Michael J Kutryb, MD
Michael J Kutryb, MD
Male
Specialties: Ophthalmology, Cataract Surgery, glaucoma
Interests: Ophthalmology
Male
Specialties: Ophthalmology, Cataract Surgery, glaucoma
Interests: Ophthalmology
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Nov 27, 2008 - 129 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
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
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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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
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
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.
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
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
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
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
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
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
I have printed this off. Thanks for this great information, Doctor K. I wish you were in my city. Do you have a clone? (-:
Dear Laura5121,
Yours are excellent and very important questions; let's hope some knowledgeable person happens along who will attempt to answer them.
Yours are excellent and very important questions; let's hope some knowledgeable person happens along who will attempt to answer them.
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?
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.
can drugs cause that much damage. he says all his friends do them all the time and have no problems.
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.
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 :)
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 :)
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...
I am right eye dominant...is it okay to put the dominant eye as the near vision...
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?
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".
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.
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.)
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.
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
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
***@****
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
***@****
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
Michael Kutryb
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
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
I am very unhappy with the results of my surgery Mono vision. Can any of it be redone ?
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 ***@****
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
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 !
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.
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.
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?
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.
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
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
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
Sph Cyl Axis Near
-4.00 -0.25 165 +2.50 add RIGHT
-4.00 -o.75 17 +2.50 add Left
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 ?
Yes, if you are speaking of laser capsulotomy or LASIK or PRK.
MJK MD
MJK MD
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
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
Follow up to my last post:
Or will I need my left eye done anyway to balance me out?
Or will I need my left eye done anyway to balance me out?
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
MJK MD
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.
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.
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?
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
MJK MD
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
Thanks for your comments.
NMD
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
Michael Kutryb, MD
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.
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.
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
MJK MD
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
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
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
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
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.
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.
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
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
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
Thanks very much,
Annie
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
MJK MD
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
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
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
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
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
MJK MD
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?
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?
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.
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?
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?
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.)
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.)
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.
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.
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.
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.
ONE MORE QUESTION: If it doesn't come up in other answers, could you discuss "multifocal lenses," and their pros and cons? Thank you!
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.
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.
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?
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?
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.
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.
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.
Correction: I went from -7.5 to 20/40, and can be corrected to 20/20 or 20/25.
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.
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.
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.
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.
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.
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 @ ***@****
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 @ ***@****
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.
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?
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?
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?
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.
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.
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
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
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.
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
thanks
Stuart
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!
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!
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.
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
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.
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.
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
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
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?
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
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
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
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
jmw70
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 ***@****
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.
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.
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.
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?
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!
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.
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.
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.
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.
Did you see my post of Jan 26? Thanks.
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!
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.
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
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
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
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
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.
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.
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!
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!
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
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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)....
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)....
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?
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.
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.
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.
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...
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...
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...
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...
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.
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.
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.
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?
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?
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.
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.
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.
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.
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.
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
***@****
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
***@****
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.
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.
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.
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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