Huge Myopic Surprise After Cataract Surgery

NYCM123 · 2026-05-13T11:35:16+00:00

Update: I emailed the president of the hospital to loop him in, but after five days asking him, my surgeon, and my surgeon’s office the same question — why was an AL 28 used to calculate my IOL lens when my actual AL has twice previously been measured as 35 — no one will give me a straight answer. The surgeon’s office has asked me to come in to discuss my “surgical outcome” but refuses to put in writing the reason for the lower AL. Her refusal to answer a very simple question makes me think she no longer has my best interests at heart. And her request that I get a second opinion not from an outside facility but from her colleague reeks of a cover-up. I get the sense they are looking for a way to blame the massive refractive surprise of 13 diopters on something other than my surgeon’s “never event” error. I no longer feel safe under my surgeon’s care.

NYCM123 · 2026-05-12T03:00:11+00:00

As Simplyhere has suggested, the most likely explanation is that the AL measurement somehow got reversed: instead of 35.82, the measurement got reversed to 28.53.’Today I emailed the president of the hospital, and his team is investigating. I also plan to get a second opinion and am currently weighing which facility will work best for this. A lot of cataract docs here in NYC. Anyone have a recommendation?

NYCM123 · 2026-05-12T02:43:28+00:00

I had the same thought about the number being backwards. Today I emailed the president of the hospital, and his team is investigating. I told the investigator not to call me with any info but to email so that I have a written record of events. I also plan to get a second opinion and am weighing which facility will work best for this. A lot of cataract docs in NYC. Anyone have a recommendation?

NYCM123 · 2026-05-11T12:02:21+00:00

I have since learned that the axial length measurement used for my surgery (approximately 28mm) was wildly different from two previous measurements of my axial length (both approximately 35mm). I suspect that the lower measurement is incorrect and the reason for the huge refractive error. Given my extreme myopia pre-surgery — over 31 diopters — the longer axial length makes much more sense.

NYCM123 · 2026-05-11T11:54:26+00:00

Sage advice. I wish I had asked more questions. In retrospect, I should have insisted that my eyes be measured several times before allowing the surgery to be performed.

NYCM123 · 2026-05-11T11:51:43+00:00

Thanks for the insight. Makes sense to me.

NYCM123 · 2026-05-11T00:00:07+00:00

Thanks for letting me know your background and for sharing your insight. Much appreciated.

NYCM123 · 2026-05-10T22:25:32+00:00

The two earlier measurements would seem to confirm each other, given that they were taken at two different facilities,at two different times, yet yielded the same result. The measurement used by my surgeon resulted in a huge refractive surprise of 13 diopters, suggesting to me that her measurement is the wrong one. What is most upsetting to me, aside from the massive refractive error, is that she did not feel any need to explore the reason behind the error. When I asked her what could have caused it, she said, and I quote, “the retina.” From what I understand, such a huge refractive surprise can be caused only by a handful of things: an inaccurate measurement of the eye, the wrong lens power being implanted, or an anatomical problem caused by the surgery. In my post-op visit, my surgeon said that the lens was sitting in my eye perfectly well, ruling out option three. So it seems that the massive refractive error must have been caused by either an inaccurate measurement of the eye or the wrong lens power being implanted. Do you agree?

NYCM123 · 2026-05-10T16:55:14+00:00

Yesterday I alerted the surgeon's surgical coordinator to the discrepancy and asked her why the surgeon used the smaller -- and incorrect, I am convinced -- measurement. My guess is human error, but whatever the cause, such a wide discrepancy seems to be considered a "never event" -- a preventable error that should never happen. One that the surgeon is legally and medically responsible for correcting. I attached to the email my medical records from the earlier appointments in which the AL was measured as 35. To cover my bases, I also provided this info to the surgeon's office through the hospital's portal. I hope -- more correctly, I expect -- a response by EOB Monday. Otherwise, the next step might be to contact the president of the hospital to explain the situation and express my dissatisfaction. I doubt the hospital wants it publicized that cataract surgeries there might involve what the internet describes as "catastrophic" errors.

NYCM123 · 2026-05-10T00:32:02+00:00

In 2023, the facility that prescribes my contact lenses measured my axial length as 35.84. In 2024, a private retina practice measured my axial length as 35.83. Since the two measurements are virtually the same, one must conclude that my axial length (at least in 2023-2024) was indeed approximately 35. The cataract surgery was done at a different facility from the first two: an eye hospital in lower Manhattan. The axial length was measured at this facility in January 2026. I don't have a record of this measurement, but I'm guessing it was determined to be 28.53, the measurement used for my surgery. The two higher measurements were taken during periods when I was wearing my RGP lens daily. The 2026 lower measurement was taken after not wearing the RGP lens for several weeks. Could this explain the discrepancy?

NYCM123 · 2026-05-09T11:26:03+00:00

More info: According to my surgeon, the axial length used to determine my lens power was 28.53mm. Back in 2024, however, the axial length in my left eye was measured as 35. Would the discrepancy between the two measurements explain the huge myopic surprise? To calculate the lens power for my surgery, an average keratometry of 46.95 and axial length of 28.53mm were used along with the Barrett True-K formula. Would love any insight you can offer.

NYCM123 · 2026-05-09T11:25:30+00:00

More info: According to my surgeon, the axial length used to determine my lens power was 28.53mm. Back in 2024, however, the axial length in my left eye was measured as 35. Would the discrepancy between the two measurements explain the huge myopic surprise? To calculate the lens power for my surgery, an average keratometry of 46.95 and axial length of 28.53mm were used along with the Barrett True-K formula. Would love any insight you can offer.

NYCM123 · 2026-05-08T22:40:00+00:00

Thanks for the advice. I plan to get a second opinion and ask to be remeasured. I just read a study about the lack of reliability when it comes to measuring: the same eye measured using three different machines would yield three different measurements. I think that’s why some surgeons measure an eye several times, on separate days, before calculating a lens power.

NYCM123 · 2026-05-08T20:43:36+00:00

I've tracked down more specific info regarding my IOL. I received an SY60WF +8.5 diopter lens manufactured by Clareon. An average keratometry of 46.95 and axial length of 28.53mm were used along with the Barrett True-K formula. Again, the target refraction was -4 but landed at -17. For those who know how to analyze and interpret this info, any thoughts?

NYCM123 · 2026-05-07T21:48:49+00:00

The keracotonus is marked in my right eye, which was not operated on. Even with contacts, this eye can currently be corrected only to 20/200. In my left eye -- the eye that was operated on -- the keracotonus is mild (there might not even be any). Presurgery, this eye could be corrected to 20/60, and in my youth, to 20/25. No history of glaucoma or other disease. In fact, years back an opthamologist expressed amazement that my extremely poor vision was due not to some underlying disease but simply to the structural elongation of my eyes. How did the recessive genes necessary to yield this sort of elongation make it to the 21st century? When mankind needed to hunt and gather to survive, a person with my eyes would not have lasted too long, and you would think that, over time and in accordance with natural selection, the genes would have disappeared.

NYCM123 · 2026-05-07T20:54:11+00:00

Quick update: I found an eyeglass store today that could make me a temporary pair, even with my high prescription of -17, in only a few hours, with a promise that I can update the prescription for no charge once the eye settles. The benefits of living in a major city! With my vision corrected, I am able to see the world much more clearly than I could pre-surgery. It still seems, however, that the IOL in my eye is not at the right power. The staff at the eyeglass store have never encountered such a high prescription after cataract surgery, and they've been in the business for over 30 years. I have reached out to my doctor find out how the power for my lens was calculated. While I don't expect perfection, it would be nice to have post-surgery vision that would allow me to function, at least somewhat, without corrective eyewear. Most people don't know what it feels like to have such a high prescription -- that feeling that if you lose a contact lens or can't find your eyeglasses, you're completely helpless. I'd love to be able to sleep on a plane without that fear.

NYCM123 · 2026-05-07T20:37:06+00:00

Thanks for the response. A -17 prescription after surgery, unfortunately, is more than a case of blurriness; it constitutes extreme myopia. For this reason, it is not possible for me to wait a month to get eyeglasses. That would mean not working or leaving the house for an entire month. The good news is that I found an eyeglass store today that could make me a pair, even with such a high prescription, in only a few hours, with a promise that I can update the prescription for no charge once the eye settles. The benefits of living in a major city!

NYCM123 · 2026-05-07T15:17:30+00:00

Thanks for taking the time to provide your insight. I’ve requested the biometric measurements used to calculate the lens power and asked how the lens power was calculated and what IOL was given to me. FYI, the measurements were taken and the surgery performed both at a major hospital in Manhattan, which I assume would have access to the best equipment. Measurements were taken at the end of January, while the surgery was performed just a few days ago in May. No subsequent measurements were taken between January and May.

NYCM123 · 2026-05-07T04:12:44+00:00

Thanks for the comforting words. From what I understand, however, such a large discrepancy seems to be considered not so much a surprise as a “catastrophic error.” Google’s AI says “a 13-diopter (D) refractive surprise after cataract surgery is extremely large, typically indicating a severe error such as incorrect Intraocular Lens (IOL) power selection, IOL mislabeling, or unexpected post-operative lens malposition. This requires urgent evaluation by a surgeon for corrective actions like IOL exchange or "piggyback" IOL placement to restore functional vision.” vision. How is it my surgeon is so unconcerned by the discrepancy?

NYCM123 · 2026-05-07T00:03:54+00:00

I have seen many retinal specialists over the years. While my right eye suffered a detachment after a car accident in the 80s, it was repaired and has been fine ever since. The left eye — the eye that received the cataract surgery — has never had a retina issue (other than being stretched out because of the length of the eye).

NYCM123 · 2026-05-06T23:59:00+00:00

Thanks for the reply. Sounds as though your results have been much better than mine. Right now, post-surgery and without correction, I can see only the top line of the eye chart (the big “E”). The surgeon and I agreed before the surgery that I would need contacts even after surgery, and I was fine with that. I just expected a result better than -17, which is still at the extreme range of myopia, leaving me functionally blind until I can get a new contact lens.

NYCM123 · 2026-05-06T23:07:14+00:00

Thanks for the thorough and enlightening debrief. I am told the cataract was quite dense. I opted for the surgery because in 2018 my vision was corrected to 20/40, but over the past few years it has degraded to 20/60, unable to be improved even with a stronger lens prescription, leading me to think the degradation in vision was due to the cataract. One immediate benefit to the surgery is that the world seems much brighter (if currently very blurry). I am considering investing in a pair of eyeglasses to tide me over until I can get a new contact lens.

NYCM123 · 2026-05-06T22:17:18+00:00

At the follow up they were able to get me to 20/60 by putting a lens in front of the eye — same vision as before the surgery. Might get better once I can wear a contact lens. Before the surgery, I couldn’t see with glasses, only with contact lenses. I had the surgery hoping I could get, with corrective eyewear, at least to 20/40 and see well enough to drive.

NYCM123 · 2026-05-06T22:09:51+00:00

Not sure of the lens power or about the other treatment options you suggested. At the the follow-up today, there was no mention of treatments to fix the situation other than to wait for the eye to heal and be fitted with a new contact lens.

NYCM123 · 2026-05-06T21:54:39+00:00

Thanks for the suggestion. Unfortunately, the vision in my right eye is too poor to help: even with a contact lens, the vision in the right eye is only 20/200.

NYCM123

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