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Medical Forum / General / Vision / April 2005Asking for less than perfect IOL in Cataract Surgery
When I go in for my cataract pre-surgery sessions in about 6 weeks, is it really _practical_ to have a 20/20 iol put in. I wonder about asking them to aim for a light myopic lens. My wife recently had a similar cataract op and when they asked just prior to surgery what sort of vision she wanted she (naturally enough) said, 'why perfect of course'. So now she realises that the intraocular lens they inserted has less accommodation than a natural lens. Vision up to 4ft is blurry. Hence she requires reading glasses for most daily tasks - working, cooking, reading, sewing, etc etc. It occurred to me that a mild myopic ioc might be more useful, with accurate close vision up to say 10ft, because for those daily tasks one could operate well without glasses, then for distance vision, driving, etc, pop on the specs. Seems that this second option would require less occasion for wearing glasses. Then as I age the focal length might extend further, mightn't it?. If I'm right, and a mild myopic iol is quite useful if it would give acuity up to 10-20ft, what diopter would do this? Am I wildly off the mark here, or is it a reasonable theory? Brian script with the L cataract which is uncorrectable with glasses: R L [cataract eye] sp -4.00 -4.50 cyl -3.00 -3.25 axis 15 155 add +3.00 +1.25 (progressives) add +2.50 +0.75 (bifocal) > When I go in for my cataract pre-surgery sessions in about 6 weeks, is it really > _practical_ to have a 20/20 iol put in. I wonder about asking them to aim for a [quoted text clipped - 30 lines] > add +3.00 +1.25 (progressives) > add +2.50 +0.75 (bifocal) Unless the surgeon is planning on implanting an astigmatic IOL, it will be a moot point with all the astigmatism you have. You wont need to worry about 20/20 uncorrected vision @ any distance because the astigmatic component that you have will prevent that. Thus even if the surgeon neutralized all or part of your myopic error the astigmatism remaining will still require you to wear an spectacle correction. frank > Unless the surgeon is planning on implanting an astigmatic IOL, > it will be a moot point with all the astigmatism you have. [quoted text clipped - 3 lines] > the astigmatism remaining will still require you to wear an spectacle > correction. How good are astigmatic IOLs now?  SignatureCheers, Bev 0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0o0 Judges are our only protection against a legal system that can afford lots more prosecution than we can afford defense. > If I'm right, and a mild myopic iol is quite useful if it would give > acuity up > to 10-20ft, what diopter would do this? > > Am I wildly off the mark here, or is it a reasonable theory? You are right on target here! I oftentimes ask for my patients to end up with a -0.50 spherical final refractive error after cataract surgery. Being mildly myopic is a good thing when you are older. As you say, less dependence on readers while still maintaining reasonable distance vision. You could even propose to have 1 eye set perfectly for distance (plano) and the other set slightly for near (-1.00 would be good). This is called monovision. It can be difficult to adjust to at first but works quite well in most cases. I think your biggest problem will be the amount of astigmatism you presently have. You posted that you have a cylinder correction of -3.00 in one eye and -3.25 in the other. If this astigmatism is due to the toric shape of your cornea (rather than lens tilt which is also possible) then standard cataract surgery will likely leave you with about the same amount of astigmatism even after the surgery. Thus your distance AND near vision will be blurred regardless. Sometimes you can request that the surgeon perform limbal relaxing incisions on your cornea during the cataract operation in an attempt to remove/minimize that astigmatism. I would talk to your surgeon about doing that or it really won't matter whether you are set perfect for distance or slightly nearsighted after the surgery-- the astigmatism will still make everything blurry and require that you use glasses full-time. Talk to your surgeon about trying to set the final end point of your refraction after surgery. Talk to him about possible solutions to your astigmatism. Be aware that you can't exactly pick a final refractive end point after cataract surgery-- it's impossible to be precise. Cataract surgery IS NOT refractive surgery. > My wife recently had a similar cataract op and when they asked just prior to > surgery what sort of vision she wanted she (naturally enough) said, 'why perfect > of course'. My doctor was very good about working with me to determine what was best, before I had my first cataract surgery. However, the concepts are a little complicated for a lay person, and it took time for me to understand. There's no concept of "perfect" vision after cataract surgery. > So now she realises that the intraocular lens they inserted has less > accommodation than a natural lens. Vision up to 4ft is blurry. Hence she > requires reading glasses for most daily tasks - working, cooking, reading, > sewing, etc etc. There is *NO* accommodation with a normal IOL. The doctor can give you close vision or far vision, but you don't get both. > Am I wildly off the mark here, or is it a reasonable theory? It's a reasonable theory for many people. My doctor explicitly gave me this choice. I chose far vision, since I was already used to putting on reading glasses to see up close (I wore contacts for distance, and reading glasses over them for close). My doctor thought that was the best choice, as I'm reasonably active. Close vision is more appropriate for those who are wheelchair bound and don't get out much. However, as drfrank has already posted, your astigmatism is quite severe, and unless you are willing to put up with poor vision, you will continue to need glasses at any distance. > R L [cataract eye] > sp -4.00 -4.50 > cyl -3.00 -3.25 > axis 15 155 > add +3.00 +1.25 (progressives) > add +2.50 +0.75 (bifocal) SignatureDan Abel Sonoma State University AIS dabel@sonic.net > When I go in for my cataract pre-surgery sessions in about 6 weeks, is it really > _practical_ to have a 20/20 iol put in. I wonder about asking them to aim for a > light myopic lens.> > script with the L cataract which is uncorrectable with glasses: > R L [cataract eye] > sp -4.00 -4.50 > cyl -3.00 -3.25 > axis 15 155 So you are just getting the one eye done? At the moment in your left eye you are -7.75 myopic in one direction and -4.50 in another direction 90 degrees to that. Thats a great deal of minus in either direction. **if** it were possible to accurately fit an IOL to give you no myopia but leave you with the astigmatism, then you would be astigmatic in one direction of -1.5D and astigmatic in tother 90 degrees from that at +1.5. Because your optical error would then be only 1.5D either side of the retina that might actually give you vastly superior vision than you currently have in your very similar right eye uncorrected - especially in bright conditions. Possibly in bright conditions you could drive and be able to see 20/40 or better without correction. Hopefully can get a result that is close to no myopia and then report back how well you can see with the remaining astigmatism. Andrew >> script with the L cataract which is uncorrectable with glasses: >> R L [cataract eye] >> sp -4.00 -4.50 >> cyl -3.00 -3.25 >> axis 15 155 > At the moment in your left eye you are -7.75 myopic in one direction > and -4.50 in another direction 90 degrees to that. Resulting in a astigmatic amount of 3.25 dpt. > **if** it were possible to accurately fit an IOL to give you no myopia > but leave you with the astigmatism, then you would be astigmatic in one > direction of -1.5D and astigmatic in tother 90 degrees from that at > +1.5. Wrong Andrew, the result is a mixed astigmatic myopic/hypermetropic eye. In one direction 1.50 dpt myopic and in the other direction 1.75 hypermetropic. The amount of astigmatism still being 3.25 dpt. SignatureJan (normally Dutch spoken) > >> script with the L cataract which is uncorrectable with glasses: > >> R L [cataract eye] [quoted text clipped - 19 lines] > -- > Jan (normally Dutch spoken) Jan I am not sure how you arrive at your answer or what part of my answer is incorrect. I clearly indicated a mixed astigmatic eye scenario for an eye with no myopia. For a presumed case of regular astigmatism dont we expect to have equal amounts of astigmatism either side of the retina? Ie 3.25/2 = +/-1.625D? Can you explain your answer please? Thanks Andrew >> Wrong Andrew, the result is a mixed astigmatic myopic/hypermetropic > eye. >> In one direction 1.50 dpt myopic and in the other direction 1.75 >> hypermetropic. >> The amount of astigmatism still being 3.25 dpt. > I am not sure how you arrive at your answer or what part of my answer > is incorrect. I clearly indicated a mixed astigmatic eye scenario for [quoted text clipped - 6 lines] > > Can you explain your answer please? For me it is astonishing to see Andrew, who says he can determine a character or behavior by knowing the persons ametropia, having such a lack in knowledge about ametropia in human eyes. I already explained your mixed astigmatic eye is in one direction myopic and not ''non myopic'' If you don not know what you are talking about then please leave. SignatureJan (normally Dutch spoken) > >> Wrong Andrew, the result is a mixed astigmatic myopic/hypermetropic > > eye. [quoted text clipped - 19 lines] > not ''non myopic'' > If you don not know what you are talking about then please leave. Jan I agree I am not an expert on prescriptions. I just have a rather simple understanding. If I am wrong it would be nice to know why that is so. Here is the original prescription: R L [cataract eye] sp -4.00 -4.50 cyl -3.00 -3.25 axis 15 155 add +3.00 +1.25 (progressives) add +2.50 +0.75 (bifocal) So we agreed he is has myopia of -4.5 in one direction and -7.75 in the other To make this easier for me to understand lets say he had a series of operations to get the best possible refraction while remaining astigmatic. 1st operation removes 4.5D of sphere -4.5 -7.75 (prior to an operation) 0.00 -3.25 (after first operation) 2nd operation removes 1.5D of sphere +1.5 -1.75 Final operation to produce best possible refraction for mixed astigmatic eye using a none toric IOL removes one eight of D of sphere. (0.125D) +1.6125 -1.6125 So in this scenario the mixed astigmatic eye has equal but opposite amounts of blurr either side of the retina but at 90 degrees to each other. To get +1.75 - 1.5 reguires an **overshoot** of best possible outcome (for a none toric IOL) by one eighth of a diopter. If I am wrong where have i made a mistake? Can somebody help out here please? Thanks Andrew Oops! I said >>So in this scenario the mixed astigmatic eye has equal but opposite amounts of blurr either side of the retina but at 90 degrees to each other. The cylinder that creates the astigmatism is in only one plane of course. So that the maximum hypermetropic blurr of 1.6125 is in the same line of the maximum minus blurr of -1.6125D with a central point being the retina. Correct? Andrew > Oops! > [quoted text clipped - 10 lines] > > Correct? No. First of all the blur is ON the retina, the theoretical sharp focus LINES (not points) are situated in front and behind the retina and as you said before at a 90 degree angle to each other (in your example) The blur on the retina is an out of focus mix of the two different placed focus lines. As a said before: In earlier posting by you, you suggest you can point out different type of personalities just by knowing (measuring?) the type of ametropia. If you do not understand right now what myopia, hypermetropia or astigmatism stands for, how did you before? My advise Andrew, keep your mouth shut on eye(care) subjects like ametropia or buy some books on the subject and come back later as soon everything is clear to you. SignatureJan (normally Dutch spoken) > > Oops! > > [quoted text clipped - 28 lines] > or buy some books on the subject and come back later as soon everything is > clear to you. Jan We seem to agree that best possible correction for this case results in mixed astigmatism of +/-1.6125 Andrew > We seem to agree that best possible correction for this case results in > mixed astigmatism of +/-1.6125 The plus component is wasted. It focuses nothing. The minus component helps uncorrected near vision. In real life, pl-325 or +050-325 is probably more useful than +162-325. And easier to get used to when they've worn minus for so many years. -MT Thats a good point Mike. I was wondering if such a mixed equally astigmaticly corrected eye might see quite well in bright distance viewing conditions - to the point that no glasses were needed for many purposes - eg swimming or water sports etc. That might suit some people possibly. I guess i have been more narrowly focused on the theoretical considerations. On the subject of the theoretical, is it not true that in this theoretical mixed astigmatic eye that the most hyperopically visible blurred *point* is 180 degrees to the most myopicly blurred *point*, althought there are many other lines of blurr either side of these points? Thanks Andrew sorry i meant "between these two points" there are many lines of 'blurr' > I guess i have been more narrowly focused on the theoretical > considerations. "Best possible correction" has to be defined subjectively. +162-325 is described as a "spherical equivalent of zero," and it perhaps _is_ "best" if far vision is most important. > On the subject of the theoretical, is it not true that in this theoretical > mixed astigmatic eye that the most hyperopically visible blurred *point* > is > 180 degrees to the most myopicly blurred *point*, althought there are many > other lines of blurr either side of these points? With astigmatic error, points blur into lines. If your prescription is pl-325x180, and you have no accommodation, a point at 14 cm will blur into a horizontal line, and a point at 20 feet will blur into a vertical line. -MT >>+162-325 is described as a "spherical equivalent of zero," and it >>perhaps >>_is_ "best" if far vision is most important. Thanks Mike. Why do you write +1.6125 as +162-325? I saw you do that last post but was not sure if it were a typo. >>> On the subject of the theoretical, is it not true that in this >>>theoretical mixed astigmatic eye that the most hyperopically visible >>>blurred *point* is 180 degrees to the most myopicly blurred *point*, >>>althought there are many other lines of blurr either between these points >>With astigmatic error, points blur into lines. If your prescription >>is >>pl-325x180, and you have no accommodation, a point at 14 cm will blur >>into a >>horizontal line, and a point at 20 feet will blur into a vertical line. True. But that is different to the case of looking at only one point. For the theoretical case of a mixed astigmatic only eye, and for a viewed point object is it not true that there is one single point of maximum minus refraction away from the fovea, and one single point of maximum hypertropic refraction away from the fovea, both being on the same axis and with all other lines of refraction meeting a line drawn between these two maximum points? Andrew > Thanks Mike. Why do you write +1.6125 as +162-325? I saw you do that > last > post but was not sure if it were a typo. The original post was about a prescription with 3.25 D of astigmatism. Then we arrived at the concept of zero spherical equivalent. You were describing that refraction as +1.6 / -1.6. (I'm not sure where you got 1.6125; half of 3.25 is 1.625.) It's more conventional to describe that surface as +1.62 -3.25 (x 180 or whatever) Or, in "plus cyl notation" it's -1.62 +3.25 (x 090). Same surface, different starting point. > For the theoretical case of a mixed astigmatic only eye, and for a viewed > point object is it not true that there is one single point of maximum [quoted text clipped - 4 lines] > other lines of refraction meeting a line drawn between these two maximum > points? I'm not sure what you're describing. The minimum and maximum fall in front and behind the retina (assuming no accommodation). With a zero spherical equivalent refraction, a point source at infinity would be equally blurry in all orientations. If a vertical line target focuses in front of the retina, a horizontal line target will focus behind the retina. In ophthalmic optics, the region mapped by a full set of such points describes a conoid, the "conoid of Sturm." The zone of zero spherical equivalent is called the "circle of least confusion." If you google those terms we may find more common ground. -MT Dear Mike and Jan Thanks for your help here. I was wrong about the line not rotating 90 degree either side of the retina. I can see that the convential way of writing the mixed astigmatic eye helps to make things much clearer. I was incorrectly reasoning that the astigmatic error only exists close to the retina on either side of it, rather than it being present across all distances from the crystalline lens thru to infinity. Jan, my original comment of +1.5/-1.5 was based on me misreading -3.25 for - 3.00 but i feel your correction to +1.75/-1.5 was based on you being a bit hasty in proving me wrong. Subsequently I did not admit my error and came up with yet another maths error instead of what i still feel would have been a reasonable outcome of no spherical error for those wanting uncorrected distance vision. From my point of view I have exhausted my interest in this area but have learnt some useful stuff. Thanks Andrew > Jan, my original comment of +1.5/-1.5 was based on me misreading -3.25 > for - [quoted text clipped - 4 lines] > been a reasonable outcome of no spherical error for those wanting > uncorrected distance vision. Andrew, I am afraid you never learn. In your example there is still a spherical error along with an astigmatic one. For me it is still astonishing to see Andrew, who says he can determine a character or behavior by knowing the persons ametropia, having such a lack in knowledge about just these different kinds of ametropia in human eyes. > From my point of view I have exhausted my interest in this area but have > learnt some useful stuff. Lets say, you think you have learned. Others might have a different view. SignatureJan (normally Dutch spoken) What about Bevs question about a Toric IOL? These seem problematic but available. Are they still unreliable or? >>With astigmatic error, points blur into lines. If your prescription is pl-325x180, and you have no accommodation, a point at 14 cm will blur into a horizontal line, and a point at 20 feet will blur into a vertical line. Actually this is now doing my head in:-( Big time! :-) a plano myope with -3.25 at 180 and no accommodation will see a point at 20 feet as a "clearly focused" verticle line like |. Yes? But this plano myope with no accommodation will see a point object blurred into a hypermetropic circle at any distance less than 20 feet and will then have the minus astigmatism added to that circle of confusion. (100cm/3.25D)/2.54cm = 12.1 inches near point in one direction. So the person has the effect of +2.8D in all directions as a blurr circle and the full effect of the minus astigmatism at 14". So 180 becomes 90 So sees a blurred line like --------- --------- Rather than --------- ??? Andrew > We seem to agree that best possible correction for this case results in > mixed astigmatism of +/-1.6125 > > Andrew We don't SignatureJan (normally Dutch spoken) > > When I go in for my cataract pre-surgery sessions in about 6 weeks, > is it really [quoted text clipped - 19 lines] > direction of -1.5D and astigmatic in tother 90 degrees from that at > +1.5. Ever Wonder why a non professional should not give advice? Its because wrong information may be taken seriously. problem 1) "...Accurately fit an IOL to give you no myopia..."????? If its accurate, why gain hyperopia? > Because your optical error would then be only 1.5D either side of the > retina that might actually give you vastly superior vision than you > currently have in your very similar right eye uncorrected - especially > in bright conditions. Possibly in bright conditions you could drive > and be able to see 20/40 or better without correction. Problem 2) The actual Rx to for the above would be +1.50/-3.00 If the axis is 180 you may get 20/40 without correction, if the axis is 90, it would probably be 20/200 or a bit better on a snelen chart. > Hopefully can get a result that is close to no myopia and then report > back how well you can see with the remaining astigmatism. > > Andrew > problem 1) "...Accurately fit an IOL to give you no myopia..."????? If its > accurate, why gain hyperopia? +1.50/-3.00 is not a hyperopic prescription. Its just a conventional way of writing the spherical equivalent of zero for the mixed astigmatism. There is no spherical hyperopic error. If you disagree take it up with Mike he explained all of this to me earlier in the thread. > > problem 1) "...Accurately fit an IOL to give you no myopia..."????? > If its [quoted text clipped - 3 lines] > way of writing the spherical equivalent of zero for the mixed > astigmatism. There is no spherical hyperopic error. 0.00/-3.00 has no spherical hyperopic error, ie. plano in one direction and -3.00 in the other. Give this correction to the patient and that would leave him hyperopic by 1.50 dipoter. Therefore he needs the hyperopic component of 1.5 added to the above Rx to correct him fully. That makes him a hyperope with astigmatism. Without the Rx, the circle of least confusion is on the retina, part of the image will focus behind the retina (The hyperopic part) the other will be in front of the retina (the myopic part) . Roland Izaac M.Sc. in clinical optometry > If you disagree take it up with Mike he explained all of this to me > earlier in the thread. > 0.00/-3.00 has no spherical hyperopic error, ie. plano in one direction > and -3.00 in the other. > Give this correction to the patient and that would leave him hyperopic by > 1.50 dipoter. I think you meant "myopic" in terms of equivalent sphere.. My feeling is that the hyperopic component in +150-300 serves no purpose. Pl-300 is more functional. -MT I can see that my wording created confusion. Its true that "No myopia" can be either plano with myopic astigmatism or mixed astigmatic. I was considering mixed astigmatic being the least blurry distant result. For a particular case of an active guy who was intolerant to contacts, loved walking in the rain, kissing, wrestling and swimming, +1.5/-3.00 might provide the best solution for him. Andrew >I can see that my wording created confusion. Yes Andrew, only to you. > Its true that "No myopia" can be either plano with myopic astigmatism > or mixed astigmatic. I was considering mixed astigmatic being the > least blurry distant result. A: S+0.00=C-3.00 means in one direction the eye is emmetropic (plano or 0) and in the other direction myopic(-3.00) with an astigmatism of 3.00 diopters. B: S-0.25=C-3.00 means in one direction the eye is myopic (-0.25) and in the other direction myopic(-3.25) still with an astigmatism of 3.00 diopters. C: +0.25=C-3.00 means in one direction the eye is hypermetropic (+0.25) and in the other direction myopic(-2.75) still with an astigmatism of 3.00 diopters. > For a particular case of an active guy who was intolerant to contacts, > loved walking in the rain, kissing, wrestling and swimming, +1.5/-3.00 > might provide the best solution for him. S+1.50=C-3.00 means in one direction the eye is hyperopic (+1.50) and in the other direction myopic (-1.50) with again still an astigmatism of 3.00 diopters Theoreticaly the vision acuity for the distance stays the same as long as the same astigmatic error is in between, or of, the myopic-emmetropic and emmetropic-hypermetropic type. Saying this you can figure out by yourself your solution is not the best solustion for someone who is not able to accommodate. For me it is still astonishing to see Andrew, who says he can determine a character or behavior by knowing the persons ametropia, having such a lack in knowledge about just these different kinds of ametropia in human eyes. SignatureFree to Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "Otis therapy" should be destroyed Jan (normally Dutch spoken) >>S+1.50=C-3.00 means in one direction the eye is hyperopic (+1.50) and in the other direction myopic (-1.50) with again still an astigmatism of 3.00 diopters >>Theoreticaly the vision acuity for the distance stays the same as long as the same astigmatic error But in practice depth of field always decreases the mixed astigmatism when the pupil is smaller than it can any other value of + or - with that same value of astigmatism. Theoreticaly the vision acuity for the distance stays the same as long as the same astigmatic error is in between, or of, the myopic-emmetropic and emmetropic-hypermetropic type. Saying this you can figure out by yourself your solution is not the best solustion for someone who is not able to accommodate. Andrew answers with: > But in practice depth of field always decreases the mixed astigmatism > when the pupil is smaller than it can any other value of + or - with > that same value of astigmatism. My answer on Andrews: You are changing the subject, a charlatanic behavior to my opinion. But Andrew, it still has no influence on what I wrote before and you still show your lack of very basic optical knowledge in human eyes. For me it is still astonishing to see Andrew, who says he can determine a character or behavior by knowing the persons ametropia, having such a lack in knowledge about just these different kinds of ametropia in human eyes. Jan Consider these options. S+.25=C-3.00 S+1.5=C-3.00 On a sunny day the eye will see about .75D better due to depth of field. so we get. S0=C-2.25 S+.75=C-.75 Andrew > Jan > [quoted text clipped - 14 lines] > > Andrew No Andrew, we still have S+0.25=C-3.00 and S+1.5=C-3.00 However the blur on the retina on a sunny day is lesser than it is under a more darker circumstance and in your two examples the combined amount off blur is the same when compared in the same light conditions. All your answers keep showing your lack knowledge in this field. For me it is still astonishing to see Andrew, who says he can determine a character or behavior by knowing the persons ametropia, having such a lack in knowledge about just these different kinds of ametropia in human eyes. SignatureFree to Marcus Porcius Cato: ''Ceterum censeo Carthaginem esse delendam" In conclusion, I think that the "Otis therapy" should be destroyed Jan (normally Dutch spoken) Jan >>For me it is still astonishing to see Andrew, who says he can determine a character or behavior by knowing the persons ametropia, having such a lack in knowledge about just these different kinds of ametropia in human eyes. Maybe life would be easier for you if i say clearly that i dont measure the refraction of any persons eyes and claim no expertise at all in this area, and have never claimed to measure the refraction of a pesons eye or claimed to have any expertise in this area. I rely on experts like yourself to know what the measurements are. My expertise is in using these third party prescriptions. Meanwhile it is interesting to know more about the eye but its not necessary for me. Andrew > > When I go in for my cataract pre-surgery sessions in about 6 weeks, > is it really [quoted text clipped - 30 lines] > > Andrew Wow a different Rx, how will this change the personality? Roland Izaac Thanks for all the discussion. > When I go in for my cataract pre-surgery sessions in about 6 weeks, is it > really _practical_ to have a 20/20 iol put in. I wonder about asking them to [quoted text clipped - 6 lines] > add +3.00 +1.25 (progressives) > add +2.50 +0.75 (bifocal) I'm the original poster, and yesterday I went in for the pre-surgery prep. This is at a public hospital here in Auckland New Zealand where my op will be on the national health, no charge to me. Which is nice. Anyhow, I was very pleased to hear from the surgeon when I posed the above queston, that she favours leaving some residual myopia, aiming for approximately -0.75 to -1.25. I'll be able to either 1) correct each eye with glasses, or 2) under-correct the non-cateract eye to leave a similar amount of myopia, -1 ish, to match the new IOL and walk around with mild myopia stereo-vision for close work/reading, and use distance glasses for driving etc. My great amount of myopia is, as some of you have noticed, not correctable with this procedure. I was impressed with the equipment they had there at this creakingly old public health eye clinic: some fancy machine for recording my existing natural lens, eyeball shape and cornea shape with a few passes of some red light thingee. My cadillac surgery is scheduled for a date in 6 weeks time. Brian SignatureBrian Adam Auckland NEW ZEALAND |
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