Are IOLs set for distance too big a change for near sighted people?
Posted , 4 users are following.
Hi. I’m 57 and have been near sighted since I was 12. I don’t need glasses for iPhone, prescription bottles, small print and laptop if set at 40cm but use them for all other distances. I have to consider cataract surgery very soon. Based on all the reviews I have read on this forum (and thanks to all for sharing your experiences and extending your support - I have certainly benefited from the knowledge you’ve shared), I am considering micro or mini mono vision. One thing I’m not sure about is whether to bias my mini-monovision for distance or near.
My question is: for near sighted people, is it an impossible adjustment if the mini-mono is set for distance? Do most/all near sighted people automatically go for IOLs set for near? If so, does aging further affect near vision (with IOLs) the same way it affects natural lens?
Thanks!
0 likes, 14 replies
RonAKA xen42188
Edited
I have recently had cataract surgery on one eye only. I have been near sighted in the -3.0 to -4.0 since I was 10 or even younger. Recently for reasons I don't fully understand my distance vision has been getting better with correction more in -2.0 to -3.0 range with some astigmatism. My close vision without glasses has always been excellent to almost super vision. I am 71 now, but when I hit 50 or so, I started losing my close vision when I was wearing distance vision glasses or contacts. This pushed me to progressive lenses which I adapted to very easily.
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Fast forwarding now to having one eye corrected fully for distance vision with a monofocal IOL, I am adapting to it fairly well. I can read bright computer print quite well at 40 cm or so, but it goes downhill quite rapidly at closer distance. Of course I have lost my close super vision. I still have my other eye, so I can still see close with it.
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Looking forward to what I will do when the second eye needs to be done I have been using a contact in my remained eye that has the natural lens. It is corrected to be at about -1.25 D under full distance correction. Now with this one monovision contact and no glasses, I can see pretty good at all distances. In lower light I get in trouble with small print, but in full sunlight I can read very small print in the 6 points range.
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If you can still see well with both eyes, I would suggest using contacts to give yourself monovison in the -1.0 to -1.5 D range to see what you like (tolerate). It is really the best way to see what monovison is like. Switching contact lens power is quite easy and cheap. Places like Costco will give you trial lenses to try.
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Ideally you want to correct for distance in your dominant eye, and for close in the non dominant. I am doing the reverse and it still seems to work for me.
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For what it is worth, I believe the large majority of people get IOLs corrected for distance. I think it comes down to what you want your vision to be like when you don't have glasses on.
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Hopes that helps some,
xen42188 RonAKA
Posted
Thank you RonAKA for a detailed reply. Simulating mini mono vision with contacts is a great idea and I will definitely try that. it'd be great to know if I can adopt to swaping the great near vision I currently have with better distance vision.
Similar to your experience, at some point (don’t exactly remember when), I lost the ability to see near clearly when wearing glasses with my distance prescription. Without glasses, near is still very clear. However it’s a problem when driving or when I need seamless vision from distance to intermediate with glasses on.
Is you distance IOL set for plano? It’s great that you can see pretty good at all distance with simulated mini-mono. Below 40cm, is your simulated vision still functional but perhaps not as sharp?
Great question about what I want my vision to be without glasses. I think I’d be happy to see distance to about 40cm without glasses if I could get that.
Thanks again.
RonAKA xen42188
Posted
There are a few times where I miss my close no glasses vision. In difficult situations for low light reading, I have now discovered I had an unconscious habit of peeking over my progressive glasses to get the very best close vision. This is something that will be lost with IOLs set for distance, and even monovision.
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Yes, my IOL eye was targeted to be -0.25 less than perfect distance vision. They apparently don't like to go to over corrected. I go for my final post op check at the optometrist next week and will then see what the residual correction in my IOL eye is. On an eye chart I can see 20/20 fairly easily with the IOL eye only, and equally well using both eyes and the contact lens monovision. I had some astigmatism but too little to be corrected with an IOL toric lens. My expectation is that I may see a final residual correction of -0.25 D Spherical, and similar cylindrical. It will not be much, but I will get prescription progressive eyeglasses which I will use when I need the very best distance vision, and for reading very small print. My plan is to still use the monovision contact solution for most of the time, and progressive eyeglasses for the small amount of time I really need them. I am probably 2 years away from having the second eye done. Vision is still pretty good with eyeglasses but now I have the IOL to compare the colours are much brighter and less yellow looking in the IOL eye.
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Based on my experience so far, when it comes time for the second eye I will probably ask the surgeon to give me a -1.25 to -1.5 D under correction. The lenses come in power steps so unless you are really lucky they can't hit a specific number. I am also considering the AcrySof IQ Vivity lens for the second eye. It was not available when my first eye was done, but it is now in Canada. I hope that it might give me monovision with a little crisper close vision. But, that is something I will have to discuss with the surgeon down the road. Hopefully by then, he will have experience using it.
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You asked about my under 40 cm vision with monovision. In bright sunlight I can read the very smallest text on a reading vision chart (J1). However is diminishes as the ambient light reduces. In lower light levels it deteriorates to about J4. Using a computer with a bright screen is very good. Intermediate vision when driving a car is excellent. Not problem at all reading the instruments on the dash. No excuse for speeding! This said you would be best to try monovision to experience it for yourself while your eyes are still good enough to give it a fair trial.
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Hope that helps some
xen42188 RonAKA
Posted
Thank you once again for a very helpful and detailed reply. I too am from Canada. I have met a few surgeons in the GTA area where I live but never really got comfortable with any of the ones I met. The need to get the surgery done is getting close so will have to soon decide.
I read in one of your other threads that you have an Alcon IQ. Vivity might be a great complement. i saw a video from TLC Oakvile and it seems like they are already using Vivity
On a different note, I was also wondering whether presbyopia continues to advance in the IOL eye just like the natural eye with age and hence would it effect the quality of near vision in IOL eye with age. Although I haven’t found a definitive answer, I came across a Mayo clinic article which says that it worsens up to age 65. So perhaps not a big issue
RonAKA xen42188
Edited
" I was also wondering whether presbyopia continues to advance in the IOL eye just like the natural eye with age and hence would it effect the quality of near vision in IOL eye with age."
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I am not any kind of eye doctor, but from what I know being able to focus closer is a muscle and natural lens ability to change shape that you lose when you get older. With a standard monofocal IOL you essentially have zero ability to change the shape of the lens, so to me it seems impossible to lose what you don't have. I think in this aspect of vision, the impact of age essentially stops when you get an IOL.
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You didn't ask it, but I have often wondered if your overall vision changes with age after getting an IOL. From what I have read that may essentially stop too. The need for vision correction is the sum of errors in your cornea shape, and lens shape. The cornea seems more stable over time than the lens, which is gone and is replaced with an IOL after cataract surgery.
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There is a Chris here who is from Toronto, and is quite knowledgeable about cataract surgery. He has made recommendations on a clinic in Toronto that has surgeons with very good credentials. Worth checking into.
RonAKA xen42188
Posted
I did a quick look at the recent threads. See the one on the IOL Exchange or YAG. In that thread Chris recommended this doctor in Toronto. Hopefully Chris checks in and comments.
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Dr. Raymond Stein at Bochner Eye-Institute
Bookwoman xen42188
Edited
I'm copying and pasting my reply, with some edits, to someone who asked a similar question a while ago:
I was -8 in both eyes until my surgeries over a year ago, having been highly myopic my whole life. After reading a lot (including this very helpful forum) and consulting with my ophthalmologist, we decided that a -2 monofocal lens in each eye was the way to go. I spend roughly 80% of my day reading or on the computer, and the thought of not being able to see close up when not wearing glasses was horrifying. Close vision is what my brain has always been used to, and I wanted to keep it that way.
I was not interested in multifocal lenses, given the issues that some people have had with them, and I don't mind wearing glasses at all. My doctor suggested mini-monovision as an option, but since I was planning to wear glasses most of the time anyway, I didn't want to risk any discrepancy between the two eyes that would be too great for my brain to handle. (As you probably know, while there are targets for what your vision will be after surgery, the outcomes can vary.)
I wound up with my dominant eye at -2 and my other eye at -2.5. The fact that my unaided vision is now so much better than it has been at any time since my adolescence is still a source of delight and wonder to me. I can, without glasses, read and work on the computer (a desktop with a large monitor), see clearly when I look in the mirror (yikes!), walk around my house and see reasonably well, etc. For watching TV and driving I wear glasses with progressive lenses, which allow me to see really well at every distance. The upshot is that I'm absolutely thrilled with my vision.
Good luck with whatever you decide!
xen42188 Bookwoman
Posted
Thank you Bookwoman for sharing your experiences and the decision you made. Its great when one knows exactly what you want and the result turns out to match the expectations. I'm really happy for you and hope to be there (at least in terms of knowing what I want) soon! Would you mind sharing if you had any astigmatism and which lenses you opted for? Thank you and all the best.
RonAKA xen42188
Posted
I am of course not Bookwoman, and I hope she replies as well. I thought I would need a toric lens for astigmatism as I had a fair amount based on my eyeglass prescription. As a result I did a whole bunch of on line research into toric IOLs. Then when I saw my surgeon for the preop consult he told me that I did not have enough astigmatism to correct with an IOL. Eyeglass astigmatism is the total of the cornea astigmatism and the lens astigmatism. They can add together or actually offset each other. The IOL only has to correct for residual corneal astigmatism because the error in the lens is gone when it is removed during surgery. The IOL correction for astigmatism can be more or less than the eyeglass astigmatism. In my case when the corneal shape was measure using topography the astigmatism was between 0.4 D and 0.0 D. The minimum astigmatism that should be corrected with an IOL is 0.7 D. That is because they come in minimum steps in power and if you have less than 0.7 D then the minimum power is too much.
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If you do need a toric, my suggestion to consider would be the AcrySof IQ Aspheric Toric. The angular position of a toric lens is extremely critical to get good astigmatism correction. While there will be differing opinions, the material of this lens has been shown in some studies to be more stable in the eye. In other words it is sticky and stays put where it should be. It seems to be the one most favoured by surgeons for toric lenses by quite a wide margin. Tecnis is trying to improve their lenses to make them more rotationally stable, but I am not sure where they are at. The Tecnis material is slightly different from the Alcon AcrySof material.
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Hope that helps some.
Bookwoman xen42188
Edited
My lenses are Alcon Acrysof IQ monofocals. I did have some mild astigmatism (I believe it was .5 in both eyes), which my surgeon corrected with limbal relaxing incisions.
Sue.An2 xen42188
Posted
Hi xen42188 I too am Canadian on east coast and had my cataract surgery at 53 (3 years ago) but opted for Symphony lenses both eyes. 95% of the time I don't need glasses for anything. I was near sighted from childhood at -2.25 and -3.00 (with a bit of fluctuation in that over the years). I think most want to keep with their current situation as that is what we are used to but I think there is no wrong answer. You may have hobbies that play into that. If you like golf having distance vision would likely be preferred. I remember first time snorkelling in Caribbean soon after cataract surgery and totally amazed at the view. Before that without prescription mask things were blurry. Or if you do woodworking, photography or another hobby requiring close vision you might prefer near vision and wear glasses for distance after cataract surgery. Again it's about preferences and no wrong answer.
Wish you a successful surgery and good outcome.
xen42188 Sue.An2
Posted
Thank you Sue. I have read many of your helpful posts on this forum and thanks for your good wishes.
Many of my activities need good distance vision which now has been affected by cataracts. I also use my iPhone a lot (probably even more now because of Covid lockdowns) and I like the current situation where I don’t really need to look for glasses to read iPhone. Besides, it’s hard to loose your glasses when one is near-sighted 😃 If I could adopt to the change, I’d rather bias my IOLs towards distance and intermediate (and use readers when needed) as that’s where I spend most of my time. I understand from your other posts that your near vision is also great with the Symphonys.
It’s an interesting decision process when one has so many options but each comes with its own compromises and uncertainties 😃
Sue.An2 xen42188
Posted
Yes I am not sure if I just got lucky or if there is something about shape of my eyes or size of my pupils that provided me very good near vision with symfony lenses. There wasn't a lot of those with them in Canada at time of my surgery - my own optometrist tried to discourage me from premium lenses - although after 3 annual exams since the cataract surgeries even she thinks my results are good.
I have a developing situation with my LE unrelated to cataract surgery which makes me thankful for the symfony lenses (called epiretinal membrane). LE sees curvy lines and vision all distances are not great (with both eyes open RE compensates. If I went with monofocals and and type of monovision I feel my vision with this condition would be significantly compromised more.
It is s good idea to try the simulation with contact lenses to see how well you tolerate monovision and to what degree. My cataracts were too advanced to try that out.
RonAKA xen42188
Posted
I am doing simulated monovision with a distance IOL in my right eye, and a contact lens in my non operated left eye that under corrects by about -1.25 D. I have pretty good reading vision, and I can read my iPhone 8+ quite easily, and now I am eyeglasses free. Still not 100% sure I will do monovision when it comes time for the second eye, but I am leaning that way.