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Avatar universal

Setting eye with macula pucker for distance IOL?

While I wait for new surgery date I found a new problem.

Doc recommended setting for distance.  This is my right eye.  Dominant eye.  Has very bad macula pucker.  After cataract surgery I'm having ILM peel.

Until cataract surgery and ILM peel, I'm wearing -10.0 contact lens in my right/bad eye.  It gives me 20/60 with slight ghosting, mild depth perception issues but I get around okay.

The problem?  All my life (61 yrs) I've had natural monovision.  Left eye was my distance eye.  Right eye reading eye.  The difference was -2.0 (OS -0.50, OD -2.50).  I could read, use computer, watch TV, drive just fine without contacts/glasses.  No depth perception problems.  No double vision.  No headaches.  Sometimes I wore contacts both eyes for sharp 20/20 binocular.  Never a problem wearing two contacts.

What could go wrong going from natural monovision to both eyes distance?  Headaches?  Dizziness?  What about binocular vision?  Will my brain see only the heavily distorted images my right eye sees, and ignore the crisp images my left eye sees?  That doesn't happen now.  I think because right eye images are too blurry (even with contact lens in) for brain to fuse images.

A month ago I asked Doc if it's bad idea to set IOL to replicate my pre-cataract monovision.  He said no.  Last week he said it's not a good idea to set right eye for monovision.  Said my right eye will never be a "reading" eye.  

My question is this.  If it'll never be a reading eye, how can it be a distance eye?  Are distant images less distorted?  Can someone explain this to me?  Why would doc change his mind about monovision?  Is it easier for him to set distance?  Like the doc and hate to second guess a doctor of all people! but I need answers to make the best choice.  Not do what someone tells me without knowing why they tell me to do it.  Especially when it comes to my vision.

Meanwhile, doc hasn't answered my major question:  Will my brain focus on, and see, only the heavily distorted images my right eye sees, and ignore the crisp images my left eye sees?   And hasn't answered questions about headaches, dizziness, depth perception.

Two cat surgeons, including this doc, said "get distance".  I asked why.  They said 'because it's better'.

Can anyone tell me if it's better for them or me?

7 Responses
Avatar universal
More info.

If I got the distance IOL I'd use my other eye without a contact lens.

That "other eye" is about 20/40ish uncorrected and gives good vision from 5" to about 12'.  Usable vision 12' and further.  If I wear an -0.75 contact I get crisp 20/20.

If the distance IOL hit plano, and I wore no left contact I'd have mini-monovision, dominant eye bias.  That's a good thing.

My major question is this.  In binocular vision, would my brain see only the heavily distorted image in my plano/dominant/distant right eye, and not see the mini-monovision/good/usable images in my left eye?
177275 tn?1511755244
No, certainly in a forum like this no one can tell you, none of the very informed regular posters here and not me who has answered numerous questions.

You have spent considerable time and money on consultations, have gotten several opinions. You feel you have the best cataract surgery you can find (I believe there is no such thing as the best cataract surgeon in the US or the world, most are quite good many are outstanding). When you seek out these "big name" surgeons you have to realize they do over a 1000-2000 cataract/IOL per year and thus you usually don't get a lot of time with the surgeon.

Obvious options: 1. Ask the retina surgeon if he thinks you would ever be able to read at near with the eye having the ERM peel  and about the choice of setting for distance or near  2. Return to the other cataract surgeon you consulted for a repeat exam and discussion of the choice of distance/near
Avatar universal
Dr. Hagan;

You said:

"No, certainly in a forum like this no one can tell you, none of the very informed regular posters here and not me who has answered numerous questions."

To which of my questions did you thus reply?

The "binocular diplopia induced by dominant eye with pucker" question?

The "what could go wrong with going from natural monovision to both eyes distance" question?

The "if it'll never be a reading eye how can it be a distance eye" question?

The "are distant images less distorted" question?

The "headaches and dizziness" question?

----------------------------------------------------------------

You also said:

"You have spent considerable time and money on consultations, have gotten several opinions."

So I should shut up and accept what I'm being told without question or answers?  That's exactly why I post.  Because I haven't "gotten" answers to my questions.

What I have "gotten" was a limited amount of time to listen to a doctor tell me their opinion, and not much time for the doctor to listen to my questions.

About 60% of posts on the eye forum are from people who've had problems with their eye care and are looking for help.  About 40% are from people looking for answers so they can avoid bad eye care.  My botched - I repeat botched - 2013 vitrectomy/ERM puts me in both categories.

That's why I have spent considerable time and money on consultations and getting opinions.

And I'm still without answers.
1 Comments
"That's why I have spent considerable time and money on consultations and getting opinions."

In other words, so I don't get fooled or screwed again.
Avatar universal
From original post:

"A month ago I asked Doc if it's bad idea to set IOL to replicate my pre-cataract monovision.  He said no.  Last week he said it's not a good idea to set right eye for monovision.  Said my right eye will never be a "reading" eye."

My question is this.  If it'll never be a reading eye, how can it be a distance eye?  Are distant images less distorted?  Can someone explain this to me?  Why would doc change his mind about monovision?  Is it easier for him to set distance?"

"What could go wrong going from natural monovision to both eyes distance?  Headaches?  Dizziness?  What about binocular vision?  Will my brain see only the heavily distorted images my right eye sees, and ignore the crisp images my left eye sees?"

"Meanwhile, doc hasn't answered my major question:  Will my brain focus on, and see, only the heavily distorted images my right eye sees, and ignore the crisp images my left eye sees?"
1 Comments
I understand your wish for exact answers. I cannot give them only generalities which I have several times. I also cannot establish a doctor-patient relationship and practice medicine here. I have taken your situation as far as I can.  Thus treading those legal and ethical boundaries will have nothing further to say. I do not wish to be implicated if after your surgery you feel I have "botched" the advice given to you. Again for all those reasons I'm signing off and wish you the best.
Avatar universal
"Thus treading those legal and ethical boundaries will have nothing further to say. I do not wish to be implicated if after your surgery you feel I have "botched" the advice given to you."

And the Oscar for best drama goes to....

The website itself has disclaimers.  You yourself have posted disclaimers.  Not even the sleaziest attorney would consider action for internet posts.  And anyone who took any internet advice without confirming that advice with their own doctor would be astoundingly irresponsible.

Besides, considering the numerous opinions you've already given all over this site, that horse left the barn a long time ago.

I'm not the only one here with a sad surgery story through provider carelessness - not error.  But I may be the only one whose surgeon had stage 4 cancer when he performed the pars plano vitrectomy, left his solo practice 3 weeks later to never return, and never told me he left 75% of the ERM unremoved as the surgical report noted.

Over the next 18 months the physicians who first staffed and then bought the practice shuffled me amongst themselves, never answering my question "Why is my OCT showing the retina getting worse and worse" and "Why is my vision getting worse and worse instead of better" except to say "come back in two months".

A review of my records for those 18 months shows every - repeat, every - record noted "residual ERM", "remaining ERM", and "ERM".  So for 18 months these doctors knew I had a time sensitive condition that studies prove leads to permanent vision damage/loss if not immediately addressed through another peel.  But not one of them told me that.  Not one referred me to another ophthalmologist.  I was the problem surgery of a dead doctor.

Only when my cataract got so bad this summer that I couldn't see did I get my records  and begin researching what had happened to me.  Post-op incompetence through and through.

Anyone in my shoes would be taking the same steps to ensure they know what they're getting and not getting for the next surgery.

My retirement dreams of enjoying grand vistas in America's wilderness areas as a full time RVer has been stolen and irrevocably damaged by irresponsible men in white coats masquerading as physicians.

You've given me some answers I was looking for and I thank you for that.  Perhaps others can fill in the blanks.
Avatar universal
"....had stage 4 cancer when he performed the pars plano vitrectomy..."

And never told me he had cancer.  He left his practice December 2013 and died August 2014.  In all I saw him 3X.  Before the surgery, day of surgery, next day post-op.  Then he was gone, never to return, leaving the "new doctors" to staff and eventually buy his practice.

I didn't learn about the cancer or death until this summer, 2016.
Avatar universal
Because residual ERM isn't totally uncommon, it might be slightly more accurate to say "A tragic series of events over several years time" instead of "botched".

The end results, however, are the same.  I'm legally blind in one eye.  The lifelong ramifications of which are only understood by those in a like position.
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177275 tn?1511755244
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