Wednesday, June 10, 2009

Vision 20/20 binocular, J 1 at near with good light. Refraction R -.50+50 x 180, L Plano +.75 x 155 R eye 20/20, L 20/25- without glasses.

Below are a few comments from Dan, another ophthalmologist who has a RESTOR IOL
(Some aspects of Dan's comments below are fairly technical and meant for eye surgeons. Don't worry if everything is not perfectly clear......)

I liked your description of the circles around lights at night. Yes they are a visible artifact but it certainly does not limit function. It's not a problem for night driving. It's certainly less of a problem than a 20/20 distance and 20/50 glare cataract. Patients need to be told to expect it, especially if it is a refractive lens exchange, but it is transient and increasingly intermittent over 2-4 weeks. I wouldn't hesitate to use the lens in truck drivers. As ophthalmologists we are rightly worried every time we hear the words glare or halo but with the Restor lens it is a fine line artifact that is easily worked around until visual adaptation makes it go away.
The "mimeograph paper" effect on near vision is visual confusion between the near focal and the far focal. Usually one is clear and the other is so blurred to seem more like a smudge than a recognizable letter. That effect will go away. This is more noticable in dim lights and with the object of regard midway between the ideal near focal point and the distance focal point(Circle of most Confusion). So adjust the lighting when you can and the distance you're holding your work. It also gets rapidly better with practice. Go without the readers as much as you can. That does short circuit the adaptation process.
You mentioned that your near vision varies at different times of day. I actually retained about a dioppter of accomadation. I'm not a morning person, so it shouldn't come as too much of a surprise that my near point moved out 3-4 inches in the morning during the first few months. Now it's a little less. Having some residual accomadation makes it even more of a learning experience that's improved by practice. The odometer falls right in between where I would see it best with the near focal and the distance focal. Even a diopter of accomadation becomes a wild card. My brain is facing the choice of A) use the near focal and relax accomadation or B) use the distance focal and accomadate. Less satisfying but equally possible choices would be to C) use the near focal and accomadate or D) use the distance focal and relax accomadation. So it is equally likely to choose the wrong option until it is experienced a few times. Practice going without glasses. Practice makes perfect.
I'm +0.25 OD and +0.75 OS. Early on I felt the same way you did, that the trial lens correction was noticably better. But after a month or so I didn't notice as much difference. I also talked to another surgeon who is liberal with contact lens correction during early adaptation and he said that a lot of patients stop wearing the contact lens before 3 months because they don't need it anymore. He uses it as a test to see if they really need a Lasik enhancement. Beleive it or not the quality of your vision will "upconvert" significantly with adaptation alone. I definitely would wait 3 months to consider Lasik. I really don't think that you will be interested in more surgery especially for the right eye. I did enhancements on 10% of my first 100 Restor 4's. Mostly for -0.50 Sph or cylinder, but I wish I hadn't because a little anisometropia like what you have can help with adaptation. 0.75 cylinder is a little marginal, but wait, your vision will improve significantly in 3-6 months. How many people with your refractive error do you put in glasses? Your surgeon did a nice job, be patient, your brain is still processing the changes.

Friday, June 5, 2009

Haven't posted for awhile....nothing to tell, other than things were about the same.
Vision today: 20/20 binocular (both eyes open) without correction...I can still tell it is not as good as with glasses before cataracts. However, it is much better than even 3-4 days ago. I am now almost 4 wks and 3 wks post improving every day. Let's talk a minute about the quality of vision the first few weeks. Although I could see, most written material seemed to be "washed out." For those of you old enough to remember the old memeograph machines, that is what it looked like. Type was not dark, it all appeared faded. Just in the last few days, this has changed. Print is getting sharper and darker. I would have thought that would have been related to a residual glass perscription.....but it is not! I have checked my refraction every day, and for the last 2 weeks, it has not changed at all. R, -.50 + .50 x 05, & L, plano + .75 x 155. For non MDs, that is not much of a perscription.
I'm not having a significant problem working, but still require a small reading aid in very dim light, such as in an ophthalmologic exam room. But that too, is getting better. Most of my patients have told me, that vision gets better with time....the only problem is being impatient.