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43 years old with cataract - looking for advice

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aaron15970
aaron15970

First off, sorry for the length of this. I have to make a big decision and am looking for some advice, I'm 43 with prior lasik (4 years ago). I developed a cataract in my left (non-dominant eye). I didn't get diagnosed for well over a year because I (foolishly) just thought my eye was changing and would need to have lasik performed again, so I wasn't in a rush (my right eye, which is the dominant eye, is perfect although presumably will also develop a cataract).

So now I need to decide what IOL to get for my cataract eye (non-dominant). I'm not touching my right eye until absolutely necessary (but should consider it in whatever decision I make).

My goal is glasses independence. I know in order to achieve this, I will have to make a trade-off somewhere. Cataract or not, I can easily see myself looking into surgical presbyopia solutions in the future if my reading vision degraded sufficiently to need glasses. Having to wear contacts since I was 15 and only being free of this for a few years, I'm very eager to avoid glasses of any kind.

I am aware of many of the trade-offs with a panoptix but think I might be a good candidate to deal with them. The current state of the eye with the cataract is that everything more than 5 inches away from my face is completely out-of-focus (it has been this way for almost a year). Also, due to the cataract, I have considerable glare/halos in that eye. My right eye (dominant) is perfect (with a small age-related burgeoning blurriness at near vision; I'm starting to zoom the text on my phone). Despite both of my eyes being as different from each other as two eyes can be, I tolerate the glare/halos just fine, and don't experience headaches, dizziness, or queasiness of any kind. I can drive at night and in any weather conditions. I can live my life fine. Even with the downsides of the panoptix, surely it would be a huge improvement over my current experience with the eye, right? For example, I'd gladly keep the glare/halos from my cataract if only the vision at all distances was clear. I should note that when the time comes to deal with my dominant eye, I would not opt for a second panoptix. I would likely choose a monofocal set for distance (if I'm happy with the intermediate/near vision of the panoptix) or a vivity set to distance (if I feel like I'd want slightly better clarity in the intermediate +.

The only other option I'd consider would be blended vision. I could consider a vivity in the non-dominant eye (the one I've got the cataract in) and then possibly go for another vivty in the dominant eye when needed. My other question would be, is it possible to get excellent vision at all distances (far, intermediate, near) with blended vision suing two vivity lens? Lets say I had a vivity in my right dominant eye right now set to distance. Would it be possible to set another vivty in the left non-dominant eye to get excellent intermediate AND excellent near vision without creating a dead zone or a zone of poor/degraded vision between the two eyes? What I'm say is, with vivty blended vision, would I be able to achieve excellent vision at all distances?

Thanks for reading this. I'm just nervous and want to make the best decision. There's so much to consider.

0 likes, 28 replies

28 Replies

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  • billy111
    billy111 aaron15970

    Posted

    If you search Vivity Extends Light there is a link that says Vivity stretches and shifts light.

  • aaron15970
    aaron15970

    Posted

    Thanks again for the comments; I appreciate it! You've all give me a lot to consider.

    If I decided to do a mini-mono or blended vision, I'm wondering about some different scenarios:

    1. What would a monofocal need to be set at to get near vision comparable to a panpotix in my non-dominant eye?
    2. If I used a vivity instead of the monofocal, what would that need to be set at in order to get near vision comparable to the panoptix? How much distance vision would that cost me?

      3)Would monovison with a monofocal lens set to near and the other set to far require glasses for clear intermediate vision? If so, would there be any overlap of clear vision between both eyes?

    3. If I used a vivity in the non-dominant eye, set to lose some distance but gain more clear vision would a monofocal set to distance in the dominant eye cover all zones? Would there be any clearvision overlap with the vivity?
    • soks
      soks aaron15970

      Posted

      1. my panoptix card says +2.17 ADD and +3.25 ADD.
    • RonAKA
      RonAKA aaron15970

      Posted

      1. The PanOptix is a hard lens to compare to. There seems to be a wide variety of outcomes with it. If I had to generalize what I see reported here, it is that the PanOpix is a little weak in near vision, but with good distance vision. And on the other hand the Synergy seems better at near, and weaker for distance. I have a friend that has PanOptix in both eyes. She needs +1.75 readers to read outside in daylight. I can easily read in those conditions with my monofocal which ended up at -1.60 D.
      2. Vivity gains about 0.5 D near vision. The standard setting for a monofocal for near vision is -1.5 D, so to give similar near vision the Vivity would have to be set at -1.0 D. If you get a monofocal set for distance in the other eye it will not cost you any distance vision.
      3. No it would not. When the near eye is set for -1.50 D and the far eye for -0.25 D, the drop in intermediate vision is insignificant. You only get a dropout if you go much higher to -2.0 D or more in the near eye. My overlap of good vision with both eyes goes from about 20" to 8 or 9 feet.
      4. The Vivity in the non dominant eye will have more overlap where both eyes have good vision, but it is really not that significant compared to having two monofocals.

      I made a post to David in the "Pros and Cons of Mini-Monovision thread which shows the visual acuity vs distance for the options you are asking about. It is in moderation. Check for it tomorrow when it hopefully comes out of moderation.

    • aaron15970
      aaron15970 RonAKA

      Posted

      My apologies if you've already stated this somewhere else (I looked at the post you suggested, thanks): I read somewhere that a good number of people have a -.25 to -.75 eye or eyes and might not notice their distance vision wasn't perfect and would likely not need glasses for distance.

      If I had an offset of -.1 for my non-dominant eye to improve reading vision, does anyone have any idea just how compromised my distance clarity would be? It's not that I'm concerned (the trade-off would be worth it with a blended/mini mono vision scenario), I'm just curious. Like, how approx how many feet out before things get too blurry; or when to things lose their crispness?

    • RonAKA
      RonAKA aaron15970

      Posted

      With a monofocal one can often get better than 20/20 vision and if the lens is close to plano possibly 20/15. If you start to slide myopic you lose that extra vision, and probably drop to about 20/20 with a -0.25 D outcome, and start to slide under 20/20 with a -0.5 D. Some people are OK however with 20/25, or even 20/30, so that is what they are doing. However to me it makes no sense to do that in a mini-monovision configuration. The other eye will give you reading vision, so why compromise on the distance eye to get better reading vision.

      .

      "If I had an offset of -.1 for my non-dominant eye to improve reading vision, does anyone have any idea just how compromised my distance clarity would be?"

      .

      I assume you mean -1.0 D? If so with a Vivity vision would probably would hit about 20/32 for distance. With a monofocal offset that much you are probably looking at 20/40 for distance. However, as I mentioned above with monovision it makes no sense to compromise the distance eye. The main thing to be aware of is not to go into the far sighted + zone. For that reason a target of -0.25 or a touch more is recommended. It is not to get reading vision. It is to avoid going far sighted without gaining any distance vision.

    • aaron15970
      aaron15970 RonAKA

      Posted

      Thanks! I wasn't very clear on my question, sorry. Regardless of the IOL I go for, I'd keep my dominant eye set for distance.

      Let's assume I'd go for an monofocal or vivity set for distance in my dominant eye (when that day comes; that eye is good now). If I picked the vivity for my non-dominant eye, what would be the ideal offset/myopia target be in that eye with a vivity for full uninterrupted clear far/intermediate/near vision (with both eyes working together) while maximizing my possible clear near vision?

      I assume if I go too far for reading vision in the non-dominant eye with the vivity, I'd create a blurry or out-of-focus gap at some point between that eye and my dominant eye (set for distance),right?

      Am I looking at an offset of something like -.75D or -1.0D for the non-dominant eye then?

    • RonAKA
      RonAKA aaron15970

      Edited

      The math of it is quite simple. The normal maximum/ideal amount of myopia to get good near vision with mini-monovision is -1.50 D. In a perfect setup you would get 0.0 D in the far eye and -1.50 D in the near eye with monofocal lenses. If you go with a Vivity in the near eye then it provides an extra 0.5 D of extended focus. So you can reduce the amount of targeted myopia in the Vivity eye to -1.00 D. You can target less than that, but your reading vision will be reduced and the need for reading glasses increased. With this differential there will be no significant gap in vision between the two eyes.

    • aaron15970
      aaron15970 RonAKA

      Posted

      Awesome, thanks. I've got an appointment with a reputable surgeon in my area tomorrow to discuss (in fact, he's the surgeon that performed m lasik 5 years ago).

      I guess I just have to decide what offset I'd prefer to shoot for. I'll also need to discuss with the surgeon what he feels likelihood of a refractive error would be, what the possible remedy would be, and in which direction (over or under correction) an error in my eye would be (if anyone can even answer questions like that).

      I'll also ask how he plans to accurately measure my eye taking into account my previous lasik (eg. ora?). I'm hoping being in possession of my pre-lasik scans will also be of some benefit.

  • aaron15970
    aaron15970

    Edited

    Thanks again for the comments; I appreciate it! You've all give me a lot to consider.

    If I decided to do a mini-mono or blended vision, I'm wondering about some different scenarios:

    What would a monofocal need to be set at to get near vision comparable to a panpotix in my non-dominant eye?

    If I used a vivity instead of the monofocal, what would that need to be set at in order to get near vision comparable to the panoptix? How much distance vision would that cost me?

    3)Would monovison with a monofocal lens set to near and the other set to far require glasses for clear intermediate vision? If so, would there be any overlap of clear vision between both eyes?

    If I used a vivity in the non-dominant eye, set to lose some distance but gain more clear vision would a monofocal set to distance in the dominant eye cover all zones? Would there be any clearvision overlap with the vivity?

  • soks
    soks aaron15970

    Posted

    sorry you are having to go through this at 43. i was 41 when this started for me 6 years ago. only now am i seeing some light at the end of the tunnel. good luck on what you decide to do.

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