24 years old, cataract in both eyes , edof or monovision

Posted , 6 users are following.

hello i am 24 years old and have cataracts in both eyes which I have to get removed.

I feel so bad that I have to give away my healhty eye function at such young age. I feel so bad about it , I need hope that it wont be a problem in my everyday life..

I've read so much about different IOLs, the doc said he would personally recommend me EDOFS with a mini monovision because of my young age

But because I said glares and halos would be a big problem for me, because I love driving at night and I wouldn't wanna give away my ability to drive.

Now we will do Monovision with Monofocals , because there is the lowest risk to losing ability to see at light and glares.

but then I've read that monovision takes away stereo vision, and that would be very very bad.

also I have read it's dangerous to drive like that.

it's so hard..

basically the most important thing to me is that I wont feel like that I'm disabled or something for the rest of my life.

Its important for me to see faces clear infront of me. I'm afraid I would from now on always see faces blurry with the monofocals set for distance / or monovision.

I dont want blur if i kiss my girlfriend or wake up next to her.

i want to be able to drive at night without problems, also being able to drive with good stereovision.

A big hobby of mine is cars, and I absolutely love driving my car at its limits on country roads.

Also I do Kickboxing and BJJ, I'm afraid I wont see my partner infront of me sharp anymore.

I still want to be able to read my texts, or change a song in the car.

My idea would have been to take the monofocals and then use multifocal contacts, I couldnt find anything to this combo in the internet.

I have no experience with multifocal contacts, I cant imagine how they would work, in my imagination I would think that they would be just like if I had multifocal IOLs, the doc said it wouldnt be as sharp as a an implanted lense tho.

I've read that it takes some time to get used to them, I thought I could maybe wear them always except when I'm driving at night and that this would be the best way to have a clear image on all distances.

also I dont care about crystal clear vision, it should just seem natural to see all distances

I really would be fine to see up to 20 meters and use glasses only for driving.

I would have no problems to wear driving glasses.

I'm so lost, I hate this decision.

I hope somebody can help me..

0 likes, 28 replies

28 Replies

Next
  • Posted

    So very sorry you have to deal with this at 24. I felt blind sided at 53.

    it really is not an easy choice to make. My surgeon said in someone of normal cataract age they are happy to gain something they lost years ago versus someone younger as they have to make a big compromise.

    It is good you found these forums and ate thinking through the options because each one comes with pros and cons.

    Myself I have EDOF lenses and do wear glasses very little. Only to see tiny print like on labels. Everyday life is for most part glasses free - however due to refraction errors etc understand that glasses free never a guarantee. I got these in late summer 2017. Noght driving for a good 6 months was challenging. Although better and I do drive at night - probably not to extent you do. I still see these huge light concentric circles around certain light sources (red traffic lights, car brakes when applied certain LED porch lights). Oddly I do not see them with sporting floodlights (I watch a lot of soccer), nor do I see them with overhead traffic lights. But you do get more halos and glare with premium lenses. Brain adapts to these but doesn't entirely filter them out. Certain personality types (the proverbial Type A ) will have more frustration than other personality types.

    Since my surgeries in Canada a new trifocal is available which some here on the forums can tell you about. They do bing about a bit better near focus than EDOF lenses. Something you should also consider and investigate.

    Monofocals give good vision at one focal point you choose (most choose distance but you could choose intermediate - ie computer distance) and wear glasses or contacts for other distances. If you do a monovision approach to gain another distance personally I would not do full monovision unless you have experimented with contact lenses. Many eyes cannot adapt to that. I could not experiment as my cataracts were too advanced. But mini monovision with 1 diopter difference is very tolerable for many.

    Something else you could consider is a monofocal with your dominant eye and an EDOF in 2nd eye. This monofocal mitigates the halos of EDOF eye. Also balances vision better as EDOF vision is seamless. Perhaps target the EDOF a little nearer to give better reading distance.

    Anyways wish you all the best in this journey.

    People here are great and many will weigh in. We are all patients like you so please discuss options with your surgeon. That person is key so please get a few consults.

  • Edited

    Sorry to hear about your condition. Stuff happens, but it is really not that bad, and not much different from finding out that you need glasses. Once you have gotten over that, it is time to decide on the best route forward. The best choice for your situation would seem to be monofocal IOLs in both eyes, adjusted for distance, and maybe combined with progressive glasses for excellent vision. You may be able to get away with just reading glasses if the implanted IOLs give you plano (the forcasted prescription was 100% accurate), and there is no residual astigmatism. It would also be possible to improve these conditions with minor surgery, but progressive glasses are best.

    The second best option would be monovision (full, mini, or micro), if you would like to take a shot at being glasses free. This has worked well for many people. If it does not work perfectly for you (3-6 months to fully adjust), then you will need glasses or contact lenses. Even if you do adapt well some correction may also be necessary if plano is not achieved.

    Reread these two options carefully. If you must have perfect vision, then some correction after the surgery may be necessary. There are no guarantees.

    Unfortunately, every person seems to be different and the outcomes cannot be predicted, so you need to do the research and try and select the option that seems to provide the best for your situation/needs.

    For reference, I had trifocal IOLs done 7 months ago. My vision is 20/20 with some astigmatism in both eyes. I do see small halos (no impact to my night driving), and vision past 30' is not as sharp as I would like. Still hoping that the latter will improve or can be corrected (no plans for glasses).

    Best of luck, be optimistic as your future vision is good with any option you choose.

    • Posted

      Hi Chris - not sure I understand this statement. There is a small percentage of people who for some reason see a larger range of vision with monofocals both targeted for distance - but that isn't the norm. Most would need progressives for near and intermediate. Premium lenses can provide more range and as is for all IOLs hitting the target or within .25 of it is key. i copied and pasted part of your reply that I was confused with - my apologies if it is just my misunderstanding.

      Mister84 - As for astigmatism it is worth getting toric lenses to correct (these come in monofocals and premium IOLs).

      The best choice for your situation would seem to be monofocal IOLs in both eyes, adjusted for distance, and maybe combined with progressive glasses for excellent vision. You may be able to get away with just reading glasses if the implanted IOLs give you plano >

    • Edited

      to clear the confusion, you belong to the small group of people who would see all distances with a monofocal just kidding. be safe.

    • Posted

      Then that sucks soks cause had I known I would have saved the expense (although much cheaper in Canada for premium lenses) eliminated the concentric circles and gone with monofocals. LOL

      Honestly more concerning is this new condition I am dealing with. With COVID19 it will be many months before I see a retina specialist.

      Staying as safe as I can. Banks considered essential service so I am at work each day - although many changes and processes in place to protect both staff and customer. Still would be nice to isolate in safety of my home. But on the other hand I have a pay cheque. Unbelievable amount laid off. Glad our gov is helping but how long can that continue?

      Stay safe soks. I am guessing all cataract surgeries worldwide are on hold.

    • Edited

      i understand the frustration for having to wait. i too need to get my right eye fixed. all cataract surgeries are on hold and my surgeon is in NYC. thanks for being in essential service and its good that they have the added protection. my group is essential rail but i only have 2 people onsite per shift and rotate them. some have complained and there is no hazard pay. unfortunately worst is yet to come. hopefully there is a cure vaccine soon.

    • Posted

      I think we are all hoping everyone works together for vaccine.thanks Soks - you too hope all turns out and this is over soon but human nature being shat it is and too many people still not self quaranting it likely get worse before better.

    • Edited

      Hi Sue, it is my understanding that aspheric monofocal IOLs will allow good vision for distance & intermediate, or near & intermediate. Glasses would then be needed for the range not covered, e.g., reading glasses for near vision when monofocals for distance & intermediate were used. These reading glasses will not help with distance vision if there is residual astigmatism or if the IOLs were not plano.

      Progressive glasses will correct for both these situations, if necessary, and also provide the correction required for near vision. Add in transition coating that automatically darkens in bright light will eliminate the need for separate dark glasses.

    • Posted

      I think you'll find who gets a better range (even with aspheric monofocsls) will vary person to person. You will see well at one distance (unless another issue going on). If you see more - it is a bonus. Which is why mini or micro monovision is a very good option and many go that route. We all go in hoping for the best but prepared to have to deal with glasses etc.If you wear glasses regularly the adjustment is less.

      The other difference is adjusting to light following surgery. With cataracts light was being blocked so for weeks after surgery everything brighter. I wore sunglasses for weeks inside my house.

      Good news this is not life threatening and urgent so you have tome to look at all the options.

    • Posted

      I think both you and Chris are correct. Distance IOL's in both eyes and reading glasses for up close may provide the overall best vision at all distances, providing you are willing to put on and take of the reading glasses as required. There are some progressive reading glasses (Foster Grant) that cover both the near and intermediate range, but most will still take them off for good distance. The monovision solution tries to solve this by using one eye for near and the other for distance. And the hope is that not so good intermediate vision from both eyes can be combined to provide somewhat reduced but perhaps acceptable intermediate vision- binocular effect. The graph below illustrates this effect in a perfect world. The hard part in this method is in selecting the right amount of under correction in the near eye. The range used is wide -- from -0.75 to -2.5. That is why contact lens trials are recommended.

      image

    • Posted

      Yes finding that right amount of under correction in non dominant eye is the tricky part - add into that the settling which can add an additional change either way. Even if you target both for plano you can have .50 diopter difference. I will leave that to the surgeons - they know ore about the measurements.

    • Posted

      Yes, I think that is the advantage of doing one eye and waiting to see what you actually get for an outcome and residual error. Then the decision on the second eye can be made while knowing half the answer as to what you have to deal with.

  • Edited

    While I wouldn't mind trading places with your for an age of 24, I sure do not envy your having to look at cataract surgery at that age. I am 70 and it is still very difficult to make these kind of choices at this age. Age brings up at least a couple of issues to consider. One is the life of the lens itself. For us old guys, one set of lenses generally does us for life. With your age it would seem appropriate to discuss life of the lens with your surgeon. A second issue is pupil size. Young people have much larger pupil size. This can cause two issues. The pupil can open up to the point where the edge of the lens can become visible or cause optical effects. The other issue is that a larger pupil reduces the depth of field of focus. This is kind of like comparing a camera with the aperture set at f1.4 compared to a f16. One of the "benefits" of getting older is that our pupil size reduces giving us more depth of focus, and more ability to tolerate a monofocus lens. Again, pupil size issues is something to discuss with your surgeon as to what impact that may have on lens choices.

    .

    I am considering monovision as well, but everything is on hold with COVID stopping elective surgeries. I can't offer you any personal experience, but I have found a couple of articles which I found quite informative on monovision options. Here is the title and author of the first one, which you should find with a google search.

    .

    Optimal Amount of Anisometropia for Pseudophakic Monovision Ken Hayashi, MD; Motoaki Yoshida, MD; Shin-ichi Manabe, MD; Hideyuki Hayashi, MD

    .

    I noticed that you are concerned about stereoacuity, and you should be as you are young and want to participate in sports that require depth perception.

    .

    I've read that monovision takes away stereo vision, and that would be very very bad...also I have read it's dangerous to drive like that.

    .

    The report above estimates the impact of varying amount of anisometropia on stereoacuity. This graph shows the loss of stereoacuity vs the amount of anisometropia used:

    .

    image

    .

    Their conclusion is that the impact of -1.0 anisometropia is minimal, and -1.5 is not that much worse. The impact of -2.0 is significant in loss of stereoacuity. Their overall conclusion is that -1.5 is optimum.

    .

    Another more recent report gives their clinical experience in using monovision. It raises the issue that more anisometropia may be needed for younger people compared to older people. And they also consider that a multifocal lens be used in the near eye -- a hybrid monovison. Seems like a good idea, but I would fear that you could get the night time vision issues from the multifocal lenses. In any case here is the title and authors to search for.

    .

    Monovision Strategies: Our Experience and Approach on Pseudophakic Monovision Misae Ito CO and Kimiya Shimizu

    .

    Hope that helps some with a very difficult choice. I would keep in mind that there is no perfect solution, just one that is most appropriate for your individual needs.

  • Edited

    Thanks for the replies guys.

    i think I'm just gonna kill myself. fk this st. If I want no reading glasses to use my phone I have to risk having glares and halos which would make me unable to drive at night. if I want vision on both eyes I'm gonna have to deal with no depth perception.

    how am I gonna be able to compete in boxing if I cant tell how far the punch is away.

    I JUST WANT TO END IT.

    NOTHING WILL PROBABLY MAKE ME HAPPY ENOUGH THAT I CAN CONTINUE MY YOUNG ACTIVE HOBBIES.

    I HATE LIFE SO MUCH I WANT TO DIE DIE DIE DIE.

    My doc literally took 10 minutes for me and then left.

    he only asked what I'm working as, nothing more and recommended edof or monovision set on 1.5D WHICH I HAVE NO IDEA WHAT THIS MEANS!!!

    I want to die I want do die I want to die.

    • Posted

      OK let me add my 2 cents since most opt for distance thinking no big deal to use reading glasses for up close.. EVERY day Im thankful I chose monofocal for near vision. I do a lot of close up work and reading. I see people close up; I drive at night with glasses. I have little to no glare. Both eyes work together, I didnt opt for minimono. But No illusion- my near vision naturally was better before cataracts than now, but its 20/20 and I do need light to see small print when I never did. The blue sky is the most gorgeous color I can imagine (toric lenses removed the astigmatism). Both were set at 1.5. I wanted closer but he said I would lose more intermediate.

      I am typing on computer without glasses; I watch TV without glasses. I use them for driving and walking an distance.

      Call the facility and ask to speak to the RN or nurse. Ask your questions when she has your chart. I know you can get great advice here from people who either havent had surgery yet or had different surgery or different needs. They are all great but You need someone to listen to you and explain. If no one there can talk to you, go elsewhere. You have the right to understand exactly what is meant by anything the dr says. It really is written up in "Patients Rights" and must be posted somewhere.

    • Edited

      I looked back over your initial post where you say that in discussion with your surgeon that you have dismissed multifocal IOLs, due to the potential issues with night time driving halos and glare. While it is not totally certain that you would experience those effects, I would agree the risk of it is significant. I have dismissed using a multifocal lens for those same reasons.

      .

      This directed you to the monovision solution with monofocal lenses. However, you expressed some concerns about loss of binocular vision and being able to judge distance in driving and in sports like kick boxing. My unprofessional opinion based on doing monovision with contacts, is that loss of binocular vision is not that significant. In driving I found that I could see in the distance well, and when I glanced down there was no problem seeing the dash clearly too. The amount of binocular vision that you retain is based on how much the near vision eye is under corrected. In your post above you mention "monovision set on 1.5 D". This most likely is the amount that the near vision eye is under corrected by. It is a pretty standard monovision value. Think of it this way. If you had your near vision eye under corrected by that amount, you would then need an eyeglass lens of -1.5 D to get perfect distance vision. That is not a lot. Some people would not get eyeglasses to correct for that amount of distance loss. And keep in mind the target for the other eye will be set to get perfect vision at distance. Between the two eyes you should get pretty good distance vision. Short story is that with this 1.5 D monovision I would not worry about poor distance vision.

      .

      The other issue is intermediate distance vision. That again, I would expect to be pretty good based on my experience with contact monovision.

      .

      What may be more of an issue is very near vision. I found I could see the computer, and normal print on paper, but I had trouble with small print like the fine print on documents that they really do not want you to read. Or in trying to read the ingredients of an over the counter drug label.

      .

      The number that you should talk to your surgeon about is the 1.5 D. While that is a pretty standard number, there is some movement to a slightly lower number, like 1.25 D. That improves your distance vision in the near eye, and increases the binocular vision even at intermediate distances, like seeing the ball hit your racket in tennis, or seeing the other guy's foot not hit your chin in kick boxing! And the reality is that there is always some uncertainly in what you will actually get after the lens is implanted. The typical accuracy is plus or minus 0.25 D. So a reasonable request of your surgeon is to ask for an under correction of your near eye of 1.0 to 1.5 D. If he gets it perfect, you will have 1.25 D, but it could be as low as 1.0 or as high as 1.5. At the end of the day any of these numbers is likely to work for all your needs except fine print text, which may require over the counter reading glasses.

      .

      Hope that helps some. If it makes you feel any better if I do go with monovision I plan to ask for a 1.25 D under correction.

    • Posted

      Ron , while 1,25 might be great for your needs, I think anyone engaging in sport where you need some kind of rapid response needs a bit more intermediate vision and that would be lost with your 1.25. Ofcourse we can postulate as much as we want and I know I would prefer very near vision like you say --although I can read small print labels , its a strain, but I have a further range of vision than I had previously. That is, if I play tennis I do see the ball a few feet ahead of me clearly. For kickboxing he does need some intermediate vision as well as most sports and going too near, loses that; as in it gets blurred a bit. My surgeon had said the .25 doesnt make a huge difference in close up but it makes enough difference in range that he didnt advise it. Having both eyes set the same does offer a depth perception needed for some activity. Its an individual choice and he needs to speak to someone who will explain all his choices. I hope he can get that. At minimum, monofocal will put less glare in front of him at night and with bright lights in indoor sports.

    • Posted

      I think it kind of depends on what you define as intermediate. I think most define it as half a meter to 2 meters, or 1.5 feet to 6 feet. It seems to me that for kick boxing that range would be important, as are ranges further than that.

      .

      It also seems to me that having both eyes at -1.5 D is an option that probably gives good computer distance vision, and good book reading, but is starting to get weak at 4 feet and beyond. In other words good for the close half of intermediate, but not so good for the beyond 1 meter distances as vision is rapidly falling off. See this graph for a measure of that.

      .

      image

      .

      With monovision however, that drop off can be compensated for with the other eye which is corrected for distance. The question then become what under correction should be used to give good intermediate vision. That is a trade off decision. From the graph below which gives the combined eye vision with different under corrections in the near eye it can be easily see that a -2.0 D is a poor choice for good intermediate vision. It is weakest in the 0.7 meter or two foot range, which may be critical for something like kick boxing. It does give good vision for reading, but that may be of lessor interest. A -1.5 D is better in the short intermediate range, but weaker in the more distant intermediate range. A -1.0 D under correction is clearly the best in the more distant intermediate range, but a bit weaker in close intermediate. That is what leads me to think that -1.25 D is a good compromise. It is not shown on the graph but should be between the 1.0 and 1.5 curves.

      .

      image

      .

      And what needs to be kept in mind is that the surgeon only has IOLs in his drawer in 0.5 D increments. In the worst case he may have to decide on an outcome of -1.0 D or -1.5 D, as there is no in between choice. So it seems to me that one needs a theoretical target, which may be achievable, or it may not. I think a discussion needs to take place between the patient and the surgeon as to what the preference is. If it comes down to the extreme of a choice between -1.0 or -1.5, what is your preference... Once the doctor has done the cornea topography he probably has a pretty good idea what the options are for the specific patient. My plan is to have that discussion with him before the final selection of power is made.

    • Posted

      A few other random thoughts for the OP.

      How important is kick boxing to you in the grand scheme of life? There are lots of other sports and physical activities that you could find enjoyable. This is extreme, but if you had lost an arm or a leg (rather than your perfect vision) would you be thinking about finding an alternate.

      So have the discussion with the doctor/nurse/consultant and follow their guidance, and use our lay opinions to help you understand what may be possible.

      There is another question that should be asked. Is LASIC vision an option after you have healed from the cataract surgery? This could fine tune each eye to achieve the desired refractive outcome. It will be an additional expense, and it may have its own set of disadvantages.

      Hope this helps in your research of all the options and consequences.

    • Edited

      Hi Ron, Since this is what I actually had done I am speaking only from my experience not what you read. I know everyone is different but setting too close takes away any oppty for seeing more than up close. I can see 4 or more feet away and read road signs. Everyone is different ofcourse. You are coming from a theoretical point and I am coming from my experience. The other point is 2 eyes working together give more close up and more distant than if we took each apart except for extremes. Then a close up eye and a distant eye (mini mono) may give more of the spectrum. I daren't say which is better for him.

      Im a huge proponent of anyone taking time to discuss with their provider as I work in medicine myself (not opth) . Thats why the OP needs to find someone to talk to him with his chart in hand especially considering his age.

      Im excited for you when you finally have this done. You've done an excellent job of preparing.

    • Posted

      the IOL diopters of 0.5D translates to 0.35D on the actual vision. please check that in your iol master measurements.

    • Edited

      My personal experience with monovision is with contacts using a -1.25 under correction in my near eye. I had the opportunity of trying varying amounts of under correction and deciding how much I liked. Then I ordered toric contacts with the -1.25 under correction for my near eye. I don't see why it would be much different with IOL's. Contacts of course give you the chance to compare and change your mind, and is the ideal way to get into monovision.

      Your correction of -1.5 in both eyes is not monovision. It is simply intentional modest myopia, equal in both eyes. It may be the best solution for your needs but I don't think you can use it to predict what true monovision is like.

    • Posted

      That is interesting. That means the IOL increments are not as gross as they appear to be, and are closer to the available 0.25 steps with normal eyeglasses.

    • Posted

      I used the wrong term- monofocal. I was thinking of the OP.

    • Posted

      yes they are 0.35. for example 16.5D iol gives me plano. but a 17D iol will make me require -0.35D glasses.

      noone is really plano. they use the iol closest to 0. so for me 16.5D was -0.19. 17D was -0.54 and 16D was +0.16D for me.

      if i wanted -1.5 i would need 20.5D iol whoxh would make me -0.19-0.35-0.35-0.35-0.35= -1.59D near sighted

    • Posted

      That is very helpful. I now know better what the surgeon can achieve. I have never worried much about what power IOL lens they use, and have only focused on the outcome residual in eyeglass power terms. That is something I can relate to.

    • Edited

      sorry i would need 18.5D and not 20.5D for -1.59D. they do the calculations for you on the iol master automatically and we can request it

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.