Correction level for 2nd eye Operation ...F.A.O.Michael J Kutryb, MD

[indi1664]

Hello,
         I have recently had CLEAR surgery on left eye and have gone form -19 to

Sphere  +1.5      Cyl -1.5      Axis 94

V.A  = 6/9     ADD = +2.25  Near V = N8

Does this make me plano or given the Axis reading would you say I am +0.5 to +0.75 given the fact I cannot see anyting clearly within 0-3 feet..eg looking at watch …is VERY  blurry…reading or computer screen …even large print is impossible without readers.

My right eye is about same (-19) but I have a  -2 cyl.

My critical question is as I am hoping to have Limbal incision during right eye surgery can you in your opinion explain how much possible correction can be attained and how do we take into account the level of Cyl correction when calculating OVERALL prescription? Given the fact i want some reading and closeup work...i know i cannot deviate too much from left eye prescription as this can cause imbalance and headaches.

Thank You

[Michael J Kutryb, MD]

If you truly were a minus 19.0 myope then you should be jumping for joy.  Somehow I wonder if maybe your number are wrong.  To know your spherical equivalent take half of cylinder and add it to sphere.  For example +1.5 shere, -1.5 cylinder equals +1.5
PLUS -0.75 for spherical equivantof +0.75.  Limbal relaxing incisions do not in general change the overall spherical equivalent very much.  It sounds like you might benefit from LRI's but your near visoin will still require reading glasses.

MJK MD

[JodieJ]

I was also a high myope (but less so than you are) with some astigmatism.  I was told that the available formulas are much less reliable for people with eyes like mine (and probably yours.)  Limbal relaxing incisions are reported to eliminate on average about 50% of the  pre-surgery astigmatism, with some variability.  I'm sure your surgeon  will aim for the best results possible, taking into account all factors.  S/he did a pretty good job with your first eye; your distance vision is good enough to pass the driver's license vision test in my state.  Best wishes and keep us posted on your outcome.  

[indi1664]

Hello Sir,
               Thank You VERY much for your kind reply.
Yes I know it seems unbeliveable ...but yes -19 spectacles and contact lenses -14.5...definitely correct.
Also the new operated prescription is correct ...now i understand how appreciative I should be given an eminent surgeon as yourself ...is quite surprised.

Dr Kutryb ..I am slightly confused ...am i right in understanding from your explanation...from my prescription (Sphere  +1.5      Cyl -1.5      Axis 94 ) this more or less equals Overall prescription of +0.75.

If that is the case than to get some shortsight blending what prescription should i be aiming for in right eye.??

My surgeon without knowing new accurate prescription was saying -2...will that not be  too much difference in correction?

Really appreciate your detailed thoughts ...as I am very concerned about getting the right balance.

Indi

[Michael J Kutryb, MD]

You seem to have a  pretty good understanding.  Yes, spherical equivalent for first eye is +0.75 which is pretty good and really should not be messed with.  The only thing you could do is LRI to reduce astigmatism.  It will not change spherical equivalent much but might increase uncorrected distance vision a line or two - like from 20/50 to 20/40 or 20/30 if lucky.  The mild +0.75 spherical equivalent will limit your uncorrected distance vision to about the 20/30 range and if your were a -19.00 myope you could have some myopic degeneration which might limit best possible vision to about 20/30 anyway.  In my experience no matter what is done, you may not see 20/20 with or without glasses due to having such a high level of myopia.

Now, regarding second eye I would shoot for something like -0.50 to -0.75 and no more because I would be afraid of a significant difference between eyes of more than 1.50 to 1.75 diopters.  I would be more willing to risk you needing to wear reading glasses than possibly causing imbalance problems.  Overall I would go for about -0.5 but this would change if you were very happy with distance vision in first eye or if the +0.75 started to shift a little more toward zero.  I would make very sure exactly what the final refraction for first eye was before making final decision.

MJK MD

[indi1664]

Hi,
       Thanks again for your great input...and as you say ...I am now able to see beyond driving requirement ..so a great blessing ....
By all means I will keep posted on here as we all need eachother ...and my severe Myopic correction will hopefully give others confidence when thinking of having surgery.

[indi1664]

A big Thanks!!! again for your detailed reply...i am rather pleased now...as all the research on this site from comments by your goodself and colleagues...led to me a similar conclusion.

I realised the -2 would have been quite a disaster and now I am much happier armed with your Excellent advice.

Take care

Indi

[Michael J Kutryb, MD]

Remember, there is a chance you could end up something like minus 2 regardless due to the built in innacuracy that is possible with such a high level of myopia.  Hopefully, you will end up close to intended refractive target - but don't be surprised if you are off a diopter or two.  It can easily happen.

MJK MD

[indi1664]

Hello,
              You are absolotely right Sir...I guess all we can do is try and get best possible the result we can...and I know all surgeons would want there patients to have the best possible outcome....but some outcomes in life even with... Excellent surgeons as yourself... we have to trust in god.

Thanks again and You take care Dr Kutryb..

Ps You have Beauuttiiiiifffful family ..three daughters .....Gonna cost you a fortune to bring  up sir...  :)) ...I have two and all they do is say please and use those eyelashes and we dads just give in.....best feeling in the world...wish them all the best ....ohh nearly forgot ...wish there mum as well...