono prior to surgery (due to my high myopia) as I had heard about risks of halos etc, however my surgeon said this IOL was better. My PSC were very small and slow growing, they didn't affect me other than in very very bright light at certain angles and in the fact that i couldn't quite see number plates clearly from required distance. However now i can, in the IOL eye, I am wondering if this was not due to the PSC but to my astigmatism (which the IOL corrected.  

I don't want to risk extraction but I don't want to have the same IOL in the other eye as I will struggle and feel sad about never seeing colours and texture in the same way again - at the moment my left (unoperated eye) can see vibrant colour, texture and better than the IOL eye at all distances except for very far where the IOL is slightly clearer . The PSC cataract in the left eye is very small and it may be years before it needs doing.  

I would be very grateful if anyone knows if there are any strong reasons why i cannot continue with IOL in the right eye (which is dominant) and contact lens in the left eye (non dominant) I've been doing this quite happily for the last few days. Then when the PSC in the left eye needs suregry (if it ever does) look at mono for near or perhaps by that time, there will be a better solution. I am very very much hoping that multifocal in one eye and mono in the other is not impossible.

[Ray T Oyakawa, MD]

I would discuss this with your surgeon.  Multifocal IOLs have relatively poor intermediate vision.  Also, you did not mention your previous refraction, but I would guess you were nearsighted and without glasses your distance vision was probably poor. Your expectations of this IOL is unrealistic.  No iol provides all ranges of vision.  

Dr. O.

[lulu888192]

sorry to post again, however i forgot an additional question which is -

The eye that has not yet had surgery is the non dominant eye. Would it be possible to put a mono lens in this eye for near and intermediate and leave the multifocal in place for far ?