Adding a second IOL after cataract surgery?

My brother has had cataract surgery done in both eyes, and
everything is fine except for one thing.

He had requested monovision, but it appears both eyes ended up at
essentially perfect distance vision. The doctor says if that's the
way things end up after things settle down, and if my brother still
wants monovision, he could get lasik done on one eye, or they could
do another operation to implant a second lens on top of the first
one in that eye.

I had never heard of having two lenses in one eye. Is this routinely
done? Are there any long-term downsides to doing this? Which
option (lasik or the second lens) would you recommend?

In case it matters, the eye he would have further corrected had a
toric lens implanted to correct severe astigmatism. I wonder if
this might affect how well the two lenses would fit together.

On Jun 6, 8:18 am, George <gh424NO824S...@cox.net> wrote:
> My brother has had cataract surgery done in both eyes, and
> everything is fine except for one thing.
>
> He had requested monovision, but it appears both eyes ended up at
> essentially perfect distance vision. The doctor says if that's the
> way things end up after things settle down, and if my brother still
> wants monovision, he could get lasik done on one eye, or they could
> do another operation to implant a second lens on top of the first
> one in that eye.
>
> I had never heard of having two lenses in one eye. Is this routinely
> done? Are there any long-term downsides to doing this? Which
> option (lasik or the second lens) would you recommend?
>
> In case it matters, the eye he would have further corrected had a
> toric lens implanted to correct severe astigmatism. I wonder if
> this might affect how well the two lenses would fit together.

If it's an IOL, then are you sure they didn't say they could take out
the first lens, and replace it with a different one, offering
different correction??

I (not a doctor) can't think of a single valid reason to even propose
a 2nd lens ... leaving the 1st in place....

If the astigmatism was in his natural lens (the one they extracted),
then it would have disappeared /with/ his natural lens. Was it,
instead, in his cornea? If so, then did they speak with him about
Limbal Relaxing Incision surgery at the time of the IOL surgery?

Lastly ... does he /really/ want monovision badly enough to repeat the
risks of surgery -- either the IOL surgery (devil he knows) or LASIK
(devil he does NOT know)?

If it works ... don't fix it.

Reading glasses and bifocals ... don't offer much risk.

Just my $0.02.

In article
<62e60eff-73bc-453e-87a5-(E-Mail Removed)>,
Neil Brooks <(E-Mail Removed)> wrote:

> On Jun 6, 8:18 am, George <gh424NO824S...@cox.net> wrote:
> > My brother has had cataract surgery done in both eyes, and
> > everything is fine except for one thing.
> >
> > He had requested monovision, but it appears both eyes ended up at
> > essentially perfect distance vision. The doctor says if that's the
> > way things end up after things settle down, and if my brother still
> > wants monovision, he could get lasik done on one eye, or they could
> > do another operation to implant a second lens on top of the first
> > one in that eye.

> Lastly ... does he /really/ want monovision badly enough to repeat the
> risks of surgery -- either the IOL surgery (devil he knows) or LASIK
> (devil he does NOT know)?
>
> If it works ... don't fix it.
>
> Reading glasses and bifocals ... don't offer much risk.

As someone else who is not a vision professional, I would also not risk
another surgery to get monovision if I had perfect distance vision.

It would also be worth asking the doctor what the chances are of getting
the desired vision. I have heard that IOLs are usually plus or minus a
half diopter of the goal.

In addition to reading glasses and bifocals, I would suggest considering
a contact.

I have IOLs in both eyes. I asked for, and got, perfect distance vision.

--
Dan Abel
Petaluma, California USA
(E-Mail Removed)

On Jun 6, 9:18 am, George <gh424NO824S...@cox.net> wrote:
> My brother has had cataract surgery done in both eyes, and
> everything is fine except for one thing.
>
> He had requested monovision, but it appears both eyes ended up at
> essentially perfect distance vision. The doctor says if that's the
> way things end up after things settle down, and if my brother still
> wants monovision, he could get lasik done on one eye, or they could
> do another operation to implant a second lens on top of the first
> one in that eye.
>
> I had never heard of having two lenses in one eye. Is this routinely
> done? Are there any long-term downsides to doing this? Which
> option (lasik or the second lens) would you recommend?
>
> In case it matters, the eye he would have further corrected had a
> toric lens implanted to correct severe astigmatism. I wonder if
> this might affect how well the two lenses would fit together.

I'm not an eyecare professional, but I've heard of getting a piggyback
(second) IOL to correct a refractive error post-cataract surgery. I
agree with the response that a second procedure to get monovision
would not be worth the risk.

Lasik may not be a possibility in your brother's case. Lasik is used
to correct myopia, which is not the problem for your brother. I
believe that CK could be used, although the results of CK are reported
to be only temporary, and the effects of repeated CK procedures are
unknown.

If I were in your brother's situation, I'd either wear a contact lens
in my nondominant eye or progressive glasses.

I'd strongly urge your brother to get a second opinion from another
board-certified cataract/refractive surgeon before proceeding with
additional surgery. Frankly, I have some concerns about his current
surgeon's recommendations.