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aniseikonia after cataract surgery

I am a 51 year- old female and first of all English is my second language, so please excuse my crude writing. I had cataract surgery about 8 weeks ago (Nov. 19)on my right eye only. I was/am a high myopic on both eyes and had full mono vision trial successfully with soft contact lenses for about 2 years prior to cataract surgery.

I wore -9D contact lens on OD(20/20) which is my dominant eye, and -8D on OS(20/30). I got AcrySof IQ SN60WF 6.5D IOL on my right eye for distance at a regional eye care surgical center. On the next day of surgery I saw the image size between two eyes were very much different that I could not focus at all. I had never heard this could happen at all from my eye doctor who took care of my many eye checkups/cataract surgery so I was very shocked and felt extreme anxiety along with imbalance and dizziness. My doctor said it is due to the difference of diopter (plano vs -8) even with wearing soft contact lens on my left eye and I have to have another cataract surgery on this left eye to correct the problem. I was not ready to have cataract surgery on my left eye at all because the cataract is minimal, and am having many troubling days and nights since.

I went for a second opinion at much bigger university eye center, and heard same answer that I need my left eye IOL done, too. Just to make sure I checked with my retina doctor one month after the surgery and heard I have no other retina/macular problem at all except for existing lattice degeneration on the far corner of my right eye. The retina doctor said this is not causing any problem with my vision. I am still dealing with my anxiety problem under my primary care doctor due to unexpected aniseikonia, but willing to accept cataract surgery if it really gets rid of this problem because it hinders my daily life in many way. I have occasional flickering and catching-something feeling on IOL eye which I think will go away as time goes.

It seems like aniseikonia after cataract surgery on one eye is well managed with wearing contact lens on other eye. But then I wonder why does this happening to me? Will it be corrected fully once my other eye surgery is done?

Currently my
OD is -0.25 (with 6.5D mono focal IOL)
OS is -10.25 +7.5 axis 58, with -8D contact lense 20/30

Originally my doctor wanted to make my left eye target -1.75D achieving full mono vision. I tried three different diopter of contact lenses-  -8D, -7.5D, and -8.5D for my left eye to see how can I handle the different near visions. I was comfortable with my current -8D contact lens which gives good near vision and distance, and with -7.5D contact lens I get very good near but somewhat poor distance vision, and very good distance but not great near vision with -8.5D lens. I was most unhappy with -8.5D contact lens because I lose some near vision with this.

With my priority of correcting aniseikonia, my doctor offered to a new target of  -1.5D on my left eye which will reduce the gap between my right IOL eye( -0.25D) using 9D IOL on my left eye. I think with this IOL my near vision would be not so good and as a very high myopic person for life I would be somewhat uncomfortable try to adjust to new life style.

I would be happy if my left eye surgery result is -1.75D as originally planned, but the worries and fear of possible aniseikonia even after surgery makes me undecided what to ask doctor. My other question is my right eye was slightly more myopic before(about -11.5D with -9D contact lense 20/20), but with 6D IOL plano was achieved, and then, is 9D IOL on my left eye bringing -1.5D after surgery?

10 Responses
Avatar universal
Aniseikonia is usually much less of an issue with  a contact lenses on the other eye after surgery than it  is with glasses since the size difference is smaller. However  as you discovered it is still possible since people have different sensitivities. Some people can adapt to larger size differences than others. There is no good explanation for "why this is happening" to you other than bad luck that you are perhaps more sensitive than most.  

re: "but with 6D IOL plano was achieved, and then, is 9D IOL on my left eye "

The power for an IOL depends on measurements of the eye like the power of the cornea, they measure the size and shape of your eye and use that to calculate an approximate IOL power. It isn't possible to tell what IOL power someone needs just from their contact lens power. Two people could wear the same contact lens power, but need IOL powers that are a few diopters different from each other. It partly depends on how much of your eye's focusing power is in the cornea, and how much is in the natural lens. You also unfortunately can't tell from the power one eye uses what power the other eye will need because it is possible the measurements of the two eyes aren't the same. Surgeons use formulas that take eye measurements and calculate the approximate IOL power needed to achieve certain focal points for the eye. e..g the formula will say that an IOL power X will likely leave the eye focused at Y diopters (whether 0D for perfect distance, -1.75D for a bit nearer for monovision, etc).

If you didn't have Aniseikonia issues when you wore contact lenses pre-surgery, then after your 2nd surgery you aren't likely to have issues either. Likely  whatever monovision worked for you with contacts should likely work for you with IOLs. However you'll note I'm not being definite,  unfortunately there is guarantee given  you are more sensitive to differences than others, but the doctors should be able to make a more educated guess by running the numbers.    The doctors should be able to use your eye measurements to be able to calculate the approximate level of aniseikonia between the eyes that you have now, what you would normally have had before cataract surgery, and what you would have after surgery. Since you are having trouble with the issue, it seems worth asking the doctor to explicitly do the calculations. Whether there is an issue will likely depend on how similar your two eyes are,   how much of the focusing power of each eye is in the lens (natural or artificial) and how much is in the cornea.
1 Comments
Hi, I have read all of your kind replies in this Eye Care Post since my cataract surgery. I really appreciate your comments which helped me more than anything to sorting my problems out and finally finding the term Aniseikonia out. My doctor said I am his first patient who experiences this, so he was not expected this could happen. It seems like my doctor and 2nd opinion doctor both were not interested on measuring the amount of my Aniseikonia. All I heard were I need my OS surgery. Now I think I need to visit 2nd doctor again to see his idea of IOL for my left eye.
177275 tn?1511758844
Your interests have not been served by your surgical team failing to inform you of the problems with your eyes working together (aneisometrophia and aniseikonia) after surgery. It is to be expected. Moreover given the amount of your myopia in your LE one would not expect a contact lens to take care of the problem. Please read this carefully:  http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You

also since your RE saw 20/20 I wonder why you had cataract surgery at all and further why your LE which has 20/30 was not done first.

If you wrote you LE RX correctly you have 7.5 diopters of astigmatism and you will need to deal with that by toric IOLs or cornea surgery laser or incisional.

Use the search feature and read the many helpful posts by JodieJ on anisekonia from previous discussions.

JCH MD
1 Comments
Thank you Dr. Hagan for your reply! I called the doctor's office to check my astigmatism, got a copy of my LE Rx: -11.00 +0.5D x101.
The office receptionist probably made mistake giving me wrong Rx. My cataract was more severe in my OD with minimal cataract in OS, that's why doctor wanted to do my right eye first.
Avatar universal
Here is a paper on the issue for your doctor:

https://www.researchgate.net/publication/51429164_Predicting_refractive_aniseikonia_after_cataract_surgery_in_anisometropia
"Predicting refractive aniseikonia after cataract surgery in anisometropia"

Here is one site with an IOL power calculator that mentions it comes up with aniseikonia if both eye's measurements are used:

http://www.augenklinik.uni-wuerzburg.de/uslab/publ/ios97/shortpap.htm
"Apart from the original input data on the left side, the results for the 2 IOLs selected are given as tables, stating IOL power, resultant refraction and expected aniseikonia."
177275 tn?1511758844
What is done is done. Still doesn't make sense to do cataract surgery on the eye with the better vision. In any case I think you are stuck with removing the left lens and putting in an IOL for the intolerable aneisokonia/aneisometrophia. With the comments of Software Developer and my article you should be able to make a better choice.   Aiming for a post op refraction of 0.00 (plano) RE and -1.75 LE would be mini-monofocal with distance bias.  It works very well for many people. To use your eyes together you would need glasses in a no-line multifocal form. You would be able to do many things without glasses.   JCH MD
Avatar universal
After getting second opinion and reviewing your comment I had my left eye IOL surgery on Feb 18th. It's been just about 4 days since.

My current right eye is plano with 6.5D IOL, advanced from slightly more from my 2 month followup of -0.25. My doctor and I chose my left IOL targeting -1.75 with 9.5D IOL(SEQ Ref -1.79).

I hoped my unbearable aniseikonia would be almost gone after surgery, but I still experience noticeable aniseikonia which is somewhat better to handle than before the surgery though. I have very good near vision with my left eye, I have very clear vision when I use my iphone or anything closer than 1 foot. But things get unclear soon after 1 1/2 foot, and everything is so fuzzy after. My right eye is seeing well from 3 feet and further(20/20).

With my both eyes open, due to the persisting aniseikonia things are not fused well. Mid-range activities like watching TV is not easy. I see very well with my right eye but I see almost nothing well with my left eye. I don't read big letters of 55 inch TV even from 5 feet apart. It affects all my intermediate and distance vision all together.

I am seeing my doctor in 3 week post op. If the difference of diopters is greater than 2 at the time and still have trouble seeing with both eyes after 3 weeks, what could be my best choice to correct or cope with this problem? My corneal thickness is 530 to 540 and I do not feel laser touch-ups is a good option(my doctor also told me the same even before left eye surgery). How about piggybag IOL or even IOL exchange? I know I need to wait at least 3 weeks after surgery to get my left eye diopter accurately but with moderate aniseikonia even after left eye surgery it makes me worried and feel need of informed. Thank you.
1 Comments
With a difference of only -1.75 you should not have significant aneisokonia. What you may be calling that is simply that neither eye is in focus at the same time and that's why its called monofocal. Moreover I suspect you may still have some cornea edema that is giving you more myopia than you will have in a week or two. I think it is far too early to be considering IOL exchange or piggyback IOLs.  Let the eye heal, let your brain get use to the mini-monofocal and also see how glasses work out to balance out the vision.  Look where you started with your high myopia. you are use to wearing glasses, your vision is far better without glasses now than its been for most of your life. Give it some time.  Most of the patients I've managed with similar refractive errors end up very happy 4-6 weeks post surgery.
Avatar universal
Yes, I will try to relax more and hope my brain adjusts to this new vision. After my first 3 week post-op visit I will update you how my visions are settled. I really appreciate your comment.
1 Comments
Also note how much brighter color vision is. Discuss with your surgeon. It generally gets much better. JCH MD
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