Lasik AFTER having a trifocal lense implanted?

Eye care
1

Hi all...

So I recently (2 months ago), had the Carl Zeiss Tri Toric lenses implanted in both eyes...

I am only 33 years old but my vision before surgery was +8.50 and +8.75 with a -3.00 Astigmatism in both eyes, I had really good corrected vision, but my vision without glasses was utterly useless. Being young and active I really wanted to lose the thick glasses that I was heavily reliant on for pretty much everything, could not see near and far without them.

2 months after surgery and I am overall very happy, however I do currently (as of yesterday) have a residual prescription of +1.00/-1.00 in the right eye, and +0.75/-0.75 in the left eye, with an ADD in the prescription of +2.00.

My surgeon suggested the possibility of "fine tuning" with LASIK and I wondered if anybody here has had this done? If so, did it make a lot of difference to your initial results, and does anybody know if I am likely to achieve a much better quality of vision given my current prescription?

One concern I have, is does getting your near vision corrected mean that you have to sacrifice some distance vision, or is the whole spectrum likely to be of better quality if the figures are closer to ZERO?

I know it has to be at least 3 months after surgery but thats fine because I work abroad and with my current schedule, couldn't possibly have it done until December anyway at the soonest. 

I also worry about coming across "ungrateful", considering 3 months ago I couldn't see a thing without very strong glasses, and now I haven't worn a pair of glasses for anything in 2 months, though I am sure there is no way I could do any up close work that required detailed vision, like threading a needle for example. However I paid a hell of a lot of money for this surgery, and want the absolute best possible results, so if LASIK can achieve this, I can't see a good reason not to take advantage of that considering it's part of the package that I bought.

Your input would be most appreciated!  

2

Hi Nizza, i would really advise you to research LASIK before going in for surgery. I to had RLE little more the then 2 months ago, and have some complications, not similar to yours though. Where are you located ?

peter

3

Just out of curiosity if you haven't needed glasses for anthing for last 2 months since surgery (I assume for cataracts unless you opted for clear lens exchange) why would you want to have lasik?   If it's for anything really close up wouldn't a pair of readers be OK?  I assume distance is fine if you're driving.  

Also if you had trifocals implanted and have no bothersome glare and halos you'd be risking getting those as lasik can produce those.

Just something to consider....

4

With monofocal IOLs (which it sounds like you got) you are in the same condition as normal eyes when a person is age 50+ where you only get one good focus range like distance. Glasses are then needed for intermediate and near vision focus.

The alternatives include monovision, where your doctor sets one eye for good distance vision  and the other eye a little nearsighted for good intermediate or near/reading focus. But then you have to get used to one eye being used for each focus range, not everyone can get used to that.  You could also duplicate this effect with a contact lens in one eye to try it out first or even continue that way rather than more surgery.

Other premium IOLs can also offer a wider focus range, but may have bad side effects particularly with night vision artifacts (halos, starbursts, etc).

5

Hi Peter! 

I am located primarily in the UK, however working out in China at the moment. What kind of complications are you having? 

Fortunately mine has been pretty smooth, I immediately had very good near vision after surgery (better than now I'd say), but my distance vision was a blur and night vision awful for at least 3 weeks to a month. Now my distance vision is very good, as is night vision and the glare etc is far less than what it was initially! 

Neil

6

Hi!

Thanks for the response...

I did not have cataracts, just extremely poor vision so opted to have a clear lens exchange as LASIK was not going to correct the amount of prescription that I had. When I say I haven't needed glasses, this means that I can drive, go about daily business, read my phone, computer, and do most things that I need to do throughout the day. Reading in certain light conditions can be a struggle but I think thats to be expected and thats fine. 

The reason I would like Lasik is that when I go for follow up's, my CORRECTED vision is still much better so that would suggest there is room for improvement right? At the moment it feels as though even though I can read and see small things, it's not too comfortable and I find pictures and videos a lot more difficult than text because it simply feels like it's too small.

Generally speaking, I don't have a problem with wearing readers, however let me give you a real world example of when this is not ideal...

I am 33 years old, and a professional musician... a few nights ago I was on stage and broke a string on my guitar, when you replace strings on a guitar it requires threading the string through a very small hole, and this hole I simply could not see. As you can imagine, being on stage during a performance and having a small amount of time to sort this, having to search for my readers is certainly not an ideal scenario. 

If LASIK is going to achieve better results, closer to that of my current corrected vision, then that can only be a good thing right? Or have I got it wrong?

Side effects wise, I do have halo's but they don't bother me really, the glare was much more of an issue for the first few weeks but now even that is bearable, some situations are more uncomfortable than others. I think the most bothersome side effect that I currently have and have no idea if it will go away or not (and doubt Lasik would affect), is this negative dysphotopsia. I always have a feeling a small shadow in my peripheral vision which is really annoying, but I am just hoping maybe it goes away over a longer period of time.

In the mean time I am just hoping to get the best possible results for my uncorrected vision.

7

Hi Night-Hawk,

I think you might have misread... I do not have Monofocal IOL's, I have TRIFOCAL IOL's, so I have good vision at near, far and intermediate at present.

My question is, there is still some residual prescription left over so will LASIK get rid of this?

8

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1954826/

9

I've read a ton of these studies since having my surgery and although it's nice to have access to this kind of information, I think it's also possible to read yourself into an anxiety attack! 

The problem is, is that we are always dealing with percentages because the results of these kind of procedures appear to be so unique to the individual, so we never really know which side of the fence we will end up on until it's done! I think ultimately it boils down to whether you trust your surgeon and the company under which they operate, and of course whether you're prepaid to take the risk for the possibility of really good unaided vision. 

In the first month after my RLE surgery, I had huge issues with artificial lights, glare, distance vision, driving at night was definitely unsafe. But now 2 months in, I'd describe my night vision as very good, not perfect, but can definitely drive safely and side effects are minimal and easy to deal with. I get halo's but they aren't that bad and in fact I don't even really think about them now. 

The big question on my mind after reading these forums, is why do some people aim to be slight Short or long sighted after surgery??? Surely the goal is to bring the numbers as close to zero as possible and have the best of everything right?? Or am I missing something?? 

10

Targeting for 0D (plano) can give good distance vision, but then near and intermediate range may suffer.  So some go for monovision or mini-monovision where one eye is set for distance and the other eye is set a little nearsighted to try to get good intermediate or some near vision as well.

Its all part of the tradeoffs with the current IOLs since none of them provide the best of everything.  They haven't managed to match the capability of a young natural lens yet...

11

I see, so even with the multifocal/trifocal IOL's, it's still a compromise between distance and near? Though am I right in assuming that there is nothing to be gained by being heavily in one direction or the other? I mean being heavily near sighted doesn't give you BETTER near vision than being mildly near sighted right? It would only mean you had even worse distance vision and vice versa? 

With that in mind there must be an optimum figure somewhere?! I just assumed that being neither near sighted or long sighted, would mean that you had the best of both worlds, but I guess there is more to it that that?

12

Only young natural eyes can get all the extreme focus range with a flexible lens.

IOLs are all a compromise and have tradeoffs: accomodating IOLs can flex/move a little to adjust focus about 1D or so - that can give good distance and intermediate (2-3foot) focus range.  Extended focus IOLs like Symfony can also get about a 1.5D focus range for good distance and intermediate, or can be shifted for good intermediate and ok near vision for example, but worse distance in that case. Multifocals offer two good ranges, near and distance, but you lose intermediate (computer distance vision) and also they reduce contrast sensitiivity and add night vision artifacts, as does the Symfony IOL.

Using monofocal IOLs you can get the best distance vision with best contrast sensitvity and no or very little night vision artifacts, but a limited focus range - thats why monofocal IOLs are often setup with monovision or mini-monovision to have one eye set for intermediate or weak near focus and the other eye for distance focus.

Its good to consider that even if your eyes are cataract free and perfect 20/20 distance vision age will cause them to lose intermediate and near focus requiring reading and computer glasses. At least there are options with IOLs to improve a bit over that, but with tradeoffs, so its very important for each individual to prioritize the focus distances they use most often and you can try to get at least two of the focus ranges glasses free, leaving glasses hopefully only for the more rarely needed focus range you use.  Like in my case I put top priority on distance and intermediate (2-3foot) focus ranges, and accept the need for reading glasses for fine print and near. Someone else may care more about reading near vision over distance for example. So there is no single perfect setup - it depends on the individual since there isn't a perfect single solution available so far.

13

Hi SueAnn-

You mentioned "clear lens exchange". Can you explain that?

Thanks!!

14

Hi Janet

I think what Sue means is that my natural lenses were clear of cataracts, I had the surgery purely for refractive correction and not because of cataracts. 

15

Hi! 

You mentioned distance as a priority for you and are fine with glasses for near. Does that mean you are no longer able to perform minor tasks in a mirror? For instance, there was an eyelash in my eye and I ended up going to my neighbor to ask for help. I wasnt able to hold a magnifying glass or readers  (as the surgeons nurse suggested) to where it helped- only distorted images. 

The nurse told me this was all perfectly normal and when I asked if she would be comfortable with such diminished near vision, she gave a resounding "Yes". I find it hard to believe that I'm one of the few who like to know if I've left the house with Bette Davis-like crazy makeup. 

Any ideas guys?

16

Thanks for the info👀😀

17

I feel the same as you Janet - I can't bear the thought of not being able to see clearly close up (and intermediate).  I'd rather have distance slightly blurred and have to wear glasses for driving or watching a movie. Ideally I'd like to be spec free for everything but if I have to compromise then I'd rather compromise on distance, not close-up.

Currently I just take my glasses off if I need to see something close-up and I read without glasses (I have to hold the book/iPad quite close though as I can't see clear much further than about 20cm from my nose).

My current dilemma is whether to go for a mini-monovision or multi/trifocal scenario.  Not sure which will give me the best results.  I'll be doing RLE, not cataract surgery as I don't have cataracts.

18

Everyone has different priority, if you have a special need for eyeglasses-free near vision than that should be your priority and have at least one eye set for that focus range.

In my own case, I find intermediate focus range (about 1D or so) is sufficient for viewing in the mirror since the mirror doubles the focus distance from the actual distance from the eye to the mirror. Intermediate focus should allow good vision at 24" or so, and that would be about 12" - I rarely need to move closer than that at the mirror.

But if someone needs to use the mirror closer than about 12" away, then targetting one eye for -1.50 or -2.00D might be good for that.