Post cataract surgery--difficulty reading

[zydeco]

I have had surgeries over the past year first for a macular pucker (left eye), and then double IOL implants (after a cataract developed in the left eye). My current prescription is OD -1.25, -.25, 55/ OS -1.75 SPH, with an add of 2.50. With or without glasses, the image in my left eye is noticeably larger than the one in my right eye. It's also darker, but two doctors have said that YAG wouldn't do me much good.

My problem is with computer work and reading. I have a pair of regular progressives and a pair of office lenses both made to this prescription, and neither works very well for computer use or for reading books. When I work at the computer now, I use a pair of glasses that were made for short term use immediately after the second cataract surgery, where the right eye prescription is OD -.5, -.75 x70, add 2.25. One optical shop person suggested that I am using the distance portion of that lens as an intermediate lens, which seems probably true. For reading books, I use no glasses, which is not ideal, but is better than what I get from any of these glasses.

I can read larger print, such as the newspaper, fairly well with or without the progressives, but the slightly smaller print in books gets tedious very quickly. When I watch TV and I close my left eye, I see a much sharper picture with my right eye than I do with both eyes open, but overall I’m happy enough with my distance vision.

In this situation, should it be possible to fit a pair of office glasses that improves my computer and reading vision? Is is possible that the prescription is just wrong? Or is the residual damage from the pucker enough to prevent any further progress? I could read much more comfortably before I started down this surgical road.

I would be very grateful for any advice.

Jim

[JodieJ]

I also have a larger image size in my affected eye related to a macular pucker.  In my case, my image size difference did not appear until after my surgery to peel the pucker (aka epiretinal membrane, ERM.)  It caused several problems, mostly with my distance vision.  (Reading problems are reportedly much more common.)  I saw several of the top retinal specialists in town, all of whom told me that nothing could be done.  It was more than 3 years later when Dr. Steve Charles of Memphis told me that my original surgeon had left pieces of epiretinal membrane in my macular periphery.  Following surgery last year to remove the remaining ERM, my image size disparity has been reduced by about 50%.  This might be all the improvement I'll get; the long delay between my surgeries may have resulted in some irreversible macular damage.  My first suggestion to you is to verify by Spectralis OCT that there is not still ERM in your eye.

The very best papers about correcting vision with distortion/an image size difference due to retinal problems have been written (in English) by Dr. Gerard de Wit of the Netherlands.  You can download "Retinally Induced Aniseikonia" from his website at www opticaldiagnostics com.  (Pay particular attention to patient #1, who had reading problems related to distortion from an ERM.)  I strongly suspect that your problem is related to your image size disparity and not a prescription error.  In my own case, wearing a -3 glasses lens over a +3 contact lens partially corrects my residual image size disparity and makes my vision much more comfortable.  It's also possible to achieve this type of correction without a contact lens by manipulating the base curve and vertex distance of the glasses lens.  There lots of good information about all this on Dr. de Wit's website.

It would definitely be to your advantage to learn as much as you can about your condition.  You may be stuck directing your own treatment.  (I was unable to find a knowledgeable eye care professional in Chicago despite major efforts on my part.  I found that consulting with Dr. de Wit online provided invaluable help.)

[JodieJ]

I believe that Dr. Feldman is suggesting that you might try relying only on your right (good) eye.  This is a reasonable option for some people, especially those with severe distortion in their affected eye.  I've read posts from people who were helped by purposely blurring the vision in their affected eye with a contact or glasses lens in the wrong power.

I don't think that the above option should be the first thing that you try.  (For one thing, you will lose all depth perception.)  I'd still recommend that you first rule out the possibility that further surgery could reduce/eliminate your image size difference.  Then I'd suggest that you try the optical solutions proposed by Dr. de Wit to partially correct your image size difference.  In my case, this type of correction gives me comfortable, virtually "normal" vision with good depth perception.  

[zydeco]

Dear Doctor Feldman--

I'm not sure that I understand this suggestion. Are you saying that it might be best to leave the left eye (which is -1.75) without a prescription lens?

Jim

[Sandy Feldman, MD, MS]

Dear zydeco,

It sounds as if you may be having difficulty adjusting to the image disparity between the two eyes and the vision distortion which may have resulted from the pucker.  Bring your glasses back to your eyeMD and have them check each eye individually and then both together. They will be able to assist in determining whether it is best to fit you with a prescription lens in both eyes or just your right eye.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California