Will neuroadaptation work? Lightheaded 5 days postop

[concernd5]

Special thanks to Drs Hagen, Kutryb, and Jody J. After reading all the posts found here at this wonderful site a few months ago, I decided to to choose blended vision (distance and intermediate) using a AMO Tecnis  lens in my non dominant eye for my first surgery.

I am a  49 year old male and three years ago I was diagnosed with Cataracts.    My vision has been getting worse so I chose to have Cataract surgery on my left eye, the left being worse than the right eye. I had the surgery this past Monday, October 17th.

On previous posts Dr. Hagen has recommended a target of +1.25 for intermediate vision.  He has also shared that he would personally choose +1.0 for himself.   I had asked for a target of a maximum of +1.25 for my intermediate vision.

  My questions are:     #1  I thought intermediate vision was approx 3 to 6 feet and a +1.25 or less should get you in that range.   If not, am I within the +1 to +1.25 range where I see objects clearest at  20 to 22 inches?    

#2   At the  follow up appointment, the doctor said I need time for Neuroadaptation to work. Could it be that my remaining Cataract eye is so bad that it isn't in a place to help with the adapting process? How long might it take?

While looking at  a distant object, and alternating between the right or left eye or both eyes the view I see appears to be coming 100% from the surgical eye, with very little, if any, noticeable changes done with my Cataract eye. I do notice that depth perception is still available when both are used together so I believe something is used in the remaining Cataract eye.

#3  Could it be that my other eye may need to be done near plano for the adapting process to work?

Thank you so much, Mitch

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

We may be on the verge of medications or treatments to stop or reverse cataracts but as over 2 million cataract operations in The USA each year show we're not there now. None of the junk on the internet is helpful

Modern IOL formula are usually accurate to + or - 0.50 (that's a one diopter range) but long eyes short eyes eyes with previous RK, lasik or corenal diease that number increase to +/- 1.00 diopter.

So you are not more than 1 standard deviation from the mean.  -2.25 will give you excellent near vision. If you were terribly unhappy then lasik can reduce it to -1.25 or even plano if you want to emphasize distance vision.

JCH MD

[concernd5]

I just came back from my follow-up appointment to find out that I am at -2.25 for my eye. The target was -1.2. How much am I to blame for not going in sooner to have my eye checked out and measured one on the IOL Master machine before my eye got so far along, I won't know. I had only an ultrasound reding to rely on.This I will say it is imperative to have your eye at least measured as soon as possible. He said that the readings would be good for 2 years. My advice is at least have your appointments! You don't have to have the surgery. I waited because I was hoping to heal the cataracts through nutrition and supplements. My thinking was that if it was a cloudy lensthen  I probably wouldn't be successful but if it were the capsule a more lively tissue I might have a chance. As it turned out the capsule was part of it.  I may have not had my nutrition program nailed down 100% or the other factors were too strong to change the outcome either way my stubborness has set me up for furthur problems or having an outcome far less than I had hoped. You can follow my posts and progress on other posts. Mitch

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

a diopter is a unit of lens power in which light from a distant source come to focus in one meter. One meter is 39.4 inches so theoretically the clearest vision would be 40 to 50 inches away. So six feet would be to expect extremely clear vision. The choice of IOLs and target refractions at this point should be between you and your surgeon and I would not intrude into your doctor-patient relationship.

JCH MD

[concernd5]

Thank you very much for your reply. I did have the wrong sign for the number.  I did post a similar question a couple of days before this post not understanding how posting to the Eye Care Community and the Expert forum worked.  Drs. Kutryb and Feldman graciously replied too.
It is http://www.medhelp.org/posts/show/692056
I am writing this to also aid others in the future.

Dr Hagen my question/concern is this: Is the difference between, a target of -1.25 and  a target of -1.0 for the non-dominant eye translate into a noticeable quality of a neuroadapted vision say beyond 3 feet and before the distance focus? Having had 20/20 vision in both eyes prior to cataracts I do worry about my feelings of spatial sense and the focusing I used to enjoy being greatly lost after neuroadaptation has finished with a new 2nd eye.  Especially after my experiences with light-headedness.

Dr Hagen I am going to have my strong dominant eye done in the very near future. I had reading glasses for the past 4 years and would had been willing to give up more on the reading front and need to use reading glasses more if in fact I would gain better clarity for the space between the two focal distances without having to use glasses. I could go with a Crystalens HD and that would cover it but I think it has too many risks accociated with it for me. As I understand it, because I am younger 49 and had fibrous tissue and cells that needed polishing from my capsule and because of the speed of just 3 years for my cataracts to develop, I most likely will need YAG laser treatment in the future.  Yag lasering for a Crystalens poses may be trickier to perform properly and requires greater skill. I also worry about the longevity of a Crystalens as it has been around for a handful of years and I have to have it last for many years because an  open capsule YAGed is a much higher risk surgery with many other greater risks associated with open capsule surgery. Lastly subsequent surgeries for other unplanned events with an open capsule should rule out a Crystalens for me. Dr Hagen any opinions on this?

Dr Hagen I had the eye measured with a machine that put alot of red dots in my vision which is supposed to be more accurite. Would you  target me for -.25 for my Tecnis lens?

For future researchers: I must be at or around the target of -1.25 because I can read items at arms length newspapers, magazines, product labels, computer monitors, etc. My Doctors target I believe was -1.18. I will post a difinitive results when I am tested for you when it comes in. I can read most any size writing maybe not for long periods of time but I haven't tried it out but for sure in a clutch no reading glasses are necessary. Personally, I think most will find no need to go greater than the target of -1.25.

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

You have the sign of the number wrong. The target for uncorrected midrange vision is MINUS -1.25  and for very close reading MINUS -2.25


Leaving a person with a PLUS refractive error means they're farsighted and there vision would be very poor without glasses.

Hopefully you just typed it wrong. SURGEONS NEVER LEAVE PATIENTS FARSIGHTED INTENTIONALLY.

JCH MD