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17484539 tn?1580565249

2nd Eye Cataract Surgery Decision - Monovision VS 2 Far IOL lenses?

Good morning, I'm faced with a decision on what type lens implant for cataract surgery on my 2nd (dominant) eye.  I posted about this in 2016; I'd had cataract surgery in my right eye with a "surprise" Far Lens implant - no discussion from my ophthalmologist-- so unwanted surprise to me to lose my near vision. I decided against proceeding with the left eye as it wasn't necessary yet. But it's necessary now.

So my choices are:
  1) Intermediate lens for my left eye which would give me mono vision, since I now have this far lens implant in right eye.  I am getting a contact lens trial for this on Feb 11. ( I am told tho the implant for intermediate would not give as flexible a result as my natural lens.)

or 2) Far vision implant in left eye too which would leave me with no near vision. I still have enjoyed having near vision in my left eye the past 4 years , even tho reading was a problem because of the difference in refraction. But with option#2 I would be completely reliant on glasses for all near tasks.  My current prescription is  I RX: Sphere R-+1.75, L-+1.00, Cylinder R: -;75, L: -2.00, Axis: R-95,L-90. For 10 yrs I have a macular pucker in my right eye with no complications, FYI. (fingers crossed it will stay that way)

I am a graphic artist. Most of my time is spent on the computer or other near tasks. (If I had it to do over I'd get two intermediate lenses but I don't have that luxury) Gosh I sure would appreciate ANY insights. Also info as to whether people like me (graphic artsits0 adjust to MONO VISION. (one intermediate, 1 far). Or whether just bite the bullet & get another "Far" IOL. Thanks in advance!
1 Responses
177275 tn?1511755244
First make sure you read this carefully:  https://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You--2019-2020-Update  ;

Having read that someone really messed up the calculations on your RE. If you wanted 'far" correction your post op prescription should be 0.00   The surgeon did not put in a strong enough lens and left you hyperopic a cardinal sin in cataract surgery. You should have also been offered a toric IOL for your 1 diopter of astigmatism. It's is amazing you can wear those glasses with such a huge difference in the two (aneisometrophia).  I would get at least 2 different opinions about your options.    I can't tell you what to do but I'm saying again the surgeon and his/her staff blew it on the IOL calculations on your first eye.
9 Comments
YES I agree, but I already know this. I no longer see this physician--obviously! It was too late in 2016 to redo the IOL on first eye I have now in 2020 to make a decision on 2nd eye, I need to determine whether intermediate or far is a better option. How do I determine this ahead of time?
I have read the article, I forgot to mention that.
You have several options:  1. Find the absolute best refractive corneal/cataract surgeon  or world famous tertiary eye center you can drive back and forth to and from in a reasonable period of time.  I am geography challenged especially the East Coast.   Johns Hopkins Wilmer Eye Institute, Mass Eye & Ear,  U of PA,  and to a lesser extend NY Eye & Ear would fit the bill. I would stay away from Columbia U, I have little regard for their ophthalmology program.   NEXT i would ask what can be done with the RE to help it see better at distance without glasses.  They might discuss IOL exchange, hyperopic LASIK, and using femtosecond laser to eliminate astigmatism and perhaps some unwanted hyperopia.       So first talk about the already operated on eye.    On the unoperated eye there is no solution that works for everyone.  Start with the fact you apparently are wearing glasses that only about 3% max of people would be able to wear because of the massive difference in the two lens.   You and the surgeon will need to decide what to target.   You would not be doing what is called "full mono-vision" for that your far away eye should have 0.00 and your reading eye about -2.00       And I would visit more than one center of excellence.     One way you might sort of simulate this is to ask yourself if you like your vision with your glasses off.  If not then likely both eyes will need to be worked on if among your goals is having acceptable vision without glasses.
Dr. H, I listen to all your valuable words--thank you!

Walking around vision not horrible without glasses now but reading a book and small print on computer very difficult. My work around has to use a large monitor and use screen enlargement sometimes but one cannot always do that.  Unfortunately my RE has a macular pucker so no surgeon very happy to work on it, due to risk. I have been looked at (RE) by a corneal specialist who thought I should leave it aloe.  I visited many after the 2016 cataract surgery including Mass Eye & Ear.   Re LE this morning I had a contactless  try on with a trial lens on the LE and result (ability to read) with the far vision was not too bad as long as astigmatism is corrected. (that wasn't done on the RE unfortunately.)  Result not acceptable with try on today with intermediate (mono) vision.  thank you for your responses, Dr H, and all you have written.  
Candice
Best of luck, very difficult situation
Thank you  the surgery cannot be done till April or May due to  my surgeon very booked (unless emergency which it is to). Decided to get Far vision for Left eye surgery with astigmatism correction.  I'm glad I tried mono vision via the contact lens try out because i would not have been happy with it. If the surgery result is close to the contact lens try out, I would be ok with it -- I think!  thank you again. I'll report back later. Candice
Okay. If you are anxious to get the surgery done ask to be put on a quick call list in case of cancellation. They are very common in cataract surgery because the typical patient is older, sicker and cancellations due to death, disease, disability are very common.
Thank you. Good idea!
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