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Cataract surgery

Dear Dr. Kutryb and JodieJ,

Thank-you very much for responding to my post about requesting a conventional rather than a toric lens for my second eye.  I really value and appreciate your advice and hope that you will not mind my imposing by asking you some further questions.

I saw my doctor again and told him that I would like a conventional lens in my left eye, rather than the toric lens that was implanted in my right eye about 2 weeks ago (T4 Acrysof Toric).  At this visit, he said my right eye was -2.00 (we had been aiming for -1.00 from the pre-operative -8.50) with .75 D astigmatism (about 2.50 D pre-operatively).  My vision is not clear at any distance now - even though, for a few days after the surgery, I could see people across a dinner table very comfortably and even drive and read a little.

I've postponed the left eye surgery that was to be done next week.  The blurry distant and intermediate vision of the right eye is not such a concern but the actively bad near vision is.  I see ghosting of printed letters that makes it almost impossible to read even large print with the right eye.  Reading glasses lessen the ghosting but it is still there.  I don't know how I would cope if my left eye turned out the same.  Reading is a very large part of my work as well as my personal life.  

Right now, wearing my glasses allows me to read with my good left eye and block out the doubled vision in my right eye.  I tried wearing my old left contact lens in my left eye - to simulate what it would be like even with a good outcome for that eye - and it is harder to read because the ghosting in my right eye interferes.

1.  Do you think it would it be a good idea to get a second opinion on the results of my right eye surgery?  (The great results immediately after the surgery do seem to indicate that the surgeon did a good job.  For the left eye surgery, he did comment that now he knows how my eye "heals" - so could the right eye problem be something to do with being keloid, which I am?  However, I am concerned that he says the results are excellent and dismisses the problems as likely related to my ERM.  If this were the case, even the immediate results should have been poor.)

2.  Will the ghosting perhaps get better as time passes?  

3.  Is it possible that the toric lens itself is creating a different kind of astigmatism, as I didn't have any ghosting with this eye before?  
- A faint double of each letter appears to the side of the letter - and switches sides as I move the page from very near to further out.  It looks as if there is no space between the words.  If I hold the page as far out as I can reach, the doubling disappears - the letters are very blurry but there are spaces between the words reappear.  
- If I hold an Amsler Grid at about 12 inches, the vertical lines are doubled with a beige color shading the space between the doubled lines.  It looks like a row of beige bamboo poles.  (I think the Acrysof Toric lens has a yellow tint.)   If I move the grid further out, the horizontal lines (and not the vertical) are doubled with the same beige color between them.

4.  Is a cataract refractive surgeon someone who does laser surgery as well as cataract surgery?

Thank-you for your good wishes too, Jodie.  Sorry for sending another long post.  After the surgery, before my vision dropped, it was amazing to wake up and be able to see and make breakfast without any corrective lenses.  I could feel my energy and quick movements starting to return.  So I'm hoping eventually to be lucky enough to get back to this.
2 Responses
Avatar universal
I'm totally lacking the expertise to comment meaningfully on your situation, and I hope that Dr. Kutryb or Dr. Hagan sees your post.  My ERM affected my near vision more than my distance/intermediate vision, but the result was a wavy distortion rather than double vision.  Your vertical double vision at 12" and horizontal doubling further out doesn't sound to me like something caused by an ERM.

You're right, the AcrySof lenses do have a yellow tint.  It's the result of their blue-light filtering feature (which allegedly protects the retina against age-related macular degeneration.)  According to the manufacturer (Alcon), the yellow tint doesn't affect color perception.

I can only guess that your decline in vision from immediately after surgery is due to some kind of inflammation--something temporary that can be treated.  What does your doctor say about the decline?  If your right eye is -2.00D with .75D of astigmatism, your near vision should be pretty good without correction, but your distance vision would be blurry.  (In response to your question, yes, a refractive surgeon does laser vision correction--LASIK, PRK, etc.)
Avatar universal
I'll bump your post back to the top so it doesn't get lost.  If Dr. Kutryb doesn't respond, you could re-post on the expert forum.
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