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Medical Forum / General / Vision / September 2005Post-Cataract Contact Lens Advice
I'm interested in a partial contact lens Rx to provide approx -1 myopia for occasional day-to-day closeup stuff, and glasses on top to complete the Rx. First a short history. In 9/2000 I had a left eye retina re-attachment. A 'superotemporal macula of retinal detachment with a large superotemporal flat tear'. Vitrectomy and SF6 gas. Operation done at a large public hospital. Pre retina surgery: R L sp -3.50 -3.50 cyl -2.75 -3.75 axis 10 167.5 Post surgery acuity 6/5 -3 with updated spectacle correction. This is remarkably good considering the macula was off. 4/2004 Predictably a cataract developed in that left eye. Pre cataract operation: R L sp -4.00 -4.50 cyl -3.00 -3.25 axis 15 155 The Left is under-corrected as the nature of the cataract was that the myopia had worsened (approx -8.50). At the time of the cataract surgery (public hospital again) I requested of the surgeon, at length, that I wanted residual myopia such as -1.00. I considered this to be a practical and useful amount of myopia. The stated margin of error was +/- 0.25. Sadly, I ended up with some presbiopia (I've since found out that they get it wrong 20% of the time). Post cataract operation: 8/2005 R L sp -3.75 +0.75 cyl -2.50 -2.00 x 20 x165 1^Bup 1^BD Note the strange squiggles like triangles which represent prism. Apparently each eye is aimed differently, 1 down 1 up. I've worn glasses since age 8 and never had this on my script before. Why is prisming evident now? Because of the disparity of the eyes? Anyway glasses with this Rx fitted (plus progressive adds) gave double vision. So it was toric contact lenses I now needed. First-time CL wearer. I'm trialling some ProClear soft lenses. I don't know the exact Rx yet, but they feel good. Acuity in the Right eye is not as crisp as it was with glasses in that eye; a result of the cyl and axis difference, I imagine. This set-up is okay for distance (the slight lack of acuity notwithstanding). But want your advice on this: A partial Rx contact lens in the right eye to provide approx -1 myopia for occasional closeup stuff, and glasses on top with zero to +3 progressive adds. Would you consider this a reasonable scheme? Thanks in advance. Brian  SignatureAuckland NEW ZEALAND >I'm interested in a partial contact lens Rx to provide approx -1 myopia >for occasional day-to-day closeup stuff, and glasses on top to complete [quoted text clipped - 28 lines] >presbiopia (I've since found out that they get it wrong 20% of the >time). That's why it's best to target a power that is close to the fellow eye. >Post cataract operation: > 8/2005 R L [quoted text clipped - 8 lines] >I've worn glasses since age 8 and never had this on my script before. >Why is prisming evident now? Because of the disparity of the eyes? Probably not. >Anyway glasses with this Rx fitted (plus progressive adds) gave double >vision. That's due to the disparity in lens powers. Was the double vision at all distances or only when your read? >So it was toric contact lenses I now needed. First-time CL >wearer. >I'm trialling some ProClear soft lenses. I don't know the exact Rx yet, >but they feel good. Acuity in the Right eye is not as crisp as it was [quoted text clipped - 9 lines] > >Would you consider this a reasonable scheme? Need to know your age, if there is an "add for reading" for the right eye and if so, the actual add power for both eyes, and the health status of the right eye. Write the Rx like this... Rt -3.50 -2.50 x 20 1^dn Add ****** Lt +.75 -2.00 x 165 1^ up Add +2.50 >Thanks in advance. > >Brian Your welcome Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical robopt@execpc.com ~~~~~~~~~~~~~~~~~~ "An expert is a person who has made all the mistakes that can be made in a very narrow field." - Niels Bohr >>Why is prisming evident now? Because of the disparity of the eyes? > Probably not. Any idea what it could be due to? >> Anyway glasses with this Rx fitted gave double vision. > That's due to the disparity in lens powers. Was the double vision at > all distances or only when your read? Yes primarily when trying to read. Vertical-aligned double vision. >>But want your advice on this: >> [quoted text clipped - 4 lines] > right eye and if so, the actual add power for both eyes, and the > health status of the right eye. I'm 55. R -3.75 -2.50 x 20 1^up Add +2.25 L +0.75 -2.00 x165 1^dn Add +2.25 I'm trialling CLs at full prescription and a couple of drug store readers +1.25 and +2.5 to see how I go for reading and working (jeweller). For closeup work I use the higher plus pair and a +1.75 Optivisor. Brian SignatureAuckland NEW ZEALAND > I'm interested in a partial contact lens Rx to provide approx -1 myopia > for occasional day-to-day closeup stuff, and glasses on top to complete > the Rx. snip > Post cataract operation: > 8/2005 R L [quoted text clipped - 8 lines] > I've worn glasses since age 8 and never had this on my script before. > Why is prisming evident now? Because of the disparity of the eyes? Possibly induced vertical disparity from the retinal surgery > Anyway glasses with this Rx fitted (plus progressive adds) gave double > vision. So it was toric contact lenses I now needed. First-time CL [quoted text clipped - 13 lines] > > Would you consider this a reasonable scheme? You will still have a 1.75 difference between the eyes with the progressives which may cause diplopia at near. A more workable solution may be to use -3.75 R and +0.75 L spherical contacts with the astigmatism and prism correction in progressives worn over. The astigmatism will result in near vision good enough for occasional tasks when wearing contacts only, driving and detailed near work would reguire glasses over. The advantage to this solution is the avoidance of a toric contact lens, which, with your amount of astigmatism is a tricky fit and the avoidance of big differences in power of the glasses. Dr Judy > Thanks in advance. > > Brian Why not bitoric bifocal RGP lenses made out of Menizon Z material? DrG > Why not bitoric bifocal RGP lenses made out of Menizon Z material? > > DrG Sure, you can try anything (although unless full mono, which is bad, he will still need readers). But he needs a working spectacle backup, IMO, for when the cls don't work (which could be always)... w.stacy, o.d. Depends on who fit 'em. DrG > > Why not bitoric bifocal RGP lenses made out of Menizon Z material? > Sure, you can try anything (although unless full mono, which is bad, > he will still need readers). What do you mean by full mono ... one eye for distance one for closeup? > But he needs a working spectacle backup, IMO, for when the cls don't > work (which could be always)... I'm getting interested in Menifocal Z RGP. I'll find out if my optician dispenses them, or some other RGP lens. Thanks for all the comments. Brian Adam Auckland NEW ZEALAND Brian, Menicon Z is the brand of material, bitoric means the front and back surfaces are ground to fit your highly astigmatic corneas, and bifocal is self-explanatory. DrG > At the time of the cataract surgery (public hospital again) I requested > of the surgeon, at length, that I wanted residual myopia such as -1.00. > I considered this to be a practical and useful amount of myopia. The > stated margin of error was +/- 0.25. Sadly, I ended up with some > presbiopia (I've since found out that they get it wrong 20% of the > time). You actually did end up with about -1.00 (the spherical equivalent of your now mixed astigmatism in that eye. And you had presbyopia already, the pseudophakia just emphasized it a bit. > Post cataract operation: > 8/2005 R L [quoted text clipped - 5 lines] > Note the strange squiggles like triangles which represent prism. > Apparently each eye is aimed differently, 1 down 1 up. I think they are just trying to compensate for the large prismatic disparity induced by the power differential between R and L. > I've worn glasses since age 8 and never had this on my script before. > Why is prisming evident now? Because of the disparity of the eyes? > > Anyway glasses with this Rx fitted (plus progressive adds) gave double > vision. So it was toric contact lenses I now needed. First-time CL > wearer. OK that is kind of predictable. I'm surprised nobody suggested slab-off prism, which could eliminated the disparity. I think you also might want to consider standard bifocals to get a more useful near area of vision. > I'm trialling some ProClear soft lenses. I don't know the exact Rx yet, > but they feel good. Acuity in the Right eye is not as crisp as it was > with glasses in that eye; a result of the cyl and axis difference, I > imagine. Good luck with that. It might work. Might not. > This set-up is okay for distance (the slight lack of acuity > notwithstanding). But want your advice on this: > > A partial Rx contact lens in the right eye to provide approx -1 myopia > for occasional closeup stuff, and glasses on top with zero to +3 > progressive adds. As above, it *could* work, but is kind of Rube Goldbergish. I think I'd try, at least as a back up useful spectacle only Rx, your full distance Rx with a standard bifocal or even trifocal, depending on your needs, and for sure a slab-off prism on one lens. w.stacy, o.d. >> At the time of the cataract surgery (public hospital again) I >> requested of the surgeon, at length, that I wanted residual myopia [quoted text clipped - 4 lines] > You actually did end up with about -1.00 (the spherical equivalent of > your now mixed astigmatism in that eye. It doesn't feel like -1 ... the nearest focal point is about 6 feet away. In my discussions with the surgeon we were, I believed, discussing sph numbers. I was 3.50 sph before, we were aiming for -1.00 sph after. > And you had presbyopia already, ? > the pseudophakia just emphasized it a bit. >> Anyway glasses with this Rx fitted (plus progressive adds) gave >> double vision. > OK that is kind of predictable. I'm surprised nobody suggested > slab-off prism, which could eliminated the disparity. I think you > also might want to consider standard bifocals to get a more useful > near area of vision. I'll ask about slab-off prism. What I had fitted to the trial glasses was the reult of a special test pair of lens of which one was thick at the top and the other thick at the bottom. Is that not slab-off? >> I'm trialling some ProClear soft lenses. I don't know the exact Rx >> yet, but they feel good. Acuity in the Right eye is not as crisp as >> it was with glasses in that eye; a result of the cyl and axis >> difference, I imagine. > Good luck with that. It might work. Might not. Visual acuity in the best eye is not as good as with glasses. >> A partial Rx contact lens in the right eye to provide approx -1 >> myopia for occasional closeup stuff, and glasses on top with zero to >> +3 progressive adds. > As above, it *could* work, but is kind of Rube Goldbergish. I think > I'd try, at least as a back up useful spectacle only Rx, your full > distance Rx with a standard bifocal or even trifocal, depending on > your needs, and for sure a slab-off prism on one lens. Thanks. Brian Adam Auckland NEW ZEALAND >>You actually did end up with about -1.00 (the spherical equivalent of >>your now mixed astigmatism in that eye. [quoted text clipped - 3 lines] > discussing > sph numbers. I was 3.50 sph before, we were aiming for -1.00 sph after. I think your original post said the left eye ended up with + .75 sph and -2.00 cyl, which means it is a little hyperopic in one meridian (+.75 and fairly myopic in the other (-1.25), for a spherical equivalent of -.50, which is pretty close to your -1.00 target. Unfortunately, if they did astigmatism relaxing incisions, they missed the mark a little. Whatever, your remaining optical situation is most easily corrected with glasses. >>And you had presbyopia already, > > ? Presbyopia means an age related decreased inablility to change the focus from one distance to another; it is independent of myopia, hyperopia or astigmatism. Anyone over the age of 40 who has their natural lenses intact has some presbyopia. Pseudophakic eyes are non focusing at any age (except for the new focusing iols which have *some, however slight* focusing ability), so the term presbyopia is not properly used to describe them. w.stacy, o.d. > Presbyopia means an age related decreased inablility to change the focus > from one distance to another; it is independent of myopia, hyperopia or [quoted text clipped - 3 lines] > focusing ability), so the term presbyopia is not properly used to > describe them. I'll try to remember this. I've always considered presbyopia to be a loss of the ability to focus. I'll switch to "pseudophakia" if I can remember it, although I don't expect I'll be enhancing communication with other lay people very much! I snipped most of your post, as I didn't understand it. I have had cataract surgery and retinal detachments in both eyes. Due to the fact that the cataract surgeries were five years apart and I was unable to wear glasses for that time, I wore contacts set for distance and OTC reading glasses over them for close work. This fit my personal preferences quite well and I was happy with this arrangement. > At the time of the cataract surgery (public hospital again) I requested > of the surgeon, at length, that I wanted residual myopia such as -1.00. > I considered this to be a practical and useful amount of myopia. The > stated margin of error was +/- 0.25. Sadly, I ended up with some > presbiopia (I've since found out that they get it wrong 20% of the > time). Some people want slight myopia as a result of their cataract surgery. I didn't, and was happy with what I got (plano in both eyes). Ending up with presbyopia is hardly unexpected. Presbyopia simply means that your eyes have lost the ability to focus. This happens to most people with age. Cataract surgery done in the normal fashion nowadays removes the part of the eye that does the focusing. Thus, a normal cataract surgery *always* results in 100% presbyopia. You can ask the doctor to set your eye for near, far or in between, but your ability to focus at any other distance is gone without correction of some sort. I am no expert at reading prescriptions, but it looks to me that if your post-cataract prescription is +.75, you got what you asked for (plus or minus .25). > A partial Rx contact lens in the right eye to provide approx -1 myopia > for occasional closeup stuff, and glasses on top with zero to +3 > progressive adds. > > Would you consider this a reasonable scheme? I chose something different, but if this works for you (and the doctor doesn't see problems), then give it a try. Once you've had the surgery, you are pretty much stuck with it, but deciding what combination of contacts and glasses work for you is easily (and cheaply compared to the cost of the surgery) changed. > I snipped most of your post, as I didn't understand it. In brief: One of my eyes is different from the other. It's quite a problem. >> I ended up with some presbiopia (I've since found out that they get >> it wrong 20% of the time). > Some people want slight myopia as a result of their cataract surgery. > I didn't, and was happy with what I got (plano in both eyes). However, one eye +1 and the other -4 is a more diffcult situation. > Ending up with presbyopia is hardly unexpected. Presbyopia simply > means that your eyes have lost the ability to focus. It means (to me) that this eye doesn't focus up close. Brian Adam Auckland NEW ZEALAND >>Ending up with presbyopia is hardly unexpected. Presbyopia simply >>means that your eyes have lost the ability to focus. > > It means (to me) that this eye doesn't focus up close. Again, the term presbyopia should not be used on your operated eye. It is pseudophakic, with some mixed astigmatism. If it had been left with more myopia (as you wanted), it would be fixed at some closer focal distance. Still non-focusing, but more myopic. w.stacy, o.d. > >>Ending up with presbyopia is hardly unexpected. Presbyopia simply > >>means that your eyes have lost the ability to focus. > > It means (to me) that this eye doesn't focus up close. > Again, the term presbyopia should not be used on your operated eye. Sorry, I have been using the wrong term. I meant hyperopic, a +0.75 script. Apologies. Brian I have been using the wrong term. > I meant hyperopic, a +0.75 script. You're still only half right. Well, less than half right. You're only hyperopic in a few meridians of that eye. With the -2 cyl or whatever it was, you are actually myopic in most of the meridians, and as I said, over all somewhat myopic as defined by the sphercial equivalent. w.stacy, o.d. > > I snipped most of your post, as I didn't understand it. > > In brief: > One of my eyes is different from the other. It's quite a problem. If your difference is in fact simply the difference in correction that is required between the two eyes, then I understand that *real* well! For the five years in between my first cataract surgery and the second, I had one eye plano and the other -10D. I consider myself very fortunate that my OMG gave me a heads up years before the first surgery, and urged that I give contacts a try. I did, and wore them for about 10 years. For that five years between the surgeries, I wore them about 14 hours a day, 7 days a week. > >> I ended up with some presbiopia (I've since found out that they get > >> it wrong 20% of the time). > > Some people want slight myopia as a result of their cataract surgery. > > I didn't, and was happy with what I got (plano in both eyes). > > However, one eye +1 and the other -4 is a more diffcult situation. Yes. My doctor gave me a choice. I could have my eye set for close, for distance, for in between, or to "match" the other eye. By matching, I would not have the problem of different corrections, and would not need to wear contacts. After 35 years of being totally blind without glasses, the possibility of getting rid of them (or just wearing little thin ones, but not being complete dependent on them), was too tempting to pass up. > > Ending up with presbyopia is hardly unexpected. Presbyopia simply > > means that your eyes have lost the ability to focus. > > It means (to me) that this eye doesn't focus up close. I'm sorry to admit that I was confusing "plus" and "minus" in previous posts in this thread. You are certainly correct, although I don't understand exactly how the astigmatism fits in here. |
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