I am really confused!!!! . 9-10 days post cataract operation far IOL eye vision keeps fluctuating from a range of 1 to 3 meters (10 feet) to 1 to 15+ meters (50+ feet). It goes anywhere from 20/25 vision to 20/70 vision. . **BUT the first 3 m/10 feet have always stayed sharp throughout the 10 days!** . Just now when I was about to post, she put lubricating gel and she was again able to see far and this time 20/20! It keeps going around in circles. . QUESTION-1: If it is IOL movement related then how come the first 3m/10 feet always stay sharp? Ok when IOL is near to plano then you could technically read all the way to near/ intermediate, but when it moves nearer you won't see far but continue to see near/ intermediate. . QUESTION 2- It does seem dryness related to some extent but why is nearer/intermediate vision not impacted? This I don't have an explanation for!!!!! . The two drops that she is taking against infection/inflammation are - Dexamethasone (steroid) - Bromfenac (Yellox) . Both the above drops have dry eyes as a possible side effect. Surgeon had said take only the steroid drop due to the dryness/reaction she had to the disinfectant that was used during surgery. . On day 4 his clinic opthomologist said we can take Bromfenac (Yellox) as it won't do any harm and because wife could handle the same combination on the previously operated left eye. . I am thinking of stopping Bromfenac (Yellox) temporarily as long as we are still on steroid drops (4 more days of steroid drops left). Rational being to help the dry eyes go away (if it is dry eyes related). Restart Yellox in 4 days time when 2 weeks of steroid drops time is up. . Any insight?
i dont have anything to measure my vision. But my distance stays pretty much at 20/20. The intermediate to close is the problem. When i use systane drops, the intermediate vision is better. But what really does does the trick for better close and intermediate is bright lightening and moist eyes! But i " throw " on some " reader" and read. Dim light is the worse . . But driving at night is great!
I think you have the answer to your question - it helps with the gel, so yes, the problem is dry eyes 
I don´t really know about the details, but dry eye can really make a mess. When I was at my second day check with iol number two, I was ordered to use some type of artificial tears each hour the next 3 days because my eye seemed very dry to them.
And they said, it was not possible to use to many artificial tears.
I think I still have dry eyes some days here and there, my vision and side effects changes from day to day, but even the worst days are so much better than previous 45 years, so I don´t really care
I have no doubt your wife´s eyes will turn out really well, she is a very good healthy candidate, with no other eye issues, she will end up with great vision, when the eyes have healed, and it all have settled.
Online surgeon on another forum responded to me
Cut and paste if in future someone else stumbles on the info-
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I suspect the IOL is not moving that the variations are normal and due to corneal changes. The cornea usually has 3 incisions put into it so it moves/changes more than the IOL.
Don’t make any changes in the prescription drops.
Your thinking is flawed. The bromfenac is the most important to prevent cystoid macular edema so don’t stop it unless the surgeon says. Steroids do NOT reduce CME like NSAIDS. Be patient. Usually takes 3 weeks for things to stabilize.
interesting comment. So IOL move very little and it is the incisions to cornea that account for visual changes.
My surgeon said that even 0.1mm movement of IOL can be noticed by patients. Maybe it was a typo and he meant 1mm?
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Either way my surgeon said be patient. 10 days gone and wife will be going to work tomorrow. Near and intermediate vision is top notch though.
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This morning after all the lubrication drops the best she could do was 20/40 vision.
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interesting comment. So IOL move very little and it is the incisions to cornea that account for visual changes.
Can be both I guess. In my wife’s case I don’t think it is the movement of the IOL. I think it is cornea surface and cornea post OP healing related. Or could be combination of all of them. I really don’t know 
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just give it time, we all heal differently and fluctuations are normal. swelling of the cornea is going down, but maybe not equally in all areas of incisions. imagine a cut on your arm and how it swells at the incision, the area around it is effected also. lots of blood is being pumped into that area to repair, its under construction, so things are being pushed and pulled.
my dr also said you cant overdose on over the counter lubricants…every 2 hours for me. i had fluctuations in vision all throughout the Rx drop phase, vision started to settle 6 weeks post op, when all drops were completed
Today, 1 yr and then 7months post op exchanges, i still have near blurry vision, over the counter lubricants are my answer ( especially when i first wake up) some days are better than others
i no longer seek perfect vision, instead am grateful for what i have, which is pretty darn good considering all the surgeries i have had!!
Does she have astigmatism in that eye? When will she the doctor and have vision tested again? It is still early. I know it’s hard, but try not to worry…Coming from someone who is a huge worrier herself!
I got my own little surprise today, but it shows how much the refraction can fluctuate.
I was at a check at the clinic, it has been 3.5 month since trifocal and 4.5 month since Lara.
Day after surgery with Lara I was told refraction was +0.5 off, but off course day after is very unsure. I know now that it really was +0.75, because their aim was +0.25 so in their view it was 0.5 off.
I had it checked after 5 weeks, I did not ask about refraction that day, and I think she “forgot” to tell me, because the history now shows it was +1.25 that day.
Today it was +0.75 and it have probably settled there.
Trifocal have also settled at +0.75
She explained that they always aimed a little high with the Lisa and Lara, they have found that +0.25 gives the best results in real life with these lenses for some odd reason, so for them this was the target they wanted to hit.
So in her view +0.75 is 0.5 over the optimal target, but with these lenses still better than hitting under the target.
I have a little bit mixed emotions that they did not explain this to me before the surgery, I really think they should have, but that said I would probably have listened to their experience anyway, they implant Zeiss lenses each day all year long.
Hi Deb, I assume astigamtism is not an issue.
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In her RE pre OP it was -.29 Cylindrical
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1 day after OP -1.25 Cylindrical, Spherical +0.25
4 days after OP -0.75 Cylindrical, Spherical -0.25
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In comparison the LE pre OP was -0.58 Cylindrical
5 weeks post OP it went down to -0.25 Cylindrical
When will she see the doctor and have vision tested again?
RE was tested 1 and 4 days after the OP. First time surgeon checked it and the second time the surgeon’s clinic’s ophthalmologist checked it. Both times everything was healthy and normal apart from some dryness. Lens was centered, capsule fully clear. Retina ok too.
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Ophthalmologist said come back in a month to see if we need fine tunning with glasses, if at all.
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We can go back anytime we want though. Also we have option of our own private very nice female ophthalmologist.
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I wanted to go to local eye glasses shop today to get the numbers checked but wife did not see the point as eye is in transition state so kind of meaningless. I still wanted to know though.
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We went for a walk and she did see far again, car number plates around 10m/32feet away.
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With her far eye she can read from 60cm/22inches. She can read that close now (10days later) and also on the day the Autorefractor said -0.25 (4 days after OP).
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We will just wait and be patient! None of the eyes could just have been straight forward for us!!!
I was at a check at the clinic, it has been 3.5 month since trifocal and 4.5 month since Lara.
Wow Viking! Time flies!
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So it is 0.75 over plano in both eyes, or 0.5 according to clinic’s POV . Interesting. Does that mean your near usable range is less than it could have been?
You are right. Thanks. It is hard not to worry though
I am no expert Danish but totally baffled why any far sightedness is of any benefit to a patient.
Yes cannot believe how long it took to get to this point. You have such a positive outlook. Reminds us all to be thankful.
Viking, maybe their +0.25 is actually 0 and they just need to calibrate their equipment? (lol)
Viking, maybe their +0.25 is actually 0 and they just need to calibrate their equipment? (lol)
Or they are just generous and like handing out free sweets, I mean diopters.
Isn’t it great that she can see clearly from far to 22 inches with a monofocal lens? Or is she seeing better at 22 inches because the far is not very clear?
Yes, 0.75 over plano both eyes.
They have done thousands of trifocal lens implants since the Lisa hit the marked 7 years ago, they are also doing a lot of clear lens exchange.
And they have got this knowledge from all their results, that people that end up 0.25 over target have best visual outcome in real life. She explained that with +0.25 people had the best far vision and the best pc screen vision, and still a very strong near vision.
+0.25 equals 6-7cm distance in midrange, but I guess they must have found out this works best with the trifocals, and it probably does if you have healthy eyes behind the cataracts.
I don´t know if it was a good plan with the Lara, but in my case ending up at +0.75 in theory my Lara almost equals a monofocal set at -0.25, even that the Lara do have a more flat defocus curve, so there is no stright comparison.
So you could say I have not got much more than the side effects from the Lara compared to a monofocal.
On the other hand, a monofocal that hits +0.75 would be really bad.
I am not happy about it at all, but said to their defense, I had very dense cataract, they had to make a lot of measurements and separate good measurements from bad as well as they could, and find the mean value.
And with the high numbers my lenses have, 29.5 diopter both, the measurements are know to be more inaccurate, so all in all they did what they could, and I am not sure anyone else could have done better. maybe by change, but these people do know what they are doing.
The lenses comes in steps of 0.5, so if they need to choose between -0.25 and +0.25 with a trifocal, I think all surgeons would choose +0.25.
If they choose -0.25 and it settles at -0.5 or -0.75 which surely would be possible as well, it would result in a very noticeable decrease in far vision. So I think their choice was right with the trifocal - and maybe with the Lara as well, the Lara is placed in my dominant eye, so you would not want this to come up short of target.
I would have like the outcome to be different, but it is what it is, I would never risk what I have now and maybe get a new problem.
Right now I am free of glasses in my daily life and have more vision than I dared dream of before surgery, so I think I just need to let it be and accept this was my fate
Sometimes Danish it is better not to know everything. Like you said you have been very happy with your visual outcome. Why should knowing what real numbers are rob you of your happiness. What’s that saying “do not let the perfect be the enemy of the good?”