Managing Post-Cataract Surgery Vision Discrepancies with Glasses

How can glasses improve significant disparity and headaches after cataract surgery in a patient with high myopia in one eye?

Initially, both eyes had a myopia of approximately 700 degrees.
Recently, the right eye underwent cataract surgery, while the left eye has only a mild cataract and does not require surgery at this time.
There is concern about the significant difference in vision between the two eyes.
The right eye was left with a prescription of 275 degrees, but post-surgery, there has been persistent dizziness and headaches throughout the day.
After two months of adaptation, progress has been limited.
The doctor suggested that new glasses could help improve the disparity, recommending 275 degrees for the right eye and allowing me to try lenses of 580 degrees and 400 degrees for the left eye.
I found the 400-degree lens to be more comfortable, so the doctor prescribed glasses with the following specifications: left eye 400 degrees, right eye 275 degrees.
However, when I went to the optical shop to get the glasses, the optometrist suggested increasing the right eye prescription to 300 degrees.
He explained that although the right eye at 275 degrees could achieve 1.0 vision, both eyes have 50 degrees of astigmatism that were not addressed, hence the recommendation to increase by 25 degrees.
As for the left eye, although a higher prescription was initially suggested, I prioritized avoiding headaches, so the final recommendation was to increase it to 450 degrees.
Since the difference from the doctor's suggestion was minimal, I accepted the optometrist's advice and got the glasses, but I found that wearing them made my condition worse, causing nausea.
I would like to ask: 1.
If I want to adjust to a state with less dizziness, in which direction should the glasses prescription be adjusted to reduce the disparity? I have heard that having too strong a prescription can also cause nausea; what would be a more appropriate reduction for the right eye? 2.
Why does the left eye feel more comfortable at 400 degrees compared to 580 degrees? I asked a nurse at the hospital, and he said it was because the disparity is smaller.
However, with the 400 degrees and 275 degrees, the prescriptions are closer together.
In reality, after adjusting with glasses, the left eye should have approximately 300 degrees of myopia, while the right eye would have 0 degrees after adjustment.
Isn't the disparity greater compared to the left eye at 580 degrees, which would leave 120 degrees after adjustment?

Xiaolan, 50~59 year old female. Ask Date: 2017/11/27

Dr. Cai Wenyuan reply Ophthalmology

Hello, it is still important to conduct an actual fitting to gradually find the appropriate prescription.
Wishing you safety and health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of the Ophthalmology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2017/11/27

More Info

Managing vision discrepancies after cataract surgery can be quite challenging, especially when one eye has undergone surgery and the other has not. In your case, it seems that you are experiencing significant discomfort and visual disturbances following your right eye's cataract surgery, despite the adjustments made to your glasses prescription. Let's address your concerns step by step.

1. Adjusting Glasses to Reduce Dizziness and Nausea: When it comes to managing vision discrepancies, the goal is to achieve a balance between the two eyes. If you are experiencing dizziness and nausea, it may indicate that the glasses prescription is not optimal for your current vision needs. The right eye's prescription of 275 degrees may have been appropriate initially, but if you are feeling discomfort with the adjustment to 300 degrees, it might be worth considering lowering it back to 275 degrees or even slightly lower. The key is to find a prescription that minimizes the visual disparity without causing discomfort.
Additionally, the left eye's prescription of 400 degrees seems to provide more comfort than the higher 580 degrees. This could be due to the fact that the lower prescription reduces the overall difference in power between the two eyes, which can help your brain process the visual information more harmoniously. It’s essential to communicate your symptoms clearly to your optometrist or ophthalmologist, as they can help fine-tune your prescription based on your feedback.

2. Understanding the Comfort with Different Prescriptions: The reason you find 400 degrees more comfortable than 580 degrees could be attributed to several factors. First, the visual system often prefers less disparity between the two eyes, which can lead to a more comfortable viewing experience. When the left eye is set at 400 degrees and the right at 275 degrees, the difference is 125 degrees, which may be more manageable than the larger difference created by the 580-degree prescription.
Furthermore, the perception of comfort can also be influenced by how your brain adapts to the new visual input. After cataract surgery, the brain may take time to adjust to the new visual signals, especially if there is a significant difference in clarity and focus between the two eyes. The 400-degree prescription may allow for a more gradual adjustment period, reducing the strain on your visual system.

3. Next Steps: Given your ongoing discomfort, it may be beneficial to revisit your eye care provider. They can conduct a thorough examination to assess your current vision and determine if further adjustments are needed. It might also be helpful to discuss the possibility of progressive lenses or bifocals if you are experiencing difficulties with near and far vision. These types of lenses can provide a more gradual transition between different focal lengths, potentially reducing the strain on your eyes.

4. Consideration of Astigmatism: Since you mentioned that both eyes have some degree of astigmatism, it’s crucial that your glasses prescription adequately addresses this. Astigmatism can significantly affect visual clarity and comfort, and if it is not properly corrected, it can lead to symptoms like dizziness and nausea. Ensure that your optometrist is aware of your astigmatism and that it is factored into your prescription.

In conclusion, managing post-cataract surgery vision discrepancies requires careful consideration of your glasses prescription and ongoing communication with your eye care provider. Adjusting the prescription to minimize visual disparity and addressing any astigmatism will be key to improving your comfort and visual clarity. If discomfort persists, further evaluation may be necessary to explore other options, such as different lens types or additional treatments.

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