Full monovision gone wrong on first eye for reading?

[gusher]

This is a followup question to my post here titled: Type of lens implant for victrectomy that was answered by Houman Vosoghi, MD . Okay. I took your advice and went with monofocal lenses and not Restor3. Very happy I did that. Thank you. My new eye doctor talked me into monovision even though at first I decided on first distance only and then mini monovision. But in the end I went with full monovision because he promised he could lasik me to distance if I could not adapt to the full monovision. I am left eye dominant and the worst cataract was in my right eye. I had all the tests done even a water immersion in my right eye to determine the distance to the retina (28.7mm). I had also gone to a retinal specialist about my floaters and he gave me a full set of tests which were sent to my eye doctor and said I was a candidate for a vitrectomy if they were still a problem 3 months after the cataract surgery. My last  eyeglass prescription after having gas perm lenses out for 4 months was DV OD Sphere -750 Cylinder Sph Axis (nothing)   OS Sphere -800  Cylinder +275 Axis 080. NV OD & OS +225. So, I am highly myopic.
I had my right eye done on Wednesday afternoon (yesterday). I was elated upon returning home to find out how great I could see in the distance, but when I tried reading, it was blurry. I figured this was normal and the eye was just healing. The next day (today) I went for my followup wearing my gas perm contact lens in my left eye. Sure enough, I was 20/20 distance with my right eye alone and a J2 with both eyes for reading. However, I feel the reading ability was mostly from my left eye with contact in. He looked at my file for several minutes and said that all the data pointed to this lens setting so that is what he went with and that this sometimes happens. I said well, no problem,  you can always lasik me so that I can read. That's when I got the bad news that it is difficult to go that way and that I would need a replant or a piggy back lens. He said that he didn't like piggy back lenses. He looked at my eye and said he noticed that I had corneal edema from the incision down to the axial plane and that once the swelling subsided, that I may be able to read with my right eye.
At home tonight, I just tested my right eye reading alone (because when I have the left eye done for distance, I will only have my right eye for reading, right?) and I could only read a book with 1.5 reading glasses. Without reading glasses, I can only read when type is 20 inches away.  
My questions are: Is it reasonable that this can happen? That I could end up with distance vision when I was supposed to have reading vision in my right eye? It seems like maybe he erred and went with a distance setting by mistake. I would think he would have erred on the side of going too far on the reading side so lasik could be used to correct it.  And I am not looking for a lawsuit, What is done is done. I am only looking for honesty and looking forward as I am scheduled for my left eye in another week since I am so myopic. I would rather have someone honest do my left eye. Is it feasible that when the swelling goes down that I will have reading vision? Any estimates on how much time it will take for the swelling to subside? Should I wait on the left eye? I can see great in that eye because the cataract is off to the side and not in my vision plane. I do great with a contact in or with no contact at all in left eye. Glasses are a no go. What are your thoughts on a replant? Or should I just live with the reading glasses?
Thanks in advance.


This discussion is related to Type of lens implant for victrectomy.

[John C Hagan III, MD, FACS, FAAO]

-

[gusher]

Thanks for your insights. I appreciate it especially testing out the full monovision first.

My right eye has been slowly going toward the close up vision. Although it is fluctuating, most of the time I can read normal print and my distance vision is still surprisingly good at 20/40 today.

I had my left eye done yesterday. My astigmatism in the left eye could not be explained simply by my corneal shape. There was something inside the eye that made it much worse but the eye doctor could not pinpoint it. He would then be guessing with a toric lens on the proper setting. He felt the best way to correct it was to put a spherical lens implant in to corrrect  me close to distance vision and to correct the astigmatism in 3 months with lasik surgery. For some reason your near sightedness has to be greater than your astigmatism to fully correct your eye with lasik so right now I am still somewhat near sighted.

In two weeks I am going to get glasses to correct the astigmatism in the left eye and the right eye will be corrected to full monovision (if my right eye doesn't reach the full monovision vision naturally) so I can test out whether I can adapt to it. If I can adapt, then I will get the replant in about 3 months also.

Thanks again.

[John C Hagan III, MD, FACS, FAAO]

-

[JodieJ]

I was also highly myopic with astigmatism.  I wanted good distance vision, but three respected cataract surgeons all told me that I couldn't expect much better than 20/40 uncorrected vision (if that).  Apparently, the formulas used to make IOL power predictions don't work that well for people (like us) who are at the ends of the acuity bell curve.  I think your surgeon is planning on using the results of your first eye to revise his power predictions for your second eye.

If you have never experienced monovision, I think that going for full monovision with IOLs is very risky.  In your place, I'd go for distance vision in my second eye.  I assume that you will be getting a toric lens to correct your astigmatism.  With progressive glasses, you should have excellent vision at all distances.  You can probably lose your specs in social situations, and you certainly won't need them for distance-vision activities.

By the way, it took my eyes much longer than 4 months to stabilize after switching from gas perm to soft contacts.  This may have contributed to your off-target result.    

[John C Hagan III, MD, FACS, FAAO]

Please post this on the other forum so Dr. Vosoghi can answer
JCH MD

[gusher]

As another followup, as I laid in bed thinking, the reason I really need a second opinion is that I lost a lot of confidence in him when he said at the end of our meeting that he would have to reconsider the lens setting he was going to use in the left eye. But when I pressed him asking him whether he would like to delay the left eye surgery he said no. I don't want the wrong lens put in my left eye!!! That's my good eye and I would think he would have good readings since the cataract isn't in the plane of my eyesight. I also will need lasik on the left eye since it has a lot of astigmatism. What to do???? Should I go to another doctor midstream? To complicate matters, my left eye is very sore since it has been 8-9 months since I last wore a gas perm lens. I am going to leave it out to let my left eye heal. But I can still see great distance-wise with just my right eye so I should be okay and feel I can function well.

[gusher]

I forgot to add the info on the implant in my right eye. It is: Diopter +11.5 Body diameter:6.0 mm Overall diameter 13.0.