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IOL lens post surgery imbalance trouble

I am a 44 year old female who until recently had moderate-severe floaters in my left eye together with a lazy left eye too which had got to a point that a glasses or contact lens presciption was no longer able to provide clear distance vision.  I have always worm glasses since childhood  for myopia with prescriptions changing with every visit to the optician.  
My prescription for lenses is -9 in my left eye and -7 in my right so I am fully dependant on glasses or lenses for everything.     The floaters in my left eye were becoming a nuisance and after seeing several consultants opted for a victrectomy procedure and was advised to have an IOL at the same time as a cataract would be inevitable  6-12 months Lester anyway - so rather than 2 ops I opted for a dual procedure.    

It's now 8 weeks after the op , the lens misted over so needed to have a YAG laser procedure to demist the new implanted lens.  

Owning to the biometry prior to surgery my surgeon said the best solution was a mono focal lens to correct my failing distance vision.  Problem is now the inbalance between my left and right ( whilst wearing my -7 contact lens) is awful - light headedness and I am unable to see close or mid vision without glasses.  The glasses I have been prescribed  sadly do not provide me with perfect vision at any distance.  I do not understand the light science and physics behind it all so forgive me, but now - and compared to my  vision before - I am hugely disadvantaged. I need glasses for reading which I was fully aware of, but different ones for computer work, since the 2 needs are different.

My distance vision is ok - quite sharp- but since everyday, every minute vision requires mutli focal adjustments the overall outcome is terrible and I regret the whole procedure.  

In retrospect the floaters than triggered this surgery could have been tolerated if I had been more aware of the outcome.  

My surgeon tells me the only way to correct the inbalance is to have the other 'good' eye done. Naturally I am very reluctant and this is not an option I am willing to consider.   Another thing I was not made aware of is that once you have and IOL you will not be able to wear a plain  spectacle lens in one eye and a prescription lens in the other- it simply doesn't work due to the image sizing on the retina- again not sure of the science but it's just not a option meaning I have to wear a Contact lens in my right eye all  day every day or wear a pair of glasses with the left eye patched over- far from ideal but the only comfort I can get if I need to take the lens out.  
No one told me about any of this prior to the surgery and that the removal of the floaters would have wider , and significantly more impactful consequences.  

I am terribly sad to have elected to have this procedure done and wanted to share my experience in case someone else is considering something similar.         Also if there is anyone out there with similar experience and how you have dealt with this , I would be very grateful to hear from you.
  I have been trawling the internet for weeks now and only wish I have found a forum that discussed this much earlier as for sure my elective decision would have been different.   My decision is life changing baed on what I have been told, other than having the other eye done which would throw up it's only significant challenges too - so not a foolproof solution.

Any help or advise gratefully received.
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Avatar universal
"Retina detachment surgery, vitrectomy, scleral buckle nightmare"- around page 15 as of 4-19-15. Please try to find out what you can do. No one told me anything.
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Avatar universal
You might fine the info at this link to be helpful.
www.opticaldiagnostics.com/info/aniseikonia.html
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Avatar universal
re: "do you know if I can wear contact lenses over IOL eyes"

Yup,  I suggested that since you have a monofocal you might consider trying a multifocal contact lens in the IOL eye, since perhaps the added focal range might help your brain merge the images from the two eyes easier. I had good luck with multifocal contacts before my cataract surgery.  There is no reason you can't wear a contact lens in that eye, many people who have some remaining refractive error after surgery use contact lenses even just for distance correction. Some people have better luck adapting quickly to low-add multifocal contacts than high-add, so you might try that first, and if you have no trouble with it then try a higher add.

re: "do you have any knowledge of whether this will / could lead to an acceleration in the deterioration of the good eye ? "

The general consensus seems to be that even if you feel eye strain, or struggle with seeing due to refractive error, that  merely using your eyes doesn't accelerate deterioration of an eye. (at least for otherwise healthy eyes, I don't know if there are any eye conditions that would change that).  

re: the Bates Method, here is an eye surgeon who seems to be good about focusing on evidence based medicine who suggests it may be merely a placebo:

http://eyesurgerysingapore.blogspot.com/2014/10/what-is-bates-method-and-does-it-work.html

re: " did consult with a refractive opthalmic specialist who wasn't able to provide me with a pair of glasses that fixed all of the disparity issues at all focal distances. "

If you do a search on some combination of "slaboff" or "slab off" and anisometropia or aniseikonia   you'll see pages talking about the issue.

I'm not familiar with the term "refractive opthalmic specialist", I'm unsure if that is an MD or a technician/assistant or what here in the US would be an optician.  In the US at least it is opticians, those that actually make the glasses, that seem to be more familiar with the optics of glass lenses. I had researched the issue on the net a bit before my eye surgery since I had expected I'd only do 1 eye and wish to at least have backup glasses afterwards even if I usually used a contact lens. The impression most opticians give is  eye doctors tend to focus on the eye itself and merely hand off the prescription to the eyeglass places and assume it can be made.. even if there is a large difference between the prescriptions for the two eyes. Obviously some doctors will pay more attention to ensuring their patients needs can be met by opticians.

re: "From the surgeon telling me, you'll need 'reading glasses' (only) to the situation I am in now is alarming and frightening- and suffice to say I am angry.   "


Many surgeons are good about cautioning people before a surgery that may be postponed that there are risks, even if they are low. Unfortunately some others have good results so often they tend to overemphasize that instead of reminding people that even if there are only a small percentage with a problematic result, that *anyone* could wind up being that "statistic". Unfortunately since some outcomes are very rare, some surgeons may not be aware of them if they'd never encountered them before. Or they   merely don't wish to take the time to  go through and talk about every conceivable outcome that is rare and figure a general warning that there are risks involved to be sufficient, since they don't expect to encounter a problem.

I can understand the frustration of course (as can many on this site of course since its often those with problems that read here), since I had only really been concerned before my surgery about the risks of night vision issues like halos and glare, I hadn't expected to have a very rare problem  with reading vision (text jiggling, moving up and down,  due to IOL and/or iris movement still 3.5 months postop. That isn't something that  can be fixed with glasses  or contacts, and 6 eye doctors say "it will hopefully resolve itself at some unknown time within the next few months, best to do nothing  now since it may fix itself .. and there may not be an option later or the only options later may not work and risk making it worse"). Of course in my case the surgery in the 1st eye wasn't optional due to a bad cataract which also interfered with reading since the vision in eyes wasn't merging well anymore, (and that eye is  causing most of the problems).
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Avatar universal
Thank you for your comprehensive email. You are very knowledgeable on the matter and I appreciate very much the time you have taken to reply to my post.

In reply to your comments-
Re-  presbyopia - general reading, computer usage was not a problem with my everyday glasses or contacts, threading a needle did require me to take off my glasses so it was creeping in one could say, but other than that all was good.

Slab off- I have not heard this term but post surgery I did consult with a refractive opthalmic specialist who wasn't able to provide me with a pair of glasses that fixed all of the disparity issues at all focal distances. What I've been left with with is a pair of specs that, working with the IOL and contact, allows me near vision through the right/un operated on eye , but no visual support or acuity through the IOL eye, for Computer usage (at a slightly longer distance) both seem to work together, but then for far vision, again the good eye does the work whilst the IOL eye is blurred.    I've been advised that the reason for this is to provide the best vision possible and without the need to take glasses off and on constantly for different focal distances.  One thing I didn't mention is that prior to see the ophthalmologist I went to my my regular high street option and bought a pair of over the counter reading glasses +1.5 in both eyes and compared to the reading vision I get from the prescribed specs the vision from the OTC glasses is better ( wearing them now) .

  I did ask about this and again the IOL eye requires a higher reading power than the good eye and given the dioptic difference my eyes won't tolerate it hence the dilution of the prescription to a point where my eyes can accommodate it.  

All in all it's a depressing situation and whilst I am usually a positive person this whole thing is getting me down.    From the surgeon telling me, you'll need 'reading glasses' (only) to the situation I am in now is alarming and frightening- and suffice to say I am angry.  

I have received more information post surgery from the refractive specialist and forums than I received pre-op and as I said in my last post, armed with the information I now have outlining the impact, consequences and huge compromises I am having to suffer and endure, I simply wouldn't do it again if I had the time again.    The floaters were nothing in comparison to my current vision, which was perfect ( other then the lazy eye) by comparison (with glasses or contacts) .

Given that my good eye is compensating for the IOL eye, with and without glasses all of the time (other than long vision) , do you have any knowledge of whether this will / could lead to an acceleration in the deterioration of the good eye ?

Also, and whilst having another surgery is the furthest thing from my mind at  the moment, do you know if you can wear contact lenses over IOL eyes to provide near and mid vision?  I have a feeling that isn't possible so would be stuck with glasses and no alternative.

Finally, do you know anything about the Bates method of eye correction ? Given all of the web trawling I have done this has only come to my attention and curious as to whether its a big scam or whether it may do some good to stop further deterioration of my good eye.

Thank you for the posts, can't tell you how much I appreciate them,

Greetings from London,UK
Apologies for any typos.




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Avatar universal
Since you wear contacts, one other possibility I'd wonder about is using a multifocal contact lens on the eye with the IOL to give it more of a range of vision so perhaps it'd be easier for it to be balanced with the other eye.

btw, I'm not positive about the details, but I *think* there are ways to measure the aniseikonia between the two eyes when you are wearing a contact lens on the unoperated eye (though you might need to find a specialist) to confirm thats the issue. Then if it is a problem there might be a way (I'm not positive) to correct it  if you don't mind wearing glasses. It seems possible  then they can give you glasses to wear over the contact lens   which can correct the image size disparity.  I think I might have read about this being done, but its a vague memory so I'm not positive its an option, but it seems to make sense.
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Avatar universal
The usual problem with wearing glasses with that large a prescription difference ("anisometropia" is the technical term) is that there is a difference in the magnification of the images. When the eye gets two different size images (aniseikonia) it can't merge them easily.

With a contact lens on one eye (rather than glasses), the lens is closer in and so there is less magnification and hence less image size difference. Most people seem to adapt to wearing a contact lens on one eye since there isn't much difference, but   not all. The degree to which people can tolerate aniseikonia varies, some people are more sensitive to it than others so I'd disagree with the assertion in the post above that you can "certainly" adapt to wearing a contact lens, given you are 8 weeks postop and have a problem still. It very well may be however that you will eventually adapt, I don't know offhand how long it can take worst case if you are going to.

It is difficult to create glasses when there is a large difference between the prescriptions in both eyes, they need to use techniques like "slaboff", which not all optical shops may be used to. I'm not sure that a 7 diopter or so difference is possible to handle, but I would suggest checking with a good optical shop to be sure they understand the problem and have checked with different labs, perhaps there is a source on the net that specializes in such corrections.

re: "My surgeon tells me the only way to correct the inbalance is to have the other 'good' eye done."

The reason for that comment is that laser correction takes place on the cornea, at almost the same location as a contact lens. There isn't much magnification difference with a contact lens, but if you are still sensitive to that much then it seems likely that you might also be sensitive to the difference if the correction is done on the cornea.

My impression before cataract surgery in my first eye was that it shouldn't be a problem to adapt to a contact lens in the other eye (  a -6D contact, the first eye was much more myopic), but my experienced surgeon made sure to order IOLs for both eyes just in case I wanted both eyes done afterall since many did notice a problem. I only had a problem cataract in one, the other eye only had the bare beginnings of one so I'd hoped to just delay doing the other. I noticed a definite sense of imbalance between the two eyes after the bandage came off on the first eye the morning after surgery, so I went ahead and had the 2nd eye done later that day. The sense of imbalance was gone as soon as the bandage came off that 2nd eye.

I very well may have been to adapt to the difference between the eyes if I'd given it time, I only had a couple of hours or less before deciding to do the 2nd eye (unlike your 8 weeks). The reason I didn't wait to see if I'd adapt is that my case is unusual because my first cataract had become a problem within a few months after it first appeared (unlike most that take years to develop) and I had this done in Europe to get a better IOL. I  didn't want to need to go back again in a few weeks if I didn't adapt, so I decided to just go ahead and get it taken care of instead of risking a few weeks struggling to adapt, or needing to go back in several months anyway if the cataract suddenly got bad in my other eye. It may be the other eye wouldn't have caused trouble for a few years, but since I had that "imbalance" it seemed best just to   fix it.
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Avatar universal
re: "I am unable to see close or mid vision without glasses.  "

Usually (but not always) the visual system adapts to use the better eye for  a certain distance. Your eye with the natural lens still should be able to adapt (while wearing a contact lens) to seeing at least at mid vision, so I'm wondering if the IOL eye might have been your dominant eye and its taking longer for you to adapt to the change due to that. I don't know if you were already wearing reading glasses before your surgery, however you are in the age range where presbyopia tends to have kicked in, so it could be that with just one natural lens able to accommodate that you would struggle with near vision even if you were adapted to the "imbalance" between the eyes.

You are much younger than the typical cataract patient and hence have more accommodation left in the other eye. So it may be that part of this "imbalance" between the eyes is due to one eye still having accommodation while the other doesn't, that it may take more time to adapt to the difference  than is typical with cataract patients who tend to have little if any accommodation in their other eye. Many people do adapt to your situation, or to things like like a multifocal IOL in one eye and a monofocal in the other, which is about as much difference in focal range as you have now between your eyes, however everyone is different and the time it takes is unpredictable. Neuroadaptation unfortunately can sometimes take a number of  months, so it is possible it will improve, but unfortunately it varies so widely doctors don't tend to be willing to predict how long such things can take. I have to wonder if an IOL that gave you more visual range, rather than a monofocal, might have been easier to adapt to since it would have been more similar to the other eye (a lens swap to a multifocal is one option to consider, though it  involves risks, and isn't as easy after a YAG which may limit what lens options you have).  The usual reason for a sense of  "imbalance" between the eyes however is due to the need to wear correction in one eye as you referred to, which I'll address in another post.
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Avatar universal
Hi, I have had one eye done, like you I had a monofocal IOL, I was -6.0 in both eyes, now I am around +0.50 in the done eye, the other is still -6.0.

So like you I still have an imbalance, I can say that at first I was unable to wear glasses to correct the difference, they made me dizzy - I was told about the image sizing problem in advance.

After a few months of wearing prescription glasses my eyes can now tolerate the 6 diopter difference, so perhaps if you stick with the glasses you will also be able to, although from the large difference you have this may be impossible.

You should certainly be able to wear a contact lens in the unoperated eye, the image sizing problem is only caused by the glasses in the operated eye vs the unoperated eye focusing away from the eye causing a magnification, because the contact lens sits on the eye there is no magnification to worry about.

Another optoin is the have laser eye surgery in the unoperated eye, if you have no cataract in this eye you should get some eye balance this way.
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