What is the best refraction post-cataract surgery?

[nancybethw]

I had my second cataract surgery 2 months ago. 15 years ago I had cataract, Yag Laser, Vitrectomy and Lazik on my left eye with poor final result. I only recently was told there is a Macular fold, but my vision has been wavy in that eye since the cataract surgery.  Due to the poor result, and no explanation as to why this happened, no surgery was done on the right eye at that time. The right eye is my dominant eye and needed about -5.00 correction for nearsightedness. The left eye cannot be corrected better than 20/40 and needs +3.5 for reading. Before my surgery 2 months ago, on the right eye cataract, my contacts were: Left +1, Right -5.5. So glasses have not been an option. The left eye does not seem to bring much assistance to my vision.

The cataract surgery on the right eye 2 months ago went well and now the surgeon said it is -.75. This is a great relief.

I don't understand my options for best correction. Do you have any recommendations? After 15 challenging years I want to see this all they way to the best that I can do. The surgeon said to test options and come back in the fall to assess if PRK is a good idea on the left eye, but wants to go slow and conservative.

- I have been given an Rx for distance only OD -.75, OS +1.00. This gives great distance but of course not any reading and weakened intermediate.

- I have been given a second Rx for progressive; same distance as above with Near Add +2.50 in both eyes.  These glasses will be ready to pick up next week for testing. I wonder about the +2.5. I am using 1.5 readers right now and they seem right.

- I asked if we can attempt monovision. This had not been presented as an option, but I was then given a +2.5 contact in my left eye which is not strong enough to bring it into the game. It really makes no difference. I think it needs to be a +3.5. (at the drug store 3.5 works for left eye) Would this be too far from the right eye? How many diopters apart can I go? Aftet being six apart for so long might the be workable?

- I would be glad if the left eye could help with reading and then I also used the distance glasses for driving. Is this realistic?

Any thoughts would be appreciated.
Nancy

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

The first thing you should do is get the progressive glasses and wear them all the time several weeks until you are comfortable wearing them, walking in them and using them. That will give you the best vision, at all distances, and is the safest and least expensive.    

You will not do will with monovision because your LE does not see well (20/40) and would give you compromised distance or near vision depending one which distance it was supposed to see. monovision also gives many distances that are not clear but would be clear with progressive mulitifocal glasses.

Your glasses RX is RE  -0.75 and your LE +1.00   +2.50 reading add.    Most people could adjust to that.  I would try and avoid PRK on your LE it won't help the eye see better only than glasses. If you had trouble the amount of hyperopia in the LE could be reduced.

Not sure why your LE was such a mystery. A macular fold would show up on the OCT easily and should have been done immediately with the vision did not return to normal.

[nancybethw]

Thank your for your reply. All those surgeries on the left eye were done 15 years ago and with many many tests, including OCT. Maybe they knew about the fold but never told me. I was just told they did not know what happened. My last appt was with a top doctor in Boston and was told nothing, essentially. He just said the lens was perfect and to leave it alone.

I will do as you suggest with the progressive glasses. I've never worn them so it's hard to imagine what that is. But I am used to adjusting to unusual vision!

I do wonder about the +2.5 for the reading add since it is so strong for the right eye and the +2.5 contact for the left eye that I have in right now does not do anything.

The left uncorrected is 20/70. The surgeon says consider is a 'spare', it really is not contributing. Because it does work with the +3.5 readers, that is why I wondered if it would be a potential monovision, correcting it for near.

[nancybethw]

Oh, my current surgeon, who is very good, says the LE lens is not placed well.

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

A  + 2.50 add in your progressives will NOT look like a +2.50 reading glasses.  First because you have -0.75 diopters of myopia at distance in your RE that helps you up close so the  + 2.50 reading glass "adds" 0.75 diopters of myopia making it the equivalent of a +.3.25 reading glass for someone that is 0.00 at distance.   Also when the multifocal lineless are ground it reduces the power by about 0.25 diopter and the RX is like a rheostat on a light by looking slightly higher you can reduce the reading power  and extend the range. Most of the post cataract patients I deal with I give _3.00. But try the + 2. 50 and see if you like it.  

This is what I tell my patients:  1. have a positive attitude "I will get used to these no line 'bifocal' glasses (really a multifocial)  2. Talk to a friend that wears them and likes them  2. When you look at something turn your nose and point your face at what you are trying to see. If you look off center towards the edge the prescription is not there or right (the glasses center is called the optical zone)  3. When you walk don't look through the lower part of the glasses, that is for reading and will make the ground look blurry and distorted. Turn your face down and look at the ground-steps-curb through the upper part of the glasses.  4. When you use a computer put the screen low and sit up high. If you do a lot of computer work you might want to use a reading lens if one works empirically           Best of luck. It took me about 6 weeks to learn to use my progressive lens.  

[nancybethw]

This is incredibly helpful. Thank you.

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

You are welcome