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After cataract surgery
In early December 2015 I had a cataract removed from my right eye. Since then I continue to have complications...I lost eye sight in my eye and I cant drive at night because of the halos are so bad around the lights. Its like having spot light shining at me all at once and it blinds me...I have always been farsighted but since the surgery in that eye, I am now nearsighted... It is very difficult looking through my eyes being different sighting...I am only 58 yrs old and I feel like something has been taken from me...My eye sight in that eye in a few weeks has changed drastically... My Drs did the YAG and my vision and the halos got worse...Please let me know what I can do, I have never had to wear corrective lenses but I used to wear readers and don't need them anymore...Something seems so wrong..
1. Cataract surgery may increase or decrease astigmatism even if a toric lens is not used. It depends usually on the way the cornea is curved. Given that most surgery is done laterally now (it used to be done superior under the upper lid) it corrects corneas that are more curved horizontally.
2. Given the way your initial surgery eliminated your astigmatism its likely you don't need the extra expense and possible complications of a toric IOL.
3. The IOL especially acrylic ones can generate a reflex from the anterior surface. Some people like this and call it their "sparkle in the eye", other people find it troublesome.
4. If your surgeon can get a very accurate IOL power in the LE (remember it didn't work as expected in the RE) and one reason may be that one of your eyes has had surgery (iridectomy) and that can affect "settling" Your glasses RX will be RE -1.50 LE plano (0.00) With about a 3 add in progressive multifocal glasses. There will be +1.50 diopter difference in the two eyes which most people can adjust to (right now you have 3 diopters given one lens is plus and the other minus)
2. Given the way your initial surgery eliminated your astigmatism its likely you don't need the extra expense and possible complications of a toric IOL.
3. The IOL especially acrylic ones can generate a reflex from the anterior surface. Some people like this and call it their "sparkle in the eye", other people find it troublesome.
4. If your surgeon can get a very accurate IOL power in the LE (remember it didn't work as expected in the RE) and one reason may be that one of your eyes has had surgery (iridectomy) and that can affect "settling" Your glasses RX will be RE -1.50 LE plano (0.00) With about a 3 add in progressive multifocal glasses. There will be +1.50 diopter difference in the two eyes which most people can adjust to (right now you have 3 diopters given one lens is plus and the other minus)
i went to the Dr. the other day to get glasses after my cataract surgery. Here is my prescription that i am now..
D.V. O.D. -1.50
O.S. + 75 cylindrical +25 axis 172
N.V. O.D. +250
O.S. +250
Last night the craziest thing happened....My niece was close talking to me and she said what is that white spot on your eye...I said I don't know what it is and my sister looked and she said she could see this white thing and she said it looks like a contact lenses...I told my Dr. that I feel something in there and if I didn't know better I would think I had a contact in there.. What could t be...my sister could actually see it...
D.V. O.D. -1.50
O.S. + 75 cylindrical +25 axis 172
N.V. O.D. +250
O.S. +250
Last night the craziest thing happened....My niece was close talking to me and she said what is that white spot on your eye...I said I don't know what it is and my sister looked and she said she could see this white thing and she said it looks like a contact lenses...I told my Dr. that I feel something in there and if I didn't know better I would think I had a contact in there.. What could t be...my sister could actually see it...
There are some people that can wear glasses for myopia in one eye and hyperopia in the other eye sometimes even huge amounts. As a generalization anytime there is over 1.50 diopters difference between the two eyes most people have problems. You have about 3 diopters difference between the two eyes. You mentioned earlier that with the glasses RX you could see 20/20 that's great. Without glasses out of the RE you should have excellent vision 2-4 feet, be able to use a computer and in good light read well printed material. With a +1.00 reading glass you should be able to see very tiny print, thread needle, etc. Since your RE is non-dominant that is usually chosen for reading which is fine. The most common option would be to do a cataract removal LE and insert IOL with goal of leaving LE Plano You should have good vision without glasses and it would be mini-monovision with distance bias. With progressive lens after surgery your vision should be excellent at all distances.
1 Comments
Thank you for the response. I plan to get the cataract removed LE and insert IOL.
I didn't ask you about the astigmatism in my left eye. The prescription I have for the glasses I currently wear has a cylinder of +.75, but I have a prescription from a year ago that has the cylinder at +1.25. My doctor plans to use a regular monofocal lens to do the LE because of less complications than using a toric lens. Do you think I will have good/decent distance vision given the range of my astigmatism may be +0.75 to +1.25? Also, if the target goal for the LE is plano, will that give him some leeway to make sure that if the goal is off that I will not have more than the
1.5 0 diopter difference between both eyes? My doctor said that the target of plano was not meet in the RE because of the way the lens has settled in my eye. He says that both my eyes are symmetrical and the same length so when he does the LE the lens settling should behave the same as it was for the RE.
I didn't ask you about the astigmatism in my left eye. The prescription I have for the glasses I currently wear has a cylinder of +.75, but I have a prescription from a year ago that has the cylinder at +1.25. My doctor plans to use a regular monofocal lens to do the LE because of less complications than using a toric lens. Do you think I will have good/decent distance vision given the range of my astigmatism may be +0.75 to +1.25? Also, if the target goal for the LE is plano, will that give him some leeway to make sure that if the goal is off that I will not have more than the
1.5 0 diopter difference between both eyes? My doctor said that the target of plano was not meet in the RE because of the way the lens has settled in my eye. He says that both my eyes are symmetrical and the same length so when he does the LE the lens settling should behave the same as it was for the RE.
I was told that a person can't be fitted with eyeglasses for one eye nearsighted and one eye farsighted. If I understand you correctly, you seem to be saying that yes, I can have glasses right now and hold off the surgery for the other eye. I do have the refraction/prescription for both eyes.
Sphere Cylinder Axis ADD
OD -1.50 +0.75 135 +2.50
OS +1.50 +0.75 040 +2.75
I am wearing my old glasses that correct the left eye and basically blur out the right one. Sometimes I don't wear the glasses at all and I feel that my brain is trying hard to get me the best focus it can. I did wear monofocal contact lens about 15 or 20 years ago for a few years. I went to eyeglasses at the time because I began using glaucoma drops for interocular pressure. I did have closed angle in the right eye and an iridotomy to fix it. The same procedure was performed on the left eye to prevent the angle from closing. The right eye (cataract removal/iol) is the non-dominant eye. It's also a lazy eye. My left eye is dominant.
Sphere Cylinder Axis ADD
OD -1.50 +0.75 135 +2.50
OS +1.50 +0.75 040 +2.75
I am wearing my old glasses that correct the left eye and basically blur out the right one. Sometimes I don't wear the glasses at all and I feel that my brain is trying hard to get me the best focus it can. I did wear monofocal contact lens about 15 or 20 years ago for a few years. I went to eyeglasses at the time because I began using glaucoma drops for interocular pressure. I did have closed angle in the right eye and an iridotomy to fix it. The same procedure was performed on the left eye to prevent the angle from closing. The right eye (cataract removal/iol) is the non-dominant eye. It's also a lazy eye. My left eye is dominant.
I apologize for not making myself clear. I had cataract removal from my right eye and a monofocal lens implant. The goal was to set that eye for modified monovisionI. My dr said he tried to get my right eye at plano, fit me with glasses, and then do the left eye later. He said his goal was off because of how the lens has settled in my eye at 16 days post surgery. He wants to take the cataract out of the left eye and hopefully aim for a 1 diopter difference so my eyes can work together. The cataract in the right eye was noted to be a 2-3 and the one in the left eye is a 2. My vision was worse in the right eye and that was the choice for doing it first. He wants to do that rather than a lens exchange. I have an appointment with another opthamologist this week to get his opinion before proceeding. I live on the Northshore of New Orleans.
Yes in that case refraction (glasses test) for each eye and vision with that RX would be very useful.
PRK and LASIK don't work well changing farsighted eyes to nearsighted eyes and neither are good options. They are to reduce myopia. What kind of surgery did you have on your RE? A cataract/IOL? If so you are likely to either have a cataract on the LE or likely to develop one and cataract/IOL or lens exchange would likely be your best procedure BUT I could be wrong and what you had done was not a cataract/IOL. If it wasn't a cataract/IOL and was a refractive procedure why would you not just do the same procedure on the other eye. JCH MD
1 Comments
FYI, lawlipop made two posts, the 2nd indicates she had cataract surgery. The 1st indicates the eye went from farsighted to nearsighted in the operated on eye. Her unoperated eye is still farsighted and she is complaining about the difference not working well . So any lasik/prk would be for myopia for the operated eye.
I am guessing when she says the doctor "wants to now make my other eye slightly nearsighted too" that she is talking about cataract (or clear lens replacement) surgery.
The odd point is she asserts the doctor is suggesting this so that she can "wear progressive lenses". Even if the 2nd eye is focused at distance rather than myopic she should be able to wear progressive glasses.
She says she only sees well out of one eye at a time, but since her other eye is farsighted, my question for her would be how the farsighted eye is being corrected when she is comparing, does it have a contact lens or is it an old pair of glasses that wouldn't have the right prescription for the operated eye? If the comparison is without glasses, it seems the farsighted eye at her age will have even less near/intermediate and so the difference between the eyes is likely more pronounced than monovision usually is. The likely issue is getting used to monovision, which might be more difficult unless she gets contacts/glasses to correct the farsighted eye, or figuring out what to do about the other eye surgically.
One question for lawlipop is what the refraction/prescription is for both eyes.
I am guessing when she says the doctor "wants to now make my other eye slightly nearsighted too" that she is talking about cataract (or clear lens replacement) surgery.
The odd point is she asserts the doctor is suggesting this so that she can "wear progressive lenses". Even if the 2nd eye is focused at distance rather than myopic she should be able to wear progressive glasses.
She says she only sees well out of one eye at a time, but since her other eye is farsighted, my question for her would be how the farsighted eye is being corrected when she is comparing, does it have a contact lens or is it an old pair of glasses that wouldn't have the right prescription for the operated eye? If the comparison is without glasses, it seems the farsighted eye at her age will have even less near/intermediate and so the difference between the eyes is likely more pronounced than monovision usually is. The likely issue is getting used to monovision, which might be more difficult unless she gets contacts/glasses to correct the farsighted eye, or figuring out what to do about the other eye surgically.
One question for lawlipop is what the refraction/prescription is for both eyes.
I have the same problem after cataract surgery performed 16 days ago. Refractive error overcorrected. Now I'm nearsighted in one eye and farsighted in the other. Why did you go with the PKR instead of a lens exchange? How bad is the PKR to go through - pain, long recovery, etc.?
I am a 66 year old female.
Any help will be appreciated.
I am a 66 year old female.
Any help will be appreciated.
I had surgery on my right eye which was farsighted and now it is nearsighted so it doesn't work with my left eye which is still farsighted. I can see well out of it, but only with one eye at a time. When refracted at the office, I could see 20/20 out of it. My doctor wants to now make my other eye slightly nearsighted too so that I can wear progressive lens. He wants to try that first before doing a lens exchange or the PRK. He thinks the lens exchange would be better to do than the PRK. He doesn't like lasik. Which do you think is the best option. How dangerous and long is the recovery for the PRK? I'm going for a second opinion in 4 days. Any help/suggestions for other second opinions. I live on the northshore area of New Orleans.
My left eye (the only one that has had cataract surgery) also ended up with a significant refractive error after an IOL implant - either because of a mistake, or because my eye (due to high myopia, a prior scleral buckle and other complications) was just too far off the norm for the "standard" calculations to work.
Let us know what the surgeons say about your current prescription - if it's just your refraction that's off, there are options. You might be able to have the IOL explanted and replaced, though if you've had a YAG capsulotomy it may be too late for that. You might be able to have a piggyback lens implanted to correct the error. Or you might be able to have Lasik or PRK to correct the error.
I had PRK to correct my error and, while I'm still healing, it looks like I'm going to end up at 20/25, which given my prior history is great.
Best of luck and let us know how the appoitnment goes.
Let us know what the surgeons say about your current prescription - if it's just your refraction that's off, there are options. You might be able to have the IOL explanted and replaced, though if you've had a YAG capsulotomy it may be too late for that. You might be able to have a piggyback lens implanted to correct the error. Or you might be able to have Lasik or PRK to correct the error.
I had PRK to correct my error and, while I'm still healing, it looks like I'm going to end up at 20/25, which given my prior history is great.
Best of luck and let us know how the appoitnment goes.
2 Comments
I made an appt for March 24th and hopefully I can find out if there is anything they can do to fix it....This will be a second opinion from a different Dr.
You don't mention which lens you received. Multifocal lenses have a higher risk of halos than monofocals, but even people with monofocal lenses can get problematic halos unfortunately. Many people who do get halos often see them get better within the first few weeks or months, others not for several months, so surgeons try to get patients to see if the halos get better, but a minority continue to have problems with them.
If they are too problematic and the patient doesn't wish to give it more time, then they consider exchanging that lens for a different model (though there is no guarantee that'll work, especially if you have a good lens now, but some monofocals are better than others and perhaps a different design would help). Unfortunately lens exchanges are more complicated after a YAG procedure, its usually better if possible to do a lens exchange first, but if needed they can usually still do a lens exchange and likely will place the lens outside the capsular bag.
Unfortunately there is no exact formula for the lens power to be used, it is merely an educated guess based on statistical analysis of past patients and their eye measurements. It works well for most people, but some people can be left either farsighted or in your case nearsighted. If they are going to do a lens exchange due to the halos then they can probably choose the right lens power for the replacement to give you good vision.
Until then you get a lens exchange (or decide not to), f you are nearsighted in that eye they can correct it with contacts/glasses. You don't mention how farsighted you are in the other eye. If there is too much of a difference between the prescriptions in the two eyes then often contacts are better, or specially made glasses that help correct for the difference in magnification between the two eyes. If you decide you definitely aren't getting a lens exchange then you can consider laser surgery to correct that eye permanently.
If they are too problematic and the patient doesn't wish to give it more time, then they consider exchanging that lens for a different model (though there is no guarantee that'll work, especially if you have a good lens now, but some monofocals are better than others and perhaps a different design would help). Unfortunately lens exchanges are more complicated after a YAG procedure, its usually better if possible to do a lens exchange first, but if needed they can usually still do a lens exchange and likely will place the lens outside the capsular bag.
Unfortunately there is no exact formula for the lens power to be used, it is merely an educated guess based on statistical analysis of past patients and their eye measurements. It works well for most people, but some people can be left either farsighted or in your case nearsighted. If they are going to do a lens exchange due to the halos then they can probably choose the right lens power for the replacement to give you good vision.
Until then you get a lens exchange (or decide not to), f you are nearsighted in that eye they can correct it with contacts/glasses. You don't mention how farsighted you are in the other eye. If there is too much of a difference between the prescriptions in the two eyes then often contacts are better, or specially made glasses that help correct for the difference in magnification between the two eyes. If you decide you definitely aren't getting a lens exchange then you can consider laser surgery to correct that eye permanently.
11 Comments
I got a acrysof lens implant...I am not nearsighted in both eyes...I was farsighted in both eyes until the surgery...now my left eye is farsighted and the right eye that had the surgery if nearsighted
There are Acrysof lenses that are monofocals, and others that are multifocals (the Acrysof IQ Restor). A multifocal costs extra out of pocket (neither insurance nor government plans cover it), so you'd know if you received one and I presume would have mentioned that. Not all monofocals brands are equal. Although I haven't seen a head to head comparison, what I've read suggests the Tecnis monofocals are less prone to halos, but there is no guarantee you wouldn't have halos with a different IOL as well. Unfortunately there are risks involved in any sort of lens exchange, especially if you've already had a YAG, but there is some chance that a different lens could reduce your halos if they are too problematic.
do you know what caused my eye to go from farsighted to nearsighted??
Surgeons put in IOLs to leave an eye either myopic or having no need for glasses at distances greater than 20 feet (called plano or by people 'window glass") It is standard practice never to leave an eye farsighted since without glasses no distance is clear (near, intermediate or distance) Please read this carefully http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You So your IOL inserted into your eye left you myopic.
yes the cataract surgery left me near sighted and i have never wore corrected lens to see distance..my left eye is farsighted..
They took out your natural lens and replaced it with an artificial lens. They don't know what power exactly your natural lens was. If they get the power of the replacement lens wrong then you wind up either nearsighted or farsighted. Usually they get the power right, but it is merely an educated guess based on statistics and sometimes they get it wrong enough to be bothersome. In your case it sounds like they got it wrong, likely through no fault of the surgeon since they all usually rely on the same formulas to guess at lens power. It is possible it is an actual mistake, like they implanted a different lens power than what the formula said, but that isn't likely.
well if it isnt likely then what happened,,, and yes it is very bothersome...my vision is worse now than when i had the cataract in there...i told my dr. that is looks like im looking through a contact or lens that is too strong for my eyes
In order for me and others like Software Developer to help you it will be necessary for your to know your glasses RX in each eye and your vision with that RX. Also would be helpful to know what the brand and model of your IOL is. I do think however your best bet is to get several other opinions about the problem by seeing other respected surgeons. JCHMD
ok ty for the information and i am going to call for an appt. with another respected surgeon and i will keep you updated about what i find out...ty for your time...
re: "well if it isnt likely then what happened,"
As I said, the formula for determining the lens power is merely like an educated guess, unfortunately there is no exact formula. It works for most people not not for all. You are likely just one of the unlucky ones where it didn't work well.
I said it was unlikely the doctor made a mistake, since it is more likely the formula was off. Doctors and their staffs are human and can make mistakes, it is possible they gave you the wrong lens by accident, but its more likely that the formula was off in your case and you would have had this problem no matter what doctor you went to. You can get another doctor to look at your records and see what they say.
As I said, the formula for determining the lens power is merely like an educated guess, unfortunately there is no exact formula. It works for most people not not for all. You are likely just one of the unlucky ones where it didn't work well.
I said it was unlikely the doctor made a mistake, since it is more likely the formula was off. Doctors and their staffs are human and can make mistakes, it is possible they gave you the wrong lens by accident, but its more likely that the formula was off in your case and you would have had this problem no matter what doctor you went to. You can get another doctor to look at your records and see what they say.
It's hard to give you specific answers to your problems from your presentation. I think the most important thing would be to get one or 2 (or 3) independent second opinions from other experiences cataract surgeons. Do your research and seek out the best you can get to. Perhaps one should be an academic center (medical school department of opthalmology). Something is wrong.
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