ghosting images after cataract surgery

[Cocobean2]

I have ghosting 3 weeks post op in my dominate eye target: plano.

Should I consider mini monovision?
If yes, why?
If no, why not?

Is the ghosting expected to improve over time?

I have Dry Eye Disease and Irregular Astigmatism and I am 60 years old
I am 3 weeks post cataract surgery (Clareon monofocal IOL) in my right eye (dominant eye).
The target was plano. My distance vision for driving is poor due to ghosting that is much worse in the distance. I see the computer screen and phone great at 2.5 feet, which is comfortable. reading distance is poor, as expected.

Manifest Refraction (Right Eye) as of 3 weeks post op

Sphere: -0.25
Cylinder: -0.25
Axis: 090
Distance VA: 20/20

My optometrist thinks my vision is good because I can read the 20/20 line in her office, but the image is not clear due to ghosting. I cannot see street signs when driving until I am very close.

My ophthalmologist approved me for the mini-mono vision  due to needing close up vision at work.

I was excited to be eligible for extended range of vision because ophthalmologist said I was not a candidate for EDOF due to my dry eye disease and astigmatism.

Now, due to my poor driving vision (which can be corrected with glasses), I'm thinking having both eyes plano.

I appreciate any advice!

Thank you!

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

Your glasses test on RE  -0.25-2.25 asix 90 is virtually no Rx at all (window glass)  If you think your distance vision is foggy then it is likely the irregular astigmatism and/or dry eye. If you have never done monovision before with contacts you are NOT a good candidate and I would suggest you consider holding off surgery on the LE till you are happy with the RE. You need a cornea topography and if irregular astig you may need fit with a contact lens. NEVER A GOOD IDEA TO DO THE SECOND EYE WHEN NOT HAPPY WITH THE FIRST EYE.

[Cocobean2]

Dr. Hagan,

Thank you for your quick and thorough response.

Is there a best approach to scheduling surgery for the 2nd eye since the ghosting is likely due to dry eye and/or astigmatism and therefore not likely to improve over time?

Irregular astigmatism was seen on cornea topography before surgery.

Here's what I understand:

1)Get right eye corrected with contact.
(Is this a contact to reshape my cornea, or just to correct the vision error caused by astigmatism?)

2)Fix dry eye (working on it, see below)

3) Schedule left eye surgery when right eye vision is as good as it gets. (Do you think 3 months [or longer]wait between surgeries is reasonable?)


I've been treating the dry eye with cyclosporine drops and warm compress, both twice a day for 9 months. (holding for now on the post surgical eye as I am still on anti-inflammatory drops for 5weeks)

I have also had Lipiflow treatment before surgery.

I have had "natural" monovision for several years before cataracts developed. So, my ophthalmologist agreed to do it.

I appreciate your advice.

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

Generally speaking if your blurred vision was due to dry eye it would clear up when you put artificial tear in or blink. So it is likely irregular astigmatism.  You would need to ask your surgery what type of contact would be best. Usually it is a rigid contact, in some instance a soft toric might work.  You might also consult a fellowship trained cornea opthalmologist and ask if surfact laser would help.  It's your call but I would consult the cornea opthalmologist first (unless your surgeon if fellowship trained which it sounds like he/she isn't)  . Another key question does the unoperated eye have irregular astigmatism. If so you could up with both eyes blurry and monovision, even in normal eyes, makes glasses difficult to adjust to given the difference between eyes.