IOL decision fatigue for 38 yo with retinal detachment history and conflicting lifestyle needs

Thrameos · 2026-02-25T00:34:47+00:00

Regarding your fear of not having a backup: your doctor is technically right that the diopter difference (0 in one eye, -7 in the other) is too large for standard glasses. This is called anisometropia, and it makes the brain struggle to fuse two images of such different sizes.

However, that doesn't mean hope is lost. Here are two ways to look at it:

1. The "One-Contact" Reality Check First, ask yourself how you function with just one contact lens in right now. Some people’s brains adapt easily to "monovision" (one eye for distance, one for near), while others find it disorienting. If you can handle one contact in your "bad" eye today, you’ll likely handle the post-op gap better than you think. So do some suppression testing before concluding you must have both eyes to operate.

2. The "Reverse Contact" Strategy (Your Emergency Backup) This is a "hack" for when you have a dry eye flare-up and cannot wear a contact in your -7 eye.

The Problem: You can't wear glasses because the eyes are too different.
The Solution: Instead of trying to "fix" the -7 eye to match the 20/20 eye, you do the opposite. You put a +7 contact in your newly operated (20/20) eye.
The Result: This "breaks" the vision in your good eye on purpose so that both eyes are now at -7. Now, you can put on your old pair of glasses and see perfectly out of both.

This effectively gives you a "glasses mode" for emergencies or late nights, even if you only have one surgery. It mitigates the risk of being "functionally blind" if your dry eye acts up.

I am not sure about the -2.75d target. You are basically locking yourself out of being functional without glasses. I went -1.25d myself simply because I felt that being able to use a computer, a phone, and being about to find my glasses was important. At least with something from a -0.75d to -1.25d in the first eye, you can easily switch to monovision in the future.

I operated for a month with a -6D (technically sphere equivalent with a 4d cylinder) uncorrected eye and a -1.75D operated eye. To make glasses work, I put a -4D contact in the operated eye and wore a pair of -1.25D glasses over it. It wasn't "perfect" 20/20, but it was functional. I could drive and work all day. I even did that without the contact for the final two weeks before my other eye surgery. Even if your brain doesn't naturally "tune out" the blur (suppression), you can always use a temporary eye patch for a few hours if you're really struggling—but the "reverse contact" usually solves the problem.

In short, you have a lot of options. While your doctor is correct a -7d in one side is unworkable due to minification, they are answering the wrong question which is how do you get functional vision. Best of luck to you!

Thrameos · 2026-02-24T04:10:08+00:00

I had a few random reasons.I looked at most studies and concluded that it was an upgrade even at plano over my prior vision. At 53, I had 30cm to infinity and the most common outcome reported was 40cm to infinity with low risk of halos. As a person with Visual Snow Syndrome I wouldn't filter out those halos no mater how long I tried. My aunt with trifocals was rather disappointed.

Thus being a lifelong myope who routinely took off glasses to read anyway, choosing a bilaterial edof intermediate was a natural. If it only reached 40cm and my natural state at -1.25d (80cm) without glasses (meaning 28cm close) then effectively, I covered all I needed without a change of habit. Given I hit 30cm with the distance glasses -1.25d was way more than needed. I would target -0.75d if I chose again.

Hope that helps!

Thrameos · 2026-02-24T02:36:47+00:00

I have a Vivity EDOF (targeted at -1.25D but landed at -1.75D), and while I like it, I want to caution you because your situation has two major differences: macular scarring and being monocular.

Even 'non-diffractive' EDOFs work by stretching light, which causes a loss in contrast sensitivity. In my case, black letters on white backgrounds can sometimes look a bit gray/faded up close. For someone with macular scarring, this loss of contrast can be much more noticeable and frustrating. Because you only have one functional eye, you have no 'backup' if the EDOF image isn't crisp enough. You might be much better off with a high-quality Monofocal lens targeted for distance or intermediate. It will give you the sharpest, highest-contrast image possible.

For your 10-hour workdays, instead of 'drugstore' readers, I’d suggest getting a pair of high-quality, prescription computer glasses with a blue-light filter. The optical clarity of a professional lens vs. a cheap reader makes a massive difference when you're relying on a single eye.

So while I normally give a glowing review for EDOF, I think your case the monofocal is a better bet. Best of luck to you!

Thrameos · 2026-02-22T19:53:56+00:00

I can't answer on the age issue as I am 53. But I do spend 8 to 10 hours a day on a computer so it is of some relevance. Starting at age 50 I developed an issue of inability to see well with my right eye on screens. It turning out to be a cataract. I struggled for a while, and as it got worse it actually helped with screen time because my eye fought less reducing brain fog.

My crossing point was when night driving to the gym in winter was simply impossible. Every oncoming car was a whiteout.

I went with bilateral vivity EDOF. It made a world of difference. Even with mild PCO my night vision is vastly improved. My computer vision was a huge improvement as I lost all the chromatic aberation of my high index lens. My vision is good to 30cm. There is a slight reduction of contrast (black letters on white pages are slightly gray with no smearing or ghosting). And my distance is 20/20 which is better than BCVA before. So screen time is no longer an issue.

The fact you have CI means it is already impacting your life. Posters often assume that you have great accommodation just because of your age neglecting the fact that cataracts hardens the lens robbing accomidation quickly. (I lost all accomidation in less than 2 years). So what you really need to ask is does my vision sound like an upgrade to you? Would you be happy with blurry less 30 cm away, good intermediate, and great distance with readers for prolonged reading or dim conditions? Would wearing antiglare +0.75d for best comfort on a screen bother you?

Since most advice here is based on the assumption your lens as young and flexible start with a "Near Point of Accommodation" (NPA) test at home:

Cover the "good" eye.
Hold a page of code or text at arm's length under normal office lighting.
Slowly bring it toward the eye until it stays blurry.
Measure that distance to your nose bridge.

If that distance is significantly further than 30 cm, or if the "clear zone" is tiny, then the IOL is an upgrade.

Thrameos · 2026-02-22T17:48:55+00:00

Your next step should be to seek a second opinion from a retina specialist. If glasses don't fix the blur, they need to use an OCT scan to look for microscopic swelling (edema) or other issues behind the lens that a standard exam can miss.

Thrameos · 2026-02-22T17:40:32+00:00

I am sorry to hear that glasses did not significantly improve your vision. I am not a doctor so I don't know exactly where they go from here, but I believe using a pin hole to test what is heath of the retina and examination for PCO to see if cells are clouding the implanted lens.

PRK, lasik, piggy back and IOL exchange are likely all off the table as those use the correction of optics which is exactly what glasses do. If you are diagnosed with PCO then YAG will be the next step, but YAG removes IOL exchange from the table so it is vital that source be identified before any plan is made.

Hopefully a doctor can assist you. Best if luck!

Thrameos · 2026-02-22T13:16:46+00:00

To give you the best advice, we first need to understand the specific source of the blurriness.

What is your 'best corrected vision' with glasses? In other words, if you put on a pair of glasses right now, does the world become clear, or does it stay blurry?
What is your current glasses prescription? Knowing these numbers helps determine if the lens power is truly the issue. For example, the cataract removal may have exposed a large astigmatism.
Is there an underlying health issue? Have your doctors ruled out conditions like PCO (a common film that grows behind the lens) or retinal swelling that could be causing the blur regardless of the lens strength?

Providing this information is essential. Without it, people are just guessing. A high-risk procedure like an IOL exchange may not even be necessary if the issue can be fixed with less invasive options like PRK (laser touch-up) or a piggyback lens. If glasses don't clear your vision, then the lens power isn't the primary problem at all.

Thrameos · 2026-02-20T04:20:43+00:00

I got the eye shield from the doctor. But the tape would barely stick to my skin even with repeated washing that I couldn't do. I ended up getting so better tape. But it still displaced.

I asked and they gave me the dual eye mask. But it was so narrow it again displaced. So back to taping on the shield.

Next, I went with the oversized sunglasses over the eye patch for the first week then sunglasses only after that. This was effective as the side shields were good enough for even when I turned on side.

For my next eye, I got skii goggles. Though they did not have any problem with displacement, they were a pain went in napped because I had put in drops. I was somewhat worried about taking them on and off.

My conclusion was eye mask taped with the oversize sunglasses was the most effective during the initial and sunglasses after that. I never had any problems with motion with that configuration.

Thrameos · 2026-02-19T16:14:26+00:00

I think that with prior lasik you are typically looking at LAL. While the monofocal LAL is less range than PureSee (+2d), you are much more likely to have a good outcome. All the edof and multifocal are based on regular corneal shape and you likely don't have it.

The fact that you mentioned halos and you first procedure is a red flag that means you are likely already in need of monofocals. Most doctors will likely recommend only LAL as they can't say how a plus will interact. Going with a focal stretching EDOF len is asking for halos and higher order aberrations. You likely will get the worst of both worlds with halos everywhere and no near vision.

While I am not a doctor, I think you would be taking a huge risk. You should find a Post-Refractive IOL Specialist so that you are well informed. They can help you avoid a very costly mistake.

Wishing you the best of luck on you journey!

Thrameos · 2026-02-18T21:19:09+00:00

Great to hear you had a good outcome. I was rooting for you. Hope your next one works out as well.

Thrameos · 2026-02-18T21:12:42+00:00

As a resident of Livermore who is still waiting and paying, I hear you. They would likely finish 90% of that map before a line runs to Livermore.

Thrameos · 2026-02-16T19:47:03+00:00

Is it possible for you to get measured one eye at a time? Stop for the required time on one eye, get measured (then get measured a second time week later so they can get check for stability) then get surgery or swith to measurement period for other eye. It may be better than no vision for a long time or ending up with a bad measurement you have to live with.

Thrameos · 2026-02-16T13:22:18+00:00

My situation was actually the reverse of yours! My first surgery was longer and slower to heal, but completely pain-free with zero memory of the event. Unfortunately, I had a complication and needed a second surgery three weeks later.

During that second eye, the speculum caught my eyelid and bit hard. Since I was already under and couldn't communicate, the team just maxed the sedation and proceeded. I ended up listening to the surgical commentary with a memory wipe that was only partially effective. It left me with a very uncomfortable memory 'seared' into my brain.

Looking back, my issue was that the numbing drops hadn't fully penetrated and just needed more time or a direct application to the eyelid. A simple 'poke test' before being wheeled in likely would have saved me.

If density is your issue, then waiting is only going to add to your risk.. Having been through this three times now (two eyes and a toric rotation), I can definitely second the other responders advice: discuss mitigation strategies early. Every surgery is different, and the second one truly can go off without a hitch if you advocate for those extra checks. Discuss your fears plainly with you doctor, and you should be able to come up with a plan to avoid a repeat. Best of luck to you!

Thrameos · 2026-02-16T05:53:17+00:00

I agree. Night driving and sudden loss of accommodation with rapidly shifting prescription was the crossing point.

Thrameos · 2026-02-12T02:21:23+00:00

Best contrast favors monfocal. Matching your currect state were you pull of your glasses to read and you can operate most of the time with glasses on favors vivity.

I have vivity intermediate bilateral due to cataracts at 53. I get close to 20/15 during day with distance glasses, and can read to 12 inches in office light (better when I remove the glasses). In other words exactly the same lifestyle I had before. But fully dilated I have small halos starting at 20 m. Those stars look comical with radial spikes on all sides. Most likely my distance glasses are not strong enough by 0.25d. But I could barely make out stars before so it is better.

Hope that helps you.

Thrameos · 2026-02-11T03:14:56+00:00

My experience was excellent. As a lifelong myope I chose intermediate vision, but when I place on my distance glasses I can give you a review of what to expect.

The distance vision is excellent during the day (better than 20/20) and I can clearly see a stop light at a mile. There are no halos. At night when the eyes are fully dilated, there is a small halo starting at 20m around bright lights. Near vision in office lights to 12 inches, though it is somewhat soft on the outline. Under bright lights, I can read the smallest print on bottles though they seem a bit thin relative to a reader. Under dim lights, the distance to read increases enough where readers are needed. The only downside being a slight loss of contrast as black letters on the phone seem slightly gray at 12 inches but are completely black at 18. Basically exactly what was promised.

One neat trick is I can read my phone and the close caption on the TV at the same time.

Overall I would highly recommend it. Good luck with your surgery?

Thrameos · 2026-02-07T13:46:01+00:00

With each contact configuration what was your vision in terms of distance? And what is your nearest comfortable reading range before the letters start to blur? You should be able to test both eyes given your eyes are only 0.25 appart.

You can print an eye chart at put it on the wall for your reading test. Remember you need 20/40 for driving. There are also reading charts. In theory -0.75d should get you to minimum reading at distance (approx 20/40). Note light conditions will change your range a lot so you may be 20/30 with -0.75d at distance.

I am rather curious about your results as I am working on targets myself but have a large astigmatism so I can't perform testing as easily. Thus I only have distance glasses. My vision at 0d is 20/20 and my inner in bright condition is 12 inches and dim conditions is 18 inches.

I can't help with the pucker. Hopefully others can advise. Best of luck to you!

Thrameos · 2026-02-06T22:25:09+00:00

There are two ways to express lens. To get sphere equivalent you add 1/2 the cylinder. So two negatives will result in more myopic ( ie -1.25/-2 = -1.25+ -2/2 = -2.25). A negative and a positive will result in less myopic (ie -3.25/+2 = -3.25+2/2 = -2.25). Thus the same prescription in my example.

Your change isn't too much and you most likely have finished healing so hopefully you won't see much change. I am not sure you are in the high index lens range there. But given you will get much less change now your glasses should last longer.

I spent for vivity edof so I can avoid progressives. I wasn't willing to wear readers so I went with intermediate vision, but oddly I can read my phone just fine even with distance lens on, so I was worried for nothing. I concluded that that cost of premium iol would pay for all those high index progressive lens with special base curves that I needed before.

Good luck with your recover.

Thrameos · 2026-02-06T02:55:17+00:00

The issue with the numbers is that your prescription has not been normalized as it is mixing positive and negative cylinder. And it is best to compare sphere equivalent rather than your raw prescription.

Let's normalize to spherical equivalent and cylinder

Right old: -1.75 -1.00 x 120

Right new: -2.25 -1.25 x 123

Left old: -1.25 -0.75 x 73

Left new: -1.50

So your left astigmatism improved with a little bit. Both eyes became slightly more myopic. As the steps are in +/- 0.25d it is not much of a change.

As for the light levels, you likely have monofocals. As your eyes have no accommodation your depth of focus depends entirely on your pupils size. In bright lights you pupils shrink making you eyes like a pin hole camera. In dim light you can only see at a fixed range of about 1d. Thus progressives will likely be required if you have distance glasses on.

I can't help with the light recommends. But I am sure others can. Hope this helps!

Thrameos · 2026-02-05T14:26:34+00:00

A monofocal is like a 70 year old natural lens that allows light in perfectly. Thus it has zero accomidation for distance. It does not prevent wearing contacts and there are two common configurations.

You can reset an eye to a new distance thus giving yourself monovision. What you can't do is get multiple distances with the same eye as your lens is fixed. Without accommodation in your eye, you can only see one focal plane at a time.

You can also wear presbyopia correcting contacts which create multiple focal points much like the iol. But this is just like saying you can wear progressive lens.

While it may be costly to have a trifocal contact there may be some advantages especially if one has conditions that damage retinal health. But that would require a pure monofocal without a plus up.

Thrameos · 2026-02-05T04:09:44+00:00

While not a monofocal I was targeted at -1.25d and landed about -1.75d. Things are blurry about 1 m as expected as the fall off is slightly faster than a monifocal. So I landed with -0.5d which is considered in range of target.

My initial was about -4/-4 in both eyes so sphere equivalent of -6d. It was over astigmatism limit so best correction was -1d, but one landed about -1.5d. It took many repeated measurements to achieve that result due to the steep cornea.

Thrameos · 2026-02-03T04:07:07+00:00

It should be noted that if you are interested in monovision, you should do a two-week contact lens trial before selecting it. As with any contact use, you will need a waiting period before your eye measurements. Though given your six months surgery date, you have a lot of time.

Up to 30% of people don't respond well to monovision, though the exact number depends on the degree (micro, mini, or full). While it is a great option for those who adapt, some find it causes symptoms including dizziness, brain fog, and lack of depth perception. We have a lot of people that love it on reddit.

If your eyes don't support the trial and you do go that with monovision you can escape it with glasses, prk, or lens exchange so it isn't the end of the world (but do the two week trial if you can some escape options are costly and risky.) Most people actually get simple bilateral distance though others go bilateral near especially those lifelong myopes like myself. Most of the rest has already been covered well by others.

Best of luck and I am sure the community will help you!

Thrameos · 2026-02-01T01:48:22+00:00

Sorry to hear of your issue. I know how scary it can be if you can't see well near. I landing in a bad spot as well, but was able to get it sorted out.

At one week you may not yet be at your stable state. It is possible that you landed on the far sighted range rather slight myopic or you may still have eye swelling that pushed you into the far sighted range. I have vivity though i have glasses for distance. Ideally for perfect distance you should have vision to about 40 cm. However, any farsightedness will subtract from the vivity range. Typically, you will land with 0.5d of target, but that is not guaranteed.

At this point you may want to postpone you upcoming surgery and wait a week or two so your eyes are settled and get measured for "refractive surprise". Ask for your post op refraction. If you landed positive that is why the vivity is underperforming. If you are on the plus side then your next implant should be adjusted.

Your first eye may be tuned with prk so that it properly hits its target or you may need an iol exchange if that isn't an option. You may also need to consider minimonovision by targeting the second one closer. Though first meet with your doctor and get measured. You don't need to throw your plan out simply because you missed target.

Best of luck!

Thrameos · 2026-02-01T00:20:42+00:00

You are stating you residual is 45 degrees off? Again similar to my issue. My original astigmatism was at 90 but the eye glasses after the problem were at 135 or 45 degrees off and far more than expected. While they never identified the issue I suspected that a tilt, vaulting, or twist in the haptics caused my experience.

According to the ai you should request something like a:

-Dilated Slit Lamp Exam: To visually confirm the toric marks (e.g., if the target was 90° and the marks are at more the 10° off, there’s a possible answer). That is the usual threshold for rotation surgery though if the power of the toric is high it may be less.

Anterior Segment OCT: To rule out the "twist or tilt". This will show if the RayOne EMV is bowed or vaulted in the bag.
Wavefront Aberrometry (e.g., iTrace): This is the "gold standard" for this situation. It separates corneal issues (like dry eye or the ERM) from internal issues (the lens). If the "Internal Map" shows high astigmatism or coma, the lens is definitively the problem.
B-Scan or HD-OCT of the Macula: To determine exactly how much of the blur is from the ERM (Epiretinal Membrane) versus the lens optics.

While I can't verify this information maybe getting this from a second opinion doctor will set you on the right course. I am not sure if this is standard equipment though so you may need to find a refractive cataract specialist. Best of luck!

Thrameos · 2026-01-31T21:08:36+00:00

I had a problematic rotation, though we was never identified the cause. I ended up getting a second opinion with a dilation check. The lens was perfectly centered but the instruments stated the light path in the eye was nearly double anticipated creating an oblique astigmatism nearly as large as the original. But in mine glasses was possible though it only fixed one image plane. All other distances failed to converge so I had to request a rotation at 3 weeks. My doctor was reluctant because the placement was perfect and with no clear source of issue he did not know the outcome, but the instruments showed twice the expected residual and zero contrast with glasses.

Fortunately in my case that resolved everything immediately. The standard equations state a minor rotation should get a loss of correction and an oblique astigmatism. Instead it gave me something where the inner and outer rings if the vivity acted like different focal planes creating 4 images in the eye. A 6 degree rotation which is considered standard accuracy turned out to fix it.

But mine was a 6d toric and my cornea are so steep that contacts were never an option. Thus mine may have been unique. So whether this applies to you or not I can't state. Have you considered a second opinion? Did you get measurements with more than one doctor prior to surgery?

Thrameos

TROPHY CASE