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Thread: Depth perception issues in SV distance glasses after cataract surgery.

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    Depth perception issues in SV distance glasses after cataract surgery.

    Patient is presenting with vertigo and depth perception issues after having cataract surgery on his right eye. Left eye had been done long ago.
    We have had one rx change that did not help.
    Vertex, base curve,OC height, and PD have been eliminated as culprits.
    Pre-catatract surgery rx:
    OD-7.00
    OS-3.25-0.25x153

    Newest RX
    OD-1.00-0.50x168
    OS-2.75-0.25x027
    Each eye works well when occluding the opposite eye. The problems occur when using both eyes together. I believe he was so used to the power difference that when that problem was alleviated, he is having the symptoms of aniseikonia in reverse. Are there any suggestions as to how to help this patient.
    Thank You,
    Jason

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    What's up? drk's Avatar
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    Make sure that they're on equal bases. If they are, consider a steeper base with higher CT in the left, to get magnification.

    Click image for larger version. 

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    Last edited by drk; 08-22-2019 at 01:50 PM.

  3. #3
    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by jasons View Post
    Patient is presenting with vertigo and depth perception issues after having cataract surgery on his right eye. Left eye had been done long ago.
    We have had one rx change that did not help.
    Vertex, base curve,OC height, and PD have been eliminated as culprits.
    Pre-catatract surgery rx:
    OD-7.00
    OS-3.25-0.25x153

    Newest RX
    OD-1.00-0.50x168
    OS-2.75-0.25x027
    They missed by 1.50 D, unless they were trying to be cute, not a good thing to pull on an age 70 something.

    Each eye works well when occluding the opposite eye. The problems occur when using both eyes together. I believe he was so used to the power difference that when that problem was alleviated, he is having the symptoms of aniseikonia in reverse. Are there any suggestions as to how to help this patient.
    Thank You,
    Jason
    Short answer, tough it out, minimizing VI at near and far. Long answer needs more data.

    Hope this helps,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    Geez why would they do that to the poor guy. I got nothing to help beyond what was said. Hopefully that wasn't planned by the surgeon and was an unplanned result. I couldn't imagine going my whole life with one eye that much more near sighted than the other and then wake up one day with it being less nearsighted, what a wrench to throw at his visual system.

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    What's up? drk's Avatar
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    I think the plan was feasible.

    Knowing the OS is going to be myopic forever ("near vision eye"), they had an option to make the OD a "far vision eye", but they couldn't target plano, because there would be too much anisometropia.

    So they took a moderate approach...make it an intermediate-vision eye, and have a closer-to-tolerable anisometropia.

    I'm surprised it did NOT work.

    What's more, that -7.00 could have been a result of a nuclear sclerotic cataract that creates myopia. Historically that eye could have been less myopic.


    It seems like a case where the surgeon has a long time between the two surgeries because of asymmetric cataract progression, and the left eye was targeted -3.00 because the right eye was, like, -5.00 or something, and there was no indication that the right eye was going bad anytime soon.

    "Oh, sure, take the side of the doctors, drk". Hehehehe.

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    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by drk View Post
    "Oh, sure, take the side of the doctors, drk". Hehehehe.
    But opticians have to try to make the eyeglasses work, and the client has to try to wear them. Not to mention that this surgeon's solution may require specialized lenses or multiple pairs, accompanied by significantly increased cost, and less convenience.

    A classic case of crap rolling down hill.

    To be fair, there's insufficient data to say that this was botched due to ignorance, maybe the client had refractive surgery, detachment, or some other complication that skewed the A-scan results.

    Regardless, the surgeons need to consult with opticians before they get creative with the post-op refractive results, especially with myopes.

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    What's up? drk's Avatar
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    That'll be the day.

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    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by drk View Post
    That'll be the day.
    Yup, not since Medicare cut their Cat Sx reimbursement about 25 years ago. Regardless, I'm not comfortable letting the surgeon have total control over the IOL/patient discussion.
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    Quote Originally Posted by drk View Post
    I think the plan was feasible.

    took a moderate approach...make it an intermediate-vision eye, and have a closer-to-tolerable anisometropia.
    Why induce any non previous non balanced vision at all? Let alone SWITCH the side of the image disparities? sheesh

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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by Robert Martellaro View Post
    Yup... I'm not comfortable letting the surgeon have total control over the IOL/patient discussion.
    Oh gosh yes!

    B

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    Update: One, it looks like they were trying for a -2.00 end result and his 5 week post op showed -1.75. He continued to decrease in minus power. Two, the patient did not communicate with me or the other optician he worked with before me, that he had almost the same symptoms pre-cataract surgery. The Dr. is trying vertical prism. Thank you everyone for your help.

  12. #12
    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by jasons View Post
    Update: One, it looks like they were trying for a -2.00 end result and his 5 week post op showed -1.75. He continued to decrease in minus power. Two, the patient did not communicate with me or the other optician he worked with before me, that he had almost the same symptoms pre-cataract surgery. The Dr. is trying vertical prism. Thank you everyone for your help.
    Thanks for the update. Tough case. Hopefully the prism is for a phoria, and not for vertical imbalance.

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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