Avatar universal

Realized erred in choice of lens soon after post surgery.

I am a 62 year old, had cataract surgery 2 days ago in my left, non-dominant eye and had a monofocal lens (+11.5D) implanted.  
Later that same day, after having had the lens put in and seeing the results, I realized that I had made a big mistake in choosing a distance lens.  I should have done with the doctor's original suggestion of -2.5 lens which would have given me good reading and computer sight. I was hoping to be able to see well at  distance after decades of wearing glasses but, now, realize, after the fact,  that most of what I do (reading, writing, pc, drawing) is mostly near or intermediate distance and I would have been better off opting for near/intermediate and using glasses for distance.  I had not realized too what  drawback not being able to read without glasses is.  I am heartbroken that instead of choosing something that would have been ideal, I chose the other and now bitterly regret it.

I am now thinking about what options I might have to mitigate the effects of my bad decision:

1)  I would love a do-over if that is an option.  Is that a possibility or do the risks of additional surgery outweigh it?  I read somewhere that exchanges are possible but easiest if done within 4 - 6 weeks of the original surgery before the lens become entrenched. Is it worth considering? Would the doctor consider such a request and what might the costs be?  Would insurance cover a do-over or would I have to pay out of pocket?

2) The other thought is go for mini-monovision.  With my left , non-dominant eye currently at 20/20, would setting my right eye for near (-1.25?) give me back most of my near/intermediate reading abilities?  My right eye is is currently nearsighted (-4.0), has some cataract but is 20/20 with glasses at the moment. Only my left eye has been operated on so far.

I was following Craig10x posts here and he seemed very happy and had great results with his monovision of 20/20 for left eye and -1.25 for right eye, needing only light readers for close reading.  However, it was his dominant eye that was set for 20/20. In my case, it is my non-dominant eye that is 20/20.   Might that make a difference in terms of outcome?

Also, while he seemed very happy with his monovision from his posts from 2011-2013, his latest post that I could find in 2014 sounded like he was considering going 20/20ib both eyes?  I don't see any more posts from him after that.

3) When my right eye needs surgery, make it a distance lens to match the left eye. In that case, I would lose what little ability I have left in my right eye to read without glasses.  Having always been myopic, I realize , now, after my let eye surgery, that I do not like not being able to read without glasses.  I know others have  mentioned it here, but it didn't really register until experiencing it now how much I don't like it.    Again, why my decision above haunts me.  

4) Any other option?

If Dr. Hagan is reading this, i would be interested in what he has to say.
I did some research here and elsewhere prior to my surgery which would have pointed me towards opting for a near/intermediate monofocal lens but for some crazy reason which I myself don't understand, maybe because after decades of not seeing distance clearly, the possibility of seeing clearly distance was too tempting and I got confused and ignored what should have been an obvious choice until it was too late. At present, I can't see distance clearly with the left eye that was operated, not sure if that'll improve over time.  
I know I erred badly and now wonder how best to correct the  mistake, if it is at all correctable. I'm so torn and don't want to make things worse by blindly making another mistake after the first.  
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177275 tn?1511755244
1.  I have said this many times that myopes that read without glasses are usually devastated when they can't.  Shame on you for not doing your research.
2.  If you elect IOL exchange since the IOL power is what you asked I suspect, but cannot say for certain, that all of your costs will be out of your pocket. It is not reasonable to expect your insurance or surgeon to pay for your unwise choice.
3. Read this carefully several times re: monovision and minimonovision. https://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You
4. Dominant eye usually set for distance and non dominant for near.
5.  What is the glasses RX in the eye that has not had surgery? Does it have a cataract and is it bothering you?

No easy solution here.
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Thanks for your prompt response, Dr Hagan.  I had talked to my sister, a myope like myself, who had had cataract surgery for distance and she said she could read everything easily after surgery and only needed readers for close up reading. I thought my result would be the same.  I just found this site recently, not long before I had to have cataract surgery, had a lot to assimilate, understanding what the various terms meant and was trying my best to wade through everything I was reading though I  missed a lot of information too which I realized when I came back looking for answers, solutions post surgery. I cried all night after the surgery when I realized the full impact of the situation.  

How much would a do over cost approximately if I had to pay out of pocket?  Probably more than I can afford but desperate enough to wonder.  

WHy is important that it is the dominant eye that is set for distance?

Rx for my not-yet surgery right eye is -4.25, cylinder 0.50, axis 089, od +2.25.  It does have a cataract but 20/20 with glasses.  The doctor said  surgery on the right eye might be considered if the left eye lens isn't compatible with  my right eye.  What the prescription would be, I don't know.

cylinder is -0.50
Just to clarify, My sister said she could read her cell phone, books, pc  with no glasses post surgery and only needed readers for  reading small print.  I did ask the doctor if that was the norm for distance lens implants and he mentioned it depended on the size of the pupil (?), took a look at mine and said it was a possibility, hence also why I thought opting for distance would give me the most flexibility in terms of viewing range.

All this is post surgery and I know now there's probably far more variation in results.  Sadly, I actually did research a lot beforehand (web, friends, family who've had cataract surgery) but sometimes, it's finding the most accurate sources in a timely manner and also knowing what to focus on amidst the wealth of information out there.  Right now, I'm just sad I missed what was truly important that I should have focused more on.
Avatar universal
I was lucky in that I was going to go for distance correction with a monofocal  IOL in my dominant LE and use a contact lens in my RE, which did not and not yet needed surgery, but my cataract surgeon convinced me otherwise and used an IOL that left both eyes in approximate parity. I tried the monovision approach with contacts 10 or 15 years ago and never really liked it.
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...make that “has not yet needed surgery”
I wished my surgeon had dissuaded me too. I had read enough to know that I didn't want multifocals which was one of the options that came up. There are so many threads here and I thought I'd found the most relevant for my situation but now realize my knowledge was still very incomplete.  
Avatar universal
I hope that many people considering cataract surgery will read this. Dr Hagan has made the same comment many times but unfortunately most of us come to this site after surgery. The reference he gives should be required reading before surgery throughout the entire world.

I assume you are based in the USA where I suspect private care gives more options to consider and I am certainly aware from this site  that most American have more knowledge than I do in the UK. I made a mistake of thinking that I could trust a private surgeon to give me the best advice and what a mistake that was. I opted for a multifocal lens based on a consultation and a written document about the lenses. The document started by saying "For patients wanting to be free of glasses, the ideal option is a multifocal intraocular lens providing distance and near (reading) vision with minimal visual aberrations. With these lenses 95% of patients no longer need glasses at all." I decided to take his advice which cost me an extra £2000 compared to a monofocal lens. I do not drive and so distance was not a real issue and like you I read and use computers a lot. My uncorrected reading vision is not good and I use varifocal glasses but also now have a pair of reading glasses because I find some text difficult to read with varifocal lenses. I have worn varifocal lenses for years without problems. I am corresponding with the surgeon about the problems with little success. His letter says "The aim was to give you distance vision in the first place." This is exactly the opposite of what I agreed and paid for. He also now claims that only 75% of people are able to read without glasses. This a huge risk compared to the 95% in his document I used to make my decision.

My opinion is that multifocal lenses should only be considered by people who have never worn glasses and they should not expect to be without glasses.
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177275 tn?1511755244
Helpful - 0
177275 tn?1511755244
Even if you would have gone with -2.50 you would have had trouble with the two eyes working together with a -4.25 in the eye not operated on with small cataract.  Anytime the difference the two eyes is more than 1.5 diopters most people have trouble adjusting.    So now you have 4.25 diopter difference in the two eyes.   I have no idea what an IOL exchange would cost but even if you had done -2.50 you would be able to read but getting the two eyes to work together would have been problematic.  I have no idea what IOL exchange would cost. Too much variation around the country.   When people look at something in the distance they align the dominant eye with the object hence using that for distance.   When the far away RX is in the non-dominant eye and the dominant has the reading RX some people are unable to change fixation and continue to use the out of focus eye for distance.   Your sister likely has a residual myopic/astigmatic refractive error and a small pupil.  My wife had surgery and she is the same way. Without glasses sees well at distance and can read good print in good light. However best vision 20/15 both eye is with custom progressive glasses which she does not mind wearing.  LASIK and SMILE procedure work well to make eye less myopic but nothing works well to make an eye more myopic.  I really don't have any good solution to your problem.
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That’s what my IOL was set within, 1.5 diopters. My LE (with the IOL) was set to -4.5 and my non-operative RE is at -6.0.
I had my one week post-op examination this morning. My corrected eye is 20/30, -0.50.  
I was told the inflammation from surgery is all healed so this is final.   Is it unusual to not be able to correct to 20/20 and plano which I was told would be the result?

I believe this is a form of monovision ( -0.50 LE, -4.25 uncorrectd RE)?
I can see well enough to drive and I can read books, cell phone without glasses which I am happy about.  However, my intermediate vision  is blurry and using the pc is uncomfortable unless I get up close.  The optometrist said she could give me a prescription for pc use.  

If I don't mind wearing glasses, is there a prescription I could ask for that would allow me to see more clearly at all distances, including when outdoors?  What would the ideal be for each eye?  How well would it work for sports?  Would there be a depth perception issue even with prescription glasses?

Something is WRONG here. A surgeon does not discharge a patient and tell them the results are final at one week post op!!!! Don't put up with that.   When you pay for cataract surgery you generally are paying for 90 days of care.   We see all our patients one day after surgery, one week after surgery  (Dilate eye and check retina carefully) and 3-4 weeks after surgery for a final exam and glasses RX. Generally the drops are tapered but not stopped for 3 weeks not at one week.  If vision is not 20/20 we want to know why.  As a minimum a macular OCT should be done to be sure the person does not have cystoid macular edema. you need to see the surgeon and demand to know why you are not seeing 20/20.   You need a macular OCT which generally you should not be charged for and if necessary a cornea topography to see if you have irregular astigmatism. you are not going to be able to wear glasses comfortably with that RX having 3.75 diopters difference in the two eyes.   If your optom "co-manages" with an eye surgeon you need to demand to go back to the surgeon.   I foresee you VERY UNHAPPY with the results you have now.
Thank you for the helpful and informative response , Dr Hagan.  

To clarify, my drops are for 3 weeks.  Ofloxacin and Prednisolone  4x/day first week, then  Pred  3x/day second week and pred 2x/day for third week.  Currently, on pred 3x/day.

The surgeon saw me the day after surgery and my operated eye vision was 20/30-2.  
A week later, I saw the optometrist who works with the surgeon.  It seems it is the standard practice at their office to have the optom follow up, not the surgeon.

She didn't dilate the eye during the visit but tested for vision which was 20/30, -0.50.  I asked if that would continue to improve over time to 20/20.  She then examined the eye, said it was healing nicely, there was no surgical scar  and that the inflammation was all gone.  She said because the inflammation was gone, vision in the eye would not improve further from 20/30.  and the -0.5 would improve my intermediate vision.  Not sure if that is indeed a plus or just to explain away why it wasn't plano.
I am scheduled to see her again in 3 weeks time (so, 4 weeks after surgery).  

Currently, without glasses on, I can see ok, though distance isn't sharp,  around the house.  Outside the house, while I can see to find my way around,  everything is not quite sharp at all distances, especially in stores like grocery and retail.   The only things I can see clearly are items about 8 - 10 inches away.  I wasn't sure if this is what I should expect.  It does feel quite discomfiting and makes me want to leave the store.  

If i put my old glasses on with the operated LE lens removed , the image sharpens up which feels better but only if I look straight through the center part of my progressive RE lens.  Otherwise, images overlap and after a while, I can feel strain in my RE.  So, I find it easier to leave my glasses off , both indoors and out.

Prior to surgery, my LE was -9.0 and my RE is -4.25 which led to thinking perhaps the 2 eyes, though flipped in power ,  might possibly work together post surgery.  If not,  per the surgeon, the next step will be surgery for the RE which will be set to distant.  

1)  Should I wait until my next visit with optometrist (in 3 weeks time) to see if there is possibly any improvement (in spite of what the Optom told me) before approaching the surgeon about my operated LE vision being only 20/30 and the reason why?  

2) Is 20/30 the reason why my distance vision feels not quite sharp?  Or because my existing RE prescription is now not compatible with the operated LE?

3) Will  wearing my glasses (LE lens removed) as much as I can, uncomfortable as the double vision is, help in seeing if my eyes/brain can adjust to the 3.75 diopter difference?  Or is that a futile exercise?

Not sure how i feel about wearing contacts but willing to consider if they can help.  Might contacts (regular? bifocals?) help with the adjustment?  If  yes, would that be for the uncorrected RE ?   Can eyes post cataract surgery  be fitted with contacts?  

4) Not sure if it is too early to ask , given the above,  is surgery for my RE to match the LE the most optimal solution?  

Thanks again.  

It used to be illegal for a surgeon to farm out their post operative care and give some of the surgical fee to the referring doctor. It was called "fee-splitting" and was unethical and illegal. Now it is neither and is called "Co-management" so your optom and surgeon are "co-managing". That doesn't mean you can't go back to the surgeon.   Some of these 'co-managing" surgeons like to keep their contact with the patient minimal so they can spend all their time during surgery and maximizing revenue. Our practice allows the patient to see the surgeon any time they request especially if a problem. I would suggest you go to see your surgeon ask for those tests and an explanation why you are only seeing 20/30.   Your vision is not "sharp"  sharp vision is 20/20 or better.   Also, in my opinion both your optom and your surgeon should have better prepared you for the problems you are having with your eyes working together, they should have been clearly outlined to you.
Thank you for the response, Dr. Hagan.  I very much appreciate being able to bounce my questions off you and get crucial feedback amidst a very stressful week.  

I contacted the surgeon this morning and his assistant came back and said that it takes 3 weeks for the eye to  heal, that the last visit shows some nearsightedness and they will check at the next optom visit to see if vision improves.   When I saw her, the optom had told me it would not?   I'm not sure what to think here.  That was my very first time with the optom, she works with the surgeon in the same medical group and follows up on his patients.

My next appt with the optom is July 12 ( 3 more weeks).  If my vision is still 20/30, I will ask for a macular OCT and cornea topography.  
My concern is is it ok to wait until then to see if it might be Cystoid Macular Edema?
If it turns out not to be CME, could it be the lens put in was incorrect?  

@sadpurple I personally would not start contacts at 62. That being said I myself am 62, and have daily wear  RGP contacts that I typically have in for 13-14 hours a day.  I like them better than glasses, but I had already been wearing them for decades before having any kind of eye surgery.  I do have a pair of glasses too that function equally well as far as distance correction.  I was released back to my optometrist in a co-management scenario like Dr. Hagan mentioned, and although I don't recall the exact timeline I didn't have any negative issues after doing so.  Thus far I haven't been back to the surgeons practice since as a patient, and hope to keep it that way.
Thank you for the helpful comments, MrPresley.  Good to know.  I hope you never have to  see your surgeon again too.
177275 tn?1511755244
Okay so it is within the same group.  And the optom is saying one thing and the surgeon's nurse something else.  That is not ideal.  While some of our surgeons co-manage with our own optoms if a patient asks to see the surgeon for extra visit or reassurance we always comply and not put them off like you were.   So yes you can wait. See what  our vision is in 3 weeks. If not 20/20 insist on seeing the surgeon and the tests. However even if 20/20 you are going to have the problem of the two eyes working together.  If the operated eye is 20/20 and the refractive error 0.00 or -.50 then you may have to have cataract surgery on the other eye leaving it maybe -1.25 (that would be mini-monofocal distance bias.) you still would need glasses but the difference would be less than 1.5 diopters and most people can adjust.
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Thank you so much for your reply, Dr. Hagan. It is a relief to know that there is a potentially good solution down the road.  That takes a load off my mind and will give me some breathing room for now.  I will check in again in 3 weeks to give an update and, hopefully, get your thoughts on whatever next steps that come up.  

Thanks again for your kindness and for being so generous with your time in helping people like me.  

Okay, look forward to your report.
Dr Hagan, let me once again thanks to you for all the help provided to users of this web site. You are a great help obviously.  I have been in touch you before. I had cataract surgery in Vienna in 2015 with a doctor who had tested the tecnis Symfony multifocal toric lens. I had been -12 myopic with 2.75 astigmatism. I now am able to do everything without any need for glasses. My left non dominant eye was under corrected  by -,5 or -.75. I had been wearing glasses and contact lenses since I was 14 or so. (I am now 73.). All this to say: I guess I was among the lucky ones in my choice of IOL and results.  But there are some success stories.

I am curious about something you wrote a few comment back: “Your sister likely has a residual myopic/astigmatic refractive error and a small pupil.”

How does the small pupil enter into the vision discussion?  Is it as if one were squinting and getting better depth of field? Or reducing the sperature on a camera.? I am asking because it seems to me that my pupils are smaller than I recall before cataract surgery. If indeed I have small pupils- for whatever reason- is this perhaps why I am so happy with near intermediate and distance vision?

I do notice that I have trouble entering g a dark room   Seems to take a long time ti adjust. Perhaps normal aging or a result of the small pupils?

Again thank you on behalf of all your followers for the time and attention you are providing.  
Yes it is exactly like depth of focus with camera aperture.  Small pupil helps focus and make depth of focus wider.  When you go in dark room pupil dilates and you lose the help of small focus plus it takes the eye longer to adjust to dark as we age. Glad you have done well, thanks for adding to the discussion.
Agree completely with @Jim_in_Italy, a big thank you to Dr. Hagan and this website in general for being of great benefit. I first came here in 2015 as well and have learned much!
I am always open for an opportunity to thank Dr. Hagan!!  I actually am armed with knowledge from reading this site when I see my Eye Md.  I think they are impressed (or maybe annoyed lol).
OMG, my lucky day.   Thanks for the kudos and the contributions you make, all of your.
I'm tossing in my gratitude and thankfulness for Dr. Hagan too!  
Thanks MjCg and if you live in the USA  Happy Independence Day, if you live elsewhere, have a good day.
I'm in Michigan, Dr. Hagan and on my way to Ireland again in two weeks!  You will never be able to know how grateful I am for the advice and guidance you provided me last year.  I plan to lurk around this forum and offer any advice I can about my own experiences whenever needed.  
Thanks. Have a great trip.  My father's side are Irish, "O'Hagan" and came to US in Great Potato Famine 1845, settled in KY and migrated over the years to MO.  All my siblings have been to Ireland except me, it is on my list to visit.    You might enjoy this article I wrote about making your 'bucket list' happen:   https://www.healio.com/ophthalmology/practice-management/news/print/ocular-surgery-news/%7B0b06f6bf-f332-4268-9097-3b62af6af22d%7D/bring-adventure-change-and-calculated-risk-taking-into-your-life
I woke up this morning and found my operated LE to be bloodshot, dull ache over the brow nearer the nose and the white of the eye looked/felt a little swollen.  I feared it might be inflammation and put in a drop of Prednisolone while waiting to hear back from the doctor on call.   The last of my prescribed dose of Prednisolone drops was completed 4 days ago on July 3 and until today, the eye was fine.

The ophthalmologist on call asked if i  could see. Yes, I can still see as before.  She said no more Prednisolone and recommended using preservative- free eye drops as they could be used every 2 hours if needed.  

I bought some Systane preservative free drops and put them in.  I still have an ache over the brow (putting some pressure on it helps relieve it)  but the redness and swelling has gone down in the past 3 hours.

I am wondering what could have caused the sudden redness?   Could it be I am over straining my operated LE because of my current monovision state?  My LE felt very tired yesterday evening and when I went to bed last night.

Not sure if it's relevant but I had played some tennis yesterday morning to see if my eyes would work together.  I had tried playing a couple of times before and had no after effects.  

Just concerned that the bloodshot came out of the blue and what might have brought it about and if there is anything I should refrain from doing or watch out for.  Thank you.

You should call your surgeon tomorrow morning (Monday) early and insist the surgeon look at your eye. since you just stopped the steroid you could have "rebound iritis" and may need to be on the steroids longer. You also need the reassurance of your surgeon looking at your post-op that has changed in appearance.  Don't let them put you off. Insist on being seen.
Thank you for the helpful and timely advice, Dr. Hagan.  I called the office as soon as the switchboard opened and managed to snag the only open appointment of the day the surgeon had.  The LE is now slightly improved to 20/25 and he also recommended another 2 weeks of Prednisolone and hopefully, that'll take care of the problem.  My eye looks a lot better right now.

Thanks again for making me aware of the need to have the issue looked at and not wait.  You don't know how glad I am to have you as a resource.

Happy to help

I  have been having a dull headache on the top of my head above the left eye and occasional ache above the left brow for the past 3 weeks.  There was a day or two when it went away by itself but came back.  Some days, the headache is more noticeable than others.

To recap, I had LE cataract surgery on June 12, had rebound inflammation and following the surgeon's instructions, re-started  the prednisolone eye drops , starting at 4x/day for a week and gradually tapering off until once a day for a week and finally, once every other day for a week before finally stopping,  all in all, a  total of 5 weeks. Looking back, the headache started  around the time when the prednisolone ended.  Might that be a factor or coincidence?

I can see fine, my eye looks normal, not bloodshot or swollen as when the rebound inflammation first occurred.  I kept thinking it would go away but it's been 3 weeks now.  Could it be related to my eye?  At what point should I be worried about the headache if it doesn't go away?

If you eye is not inflamed and there is no increase of intraocular pressure then the surgery or Pred drops should not be a factor. After 3 weeks they should be metabolized and gone.
Thanks, Dr Hagan, that's helpful to know.
If rebound iritis occurs in one eye, is there a likelihood of it happening in the other eye as well after cataract surgery?   In which case, would it make sense to extend the duration of the pred drops to more than the usual 3 weeks?
Yes, out practice if someone has rebound is to use a slower taper maybe 5 weeks instead of 3.
I'm curious how your practice does the tapering?  
I've heard of 4x/day the first week, then 3x/day,  2x/day, once/day and eventually every other day for each week.  Another version was  4x first week, 3x second week and then 2x for each of the remaining 3 weeks.   Is any one configuration preferable over another and why?

I was reading your blog post on dry eyes and Artificial tears.  I currently use Systane preservative free drops for dry eye after cataract surgery.  When putting in the drops,  the eye sometimes feels cloudy and it takes a while for the vision to clear. Other (most) times, vision is clear as soon as the drops are put in.  These are drops from the same vial .  Is this normal?  Why is there a difference given they are from the exact same source?  Also, for preservative free drops, is it correct that there is no risk of overusing?

We taper the drops over 3-4 weeks. There is some variability depending on how the inflammation is resolving.  You can't over-use any artificial tears like a drug over-dose. Some people are sensitive to preservatives so in people using lubricants more than 4 times/day or a history of preservative allergy then preservative free are better but they are more expensive.  The effect of the drop on the depends more on the state of the cornea and the environment (windy, dry, moist, irritants).   Think of how some food upset you stomach sometimes not others.
I had cataract surgery on both eyes, LE was in JUne and RE was August.  I was expecting to get my glasses Rx when I went to see the opto (who works with the surgeon in his med group) last Friday for my final/3 week follow up visit.

1) To my surprise, I was told they don't give out Rx and I had to go to an outside opto.  
The opto did do some  tests where she asks "Is 1 better? or is 2 better?" but that was it.   Everyone I had talked to who had cataract surgery with other practices said they received an Rx from the surgeon's office.  I'm not sure what to think.

2)  The opto said ok to go ahead with get an Rx as my vision had "stabilized."

The readings for my RE are 20/70 (day after surgery), 20/125 (1 week later) and 20/100 (3 weeks later) .  

For my RE surgery, I said I didn't mind wearing glasses for distance but wanted to be able to read without glasses if possible. Opto did some measurements and said they would shoot for -1.25. I was happy to hear that, esp since it coincided with what Dr. Hagan had suggested earlier.  1 week post surgery, she said the reading was -1.75.  Last Friday, at 3 weeks post surgery, she said it was -2.25.    This was all verbal and I had to really ask for the information.

The above numbers are different each time.  Is it ok to go ahead with getting an Rx or might things still change?

3) I had rebound inflammation when my LE was done previously. When I asked if I needed more time for the prednisolone drops for my RE, The surgeon said to go 5 weeks (5x/day, 4x/day then 2x/day for the remaining 3 weeks).  
When I had rebound on my LE, I was asked to do 4x/day tapering down to 1 drop every other day over 5 weeks).  So, what he said differs from my previous experience.  When I mentioned it to him (twice), he never responded.

When I saw the opto for my follow -ups , she recommended tapering the drops over 4 weeks (4x/day, 3x/day, 2x/day, 1x/day and then stop) which is what I am doing.    I am currently in the 4th week at 1x/day.  

Dr Hagan, Do you think the above protocol and 4 weeks is enough?  You had mentioned earlier that your office normally tapers over 5 weeks.  Should I go back and ask if I need to go another week?

Thank you for any light you can shed on the above, Dr Hagan. Just when I think things are resolving, I end up getting more confused by what I'm told.  The good news is that I can function fine without glasses at present for near, intermediate and far (though will be better when I get my Rx for distance and near.)

Large practices of eye surgeons that cater to optometrists (what is called co-management in the USA) often will not do a post surgery glasses test (refraction) letting the referring optometrist do it, charge for it and charge for the glasses.

I can't comment on how long you should taper, nor can I excuse the surgeon not answering your direct question. If a patient of our has rebound inflammation we would likely taper over 6 weeks often going at 4-5 weeks to one drop every other day for two weeks.
Latest update:  My Rx prescription is LE -0.50, RE -2.00, -0.25 + axis 090, add +2.00.
I am fine without glasses except for certain activities like bird watching, tennis, driving ,esp at night.

Currently I have a pair of single vision glasses (distance only) and it works fine for bird watching but driving can be problematic if I need to refer to google maps on my phone at the same time.  I know progressives will give me good vision at all distances.

1) Instead of progressives, can I get single vision glasses to sharpen my LE (-0.50) but leave my RE as is? That would mean a 2.0 diopter difference instead of 1.5 diopters which, from what I've read here, can be problematic in getting the eyes to work together.  However,   Prior to cataract surgery, the diopter diff between both my eyes was 4.0 diopters.  Given that, would a 2.0 diopter difference be workable in my case? Or adjusting one eye but not the other won't give me crisp distance vision?

2)I've noticed that the Add no. is always the same for both eyes even if the Refractive error is not the same.  Why is that?

Thank you for your patience with all my questions!

If you do not put a prescription in your LE for distance then you are using monovision. Your LE only for distance and your RE only for near. You will lose depth perception, not see as well (because only using one eye) and not something I would recommend.  Get the progressives and move on.    The basic glasses RX is the distance RX.  The reading part is "added" (hence name add) is the same to keep eyes focused in the same spot at near.
Thank you for the explanation, it makes everything as clear as ... 20/20 vision!   Overall, I am very happy with my end result  and feel very fortunate that it all worked out as well as it did.

Just wanted to add that I am thankful to have found this website.  I've learnt a lot, thanks to everyone's threads here, people who've taken the time to respond and share their experiences and  ESPECIALLY Dr. Hagan for your time, patience, for everything.

Thank you for taking the time to say "thanks'. The % of people actually communicating any gratitude for free medical advice is probably about one in 25.
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As Dr. Hagen said, dominant eye is usually set for distance and non-dominant for reading.  I had my vision set up for this when I wore contact lenses and it worked so well that I did it when I had cataract surgery and LOVED the results.  That being said, when my dominant eye needed macular surgery and I was unable to see out of it for many weeks, I was fitted for a multi-focal contact lens for my non-dominant eye so that I had all range of vision during my eye surgery recovery. It worked fairly well for the 8 to 10 weeks that I needed the contact lens but I will tell you....it drove me a little batty forcing my non dominant eye to now be dominant.  I had eye strain and headaches but tolerated it because the contact lense allowed me to drive and do other activities during my recovery. My advice to you would be to think long and hard about changing around your dominant and non dominant eyes.  I really hope you can just change out the lens that is not working for you.
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Thanks for comments and sharing your experience.
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