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Michael J Kutryb, MD  
Male

Specialties: Ophthalmology, Cataract Surgery, glaucoma

Interests: Ophthalmology

Kutryb Eye Institute - Titusville
321-267-2020
Titusville, FL
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Cataract Surgery MonoVision Tips

Nov 27, 2008 - 159 comments

I've seen several posts in recent weeks about desired monovision after cataract surgery.  Since this is a subject near and dear to my heart that I deal with every day at the office, I wanted to give you some tips on how I deal with this very tricky situation.

1.  Monovision is not for everyone, especially if you are into athletics or want clean crisp distance vision.  In general, it seems to appeal to people that don't like the look or feel of glasses on their face and are higly motivated and willing to make sacrifices in vision quality to achieve that.

2. You seriously need to have tried it successfully with contact lenses before considering monovision after cataract surgery.  The intraocular lens implants used with cataract surgery are basically permanant and not easily replaced, so changing your mind after the fact is something to be avoided at all costs.

3.  Decide what your vision priority first and try to get that accomplished before going for priority number two.  You're not allowed to say "I just want to see at all distances without glasses" here.  That would be a wonderful result and something to shoot for but being realistic, you need to decide if I had to choose, what would I most desire, the ability to see near or far without glasses.  In my practice, I find out the main priority and shoot for that first and if I can achieve it in the first eye then the second eye has some wiggle room for me to add some near or distance vision as desired.  It is more of a DISTANCE plus some near added in or NEAR with a little distance added in.  This is a little of a mental game but my goal is to set expectations in a reasonable way and avoid giving in to the "I want it all, I want it now mentality" that has become more common, especially in the baby boomers.

4.  Mini-Monovision is a very desirable result for many patients and usually provides excellent distance vision and some useful near vision for computer work, and light reading like price tags and menus.  It is my favorite technique.  For example, after determining the dominant, I would aim for 20/20 distance vision (as close as possible) in that eye and then aim for something like 20/50 in the non-dominant eye with about -1.25 of myopia or nearsightedness in that eye - just enough to support a small to medium amount of intermediate and near vision.  It is such a small difference between the eyes that a great many patients can adjust to it quite well. These patients already can see almost perfectly for distance with one eye so that the non-dominant eye is freed up somewhat to be a little less sharp for distance and a little better up close.  There is one caveat with this technique and that is that it is crucial to get the first or distance eye as clear as possible for distance.  It it is a little off for distance, then I am occasionally forced to make the second eye for distance as well since these patients usually have distance vision as the main priority.

Keep these ideas in mind when considering cataract surgery, and I welcome your comments and questions.  I really enjoy communicating with my surgery patients and getting to know what they want out of cataract surgery.  I get to be the "Vision MatchMaker" every day and it's a responsibility I take very seriously.

Michael Kutryb, MD
Kutryb Eye Institute
www.kutrybeye.com

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by JodieJ, Nov 27, 2008
Thank you, Dr. Kutryb, for posting this detailed summary about this excellent option for many people.  I'd like to add a couple of possible contraindications to monovision:  a history of strabismus or an existing phoria (called "latent strabismus" in the LASIK literature).  Most people with a mild phoria (like me) probably don't know they have it, but it's easy for the surgeon to test for it.  After developing double vision from monovision contact lens wear, I learned that this type of breakdown is not uncommon for people with "latent strabismus" doing monovision with contacts or through LASIK/PRK.  I assume that the same type of breakdown might occur with monovision from implants.    

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by tia2808, Nov 27, 2008
what cause gi bleeding in pemture babys n how cn it be stop

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by purpleberry2003, Nov 30, 2008
I am 35 years old and had cataract on both eyes this year. Had the right eye done in Aug and the left eye done in Sept. My Dr said the cataracts was so bad that there was no other option but the surgury. Honestly, I think my eyes are worse now. I had to get a new perscribtion in glasses with bi focals. I hate them !!!!!!

Right after the left eye was done and sitting in the recovery room, I kept telling them that it felt like something was in my eye. They searched and searched and found nothing. 2 weeks later I went to my post op and he found that the lens wrinlked. OH WHAT A FEELING !!!!!! the itching and burning is out of control.

To make  a long story short, I no longer have insurance that will pay to have it fixed. So now I must live with this until I can afford to get it fixed.

I sometimes wonder If I would have been better off not getting the surgury

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by retiree0418, Dec 01, 2008
I recently had cataract surgery on both eyes. My opthamologist recommended using the RsStor lens. However there was a problem because my left eye was extremely myopic and elongated and the ReStor lens could not be used. I chose to have a ReZoom lens in my left eye and a ReStor lens in my right eye.  I now get 2 images and my brain has to sort it out. Both eyes focus if I look straight ahead or look down, but if I look up my left eye image goes up and to the right. I don’t know if it’s the ReZoom lens or my myopic left eye causing it. I now have 20/30 vision in my left eye and 20/25 vision in my right eye. It's a great improvement over what I had but I have to use reading glasses to clearly see a computer screen or read a newspaper.


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by Michael J Kutryb, MDBlank, Dec 02, 2008
Thanks for your comments. Every patient is different and multifocal and accommodating lens technology is far from perfect.  In some ways at 20/25 to 20/30 you have a nice result but I suspect there's something unnatural about your vision - but I guess we're all imperfect in many ways.  At least you have some pretty good vision.

Regarding the young person with pain after surgery - that is related to a scratch on the cornea or an irritated incision.  it should only last a few days.  The wrinkled capsule is extremely common in young cataract patients with PSC type cataracts.  A yag laser will help the problem in about 99% of cases but need to wait a few months after the original surgery.

MJKMD

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by laura5121, Dec 09, 2008
If one needs to have cataract surgery what methods are being used to avoid
post surgical glaucoma. Does this condition occur because the IOL sooner or
later causes the aqueous fluid to clog or not flow thereby building up pressure,
thereby causing glaucoma.  What should one look for when selecting a
surgeon in order to avoid post surgical problems.  Thank you very much for
whatever information you can provide.
by laura5121

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by starman6600, Dec 31, 2008
Dear Dr. Kutryb,

Thank you for this excellent posting and for all of the helpful ideas which you have given me personally. I especially value your idea of the mini-monovision and may consider that for myself.   From your comments and Dr. Hagan's, I learned that, as a prior RK patient, I need to go with a monofocal lens.   I learned that I have a positive spherical aberration and therefore am likely eligible for the Technis lens (which may be especially helpful for night vision).  Just to clarify one point, I am hyperopic at about +1.50 in my dominant eye ( I erred the other day when I wrote -1.50).  I hope to be communicating with you further in the future before making a final decision to proceed with a lens implant.  May I add, as an aside, that your comments are not only beneficial to patients, like myself, but they are also helpful to your fellow physicians.  As a result of your wonderful shared information, you save other physicians many hours of answering questions that patients have  in their decision-making process.  Thank you again for all that you do for us.  Best wishes, Starman aka Frank


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by AudreyRose, Feb 16, 2009
I have printed this off.  Thanks for this great information,  Doctor K.  I wish you were in my city.  Do you have a clone?  (-:

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by Spido, Mar 02, 2009
Dear Laura5121,
Yours are excellent and very important questions; let's hope some knowledgeable person happens along who will attempt to answer them.

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by lisa906, Apr 06, 2009
my vision is 20/400, and i use contacts to see far away. can this be corrected w/o having to wear glassed for near vision?

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by lisa906, Apr 06, 2009
my 18 yr old son did mushrooms more than once  and other drugs.  now he has double vision, accom insuff, focus and memory problems, severe enough that he says he cant work or go to college til its fixed.  
can drugs cause that much damage.  he says all his friends do them all the time and have no problems.

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by Michael J Kutryb, MDBlank, Apr 06, 2009
Your only chance is either bifocal contact lenses (which don't work well for some people) or monovision with one eye for distance and the other for near with contact lenses.  Tell your son that drugs are a very bad idea and that his friends don't know what they are talking about.

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by Purple_Couch, Jun 29, 2009
Thanks, for your answers here, Dr. Kutryb, and for referring to me as a "young cataract patient" - it's been a while since anyone called me that!

You're worrying me, though by saying that a wrinkled capsule is extremely common.  Yikes!  I had my right eye done a couple months ago and the results were perfect (my vision is now 20/20 in that eye).  My left eye is next month, and now I'm wondering if I'm not expecting too much by hoping that the result will be just as good.  What exactly are my odds of encountering this complication, and how long will I need to wait to get it fixed if it does occur?  Why is this more common in younger patients?  Or is it just that it's more common with PSC cataracts, which are, in turn, more common in younger patients?

And why do you believe it's imperative to have tried monovision with contact lenses previously?  Are there some people who just can't learn to see that way?  When I wore contacts I only wore them in one eye - the other didn't need correction.  Would this experience count as having tried monovision?

Thanks in advance for your input.  And, again, for the "young" thing. I'm only 44, but the cataracts are making me feel old :)

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by stutk, Jul 15, 2009
I am 35 years old...I have perfect 20/20 in my left eye and need cataract surgery in my right eye...would you recommend a monofocal set for reading....that way i can see far with my left eye and have both eyes for reading (essentially monovision)...and eventually when i hit over 40 and my left eye starts losing the reading then i will have my left eye for seeing distance and my right eye for reading...

I am right eye dominant...is it okay to put the dominant eye as the near vision...


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by EGD, Jul 16, 2009
Thanks for the info.  I had lasik monovision correction six years ago and now have cataracts in both eyes.  I am planning a monovision correction with cataract surgery.  Has anyone had any experience with this?

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by tuggy128, Jul 25, 2009
What can you tell me about the success of presbyopia correcting lens for multiple distance?  I have been extremely nearsighted for the past 50 years (I'm now 61) and cataract surgery (recommended two weeks ago my opthalmologist) seems like a miracle if I can have improved vision.  I read your comments with great interest about monovision but didn't see anything about presbyopia correcting lens.  I really want to make an informed decision and only found out about the presbyopia CL in my search for info on the internet.  Can you give me some information?  I guess I'm one of those boomers who "wants it all and right now".

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by Michael J Kutryb, MDBlank, Jul 25, 2009
To EGD, yes this can certainly be done after lasik with excellent results.  In fact I just the exact thing for our office mananger's mother and she is 20/20 distance and near.  Great care need to be taken to get exact corneal measurments preferably with a pentacam, orbscan or zeiss atlas toprapher in order to utililize the post-refractive lens calculation formaulas.  Mistakes can be made if surgeon is not very familiar with these types of cases.

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by Michael J Kutryb, MDBlank, Jul 25, 2009
To Tuggy128 - that's really a big question. In my personal opinion I would go with distance for both eyes or distance one and mini-monovision in the non-dominant eye or last resort is crystalens which often utilizes mini-monovison anyway.  I cannot really make a recommendation for any of the other presbyopia correcting lenses.  Crystalens HD is the one least likely to cause terrible visual side effects but it can be off target sometimes, and may require a lasik or prk or piggyback lens procedure to tune up the vision for disappointed patients (this is done up to 10 % in some practices.)  With my standard aspheric monofocal patients this type of tune up is something I would do about one in 500 patients or about 0.2% of the time.)

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by tuggy128, Jul 27, 2009
Thanks for your input.  I really appreciate getting your professional insight to help with my decision.  What vision I have left is worth preserving and I certainly want a good outcome without making things worse, or at least difficult to adjust to.

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by agility, Aug 01, 2009
I had surgery on my right eye 6 days ago & am experiencing being öff balance" & not sure on my feet. Has anyone else experienced this? So far am not getting a good answer to my question. My doctor wanted to do the left eye 2 days from now & I cancelled that surgery until I get some answers. She put a contact lens in my left eye to bring it more in line with my right eye but that has not helped. Jo

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by suri74, Aug 31, 2009
Dea Michael J Kutryb

Thank you for your valuable suggestion on Mini Monovision.How much additional power can I add for near, in cases of Mini

Monovision cases?.

I would like to add one more point on suitable patients for mono vision,countries like India women prefeer

to weare saree.For them it is difficult to carry glass,I found they are  the happiest people afeter this kind of surgery.

With Regards

Dr Marpuri

***@****

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by Michael J Kutryb, MDBlank, Sep 03, 2009
You can go up to -1.50  or all the way up to something like -2.75 or -3.00 (but then it is regular monovision.).  But you need to have a feel for how you will adapt to those different degrees of myopia - a contact lens trial is helpful.

Michael Kutryb

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by sri009, Oct 04, 2009
Dr.Kutryb,
I had cataract surgery done on the left eye 2 weeks back. Now I am able to see and read things which are at a distance of 20 inches to 30 inches (my computer screen) without the help of any glasses. My Dr. says that he tried to set the eye for distant vision but it has ended up being intermediate vision. He says when I get my right eye done he would set it for perfect distant vision. Here are my concerns.
1. Is 20 to 30 inches intermediate vision or near vision in the first place?
2. Will I not end up having depth perception issues with one eye set for distant vision and the other eye set for 20 to 30 inches. Currently with the combination of my operated left eye and the non-operated right eye I am having depth perception issues of varying degree while looking at things at different distances, even with corrective glasses on for the left eye (power is -0.75, the power seems to be fluctuating).
3. I do not mind wearing glasses but I want the perfect vision which I had before I developed cataracts. I am only 32 yrs old and never wore glasses. I do not want to have issues judging depth.
4. If I set my right eye too for 20 to 30 inches will there be no issues of depth perception at all? Is this advisable? If not, what is the best distance that I should get my right eye set to?
5. I do not mind wearing progressive glasses all through my life but I do not want to have issues judging depth all the time. What is my best option?


Please advice. I only have one shot left now. All you feedback / suggestions would be greatly appreciated.

Thanks,
Sri

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by bes7172, Oct 05, 2009
I am very unhappy with the results of my surgery Mono vision. Can any of it be redone ?

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by bes7172, Oct 05, 2009
Sorry, I should explain more. I am over 50, and cannot see from near or far. developed cataracts. made the decision to have one eye [right eye done for seeing close] and later left eye for distance. Terrible decision for me. I WISH I had made them both for near [reading] vision, and just worn glasses for distance. Now I can't see near or far. It is worse that when before the cataract surgery I had the sharpness of the distance, yet the blurreness when trying to use both eyes together. Same for the near. haven't got the two galsses yet, but how crappy to hav to need two different pairs of glasses. I was miserable at a dinner lastnight due to this very uncomfortable vision situation. Is there any way that i can get lasik or anything to get both eyes thae sme to see good for near ? I hate the mono vision. is was a terrible mistake for me. perhaps it works well for some. Pease doctor respond as soon as possible. thank you so much...bes7172,      email ***@****

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by bes7172, Oct 07, 2009
Gee, my vision must be so bad, that I can't even spell words right in the above post. Actually I'm a bad typist. Please help Dr. can .my cataract surgeries be changed to take the implant for distance out of the left eye. How risky is that ? Or is it even possible ? Can lasik be done now to help ? Thank you very much . This mono vision is horrible for me. The near in right eye is good but the distance in left causes extreme blurriness

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by hnw138, Oct 21, 2009
I am going to have cataract surgeries shortly, and have to decide whether to go with mono vision or with distance for both.  I am a golfer and tennis player, and very active 60 yr old woman.  I am near sighted, and my visions are -6.5 on both eyes, and my right eye is dominant. My Dr let me try -6.5 for the right and -4.75 contact lenses for the left eye.  I can read menu at restaurants and things at supermarket, but I can't read books comfortably in this combination.   Among your patients, what percentage would choose mini-monovision over distance bor both ?  Do you think I should try -6.5 and -5.25 (-1.25 from 6.5) as you suggested in your blog ?  Thank you very much !  

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by Bosibos, Nov 18, 2009
Dr. Kutryb,
Thank you for the information about mini-mono vision.  I had a Toric implant put in m right eye one week ago since my Dr. said it was my only option since I had astigmatism.  According to my eye exam yesterday,  my distance vision is 20/30.  I cannot see anything in the intermediate or near area with that eye and am very unhappy with the result.  I really do not feel my distance vision is great with that eye, either.  Now,  the question is...should I go with only distance in my left eye or ask my surgeon to shoot for intermediate.  I don't mind wearing glasses for reading.  Any suggestions would be helpful.
Thanks you.

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by Zivadavid58, Nov 21, 2009
I have in the Left Eye a Baush & Lomb Monofocal Lens Akreos Adapt Plus 12.5 diopters.  My Right Eye has a bad Cataract with a -5 Myopia.  I'm confused whether to replace it with a Monofocal Lens -1.5 or -2 which will give me a Blend Vision or should I replace it with a Multifocal Lens?   Would you please let me know which Multifocal Lens is the more successful in my case?   The Crystal Lens HD Version or the Restore Lens?  I also heard good reports on the Tetraflex Lens.  Some Doctors' opinions prefer not to mix Multifocal with Monofocal.  They say that Multifocal works better on both Eyes rather than one?   Please let me know?

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by Lainey28, Dec 12, 2009
I wish I had found your information earlier, I am a woman of 52 years and have cataracts in both eyes.  I was short sighted 1.75 in both eyes but my vision deteriorated in the right eye because of a cataract (over a year). The right one required surgery.  I spoke to my surgeon and said I would like monovision.  He said as my left eye had good reading vision he would put a distance vision the the right eye.  I told him I had concerns about this as I had read that it is normal practice to put distance vision in the dominant eye, he did not seem to think this was the case.  Anyway I had surgery which I found a bit traumatic as I thought I was going to have an injection but had topical drops instead.  Even though it was not painful I found it disturbing. I might go for local for my other eye.  I am a coward!  My eye seems to be okay - it has been 2 weeks and my vision is so clear and my vison is working well for reading too.  My night vision is not so good even though I put my glasses on to correct distance vision in my near sighted eye.  I was driving along the dual carriageway and it looked like a truck had stopped on the road, but it was parted in the layby!  My question is what differrence is it going to make to my vision now that I have distance in my non dominate eye.

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by DallasCPA, Dec 16, 2009
Dear Doctor & patients,

I'm very confused & concerned about getting eye surgery... I'm in my early 50's and can no longer wear my GP contact lenses due to dry eyes.  I had great, crisp correction of astigmatism & severe myopia for many years with my GP contacts, then used reading glasses over them throughout my 40's until I could no longer tolerate my dry eyes...

Now, I am wearing progressive glasses for over 2 years, but  many of my activities are limited, including driving because my vision is not crisp & I do not have the peripheral vision that contact lenses provided.  I've become much less active & it is affecting my work ...

I am a CPA & an avid reader, so my vision is crucial.
With my astigmatism, myopia & presbyobia... what type of implants would you recommend?  I've been told I am not a good candidate for laser surgery, and one surgeon suggested CL HD, followed by yag & then lasix if needed (probably needed...)... meaning 6 total surgeries -- 3 in each eye.

This was from a very high-volume "big name" clinic in Dallas, with little input from the doctor himself -- who briefly looked over my chart after a technician spent considerable time examining my eyes.

Should I get a 2nd (and 3rd opinion)?  I'm concerned about "waxy" vision or ending up with worse dry eye problems, making my vision worse than better.  The information seems very confusing & I'd like more objective information, especially concerning astigmatism & eye surgery...

I've seen some eye docs who prefer aspheric implants vs Crystalens HD, and I am also wondering about the details gearing the procedure more to close (reading) vision versus distant vision.  Is all this considered "wavefront" technology?

And last, but not least, what about significant side effects with the newer implants (like waxy vision, glaring & halos?).  

Thanks so much for your time & any guidance you can provide,

Sincerely,
Dallas CPA



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by shindi49, Dec 19, 2009
I have just turned 60 and have been diagnosed with cataract. This is my priscription now. I have been short-sighted since the age of 18  and started going long sighted at 40. I see the cataract operation as an oppotunity to reduce dependancy on glasses. If I can see distace and intermediate without glasses I shall only be too pleased. Can this be achieved?


Sph                    Cyl                    Axis             Near
-4.00              -0.25                 165               +2.50 add         RIGHT
-4.00              -o.75                   17                +2.50 add         Left


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by jiyacutegal_jain, Jan 10, 2010
I have been operated 10 years back  for left  eye cataract.and right  eye there is no catract is   it possible to do  laser of only one eyes ?

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by Michael J Kutryb, MDBlank, Jan 10, 2010
Yes, if you are speaking of laser capsulotomy or LASIK or PRK.

MJK MD

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by DELTABRAVO, Jan 24, 2010
I am getting a mono focal IOL in my right eye due a severe cataract. My left eye only has a very minor cataract.
Assuming the Mono-focal IOL gives me good distance vision and I will wear my contact ,-8.5 in the left eye, will that allow me to do the things that I love, such a play hockey, run triathlons etc.

I need reading glasses now with my contacts and assume I will need them after the surgery ,with  a different Rx for the right eye.

I'm 49 and read quite a bit.

Does this scenario sound realistic to keep doing what I like to do?

Thanks

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by DELTABRAVO, Jan 24, 2010
Follow up to my last post:

Or will I need my left eye done anyway  to balance me out?

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by Michael J Kutryb, MDBlank, Jan 24, 2010
You're right on.  As long as you can wear the contact lens in the left eye and see well you should be fine.  That assumes you will have good uncorrected distance vision in the right eye.  If you still end up with some refractive error for distance you might find that you have to wear glasses or contact lenses to get the best distance vision in that right eye.  Jut remember that there are no guarantees that you will not need glasses for distance in the surgery eye.  Please keep your  soft contact lenses out for at least 2 to 3 weeks before you measurements and your surgery.  If hard or gas permeable lenses leave them out more like 3 weeks or however long it takes for complete stabilization of the corneal curvature and power.  I see no reason you will need to get the left eye done unless you get a cataract in that eye or have new problems with contacts that you never had before.  Make sure your surgeon is getting very good measurements for your surgery (IOLmaster) and gets very accurate k-readings.  It doesn't hurt to also get manual k-readings and corneal topography in these cases.

MJK MD

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by DELTABRAVO, Jan 25, 2010
Thank you I will ensure hat the measurement guidelines you mentioned are done.


Two more questions:
I'm told that I will need to wait 3 weeks before I can start playing hockey again, and 2 weeks for jogging and biking and swimming.
Does that seem reasonable or is that too aggressive?

Also, how long do I need to wait to be able to use contacts, get a new Rx, in the right eye if I need them for the best distance vision.

Thanks again.

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by Jean420, Feb 09, 2010
I had a retina detachment about 4 yrs ago in my left eye. Now I have developed a cateract in my right eye. I'm scheduled for surgery this week to remove cateract in my right eye (scared to death). However, I will have another surgery next week on my left eye. The Doc wants to balance my eyes out by putting a piggy back lens in the left eye to match my right eye........ any suggestions............has anyone had a piggy back lens put in due to retina detachment?  

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by Michael J Kutryb, MDBlank, Feb 11, 2010
My suggestion would be to also consider matching the right eye to the left eye (in other words leaving it nearsighted just like the left eye.)  This would be your other option and would allow you to get away with only one more surgery rather than two. Also, it might be difficult to get insurance to pay for a piggyback lens.  My preference if you want to go that way would be to either just leave the right a little nearsighted in order to match with the left eye, or make the right eye closer to plano (no glasses for distance) and then later consider lasik or prk on the left eye to match the right.  Remember that more intraocular surgery (piggyback lens) equals a higher retinal detachment risk (especially in someone with a prior detachment.)  I just hope your surgeon is thinking it all through.

MJK MD

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by Sandy74229, Feb 26, 2010
I am a 74 year old female who wore mono vision contacts for 20 years with no problems and had mono vision cataract surgery about 12 years ago.  The last year and much worse the past three months I have symptons of Strabismus.  My left eye turns in toward my nose.  No one had noticed this but the opthomologist had no trouble seeing it. My vision is very distorted at times.  It is the near sight eye.  The far sight eye is fine.  His recommendation is to strenthen the left eye muscle by wearing glasses and perhaps with time, surgery to the muscle might be done when he gets some measurements.  I had an MRI or the head and had a normal brain.  I have had the glasses for a very short time but wearing them is difficult as my vision is more distorted now, all the time.  Prior to the glasses I was bothered mainly while driving a car or trying to look directly into the eyes of the person I was talking to.  Do think I am on the right path with glasses or do you think the near seeing cataract lens could or should be removed.  Wearing the glasses I am distorted all the time and it is more difficult to drive and to go on with a normal life.
Thanks for your comments.

NMD

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by Michael J Kutryb, MDBlank, Feb 26, 2010
Make sure you don't have a left sided, 6th cranial nerve palsy which would make the left eye unable to turn to the left very well.  You might notice that the double vision gets better when you look to the right and much worse when you look to the left.  It is a very common problem and would often not show up on MRI.  I really don't see how the implants would relate to the strabismus after you did well for so many years.  It would be easy to simulate elilmination of the monovison by wearing a distance vision contact lens on the nearsighted eye to even the eyes out temporarily. I doubt it would help but worth a shot I suppose if no cranial nerve palsy.

Michael Kutryb, MD

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by Jay_from_Beantown, Mar 05, 2010
I am nearly 54 and have tentative plans for the surgeon to install a -1.0 monofocal IOL in my left eye.  I already have a rezoom lens in my right dominant eye, but am bothered by the large halos and glowy shadows, and don't want to cement it with another multifocal.  With the -1.0 lens I am hoping that near vision clarity will be better (3-4 ft out), understanding that I will be sacrificing distance vision, that the rezoom is handling for me now quite clearly.  I can read pretty well with the rezoom eye, but expect to wear reading glasses for the computer and fine print after surgery. Dr Kutryb, it seems this approach is similar to your mini monovision approach but with a multifocal ...can you advise if this is so, and if my direction is a good logical approach?  What type of combined vision is likely if we go as currently planned? Should I use a stronger lens  to be able to see peoples faces, the speedometer or grocery store shelves clearly for example (which is my hope)? Also what am I sacrificing if I go with the  -1.0 lens versus a 0 lens?  My left eye vision is too blurry for a contact lens trial.
Sorry, one last thing, what do you think of the new acrylic Akreos "reduced aberration ,enhanced depth of field " lens, using this versus the B&L silicone aspheric type in my case?  Thank you, it is great to have someone so considerate to share their expertise with the public.

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by Michael J Kutryb, MDBlank, Mar 05, 2010
My decision would have quite a bit to do with where you are now with the left eye.  My first inclination would be to go for distance (plano) with the left eye UNLESS you are currently already about a -1.00 or -1.50 or so.  Don't make yourself something you have never been (nearsighted) unless you really, really want that.  THe akreos and silicone aspheric both have the same optics but the akreos just goes through a smaller incision and I have heard claims (totally unsubstantiated by reseach data) that it could offer more depth of field by minimal accommodative effects.  Basically  the same optics overall in my opinion.
MJK MD

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by Jay_from_Beantown, Mar 05, 2010
THKS for responding!  No I have never been near sighted - just gradually needed reading glasses of 1.5 to 2. Your opinion is similar to my second opinion Doc.  I'm still confused because the first Dr is prominent figure in Boston, and seemed to think that adjusting the left eye to -1.0 may allow me to be generally reading glasses free  for intermediate reading(perhaps not for for reading close up), this given the rezoom eye is giving me pretty good close up reading, and also very good distance already.  Is his premise off base or do you think the tradeoff is just not worth it?  To your point, I definitly don't want to end up near sighted to the point I need glasses for distance as well (so so vision on both ends) - but didnt think that was going to happen with this approach?

I am actually leaning in the plano direction now , but still want to know what king of vision to expect one way or the other. Can you estimate how my vision will be with Plano left eye and Rezoom right eye for the intermediate closeup tasks?  Will I likely need reading glasses to see the 3- 4' stuff I describe - or will the rezoom still allow me some pretty good vision in this 3-4 ft range despite the blurryness of the monofocal eye?    If plano choice just means reading glasses for close tasks it seems like the way to go. But if 3-4 ft stuff is blurry, my fear is I must forever have a pair of reading glasses on the bottom of my nose, while driving (to see instrument panel), walking the market isle, etc?   I realize you can't possibly know for sure the outcome with my eyes, but any educated guess/advice appreciated.  Many THKS

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by Rudy1012, Mar 06, 2010
Dr Kutryb

First let me thank you for all your efforts helping us cataract suffers wade through all the confusion, smoke and hype.  Giving us the benefit of your experience and educated opinion helps us make the best decision on our most valuable sense ---- sight.

I am 65 years old and have worn glasses and contacts (nearsighted) for 40 + years.  For most of my life my corrections were in the -3.00 to -4.50 range and my corrections seemed to wander around over the years --- first going up to – 5.50 and then later in life drifting down to the -3.50 range.  About 5 years ago my doctor said he started to see the beginnings of cataracts.  The corrections required for my glasses zoomed up like this

Year 2006 R -5.75 L -4.75
Year 2007 R -7.75 L -5.25
Year 2009 R -9.50 L -7.75

My eyes have been thoroughly examined and the deterioration seems to due to the progression of the cataracts --- retina, etc appears healthy

It’s now time to pursue cataract surgery.  I’ve been dragging my feet because I’ve seen the rapid pace of technology improvements in IOL lenses and cataract surgery so I wanted to wait as long as possible.  I wish I could wait another 5 years but its time and mini monovision is the approach I'm going to take.

Two questions.
  
First, how do you determine what proper corrective power I need for the IOL lenses since I’ve been around -4.00 most of my life, but now I’m way up there?  How can they determine what I really need so I’m not way over-powered ---

Second,   How critical is microsurgery?  I was under the impression that most procedures were now being performed making incisions at the 2.3mm level or less, and when I recently met with a cataract surgeon and I asked he told me he was using 2.8mm incisions.  I was shocked and when I challenged that he said microsurgery was unnecessary and presented additional risks.  What is your opinion here.

Thanks

Rudy



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by goodone1229, Mar 30, 2010
Dear Dr. K:

I had cataract surgery on my left eye last week and literally see for miles and miles.  Is that NORMAL??? I've been extremely nearsighted most of my life and now have to decide what to do to my right eye (sound familiar?).  I am a legal secretary and read just about anything I can get my hands on that has to do with current affairs and global matters.  I have fought for 40 years to stay out of glasses and I have to make up my mind soon.

Thanks

Sherri G.    

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by suzyhok, Apr 09, 2010
Dear Dr. K:

Surgery is scheduled for my right eye in a couple weeks to correct the cataract that is in my field of vision.  I also have some in my left eye that will need surgery eventually but according to my doctor I could wait a bit.  My inclination is to have both done soon.  I can't make up my mind between the multi-focal and regular implants.  I am pleased that he says he can fix my astigmatism at the same time.

To tell you the truth seeing all the problems people has had make me nervous.  The possibility of being able to read and see well at distances makes me lean toward the multi-focal implants in both eyes. (My doctor said he needs to put the same type of lens in both eyes.)  I am 63 yrs old and have worn glasses for the past 15 years for both reading and distance.  Before that I was fine with reading glasses as needed.

In a post from 2007 JCH III MD said he didn't 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."  

Is the technology where it needs to be for multi-focal implants?   How many eye surgeons are choosing to use multi-focal lenses on themselves and their families now?  What percentage of patients feel the added cost of the multi-focal implants was worth it because they are greatly satisfied?  Is there any way of knowing if I will need to wear glasses after multi-focal surgery before I have the surgery?  

Thanks so much...
SuzyHok



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by Annly, Apr 23, 2010
I have a question regarding monovision after cataract surgery.  My doctor suggested this because after cataract surgery in both eyes, I know have double vision.  He said that monovision will correct the problem.  Do you find this to be true?
Thanks very much,
Annie

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by Michael J Kutryb, MDBlank, Apr 25, 2010
Monovison or mini-monovison is not a treatment for double vision and for certain people monovision, in particular, can be botherson.  It is very important to determine the best candidates and explain all the effects that could be expected.  A trial of contacts to simulate the effect is a great idea also.  Your question is vague and I'm not sure I understand what you are asking.  Again, if you have double vision, cataract surgery in only select cases will improve things.  THe problel is usually more complex than that.  In some select cases the cataract surgery with appropriate IOL lens selection may help.

MJK MD

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by Annly, Apr 26, 2010
Thank you for your reply, Dr. K.

Before having cataract surgery in both eyes I did not have double vision.   After having the second cataract surgery my line of sight in one eye is higher than the other, causing a double image when using both eyes together.  My doctor has said that going to close vision in one eye would eliminate this double image.  This would mean having a different lens added in one of my eyes.  In the past I used to wear a contact in one eye only, so I have experienced monovision and it worked well for me.  The only problem with it was that I couldn't wear the contact for long as it became uncomfortable.

Sorry about the vague explantion.  I hope this is a clearer explanation.

Thank you so much,
Annie

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by Riccardo, Apr 26, 2010
I'm a Crystalens implantee, and my question is about the relative merits of follow-up PRK vs. wearing a contact lens in one eye: I had Crystalens AO implants late last year upon the removal of severe cataracts at age 60. I'd worn progressives previously (mostly for presbyopia, but also for slight astigmatism), and my right eye was dominant. But my first surgery was on the left eye because it had the worse cataract; left eye's post-op outcome was very good, focusing well from reading to infinity. Right-eye surgery one week later was sub-optimal, with fuzzy focus beyond arm's length, but with slightly better reading acuity than w/left eye. Essentially, my overall outcome was unexpected (by me) monovision, but with somewhat annoying (although slight) blurry/double-vision overlay on my binocular vision, because of the poor right-eye distance focusing. LRIs on both eyes eliminated almost all the astigmatism.

Left-eye Crystalens diopter prescription was exact (22), but right eye's (22.62) was in between the available half-step powers, and a decision was made at time of surgery to opt for the IOL whose diopter power would favor reading (23), vs. distance (22.5). That may have been the wrong decision. Two YAG treatments on right eye, at about 6 and 8 weeks post-op, did little or nothing to enable accommodation for distance. Three-month measurements show left-eye focal sharpness is about 18" to infinity, while right-eye range is about 15" to 4 ft.

My surgeon had said he'd eat the cost of PRK if I needed follow-up refractive enhancement, but he now agrees w/my concern about possible chronic dry eye, and he says PRK outcome could be +/- expected result by 1/4 to 1/2 diopter, and I might be even less satisfied afterward. He recommends I do nothing because I have good focal range overall, but I can't shake my annoyance at the slight blur that intrudes into my distance vision, even though it's sometimes barely perceptible. (It's impossible not to compare the left/right outcomes, as much as my doc advises I avoid doing that.) Generally, I strain a lot to read subtitles or sports scores on a 40" TV at about 15 ft.; driving at night is sometimes stressful; and I especially notice the focal deficiency in supermarkets and big-box stores (except when reading product labels) and while playing tennis or hiking.  

I'm "test driving" a soft contact in my right eye (prescription: -0.75) to simulate ideal PRK outcome; the contact eliminates the slightly blurry overlay, giving both eyes equal distance range and improving my vision when driving, shopping, playing tennis, walking, etc. However, I lose some sharpness in reading with the contact, though newspapers are still a breeze, and even the phone book is readable in good light. With the contact in, a mild reader works well for fine print or long-term reading in soft light.

For the Crystalens surgeries, I'm out-of-pocket nearly $9K, half of that attributable to the right eye, so I feel I didn't get my money's worth. I'm not entirely keen on the idea of wearing and maintain a contact lens for the rest of my life whenever I want to optimize my vision. But I'm also not eager to undergo PRK if that means facing potential complications (although my surgeon is an eminent expert and highly experienced). I'd like to get some third-party professional and end-user opinions about my options to help me decide on a course of action. Thanks.

Arthur        

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by Michael J Kutryb, MDBlank, Apr 27, 2010
You have three choices.  Leave it exactly as is vs wear contact sometimes vs have PRK on the eye and have reduced reading vision.  Those are your options and it sounds like you may be favoring PRK as your best alternative as long as that is what you want and you understand there are no guarantees except you will definitely have less reading vision.  Not a terribly difficult situation overall. You just need to make up your mind which way to go.  Good Luck.

MJK MD

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by Riccardo, May 04, 2010
Thanks, Dr. Kutryb.  

A follow-up question re your conclusion that I'll "definitely have less reading vision" if I choose PRK to fix the 20/60 right-eye myopia from the Crystalens prescription error:  

In testing a -0.75 contact to simulate PRK result, I'm quite OK with the very small overall degradation in my reading vision, so does that definitely indicate I wouldn't lose any more reading acuity from PRK than I'm losing with the contact?

I understand that the over/under correction error w/PRK might be +/- 0.25 diopter, but I've also tested contacts that are -1.0 and -0.50 (i.e., 0.25 up and down from my -.75 contact), so I've experienced what might be the PRK error outcome (and I'm OK with either result).  Again, PRK that yields a -0.75 refractive fix of my poor distance vision wouldn't cause any more near-vision loss than the contact does, right?

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by Michael J Kutryb, MDBlank, May 04, 2010
You are correct.  a PRK correction of -0.75 will essentially be the same as a -0.75 contact.  Understand that this is a very small correction and the computer may end up reducing the laser correction to something like -0.4 or in that range as a normal age adjustment.  You are getting into the range where an overcorrection is possible.

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by Riccardo, May 10, 2010
Thanks, Dr. Kutryb, but I'm still a little confused. If we're shooting for a -0.75 correction and end up with -0.4, wouldn't that be an undercorrection? My actual contact prescription was -1.0 to gain equal distance with the other eye, but I thought a possible PRK overcorrection at that target would diminish my reading acuity, so I opted to hedge a bit by trying a contact with distance correction of only -0.75, and it was OK for both ranges.

Either way, is it true that the margin of error shrinks with PRK when the target correction is small?

Q: My surgeon (a B&L consultant) was among the first to do pre-release implants of Crystalens AO last year, but I'm wondering if in late December (when I got mine) he may have still been tweaking his prescription formulas from those he'd used for the HD iteration. Isn't it true that each new Crystalens generation requires some trial-and-error recalibration of formulas?  Regardless, tapping his own PRK database now, shouldn't he be able to tell me his success ratio in precisely hitting a -0.75 correction target with Crystalens patients who had the same degree of "myopic surprise" as I did?  

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by Michael J Kutryb, MDBlank, May 11, 2010
The laser computer automated does its own calibration so in effect we often see that it only takes a -0.4 treatment (for example) in order to achieve a -0.75 effect.  Things you really don't need to know but what I'm trying to tell you is that it is just a very, very small treatment and almost at the lower limits of what can be accurately done.

Regarding your surgeon, he's doing the best he can with the accommodative lens technology available today which is still improving.  There are still some minor issues with refractive accuracy (as there are with any lens but somewhat more with a crystalens due to the flexibility in the eye.)



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by susieyes, Aug 11, 2010
Thank you for your excellent article on choosing an IOL for cataracts.  I am 52, with a severe cataract in the right eye, and a minimal cataract in the left (dominant) eye.  I am nearsighted (-5), astigmatic and presbyopic.  My surgeon has offered me a Crystalens or distance correction in the right eye, and is leaving it to me to choose.

  I am wondering if a near correction, followed by a Crystalens in the left, would be appropriate.  Or is this type of "mix and match" approach not wise?  I would be willlling to experiment with a bifocal contact in the left prior to surgery on the left (which is not expected for several more years).

  Thank you.

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by Clearsee, Aug 15, 2010
I have a lot of questions. Before I ask them, I wanted to say thanks for not only the website but for your answers to questions. You are doing more good than you know.

I am 52 years old, and just had my left eye done. It was the bad eye, but also the non-dominant eye. They installed a distance vision lens in it, because if they'd installed a near-vision lens then I'd have been committed to monovision and they didn't want to do that. It is an "ACRSof IQ" lens. The card they gave me gives the following information:

MODEL: SN60WF power 13.0d
LENGTH: 13.0 mm
OPTICAL: 6.0 mm
UV with blue light filter

Could you please tell me what all of that means?

The surgery was done three days ago, and so far I am delighted with the results. I understand that it will take time for my eye to heal. The colors, oh wow! Each day, acuity improves too. Today, I can almost read license plates on cars from 40 feet away, and if I get within 20 or so feet I can make them out.

QUESTIONS: How long does the recovery take? How long will it be until I know what my permanent vision will be?

Before the surgery, the doc told me that part of the cataract was attached to the back of the capsule. He explained the possible need for a vitrectomy. It didn't happen. He said he played it safe and left a bit of the cataract in, and can get the rest of it with a laser if need be. I can see the parts he left in if I do a pinhole.

QUESTIONS: Could you please comment on how my doctor played it? Sounds very much like he did the right thing, but it would be interesting to hear your view. What are the risks of the followup laser procedure? When would he do it? If they don't do it, could the cataract start growing back?

Now I am thinking about monovision or "mini-monovision." To do this, I presume they'd put some near-sightedness into the right eye. But that's the dominant eye, and my understanding is that they prefer to put near-sightedness into the non-dominant eye. The left eye's "potential" is between 20/25 and 20/40. The right eye's "potential is 20/20. My inclination is to not go with any kind of monovision, and instead rely on reading glasses, but I am open-minded and interested in what you might have to say.

QUESTION: What's your gut feel in my case? Trust me, I'm not going to run out and necessarily do what you tell me to do. I seek your perspective as a better way of understanding what my own surgeon tells me. I like him a lot, and have high confidence, but I only get one set of these things and can't know too much.

Finally, some other miscellaneous stuff.

QUESTIONS: I had some astigmatism in both eyes. The surgeon did a slight alteration in the incision to correct it some. I am thinking that the ACRSoftIQ lens is part of working on that too. Am I correct in that impression?

Could you talk a bit about the possibility of putting a different kind of lens, i.e., Crystalens, in the right eye, and what the pros and cons might be?

THANK YOU VERY MUCH IN ADVANCE. My 1 week followup is August 18th, and the right eye is scheduled for August 31st.

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by Clearsee, Aug 15, 2010
ONE MORE QUESTION: If it doesn't come up in other answers, could you discuss "multifocal lenses," and their pros and cons? Thank you!

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by Michael J Kutryb, MDBlank, Aug 17, 2010
To Clearsie,

Sounds like you're doing well.  Doctor has already done non-dominant eye for distance so he has already chosen a path against mini-monovision so you may be best suited to go ahead and go for distance in dominant eye.  Younger patients with PSC cataract (posterior subcapsular cataract) often have a sticky plaque right on the posterior capsule.  It is often so adherant that removing the plaque would tear the posterior capsule and possible allow vitreous gel to escape into the anterior chambe and require a vitrectomy.  In these cases, it is prudent to polish the capsule as much as safety allows then just leave the rest to be lasered with a yag laser in 3 or 4 months after the implant has become firmly encased in the contracting capsule.  The laser makes a very controlled, gentle opening and vitreous will not escape in 99% or more of cases.  A multifocal lens is not an option for you since you already had a monofocal in first eye.  Crystalens accommodating implant could offer some degree of a little near vision and will cost you about $2400 cash.  That can be discussed with your surgeon but it does work best if done in both eyes so may not be worth it at this point.  The Acrysof IQ lens you have is excellent, I have put in thousands but it does not correct astigmatism.

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by Yoke, Aug 17, 2010
Dear Dr Kutryb,

I've posted it before and got feedback for Dr Hagan and would appreciate some comments from you:

My son who is 22 had a cataract in his left eye ,. this was removed. But the doctor reduced his vision to -6. His right eye is -8.5. He says that is the safest option as he is young and for stability purposes as I understand form my optpmetrist that the image sizes are different.
The doctor says that in future he can always bring it down to zero in the event a cataract develops in the right eye

Anybody with the same experience and please comment ? Thanks for reading my post.
Can you suggest options for the future?


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by Clearsee, Aug 18, 2010
Thanks very much for the answers. They really helped a lot. I wish my surgeon had mentioned multifocal. I could easily afford the extra money, but I am not going to have them go back in for this.

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by Clearsee, Aug 18, 2010
I just went to my 1-week followup appointment and was wondering about something the eye surgeon told me.

My left eye vision with the distance lens went from -7.5 to between 20/40, and can be further corrected to between 20/20 and 20/25 with glasses. The doctor is ecstatic, and I'm pretty damn happy and amazed too. He says he'll "burn out the rest of the cataract" in a month or two, and I will notice a difference.

I told him that the acuity is one thing, but that I'm seeing ghosts, and two or three lights when looking at a single point of light. When I look through a pinhole, all that goes away and I see great. This was the same with my cataracts until the last few years when they got really bad.

My doc says the ghosting is the result of astigmatism, and that this can be corrected either with glasses or with Lasik. Dr Kutryb, I did a Google search on astigmatism and all the hits described it as "blurring." I saw no mention of this double- and triple-vision. My gut feel has been that the ghosting (which is infinitely worse in the cataract affected eye, which instead of three lights from one, sees 30 or more lights from one) has always been the artifact of the cataract, so I am wondering if this might go away when he does the YAG lasering.

So, what do you think is responsible for the residual ghosting, the remnants of the cataract or astigmatism? I want to reiterate here that I have nothing but good words for the eye surgeon. But he's really busy, and it's always good to get another angle in case I misunderstood.

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by Clearsee, Aug 18, 2010
Correction: I went from -7.5 to 20/40, and can be corrected to 20/20 or 20/25.

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by Michael J Kutryb, MDBlank, Aug 19, 2010
It sounds like the doctor did just fine and this will make him balanced with the other eye.  If the surgical eye was made closer to zero prescription then he would have been forced to wear a contact in the other eye or have Lasik in the other eye to correct the huge inbalance.  As is stands now he can wear glasses or if he wants he can wear contacts in both eyes.  Also down the road he could also have Lasik on both eyes if he wants to try to be contact or glasses free to some extent.

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by robrtr, Aug 22, 2010
Dear Dr Kutryb,

First, thanks for all your comments.  This thread is very informative.

My first surgery is in two weeks.  My surgeon is not a fan of monovision.  My optometrist highly recommends it.  My problem is that the first eye being corrected is the worst cataract.  It's also my non-dominate eye.  Both my surgeon and a second opinion recommended the the worst cataract be replaced first.   If I'm fortunate enough to achieve plano in the first, non-dominate, eye, could the second, dominate eye, be undercorrected?  Or is it better to aim for plano in that circumstance?

By the way, both surgeons I consulted with expressed the same reason for avoiding monovision.  I'm -8 in both eyes, and they feel that the corrective estimates are imprecise enough that any intended target under-correction could be magnified by as much as a additional diopter.

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by Michael J Kutryb, MDBlank, Aug 24, 2010
In that case you could do the worst cataract (the non-dominant eye) and aim for a little myopia. Use the IOL master and also do manual Keratometry readings (multiple K reading also with corneal topography unit) and Holladay IOL Consultant software and leave a little wiggle room for slight myopia in that eye.  Then go for  plano in second eye.  Actually you are the perfect type of eye to leave a little myopia in the non-dominant eye.  Ask surgeon why with IOLmaster and multiple careful K readings and Holladay IOL consultant calculations why the refractive target can't be more closely predicted.

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by falconerz, Aug 29, 2010
I never saw an answer to Lainey28's question about what the problems are for doing  monovision with the dominant eye used for reading. This is what I just had done because it was the worst cataract and I think my doctor wanted to make sure to get the distance eye accurate so that's why she chose to do the reading eye first even though it was my dominant eye. Just wondering what problems I've set myself up for . I also don't think she did mini-monovision & now I'm afraid that's what I was used to both with contacts and later with PRK. I feel like I can't see out of my right eye for distance at all.

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by kidsmrk, Sep 17, 2010
I am having cataract surgery Mon.  I currently and have for years had monovision so of course I selected that as my choice for cataract lens.  I have not worn glasses/contacts for several years and have only in the past year required reading glasses of 1.25, I think due to my cataracts.  

I believe (don't know terms etc. well) that my vision in my near eye (left eye) is currently 1.25, the doc is proposing changing it to 2.00; my right (my far eye) will not be done for a couple of weeks and I don't know the numbers for it.  There was some mention by the doctor that I might need bifocals after cataract surgery.  Why would this be?  Why wouldn't he just give me implants that match the setting of my eyes as they were before I needed reading glasses and had cataracts? I saw near and distance well at that time.  I don't want to wear bifocals.

Also, can contacts be prescribed after one has had cataract surgery?

Thank you, I'm so glad I found your site, it's so helpful to have a qualified unbiased opinion.
L @ ***@****

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by Michael J Kutryb, MDBlank, Sep 19, 2010
The young eye has the ability to see near and far due to a process called accommodation.  The lens actually changes shape to add more or less power for near or far.  The process degenerates slowly after age 40 a little every year.You and your doctor need to clearly know what it is that you like because your really only going to get one chance to get it right as lens exchange is usually avoided if at all possible.  In general, try to forget about what it was like when you were 20 but start thinking about trying to get vision like when you were 50 or so, and that is the ability to see pretty well in distance and having a little bit of near vision but not enough to do extensive amounts of reading and definiite problems with very small print.  Concentrate on trying to get good distance vision expecially in your dominant eye since 70% or more of what you do is with distance vision.  With the non-dominant be very careful about how much near vision you want to get since you may not like the imbalance between the eyes.  Very important to actually know if you can accept the imblance, if not sure try contacts as a trial. This is not the time to just try it out with the cataract lens impalnts - you and your doctor need to be very comfortable that you will like the outcome.  My suggestion, is that if you are not really comfortable with real monovison you might want to play it safe and go for distance in dominant eye and maybe only -0.75 in non-dominant eye.  Near vision won't be that great but that is far safer than risking being miserable because you are completely out of balance.  Now if you are totally comfortable in  past with monovision contacts with a major imblance then real monovison implants are a good possibility.

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by Kathi9, Oct 13, 2010
I am a 54 year old woman and I had cataract surgery about a year ago (both eyes).  I have been back to my Dr. many times since then and I cannot seem to get him to take my fears and concerns seriously.  I gave my eyes time to heal, went to my dr. visits, did everything I was supposed to, but I cannot see anything up close.  when I tell my dr. I cannot see to read anything and that I cannot drive and park my car anymore because I've tried and I don't have the ability to judge distances anymore; the doctor just seems to not pay attention to what I am saying and how it is affecting my entire life.  I can't read anything anymore and that is almost unbearable to me.  What do you thinnk is wrong with my vision now and what would you recommend to correct it?   There must be some procedure that will correct my vision.  It is much worse now than when I had the cataracts.  Maybe if I knew what was wrong, I could tell my doctor or get another doctor to help me.  Can you advise me what to do?

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by flyguymd11, Oct 21, 2010
Dr. Kutryb,
I am a 49-year-old commercial airline pilot.  Two weeks ago I had the cataract in my right (dominant) eye removed and a Crystalens AO implanted.  Since the first day post-op I have been myopic in that eye.  The Snellen chart says 20/40, but from a functional standpoint I can't see anything beyond about two feet. Viewing TV or reading highway signs is impossible, never mind landing a half-million pound jet at night in the rain.  My surgeon, my optometrist, and a Bausch and Lomb "Clinical Outcomes Specialist" all say that I shouldn't be worried, that there's a 3-month healing period, etc, and that any problems leftover at the end of 90 days can be cleared up with YAG and/or PRK/LASIK.  The surgeon has also had me on cyclopentolate continuously to prevent my eye from accomodating and assure that the lens remains posteriorly vaulted.  I have a few questions:

1. If the lens is already in a position which should provide the best distance vision, and that vision is awful, how will it possibly get better by itself over time?

2. Of what use is an accomodating IOL if I can already see close-up (though with subtle ghosting) when the eye isn't allowed to accomodate?  Won't it just allow me to read at three inches instead of six inches?

3.  What could have caused this result?  My concerns about incorrect lens power or incorrect positioning have been dismissed.

My career depends on my vision (20/20 distant required) and the fewer procedures (i.e., risks) I have done on my eyes the better, so I'm not sure I should consider several laser treatments three months from now as just to be expected.   Given that what are my options at this point?

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by Michael J Kutryb, MDBlank, Oct 23, 2010
Sounds like you might need Lasik or PRK to touch up the refractive error which is likely myopia.  Accurate cataract refractive outcomes depend on excellent measurements, using very advanced mathematical calculations, selecting the proper power implant and of course good surgery.  I often take multiple measurments especially for the cornea powers (k readings) and sometimes need to average them out.  The K readings are the most common reason for unexpected results.  Anyway what I am getting at is the the measurements are incredible important as are the mathematical calculations for which I use the Holladay IOL Consultant sofware.  The calculations rely on predicting the effective lens position (ELP) which is precisely where the IOL will sit in the lens capsule in the eye.  Extremely large patient samples are used to determine average ELP's. The ELP or position of the lens is even more important the the K readings.  We depend on consistancy and stabilty in determining these things and getting accurate results.  Now fast forward to the crystalens.  If you think about all the pictures and model lens you see, they all show the lens flexing forward and back.  Now think about the eye in the early postoperative period.  Where is the lens going to be?  What is it's ELP? Is it going to be a little less predictable?  Of course.  That is why patients are placed often on cycloplegic drops to try to recuce any contraction of the focusing muscles but still it can be hard for this lens to stay where it is inteded to stay based on the IOL predictive formulas since the ELP can move based on the design of the lens.   Anyway the bottom line is that the lens may have shifted forward a little bit and left you nearsigted and you may require a laser touch up procedure to achieve better distance vision.  It happens in about 10% or less of patients with crystalens. You probably did a lot of research on this before surgery so you would likely know that a small but significant percentage of patients might need an enhancement procedure which is usually done free of charge.  Your options are to wait and see, wear glasses, or possibly have lasik or prk.

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by flyguymd11, Oct 23, 2010
Thank you for your comments.  I must be in the unfortunate 10%.  Lots of pre-op measurements were taken:  K readings with manual keratometry, IOLMaster, OPD, and Pentacam, well as topography with OPD-Scan and Pentacam, and axial length with IOLMaster and by immersion.  So just bad luck I suppose.  In your opinion, is just waiting out the three months before taking any corrective action a good plan? Should I get a pair of glasses made in the interim to let me see better or is "forcing" the eye to try to focus further away a better idea?  And after PRK/lasik to remove the myopia, will I still get the benefit of the accomodative ability of the Crystalens in order to see intermediate and close-up?  Sorry to ask so many questions, but it's really tough to get through to my docs.  Thank you for this invaluable service you're providing.

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by Stuartm, Oct 24, 2010
Dr. Kutryb

I am 57 and have been a professional pianist for the last 30+ years. In my work I have to be able to focus on the printed music on the piano and also see the performers who are much further away.
I have been managing with multi focals for the past few years but my eyes seem to have gotten worse in the last year and I now wear mid-distance glasses for reading the music. The problem of course is that I can't see clearly in the distance so if someone is talking to me I can't tell plus distant things are annoyingly blurry.

I had a consultation about laser surgery only to be told I was too old for that but a lensectomy would be possible. The surgeon suggests giving me distant vision in my dominant eye and then in the other eye the lens would give me a focus at about 50cms, which is roughly the distance from my eye to the music rest on the piano.

I should also tell you that I have astigmatism in both eyes with one being pretty bad.

I know that the brain is amazing and will be able to adjust to the different foci in each eye but as music consists of lots of little black dots and lines I'm concerned that my intermediate vision will not be clear enough.

Also as one plays the piano the movement of the body means that the distance to the music can change slightly.

I'm just unsure whether the surgery sounds too good to be true and I'm going to end up with more of a problem than I have now.

Have you had any experience with monovision for musicians.

I have booked the surgery for next January so I have plenty of time to change my mind. Any thoughts you have would be much appreciated.

thanks

Stuart



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by Michael J Kutryb, MDBlank, Oct 25, 2010
I  probably wouldn't do monovision on you if you had not had good success with it in contacts already.  Be very wary of monovison if you haven't tried.  Why don't you try contacts for a while since you said you don't even have mature cataracts yet.  I'm still don't understand why new glasses won't help.  With your vision being so valuable, and needing vision at different distances,  I would probably hold off surgery until you had basically exhausted glasses or contacts as an option.  Progrssive glasses have worked in the past and may be your best bet in the future, perhaps even after cataract surgery.

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by Stuartm, Oct 28, 2010
Thanks Doctor. I am looking into contact lenses at the moment. My astigmatism is quite severe  which my optometrist says makes lenses less of an option but he is consulting with the lens companies looking for possible solutions. I have decided to shelve the lens surgery. I think it is definitely a last resort scenario and your comments have given me confidence that I have made the right decision. Thank you so much for taking the time to give me your opinion.
thanks
Stuart

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by Shysterbiker, Nov 01, 2010
I am having cataract surgery tomorrow, considering mini mono focal.  I tried mono vision contacts 8 years ago and could not tolerate the halos and glare.  My cataract surgeon (2nd I've consulted) says that was from the contacts and there will not be a problem with glare and halos with surgery.  This advice is obviously contrary to what is being said here.

He also indicated that if I didn't adjust to it he could do Lasik to bring up the power in the non dominant eye.  

He recommends -1.75 or -2.00.  Dr. Hagan recommended -1.25.  I mainly want near vision for computer and desk work, I don't mind wearing cheaters for close reading.

I'm 61, practice law and ride motorcycles and use the internet and TV as recreation.  I've also had a retinal detachment 18 months ago in the non dominant eye.

HELP!

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by Michael J Kutryb, MDBlank, Nov 01, 2010
Why are you pushing for monovison if you haven't had success in the past.  I would do dominant eye first and get as school to 20/20 distance as possible. After first eye you can then think about what you want to do with no-dominant eye use it to enhance distance performance or leave it a little myopic but more in the -1.00 range to try to limit chances of being very off balance.  Even -0.75 will give you just a little near vision.  If you're a lawyer you will proabably  need reading glasses anyway due to all the reading.  Mini-monovision is intended more for seeing a menu barely, seeing to eat, seeing numbers on phone etc - not extensive reading.  Plus real monovison (-1.75) might  make it dangerous to drive or ride your bike.

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by neilk, Nov 12, 2010
I had a detatched retina repaired successfully. Now, a year later successful cateract surgery with 20/20 vision. Now I am going to have my other eye done. I would like monovision in a very small degree so I can read just a bit  realizing I will still need reading glasses for major reading and computer etc, My question is, will I be able to play golf and see the ball when putting as well as fairly good far. I just want to reduce the dependence on reading glasses ALL the time for minor reading of labels, menues, etc. Will  this small monovision be that noticable?? or of any real concern?? Thanks,, Neil

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by Michael J Kutryb, MDBlank, Nov 14, 2010
I really can't say for sure and in those patients with concerns like yours I often just go for distance in both eyes especially if they have never been nearsighted in the past or tried monovision in the past.  If the upcoming eye is the non-dominant eye and you are historically nearsighted, then slight monovision might very well work for you but again I would not hesitate to skip monovision in a patient with all your concerns.

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by cataract_surgery, Nov 30, 2010
My cataract removal experience was fantastic. I had no discomfort at any time. My vision improved from 20/90 to almost 20/20 within 48 hours after surgery. I had a mild sedative only. I remained awake and alert throughout the surgery. It was outpatient surgery. I was released about three hours after arriving at the Cataract Surgery  center.

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by confusedbob11, Dec 08, 2010
Dr. Kutryb

I am going crazy. I am 39 years old and have never had problems with my eyes until the last year or so when I have been developing cataracts. I just had Restor put in my right eye this past Monday. Up until then I was really struggling with the decision of which type of lens to use. I didn't want to wear glasses but wanted the best itermediate and long distance vision I could get. My Doctor only uses the Restor lens and I am wondering if I should have went to another Doctor and see if Rezoom would have been a better choice (too late)?  I am supposed to get the other eye done in two weeks. Please answer these questions if you get a chance.

1. I still play very competitive Volleyball and softball and wonder if I am going to be able to see the ball in both day and under the lights at night. Also, will I be able to see a golf ball around 200 yards or so hit the ground?

2. My near vision is OK and seems to be doing what it is supposed to, but my vision from 20 to 25 yards away seems a little blurry? will this get better when the other eye is done? or is this what I should expect with Restor?

3. An older lady in my office had the Rezoom done about 6 months ago and when I compared distance vision with her in a few test when she shut one eye it seemed she could see more clearly. Is Rezoom better for 20 to 30 yards out, or will my Restor lens get better with time?

4. If you wanted better overall vision and didn't want to wear glasses which Multifocal would you choose? or would you choose the Standard lens and just wear glasses or contacts to read?

5. If I did the standard lens would I see everything perfectly from arms length and further? and just need glassed to read? Or would I still have a little blurry sight from 20 yards and farther?

So many things are running through my head and don't want to make the wrong decision for that next 20 or 30 years?

Thanks, Bobby





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by confusedbob11, Dec 08, 2010
Also, I am doing all kinds of test with the other eye shut. Is this not realistic or will things get better if I put the Restor in the other eye as well. Guess my question is do things look distorted when trying to figure out if the first eye done with Restor is what I want? Figured I need to make this decision before I get the other eye done?



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by cab251, Dec 17, 2010
I had cataract surger and chose monovision., distance in right eye and close vision in left eye.  I have astigmatism and see double vision at night while watching TV in a dark room, or when attending a play when the stage is lighted .The surgeion put the wrong lens in the eye making it impossible to see properly.  I was transferred to a Lasik doctor on staff and he is concerned aboutthe double vision. He has givien me a contact for astigmatisim and I still see double as before.  So it seems obvious that the Lasik will not fix the double vision.  The lens  were positioned impropery and he suggested we could remove the lens but insists we should not go there unless it's imperative.  I don't want to do that.
Aftre doing some research, it appears that the opinion of some is that the double vision is caused by damage to the muscle in the eye and a minor surgical procedure may fix the double vision.  I do have a droopy left eye since the surgery.
Is it reasonable for me to assume that the Lasik procedure will bring the eye with the wrong lens to a reasonably comfortable position with the right eye and that after this process, having minor surgery to correct the muscle may clear up the double vision? I am wearing an astigmatism contact to the strength he is suggesting.and it helps some. But the double vision remains.  Thanks for you help

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by mjrsharkpt, Jan 04, 2011
I am an extremely healthy 79 (no meds) scheduled for cataract surgeries #1 and #2 later this month.  I am leaning toward mini mono lenses but wonder if I understood my surgeon correctly just now.  He said he usually does the dominate eye (my right) first for distance, as you have said is the better method, but he would still do my worst cataract, in the left eye, first, as long as I understand that I won't have good distance vision until after the second op. I gather he thinks it important to remove the worst cataract (I can't read any of the eye chart with the left eye) first.  Your comments would be appreciated.  Thanks

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by jmw70, Jan 21, 2011
I had my left (dominant) eye 's cataract removed on 1/17/11 with a monofocal lens for distance inserted.  Before the surgery I used 3.0 reading glasses, and 1.25 glasses for movies, plays and some TV.  As of today my left eye is about 20/30,  My principle aim was to eliminate all glasses, but my doctor thought that unlikely.  So I suggested making both eyes successful at reading, but he discouraged that, as he thought I would end up keeping my far glasses on all the time that I wasn't reading.  He suggests adding moderate near vision to my right eye, with not so much difference that I would find it uncomfortable.  But with monovision, will I now need prescription glasses?  Thanks.

jmw70

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by Murl74, Jan 22, 2011
Oh dear: I am so very much confused:years ago I wore gas permeable semi rigid lenses   and have been nearsighted since the age of 12...am now 74 yrs old: facing cataract surgery in 3 weeks on R.eye to be followed  4 weeks later on left eye; MY BIG DECISION....what type of IOL do I want ???.....Eye Surgeon suggested monovision,which after reading all of the comments here,has me very much concerned re:that procedure..................my R.eye is distorted from the use of RGP lens and I appear not to be a candidate for the Restor Lens,which is what my surgeon uses as a multifocal...... Question....I would still like to be able to see my face in the mirror to apply make-up and to see up close without glasses.....I have worn  progressive lens trifocal  glasses exclusively for the past 10 years and had worn monovision contacts previously wth no problems.......however with the halos around lights,night driving has become nearly impossible..as well as not being able to see street signs at night.........BIG QUESTION........would I be happy with monofocal lens for distance in both eyes and how close  would I still be able to see   ??  Would I be happier if I chose a monofocal to see near vision  and glasses for distance ??? Murl RNC  ***@****

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by Michael J Kutryb, MDBlank, Jan 24, 2011
To mjrshrpt - I am totally fine with that - the order is not crucial and will generally not affect the end result usually.  For the record, though, my attititude is, if the distance eye is not really good for distance post op then  I may not even do mini-monovisin in the non-dominant eye but rather seek to mazimize the distance vision.

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by Michael J Kutryb, MDBlank, Jan 24, 2011
To JMW - don't make the non-dominant eye for reading unless you are happy with the distance vision as it is in the left eye after the surgery, and you feel confortable that you will not mind the blurred distance vision in the right eye postoperatively.  You have been hyperopic for years and I am reluctant to suddenly make these type of people myopic (nearsighted) unless they have tried it with contacts successfully.  Monovisoin is definitely not for everybody and it is a little bit of a gamble unless you have done well with contacts or have been nearsighted before surgery.  Talk with your doctor and consider a trial of contacts or at least a trial glasses lens to simulate the result and see if you like it.

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by Michael J Kutryb, MDBlank, Jan 24, 2011
Most people don't want to stay nearsighted in both eyes unless they absolutely love to read constantly with no glasses.  I would strongly consider either distance in both eyes or distance dominant eye and minimovison in non-dominant eye.  It is crucial that the RGP contacts be out for about a month before measurements and that multiple measurements are done on separate weeks to make sure they are stable and not changing.  A corneal topographer is also very useful to follow the changes that will occur in the cornea after the contacts are out for a while.  If the cataracts are very cloudy, you should be very happy after cataract surgery.  A  lot my decisio would be based on how you are currently doing in your contacts, what exactly the vision is, and if one eye is already set for near vision (monovision) which is very often the case in someone like you.  In that case, I would try to re-create the way you saw with contacts 5-10 years ago, keeping in mind the the vision with an IOL is often not as good as a RGP contact lens which does an awesome job of reducing astigmatism - another very big - possibly the biggest factor in your surgery.

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by Patra701, Jan 26, 2011
I had cataract surgery last year by a surgeon who had performed PRK on my eyes ten years earlier. The week before the surgery I inquired if there was any risk of the IOL not being the right strength, as I had read online that this could be problematic with eyes that had previous laser surgery. He adamantly insisted that nothing could go wrong, I would have 20/20 vision after the surgery. I trusted him. During surgery I had some problems with allergic reaction to gel as well as high pressure, but that worked out OK in a few days. However, my vision was blurry and after a month he admitted he had "guessed" at which lens to use and had placed one that was too weak. He offered to do an IOL exchange at no cost (though I would have had to pay the $1,000 hospital charge again); I read online how risky IOL exchange is and decided to see a doctor about laser correction. This new doctor concurred that PRK would be far less risky than lens exchange (my cataract surgeon no longer performs PRK). So I had PRK last summer, my vision is now 20/15 in the eye but I have a bill for $2,200 for the PRK. My surgeon has admitted several times that he made a mistake. Should he not help me pay for my PRK?

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by cduv1015, Jan 31, 2011
Goodevening Doctor!  I just came on your website and after reading several of the posts I am hoping you can give me some insight.  I am 56 and have worn what I'm now hearing referred to as mini-monovision.  My distance correction has been close to -3.75 for years.  About 10 years ago my optomotrist took -.75 off my left eye before I actually needed much help in the reading area.  I have worn a Hydron Z6 in that strength for this entire time.  In Oct. I went in for my yearly exam but was also having a little more problem with distance than before.  To make a long story shorter, he fitted me with disposable lenses and upped the power in both eyes by -.25.  At the same time, the office I worked at moved to a new location and not only was I on the computer 9+ hrs. a day but there was constant glare the whole day.  I started having severe eye strain and wasn't able to adjust to the particular contact he placed me in.  Over the course of the next 2 1/2 months I was fitted with 2 different brands of disposables (air optix and avira).  He tried toric lenses for a small, longtime astigmatism in the left eye which has never been corrected.  I still wound up having double vision problems, severe eye strain and eventually I couldn't even do my job and had to quit.  I saw another optomotrist a couple weeks ago and she felt the astigmatic correction wasn't necessary since I was content to have the distance corrected and use reading glasses when necessary.  However, the problem I'm still having is that my eyes just do not seem to want to work together very well and my peripherial vision to my left tends to double images unless I turn my head and look directly at an object.  I never have had any problems and wasn't having anything like this in my life.  I've worked for 2 dentists and have done basically the same type of work for 13 years.  It wasn't until the move to the new office and change in contacts did problems arise.  My main question is, can monovision cause problems of this nature readjusting to straight spherical contact wear?  I do not have cataract, glaucoma and my eyes are healthy.  Money is really an issue since my income was our constant source and my husband is self-employed and work is very slow right now.  We do not have any health insurance coverage so it feels like options are really limited.  I really would appreciate any help you can give and would be happy to provide my personal email to you.  Thank you for your time!

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by Michael J Kutryb, MDBlank, Feb 01, 2011
I would just get contacts for distance vision in both eyes and get a pair of reading glasses to wear around your neck to wear part time.  Bettter to be at least good at something (aka distance vision) and wear glasses part time for reading than to be all messed up for near and far.  It will take quite a bit of time just to get you good for distance I figure since you are a difficult contact lens fit.  Also your biggest problem is too much computer and reading time.  It will make your eyes tired, sore, dry and blurry.  Cataract surgery is really not something for you to even think about for many years.

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by cduv1015, Feb 01, 2011
Thanks Dr. Kutryb.  I am currently wearing Biofinity's and they seem to be fitting better than any other disposables I've tried.  The Hydron Z6 were never a problem but are no longer made.  It just seems like the adjustment to getting back to binocular vision is much harder than I thought and the peripherial doubling on the left side (was reading eye) is something I haven't been able to get an answer for.  I do appreciate you getting back to me.

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by TtheK, Feb 12, 2011
Dear Dr. Kutryb -

I am 66 years old and have worn monovision hard contact lenses since I was 16.  Therefore, my ophthamologist thinks I could adjust to monovision cataract surgery.  My right contact lens is for near vision, and my left one is for distance.  Will I have trouble adjusting to surgery if I switch and make my right eye dominant for distance and my left eye for near?

Also, my ophthamologist said I must choose a specific distance for the near vision eye - computer distance, book distance or something inbetween.  If I choose computer, I need to wear reading glasses for books.  If I choose book, I must wear glasses for computer use.  If I choose inbetween, neither will be perfect.  Do your previous patients have a preference?

Thank you.

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by Patra701, Feb 16, 2011
Did you see my post of Jan 26? Thanks.

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by maggzie, Mar 13, 2011
I have successfully worn monovision contact lenses for over 15 yrs, which is good since I find reading glasses are a chore. Last December I had cataract surgery in both eyes, giving me 20/20 distance vision in both eyes; astigmatism if any is negligible. My plan was to go back to monovision after surgery, with one reading lens, since monovision has worked well for me for so long. But since surgery 3 months ago, my long-time optometrist still hasn't been able to help me figure out the correct prescription for a reading lens; and now she's losing patience as well as confidence in my feedback. We discovered almost immediately that the Purevision multifocal lens was the best choice, and that I can put the reading lens in either eye (dominance doesn't seem an issue). However, for a long time, one difficulty was that she didn't explain about frequent blinking (it makes all the difference), so consequently I no doubt rejected some trial lenses that were probably OK; I have since learned now to blink often and the trial lenses have begun to work better. In fact the +1.75H is close for me (the computer screen is 24" from my eyes), but I still find I have to lean forward about 8"-12" for the best vision while typing, and it has been causing eye strain. I feel one more diopter would be better (whatever would allow me to push the computer further away for comfortable typing), but the optometrist, having lost all patience at this point, thinks I should just accept that the +1.75H is as good as its going to get. One confusing thing is that the +2.50H lens causes me to have to lean even closer to the screen for clear vision than the +1.75H. Does this make sense to you? It doesn't to the optometrist, and now she has given up on me!.. But shouldn't the higher prescription number mean higher magnification not less? Could you provide me any insights about monovision after cataract surgery before I seek out another optometrist?  Thank you!

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by Michael J Kutryb, MDBlank, Mar 13, 2011
I would skip the multifocal lens unless you want to wear it in both eyes.  I would just wear a regular +150 lens in the non-dominant eye and call it a day.  That will give you a little bit of near vision particularly for computer.  If you want to be able to read fine print you could wear a +1.75 or +2.00 but you would lose the computer vision.  If you want to wear a multifocal lens in both eyes go ahead but it will make your distance vision significantly worse.  You want too much - so just from an outsider, I would just go with a +1.50 in one eye - get what you get - and adjust to that.  Just my off the cuff thoughts.  By the way, the reason you are always blinking is probably the multifocal lens.  Just use a regular lens like acuvue oasys or o2 optix.

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by LLKJ1st, Apr 01, 2011
Dear Dr. Kutryb,  April 1, 2011
Your posts have been so helpfu. My appt. with the doctor is next week for cataract. My fear of complications is overwhelming. I would like the Toric Lens since I have Astigmatisms in both eyes, but I am very concerned about the functional ciliary muscles and the risk of rotating out of position.  Do The standard traditional lens have the problem of rotating. I realize they wouldn't correct the Astigmatisms. But, would it be possible to do my left non-dominate eye at 0.75 so I could see to put make-up on even without the glasses, and 20/20 in my right dominate eye?  Realizing I would  be wearing glasses all the time. I pray for a fast response.  Sincerely, LLK

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by SMWood, Apr 21, 2011
SMW   Apr 21, 2011
I am an active 68 yr old woman.  I had cataract surgery on my right eye Jan 2011 and had a Crystalens AOL implant.  I was told I was a good canidate for this lens.   I now have good near vision but distance is blurry.  The Dr, says my problem is I have astigmatism (I was not told of this prior to surgery and we did not discuss that he was going to do a procrdure to fix this).  It was 2.50 and is now 1.25.  I am now using Restasis for dry eye that was never a problem before surgery and I have almost daily headaches.  The plan is to do cataract surgery using a regular lens on the left eye and focus it for distance.  Then PRK to fix the astigmatism remaining in right eye.  I read your article that mono vision can be succesful but I don't know which is my dominate eye.  I would like to hear your thoughts... if this is the best course... and what could be any long term complications.  I have an appointment in 3 weeks and would appriciate your input.  Again, thank you, SMW  

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by Michael J Kutryb, MDBlank, Apr 25, 2011
It sounds like monovision is what you are going to get - so not clear why you had to pay extra for crystalens when it is just being left for near vision.  You may want to discuss that with your surgeon.  Determining your dominant eye is very easy to do in office.  Look through a quarter size hole in a piece of paper with both eyes holding the paper at arms lenght.  Look at a sign of picture across the room through the hole making sure to use both eyes.  Pull the paper slowly toward your face and keep your focus on the original object.  Whichever eye the hole in the paper goes toward is your dominant eye.

I think the main thing here is to discuss why you have to pay extra for the crystalens if you only have near vision and poor distance vision in the right eye and if the lens is so good, why is a standard lens being used in the other eye.  In other words, it seems as if the surgeon could have achieved better results with a standard lens.

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by Craig10x, Apr 26, 2011
Hello Dr. Kutryb....i recently had cataract surgery in both eyes....the surgeon did mini-monovision....He corrected my right (dominant eye) to 20/20 and my left eye (non dominant) to 20/100...On the eye charts, my combined (blended vision) is 20/20...I am able to work with the computer (it is pretty clear though not razor sharp) and read for short periods of time without glasses...It's great to be able to do mid and close stuff such as reading menus, looking at stuff on he grocery shelves, etc all with any glasses...

I have noticed that in particular my distance vision, though very clear, i do experience a bit of a blur...it is mostly noticable when reading a sign, watching the credits on a movie in theatres, on the tv at home also, etc...

It is bit annoying (and somewhat fatiguing at times)... I just had the operations 1 month ago and just finishing the eye drops cycle...It always feels like my slightly nearsighted eye is pulling down that quality a bit...

My question is..should i not expect any further improvement?  Or do my eyes need more time to heal and my brain to adjust to the blended vision?  Will it eventually pull in that extra bit of sharpness and the blur effect go away?

It's funny..it just really needs to be a "tad" sharper (or crisper) without the slight BLUR effect and i would be extremely happy...any chance of that happening? Or am i expecting too much?

Note...when looking only through the distance eye...it is pretty perfect...no blur...sharp and clear...It is only on the blended effect where i am getting this...

Your feedback will be most welcome!

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by westfiels, May 30, 2011
Dear Dr. Kutryb
First of all, let me thank you for all the good work you are doing by guiding us.

I am 61 years old, quite healthy and active lady.
Unfortunately, I was diagnosed with glaucoma in my right eye and optic high pressure in both eyes in Nov. 2009.
I was prescribed eye drops. Then Last year in June, trabeculectomy was done for my right eye, which corrected the pressure totally  and I don't have to use the drops in right eye. I use the drops now only in my left eye. But I developed cataract in the right eye. The cataract was so bad that I could hardly see clearly.
The cataract operation was done last week ie on 24th May 2011.
The IOL replaced is:
Model 920H Aspheric
Power  +13.5
Length 12.5 mm

I don't understand above description at all.
But I can see now quite clear with the right eye, Distant as well as reading and using computer.
My left eye has -4.5 no. If I wear -4.00 lens in left eye, I can see distant clearly and near vision also not bad.

I am really confused. I used to wear .4.75 in my right eye and -2.75 in my left eye, which gave me perfect vision ie monovision.But after cataract, my right eye's no. had shoot up.

Please advise me what to do.
Tomorrow ie 31st May is my follow up.

I don't know what the Doc is going to discuss. But I want to be sure.
Can They do glaucoma operation and correction or cataract in my left eye at the same time?

Desperate for your advise.

Thanking you

Aroona

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by Michael J Kutryb, MDBlank, May 31, 2011
All your questions like this are supposed to be talked about BEFORE surgery.  In other words what was the refractive goal of the surgery in the right eye?  Was it zero or -1.50 or -2.00????
Ask doctor what your current refraction is and what the target was.  It sounds like the right eye is doing well.  Your next step is probably to do the left eye with a goal of at least some monovision to see near - maybe something like -1.00 or -1.25 and yes if necessary glaucoma and cataract surgery can be done together but again only if really needed.

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by westfiels, Jun 01, 2011
Thank you so much for coming back.
My follow up yesterday was good. The pressure in the right operated eye was 11. My Doc is pleased with that.
Next follow up is after six weeks. He has kept -1.5 in thr right eye.

Now my left eye has -4.5 vision.
I have to use Azarga eye drops twice a day in my left eye to control the pressure.
My Doctor will decide when I see him in 6 weeks what to do with my left eye. At the moment I wear contact lens in my left eye of -4.00 and I am comfortable to use computer and to read.

I would be very happy if my glaucoma and correction in the left eye is done at the same time.
I would like to take your advise for this. Yes, I would like to have mini monovision.
Also, I would be grateful if you explain me how glaucoma and cataract surgery can be done together. This is because, after my glaucoma operation was done on my right eye, the cataract started severely.

Waiting for your advise.


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by gusher, Jun 17, 2011
My new eye doctor talked me into full monovision even though I decided on distance only first and then mini monovision. But in the end I went with full monovision because he promised he could lasik me to distance if I could not adapt to the full monovision. I am left eye dominant and the worst cataract was in my right eye. I had all the tests done even a water immersion ultrasound in my right eye to determine the distance to the retina (28.7mm). I had also gone to a retinal specialist about my floaters and he gave me a full set of tests which were sent to my eye doctor and said I was a candidate for a vitrectomy if my large floaters were still a problem 3 months after the cataract surgery. My last  eyeglass prescription after having gas perm lenses out for 4 months was DV OD Sphere -750 Cylinder Sph Axis (nothing)   OS Sphere -800  Cylinder +275 Axis 080. NV OD & OS +225. So, I am highly myopic.
I had my right eye done on Wednesday afternoon (2 days ago) and this was supposed to be my reading eye. I was elated upon returning home to find out how great I could see in the distance, but when I tried reading, it was blurry. I figured this was normal and the eye was just healing. The next day (yesterday) I went for my followup wearing my gas perm contact lens in my left eye. Sure enough, I was 20/20 distance with my right eye alone and a J2 with both eyes for reading. However, I feel the reading ability was mostly from my left eye with contact in. He looked at my file for several minutes and said that all the data pointed to this lens setting so that is what he went with and that this sometimes happens. I said well, no problem,  you can always lasik me so that I can read. That's when I got the bad news that it is difficult to go that way and that I would need a replant or a piggy back lens. He said that he didn't like piggy back lenses. He looked at my eye and said he noticed that I had corneal edema from the incision down to the axial plane and that once the swelling subsided, that I may be able to read with my right eye. But what really concerned me is at the end of our meeting when he said he might have to reconsider the lens setting for the left eye. How can that be? The cataract is off to the side and I can see well (with glasses/contacts) so why would he not be able to have a good estimate of what I need for my dominant distance eye. I’ve lost a lot of confidence in him.
At home last night and this morning, I tested my right eye reading alone (because when I have the left eye done for distance, I will only have my right eye for reading, right?) and I could only read a book with 1.5 reading glasses. Without reading glasses, I can only read when type is 20 inches away.  
My questions are: Is it reasonable that this can happen? That I could end up with distance vision when I was supposed to have reading vision in my right eye? It seems like maybe he erred and went with a distance setting by mistake. But I lost a lot of confidence with him I would think he would have erred on the side of going too far on the reading side so lasik could be used to correct it. Is it feasible that when the swelling goes down that I will have reading vision? Any estimates on how much time it will take for the swelling to subside? Should I wait on the left eye? I can see great in that eye because the cataract is off to the side and not in my vision plane. I do great with a contact in or with no contact at all in left eye. Glasses are a no go. What are your thoughts on a replant? Or should I just live with the reading glasses?
On a positive note, the floater while still there is a lot less noticeable so I am keeping my fingers crossed that won’t be so much of a problem.
Thanks in advance.


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by Michael J Kutryb, MDBlank, Jun 17, 2011
For now I would just wear the contact in the left eye and be very glad for the outstanding vision for distance in the right eye.  Later, you could consider having a slight bit of monovision for near in the other eye but we can't be 100% sure you will like your dominant left eye for reading.

It is important to remember that IOL calculations are just predictions and have a definite margin of error due to complex measurments and complex mathematical models.  The margin of error is significantly greater for eyes with axial lenghts that are very long or short.  So, even though you didn't get exactly what you wanted, you still have a safe and useful result.  

Just a note, for long axial length eyes like yours, I typically use the Koch modification formula to get a modified axial length then use the Holladay 1 formula.  This will come up with a slightly higner power lens and reduce errors in the hyperopic direction. Finally, although no one will ever know, I suppose it is possible that your request for near vision got lost in the shuffle.

Finally, I didn't hear you measure IOLmaster readings for the IOL.  That is a key test and, in my opinion, is a little more reliable than immersion scans alone.  Many surgeon do both but rely chiefly on IOLmaster.



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by gusher, Jun 20, 2011
Thanks Doctor Kutryb,

Yes I did luck out and am thankful that I have good distance vision.

BTW, I forgot to mention my eye doc inserted a +11.5 Diopter lens, body diameter 6.0mm and overall diameter 13.0mm. Not sure what the IOLmaster reading was but I will ask. I have a feeling that the cataract was so bad that they could not get a good reading.

I am a geophysicist in the oil industry searching for new deoposits of oil & gas and while there is a lot of science involved, there is also a lot of art to my work as well so I can understand the same holds true for eye surgeons.

Being left eye dominant, I will go with the distance vision in that eye. Would you comment with your own personal opinion if you were in my shoes on whether at this point you would 1) live with the right eye as a distance eye and go with reading glasses or 2) go with a replant to get the monovision with the option to have lasik if I cannot handle the monovision? Knowing that a vitrectomy may be needed down the road if the huge floater rears its ugly head again. The first surgery was a piece of cake so I am drawn to a replant but I assume the inc\ision for a replant would be much larger to extract the lens in there right now with possibly more complications.



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by Michael J Kutryb, MDBlank, Jun 20, 2011
Wear a disposable soft contact in right eye for a few days to simulate the amount of mono vision you want.  For example you could try a +1.50 lens.  If you like that, then you can consider either a piggyback lens or a lens exchange (my preference if I wanted to change out the power in thte early post op period.). Using MST micro forceps and scissors the original lens can be bisected and removed through the original incision.  But make sure you try the contact lens first to be sure you know what you want.

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by gusher, Jun 21, 2011
Thank you!!!! That's a great idea. Because my cataract in my right eye was so bad I couldn't test out the monovision prior to surgery. It didn't cross my mind that I could test it out before after the surgery to decide on the replant. If you ever relocate your practice to Denver, let me know.  

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by Craig10x, Jun 23, 2011
Dr. Kutryb....you probably missed my post above (it is from Craig10x on April 26th, 2011) When you get a chance, if you could just read it and then would appreciate your feedback on it...Thanks....Craig

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by Michael J Kutryb, MDBlank, Jun 24, 2011
It might get a little better as you ger used to.  That's about all I can say.  There is definitely no guarantee.  I've had a few patients with similar complaints, who improved after a few months.  Otherwise, don't be ashamed or afraid to get a pair of glasses to sharpen distance vision to use on an as needed basis.  So in the end only time will tell.  The real question is what are you willing to do about it if it doesn't get better.  IOL exchange?  Probably not.

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by Craig10x, Jun 25, 2011
Thank you for the response Dr. Kutryb...i thought you might have missed my comment which is why i directed your attention to it (lol)...and appreciate your comments..

Well, let's see..it's been just about 3 months now...I can't say i have seen much of a change...I guess i keep hoping it will just get slightly better...

I realize one can't expect perfection...on the one hand i think..wouldn't it be marvelous to have both eyes at 20/20 so my distance would be so wonderfully crisp and sharp (as it is with my right eye)....but then i would probably be rather unhappy with looking at things 4 ft and closer (which i can tell would be very blurry) and i'd be putting on those reading glasses a LOT...

I really like the fact that right now it is very RARE i need to pop on those "cheaters" (lol) because i have all 3 ranges...distance...medium and close...Though none are absolutely PERFECT...

By the way on the eye charts, the Opthomologist at my Eye Surgeon's office that examines me tells me that my blended distance vision is 20/20 and my close (reading) vision is also 20/20....that is true...

It's just the slight blur effect...I guess i keep hoping that my brain will be able to pull in the image with a slight more crispness at all 3 ranges (Distance/Mid/Close)....

I guess an IOL exchange would not really resolve all problems...I suppose i could do as you suggest and get glasses for occasional distance use though i do have to say that after a almost a lifetime of being dependent on eyeglasses (got my first pair at about age 11) i love being just about totally free of them...

He "sighs" (lol) if only i could just get that "tad" more sharpness in my blended vision...but perhaps i am hoping for too much...

Since it has been 3 months now...would that mean there isn't much chance that it will get any better as it is?
I was curious how long some of your patients found it took before they finally reached the optimum point (who had the mini-monovision as i did)....



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by Noahs_mom, Jun 26, 2011
My 5 1/2 year old son is extremely near sighted in one eye and 20/20 in the other.  What treatment would you recommend?

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by Michael J Kutryb, MDBlank, Jun 27, 2011
You really need to discuss this with a board-certified pediatric ophthalmologist.  It is possible that a contact lens would be useful in this situation vs glasses.  In a few cases, Lasik surgery can be an option but usually only after all conservative treatments have been tried.

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by Michael J Kutryb, MDBlank, Jun 27, 2011
To Craig10X,

Usually if you are not going to like it in the first 3 months or so, I doubt you will magically like it later.  You might learn to live with it and complain less, but I don't think you will learn to like it.  You can always have lasik or a piggyback lens or even wear a contact lens again, so there is no harm in waiting.

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by Craig10x, Jun 27, 2011
Thank you Dr Kutryb...appreciate your comments...I guess i will wait awhile and see how i feel about it...Overall, it isn't bad actually and i do like the freedom from glasses most of the time as it is now...but i guess i can always consider a lasik touch up...i will have to discuss it with my surgeon and see what the best options would be (just in case)...

Meanwhile, To me it feels likes it is just a little bit off...i will see if i can learn to live with it as it is...

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by Craig10x, Jul 22, 2011
Hello again, Dr Kutryb....I had talked to my doctor and he feels that it could take a few more months to fully adjust to it...so i am holding off for awhile i making a decision on whether to stay with the mini monovision or go for distance in my non-dominant eye (which he used a 20/100 correction toric lens for)...

I was just wondering IF i did decide to get the non-dominate eye corrected for distance, is the better way to go a laser touch up or iol exchange?  In other words, what are the advantages/disadvantages of each way and which do you usually prefer to go with in this type of situation?

Thanks...

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by eyecatching, Aug 22, 2011
Dr. Kutryb,
I am having cataract surgery shortly for the right eye. What are your thoughts on the power of an IOL in a near sighted right eye which appears to be the non dominant one, and where the left eye is -1.75? The left eye sees up to a good distance away and needs correction only for detail as in driving and watching TV. I did have a retinal detachment in this eye and currently some floaters. The right eye has also had a detachment and a scleral buckle inserted. Also ERM surgery. My surgeon suggests setting to the same as the left eye. I do not want to feel I cannot see much further than the computer screen with the right eye but how much further away would be a good option without too much monovision occurring? Thanks for any input.

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by flamingo1820, Sep 29, 2011

I am 68. I have just been diagnosed with cataracts in both eyes, worse in the left eye.  I am left-eye dominant and have worn monovision contact lenses for at least 10 years with no problems. For a few years I wore a single contact lens in my right eye for reading and before that I wore over-the-counter reading glasses for a few years starting in my late 40's.  My ophthalmologist is pushing crystalens, altho of course he has told me it is my choice.   My independent research leads me to wonder if  monovision would not be better for me, with a more reliable outcome. Right now my near vision is satisfactory with the contact lenses, but my distance vision has never been satisfactorily corrected with either glasses or contacts.  I had perfect vision--near and far-- until I started needing reading glasses.

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by sandybeach2, Oct 06, 2011
Thank you for your useful posting, doctor. I have just had monovision IOLs fitted to right (dominant, long sight) and left (short sight) eyes. I had worn monovision gas permeable contact lenses for 20 years (I am now 60), so was very happy to go down this route, as was my surgeon.  I anticipated having to wear glasses for reading after the op, but he was hopeful that I wouldn't have to.

The long sight lens is wonderful, but the short sight lens, while giving me excellent medium vision - fine for larger print and the computer -  is not so good for normal reading. I have to hold a book almost at arms length and cannot focus on small print at all. Perversely, I'm now unhappy at the thought of having to wear glasses for reading!  This eye was only operated on three days ago, but I think my brain has made most of the adjustment it is going to and it seems clear that the lens is not strong enough.

What are my options likely to be now? Can the IOL be replaced and is this advisable? Can laser treatment help? Can I get a single left eye contact lens to compensate? Or is it the dreaded glasses?

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by morefun, Oct 15, 2011
Hi Doctor,
So happy to have found you as I am pondering what to do.I am 53.  I had cataract surgery in May on my right dominant eye, corrected for distance.I got prescription glasses to correct my vision, and was unable to get used to them.  I have been using my right eye for distance and doing fine, and seeing enough to read with readers.   I am having surgery this Tuesday on my left eye, trying to decide on monovision, and what strength. I wore glasses happily until the traumatic cataracts. If I want to be able to see intermediate distance, like at the grocery store, what strength would you suggest? Up until yesterday, I was going to just get both corrected for distance, but when i tried to imagine life blurred, i rethought this. Any suggestions? I don't see well enough with the eye to try contacts.

Would love your opinion.

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by jonathan1962, Nov 20, 2011
Dear Dr Kutryb
This site is a great resource - thanks! I am 49 (previously shortsighted R-3.75, L-3.25 and very happy with varifocal glasses) and have had my first cataract operation on my dominant right eye with a monofocal lens 2 weeks ago. The result is excellent distance vision in this eye. My priority is to regain good vision at all distances with glasses, but it would be handy to be able to manage without glasses for swimming, round the house, eating out etc. I have read through your site and am inclined towards the mini-monovision so my left eye (currently -3.25) would be -1.25 with a monofocal lens. I have tried to test out with contacts, and this is quite good, but am advised I still have quite a bit of accommodation in that eye which I will lost so it is difficult to be sure how I will find it.
My main question is whether in terms of correcting my final vision with glasses it is better to go for balanced distance vision in both eyes, or will I do equally well if I have the mini-monovision? I have a hunch that my overall vision with glasses will be better if both eyes are balanced, perhaps because the lens magnification will then be the same for each eye, but have no idea whether that is really the case.
Thanks for your advice.





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by annasthree, Dec 01, 2011
Thank you so much for sharing your knowledge...i just came upon the site today. Three weeks ago I had a distance lens put in my right eye ...cataract removed...very please with the results...seeing wonderfully. One week ago had my left eye cataract removed and a close up lens put in...My balance is much better as was sooo off between having the eyes done. Questions is I have a shadowing effect with the left close vision lens...Is that common with all implants or just with the mono vision ones and the eye that the close vision lens is placed in... Vision is great but still getting used to the mono vision aspects overall. I did well with mono vision contacts for several years. Will it all get even more balanced out with time and will the shadowing go away??? Thanks so much.

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by gmann117, Dec 23, 2011
Dr. Kutryb,
I recently had cataract surgery and my opt. told me monovision would be good for me. I has been a disaster. Constant blurry vision, terrible depth perception, and reading quality is low. I am going to have the near iol replaced with a distance iol. Why do you write that this is a problem
Thank you
Donald Gleason
***@****

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by 4eyes4me, Jan 06, 2012
I am also interested in learning more about replacing an IOL. I had monovision lenses implanted a few weeks ago and I am not happy with the result. My doctor said he could replace the non-dominant lens if I am unhappy with it. He did not seem to be so concerned about doing that procedure. What are my other options? Can I get good distance vision with LASIK? Can I wear a contact lens in the non-dominant eye, using reading glasses for near vision?

I would like to know my options for having distance in both eyes -- replacement of lens, LASIK, contact lens or glasses? If I opt for replacing the lens, how long can I wait to have that done? Must it be done soon after the original surgery?

You give excellent advice on this board and I only wish I read it before going into the monovision. Thank you.

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by gmann117, Jan 28, 2012
Dr. Kutryb,
Can macular scarring be treated. If so how? Does it make sense to have a short distance IOL put in an eye that has macular scarring? Can it work. I replaced the original short lense with a distance lense and now have a bubble in words and elongated faces if I cover my right eye. Seems ok with both eyes.

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by dirkette, Mar 04, 2012
Does one lose the ability to view 3-D movies with monovision lenses?

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by trish715, Mar 15, 2012
I am 60 years old. I have been nearsighted most of my life, but as I grew older, my distance vision improved and started needing readers.  I even passed the driver's vision test without glasses four years ago (for the first time in my life). Around that time I had developed a cataract in my left eye that progressed very rapidly, and I lost most vision in it.  I had surgery on that eye one week ago and opted for an IOL implant for distance.  My distance vision is incredible in that eye, but I have lost all close and most intermediate vision.  I can't read anything on the computer, and the food on my kitchen table is even blurry. This is not a problem at all right now, because my right eye with mild cataract is seeing great for most reading and intermediate vision, although I now realize my distance is fuzzy and colors are faded. Both of my eyes are working beautifully together, with absolutely no adjustment time between distance and near focusing.  I would love to keep this vision, but I know I will need cataract surgery on my right eye within the year.  Since my vision is so good now, do you think I would be a good candidate for monovision (distance in left and moderate to close in my right)?  Basically, I think that is what I have right now. I don't mind wearing glasses for small print and extended close work, which is what I do now.  Please respond, because I go for my post-op appointment in two weeks, and I would like to know what questions to ask and what results to hope for.  It's hard to get him to give me a straight answer and says he can't make promises.  I'm not looking for a promise. I just want an honest and professional opinion before I have the other cataract removed.
Thank you for your time reading this lengthy post.

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by BionicEyesDS, May 24, 2012
To Dr. Kutryb,
First of all, I thank you for your time in reading/anwering all these questions!

I am an active, sports playing 33 year old male. I recently had cataract surgery (right eye) and chose to the Alcon Toric IOLs with mini-monovision. The goal was for my right (dominant) eye to be at plano. However after my checkup 10 days later, tests showed that I am at -1.25D. To compensate, my Dr mentioned 2 options:
1) Shoot for plano in my left eye (non-dominant) and leave my right eye at intermediate vision, which I'm worried about adapting to
2) Lasik my right eye (dominant eye) to plano and shoot for intermediate in my left

My question is how difficult is it for most people to adapt to "reversed or opposite" mini-monovision and which option would seem least risky to you? I'm currently a wearing a -4.75 contact in my left (per dr's instructions) to see if I could adjust. I am not dizzy however my distance vision with both eye isn't as clear as if it was only through just my left eye with the contact. Does that mean I should be able to adapt?

Thank you in advance

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by Char15, Jun 13, 2012
Dear Dr. Kutryb,
On Monday I had cataract surgery on my left eye.  I am 62 years old and I opted for monovision since I've had years of wearing monovision lenses successfully.  The surgery on Monday corrected my vision for up-close readiing to 20/20.  My surgery for the cataract in my right eye for long-distance is scheduled for a week from next Monday and I'm now concerned because I put my monovision contact lense in my right eye, since Monday's surgery, and cannot seem to focus at all.  It's as if the prescription is "off" and now I have difficulty seeing the computer and reading altogether.  Does that mean that my current prescription for distance in my right eye won't work well if I have the surgery on my right eye in a couple of weeks.  My business requires that I use the computer and be able to see detailed images.  Why am I currently having issues focusing once I put my contact lense in for distance when I never had a issue seeing before when I wore monovision contact lenses in both eyes prior to this surgery.  I'm now debating whether I should have that second surgery on my eye for distance with my current prescription.  Please help...I don't know what to do???  
Thank you for your time and assistance in this matter.

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by klg62, Jul 24, 2012
Dear Dr Kutryb,
I am a 50yo with glaucoma and cataracts due to previous long-term prednisone therapy.  Had dominant eye cataract removed 1 month ago corrected to 20/20 with a toric lens.  I've been fitted for a contact in the non dominant eye to try mono vision.  I loved it when it was first fitted, but have been limited in assessing its effect due to severity of remaining cataract and lack of tear film to support contact wear.  Can I try instead with my old reading glasses (dominant eye lens knocked out)?

My profession requires a lot of reading, both books and computer.  As a lifelong myope (-7.5), I am concerned about having both eyes set to distance.  I THINK the mono vision will be tolerable, but will the need for heavy reading place too much dependence on that one eye?  Am I better to go for distance and use reading glasses?

Also, if I do mono vision can I still get glasses so that I can do heavy reading with both eyes?

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by bbow599, Aug 09, 2012
After wearing a reading monovision contact in my DOMINANT left eye successfully for more than 25 years, I developed cataracts in both eyes, did significant due diligence research about cataract surgery and chose monovision. Then I had surgery this summer with monovision implants in both eyes a month apart. The surgeon used the Holladay IOL Master measurement method for both eyes. On July 2, the surgeon implanted Staar CC4204A Diopter +22.0 in my right NON-DOMINANT eye for distance vision, the eye with the worst cataract. The next day, my vision in that eye tested at 20/20. Such joy. Colors were magnificent. I even had to clean the house because I could see dirt I couldn't see before. I had perfect intermediate vision at 5 feet, as well as at distance to infinity. Great for driving and watching TV. AND, I could read even fine print--8 pt.--despite the fact I still had a cataract and minor astigmatism in the left eye.

On July 23, the surgeon implanted the reading lens in my left DOMINANT eye, Staar CC4204A Diopter +24. (Fifteen minutes before the surgery I had told the surgeon that I experimented the week before by inserting a +2.25 contact lens in that eye for several hours and all I could see was a blur, but she said I didn't understand what I was talking about, which is probably true, since the implant was a -2.25.) When I went home and turned on the television later that day after surgery, all I could see was a blur sitting nine feet away. The next day at the post-op appointment, the right eye that had tested 20/20 the day and week before now tested 20/100, much to the surgeon's surprise, who acknowledged not knowing what happened. Seems pretty coincidental to happen the same day as the second surgery, doesn't it? Or perhaps not related to second surgery at all?

Yesterday, 2 1/2 weeks later, test results were the same. Eye pressure is normal in both eyes. The surgeon said it was possible the right eye implant moved forward. Or that the manufacter of the implant was off by a half a Diopter. (No mention that the surgeon's measurements might have been off. Or that the surgery might be to blame.) I was given two soft contact lenses to try wearing on the right eye--a -1.50 and a -1.25 to see which one corrected my vision to the right degree, and/or to my liking.

The solutions she suggested include: Glasses worn 80% of the time (unacceptable), taking out the right eye implant and replacing it with another with the correct Diopter strength (billed to Medicare, the surgeon said they "might" pay for, but it strikes me the surgeon should do this free if I chose this riskiest option), Lasik surgery (which I suppose I'd have to pay for, since Lasik is not done in their office) or wearing a contact lens the rest of my life. (My eyes are very healthy and solid in every other way, the surgeon says.)

Questions: 1) What do you think really happened (have you heard of this happening before)?
2) Of all the options, what seems the best choice? (I'm retired, but work on a computer all day most days and also travel overseas annually for extended periods--six weeks at a time--and do library research as well.)
3) I'm extremely disappointed that I have to move my chair within five feet of my large screen TV to be able to see the on-screen TV guide well enough to read it when I could make out every leaf on nature channels for the first time the week before. So sad. (And the surgeon allowed me to easily talk her into putting the distance lens in the non-dominant eye--poor professional judgment on her part--because I'm a painter and can only close my left eyelid to sight down my left arm holding the paintbrush to line up landscape elements on he horizon. Pretty darn bad reason to ruin my eyesight for life if the surgeon knew the dominant eye should only be used for distance vision!! I'm left-handed, you see.)

One unhappy patient

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by josie707, Aug 16, 2012
Dear Dr. Kutryb,
I find myself as many others in the stressful situaltion of making a decision regarding a lens exchang after recent cataract surgery/ I had been a happy monovision contact lens wearer for about 18 years, but my optometrist scared me with works like "permanent" and I remembered how many times I had to try different contact lenses to get the right, so I choose traditional single focus lenses for distance.  We obviously get really spoiled with monovision because we can see at all levels. I didn't get to see the surgeon after the first surgery to tell him how I was struggling and then just went with traditional because I didn't know.  The very next day, my optometrist told me two things that would have completely made up my mind to do monovision, but neglected to tell me until then.  I have 20/20 distance in both eyes, but am considering a lens exchange, but am worried about how serious the risks are.I will have to make up my mind soon (6 weeks post op) when I see the surgeon, so I am trying to decide what to do.I am reaching for glasses all the time...but I can make peace with that if I need to.  I just want to make the right decision, I already feel I made a foolish one.And I only have a brief window to make this decision in. I know this has been discussed, but could you share your thougths with me here? Also, who do you know in the Chattanooga, Tn. area that would be really skilled at this process?  Thank you so much!

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by pjblues, Aug 16, 2012
Very timely information.  I am having cataract surgery next Wednesday, August 22nd, on my left eye and fretting about which way to go....near..intermediate..or distance.  I previously had cataract surgery on my right eye....which is now 20/20.    I am very happy with the clarity of this new lens and 20/20 distance.

Years ago.....20 years or so....I tried a contact in one eye and nothing in the other....and hated it....so I have a lingering concern/fear that my brain will not accept the near.   I have tentatively directed to go with a more intermediate lens....but still vacillating...on whether to go with a second distance lens or an intermediate lens...  I don't mind wearing glasses for reading and computer....but would like clarity seeing the dash board of my car while driving....or clarity looking at someone across the table etc...

My concern with two distance lens is that I might need glasses ALL the time for none distance tasks etc. etc...

Your 20/50 range for the second eye might be the way to go....WOULD LOVE TO HEAR FROM YOU

Pam Scully August 16,2012

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by EyesNeedHelp, Aug 22, 2012
Hi,

I hope someone who's had mini-monovision done will be willing to comment on the following concerns because I plan on  IOLs after cataract removal soon, probably mini-monovision. I have a very reputable ophthalmologist who is also recommended by my retina specialist, and many friends have been happy with their results from this cataract surgeon (but none of them know exactly what they had done)

I also suffer from severe dry eye & eye allergies (undoubtedly exacerbated by the dryness).  Right now, it's controlled to just-tolerable levels with Restasis, antihistamines (oral & drops) & multiple types of artificial tears, & I just learned about one other non-prescription option from one of Dr. Hagan's blogs that I've ordered to try.  I've worn glasses since about age 14, so I don't mind doing so post-op.  However, if I have one eye set for intermediate and one for distance, then I'm worried that I won't be able to check my eyes closely enough:  for filaments, redness, stray hairs, etc., not to mention apply eye drops inside or ointment to the margins to control chronic blephariiis  --  all of which seem virtually impossible while wearing eyeglasses.

BTW, I can't risk a trial of full-monovision, because even before my eyes were this dry (i.e., 30 yrs ago) I wore contacts and had to give them up due to dry eye & multiple related symptoms, and my work relies on decent vision.

Can those of you who have had mini-monovision done (i.e., IOLs for both eyes already) please comment on how well you are able to examine your own eyes or apply eye ointment to the lid margins,  If you do comment, please indicate what type of mini-monovision you had done, if you know.  Thank you!!

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by NanCcan, Aug 31, 2012
I had cataract surgery on both eyes almost a year ago. My dominant eye now has 20/20 vision and my non-dominant eye works well for reading books, computer screen and dashboard of car. My eyes were otherwise healthy before surgery. I am one who hates wearing glasses, so I am thoroughly enjoying the freedom from glasses.
I did try wearing a contact lens for near vision in the non-dominant eye before any surgery. It only took my eyes/brain about an hour to adjust to seeing two different distances in two different eyes. After surgery it took weeks to feel totally comfortable with the different information coming from each eye (I believe this was because I was able to see sooooo much more after the cataracts were gone; there was much more information to process!), but this continued to get better and better for as long as 6 months.
I was still having problems with oblique rays of light when looking at a single source of light at night - a different angle in each eye. My doctor guarantees his work for at least a year, so, having discovered a slight wrinkle in each lens, he did a simple (few minutes in his office) procedure which (expectedly) resulted in small bits of debris that would usually dissolve or otherwise go away.  Those "floating" bits have not gone away and are now causing many oblique rays of light when looking at a single source of light at night.  I can still see much, much better than I could before surgery, but not quite as well as before this procedure. We plan to attempt to break up those bits further with another yag procedure.
I hope this won't create even more bits of debris for light to reflect off of at night.

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by TAZMANUK2013, Dec 28, 2012
Dear Dr

Ive had both eyes done both set to see far i had my right eye done a week ago and left eight weeks ago.

I know i need reading glasses but how long does it take for the iol to adjust and stabilize and work together as near vision is still too much all blurry not sharp

Remember its only been one week for right eye and eight weeks for left.

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by colk, Jan 02, 2013
Had cataract surgery and can't see clearly past 10 inches because wrong power of IOL. What can I do?

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by johnleonard, Jan 05, 2013
By RSD January, 2113

Dr. Kutryb:

How would your principles detailed in your Nov, 2008 posting change for a person who had monovision glasses,
extreme myopia (-20 and -16) and needs cataract surgery to remove cataracts

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by Michael J Kutryb, MDBlank, Jan 05, 2013
For extreme myopia I typically shoot fit close to Plano or -0.5 range in dominant eye and around -1 or -1.5 in non dominant eye using Koch modification to Holladay 1 formula, all the while understanding that the target us more elusive at these high extremes of myopia.  Typically the patients are absolutely thrilled even if they get anywhere in the ballpark.  I always have patients like you see a retinal specialist before surgery to look for any hidden retinal tears or weak areas that could lead to a retinal detachment since the risk of one is much higher in extreme myopia.  Finally these type if eyes often don't have 20/20 type potential due to Some stretching of the retina due to s very large size if the eye.  The near vision you have now is only useful to see things 4 inches from your face do you would appreciate beings able to see things at 20 inches away and some distance as well.  Expect a very low implant power on 3 to 6 range give it take some.  You'll do great and make sure about the retina consult.

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by Michael J Kutryb, MDBlank, Jan 05, 2013
To colk you need to discuss with surgeon and ask what is going on.  Was this intended or was it a mistake in Iol power or will it get better in coming days.  If Iol power was incorrect then three options exist: surgery to replace Iol is best option and should be done as soon as possible if indicated.  Otherwise if there is a delay, you can have LASIK surgery to correct the myopia or a piggyback(second) Iol in select cases.  Generally Iol exchange is the way to go and I would do it within 1-2 weeks if there was a very unexpected and undesired amount if nearsightedness.

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by JackM829, Jan 21, 2013
I'm going in for cataract surgery in two months. I'm extremely near sighted (-9 in right, -10.5 in left) and suffer from retinitis pigmentosa.

One thing I really rely upon is how crisp my very near (right up to my face) vision is and that's how I'm able to read tiny print, so I decided to stay completely near sighted - basically no correction at all.

Now I'm thinking of no correction in my left eye, and correct for distance in my right. Then I would just use a contact lens in my left eye for distance/intermediate. Wondering if that's possible. I haven't discussed this with my surgeon yet, but this is the route I'm leaning towards.

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by Shikha75, Mar 10, 2013
Hi

I am 38 years old. I underwent Lasik surgery and opted for mono vision. Before that my left eye had -4 and right eye - 5.50. So without lenses I would most likely use my left eye more so I assume that was my dominant eye. So now after Lasik I can see far things with my right eye and closer with left. Does that mean that it should've been corrected the other way around?

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by JMZ1956, Mar 18, 2013
Dr. Kutryb:

I recently had cataract surgery in my right eye.   I wore gas permeable contact lenses but I could never get my right eye corrected even with a contact lense.  I was able to use my right eye for reading so I had my left eye (with a corrected contact lense) for distance and my right eye for reading.  After having the cataract surgery in my right eye, my vision in my right eye is now 20/20 (can't tell you how cool that is considering I have worn glasses or contacts since third grade) but now I need reading glasses.  My doctor tells me that I have the start of a cataract in my left eye and, while I don't need surgery now, I will eventually need it so I have decided to have the cataract surgery in my left eye.  I am just a little confused as to what I should do with the surgery in my left eye - do I want to shoot for correcting the vision in my left eye to 20/20 and just resign myself to having to wear reading glasses for the rest of my life or should I sacrifice a little for distance in my left eye (maybe 20/40 or 20/50) and have the ability for up close reading with my left eye and not need reading glasses?    Is it possible to have 20/40 vision in my left eye and have the ability to read with that eye?  If so, how much of a difference would there be between 20/20 vision in one eye and 20/40 vision in the other?  would I even be able to notice the difference?   Would you recommend sacrificing a little distance vision in one eye in order to have the ability to read without reading glasses?

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by CherylLee76, Apr 30, 2013
dr. Kutryb,

What implant strength is best when one eye has become myopic around -3.5 in left eye after vitrectomy and right eye is .+25. I would like the eyes to be balanced, so they don't have to fight one another to see. I have always had 20/20 vision and used readers since I was 45 or so. I would rather see distance and although seeing 10 feet away is also important and would like this to be a clear also. I am staying away from the ReZoom, ReStor and Crystalens...going towary the AcrySof IQ with blue blocking. Most important is to see clearly.

I wear a -2.25 contact because the -3.5 was so strong both eyes were fighting each other. -2.25 is more tolerable. I get halos and strands of light coming off light sources now, since I started having floaters 2 years ago. I was told my an optometrist I probably had the start of a cataract also in my right eye. Can you see cataracts easily when being examined or is it that you may have the symptoms such as halos etc even before the cataract is found by my doctor?
Thanks for the help and information.

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by Guz926, May 01, 2013
Dr. Kurtryb,

I've been blind in my right eye since age 8 (cataract and detached retina).  At 16, I had to have the cataract in my left eye removed which caused the retina to detach 3 months later.  A scleral buckle was done to repair the detachment.  I'm now 43 years old and am considering a lens implant for my left eye.  Doctor says I need a "Glued IOL OS" because of the way my cataract surgery was done in 1986.

I understand what's at stake given I only have one eye, but separating the consequences from the risk, is the risk that something will go wrong really that great given my circumstances?  Will having an implant somehow greatly increase the chance of another detachment beyond the chances that I already live with (i.e. I assume that I'm already living with a heightened risk from the general population given that I've had a detachment with or without further surgery)?  Are there other complications that I'm at greater risk for?  

And if the risk is greater, is it significant?  Again, I realize that even if the risk was minute if something does go wrong, the consequences could be great.  I just want to get a better sense of the risk itself.

Thanks

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by vcdlady, Jun 05, 2013
Dear Dr. Kutryb,

I just turned 70, and need cataract removal in left eye (all 3 types of cataracts in left eye, plus congenital cataracts), as the blurred vision in left eye is getting to me (both eyes still trying to work together).

I had small retinal tear-- lasered shut a few years ago--, in upper outer quadrant of left eye, after a vitreous separation. Also have high normal eye pressure (staying steady at 18 for years), but not yet glaucoma. Also have dry eyes (using preservative-free Refresh Celluvisc Lubricant eye drops.

I'm happy to wear glasses (have worn them since childhood). I don't have a dominant eye--both eyes really work together. Was farsighted, but cataracts have acted like convex lenses, decreasing farsightedness.

To prevent dysphotopsia, I want a monofocal IOL, probably set for 20 feet/ infinity, for my very cataractous left eye.

I want to avoid DYSPHOTOPSIA, as an adverse side effect of cataract surgery.

Which IOL's have you found, that are least likely to cause dysphotopsia, in your own experience? I've read that acrylic square edges are more likely to cause both positive & negative dysphotopsia.

What do you think of STAAR's hydrophilic Collamer (collagen, etc.) IOL, specifically their CC4204A monofocal  intraocular lens?

Which IOL's do you use, to try to PREVENT dysphotopsia?

Thank you in advance, for the great help you give on this forum!

Sincerely, Carol Sidofsky
***@**** (cell: 970-531-5000)
Former nurse

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by janellen60, Jul 26, 2013
I had a monofocal implant recently   Cataracts showed up years after lasik and vision of -.50 in my dominant eye, and -2.50 in my other eye for monovision, I was happy with that rx although I wished for 20/20 in my dominant eye, it was do-able.  I am a working artist and need my up close vision to be crisp.  The implant resulted in hyperopia to the point where everything is blurry.  There is no part of my vision with that eye that is clear.  My other eye is scheduled for surgery and the target is -2.50 knowing that the eye that has been done resulted in +2  my Dr thinks this is safe that I will not end up farsighted with the eye that should be for up close vision. I feel the need to get the eye done since it is so myopic now with the cataract that my eyes are very far apart in their type of vision.   My Dr told me I could have a piggyback lens implanted in the hyperopic eye after the vision is stable.
I need to see up close and the blurry vision is extremely disheartening, so I am leaning toward having the piggyback lens even though it's going to be expensive.  
What would you do?  

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by robp61, Aug 14, 2013
I just had cataract surgery on my right eye which is my dominant eye and I had good close vision in that eye. Now I have great distant vision in that eye. My doctor wants to give me good close vision in my left eye when I have the cataract done in a few weeks. I was a successful monovision wearer of contact lense many years ago. I am now 78. My right eye now has 20/20. Do you have any suggestions for the best lense to use in my left eye when I have the surgery in a few weeks.  I already have good distance vision in that eye but if we go for the monovision he will have to do the correction for close vision in that eye.  Hope I wrote this so you understand,,,,,sure gets confusing.

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by cholla20, Sep 18, 2013
I am having cateract  surgery on my left eye.  I had my right eye done for distance.  I am very nearsighted in my left eye with high myopia.  I also have astigmatism.  My question is shoulod I have mini monovision and do I need my astigmatism corrected or do I have the other for distance.  He told me he did not know what my close vision would be like if I had mini monovision. Also if I had the eye done for distance could I wear a contact lens to read?  Please help!

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by sadwithresults, Sep 29, 2013
I would greatly appreciate your help. My vision prior to surgery was -3.50 and -4.75 plus astigmatism and farsighted. I had cataract surgery 10 days ago on my left eye. It was corrected for distance with AcrySof Toric IQ lens. Day after surgery vision tested at 20/35. 3 days ago surgery on right eye for distance with AcrySof IQ lens. Lens was supposed to be another Toric lens but lens was found to be defective as the Dr was about to put it in. My lens was already removed. There were no other Toric lenses in my strength available; so a Non Toric lens was used. Everything that I see is now Blurry! This is so upsetting since I could see fairly clearly out of the 1st eye by itself. The left side of what I saw was blurry. Did not choose any monovision because no test with monovision contacts had been done prior to surgery. Was afraid of not seeing clearly at any distance. Unfortunately that is exactly what I have now anyway. What can be done now? The vision now is more than just a little blurry. It is as if I can't even see as far away either. I also am seeing large rays of light when looking at a light. It is worse when outside.  My vision was much more clear far away and i could still see close up after 1st was done before 2nd eye. Does that mean mono vision was starting to work for me before 2nd eye? I should have chosen the monovision. How risky is LOL replacement surgery? How soon should it be done? Thank you

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by jgoliny, Oct 24, 2013
hi Doctor,

I am 51 year old presbypoic who had both eyes corrected for distant vision on Sept 20, 2013 ( as strongly suggested by the optometrist in the Lasik Vision Institute here in New York). She told me I would have difficulty of depth perception if I opted for monovision which really scared me off. This is the reason why I opted for distant vision correction for both eyes. But after having Lasik done for distant vision correction in both eyes, I lost my near vision by 50%.  Its been 5 weeks now post Lasik correction, and I could not read a magazine or book without reading glasses.  For the past 4 weeks, I have been wearing a +1.5 contact lens on my left non-dominant eye, and I find it working very well for me both looking at distant objects, driving and reading without any eyeglasses.  I think Monovision works for me. My brain switch easily from seeing distant objects to reading books instantly witohout problem. If needed, I will be very willing to wear reading glasses to do fine detail work, and wear another pair of eyeglasses for night driving.  My question is, when is the best time to do a second Lasik correction for my left eye to bring back the near vision ( and keep my right dominat eye the same)?  I hope to hear from you. Thanks.

jgoliny

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by jgoliny, Oct 24, 2013
Dr. Kutryb,

I have also another question regarding second time Lasik.  Aside from asking when is the best time to do second lasik for monovision after both eyes being corrected for distant vision, I would also like to ask which method is preferred for this case, is it corneal flap lift or PRK?

jgoliny

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by claireelaine, Feb 07, 2014
I was very short sighted from the age of 11 and was very happy when contact lenses were fitted at the age of 43.  I am now 69 and about 6 years ago had intra-ocular accommodating  lenses fitted into my eyes.  The surgeon was very happy with the result but noticed that I had some crinkling at the back of one eye and stated that this may need some attention later.  I had a few years with perfect vision for distance and for reading.  Just over 3 years ago I started to develop debilitating headaches, burning eyes and became bothered by bright light (television, white paper when reading, sunlight) and found myself shading my eyes all the time.  Most days I would manage to operate as normal until after reading the newspaper and doing a crossword and my eyes would be so sore and my headache crippling that I would go to bed in the darkness until evening.  The headaches occurred daily and my quality of life badly affected.  Visits to doctors, opticians and eye specialists were fruitless. The consultant at the hospital was quite dismissive and could not see any reason for my distress and diagnosed eye-drops again.  I had been sitting waiting to see him for a while and the headaches and burning eyes meant that I had to keep my eyes closed in the waiting rooms. I was diagnosed with mild blepharitis and had to bathe my eyes with baby shampoo, use heated eye bags and apply eye-drops.  Over 3 years I have suffered with all the above symptoms and my eyes were even more sore and my headaches debilitating.  By this time I began to think I was going mad.  Nothing is worse than being told that you have a mild condition and you are crippled by it

I had another appointment with a specialist at the same hospital I had attended before.  He tested me for about 20 minutes and said I did have blepharitis but that it was very mild and not really a problem and would certainly not have caused me to have to lie in darkness day after day for years.  His diagnosis was CLASSIC MIGRAINE.  

Since then I have not bathed my eyes much or used eye bags or worried about sore eyes.  I wear reading glasses at all times when reading and only read for half an hour at a time. I listen to audio books when I go to bed and try not to strain my eyes at all.  I do not now have headaches or sore and burning eyes.  I think that the worry of trying to scrupulously follow a regime of eye bathing and heated pads etc was making my eyes more and more sore and the symptoms were caused by migraines not blepharitis.  I stopped worrying and am now so much better but feel angry that it took 3 years for a sensible diagnosis.  The macular degeneration in my left eye is worse and does affect my reading without reading glasses.  I only found out that the crinkling in the back of my eye mentioned years ago was macular degeneration when I saw an poster in a Health Centre which asked you to close each eye in turn and if the straight lines were not straight then this was a sign of the condition.  My left eye had the same crooked lines as the poster.   I do not know whether this weakness in the left eye was the cause of the headaches because I could still read without glasses and still can.

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by Peggy333, Feb 09, 2014
Dr. Kutryb,

I am a 69 yr old female and I have a  sn60wf in my R eye - set at plano (20/20) as of  March 2010.  I had both  nuclear and sub-capsular cataracts then and have both again in my L eye. The cataract in my L eye is very bad and needs to be done quickly.

My own opth.  does not work with this lens & suggests  -1 in the L eye and the surg. (who did the right eye) believes that unless a person has tried contacts it is 20/20 for the L eye as well. My Dr. feels I will have trouble adjusting to that. Another said -.75. One of them felt I may get double vision is set wrong. I had a lazy eye as a child and see that one can have a latent susceptibility to strbusmis. I worry that a mini mono could bring that out but on the flip side it seems that t 20/20 in both eyes can do that as well.

You have vast experience with these particular  lenses - what do you feel would be the safest  for me to avoid a possible problem with double vision after the L eye is done? I am already feeling unsettled  about the surg. asdue to illness in the family - I have  waited far too long to have this done.

With appreciation,

Peggy

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by RoseMaryK, 11 hours
Dr. Kutryb,

I am 48 yrs old I had lasik done twice once in 2000 to correct my near sidedness in both eyes then In 2010 I had a revision as I was not seeing as well so he did my right eye only and gave me monovision  which worked well I have been diagnosed now with cataracts in both eyes but more in my right eye that is my dominate eye I have gotten 2 opinions and I am so confused on what to do as far as what type of lenses to get one recommend the multifocal  lenses then the doctor on my insurance plan said I wouldn't like the multifocal cause I wouldn't see intermediate  and not well at night and he recommended me to do monovision with my right eye to be my dominate eye again and left for reading I also  have astigmatism. Is there any advise on the type of lenses to do.

Thanks Rose

hope to hear from you with some advise as I am very emotionally exhausted and confused on what to do

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