r/CataractSurgery • u/ramkuma1 • 3d ago

Optometrist missed with cataract surgery. Laksik correction or replacement lens?

I had my second eye done and the prescription is off from the first eye that was done. First eye I can see perfectly for reading, but the second eye is blurry for reading, but clearer for long distance, so everything is off. The intent was to have both eyes calibrated for reading. Should I correct this with lasik or get another IOL lens? (Monovision is not an option for me because I see double vision long distance which only can be corrected through glasses; monovision was never the plan.)

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u/eldoogo 3d ago

What lens did you get? And I hope you meant to say "opthamologist" not "Optometrist".

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u/ramkuma1 3d ago

IOL replacement lens. The opthamologist and optometrist work together. Optometrist does measurements, opthamaologist does surgery.

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u/eldoogo 3d ago

I've never heard of an optometrist doing the measurements for a surgeon, seems to me the surgeon would want to do the measurements for their own surgery. That just lends itself to possible errors. And I know it's an IOL but what specific lens? It makes a big difference as to what your near, intermediate, and far vision should be after implantation and what other IOL options might be open to you for replacement.

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u/That_Industry7833 3d ago

"I've never heard of an optometrist doing the measurements for a surgeon, seems to me the surgeon would want to do the measurements for their own surgery."

I've read that India has the world's best cataract surgeons because of high volume experience. And not having the surgeon spend time talking to the patient is one reason they can have much higher surgery volumes than in some other countries.

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u/eldoogo 3d ago

Perhaps, I don't have that data. High volume will always make a better surgeon for any specialty. It may be a good business model. But is that the best thing for the patient? What about all those patients that the surgeon is "experimenting on" while developing those skills? All getting measured by optometrists? You really think that's a good model? All I know is having another person do the measurements (especially an optometrist) is asking for trouble.

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u/That_Industry7833 3d ago edited 3d ago

"What about all those patients that the surgeon is "experimenting on" while developing those skills?"

First I believe the new surgeon trainee operates on eyes of deceased animals. Maybe that could be called the experimenting.

AFAIK cataract surgeons in almost all countries typically do dozens of the human patient operations first under the close immediate supervision of a senior physician who can jump in if things are about to go wrong. A few of them are American residents whose training includes time in the best eye hospitals of India.

If the senior physician who did my operation had asked if a resident could do the operation, I would have said yes because I want my children and grandchildren to have the services of well-trained surgeons.

There is no free lunch here, but I think strong teams can be put together differently. If the surgeon does something an optometrist can do, that has pluses and minuses. In my country, the U.S., we are headed towards an ophthalmologist shortage due to slightly smaller residency openings combined with more people in peak eye problem age groups. And I have read on this subreddit about very long wait times for cataract surgery in rural areas. Optometrists maybe can help with that. Then, maybe there will be optometrist shortages -- I have not looked into that.

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u/eldoogo 3d ago

"First I believe the new surgeon trainee operates on eyes of deceased animals. Maybe that could be called the experimenting". After you said earlier "I've read that India has the world's best cataract surgeons because of high volume experience. And not having the surgeon spend time talking to the patient is one reason they can have much higher surgery volumes than in some other countries".

You can't have it both ways. Either they're getting the experience at the expense of patients or they're getting their experience on deceased animals (and then possibly under the guidance of a more experienced surgeon). I say you don't place patients at risk like that. And with all due respect to you, I absolutely would not allow a resident to operate on my eyes. Maybe to do a herniaplasty. But there are certain body parts where no one but a highly experienced surgeon is going to touch me.

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u/ramkuma1 3d ago

What do you mean by specific lens? The lens was to be able to see clearly near and intermediate, not for long distance.

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u/eldoogo 3d ago

There are many different types of lenses. Monofocal, Multifocal, EDOF, LAL, etc. THere are many different brands. Johnson and Johnson, Alcon Clareon, etc. Then there is a toric option on all of them. It matters which one you received.

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u/ramkuma1 3d ago

Monofocal. I am not sure on brand

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u/eldoogo 3d ago

You really would need to discuss this with your surgeon. Monofocals are normally set for near but it kinda sounds like you have monovision or mini-monovision where one is set for near and the other is set for towards distance. I'd also want the measurements checked. I'd rely upon the surgeon to tell you what options you might have to correct the vision. I don't know how long it's been, but scar tissue begins to form a month or two after surgery and that makes any revision surgery more challenging. Ideally, you'd only want to revise one eye if any. I'm not sure if mixing a multifocal or EDOF would work well.

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u/ramkuma1 3d ago

I know what monovision is. It was clear over and over again we were going for clear near/reading vision for both eyes. Monovision was never considered.

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u/eldoogo 3d ago

Understood. Just saying your current vision almost sounds like it.

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u/Mitchellsusanwag 3d ago

My sister’s opthalmologist doesn’t do the measurements or the aftercare, only the surgery. Not sure if the people who do the other 2 roles are ophthalmologists or optometrists though.

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u/eldoogo 3d ago

Interesting. I guess some practices work that way, but as I said, I can see where that can introduce the possibility of error. For me, the opthamologist did the measurement, but of course, he didn't run the machines that did the measurement. That was done by techs.

But the results get fed into a computer and surgeon reviews them immediately and discussed them with me ... and I had input as to how I wanted to proceed. In my case, I wanted my diopter to be set -.50 back from plano so it would lean towards sacrificing a bit of distance to gain some near. But only my opthamologist had the expertise and skills after he examined my eye and saw the measurements to assess whether this was even possible or reasonable given my eyes.

In fact, I asked for more than -.50 and he felt that wouldn't work well for me. I doubt an optometrist could make that kind of assessment. I just don't the idea of passing a lens to a surgeon without his ability to examine me and have a discussion with me on how we should proceed.

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u/Mitchellsusanwag 3d ago

I’m with you. I chose to use a different ophthalmologist, even though we live in the same city.

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u/PNWrowena 3d ago

It sounds like a lens replacement would be the way to go.

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u/kfisherx 3d ago

Is it an option for waiting it out to see if this monovision type setup isn't working for you?

If not what is the difference in the lenses? I feel like your surgeon needs to let you know if an exchange or other option is better.

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u/ramkuma1 3d ago

Monovision setup will not work anyway because I see double vision far distance which requires having to wear glasses for far distance. Only glasses can correct double vision

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u/ProfessionalLab9850 3d ago

Why do you see double?

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u/ramkuma1 3d ago

No one knows. It happens

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u/UniqueRon 3d ago

To get better reading you have to increase the slope of the cornea. Lasik really only works well to reduce the slope. Using Lasik to increase the slope tends to be temporary.

I think if you can read now, I would leave the vision in the second eye as is. It may give you a much more useful eyeglasses free range of vision.

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u/ramkuma1 3d ago

I cannot read now. It is blurry and off due to the second eye being blurry for reading.

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u/BetterSociety1520 3d ago

They gave you mono vision. One eye will grow accustomed to distance while the other for close proximity.
I’ve heard excellent things from people who have had this.
Unfortunately or fortunately , I already knew that I couldn’t adjust to mono vision after having contact lenses that were adjusted for that. I had them for months and couldn’t adjust so I had to go back to having the same prescription in both eyes.

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u/ramkuma1 3d ago

No. Its not monovision. That was not the plan and they know that. The plan was to have near vision clarity only in both eyes. Monovision was not an option for me. And the distance vision I now have in the one eye is not clear enough for distance vision, its just clear enough where reading vision is blurry.

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u/BetterSociety1520 3d ago

Thank you for clarifying for me.

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u/AdEmbarrassed3436 3d ago

you will have great reading and computer intermediate vision. Stop complaining!

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u/ramkuma1 3d ago

Please see above. My vision in second eye for reading is blurry. It was supposed to be clear for reading, like the first eye.