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Progress post monofocal IOL + Trifocal IOL

I am 35 years old and have just had my IOL surgery.

In the first few days post IOL surgery, I found this website very helpful in that there was a post surgery diary of someone who had trifocal IOL's implanted. The diary is both useful in reassuring people about things which may seem odd but resolve, and in alerting people to when things might not be quite right.

Therefore, I decided to put my experience up for anyone who is interested to read (or yawn) over)!

I am far-sighted, with astigmatism (original prescription between +7 and +8 in both eyes with marked astigmatism in both eyes).

I had LASIK surgery 13 years ago with reduced my prescription by half and corrected most of my astigmatism in the left eye, and a significant amount in the right eye. This allowed me to enjoy the benefit for a good while - especially with young eyes being able to accomodate so well to overcome a lot of the residual deficit. However, my accommodation ability has deteriorated gradually over the past 13 years to a point where multifocal glasses were the likely next step - so I decided to go for IOL.

I had a toric monofocal lens put in the right eye (worst eye) as I have a corneal scar and residual astigmatism in that eye and the defects wouldn't allow for me to see well with a multifocal lens (as evidenced by multifocal contact lens trials!).

23 Feb 14

It is now 2 weeks post op and I am seeing well with the right eye - watching TV, reading number plates easily and night vision is excellent with no halos or glare (better than its ever been with glasses). The eye drops were very drying and even though it is day one of not having to do drops, my eye feels better already.

I have just had a FineVision Trifocal lens implanted in my left eye.5 days ago. Day 1 and 2 were "interesting" - my vision was just off 20:20 at my 24 hour post op check, but things were still very "weird" to look at with my left eye. I am now day 4 post op and things are getting better everyday. I am now managing to do computer work with the screen set to 110% zoom, can see the TV well and distance is good.

My eye is still very irritated and a bit scratchy, and I am seeing "targets" around lights - but it is still early days and I hope things will continue to improve.

Will keep you updated!

27 Feb 2014

(Day 19 since right monofocal implanted, and day 9 since trifocal implanted in left eye).

R monofocal: my eye continues to be a lot more comfortable now the drops are finished. My vision is still very good and still surprises me when I open my eyes in the morning! No halos, no glare, very good night vision. Able to see clearly in the distance and able to read computer well, and books well.

Overall, very impressed with my range of vision in this eye as the plan was for it to be my middle and distance eye.

L trifocal: things are still settling but going in the right direction. My eye is no longer scratchy all day ( but feels like I have a foreign body in it after about 11pm when I am tired). The "targets" or rings around close up light sources (e.g. light bulbs in the house and headlights close up) have gone. Those in 50 feet and beyond are still there but dont seem as bad.  Distance and intermediate vision is very clear.

I am still not there with computer work and reading HOWEVER - it is getting better! 2 night ago, I was getting a little impatient and wondered how much was down to healing and how much was down to my brain (!) so I persisted with trying to read a book by lamplight with my right eye covered. I held the book much closer than I would usually. At first, everything was blurry, however, with persistence, the focus became better and better and I was astonished at what I could read - the font even seemed to get bigger. I then uncovered the right eye - and initially, my eyes felt like opposing magnets (not wanting to work together) ... but then ....! Suddenly it all came together and I had incredibly clear stereo vision! I was able to read really close like this for a while and went to sleep feeling very well reassured.

My vision the following day was much better than it was before before.

I am continuing to do some reading exercises every now and then.

I am happy to wait for things to settle - and I am not entirely sure whether I am doing eye muscle exercises or brain exercises or forcing the lens into a more centred position (any comments welcome!)- but whatever I am doing is working! Hopefully, I can achieve the focus and clarity as a permanent fixture!

Thought that might be useful to anyone else who wants to try it!  

My follow up appointment is tomorrow. Will update this post.

Katie
17 Responses
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Avatar universal
Hi - I am having multi-focal lenses in both eyes done in the near future. At the time of making the decision I was also considering micro monovision using 2 standard monofocal IOLs ( one eye adjusted for distance, the other for near).  Personally if I was forced to use monofocal in one eye I would have done the other eye as monofocal but with monovision - however I am glad the mix of two different lenses has worked for you.
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Avatar universal
For anyone worried about what combo to use - have you been offered a contact lens trial??? I was given the opportuniy to mix and match various monofocal and multifocal combinations - then reported back which ones were good and which ones were terrible. This might help to settle some people's worries, especially if one eye has been done already and you are having to decide on the second.


Another note. It was mentioned to me before having the surgery that during my contact lens trial )of numerous combinations), I should include experimenting reading in low light (such as in a restaurant, with a menu). I can confidently say that there are many more cocktail options than I ever imagined since having my surgery!!!! reading in a restaurant environment with a trifocal has not been a problem for me.
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Avatar universal
Hi

Sorry for late reply.

The "problem" of mixing types of lenses wasn't brought up at all. The surgeon is incredibly well regarded and experieced and put a lot of thought into his plan for me as I am relatively young (compared to his average patient).

A multifocal or trifocal wasnt an option for my right eye as I have a corneal scar and the multiple focal points simply amplify the effect of the defect.
I was most hoping to achive good reading vision so as not to have to wear glasses for everyday work. He decided a trifocal was the best way of achieving this.

I cant notice when my eyes are using what focal point or which eye is doing the work for each distance - unless I close one eye at a time and compare them.

In my opinion, the brain is an incredibly clever machine and is capable of sorting a whole heaps of input out. For argument sake, if you had two trifocals, the three focal points in each eye would never be perfectly matched, so in essence you would acutally have 6 focal points - so if your brain is capable of sorting out 6, then why cant it can obviosuly sort out 4 (three in one, and one in the other!!.

Hope this helsp and hope you are getting on okay.
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Avatar universal
Sorry

The second reason is that the left eye still has some residual astigmatism.

The right lens is toric and corrected for my astygmatism.

The surgeon said the astigmatism in the left eye is so small it wouldnt be wise to correct with the lens. There is therefore still the option of a small AK procedure to correct the small astigmatism in the left eye. Not sure I will bother with that
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Avatar universal
You wrote: "the right eye is notably clearer than the left. Two reasons:"
and then put just "1)"  !
the second reason would be...?   :)

I was also considering a mono/multi mix myself, and hence i join etrader in a request for some more experience and details.
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Avatar universal
Hi, thanks for the update.

I have had one eye done so far with a monofocal lens, I am thinking about a trifocal lens in the other eye but my surgeon warns against it, his view is that mixing monofocals/multifocals is not wise - infact he does not fit multifocals at all as he does not believe in them - his advice was to wear some varifocals if needed.

I did ask another surgeon, I am in the UK btw, who does fit multifocals/trifocals about having a trifocal in the other eye but he also advised against it - he believed that mixing different types of lenses was not wise.

So I am wondering about your results - were you warned about mixing monofocals/multifocals at all?? or are you quite happy with the results.
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Avatar universal
Long overdue update!

A few things have happened since I last wrote.
Important to note first is that I am seeing really well and do not regret going for the IOL at all.

My left eye inflammation settled perfectly eventually.

However...! My vision in both eyes gradually seemed worse than their individual peak times of vision - like a haziness.

Low magnification cheap glasses made no difference at all and I kept blaming it on likely dry eye so was very diligent with preservative free eye drops and eye hygiene, waiting for it to clear.

However, I had a follow up with the surgeon and he explained that I had developed significant Posterior Capsule Opacification in both eyes (Grade 2.5 in the worst eye) and he advised YAG laser capsulotomy. He also said that a small AK procedure on my left eye would be advised to sort out the remaining astigmatism in the left eye.

The PCO seemed to develop  quite early, but I was well aware of this as a common risk - and the research shows that the younger the patient and the more complex the type of lens implanted, the higher the likelihood of developing PCO.

I wanted better vision, but the idea of having no division between my lens and the back of my eye was concerning to me. I did a lot of reading on this to make sure I was doing the right thing.

Some people decide not to go ahead  - as every procedure does carry risks - and its a personal decision.

My personal reasons for going ahead with it were 1) my reading vision wasn't up to scratch and reading glasses weren't the answer  2) if I left it longer, a more thickened capsule can bring with it more complications as the energy needed to perform the YAG is greater and therefore subjects the retina to more energy, and the debris coming off is denser.

I decided to go ahead.

The procedure was painless and as the dilating drops wore off, my vision got sharper and sharper - to the point where i was walking back from the train station reading everything in site and admiring the sharpness of leaves on trees.

The difference is amazing.

The only thing left now is.. (there is always one thing!!!) the right eye is notably clearer than the left. Two reasons:

1) I have  floater (lucky me!) - right next to my central vision in the left eye. Its like a little cloud or puff of smoke that swings with my eye movements. It was there from the moment the dilating drops wore off, and hasn't changed.

It is a bit annoying and I can't help squeezing my eyes together every now and then as my brain must thing its a mist or dryness that can be cleared.

It was seen by the optometrist at my post YAG follow up - and it is apparently far back in the middle of my eye (not attached to the posterior capsule).

I have been advised to wait a few months to see if it settles.

The good thing post YAG is that the haziness has gone, my reading has improved significantly - I am now comfortable on the laptop and reading in dim light is much better and my distance vision is lovely.

So I will wait to see what happens with this floater - as I feel that if that puff of smoke wasn't there, I probably wouldn't need the AK procedure.

However, if this is as good as it gets, then I am more than happy!

Its a long journey - but I have found it's definitely worth it.

I will update if anything else turns up!
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233488 tn?1310693103
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Avatar universal
Awaiting your latest update.
Thanks in advance.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
Anne102: hope things are going well.

Update:

Went to my follow up on 5 days ago. They said the anterior chamber inflammtion is no longer visible and advised I can now step down gradually on the steroids. I was alsl told to stop the Voltarol altogether. My eyes were found to be very dry from the drops - accounting for why I was starting to need to blink a few times to get clear vision, so I was given some preservative free lubricating drops.

I am now on 4 steroid drops a day (was 6 initially). My vision has been very up and down - not too sure what is due to what: dryness or inflammation. No discomfort any more though.

I have another follow up in 2 days time.
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Avatar universal
Thank you for your long detailed post. It explained something I was curious about--the need to take steroid drops in a stepped down fashion.

I had cataract surgery two days ago and one of the eye drops is a steroid, and I will be taking the steroid drops for five weeks, and the number of times a day I take the drops will be gradually stepped down.

Now I understand why this is done.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
Update (now 38 days post 2nd eye IOL)

A few things have happened since I last wrote.

I went to my two week follow up for the seocnd eye. I explained that my newest eye (left eye: trifocal) was not as good as my right eye (which was supposed to be my weaker eye) and I was doing exercises to encourage adaptation and had noticed difficulty coordinating my eyes (binocular vision), I was prepared to be patient but wanted to know if this was expected.

My eyesight at the 2 week follow up was not as good as recorded the day after the surgery. I was told to allow healing and that no intervention would be considered until the 3 month mark. I was advised to get a pair of +! reading glasses to help me read in the meantime.

+1's didn't make any difference so I persisted with reading exercises.morning and evening.  However, the left eye continued to bother me and I was increasingly aware of the residual astigmatism as compared to the right eye.

5 days before my month follow up appt, I had a foreign body sensation in my left eye, with a background mild ache. I tried a saline eye bath a few times and golden eye ointment but these gave very transient relief. I was soon due to leave for a friend's wedding in South Africa so made an urgent appointment.

I was told I had some rebound inflammation in the anterior chamber and was given the steroid and NSAID drops to start again (taking the steroid 6 times per day). As advised, I wore dark sunglasses to avoid pupil contraction. Within 48 hours, my vision and comfort had improved significantly and I wanted to read everything! I have been using the drops for 9 days and the vision has stayed really good with easy binocular vision for the first time since the surgery. The discomfort is gone and I cant notice the astigmatism anymore.

The drops are just a bit drying (as I found in the 2 weeks post surgery).

Thank goodness a cause was found! I am due for another follow up appointment tomorrow and have been told that if the inflammation has gone, I will start a gradual step down of frequency of applying drops over a few weeks to avoid the rebound inflammation. .Hopefully things will stay settled as I come off the drops.

I thought this might be useful for others to know about in case you experience similar problems.as anterior chamber inflammation post IOL is not uncommon.

Will update on progress.
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Avatar universal
Hi Phil

I am in Leicester, but moving up to Cheshire this weekend.

Had surgery in London.

Katie
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Avatar universal
An excellent write-up. Good wishes for your continued progress. Where, geographically, are you based.

I believe the more of these personal diaries that are written, the easier it will be for everyone having or had the procedures to understand fully the learning curve and time taken to achieve good vision. I have seen nothing like these anywhere on the internet, and really thank Medhelp for allowing them to be written and shared. These are fully unbiased, and in so much more detail than any medical study published.

Will watch your progress with interest.

Phil
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