IOL options with impaired acuity after ERM peel

[chazas]

My eyes were both very myopic, around -9 each.  I’ve been happily wearing multifocal contact lenses for years.

Last April, I had a retinal detachment and an emergency vitrectomy – I got a scleral buckle and had a gas bubble. I almost immediately got a cataract.  I wanted to go with a multifocal IOL to correct the cataract, but then I developed a significant epiretinal membrane, which made hat inadvisable.  

A couple of weeks ago I had a combined second vitrectomy/membrane peel and monofocal IOL implantation.  They were aiming for -1 to -1.5 so that either I could decide to either use the eye for mini-monovision (get the other eye done plano later) or just have a consistent near/intermediate focus. Recovery from the membrane peel seems to be going ok – the surgeon says I’ve gone from 20/400 best corrected to about 20/80, though so far it’s not clear to me whether this eye will ever have sufficient acuity for easy reading.  The other problem is that we had a big refractive error – if I remember the numbers right, I’ve ended up about -4.5, but (at least with the stitch still in) wit about +2.25 of astigmatism.  The surgeon said that effectively leaves me around -3.5, an unhappy result.

She’s ruled out explantation of the IOL as too invasive because of the multiple surgeries, says that when things settle down I could do either a piggyback lens or have Lasik.

So here are the questions.

Has anyone had either a piggyback lens implant or Lasik to correct an IOL refractive error?  How did you choose the approach?

Any input on abandoning the mini-monovision plan and having both eyes done about the same, whether plano or about -1.5?  As a non-expert I would think that if I continue to have significant acuity problems with one eye, having both of them at about the refraction is probably going to give me better results.

As an alternative, has anyone ever heard of a strategy using one eye for everything and the lesser quality eye just for periphery/stereopsis?  I.e., not worry too much about where the “bad” eye ends up, and get a multifocal IOL (or just wear a multifocal contact) on the other.

Thanks for any thoughts.

[JohnHaganMD]

If you have confidence in your refractive surgeon would suggest going with what she/he recommends. JCH MD

[chazas]

Something odd is going on, and the opthamologist doesn't know what.

The first time he had his assistant do the refraction in my "bad" eye they couldn't get me closer than 20/200, which was odd since my previous doctors thought I was correctable to 20/30ish.  So he had me go to their practice's best optometrist, who was the one who refracted me to 20/20 as per my last post.

So I go in today to "confirm" the refraction and the opthamologist's assistant (a different one) again couldn't get me better than 20/200, though he says he was using the measurments the optometrist gave him.  They're sending me back to the optometrist to double-check and I've politely suggested it might eventually be a good idea to have both doctors in the office at the same time.

I'm semi-convinced that the two assistants are making some fundamental mistake - but it would be very odd to have it happen twice. The opthamologist doesn't see any sign of a new membrane or anything like that.  

Has anyone ever had this happen?

[JohnHaganMD]

Not very often especially if both are competent refractionists. Having both in one room is good idea.  Be sure you're not peaking and reading the line with your good eye.

JCH MD

[chazas]

Thanks.  I wasn't peeking.  :-)

I've asked my retina specialist for another referral to get a second opinion as well.

[JohnHaganMD]

best of luck

[CBCT]

Hi Chazas,
Like you, I have retinal issues (cryo and laser for two tear experiences -- but no buckle, macular pucker and retinally induced   aniskonia).  I am very happy with my surgeons (cataract and retina), but my experience with their techs doing refractions has not been so good.  I have also had varied experience with optometrists.  If you can't solve the mystery with the resources at hand, consider contacting Ohio State University School of Optometry -- perhaps they can field questions, or refer you to a local graduate of their program.  I contacted Dr. Toole, an OHU professor, who was very helpful.  
Best wishes.