Aa
Post-cataract surgery farsightedness & astigmatism
Hi,
I posted three weeks ago about extremely blurred close vision after cataract surgery on right eye which was supposed to have been set for close vision (it was the far vision that actually improved, although nowhere near good enough to function without correction). Previous to cataract I had been extremely myopic (-7.0) all my life, had worn hard contacts for 48 years and had been corrected monovision for 20+ years with right eye for close vision.
Surgeon said everything looked great and sent me to optometrist for refraction. He said he could get me to 20/30 either close or far so we first tried close to maintain the previous monovision. Wearing the lens, I had a field of somewhat clear vision from about 5 inches - 7 inches. Anything closer or further was a blur. Obviously not workable. Next we tried correcting the eye for far vision with the goal of reversing the monovision. While the corrected right eye seemed to function ok for distances from about 4 feet to infinity, I soon realized that I was seeing details through a dilation-like blur and couldn't really drive safely or even watch TV unless I switched the left eye back to far vision correction.
Yesterday during another refraction, the doc did something that allowed me to see crystal clearly for the first time since the cataract formed. He told me he had discovered an astigmatism and will now try another "flatter" lens that will hopefully make the corrected far vision actually workable. I'm obviously hoping the third time's a charm.
Three questions. (1) What would cause a surgery/implant that was supposedly designed to correct for near vision to have just the opposite effect and make me extremely far sighted?
(2) Since I now have better uncorrected far vision in my right eye (and soon hopefully corrected as well), which now makes it the "dominant" eye, do you think that reversing my previous 20+ year monovision has a real shot? It would be great if it could because with my "close" lens in my left eye I can read the smallest print and not have to resort to reading glasses.
(3) Is it likely that the surgery itself caused the astigmatism? My yearly eye exams had never identified the condition.
Thanks!
I posted three weeks ago about extremely blurred close vision after cataract surgery on right eye which was supposed to have been set for close vision (it was the far vision that actually improved, although nowhere near good enough to function without correction). Previous to cataract I had been extremely myopic (-7.0) all my life, had worn hard contacts for 48 years and had been corrected monovision for 20+ years with right eye for close vision.
Surgeon said everything looked great and sent me to optometrist for refraction. He said he could get me to 20/30 either close or far so we first tried close to maintain the previous monovision. Wearing the lens, I had a field of somewhat clear vision from about 5 inches - 7 inches. Anything closer or further was a blur. Obviously not workable. Next we tried correcting the eye for far vision with the goal of reversing the monovision. While the corrected right eye seemed to function ok for distances from about 4 feet to infinity, I soon realized that I was seeing details through a dilation-like blur and couldn't really drive safely or even watch TV unless I switched the left eye back to far vision correction.
Yesterday during another refraction, the doc did something that allowed me to see crystal clearly for the first time since the cataract formed. He told me he had discovered an astigmatism and will now try another "flatter" lens that will hopefully make the corrected far vision actually workable. I'm obviously hoping the third time's a charm.
Three questions. (1) What would cause a surgery/implant that was supposedly designed to correct for near vision to have just the opposite effect and make me extremely far sighted?
(2) Since I now have better uncorrected far vision in my right eye (and soon hopefully corrected as well), which now makes it the "dominant" eye, do you think that reversing my previous 20+ year monovision has a real shot? It would be great if it could because with my "close" lens in my left eye I can read the smallest print and not have to resort to reading glasses.
(3) Is it likely that the surgery itself caused the astigmatism? My yearly eye exams had never identified the condition.
Thanks!
Yes, it seems that your surgeon has undergone a major attitude adjustment related to your case.
Yes, I do believe my moderately close vision may be at last starting to slowly improve, which is certainly encouraging. At this point the reading glass improvement is pretty much limited to a relatively short field, say 18 - 36 inches. (which is certainly a hell of a lot better than the three-inch range my first try at a contact 3 weeks ago yielded) Tomorrow I'll try a higher power than my wife's +1.0 and see what that does, but I think I'd want a contact that could give me corrected vision for a bit wider range and in particular gets me closer than my left eye far contact allows without a reader over it.
If, though I can start comfortably reading with my right eye either with a contact or the contact/reader combination, I may think twice about an explant/re-implant procedure even though I did get the wrong IOL.
Yes, I've definitely become somewhat of a cause celebre with my surgeon and actually the entire Scripps Ophthalmology Dept. My interpretation is they know they screwed up big time on the IOL measurement and they know I know it as well. About two weeks ago, based a lot on your input--so much thanks!--I began introducing my contacts with them by saying "I'm the person who got the wrong IOL.." Ever since there's been a definite "whatever I can do to help" attitude from all concerned. The old squeaky wheel syndrome, and less cynically, some real caring, I would think too.
I'll keep you posted as events transpire!
If, though I can start comfortably reading with my right eye either with a contact or the contact/reader combination, I may think twice about an explant/re-implant procedure even though I did get the wrong IOL.
Yes, I've definitely become somewhat of a cause celebre with my surgeon and actually the entire Scripps Ophthalmology Dept. My interpretation is they know they screwed up big time on the IOL measurement and they know I know it as well. About two weeks ago, based a lot on your input--so much thanks!--I began introducing my contacts with them by saying "I'm the person who got the wrong IOL.." Ever since there's been a definite "whatever I can do to help" attitude from all concerned. The old squeaky wheel syndrome, and less cynically, some real caring, I would think too.
I'll keep you posted as events transpire!
It took longer than 3 weeks before my corneas stopped changing when I switched from hard to soft contacts. (Eventually I regained all my previous astigmatism.) But I really don't think that this the reason for your IOL power miscalculation.
If your near vision becomes clearer with readers worn over your contact, you should be able to get the same effect with a different power contact lens (without readers). It sounds like your near vision is improving with time--great news!
It's good to know that your surgeon has been devoting so much time and effort into finding a solution to your current problems. (Was it something you said?)
If your near vision becomes clearer with readers worn over your contact, you should be able to get the same effect with a different power contact lens (without readers). It sounds like your near vision is improving with time--great news!
It's good to know that your surgeon has been devoting so much time and effort into finding a solution to your current problems. (Was it something you said?)
Hi Jodie,
Since I had worn hard contacts exclusively/continually for 48 years I too was concerned as to how long I'd have to leave them out before the measurement (The only pair of glasses I have are sunglasses from 25+ years ago that are pretty far off). Surgeon said three weeks, and that's exactly what I did. He did say I could put the lenses in again after the measurement for the 3+ weeks until surgery. That surprised me some, as I thought wearing the hard lens again would "reshape" the eye and make it different from what was measured. Could that be a factor in the huge measurement error?
Spent three hours getting "injected and inspected" at the retinal specialist this morning. Bottom line is no macular swelling, which, according to her leaves the IOL as the only explanation for uncorrectable near vision and "dilation like" blurring in corrected (20/40) far vision. My surgeon was there too this morning and based on the results has switched my eye drops to Xibrom which I'll take until I see the piggyback expert on Tuesday. Surgeon now seems to be thinking that piggybacking has a small chance and Laser Rx even less, so it seems like we are pointing towards the explant/re-implant option.
One interesting side note. Since my cataract surgery there's been no way I could get any reading level vision out of the right eye with/without contacts. Sitting at the computer now, about 18 inches away, with my corrective contact in I cannot read any of the letters on the screen including the large "Post Comment" Bar script. Starting last night, though, with my contact in and wearing my wife's +1.0 reading glasses, I can read all the words I'm typing with my right eye as long as I don't get closer than a foot or so, It only works when I have the contact in and it's still a little "dilated looking" like everything else, but I think I'll run over to the drug store soon and try different powers to see how good I can get it. I mentioned it to my surgeon this morning but since my eye was quite dilated and my contact was out we really couldn't put it to the test.
Stay Tuned!
Since I had worn hard contacts exclusively/continually for 48 years I too was concerned as to how long I'd have to leave them out before the measurement (The only pair of glasses I have are sunglasses from 25+ years ago that are pretty far off). Surgeon said three weeks, and that's exactly what I did. He did say I could put the lenses in again after the measurement for the 3+ weeks until surgery. That surprised me some, as I thought wearing the hard lens again would "reshape" the eye and make it different from what was measured. Could that be a factor in the huge measurement error?
Spent three hours getting "injected and inspected" at the retinal specialist this morning. Bottom line is no macular swelling, which, according to her leaves the IOL as the only explanation for uncorrectable near vision and "dilation like" blurring in corrected (20/40) far vision. My surgeon was there too this morning and based on the results has switched my eye drops to Xibrom which I'll take until I see the piggyback expert on Tuesday. Surgeon now seems to be thinking that piggybacking has a small chance and Laser Rx even less, so it seems like we are pointing towards the explant/re-implant option.
One interesting side note. Since my cataract surgery there's been no way I could get any reading level vision out of the right eye with/without contacts. Sitting at the computer now, about 18 inches away, with my corrective contact in I cannot read any of the letters on the screen including the large "Post Comment" Bar script. Starting last night, though, with my contact in and wearing my wife's +1.0 reading glasses, I can read all the words I'm typing with my right eye as long as I don't get closer than a foot or so, It only works when I have the contact in and it's still a little "dilated looking" like everything else, but I think I'll run over to the drug store soon and try different powers to see how good I can get it. I mentioned it to my surgeon this morning but since my eye was quite dilated and my contact was out we really couldn't put it to the test.
Stay Tuned!
I have another idea about what might have gone wrong with your power calculations. How long did you leave your contacts out before your eye measurements were done? There's no consensus, but probably two weeks without soft contacts is sufficient, several weeks (or longer) without hard contacts is needed in order to get accurate corneal measurements.
I'm very glad that things seem to be quickly heading in a positive direction for you. If a piggyback IOL or a refractive procedure can get you good near vision, that would be great.
Were your eye measurements done using an IOL Master? My best guess as to the cause of your 4-5 diopter deviation from target is measurement error. (You might ask the cataract/refractive consultants you'll be seeing what they think happened.)
Good luck with your upcoming consults, and keep us posted.
Were your eye measurements done using an IOL Master? My best guess as to the cause of your 4-5 diopter deviation from target is measurement error. (You might ask the cataract/refractive consultants you'll be seeing what they think happened.)
Good luck with your upcoming consults, and keep us posted.
Have an Answer?
You are reading content posted in the Eye Care Community
Top General Health Answerers
Kansas City, MO
Grand Prairie, TX
San Diego, CA
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.
