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High myopia become hyperopia after cataract sugery

Hi all,
I was a high myopic with astigmatism (-14.00D spherical and -4.00D cylindrical in both eyes). I was having 6/18 vision with glasses before I got cataract. I also have lattice degeneration and laser treatment for retinal tear.

5 months ago, I got cataract surgery with Phaco+IOL (monofocal alcon acrysof +4.0D) and limbal relaxation, after sugery I got 6/12 vision without glasses which comes to 6/9 with glasses (RE: 0.0D Sph & -0.5D Cyl, LE: +0.75D sph & -1.0D Cyl).

As you can see I became hyperopic with +0.75D sph  in my LE instead of myopic,

Am I going to have any complication in future (either with vision or retinal stability) with this error  or I am still in the process of stabilisation of vision after cataract surgery (its almost 5 months)?
2 Responses
177275 tn?1511755244
No the glasses RX will not cause problems. The difference is without glasses your distance vision is much better than it's been for many years and your near vision is not clear. Your glasses RX should have an "add" e.g. +3.00 add and your glasses no line multifocal progressive lens. Any problems will likely be related to your high myopia. That is due to a long eye and that didn't go away. Just your glasses RX different because the rest of the thick RX is in your eye on the IOL
Avatar universal
By 5 months vision is   fully stable, usually they'll even consider laser correction by 3 months since its stable.

To be more specific than the doctor's post, any risk of retinal  issues are related to high myopes having longer than average internal structures so their risk of things like retinal detachment and other issues is higher. The surgery didn't change the size of your eyes so those risks are still present, and the hyperopia doesn't change that  risk (in either direction) since the refractive error itself isn't what causes the risk.

Actually your LE isn't quite as farsighted as the +0.75D indicates due to the mixed astigmatism. Your eye's power in one direction is +0.75, while in another it is (+-.75 + -1.00) = -0.25D, for an average power, called the spherical equivalent,  of  (+0.75 + -0.25) / 2 = +0.25D. Unfortunately astigmatism does cause blur reducing the quality of vision a bit so overall your vision is likely not  as good as it could be even for distance in that eye.

Some people consider getting a minor LASIK/PRK tweak to their vision if they wind up hyperopic with an IOL because it reduces their near/intermediate vision, which is already very reduced with a monofocal IOL, which can correct the residual astigmatism as well. Some highly myopic people who weren't candidates for a large laser correction (e.g. due to corneal thickness) may be able to get the smaller correction required for something like that. If your RE has good enough distance vision (which it may despite a bit of astigmatism, it could be even better than 20/20) you could even consider adjusting the LE to be a little bit nearer in monovision to give you a larger range of vision (though not everyone likes monovision, you could do a contact lens trial).  Small corrections tend to be more accurate than large  ones.

I have one eye left +0.5D after cataract surgery  that I may eventually get a laser tweak for, but in my case its less of an issue since that eye has 0D astigmatism so distance is decent, I have the Symfony IOL for a larger range of vision, and my other eye was on target to  balance it out to give good vision over a large range.
16 Comments
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Dear Dr. Hagan,

I am really thankful for your response.

By profession i am a scientist (Immunologist). Actually I am worried about my near vision due to this hyperopia in LE.

Somehow I got three different Rx glasses for LE in last 5 months in my follow ups and this +0.75 Sph (in my 1st and 2nd visit, it was only Cyl) came in my latest visit (3rd visit) last week.

I am happy with distance vision as it's coming 6/9 with glasses but can you comment on my near vision due to this hyperopia and what could be the reason for fluctuation in refraction in LE, which was stable before cataract surgery.

I have reading addition of +2.50D in both eyes.

Thanks
Prabs

5 months post op it should be stable even with the extra cornea surgery that was done.  As long as +2.50 works for you that's great. Theoretically to see as good as you can at all possible distances you would nee progressive multifocal (no lines) with your distance RX and a +3.00 add.  Right now your different adds correspond to different distances. Larger numbers clearer nearer to you and have more magnification lower numbers focused further away and less magnification.
Sorry Sir for bothering you again but it will be great if you can please clarify these two points for me,

I didn't understood +3.00 add in your above response,
you mean my Rx, should be like-

LE:  -0.00 Sph and -0.50 Cyl,
       Near Add +2.50

RE: +0.75 Sph and -1.00 Cyl,
       Near Add +3.00

I am little bit confused, As per my understanding, in progressive this will make +3.75 D in RE for reading.

One last question: my age is 37 now, will my near Rx will change by age, as usually it happens or it's almost fixed after catarct surgery ?

Thanks
First of all something is missing from your glasses RX and that is the "axis" of the cylinder.

Second the add in both eyes would be +3.00

Third the total IOL power is the alebraic sum of all the numbers thus a +3.00 on the bottom of progressives will not look like a +3.00 over the counter readers.

Forth: the IOL power is only at the very bottom up the glasses. As you look higher the power reduces and the focal point recedes. Most important thing is custom RX not like over the counter reader with same add.
Axis in LE 180 degree and RE 165
Okay so to reiterate looking through a custom progressive with a +3.00 add is nothing like looking through a +3.00 over the counter reader. With modern small incision cataract surgery the glasses RX is usually very stable and I have hundreds and hundreds of people that the first glasses RX after surgery still works fine 5-6 years later.
re: "Actually I am worried about my near vision due to this hyperopia in LE."

The hyperopia as I detailed in my post is very small, the spherical equivalent (average power) of +0.25D. That by itself has little impact on your near vision without correction because your other eye makes up for it, since it  has a spherical equivalent of -0.25D and so it has a bit better near vision, so your brain would use that for nearer things.  However since the two eyes are a bit different, over the counter readers would likely only adjust one eye or the other well, while leaving the other just a bit off.

I'd suggested the idea of laser correction for  monovision if you wanted more near without glasses, since you could for instance adjust  your hyperopic eye to be -1.25D, mini-monovision of a 1 diopter difference between the two eyes (or more perhaps, if you do a contact lens trial), to get a little more near from that eye. If you wear glasses, the add for both eyes should be the same, since they correct the both eyes for distance, and then the add is on top of that.
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Thanks a lot to Dr. Hagan as well as SoftwareDeveloper for nice suggestions and explanations.

To make long story short, I should go for prescribed progressive RX with all corrections of Shperical and Cylinder and Add for near vision +2.50 as my optometrist is suggesting.

My last question as I mentioned earlier also-

My reading addition for near vision will be almost fix for life due to monofocal IOL implant or it will keep increasing as I grow old (at present my age is 37) as in natural cases?

Thanks
No it won't change since normal presbyopia is caused by the natural lens getting stiff and non-compliant. the IOL is fixed and does not change or 'age'  I would suggest you consider +3.00 add in progressives rather than +2.50 as things like medicine bottle and other very fine print might be difficult to see with +2.50
Dear Dr. Hagan I am delighted to get your quick respnses.

One confusion, may be a stupid question for you but please please clarify-

My current prescription is as below:

RE- Sph: 0.00,  Cyl: - 0.50 180 degree

LE- Sph: +0.75, Cyl: - 1.00 165 degree

Near Add: +2.50 for both eyes


If I will have Add +3.00 in my RE, won't it make +3.75 in bifocal or progressive because it will be added to +0.75 Sph from distance vision.

If your present glasses meet your needs for very small print don't change anything.  And you are still not 'getting it"   Your present reading RX is  RE +2.50 -0.50 axis 180 and LE +3.25 -1.00 axis 165   if you had a +3.00 add the reading RE  RX would be +3.00 -0.50 axis 180  and LE +3.75 -1.00 axis 165      The vision will not look like a +2.50 or +3.00 reading glass.
Dear Dr. Hagan

Now I am very clear, actually this was the confusion.

I was assuming that +2.50 is my final Rx for reading and in prescription they should write Add LE +2.50 and RE +1.75 to achieve effective +2.50 reading power.

Now I am clear that +2.50 or may be +3.00 is a top up on my distance Rx and my effective reading Rx will come accordingly as you said in above response.

or theoretically in other words I should wear over the counter reading glass of +2.50 or +3.00 on top of my distance glass (that is use two glasses simultaneously).

Am I right ??

Thanks
Why would you wear two pairs of glasses? That changes the optics. If it works fine but it just doesn't work for most people.
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177275 tn?1511755244
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