Post Vitrectomy/ERM & cataract surgery

[SparklyOats]

I had a vitrectomy/ERM (epiretinal membrane) last August in my rt eye. I’m 60 and nearsighted, have worn glasses since 4th grade, wore contacts in my 20s and 30s, and currently wear glasses with bifocals. I have no problems with wearing glasses or needing bifocals—vanity is not an issue, but being able to see IS an issue for me.  

I have a cataract that is impeding my vision in my vitrectomy eye, & I met w/the cataract surgeon from Kaiser yesterday—she has experience doing cataract surgery on vitrectomy/ERM patients.  She also said I have a small cataract in my left (good) eye that will need to be addressed in probably 5 years or so.

As for my right (vitrectomy) eye, she said if I wanted to continue to be able to read in bed without glasses, I'd get an IOL that is -2.5.  I would probably need glasses for distance because of my left ("good") eye.

She said that if I wanted to see distance, I'd have to wear glasses for reading, I'd get an IOL that's  -.04.  If I chose this, she said I’d probably have to wear a contact in my left eye (along with my regular eye glasses) until I get the cataract done in THAT eye in 5 years or so.

My optometrist recommended an IOL that is -4.50.  This is quite a disparity from what the cataract surgeon recommended for either near or far vision, based on what I'd want.  The cataract surgeon recommended the IOL for far vision, but said it's up to me.

At Kaiser, they use an acrylic aspheric monofocal IOL, specifically the  za9003 (Tecnis Aspheric IOL) by AMO (Abbot Medical Optics Inc).

How do I determine what would be right for me since it's not like I can go back once it's done?

Is it based on whether I “value” being able to thread a needle and read in bed without glasses, or if I value being able to have far vision??  I’d like to be able to see to drive at night too.

How do I tell, ahead of time, what will be best for me??? How can I tell how far I'll be able to see the TV, the computer screen, a sewing needle and thread, reading a magazine or reading a recipe?  How can I tell how well I will see when I'm driving, reading signs and street signs, ???

How can I know if I'll still need (thick) glasses due to the trauma of the vitrectomy that makes me not have the perfect eyeball for this surgery?

How do I know the length of a clear field of vision in front of me from my nose to 5 feet out from my nose, or in the distance (and how far? and is that with glasses or what??), before I have the surgery??  

Is there any website like Cataracts for 60 Yr Old Post Vitrectomy Dummies that will explain things in a way I can understand??

I don’t want to get the wrong IOL and decide after the IOL is in place, that it’s making me crazy!  I'm sorry if I sound confused--I am ! I'm not even sure I'm communicating effectively... thanks for any help.

[JohnHaganMD]

=

[BigOilerFan]

Hello all. Wondering about your situations 5 or 6 years later. Would appreciate your comments to my situation. I'm 63, was -5.25 in both eyes. Having vitrectomy ERM in ten days on my right (dominant) eye. Used to love mono vision with contacts prior to retinal problems. Doc says he can expect 80% vision post vitrectomy. I'm wondering if I should go distance with my good, non-dominant eye and, say, -2 on the eye which will only be at 80% potential. I'm going to be needing cataract surgery within a year so really concerned about how I should go. I'll practice monovision with contacts as soon and as long as I can.  If I knew my good eye would stay healthy and could become my dominant, distance eye I would know how to select my IOL's during cataract surgery. Appreciate any comments you have from your own experiences.

[homecrafter]

Can you please give us an update on what you decided with your IOL and how happy/unhappy you are with your decision?

I am facing the same decisions right now and am impressed with how you asked all the same questions that I am thinking.

Would love to hear your update.

[SparklyOats]

Hi JodieJ,

Even though you're not an eye care professional, your acumen is impressive, and your having experienced things first-hand--and your extensive research-- warrants my addressing questions to you--your ROCK, girl!  :O)

My optometrist said it is possible that eye dominance can change. Historically, my right eye used to have much better vision than my left.  

I just don't want to make a "mistake" and have the *wrong* IOL put in my cataract (right) eye and I've been perseverating about this, to be sure.  Both my cataract surgeon and my optometrist tell me I'm overthinking this  lolam.

Thanks again, JodieJ, for being there and for the suggestion of a magnifying mirror.  

[JodieJ]

I'm really flattered that you're addressing your questions to me, but I'm not an eye care professional.  I don't believe that eye dominance changes (but verify this with your optometrist/ophthalmologist.)  If your optometrist thinks that you're right eye is dominant, s/he's probably correct.  You could get your surgeon to reconfirm this.  With mini-monovision, the dominant eye is corrected for distance, the non-dominant eye for intermediate vision.  (When I did monovision with contacts I could use either eye for distance vision, but I don't know whether this is unusual.)  I think that trying out mini-monovision with a contact in your left eye is a wonderful idea.  I predict that you will be very pleased with your cataract surgery results.  By the way, magnifying mirrors are great for applying mascara.  They used to be fairly expensive but are now widely available at reasonable prices.

[SparklyOats]

Hi, JodieJ,

Ohhh, a few more questions please...  My left eye is my dominant eye, but can eye dominance change?  Years ago, I remember my right eye being my dominant eye.

My right eye is getting an IOL for distance on Sept. 1st, and then I'm scheduled to try out some different daily contacts for my left eye. I think that will give me an idea of mini-mono vision so I can give input down the road when my left eye is done.

My optometrist of 25-plus years (very experienced, highly regarded) thinks that I'm right-eye dominant and I'd really benefit from mini-mono vision.  

All I know is right now, doing those "eye dominant tests", I'm left eye dominant, but I'm right handed, chew on my right side, use the phone with my right ear, and sit on the right side of any classroom...not sure if that's how eye dominance is figured out, which is why I wondered if eye dominance can change because of circumstances (i.e. not seeing well out of the right eye)!

It would be nice to see up close to put on mascara, and pluck some of those wayward eyebrow hairs, without trying to see around the lenses of those "readers" glasses!  

So, right eye with an IOL for distance, and left eye for a contact lens, then down the road, left eye for an intermediate IOL to give me mini-mono vision... does this sound right or do I have things backwards?

Thanks for any input!!!!  Happy weekend!!!!

[JodieJ]

With mini-monovision, the dominant eye is corrected for distance vision.  If you got distance vision in your right (non-dominant) eye, then the logical choice for your left (dominant) eye would be distance vision as well.  I think this is what your surgeon suggested.

I'm thinking that getting intermediate vision in your right (non-dominant) eye might be a better choice.  Then you'd want distance vision in your left (dominant) eye.  This would give you a wider range of focus than two distance eyes.  But I think you'd be pleased with either option.  Being significantly myopic has few (no?) advantages.

I've had several eye surgeries, some before there were forums like this one.  I know how anxiety-provoking it can be not to have answers to your questions.  I'm always happy if someone can benefit from my experience--even though my it's important to keep in mind that I'm not an eye care professional.

[SparklyOats]

Thanks, JodieJ, for your quick response.  I'm still confused.

If I get distance vision in my right (vitrectomy/ERM) eye, then what correction would I get in my dominant left eye down the road when my "beginning" cataract obscures my vision to the point where I'll need another cataract surgery?

Again, many MANY thanks for being there, and always being willing to answer many questions.  You are certainly make a positive difference in so many of our lives by your freely sharing your experiences and knowledge.

[JodieJ]

If your right eye were corrected for distance, I don't think that correcting your left eye with glasses would work.  (You'd probably have double vision.)  You'd either need to wear a contact lens in your left eye or have early cataract surgery.

Can you (dimly) remember what your vision was like when you used to wear contacts but had only inserted one lens?  You could see better than with no contacts, although prolonged vision with only one contact would probably give you a headache.  But you could certainly get around your house and see your dogs with your right eye corrected for either distance or intermediate vision and your left eye uncorrected.

With both eyes corrected for distance, you could drive, watch movies, and participate in most sports without glasses.  However, everything within arm's length would be blurry.  Personally, I think think that intermediate vision in the non-dominant eye and distance vision in the dominant eye (mini-monovision) is a more desirable correction.  (For one thing, you could see how to style your hair without having your glasses get in the way.)  Many people with this correction only need glasses for prolonged reading or seeing small print.  If you didn't like mini-monovision, progressive glasses would give you the same vision as you'd get with progressive glasses and both eyes corrected for distance.  

[SparklyOats]

JodieJ,  please, a few more questions if you may...

I went for another consultation with my cataract surgeon and asked a bunch of questions.  

Based on my lifestyle, my vision, my OCT and A-Scan results, etc., she is recommending correcting my non-dominant eye (the vitrectomy ERM one) for distance. She said if there is a problem with both my eyes working together, she'd do early cataract surgery on my dominant eye and correct that one for distance as well (JodieJ, you mentioned early cataract surgery might be an option as well).

She also said that if I'd feel better having intermediate correction of  -1.25, that would be fine too, but it's up to me.

No matter what I do, I'll be wearing glasses, and maybe a contact lens, and really, that's not a problem.

Is there a *probability* that my dominant left eye and vitrectomy/ ERM/cataract right eye will work well together if I get my right corrected for distance, and my left has corrective glasses for distance?  

If I get my right eye corrected for distance, well, when I wake up in the morning without my glasses, am I going to be kinda blind and not see the furniture and then run into things???  Will my see-around-the-bedroom-on-the-way-to-the-bathroom vision be worse than it is now without glasses or will I see better or kinda the same as I do now?

If I get my right eye corrected to intermediate, well, when I wake up in the morning without my glasses, am I going to be kinda blind and not see the furniture and then run into things???  Will my see-around-the-bedroom-on-the-way-to-the-bathroom vision be worse than it is now without glasses or will I see better or kinda the same as I do now?

Everything is blurry anyway without my glasses, but I can sure see the furniture, the dogs, and if there's a doggie squeeky toy in my path.

Thanks for any help!!!

[SparklyOats]

Thanks, Jodie.  

Working in a clinic setting would be like heaven to my favorite school psychologists!  The high school setting is crazy-stressful and they have to wear so many "hats" as part of their job description!

Happy Friday, happy weekend!

[JodieJ]

I'm glad that my info is useful to you.  I was really happy with my cataract surgery results and hope that you will be equally pleased.

I admire special ed teachers--they're performing a difficult job.  I work in a clinic, not a school.

[SparklyOats]

Thanks so much for more info !  You have given me more info in a few posts than I was able to get from my appointment--and perhaps that was more of a reflection that I didn't know what to ask.  

(I've always felt a kind of kinship with you being in the school system as a psychologist and of course, the vitrectomy/ERM experiences about which you so eloquently and informatively wrote--and that I was in my 50s then as well, and still working as a spec ed teacher).

Again, MANY thanks for the info and ideas and suggestions.  If you ever want to "talk school" or something, just send me an email (remove the spaces):  sp e cial e mail 12  @  ya h o o . c o m

[JodieJ]

A target of -2.5 would give you good uncorrected near vision in your non-dominant eye.  You could go for a target within the range of good intermediate vision (mini-monovision) to (pretty) good distance vision (full monovision) in your dominant eye.  Progressive glasses (with thin lenses) would provide good vision at all distances.

Usually the dominant eye is corrected for distance vision with a (mini) monovision correction.  I would not recommend correcting your non-dominant eye for distance, which would not allow you to use both eyes together unless you wore a contact lens or had early cataract surgery...

[SparklyOats]

Thanks for the additional info, Jodie.  

I'm not sure Kaiser would do my dominant eye unless the cataract is at a point where my vision in that eye is impeded.  It is a question I'll ask, though...thanks for that input!

Perhaps one of the questions I should also be asking is:  
What target diopter should I get now in my right eye, so that down the road when I get my dominant left eye done, will end up with good to excellent results... and does that mean not-so-thick glasses, bifocals, progressives, or what?

My uncorrected near vision in my left (dominant) eye is about 8 inches from my eye to the page I'm reading in a book.  With my bifocals, the distance is 12 inches.

In my right vitrectomy eye, it's about 3 inches from my eye to the page I'm reading in a book. With my bifocals, the distance is about 6 inches from page to bifocals.

I really appreciate your (ahem) insights!  :O)

[JodieJ]

If you correct your right (non-dominant) eye for distance, you'll have to wear a contact lens all the time unless you get your left eye done early.  (Will your insurance pay for early cataract surgery?)  You'd probably want to eventually get your dominant eye corrected for distance vision, too.  You'd need progressive glasses for all intermediate/near vision tasks.

If you chose a -2.5 target, you could continue to wear glasses.  Since you are used to having good uncorrected near vision, you'd probably be happier if you didn't lose it.  I vote for this option.

[SparklyOats]

Thank you both for your input.  It is much appreciated!  

My right (vitrectomy) eye, when wearing glasses, doesn't really have any distortion as I could see quite nicely for both distance and reading post-vitrectomy.  My dominant eye is my left eye if that makes any difference.

Now, of course, with the cataract, it's like looking through a film of vaseline over my glasses on the right side.

This begs the question for me about...how can I try out the corrections using contact lenses before proceeding if I cannot see clearly out of my right eye from the cataract distortion?

I'm not sure if either of you follow up on your initial responses, but if you do, I'd really appreciate hearing from you. If not, well, I'm sending "thank you" vibes your way!

:O)

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

-

[JodieJ]

You're in a situation where one solution does not work for everyone.  A lot depends on your preferences, how well you see in your right eye, and what your insurance will cover.

Wearing a contact lens full time in one eye works very well for some people, but it was definitely not my choice.  My Blue Cross paid for the cataract surgery in my unoperated eye (which may not have needed cataract surgery for a couple of decades.)  I've never regretted doing this.
  
Is there noticeable distortion in your vision with your right eye?  If so (and you opted for a target of -2.5), you might not be very comfortable with prolonged reading or sewing if you relied on only your right eye.  You'd probably have the same problem with driving if only your right eye was corrected for distance.  In my own case, I'm almost never aware of the residual distortion from my ERM because both my eyes are corrected for the same distance, and my brain somehow has learned to screen out the distortion from my bad eye.  (I hope I haven't confused you.  Your cataract surgeon is suggesting corrections that involve using only your right eye for certain tasks, but this may not be your best option if your vision is distorted in that eye.)  I'd suggest that you try out your surgeon's corrections with contact lenses before proceeding.  This would give you more information to consider before making a decision.

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

As a generalization you never want to leave a person -4.50 post op no matter what the other eye is.  If a person opts for distance usually it -0.25   for intermediate about -1.25 and for reading -2.25.  So your surgeon is on beam and the optom is off beam. You were given good surgical discussion.

The whole issue of what post op power to opt for and possible trouble with the eyes working together have been discussed many times and at great length. You can access them using the search feature adn archives. Especially useful are the posts by JodieJ who has had ERM surgery, catarct surgery and has had problems with the eyes working together post op.

The IOL your group uses is first class.

Good luck.

JCH MD