With this RX, IOL left eye & glasses right eye??

[Ginger222]

I'm trying to get a better understanding of what our options might be before my husband's cataract consult so we can can be better prepared to ask the appropriate questions.

A little background... The optometrist he had been seeing for several years was puzzled as to why his RX had changed so dramatically over the course of 6 mos. or so and he couldn't find the cause. He was not able to get him clear vision in the left eye & recommended seeing an eye MD, which we did. The MD promptly found a cataract (I don't know what kind?) He was quite baffled (& a little irritated) as to why this other person hadn't identified it. Supposedly the optometrist had checked for that, as well...

Anyway... As stated in my previous post, we're thinking that a standard aspheric IOL would best suit my husband's personality and lifestyle. He's worn glasses all his life, so still wearing them post surgery would be fine. We are looking for the best option for a more predictable, clear vision outcome, with a minimal adjustment period.

I don't understand what this RX means in terms of astigmatism, etc., as it might relate to his IOL options...

It says     Right eye     Sphere -525   Cylinder -100    Axis 163
               Left  eye                 -575                -050            090  (this is the eye later discovered to have cataract)

There is also a "reading RX"

               Right eye     -350     -100     X  163
               Left eye       -400     -050     X   090

Based on those numbers, would he be able to wear an aspheric standard IOL in the left eye and glasses for correction of the right eye? He's not a contact fan.

Thanks for any information you can provide!!!

[Ginger222]

Thank you, JodiJ, for your comments!!  I'm still trying to figure out this posting thing so that Dr. Hagan would even see it to respond, as well...

Dr Hagan,

We learned at my husband's consult that he has a rapidly developing cataract in the right eye, as well. At that time we had told the physician that we would hold off on his right eye since it wasn't bothering him very much.

Well his vision in the right eye is deteriorating rapidly  (he has had 3 spinal steroid injections recently which we're guessing is a contributing factor in his cataract development).

At the time of the consult the doc had decided on an aspheric Alcon IQ mono for the left eye set for distance which he could maybe tweak a bit for some intermediate vision (is how I understood it, anyway.) He is right eye dominant, however.

When ever we needed to do the right eye he recommended a toric due to his astimatism. We've now decided to go ahead with the right eye 2 weeks after the left (haven't confirmed  this with the doc, yet) but the toric premium is really not an option for us at this time, financially, so I'm guessing we'll need to go with another standard aspheric and LRI's?? He appears to be very experienced with LRI's but prefers the toric for a more predictable, accurate outcome, from what I can understand.

So my question is this... Now that we have to do both eyes should we be approaching things differently?? Since he doesn't particularly mind wearing glasses, would he best off having both eyes set for distance and wearing glasses?

I'm not sure what the best approach is now... The doc. did suggest that he would not be a good candidate for any of the multi. focal, etc. lenses because he has very large pupils. That was just fine because we had already determined those might not work well for him, anyway.

So given that he now has to have both eyes done, but he's right eye dominant with astigmatism and is having the left eye done first....

What should I hope/expect the doc. to suggest to him regarding how each eye should be set. He didn't seem very keen on the mono vision approach and frankly I think hubby would have a hard time adjusting to that, anyway. He's always been sensitive with his vision.

He just wants whatever will allow him to see the best with the least amount of grief and potential issues.

[JodieJ]

Everybody's different, and there is no "best" solution.  I have a history of developing double vision from wearing monovision contacts, so I wanted to have both eyes at the same target.  With aspheric monofocal IOLs and limbal relaxing incisions, both my eyes are plano and 20/20 for distance, but my near and intermediate vision are quite blurry.  Consequently, I usually wear progressive glasses.  (I know other people with the same vision as me who rarely wear glasses, but they are not avid readers or online much.)  I probably would not recommend my correction to your husband.  I think he'd be happier with mini-monovision (leaving his non-dominant eye slightly nearsighted, with good distance vision in his dominant eye.)  I don't think he'd have trouble adjusting to this after both his eyes were done.  Between surgeries, I'd suggest that he try a 1-day disposable contact lens in his unoperated eye.  This has worked for people in their 60's and beyond who have never worn contacts before.  Otherwise, he will probably feel very unbalanced, and he may have difficulty performing some daily tasks (unless he patches one eye.)

[Ginger222]

Thanks, for responding, Jodie J. Your comments are always appreciated :) I guess the right eye insurance question I asked you about several weeks ago took care of itself with a cataract having now appeared.

So given that he now has to have both eyes done, but he's right eye dominant with astigmatism and is having the left eye done first....

What should I hope/expect the doc. to suggest to him regarding how each eye should be set. He didn't seem very keen on the mono vision approach and frankly I think hubby would have a hard time adjusting to that, anyway. He's always been sensitive with his vision.

He just wants whatever will allow him to see the best with the least amount of grief and potential issues.

[JodieJ]

With both eyes set for distance (plano), everything within arm's length is blurry.  Your husband would need glasses for all near and intermediate vision tasks, including reading, shaving, seeing his monitor.  For most people, leaving the non-dominant eye a little nearsighted is a more versatile correction.  BTW, the numbers posted above suggest only mild astigmatism, which could easily be corrected by LRIs.

[Ginger222]

We learned at my husband's consult that he has a rapidly developing cataract in the right eye, as well. At that time we had told the physician that we would hold off on his right eye since it wasn't bothering him very much.

Well his vision in the right eye is deteriorating rapidly  (he has had 3 spinal steroid injections recently which we're guessing is a contributing factor in his cataract development).

At the time of the consult the doc had decided on an aspheric Alcon IQ mono for the left eye set for distance which he could maybe tweak a bit for some intermediate vision (is how I understood it, anyway.) He is right eye dominant, however.

When ever we needed to do the right eye he recommended a toric due to his astimatism. We've now decided to go ahead with the right eye 2 weeks after the left (haven't confirmed  this with the doc, yet) but the toric premium is really not an option for us at this time, financially, so I'm guessing we'll need to go with another standard aspheric and LRI's?? He appears to be very experienced with LRI's but prefers the toric for a more predictable, accurate outcome, from what I can understand.

So my question is this... Now that we have to do both eyes should we be approaching things differently?? Since he doesn't particularly mind wearing glasses, would he best off having both eyes set for distance and wearing glasses?

I'm not sure what the best approach is now... The doc. did suggest that he would not be a good candidate for any of the multi. focal, etc. lenses because he has very large pupils. That was just fine because we had already determined those might not work well for him, anyway.

Thanks for any thoughts!!!

[JodieJ]

Possibly Blue Cross would pay for LASIK--I think a case could be made that it was "medically necessary" for your husband if he could not tolerate a contact lens.  He should probably get recommendations from more than one cataract/refractive surgeon, who could provide info about advantages/disadvantages and insurance.  (It used to be harder to make accurate IOL power predictions for an eye that has had LASIK, but I've read that this is no longer the case.)  

[Ginger222]

I don't know what this particular surgeon might recommend...  We haven't met with him yet. I think hubby would like the idea of Lasik for the other eye but it isn't in the finances just now. Can't imagine insurance would go for that one??

From what I understand he probably has a pretty good chance of developing a cataract in the other eye as well... particularly because this one developed so quickly. Is there any advantage or disadvantage to placing an IOL in an eye that is undergone a prior Lasik procedure??

[JodieJ]

I forgot to mention another option:  getting LASIK in the second eye.  I actually had measurements done for both LASIK and an IOL for my second eye.  However, I was so pleased with my results with an aspheric monofocal IOL that I knew I wanted another one for my second eye.  If your husband had his IOLs set for modified monovision, with a little luck he would only need glasses for prolonged reading or seeing small print.

[JodieJ]

Definitely speak to the insurance person in the ophthalmologist's office about this.  I had only one fast-developing cataract as the result of having had retinal surgery, and I had high myopia (both eyes).  I had no problem getting Blue Cross to pay for my second eye, but I'm honestly not sure what was on the paperwork for the claim.  (What is the surgeon recommending for your husband's second eye?)  

[Ginger222]

Thank you for your reply... Do you really think that might be a possibility??? Insurance paying for both eyes when only the left requires treatment at the moment? What might they be willing to do for the other eye in your opinion? We have BCBS, our potential surgeon is an in network provider, but I haven't investigated the coverage details yet. We hadn't even considered that but it sure would be great!!

As far as using a contact, I'm not sure if he could get used to that or not. He never really cared for them when he was younger because his eyes were so sensitive... Granted I'm sure they've changed a lot over the years. He's 46 now and hasn't tried contacts in probably 25 years.

Again, just trying to get our thoughts/options together so we can make an informed decision. It's really helpful being able to bounce this off of folks who've been there rather than trying to understand and digest it all in one office sitting!!

Thanks again...

[JodieJ]

I agree with ace399.  If your husband's vision were corrected for distance, glasses would not work.  He would have to wear a contact lens in his right eye.  An alternative might be to correct the left eye to about -300, but I personally would not choose this option.  Another option would be to do the right eye sooner rather than later.  In your husband's case, his insurance would probably pay for both eyes.

[ace399]

I had a Crystalens HD IOL in my right eye and eye glasses for my left eye (-6.25 D) and I could not cope due to the difficulty in my eyes trying to resolve the large difference in the image sizes.

[Ginger222]

Thank you very much for your response. I'm not quite clear on his ability to have an IOL in the left eye and glasses to correct the vision in the right eye... I don't have a very good understanding of what all the numbers mean.

I recall reading something about it being a problem if there is too great a difference between the vision of both eyes? Does that apply here?

So would the left IOL perhaps be set for distance vision and then wear his glasses for the right eye? Is that a possibility?

I have to say we were quite relieved to hear it was "only" a cataract from the MD. We were becoming quite fearful that if it wasn't a cataract it could be something much more serious.

One last question... What does the  add +1.75 for each eye mean??

Thank you so much for your time!!

[John C Hagan III, MD, FACS, FAAO]

The amount of the astigmatism is "cylinder" and the direction is "axis"

You husband has only a modest amount in the right eye and very little in the left eye.

A reading on the cornea called a keratometry reading will be done to determine if he has unexcpect amount of corneal astigmatism. Usually the glasses RX and the K reading agree.

It is possible to reduce astigmatism by putting the surgical incision in the direction of the astigmatism. An aspheric monofocal IOL should give good results without a toric IOL or limbal relaxing incisions. (LRI)

YOUR CASE ILLUSTRATES THE DIFFERENCE BETWEEN A NON-MD OPTOMETRIST THAT DIDN'T IDENTIFY THE CATARACT AND AN EYE MD THAT DIAGNOSED IT EASILY.

jch md

[Ginger222]

Sorry, the first RX above also says ADD +1.75 for both eyes???