Vision in 2 Eyes

In my previous thread ("from Macular Hole to Retinal Detachment to
Cataract") I described my present situation and a brief history of my
eye. I am not an eye professional, only a 68 yr old healthy woman who
just wants to retain her vision and independence, so please bear with
me. I appreciate much the input from the professionals in this group,
but any personal experiences of others contributes to my evaluation,
and I am intelligent enough to sort things out using logic, some
knowledge and science, and mainly common sense.

I have just discovered my last (and old) Rx, and was quite surprised,
since I have forgotten the numbers. Here they are for my distant
progressive glasses, as prescribed on 11/20/03:

Sphere Cylinder Axis Other
O.D. -2.50 -2.00 80 20/30
O.S. -3.75 -1.00 92 20/25
Add: +2.00

I still use these for driving, outdoors and TV viewing, and
occassionally for some other activities involving distant vision.

I have another Rx, prescribed on the same date, which was designed
originally for use by the computer, but I wear them most of the time
indoors, as the first pair is somewhat uncomfortable at this stage.
Here are the numbers:

Sphere Cylinder Axis Other
O.D. -1.25 -2.00 80 20/30
O.S. -2.50 -1.00 92 20/20
Add: +1.00

My vision in the left eye (my "good eye") is practically unchanged,
but the right eye, after the multiple trauma it has sufferred combined
with the resulting cataract, is very poor. I believe it's now -7.75,
but have no clue as to the astigmatism.

Interestingly, my right eye (the "bad eye") was originally less myopic
than the left, though had more astigmatism. I believe the "20/30"
indication under "other" is the corrected result, which probably could
not be brought to 20/20 with any Rx. My speculation is that I already
had then the beginning of a macular hole, which had developed during
the following years to stage 3, and eventually was diagnosed and
operated upon on 10/11/06.

If you recall, my cataract was formed within one month after the mac-
hole surgery, and on 12/14/06 I had a retinal detachment surgery,
contributing to a further growth of the cataract. Both the mac-hole
and the retina are holding on in place, at least for now.

Despite the current great gap between my eyes -3.75 and -7.75), I see
pretty well, although the left eye does most of the seeing. The fact
is that the gap does not interfere with my overall vision, and I
wonder about it. According to what you guys have written to me on the
former thread, my brain should not be able to process the combined
signal from both eyes, or I should see double, which I don't.

The numbers I provided are of great importance in determining the
route I will take in replacing the lens in the affected eye. At this
point I am determined not to tamper with the good, cataract-free left
eye, which means it will remain -3.75 for distance. Probably at some
point in the future I will develop a cataract in my left, but I may be
"lucky" and die before this happens, who knows? Meanwhile, I will
have to live with that eye as it is, correcting the other (the bad,
right eye) in such a way that will not cause a big clash in the near
future or at a later time when I will be forced to replace the other
lens as well.

Based on this information, what's your opinion? I have an appointment
with the new cataract specialist Friday morning and I wish to have all
the feedback I can get by then.

P.S. My myopia was much higher in previous years. I believe it was
around -5.00 to -6.00, but was decreased gradually since my mid 40's,
when I first needed bi-focals and the astigmatism appeared.

In article <(E-Mail Removed) .com>,
"Ms.Brainy" <(E-Mail Removed)> wrote:


> Despite the current great gap between my eyes -3.75 and -7.75), I see
> pretty well, although the left eye does most of the seeing. The fact
> is that the gap does not interfere with my overall vision, and I
> wonder about it. According to what you guys have written to me on the
> former thread, my brain should not be able to process the combined
> signal from both eyes, or I should see double, which I don't.

The brain is pretty smart. After some time, it just ignores one image
and you see out of one eye (which is what you posted). This works well
for most things. I don't recommend tennis.

:-)

Since you're determined not to touch the left eye, I'd have the surgeon
target about -2.00 after IOL (spherical lens, of course). You should be
easily able to tolerate that differential, and if you change your mind
about that left eye, then target about 1.00 D less minus than whatever
you end up with in the right eye for the left. The reason I think you
might change your mind is you may end up with so much greater clarity
and vividness of color that you'll actually want them to do the left
eye. My reasoning is that most people can easily handle a diopter or so
difference between the eyes. You may not have a clinically significant
cataract in the left eye, but I can assure you you have some degree of
discoloration and haze in that lens.

w.stacy, o.d.

Ms.Brainy wrote:

>In my previous thread ("from Macular Hole to Retinal Detachment to
>Cataract") I described my present situation and a brief history of my
>eye. I am not an eye professional, only a 68 yr old healthy woman who
>just wants to retain her vision and independence, so please bear with
>me. I appreciate much the input from the professionals in this group,
>but any personal experiences of others contributes to my evaluation,
>and I am intelligent enough to sort things out using logic, some
>knowledge and science, and mainly common sense.
>
>I have just discovered my last (and old) Rx, and was quite surprised,
>since I have forgotten the numbers. Here they are for my distant
>progressive glasses, as prescribed on 11/20/03:
>
> Sphere Cylinder Axis Other
>O.D. -2.50 -2.00 80 20/30
>O.S. -3.75 -1.00 92 20/25
>Add: +2.00
>
>I still use these for driving, outdoors and TV viewing, and
>occassionally for some other activities involving distant vision.
>
>I have another Rx, prescribed on the same date, which was designed
>originally for use by the computer, but I wear them most of the time
>indoors, as the first pair is somewhat uncomfortable at this stage.
>Here are the numbers:
>
> Sphere Cylinder Axis Other
>O.D. -1.25 -2.00 80 20/30
>O.S. -2.50 -1.00 92 20/20
>Add: +1.00
>
>My vision in the left eye (my "good eye") is practically unchanged,
>but the right eye, after the multiple trauma it has sufferred combined
>with the resulting cataract, is very poor. I believe it's now -7.75,
>but have no clue as to the astigmatism.
>
>Interestingly, my right eye (the "bad eye") was originally less myopic
>than the left, though had more astigmatism. I believe the "20/30"
>indication under "other" is the corrected result, which probably could
>not be brought to 20/20 with any Rx. My speculation is that I already
>had then the beginning of a macular hole, which had developed during
>the following years to stage 3, and eventually was diagnosed and
>operated upon on 10/11/06.
>
>If you recall, my cataract was formed within one month after the mac-
>hole surgery, and on 12/14/06 I had a retinal detachment surgery,
>contributing to a further growth of the cataract. Both the mac-hole
>and the retina are holding on in place, at least for now.
>
>Despite the current great gap between my eyes -3.75 and -7.75), I see
>pretty well, although the left eye does most of the seeing. The fact
>is that the gap does not interfere with my overall vision, and I
>wonder about it. According to what you guys have written to me on the
>former thread, my brain should not be able to process the combined
>signal from both eyes, or I should see double, which I don't.
>
>The numbers I provided are of great importance in determining the
>route I will take in replacing the lens in the affected eye. At this
>point I am determined not to tamper with the good, cataract-free left
>eye, which means it will remain -3.75 for distance. Probably at some
>point in the future I will develop a cataract in my left, but I may be
>"lucky" and die before this happens, who knows? Meanwhile, I will
>have to live with that eye as it is, correcting the other (the bad,
>right eye) in such a way that will not cause a big clash in the near
>future or at a later time when I will be forced to replace the other
>lens as well.
>
>Based on this information, what's your opinion? I have an appointment
>with the new cataract specialist Friday morning and I wish to have all
>the feedback I can get by then.
>
>P.S. My myopia was much higher in previous years. I believe it was
>around -5.00 to -6.00, but was decreased gradually since my mid 40's,
>when I first needed bi-focals and the astigmatism appeared.
>
>
>

William,

We are beginning to get closer... When you say "spherical lens, of
course", do you mean no correction for astigmaism? or is it obvious
that the astigmatism will be corrected as necessary? [I presume IOL
can correct astigmatism.]



On Mar 22, 1:12 pm, William Stacy <wst...@obase.net> wrote:
> Since you're determined not to touch the left eye, I'd have the surgeon
> target about -2.00 after IOL (spherical lens, of course). You should be
> easily able to tolerate that differential, and if you change your mind
> about that left eye, then target about 1.00 D less minus than whatever
> you end up with in the right eye for the left. The reason I think you
> might change your mind is you may end up with so much greater clarity
> and vividness of color that you'll actually want them to do the left
> eye. My reasoning is that most people can easily handle a diopter or so
> difference between the eyes. You may not have a clinically significant
> cataract in the left eye, but I can assure you you have some degree of
> discoloration and haze in that lens.
>
> w.stacy, o.d.
>

In article <(E-Mail Removed) .com>,
"Ms.Brainy" <(E-Mail Removed)> wrote:

> William,
>
> We are beginning to get closer... When you say "spherical lens, of
> course", do you mean no correction for astigmaism? or is it obvious
> that the astigmatism will be corrected as necessary? [I presume IOL
> can correct astigmatism.]


A bad presumption. As I understand, and I'm not a doctor, the IOLs that
fix astigmatism don't always work. This requires another surgery. If
that doesn't work, another surgery. Each one has a risk. I wouldn't do
it.

If your astigmatism is mostly corneal, it can be corrected with limbal
relaxing incisions (LRIs) at the same time. If it's lenticular, it
will automatically be corrected. I wouldn't mess with toric IOLs in
your case. Any remaining astigmatism will be mild and easily
correctible with your glasses, so you may opt out of the LRIs as they do
add cost. By spherical I really meant simple, single vision, as opposed
to multifocal IOLs or "focusing" IOLs. I am in favor of prolate optics
if applicable to your eyes, and I think they are, because they can
improve the sharpness of your vision over standard optics.

w.stacy, o.d.

Ms.Brainy wrote:

>William,
>
>We are beginning to get closer... When you say "spherical lens, of
>course", do you mean no correction for astigmaism? or is it obvious
>that the astigmatism will be corrected as necessary? [I presume IOL
>can correct astigmatism.]
>
>
>
>On Mar 22, 1:12 pm, William Stacy <wst...@obase.net> wrote:
>
>
>>Since you're determined not to touch the left eye, I'd have the surgeon
>>target about -2.00 after IOL (spherical lens, of course). You should be
>>easily able to tolerate that differential, and if you change your mind
>>about that left eye, then target about 1.00 D less minus than whatever
>>you end up with in the right eye for the left. The reason I think you
>>might change your mind is you may end up with so much greater clarity
>>and vividness of color that you'll actually want them to do the left
>>eye. My reasoning is that most people can easily handle a diopter or so
>>difference between the eyes. You may not have a clinically significant
>>cataract in the left eye, but I can assure you you have some degree of
>>discoloration and haze in that lens.
>>
>>w.stacy, o.d.
>>
>>
>>
>
>
>