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Avatar universal

The most neutral monofocal iol

I'm writing here because I'm really desperate and cannot find an answer. Almost one years ago had eye surgery and got two hydrophobic multi-focal intraocular len. I still had no cataract, I was starting losing my near vision and the surgeon suggested this operations. But at once the vision was a nightmare with huge halos, huge starburst, flickering light night & day, unstable vision. Nothing helped and 10 months later I was just exasperated. After trying to convince my surgeon, for months, that something went wrong (really?!) and the lens should be replaced, he decided to exchange the lens in the right eye only with a hydrophilic monofocal lens.
Many problems have solved but I can still see very annoying halos, flickering reflections 40 days from the operation. The surgeon told me just to wait but I have this sense that the problem won't solve very much. So for the left hand I'm still waiting because I don't want this same lent but something different and the most possible light phenomena-free ...
I have 2 questions please:
1) is that true that silicone-made, with rounded edges iols are more forgiving about annoyances?
2) how much the refractive index of the lens influences internal reflection? Human lens is 1.41, my lens is 1.47. Has that something to do with the disturbances I have?

Thank  you for your help!
6 Responses
177275 tn?1511758844
To your first question the answer is NO. To your second question the refractive index of your IOL does not contribute to your problems.   Your problems are not uncommon and one of many reasons I don't recommend "refractive lens exchange" or "Clear lens extraction".  As you said you didn't have cataracts you just didn't want to wear glasses.  

Even for people with cataracts they are not uncommon problems and using the search feature and archives will show you. You have "dysphotopsia" or unwanted light reflexes.  I would suggest you get a 2nd and third opinion from different cataract/IOL/Cornea/refractive surgeons in your area. Glasses likely progressive multifocal are in your future.
Thanks! Hypothetically what lens would you use in my case?
My wife just had cataract surgery on both eyes. We chose Tecnis Monofocal ZA9003   Its important to understand there is no best automobile but there are a lot of very good ones.  There is no "best" IOL.   There are a lot of very good IOLs.  Most monofocal give very good results.  As people start asking for more and more glasses independence then the IOLs become more complicated, the surgery much more expensive and the chance of complications more common.
I see, yes. The Tecnis Monofocal ZA9003 has rounded optiedge, so probably a good choice. I read that most problems about iols are because the truncated edges.
Here they say that refractive index can cause reflections.
Those are all potential problems. But the 'experts" often disagree and each uses different IOLs.   There is no IOL that someone, somewhere has not had problems with.  I still say your best option is an independent 2n and 3rd consultation outside the office you go to.
I had a Acrysof IQ monofocal IOL implanted in one eye only following cataract surgery, and have had no complaints.  Had no reason to go with a multifocal since at this time the other eye has needed nothing done other than wearing contacts.
MrPresley, thats where I am at as well.
My right (dominant) eye has a significant cataract that now has best corrected vision of 20/50 or so. I've got a tentative surgery date of 10/24 for that eye, planning for a Tecnics Toric monofocal.
My left eye has a very early stage cataract, but probably won't affect my vision for several years yet - so I could just use an RGP contact in that eye after the right eye surgery.
Usually a monofocal IOL is set to correct distance vision, however I did not go that route since it would have left a wide disparity in the uncorrected vision in both of my eyes, and I may very well never need to have cataract surgery in my other (right) eye.  As it is now, both of my eyes are at approximate parity and corrected with RGP contacts to 20/15.  
By the way NightHawkGuy, best of luck in your cataract procedure next month.  It took about three months after the initial evaluation and measurements for me to get mine done, but that's to be expected I suppose when going to a reputable surgeon.
Yep its taken several months for me as well.  I got cataract consulations with 3 different surgeons over the past 3 months. The 3rd one I liked the best, had to make the consultation appt with him nearly 2 months in advance! He offers both femtolaser and ORA as options, but I probably just go with manual blade surgery but with ORA. The femtolaser added cost ($1700) nearly doubles the price with a toric IOL, but the ORA added cost is reasonable ($300).
The current plan is to target my right eye for just slightly nearsighted (-0.25D) to hopefully avoid getting overcorrected farsighted.  That eye I believe used to get 20/15 corrected with eyeglasses or contacts before the cataract affect its vision starting almost 4 years ago. So even with a little nearsighted could probably still get close to 20/20 if the astigmatism is corrected well by the toric IOL - I have nearly 3D cylinder in that eye. The surgeon told me he usually tries to leave a small amount of astigmatism (0.5D or less cylinder) since as the eye ages he told me the with the rule astigmatism can reduce slightly. That can also increase the depth of focus a bit.
Dr. Hagen, I am scheduled for cataract surgery on March 5th and have to decide between the Tecnis toric monofocal or the Alcon toric monofocal.  Can you please share with me why you and your wife chose the Tecnis for her surgery?  I would be so appreciative to hear back from you as I am really struggling to make a decision.  
Think about IOLs like automobiles. If any auto was the best in the world and dramatically better than the others then most people would drive that automobile.  Ford, Chevy, BMW, Audi (my car), Lexus, Jeep, Honda etc etc all make good automobiles.   Tecnis and Alcon are both respected companies. Our surgicenter does not stock Alcon IOLs.   Most hospitals, surgicenters don't carry every brand of IOL.   We would not use an IOL on our patients that we would not use on ourselves and our families.   I don't think you can really make a bad choice between those two companies.  The skill and experience of your surgeon is far more important.
Dr. Hagen, thank you for taking the time to respond to my question.  I was really hoping you would say, "pick the _______ lens, it's the best" but I understand there is no perfect choice.  It sure would make it easier if there was!  I was hoping to avoid the glistening and odd light reflection that can occur with the Alcon by going with Tecnis but my surgeon told me the Tecnis can have issues with shimmering and shadows.  I'll have to decide which of those, should they occur, I am willing to risk.  Thank you...I do appreciate your response.
Shimmering and shadows are normal for most IOLs, my wife had them, they usually clear up in 4-8 weeks.   Either one is a fine IOL.  We all drive automobiles that scores of people have died driving.  
Dr. Hsgan, I recall reading that even though your wife had some astigmatism, she chose a standard monofocal lense.  May I ask why she didn't go with a toric?  
She doesn't mind glasses and did not want to take the 1-2% chance of having a second procedure.
Thank you!
@cazms53 are you planning on having cataract surgery performed on both eyes or only one?  Regarding shimmering, I experienced some of that for a month or two following surgery with the basic ALCON monofocal IOL that I have, which I can best describe was like being in fluorescent lighting that is flickering rapidly.  Never was particularly bothersome, and usually only occurred outdoors in the daytime. It either resolved itself or I adapted to it, because I've never noticed it since.
Avatar universal
The best corrected vision in my left eye dropped to 20/70 before the cataract surgery. The nearsightedness in my right eye is currently -6.0D with a baby cataract, and with the IOL in my left eye it is at -4.5D.  
My right eye also has glaucoma the past 4 years. I noticed in the results listed for my last cataract consultation, the eye surgeon listed that as "mild" glaucoma. I take two types of eyedrops a day in that eye to keep the IOP in that eye under control to normal levels and with that the eye's glaucoma has not gotten worse over the past nearly 4 years.

The eye surgeon also told me that after cataract surgery typically the IOP drops 4 points.  I hope that is the case for me, since then it might be enough to get me down to only one IOP eyedrop/day.

The surgeon also told me his results are that over 90% of his cases have resulted in achieving within 0.5D (power and cylinder) of the target.
I found an online article that discussed how astigmatism is more common "with the rule" in younger people until age 60+ when "against the rule" becomes more common.

If someone had "with the rule" astigmatism up to age 60, expect this aging effect to become more "against the rule" to have a small cancelling effect causing a net less astigmatism as aging continues? If so, how far could it go into your 80s-90s?
Can't answer regarding the astigmatism, but the IOP in my left eye did drop following cataract surgery in the manner you described.  Mine has never really been high to begin with however.
MrPresley, did you get an IOP drop of 4points or more? How long has it been since your surgery?
It was right at a drop of 4 the last time it was checked in June.  My cataract removal surgery was performed on March 20 of this year, and of course my IOP spiked the day immediately following surgery but even then still remained just below 20 or so.  Mine typically ran 12-14 before, and my left eye (on which the surgery was performed) was down at 8 in June.

Rx eye drops I used for the month following cataract surgery were Besivance, Diclofenac, and Prednisolone.
Also I tried a "poor man's monovision" test earlier this year where I used a contact lens I had on hand in my right eye for distance correction and left my other eye uncorrected to use for close up.  I had not worn the pair of contacts that I had since fall of 2015.  Of course my close up vision in my left eye was being affected by the cataract, but it gave me enough of a feel to realize I still don't like monovision.  I tried it years ago with contacts in both eyes and did not like it much then either.
The last set of RGP contacts I used up until about 4 years ago I had mini-monovision with the dominant right eye for good distance and the left eye less than -1D which at least gave me decent intermediate range and still good distance vision too.

Unfortunately the RGP contacts would warp the cornea a bit (goes back to normal if you stop wearing the contacts for a week or so) that makes it difficult to switch between the contacts and glasses that are setup with an Rx for when you haven't worn the contacts for weeks.

Good to hear you got a 4 point sustained reduction in IOP after the cataract surgery in one eye.  If I can get something similar, that would probably allow me to reduce down to only one glaucoma eyedrop per day (just before bedtime), which is much easier to cope with.
Best of luck with your upcoming cataract procedure, and of course come back and post up your experiences with it.  It's good to have your dominant eye restored to dominance, which was the situation in my case.

One interesting point about cataract surgery is it's done with the patient more or less "awake".  It wasn't too bad in my case, and really not much  worse to me than having laser repair of a retinal tear in my ophthalmologist's office.  If you can get down to one eye drop per day all the better, that may seem positively easy after the post-op 4X daily drops that may be prescribed for the first month after cataract surgery.
The eye surgeon I am going with does a new technique to significantly reduce or totally eliminate those post-op eyedrops by injecting one time into the eye at the time of surgery and it lasts for a few weeks!
I remember that my optometrist mentioned that one-time injection when I went back after the cataract surgery to get new contacts.  Doesn't it eliminate the need for anti-inflammatory drops like prednisolone and/or  diclofenac?  The third drops I used were an antibiotic so something like that may still be necessary.
As a caveat my optometrist was the one who originally referred me to the cataract surgeon.  I had asked him originally "Who would you see if it were you?" and he gave me the names of three specialists.  The one we settled on was great, and after the surgery and day-after follow-up were done I was released back to the optometrist about a week later to update my corrective lenses.  I remember telling then him that I was going to be using drops for several more weeks so we could wait until afterward to start back with contacts.  I was actually glad for the delay because that gave my operative eye time to settle into its final visual acuity.  It's soon going to be 6 months since I had it done and there's no indication yet that I will need a YAG procedure done.
Avatar universal
Today I finally got the entire sequence of appointments setup for my right eye cataract surgery!

The surgery date is 10/24 @11am and was told the surgery takes under 30min, and then rest for up to 60min before going home.

I have the cornea measurements pre-surgery office appointment a week before the surgery and a pre-op mini-physical exam by a nurse practioner next week which is under 30days before the surgery.

Only two post-op followup office checks scheduled, 1day after surgery and 2weeks after.

They are also sending a Rx to my local drugstore for the two non-generic eyedrops that only require 1drop each per day for the 4weeks after surgery. The reason the does is so low is the doctor also does a one-time eye injection at the time of surgery as well.

They told me if the copay total for the eyedrops is over $100 to cancel the Rx order and call them to get them at lower price.

The names of the Rx eyedrops are:  Durezol (steroid) and Ilevro (NSAID)
Yours is moving along a little faster than mine did.  I went in for the pre-surgery measurements and consultation about 3 months before the actual surgery took place.  There was also no pre-op mini-physical, or a 2-week follow-up.  There was a one day-after follow-up, after which I was released back to the optometrist who originally referred me to the cataract specialist.  I did not use those specific eyedrops, rather a steroid, a NSAID, and a antibiotic.  I will soon be at 6-months post surgery and all is well.

Best of luck.
One other comment, the day I had cataract surgery performed I noticed a reference on the pre-op paperwork to "floppy iris syndrome".  I asked about it and was informed that OTC supplements containing saw palmetto can cause this, and it's simply something the surgeon should know about as a precautionary measure beforehand.  So, the list of Rx meds and/or supplements you provide the facility beforehand during your initial evaluation should always be as complete as possible.
The primary cause of floppy iris syndrome is use of Flomax for prostatic hypertrophy
Avatar universal
Yesterday  I had the pre-op checkup to get cleared for the upcoming cataract eye surgery, scheduled for Oct 24.
All was normal intially except my BP is always very high only at the doctor's office - an hour before at home it was below normal as it usually is measured daily at home.

However at the end an EKG was done and it detected "right bundle branch block" but without any other symptoms, so that was considered benign - just something to monitor at annual physical exams.  Could have been that way for years or even decades since I never had an EKG before and the heart sounded normal with the stethoscope. So just something for the general doctor to monitor at annual physical exams in the future.

So I was cleared for the cataract surgery.
Next up is the cornea measurements in 3 weeks where the final choice of the IOL type will be made.  Also at that time I can get a $10 kit containing the eye shield, paper tape, and sunglasses.  Also will setup to pickup the two Rx eyedrops bottles for use 4 weeks after surgery, 1drop/day of a steroid and 1drop/day of a NSAID. Surgery date is one week after that.
Avatar universal
This week I had the appointment for biometry, cornea measurements.  The eye surgeon called me today and confirmed the measurements were as expected and my right eye had the expected 3D astigmatism and slight nearsightedness.

So he went over the IOL options and I selected for my right (dominant) eye the Tecnis Toric monofocal IOL to be targeted for good distance vision (0 to -0.5D) with elimination of the bulk of the astigmatism.  He will use ORA but not femtolaser for the surgery, scheduled for next week on Tuesday.

I have my two Rx eyedrops already, only will have to use one drop of each per day in the right eye for 4 weeks post-op. I hope everything goes well next week with no complications.

The doctor told me the top thing to avoid doing to reduce risk of toric rotation, etc is rubbing the eye.  He said the most common reported feeling in the eye after surgery is like feeling a foreign object in the eye.
Okay thanks for your post. These posts are helpful for people learning how different surgery is for different people.
I made it a point to avoid rubbing my left eye both after a vitrectomy/ERM peel and subsequent cataract surgery, and have continued to avoid doing so to this day for both eyes.

Best of luck again on your outcome.
I got the final out of pocket costs today for my right eye cataract surgery scheduled for tomorrow morning.
The Tecnis toric monofocal IOL cost is $1300 and ORA is $300.  I expect my part thru insurance for the basic surgery cost will be $400-$700, so the total for my right eye with a premium IOL should end up a little over $2000.
Not too bad.
Its now been 24 hours since my right eye cataract surgery with a Tecnics toric monofocal IOL yesterday around noon.

About an hour before the surgery, they had me take off all my clothes except underwear and put on a gown and little bootie socks, plus a hair covering on my head. Then lots of eyedrops for numbing and dilating the eye.

During the surgery which took about 10min or so, they used an IV for just a weak calming effect, but I believe I kinda dozed off for a few minutes during the surgery because it was over so quickly I didn't feel a thing! The doctor just said it all went perfectly and out to rest for a half hour or so before being driven home and had lunch.

Yesterday my right eye was quite blurry/cloudy and still very dilated, but I could see enough to tell colors are different from my left eye as expected more blueish whites.  The eye vision also had big halos around bright blue LEDs like on my cable modem and around outside lights and even the moon in the sky -  but I know thats a typical symptom until the eye heals and the dilation goes back down.

Yesterday I didn't have pain in the right eye, but it felt tired and I could feel a little something whenever I blinked. For the first time, I put in my once a day two eyedrops in the afternoon yesterday (1 steroid and 1 NSAID) and some lubricating drops as well. The eye looks fine in the mirror, not red or bloodshot.

Today after a good night's rest, the right eye feels much better - now I don't feel anything even when I blink and the pupil appears to be back down to normal size, the same as my other eye. So the vision is better than yesterday, no halos around blue LEDs so far today and now though the vision in the right eye varies I can make out 20/40 line and sometimes better down to the 20/25 line at times from 20feet away. However the contrast in the right eye is currently poor compared to my left eye, so the vision isn't sharp and clear yet - I hope that will improve as the eye heals.  Also currently the right eye appears to be a little far sighted maybe +0.5D or so, I hope that will come back down into the target range of under 0D to -0.5D over the next few weeks. Since the pupil is no longer dilated, I can handle normal light levels inside today much better than yesterday and I'm currently using my old eyeglasses with the right eye lens removed.

I have my next day check by the eye surgeon later today in a few hours, so I can report this to him but I expect the suggestion will be to just wait and let the eye heal for the next few weeks and hopefully the vision improves.  I am happy I have no pain or discomfort in the right eye at all right now, I am using lubricating drops since here the air is really dry this week. I am going to put in my daily does of 1drop of steroid and 1drop of NSAID eyedrops now.

Thats my 24 hours after cataract surgery report for today.
The IOL identification card I was given reports:
Tecnis model ZCT450
+15.5D SE  4.5D CYL

This IOL model is a toric monofocal designed for astigmatism correction of 3.0-3.5D in the corneal plane.

I haven't noticed any obvious significant residual astigmatism effects so far, so it appears to be close to the correct axis of rotation.
thanks for the update
The day after surgery checkup with the eye surgeon today went well.  He said the cornea looks good and vision had improved today to about 20/30 and expects the vision to improve and stabilize over the coming weeks.

Also during surgery he verified I had no weak zonules or any other issues that might give me a higher risk than usual for toric IOL rotation, etc.  So the trauma to my right eye 40 years ago apparently was not severe enough to cause issues for me with a toric, thankfully!

All he noticed was my cornea did appear dry, but thats typical in this very dry weather we are having this week in Southern California.  I am using preservative-free lubricating eye drops several times a day and the eye feels fine to me and the eyes don't have any significant redness today, even after the surgery.
Great news on your outcome thus far.  I used the drops as instructed, but was glad when they were finished.  I haven't had any dry eye issues myself since having the surgery.

I'm just now hearing from the anesthesiologist's office regarding submittal of their charges to my insurance.  Wheels turn slowly sometimes, mine was done last March.  I recall the anesthesia used seemed mild, as I was awake during the procedure but it was not painful.  I remember the cataract surgeon instructing me to hold my eye steady or something to that effect toward the end of the procedure, and although the experience wasn't exactly comfortable I would have no qualms about having the other eye done should it ever become necessary.
Everyone has a different definition of "not bad" and "really expensive"  My wife just had surgery (cataract/monofocal IOL) on both eyes and our out of pocket cost with Humana was about $750.  So $750 vs $4000   is quite a difference for most people
Mine ran a little over $300 out of pocket for a monofocal IOL in one eye, which is about the same as yours.  When the anesthesiologist charges are settled I will probably owe another $50 or $60 I expect.  The facility offered the full lineup of premium lenses but I never looked into the cost since the cataract surgeon and I had settled on a monofocal.

By the way we were in the Kansas City vicinity (Liberty) a few weeks ago as part of a massive road trip.  Had to go through St. Louis on the way where the traffic has become "challenging" to put it nicely.
Yes traffic in St. Louis is challenging. I used to be on the staff of Liberty Hospital.  Liberty is about 10 miles from my Discover Vision Center office in KC North.
I expect my part of the cost thru Blue Shield insurance for the basic surgery will be similar, under $750 or so. The extra out of pocket costs for the toric IOL and ORA was in the near $2000 range as I expected from costs I got from my two other consultations.
I'm noticing I get a significant improvement the last couple days after a good night's sleep!

Yesterday my vision after I awoke in the morning had improved to the 20/40-20/30 range and stayed there the rest of the day.

Today (3rd day) again I awoke after a good night's sleep to vision improved, this morning I was seeing 20/25 and at times 20/20. So it appears I must be very close to my target just under 0D for the right eye and hopefully will stabilize at the best vision I've had for short periods today.  Seems like I get a big improvement after each night's rest and no change during the day other than within the range of variation.

From what I've heard every eye is different and how long it takes and how the cornea heals will vary, so could take a few days or weeks.  Best to have patience and get extra rest.
As I expected, I am seeing my color vision in the right eye with the Tecnis toric IOL has stronger blue/violet in the color spectrum than the left eye.  Whites in the right eye appear pure white compared to a slight yellow/green tint in the left eye.  Seeing whites on a sink, a t-shirt, or the white of a cat's fur is stunning in the right eye!
The clarity improvement after the IOL was also one of the first things I noticed.  Later a minor flickering lights effect when outside in bright light or inside under bright fluorescent lighting, which has since resolved itself.  
The clarity improvement after the IOL was also one of the first things I noticed.  Later a minor flickering lights effect when outside in bright light or inside under bright fluorescent lighting, which has since resolved itself.  
Almost all women and most men notice the improvement in color vision with all types of IOLs;  some are bothered by the brightness for several weeks as the cataract is like having a pair of sunglasses within the eye. After surgery more light is getting back to the retina. Over time the retina changes its sensitivity. Many people, my wife included, noted some flickering and 'water spots' in the peripheral vision under some light situations. It's felt this likely comes from the incision.  This almost always goes away. Some people read better right after the surgery without glasses than later on (but the distance vision gets better and the near worse) this is due to some swelling of the cornea from the surgery which increases the radius of curvature and makes the eye more myopic. As the swelling goes away it may affect the near vision without glasses.
The refraction result seems to be very close to the target (near 0D) after 3 days since surgery.  Vision still varies in  my healing period, but visual accuity in good light reaches 20/20 at times but most of the time 20/25-30 during the day today.

I only had effects like circles around lights at night the first day, those are all gone now.  For a couple days I noticed a small black floater like thing in the right eye at times, I thought a tiny bug was flying around me.  But that too has disappeared since yesterday.

The only negative issue I still have is  reduced contrast sensitivity in my right eye compared to the unoperated on left eye.  But the right eye has mild-moderate glaucoma where the left eye does not, and that may be the reason for it.  Or could contrast sensitivity possibly improve over the coming weeks of healing? Could the intenser whites cause the receptors in the eye to wash out the image until the eye gets used to it?
Yes  re calibration of light and color goes on for a couple of months at least
Avatar universal
Today I awoke and my right eye was blurry compared to the last couple days.
Today its back to how it was the day after surgery, vision still varies but barely 20/40-50 most of the time, though it can still get clear and sharp for short periods.

So I assume I will have to just be patient and wait for the cornea to completely heal over the coming weeks and expect variable vision each day until hopefully it eventually stabilizes.

Its like the cornea varies between clear and a little cloudy or perhaps temporary astigmatism? Could dry eye be a contributor to this effect?  I'm using several drops of PF lubricating drops each day, in addition to my glaucoma eyedrops and the steroid and NSAID drops.
variability is common in the first several weeks. Dry eye could be a problem especially if vision is better after blinking several times or instilling artificial tears.
Today is exactly 7 days after my right eye cataract surgery.

From my tests at home, my right eye with the Tecnis monofocal toric IOL appears now to be very close to the target of -0.25D, I'd say its within 0.25D of the target right now.

My distance vision is much more stable today than the past week, I'm getting 20/25 to 20/20! I moved the taking of my eyedrops to night time only, an hour before I go to sleep, to avoid the blurring effects from the drops during the day. I'm getting the best and most stable vision in my right eye today since the surgery, I hope it stays here or gets even better from here on out!

Also at 1week the doctor had told me pretty much all the restrictions are lifted including no more need to wear the plastic eye shield taped on during overnight sleep, yay!

Wearing my progressive eyeglasses with the right lens removed gets me good distance vision in both eyes but the image size difference is right on the edge to handle with a little discomfort at times.  My left eye (no IOL) Rx is -0.75 -2.00 x178

I wonder if thats enough difference to get cataract surgery on the left eye covered by insurance due to imbalance sooner than what might take years for the early stage cataract in that eye to get worse enough?
Most cataract surgery patients have both eyes done, but I chose to not do so since I have macular pucker in my right eye to some degree, and if it ever requires surgery I’ll deal with the cataract development then that would almost certainly follow.  Images in my eyes are essentially the same size, with those in the left eye (with the IOL) possibly just a little smaller but sharper.
I doubt it. In most cases need more than 1.75 diopters difference between the two eyes. Likely 6-8 weeks from now they will work find.
Mine was set for 1.5 diopters difference, with my left eye (with the IOL and my dominant eye) being the one set to be less myopic.  No significant issues.
work fine not find.
Even though my right eye originally was my dominant eye, I believe my brain adjusted for the past 3 years when my left eye had much better vision than the right eye due to the latter's worsening cataract caused blur and increased myopia.

Now that my right eye is corrected with the toric IOL to 20/25 or so, it is the better uncorrected eye. But my brain when both eyes are open, seems still used to the left eye primarily as it was using it for good corrected vision until this past week.

Would it be expected that my brain will adjust in time to the right eye being dominant again with the better vision now in that eye?  Though if I wear my progressive eyeglasses (with the right lens now removed) I still get a little better vision with the left eye corrected nearly 20/15.  I guess I'd have to not  use the glasses for weeks or months to get the brain to better use both eyes more equally?

This is only an issue because eventually I'd consider having the left eye corrected for mini-monovision at perhaps -1.0D, but then I'd need the brain to use the right eye for distance vision as the dominant eye again.  That combo worked well for me about 10 years ago with RGP contact lenses, but that was years before cataract blurred the right eye's vision.
Today is the 10th day from the cataract surgery on my right eye with a tecnis monofocal toric IOL.

This morning, my vision in the right eye improved to a new best since the surgery - I was able to read the 20/20 line at 20feet clearly and almost able to read the 20/15 line at times!

This is the vision I used to have in the right eye a few years ago best corrected with glasses or RGP contacts before the cataract affected that eye. Its also getting very close now to the current best corrected vision in my left eye which has only an early stage cataract.

I hope the right eye's vision stabilizes at this spot or better in the coming weeks, I would be very pleased with this result!
I also noticed my Blue Shield insurance processed the claim for the cataract surgery already.  After they reduced the cost, my portion was only $115 for the basic surgery, plus about $800 for the out of pocket cost I paid for the extra cost of the toric monofocal IOL.

Add to that the cost of my two eyedrops ($60) and copays for the pre-op appointments (about $40 total) the current grand total cost to me is very close to $1000 for my right eye.

I think thats very good for a premium lens surgery and I'm getting an excellent refractive result eliminating my ~3D astigmatism in that eye!
I had my 2 weeks after cataract surgery quick checkup with the eye surgeon yesterday.  He said the eye looks good, healing nicely and I can stop the steroid and NSAID eyedrops in a couple weeks.  I could also get a new eyeglasses Rx at an optometrist in a couple weeks, it will be interesting to see how my right eye with the Tecnis monofocal toric IOL ends up then.  

This week the right eye's vision has been more stable, usually 20/20 when I wake up in the morning and stays that way until early afternoon when it fades a bit to 20/25-30.  At the checkup yesterday which was about 4pm, they measured the right eye at 20/25 which was much improved from the day after surgery which was 20/40 then.

I'm hoping my right eye's vision will get more stable after I don't have to take the eyedrops soon.  The injected steroid and antibiotics should be starting to wear off soon after 2 weeks since it was injected during the surgery procedure.

I noticed more line items were added to the bill yesterday, so the price is now closer to what I expected initially.  Hopefully they won't add any more to the bill after this. Just waiting to see how much the insurance covers for the new line items in the coming weeks.

My left eye only has an early stage cataract that hasn't affected its vision, and may not do so for years if it behaves like the right eye did that took years from the initial detection of the cataract until the vision worsened.  The left eye can still correct well and stable to about 20/15 at best correction with eyeglasses, so its probably not worth the risk to get an IOL in that eye until its needed. Though it would be nice to get the great pure whites and nice colors that I see from my right eye compared to my 63 year old yellowish natural lens in the left eye. :)

That is all the checkups that my eye surgeon does after the cataract surgery, so I have scheduled a full annual comprehensive eye exam for early January with an opthalmologist that has  some specialities in glaucoma and dry eye as well as cataract surgery.
Realize it is unethical for a cataract surgeon to "dump you" to an optometrist or medical ophthalmologist if you are having any problems at all.   The surgeon has a legal and ethical obligation to follow you until you are happy and pleased with the surgical result.  A lot of "chop shops"  dump the patient, many of whom have paid a lot of out of the pocket money for premium IOLs, femtosecond lasers, ORA technology, etc to referring optometrists or medical ophthalmologists with whom they split the surgical fee. these fees are often not disclosed to the patient nor is the patient always aware of their right to continue with the surgeon if things aren't going smooth.
I could have scheduled my next comprehensive eye exam with that eye doctor, but in talking to him he doesn't do the extra stuff I need for my glaucoma maintenance (visual feed tests, OCT, etc) that some of the other eye doctors at the same office do, so I scheduled with one of his colleagues for that.  But I could schedule with him again if  a problem with the IOL arose in the future like if the toric rotated, etc.
I agree completely with NightHawkGuy about the noticeable clarity differences between the eye with the IOL vs the one with a baby cataract.  I was fortunate and never had to return to the cataract surgeon for any complications after being released following my procedure.  Also so far after what will soon be eight months there's also been no sign of a follow-up YAG procedure potentially being necessary.
Yesterday was 4 weeks from the cataract surgery on my right eye with a tecnics toric monofocal IOL.  The vision in my right eye has been more stable and around 20/25-20/30 most of the time the past several days and I have now stopped the steroid and NSAID drops as instructed by the surgeon at the 4 week point.

I was also told I could get a refraction eye exam for new eyeglasses after 4 weeks and I went to an optometrist for that today.

Here is the new eyeglasses Rx I got today:
OD(R): PL    -1.00 x115
OS(L): -0.50 -1.75 x170
ADD: +2.50
PD: 63

The left eye which still has the natural lens and only an early stage cataract that hasn't effected its vision was essentially unchanged from the last Rx a couple years ago, within the 0.25D steps of the lenses and a few degrees difference in axis.

A few years ago, my right eye's Rx had been almost -3D cylinder with an axis of 165 and a power of -0.75 (before the cataract made that eye more nearsighted).

The target for the right eye was -0.25D, so plano is within the best expected +/-0.25D accuracy of both the IOL and the refraction result.  The result could in reality be closer to -0.25D since many of my subjective answers to "better or worse" were about the same.  

The optometrist told me that was the case in regard to the cylinder value, so it was kind of a toss up between -0.75D and -1.00D for that. I expected about 0.50D residual astigmatism, so it ended up a little more than that.  But perhaps with more healing time and aging that cylinder might reduce further.

The axis result of 115 was unexpected however to me, since thats quite a bit off from the original 165 value.  I thought the toric IOL would reduce the cylinder but not change the axis significantly.  

Any ideas on what might cause that axis shift and might it change much with more healing time over the coming months?
The variables would be how your toric IOL is located in the eye aligning with the true cornea astigmatism. You may be "off axis" the other variable would be the changes in the cornea caused by the incision (size and placement) Most incisions are in the temporal position and reduce plus cylinder at 180.
Should my eyes have no issues being  able to work well together and be comfortable (perhaps after an adjustment period) using eyeglasses with this rather modest difference (about 1D diff in cylinder, 0.5D diff in power) between the eye Rx?

Does the right eye refractive result seem to indicate the toric IOL has not rotated significantly in the one month since the surgery?  The bulk of the astigmatism in the right eye has been reduced from originally almost 3D cylinder to 1D or less and vision in the eye doesn't have the obvious astigmatism effects I had before surgery and are noticeable in my left eye which has almost 2D cylinder.  I guess with 1D or less cylinder the effect is just adding some blur to all distance viewing? That will hopefully be eliminated with the new eyeglasses Rx.
You will probably have some adjusting to do with that RX primarily because the astigmatism in each eye is in opposite directions. I can't tell if the amount and direction of astigmatism is due to toric off axis or due to corneal incision.
Could the astigmatism cylinder value be varying as well? That could explain the variable vision I've been experiencing, though the range of variation has reduced over the previous weeks.

For the past 5 days, I'd estimate my right eye's accuity at 20ft varies between nearly 20/20 and 20/40.  Most of the time its around 20/25 to 20/30.  The right eye also seems to be worse in dimmer light than the left eye, so I get better accuity in the right eye in good lighting.

Perhaps the right eye astigmatism is varying between 0.50D to 1.00D or so.  The refraction eye test I had at an optometrist yesterday was in the afternoon a little after 3pm, and my vision is best in the morning and fades some in the afternoon, so that was probably near the worse end of the variation I experience.  So maybe a little less cylinder may turn out to be better, to get it near the center of the variation?  Hopefully as more cornea healing happens in the coming weeks/months, the variation will reduce further and perhaps settle close to the expected 0.50D astigmatism point.

I also still experience at night outside in darker conditions when my right eye pupil size is at its highest, the jagged half circle above some bright light sources.  Could that be due to light scattering at the cornea incision point and is it possible it would eventually go away with more healing time? Reducing the pupil size just slightly by starting for a second at a flashlight or inside a car at the overhead cabin light makes the half circle artifact disappear completely.
My eye pressures measured at the optometrist a couple days ago was 20 in each eye.  That was down from L=20 R=24 a couple weeks ago and L=18 R=20 the day after surgery.  

It was expected my right eye's pressure might go up a bit for awhile due to the steroid drops, and now that I've been off them since last weekend the pressure did come back down and hopefully will come down even further in the coming weeks.

The last 3 pressure measurements were just down with the simple air puff test which I know reads higher than the more accurate GAT test (blue light with numbing drops) that my glaucoma specialist uses.  I believe on average the air puff test reads about 3pts higher, so if thats the case that would be closer to my IOP measurements from a few months ago where I usually get between 16 to 18 (with GAT) in the right eye.

My eye surgeon had told me typically after cataract surgery IOP reduces about 4 points.  Any idea how long after surgery that might happen, perhaps several months later?  That would be nice if it happens since that might allow me to eventually eliminate one of my glaucoma eyedrops.
The kind of astigmatism you have "against the rule" generally increases over time (not much though).  Lowering of IOP generally occurs within 3-6 weeks in most people.  The average is about 2 points,  more in glaucoma suspects.
I notice the pupil of my right eye one month after cataract surgery seems to dilate a little more now than my left eye.  Is this common after cataract surgery and typically will the max pupil size gradually decrease in the coming months?

My one night vision artifact is I see a half circle extended out from some bright light sources in a dark environment only when my right eye's pupil is dilated as fully as it can get then. Just slightly reducing the pupil size by looking for a second at a close light will eliminate the artifact.  So if my right eye's pupil will in the future reduce its max dilation size that should eliminate this issue.  Also max pupil size should also decrease as I age more, is that correct?
You should ask your surgeon about the pupil. In some cases the pupil doesn't dilate well and special devices (pupil expanders) have to be put in.  This can leave the operated eye having a somewhat larger pupil but it usually still reacts to light and accommodation.  If the problem persisted over 3 months Alphagan P might be tried to keep the pupils from dilating as much in the dark.
I awoke this morning to the best vision in my right eye I've had in that eye since the cataract surgery 5 weeks ago!  I could easily read the 20/20 line at 20feet on a standard eye chart most of the time this morning and with a slight -0.25D correction could make out the 20/15 line!  

The -1D cylinder astigmatism measured at an optometrist a week ago must have reduced to -0.5D or so I suspect as my cornea appears to be healing better now that I am not on any of the steroid and NSAID eyedrops (they were stopped a little over a week ago).

I'm hoping my right eye continues to heal and holds this excellent vision I'm experiencing today - this is the distance vision target I had hoped for in this eye with the Tecnics monofocal toric IOL.
Merry Christmas
Great news on your outcome thus far, congrats!
I've learned you have to be patient and not expect the best results too quickly.  For new cataract surgery folks, don't worry if you don't achieve you target vision the first week like some do, It can take a month or more for some of us...
I had a simple non-dilated eye exam by an optometrist 2 weeks ago to get a new eyeglasses Rx for my right eye post-cataract surgery with the Tecnics toric monofocal IOL.  At that time, the resulting Rx for my right eye was:
PL -1.0 x115
My left eye's Rx was essentially unchanged from the past few years, as expected.

I ordered a new pair of eyeglasses two weeks ago with the new Rx and I got it today.  The left lens was fine as in the past, however the right lens was obviously way off. I had to tilt the eyeglasses about 45+degrees to the right (clockwise) to find the spot for the best vision at 20feet for the right eye.  However even at that best spot, it was no better than uncorrected now since my right eye's vision has improved over the past couple weeks as the eye continues to heal.

I had suspected the Rx would be off since my right eye's vision had obviously changed since the eye exam two weeks ago. Back then I was getting 20/30-40 at 20feet, but the past several days I get better than 20/20 in the morning uncorrected.

If tilting the eyeglasses to my right (clockwise) about 45 degrees effectively adds to the axis angle, that would shift the axis from 115 to about 160 or so.  Which was the old axis for my right eye prior to cataract surgery.  So I suspect my right eye is now close to the old axis and with smaller than the -1D cylinder measured 2 weeks ago, probably -0.5D or less since I can get better than 20/20 in the morning most days now.

I'll keep monitoring my right eye vision over the coming weeks to see if it remains stable here before I would get another refractive eye exam for an updated Rx.  However if it remains or improves further from where it has been this past week, that probably would indicate the astigmatism has dropped to 0.5D cylinder or less at which point I probably wouldn't bother to attempt to correct it since the axis might keep moving around a bit while the eye keeps healing in the coming months?  At most I notice I can improve the right eye distance vision very slightly with only a -0.25D power lens and that was the original target for that eye, so its probably between -0.25D and plano now.

I can return the new eyeglasses for full credit for a future order, so I will do that but wait on ordering new pairs until I'm sure my right eye's Rx becomes more stable as the healing process continues.

My eye surgeon had recommended getting a new eyeglasses Rx 4 weeks after the surgery, but apparently it may be better to wait longer than that especially if you notice your vision is still varying at that time. It probably varies quite a bit between individuals.
I did an internet search with "astigmatism test" and found some online websites with some free astigmatism test patterns that can be viewed from the computer screen.  They are basically lines at various angles from horizontal to vertical and diagonals in between like spokes on a wheel.  Also a test pattern that is just a bunch of horizontal and vertical lines.

With significant astigmatism, some of the lines at different angles will appear darker/thicker/sharper than others.  Without astigmatism, all the lines look the same.

With my left eye (no IOL) that has about 2D cylinder astigmatism near axis 180 without eyeglasses, the vertical lines look dark and clear while the horizontal lines on the computer test pattern look gray and less clear. At other angles the lines also appear less dark than the vertical lines.  But with my eyeglasses correcting the astigmatism in the left eye, all the lines at all angles look about the same.

With my right eye (with the toric IOL) uncorrected all the astigmatism test patterns lines at different angles look dark and very similar, close to how they look with my left eye with they eyeglasses correcting the astigmatism.  So I would conclude from these tests, that my right eye must now have a very low amount of residual astigmatism now.  I would think with 1D or more cylinder the test patterns would not look this good, so I suspect the cylinder is probably down to 0.5D or less now, which probably isn't worth trying to correct that small amount, if it stays there!
I waited two months or so myself after cataract surgery before I got a new contact lens and glasses Rx.
Yep, 2months after surgery seems about right, Mr. Presley!
My eye surgeon told me one month and  so I got an optometrist eye exam then though my right eye's vision was still varying day to day.
However in the past week its been much more stable averaging around 20/25 but some days 20/20 or a little better. So perhaps in January if its still stable thru that time, I might get a new refraction Rx.  Though i believe the astigmatism is getting down to 0.5D or so now, thats the point it may not be worth the bother to try to correct that small amount.
Today is 7 weeks after my right eye cataract surgery.
I stopped the steroid and NSAID eyedrops I was taking for the first 4 weeks as instructed, 2.5 weeks ago.  Since that time for the past couple weeks my right eye uncorrected vision has been more stable daily in good light, each morning during this period I can read at least the 20/25 line and usually 20/20 or even 20/15.  I have been using a few lube eyedrops for dry eye each day mainly due to the very low humidity weather in my area the past couple weeks.

The only issues I still have noted with my right eye vision is at night and in low light conditions.  Outside at night when my right eye's pupil is at its max size I can see a thin jagged half circle arc/halo of light above some bright light sources but this disappears if my pupil is slightly smaller after looking at a light closeup for example. Usually while driving at night there is enough background lights from other cars, etc to keep my pupil from being max size and so the half-circles are usually not there so its not a major issue.

However, I've noted driving at night or in low light conditions my right eye's vision is a bit blurry compared to how it is in the day with good light.  In the day especially outside in the sunlight the right eye's uncorrected distance vision rivals my left eye corrected at 20/20 or better, excellent quality.  But at night or low light, the right eye acts like its about 20/40 in comparison with my left eye corrected with eyeglasses that is still giving me 20/20 or better vision in the same conditions based on how I can read road signs on the freeway ,etc.  For example, from the point I can make out the text on an overhead road sign on the freeway with my left eye, I estimate I have to get about half that distance or close to the sign to make it out with the right eye at night.

Is this reduced night vision common post cataract surgery and if so, does it typically improve after months later? Or is it more likely a symptom of something unrelated to the cataract surgery, such as a issue with retina or the early stage glaucoma in the right eye?  

I could have had this night vision issue with the right eye prior to the cataract surgery, but it would have been masked by the cataract which made that eye very blurry in all conditions for the past couple years.

I will be having a regular full comprehensive eye exam with an opthalmologist in a month or so, is there anything I should have him check specifically beyond the usual tests for my right eye night vision issues?
Yesterday I had my scheduled full dilated eye exam for the new year with a comprehensive ophthalmologist I plan on going to for my future general eye medical needs.  Besides regular annual eye exams, I require basic glaucoma maintenance with IOP checks 2-3 times a year, annual visual field test and annual OCT or similar imaging. My right eye glaucoma which has been described as mild to moderate, has been controlled with eyedrops and stable for the past 4 years since diagnosed.

I believe I don't require a glaucoma specialist at this stage as my regular eye doctor would that be correct?  The comprehensive ophthalmologist I chose has special interests in glaucoma and dry eye which I also have, so I thought he was a good choice for my current needs.  He could refer me to any of his specialist colleagues if I ever needed special surgery for glaucoma, or a retina specialist, etc in any case.  Just like I went to one of his colleagues, a cornea specialist for my recent cataract eye surgery, though he does cataract surgery as well.

My eye exam yesterday went well, and my right eye with the IOL was about 20/20 there that day.  The autorefraction result the tech did prior to the exam indicated the residual astigmatism was down to -0.50D cylinder now as I had suspected, with PLANO power.  They did IOP tests first with the basic airpuff test that always gets higher readings with my thicker corneas than the blue light (GAT) test.  But the doctor did the blue light IOP test as well where I got 15 in each eye, which was as good or lower than what I've had the past year or two with the eyedrops.  In comparison with the airpuff test it measured 18 and 20!

I like this doctor's personality (much more easy going, easy to talk to) and he was the first ophthalmologist I've found that told me he doesn't have a problem prescribing the generic latanoprost eyedrops instead of the more expensive brand names like the Lumigan my previous glaucoma specialist ophthalmologist preferred. He has found latanoprost works as well as the brand names (Lumigan, Travatan) and has the fewest side effects, and starts with that.

He setup a plan for me to have the annual visual field test next month (my last one was last Feb, so right on time) and a followup with him in Mar and go over the results.

I know that in this field, that many ophthalmologists are now specialists, with fewer general comprehensive ophthalmologists.  Also, my old ophthalmologist (who retired back in 2010) would do everything including refractions for eyeglasses and/or contacts which nowadays very few or no ophthalmologists provide, instead referring you to an optometrist for that?

But for my main eye doctor, from my experience, I now believe a comprehensive ophthalmologist (rather than a specialist) is the best choice for me.  Does that sound like a good choice for my current eye status?
First of all I am a comprehensive ophthalmologist and we are "specialists".  Eye MDs that practice glaucoma, retina, oculoplastic, pediatrics, neuro-ophthalmology are "sub-specialists"  I manage several thousand glaucoma specialists and don't often need a glaucoma subspecialist unless the patient needs surgery. Moreover  retina subspecialists are not ideal for glaucoma, glasses or contacts. etc.  So your plan is sound.   RE: latanoprost. It is the #1 glaucoma drop in the world and virtually everyone starts there.  No question that lumigan and travitan-Z are stronger and longer lasting so if latanoprost not working move up to the brand names. Rarely ever any need to start with brand name. I do not like Lumigan as I and many other ophthalmologist find it too irritating to the eye and eyelid. Travitan-Z is the gold standard but again no need to start there.  Glad your surgery turned out well.
I had my last in the initial sequence of office visits with my new comprehensive ophthalmologist yesterday for the start of this year.  I had gotten a full dilated exam back in early Jan where eye photos were also taken, then last month got visual field test, and yesterday OCT imaging.  

The doctor went over the VFT results and indicated it still about the same (stable) as  the past 3 years. So keeping me on the same eyedrop medications.  My IOP in my right eye (the only eye with optic nerve damage affecting one quadrant) was measured as 16 with the blue light, its been staying around 15-16 with the eyedrops after the cataract surgery from 4 months ago.

He is keeping me on the Lumigan in both eyes at least until my supply runs out in a few months, then might be able to try switching to the generic latanoprost.  Also staying on the generic dorzolamide+timolol combo drop only in my right eye.  I still have a supply of that to last for several months, but the doctor did mention all the dorzolamide drops have been out of stock for a few months.  Hopefully that supply issue from the drug manufacturers will be resolved soon before I run out.  He mentioned if there is still a supply issue months fron now, he could switch to me to a different eyedrop combo.  

I also see there is now a preservative free version of dorzolamide+timolol but not in a generic version, as Cosopt PF, that is covered by my blue shield insurance.
Interestingly, I observed at my eye doctor visit yesterday when my visual accuity was checked, I could only read at best the 20/25 line with my right eye, the one with the toric IOL that was measured with autorefractor to have about 0.50 to 0.75D residual astigmatism and near plano power.  

While at the eye doctor office I then put in one drop of lubricating eyedrop and I could then read the 20/20 line clearly with that eye but only for a few minutes after putting the drop in.  So my dry eye seems to have some effect on my visual accuity that varies, best in the morning and less so in the afternoon which was when the eye doctor visit was.
Thanks for posting. I don't see a question there.
Yeah it was more just an update and observations.

Though have you also encountered this current issue regarding the allocation of dorzolamide based eyedrops that my eye doctor told me about yesterday?  I did a quick internet search and found several articles about it online from a few months ago and then some of the manufacturers were predicting stock should return late Feb or early March, so I wonder if this is the case or if the issue now continues for a longer time period?
Yes there has been nation-wide and regional shortages of many glaucoma medications over the past several months. A nightmare for ophthalmologists and their staffs to work around.   My opinion the behavior of many pharmacuetical companies is reprehensible.  We used to be able to prescribe 5 ml of generic prednisolone acetate for $4 at Walmart's. Now its over $85 in some places.  But don't get me started on that or what Alcon did to try and keep the price of Restasis up.  
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