Questions for IOL after vitrectomy....

[OhMyEye]

Everyone;

I've read Dr. Hagan's "Consider ALL The Options" post about cataract surgery.  It was a good introduction.  Then I searched the archives and read about IOL's until I don't understand anything that I've read!  Thought I'd try a different approach.  Here goes.

In 2013 I had a vitrectomy with ERM peel for PVD induced macula pucker (right eye, which is also dominant eye).  The operating surgeon died shortly after the surgery and despite seeing 3 different ophthalmologists during the next two years, my uncorrected vision during that time went to 20/400.  I grabbed a -6.0 OD contact and got on with living.

This spring my vision got even worse!  So I went to Dr. Steve Charles in Germantown, TN. I learned from him that not all the ERM was removed in 2013.  I'll need ILM removal but Dr. Charles said my cataract is too dense for him to see through.  He said get the cataract surgery first.  I've an upcoming appointment to see Dr. R.J. Mackool in NY about the cataracts.

I'm trying to educate myself but, boy, it gets confusing with all the terms!  Here's the questions I have so far (more to come):

1. What exactly happens when you first see a cataract specialist?

2. What is "post surgery targeted refractive error", and how does it apply to the IOL selection process?

3. How does the doctor target the refractive error, by some kind of machine?

4. My left eye has BCVA 20/20 with -0.50 contact lens.  My right eye (the bad eye) BCVA is 20/80 with -10.0 contact lens.  What power IOL is best for the right eye, and why?

5. Please explain this whole mono v. mini-mono v. fixed plane stuff.  I get the concepts, but would like to hear what that translates to in everyday living.

6. I used to do some competition shooting.  Nothing too fancy.  2 and 3 gun with a few barricades, poppers, etc.  What IOL would/might let me do that again; near, intermediate, or distance IOL? What would I sacrifice with that type IOL (distance vision, driving, reading, etc)?

Thanks to all who answer.  I get so discouraged about all this.  Being more like Felix Unger than Oscar Madison doesn't help.

[JohnHaganMD]

1. The Eye Surgeon does a complete eye exam, refraction (glasses test), dilates the eye and checks front and back. Then discusses your diagnosis, your options surgical and non-surgical, risks, benefits.  If you decide on surgery costs are discussed. Types of IOL: monofocal, toric, multifocal (risk and costs of same),  Any other eye diseases that might make your post op vision less than normal are discussed (e.g. macular dengeration, glaucoma, amblyopia, etc.)
2. The target refraction is what your distance (20 feet) glasses RX would be.  So if want best distance the target wold be 0.00   If you want to read without glasses the RX would be about -1.50 to -2.00
3. The eye is measured with A-scan ultrasound and radius of cornea. There are various formula. For normal eyes the error is plus/minus 0.50 diopters   For longer or shorter or eyes with previous surgery the error range is higher.
4. That will vary depending on a. your target post op uncorrected refractive error. b. the parameters of your eye (axial length, anterior chamber depth, cornea curve).
5. This is reviewed in my article. If anyone wants to chime in they are welcome to post.
6. After middle age shooters are never happy with their sight picture as the aging eye cannot focus on front/back/target  quickly.   So no type of IOL or target post op refractive error works best for every shooter.  Most shooters go for between -1.00 and plano but can't emphasize too much nothing will give the sight picture of youth except for optical or electronic sights.