Advice on Cataract Surgery IOL Selection

My experience with a monofocal set for distance is that I have no problem shaving with the vision I get. I also have no problem with seeing my dash instruments in my vehicles. But, that may vary from person to person. For sure, with a monofocal set for distance I need reading glasses to see up close to read. But, the reality is that if you choose not to correct astigmatism, your ability to see without glasses is going to be limited. If you correct astigmatism with toric lenses you have the mini-monovision option to target you dominant eye for distance and under correct your non dominant eye to be about -1.5 D myopic. This combination will let you see from reasonably close to distance without glasses.

I'm the resident near vision person (-2 monofocal IOLs in both eyes, but one wound up at -2.5). It works perfectly for me, since I spend most of my day either reading or on the computer. I wear progressive glasses to watch TV and when I go outside, and having been a high myope (-8) for most of my life I don't miss the distance vision I never had. I did not want to lose my near vision, and this has allowed me to keep that while also vastly improving my intermediate and distance vision anyway.

Many of us like being nearsighted, since it's what we've been used to for decades. As my surgeon put it, "your brain will be happier with what it's always known."

Hi Bookwoman,

I always like seeing your posts regarding your success with the near/intermediate vision. I'm planning on targeting for similar outcome as you when I get my surgery sometime next year but I think I still need the reassurance. At what distance does your very near vision start dropping off and does it become a complete blur at some point? What distance does your eyes naturally focus on when you first get up in the morning and is anything blurry? Also I can't remember if you had any astigmatism before your surgery and if you got the toric lenses? Donman I'm in your camp about keeping it simple and correcting the astigatism with glasses since I will be wearing them anywhere. I'm going to post a separate post if anyone obtained any type of glaucoma procedure at the same time as their cataract surgery. I'm a "suspect" for glaucoma and I can get a procedure like a shunt at the same time as the cataract surgery but I'm leaning towards keeping that simple as well and not doing anything for it at the same time as the cataract surgery.

I will post full details next week in a new thread but for what it's worth I had Eyhance implanted 48 hours ago in my right eye with a predicted target of -0.21 and I'm seeing 20/20 distance and can read my iPad easily at 14" with my un-operated eye closed. I'm writing this post on my iPad now without readers. Crystal clear. My Eyhance eye can actually see much better at that distance than my unoperated eye. I can even see my iPhone 12 mini contacts list down to 10" pretty clearly in my bright living room. Amazing.

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Of course this may change (early days yet) and your "mileage" may vary significantly and this result (so far) is probably far from the norm but it's looking promising. I was considering a 0.5D offset for my non-dominant eye but if this outcome in my dominant eye "sticks" I will probably just do first minus in the second eye as well (as opposed to second minus for more near).

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Anyway you may want to consider Eyhance at first minus in the dominant eye and depending how it turns out, do some micro-monovision in the second eye. It's a very low risk IOL (unlike multifocals) so you'll get monofocal quality distance as well as dashboard vision (almost for sure) and if you're lucky and all goes well you may even get a bit closer than dashboard vision. An IOL to consider.

Thanks to all who replied. Bookwoman, the plan is to do my left eye first because that cataract is worse, For my right eye, my surgeon said something about aiming for near vision. Is that what you did? I don't understand what -2 and -2.5 mean,

Ron, I amazed you can see to shave with distance vision. I have heard about others who can't. I guess cataract surgery results vary from patient to patient for a variety of reasons. BTW, you really know your optical physics!

Dave989 My surgeon said since I was using a toric for my astigmatism and I was aiming for intermediate vision, it would be better for me to use a Tecnis IOL rather than an Eyhance because it would make my eyeglasses prescription more accurate for my astigmatism correction.

Correction to Dave989, I mean since I am NOT using a toric IOL, my surgeon said the Tecnis would be better for me rather than the Eyhance to correct my astigmatism