2nd IOL time - Q about the power -sn60wf

[Peggy333]

I have finally adjusted to my Alcon sn60wf  in the R eye. The L eye needs a replacement asap. I have a  nuclear and a sub cap in that eye as I did with the R. one. After much research - I feel it is best to have the same with  the same surg. I am set at plano in the R  eye (20/20) and my question is about the power of the L lens.

Prior to developing cataracts  I was comfortably near sighted with my dominant R eye at 20/30 and L  was 20/25. Over the past 4 yrs.  I have liked the softer vision with both eyes( vs closing the L and seeing through the R 20/20)  -  but then I understand that my normal left lens can adjust to near and far and the mono IOL will not. My astig. was in the lens and is gone &  I do not want a toric  - just the same sn60wf - it is the strength I am concerned about.

My reg. opth. (does not work with this lens) is concerned that  I will lose my closer mid-range but he is not familiar with my  lens. Some of you have this lens and  know it's attributes - I seem to recall that the sn60wf is better at compensating at midrange? If so - then I would not lose that compensating with 2 of these  IOL's  in place? He is  concerned that I will be very uncomfortable with 20/20 in both eyes and that -.75 may be  too little.

I am" pseudo adjusting" to things closer and he feels that I would  lose that-  but maybe not if this  lens is more capable that he  is familiar with.  From what I understand with -.75 I won't notice it - but seems that I will be able to read a bit like bigger labels or a wall phone- hopefully dashboard - without readers? Also- right now I can grab over the  counter  readers to use (when I don't need my mid/range).   Would the same strength  work on both as it does now  (if one is -.75 and one 20/20?) That has worked when I had my 20/20 (R.) & 20/25 (L) vision until the L eye cataract has blinded me.  If -75 provided me with  any sense of that- it would be wonderful and I would not have to take a risk of not adjusting to something that is further apart like -100.. I have no objection to wearing my mid/range reading for  reading / computer work or cook/eat  as I do now.

I have located several articles that recommend the .-75 and saw a post from a  patient who wrote  that she had  her IOL's  lens set at one near and one far but she  had a lazy eye as a child - and after several  years - with no warning-  she developed strabismus and required surgery as she  could not maneuver stairs safely any longer. I had a lazy eye as a child and wore a patch for a summer & did the pencil exercises. My L eye has been jumping out a bit lately due to the much decreased vision and -.75 seems safer for me.

I read 12-14 hrs a day in my career and I recall how nice it was to read with 2 eyes  with my mid/range-reading glasses. I also saw an article that stated “If you’d make a  patient plano in both eyes, targeting for distance, he’d need +5 D reading glasses. As any optician will tell you, a pair of +5 D reading glasses is expensive to manufacture. You’ll have to put prism in the glasses to bring the images into alignment, because looking through +5 D spectacles without prism will cause diplopia at near—the brain will require excessive fusion to merge the two images. By intentionally making the patient myopic at the time of cataract surgery, you’ve turned an inexpensive device into a powerful low-vision aid, improved the patient’s quality of life and reduced the economic burden for the patient and society—all because you took optics into consideration.” That would be horrible.

I think Jodie has my lenses and she noted she can see the dashboard with both set at 20/20. The surgeon likes both plano – my reg. opth likes -100 and another I have consulted likes -.75 .

Please thoughts on this  - I really want to be comfortable with my decision.

Peggy

[Peggy333]

I understand about the error margin - .25-.50 & am confused that -.75 is considered fool proof to assure the one eye remains a bit myopic &  does not go over 20/20 with the other at  20/15.

You use the sn60wf - do you usually find that people adjust well to -100 in the eye  better than -75? I thought I was 20/20 in the R eye but have had separated tests and am 20/15 would not want to be over corrected want to remain myopic in L eye but have had no experience with this as I never wore contacts. Was told -100 and -75 by two Dr's one siad with a aspheric he uses -.75 and non-asph  he uses -100.

[Peggy333]

Actually I could not do computer work but can read a bit on it. The surg says will not do anything but 20/20 unless one has worn contacts to know they adjust to difference and my Dr feels that even though I never wore contacts the cataract has done that & I will adjust and will not adjust to 20/20. My history of lazy eye as a child makes me concerned about a muscle imbalance but so does the worry of not adjusting to a 20/20.
I was 20/30 in the R eye before the IOL (now 20/20) and 20/25 in the L - is -100 similar to that? Someone said with an aspheric  that -75 is more of a -100.

Peggy

[Peggy333]

Thank you for your comment  -I cannot do computer work without a 1.25 mid range. Do you feel that -1 could cause problems with muscles etc as I have never worn contacts. If it is -.75 does that aid in keeping a  good mix of dominant to non-dominant eye? I am concerned that one wants 20/20 in each eye and theo ther feels that 20/20 in each eye will cause me misery.

peggy

[Ray T Oyakawa, MD]

A +2.50 readers is usually need to read when the eyes are set for distance.

First, see if you can do computer work with your right eye.  Most monofocal lenses to not have very good intermediate when set for distance including the SN60WF. If not I would recommend the left eye be set for -1.00 to -1.25 and it should work well for the computer.  The disadvantage of this set up is the need for reader with a power of approximately 2.50 in the right and 1.25 to 1.50 in the left.

Dr. O.