Post-Cataract Surgery Vision Issues: Can I Adjust My Prescription?

Postoperative refractive issues after cataract surgery?

Hello, doctor: I have cataracts in both eyes.
My right eye originally had a prescription of -6.25 diopters, which increased to -13.50 diopters due to cataracts, along with presbyopia of +2.00 diopters and astigmatism of -1.25 diopters.
The cataract in my left eye is less severe; my nearsightedness increased from -5.75 diopters to -8.00 diopters, with presbyopia of +2.50 diopters and astigmatism of -1.50 diopters.
After correction, my left eye can achieve a vision of 0.8.
During the initial surgery on my right eye, I requested the surgeon to leave some degree of nearsightedness, but the surgeon insisted that both eyes needed surgery.
We eventually agreed to operate on the right eye first, leaving a prescription of -1.00 diopter.
However, after the surgery, I ended up with +2.50 diopters of presbyopia (measured with instruments), and my corrected vision is +2.50 diopters for presbyopia.
Now, the disparity between my two eyes is too great, and I can only see well with one eye.
I would like to ask if I can leave a nearsightedness of -3.00 diopters in my left eye if I undergo surgery, which would account for the presbyopia of +2.50 diopters, leaving me with -0.50 diopters.
However, my right eye still has +2.50 diopters of presbyopia.
Would this be feasible? Would there still be a disparity issue? Where can I find other doctors who share my perspective?

CC, 50~59 year old female. Ask Date: 2020/10/06

Dr. Gao Pilin reply Ophthalmology

Hello,
If the left eye has a prescription of -300 degrees for myopia, and the right eye has a slightly different prescription, there will still be issues with binocular disparity, and you may only be able to see clearly with one eye at a time.
I'm not sure why you would want to leave such a high prescription in your left eye; perhaps it's to avoid wearing glasses for near vision while using the right eye for distance vision without glasses.
This means the right eye is for distance and the left eye is for near vision.

I do not recommend this approach.
I believe both eyes should have similar prescriptions so that you can comfortably see without glasses most of the time, and then wear reading glasses when needed.

The ophthalmology department at Puzi Hospital in Taiwan operates on Monday, Tuesday, Thursday, and Friday from 8:00 AM to 12:00 PM, and Wednesday from 2:00 PM to 4:30 PM.
Please note that online responses should only be used as a reference; if necessary, you should seek medical attention at a healthcare facility.

I hope to have the opportunity to assist you.

Best regards,
Gao Pilin

Reply Date: 2020/10/06

More Info

After cataract surgery, many patients experience changes in their vision that can lead to confusion and frustration, especially when it comes to adjusting their prescription glasses. In your case, it seems that you have undergone cataract surgery on your right eye, and you are now considering surgery for your left eye. You have also expressed concerns about the significant difference in vision between your two eyes, which is commonly referred to as anisometropia.

To address your questions, let’s break down the key points regarding your situation:
1. Understanding Post-Surgery Vision Changes: After cataract surgery, it is common for patients to experience changes in their refractive error. This can include shifts in nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. In your case, it appears that the right eye has undergone a significant change, resulting in a higher prescription than before surgery. The goal of cataract surgery is not only to remove the cloudy lens but also to optimize vision based on the patient's lifestyle and visual needs.

2. Adjusting Prescription for the Left Eye: You mentioned wanting to leave a certain degree of nearsightedness in your left eye after surgery. It is essential to communicate your visual goals with your ophthalmologist. Leaving a degree of nearsightedness (in your case, 300 degrees) can help balance the vision between your two eyes, especially if your right eye is corrected for distance vision. However, it is crucial to consider the overall balance and how your brain will adapt to the difference in prescriptions. A significant difference in prescription can lead to visual discomfort and difficulty in focusing, especially when using both eyes together.

3. Potential for Anisometropia: If you choose to leave a higher degree of nearsightedness in your left eye, you may still experience some degree of anisometropia, which can cause issues such as double vision, eye strain, or difficulty with depth perception. The brain typically prefers to have similar input from both eyes, so a significant difference can lead to visual discomfort. It is essential to discuss these concerns with your ophthalmologist, who can provide guidance on the best approach to minimize these effects.

4. Finding a Compatible Surgeon: If you are looking for an ophthalmologist who shares your vision philosophy, consider seeking a second opinion from a specialist who has experience with cataract surgery and refractive lens exchange. You can ask for recommendations from your current ophthalmologist, or you may want to look for surgeons who are affiliated with reputable eye care centers or academic institutions. Online reviews and patient testimonials can also provide insight into a surgeon's approach and philosophy.

5. Post-Operative Care and Follow-Up: After your left eye surgery, it is crucial to have regular follow-ups with your ophthalmologist to monitor your vision and make any necessary adjustments to your prescription. Your doctor can help determine when it is appropriate to update your glasses based on the stability of your vision after surgery.

In conclusion, while it is possible to adjust the prescription for your left eye during surgery, it is essential to have an open dialogue with your ophthalmologist about your visual goals and concerns regarding anisometropia. Each patient's situation is unique, and your doctor can help tailor the surgical approach to best meet your needs. Regular follow-ups and communication with your eye care team will be vital in achieving the best possible outcome for your vision.

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