What is range of vision after iol for nearvision

[1939Narvik]

I am having a monofoncal iol in both eyes due to cataract. My Surgeon thougt technis eyhance was a good ide. Im myopic - 4,5 and 5,5 with astigatism. Im som afraid i have tanken the wrong decission. Dont think I can make the switch from nearsighted to loose my nearvision. Another surgeon suggested to put me on 2 minus and be a bit myopic. With one toric Lens. Now that seems better to me. Im just habby to SEE better and drive again. The glasses or contacts is not an issue anymore.  But what will my range ov vision be? Can I see within my house? Even if its blurry, will I see my children 3-4 meters away.? Anyone in my situation?

[1939Narvik]

Im really greatful for your answer. Im having both eyes taken the same day under general anesthesia, due to servere anxiety. I never thougt this prosess would be so hard.

[JohnHaganMD]

This is about all I'm going to say.  We do tens of thousands of cases and we almost never use general anesthesia and never do both eyes at the same time.  WHY:  1. general anesthesia if far more dangerous and expensive.  2. Infection the worse possible complications the the major cause of complete blindness after cataract surgery.  A real tragedy if only one eye but both eyes?  3. It does NOT allow you to make adjustments on the second eye  "e.g.  doctor please set my send eye with better near vision or better far vision  4. It is possible for IOL power to be 'way off'  then you have both eyes that are 'way off"  

[1939Narvik]

Im so afraid i cant lay still - panic if im awake during surgery. I really wish I could to this the ordinary way. I really wished for one eye at a time, but They said I had to take both when general anesthesia. Any  suggestion what i can do to relax due to great anxiety? I also  have wished for one eye because  of the reason you mentioned. One doktor said IT would be more difficult to place the toric Lens under general anesthesia while the other said IT would be fine..I am 54 years old. .In my file it says that the left eye is dominant. The numbers: left eye; os: 0,30 (-4,75/ -0;75x90. Right eye: O 025 (-5;0/-1;75x90). My contacts are stronger so I see a bit better far away.  When I last week measured eye for temoprarly new contacts at my optician the astigatism in right eye was 2.25. ) She said I now have 30 percent vision. I have regulariy cornea/ OD Cornelia astigatism.Not slanted (?) OD. I really value your opinion, if you have one more input to this.  Thanks a lot!

[1939Narvik]

Im so afraid i cant lay still - panic if im awake during surgery. I really wish I could to this the ordinary way. I really wished for one eye at a time, but They said I had to take both when general anesthesia. Any  suggestion what i can do to relax due to great anxiety? I also  have wished for one eye because  of the reason you mentioned. One doktor said IT would be more difficult to place the toric Lens under general anesthesia while the other said IT would be fine..I am 54 years old. .In my file it says that the left eye is dominant. The numbers: left eye; os: 0,30 (-4,75/ -0;75x90. Right eye: O 025 (-5;0/-1;75x90). My contacts are stronger so I see a bit better far away.  When I last week measured eye for temoprarly new contacts at my optician the astigatism in right eye was 2.25. ) She said I now have 30 percent vision. I have regulariy cornea/ OD Cornelia astigatism.Not slanted (?) OD. I really value your opinion, if you have one more input to this.  Thanks a lot!

[1939Narvik]

One more thing, just so I understand. Is the general anesthesia in it self a factor that can cause a Worse visual outcome. I mean, if a person tolerate the general anesthesia in itself. When you sleep you cant cooperate with eye movements . Has that anything to say.? (I have scheduled a new meeting with the surgeon . Its a public hospital) If I cant motivate myself to do the operation without beeing put to sleep, i will really work hard to Get one eye operated first. Witch eye do you think that should be? And shold I in that case wear a contact in the other eye to see ok before next surgery? Im very grateful for your opinion.

[GrandKK]

Narvik....I understand the anxiety. Within the last year and a half I've had retinal surgery and cataract surgery.  I was panicking about being awake for each due to my anxiety and I'm also claustrophic. The retinal surgery was close to an hour long while the cataract surgery was about 10 minutes. My fears were needless. The sedation they gave me made me totally relaxed...as if I didn't have a care in the world.  I don't remember much of either procedure. One thing I did that may help is taking an Ativan an hour before the procedure...with approval from your surgeon of course. Try not to worry..there is no need. It will be so much easier than you anticipate.

[JohnHaganMD]

Narvik:  Where do you live?   THIS IS VERY IMPORTANT:  The measurements for IOL are NOT ACCURATE in contact lens wearers.  To get accurate readings you would need to stop wearing contacts completely. Have a set of measurements (the contacts change the curvature of the cornea which is an important factor) after leaving contacts out over night. Then NO CONTACTS and another set of readings in a week.  You would need two sets of readings done a week or more apart that are the same before those numbers are used in the IOL  calculations.   SECOND   general anesthesia does not make it more difficult to put in toric IOL. Your LE (called OS) is borderline for toric IOL but RE (called OD) would benefit if skilled surgeon.  LAST POINT  Everyone is anxious about surgery on their eye, I would be also if me, my wife who has had IOL surgery was also.  When you come in they give you some medication to relax you. Before they do the injection to 'put the eye to sleep' they give IV medication that puts you to sleep for several minutes so you don't see or feel the injection. During surgery you are given IV sedation to relax you.   TO CONCLUDE ACCURATE CORNEA IOL MEASUREMENTS CANNOT BE DONE WITH YOU WEARING CONTACTS AND HAVE SERIAL MEASUREMENTS THAT HAVE TO AGREE.  Please tell me where you live. These practices seem strange.

[1939Narvik]

Thank you so much for responses! I will really try to motivate myself to NOT submit to general anesthesia or at least try to get two seperate surgeries. I live in Norway. The hospital is Ullevåll hospital/ university hospital in Oslo. I think the surgeon is well skilled. I am aware that contacts can influense the meassurments..The last meassurments at the hospital was in the fall 2019 I wore contacts right until minutes before my apoitment. My fault. I mentioned it but they didnt say anything about it. Otherwise there was a solid evaluation, I belive.  Maybe they will meassure again on surgery day. I will ask, but I do think I will get an updated evaluation since I havent been there for meassurments since fall 2019. My meeting a few weeks ago with the surgeon, was because I asked for a meeting, to discuss lenses. Unfortunatly  we agreed on Technis Eyhance, witch I regret. At least Im happy to go for still being myopic. (He did look quickly into my eyes though.) The last meassurment / right eye 2.25 astigatism was taken few days ago  after several hours Not wearing contacts. That was at the store where I buy lenses.Im so glad for your help!

[JohnHaganMD]

Best of luck.  Some people that wear contacts it can take 5 days to 6 weeks for the cornea to return to its normal state. There are differences in surgical practices between USA and Europe.   Europe are more likely to inject antibiotics and steroids into the eye at end of surgery so patient not have to use drops,  doing both eyes at once, especially in countries with socialized medicine which reduces cost to state, are much more common in Europe.  I don't know about general anesthesia.  In a super nervous patient we will prescribe tranquilizers to be taken day or two before and day of surgery.  By calm reassurance and explanation we are able to do the most nervous individuals.  General anesthesia is used only for wildly uncooperative patients (e.g. dementia). Good luck.

[1939Narvik]

Thank you from my hart for all your help to me and others.  Your a big inspiration sharing knowledge and care. I might post an update.

[JohnHaganMD]

Best of luck.

[JohnHaganMD]

First start by carefully reading this article:    https://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You--2019-2020-Update  ; Most near sighted (myopic) people that are used to reading without glasses are extremely unhappy if the IOL is set to distance and no glasses for greater than 20 ft or 6 meters   target post op refraction 0.00     I always try and dissuade patients from doing that.  Putting in an IOL to leave your non-dominant (reading) eye -2.50 would likely make you very happy. On the second eye you could tell the surgeon if you want more help for near in which case -3.00 could be put in or what most people do go for better intermediate distance say -1.50.  In the article I asked you to read that is called mini-monofocal near bias.  If you went for no RX for distance in your dominant eye 0.00 that would be full monofocal and is difficult for most people to adjust to and glasses are often very uncomfortable to wear. Your ability to see your children at 3-4 meters without glasses would be better post op than it is now.  Exact distances are not possible to predict exactly because of other variables like the IOL manufacturing process, your pupil size and how quickly they change shape and other factors.  If you have more than 1 diopter of astigmatism then a toric IOL would be a good consideration also.

[at_239]

Dear Dr Hagan, I had Tecnis Symfony implants but no matter what vision you expect or get after cataract surgery, my problem is that my sight is deteriorating with time and this started only a matter of weeks after the operations were done. People I know with monofocal lenses tell  me that they did not need distance glasses originally but now do. I have never seen sight deterioration after surgery discussed, and I assume this is because the shape of the eye is changing. What therefore is the point of paying for premium lenses in the belief of a glasses free future for life?

[JohnHaganMD]

You have posted on the eye forum about 15-20 times. You should have a little more insight. First an IOL only replaces the lens. The person doesn't get a new eye. Over time, with age the other parts of the eye often develop problems.  So the cornea, iris, vitreous, optic nerve, retina, macula vitreous and brain visual system age and have other problems.    Second: a honest surgeon, even with the best surgical skills can never tell a person that they won't have to use glasses for some things.  Even with premium IOLs many people need glasses for reading, computer work, night driving etc.   The most common reason for a person not seeing 20/20 after surgery is the presence of other eye diseases. When we say 20/20 we are talking about with glasses.  The perfect IOL that doesn't ever need glasses for anything for everyone getting that IOL doesn't exist and probably won't for a long time. Most people paying for premium IOLs need to be satisfied with not needing glasses 90% of the time.

[at_239]

Dear Dr Hagan,  I appreciate your reply. I am in the UK and with the domination of the NHS, which is basically take it or leave it, I believe we do not have the same understanding of health conditions because we do not have to make choices. We are just told what we can get. In this case I opted for private care and I mistakenly thought I could trust the consultant. It has taken me a lot a research to try to understand what has gone wrong in an area where I have no qualifications. It is very difficult to accept that dishonest surgeons exits in health care and to come to terms with how easily they deceive us. I am presently using an arbitration services to further my complaint and I want to be sure I understand the background and that is why I asked the question. But don’t worry, I didn’t realise there was a limit to the number of posts. I won’t bother you again.