At what point did your cataracts become intolerable?
Posted , 7 users are following.
so my best friend got a cataract removed in his fifties when he could no longer see much of anything. he was ecstatic at the results. my folks got theirs done in their seventies. i know people are advised to wait until the situation gets pretty bad and at that point, most folks see a massive improvement.
however, i am only 60 and my only real issue is the glares and starbursts that make driving at night less than enjoyable. of course, i also get glare in the day (and correct me if i am wrong but i think cataracts impede vision even in bright sunlight with no glare since all light is passing thru the lens)., as well as annoying floaters (a different issue), but im curious about what point others were at when they decided to take action. ie: what were the conditions that led to one saying "no more"?
i ask because i know doctors say to wait as long as possible since their are always inherent risks and complications as well as the inevitable compromises.
so good people, tell me a little about your experiences so i can weigh my options for waiting or proceeding and thank you
0 likes, 31 replies
RonAKA Dapperdan7
Edited
I made it to my 70's with no significant issues with cataracts. My optometrist kept reminding me that he was seeing some evidence of them developing on each annual exam, but with eyeglasses I could easily get corrected to 20/20 vision. So, I just kept putting it off, and since I am in Canada with public healthcare, surgeons are not allowed to bill to the system until the surgery is "justified". Not sure what the criteria is, but I think it is when the eye deteriorates to 20/40 even with correction. I believe there is some subjectivity around it. For example if driving at night has become a problem they are likely allowed to go ahead before you hit that 20/40 corrected point.
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At some point which seemed to almost happen overnight, I started to see double images of the text on a TV screen. I had forgotten about the cataract thing, and was concerned I was developing some serious eye disease, and went for an exam at the optometrist. He said I had a cataract that was the cause of my issue, and asked if I wanted to be referred for surgery. I was somewhat unprepared for that, but agreed to be put into the queue, which can be a long wait in Canada. After a year or so, I got in to see a surgeon, and I think about 6 months later I got my first eye done. My second eye did not qualify to be done, but after a year or so of having one eye done and not the other I pushed for the surgery on the second eye.
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I don't know how bad your night driving issues are, and how well they can be corrected with eyeglasses, but that may be the driver for your surgery. If your vision is tolerable and can be well corrected, I would not rush into a surgery.
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While there are extended depth of focus lenses and multifocal lenses on the market, I think the safe choice is still the tried and true monofocal lenses. And the best option to use them, that most people do not consider, is the mini-monovision solution. The best way to trial if that is a solution is to do it now by simulating it with contacts. Before cataracts I did contact monovision as a solution to not wearing glasses. It was OK, but the contacts I had at the time were a pain to handle, so I abandoned them. Then after my first eye was done due to the cataracts and I got a monofocal set for distance, I went back more seriously to using a contact in my non operated eye. I found much better contacts, and I went about a year without glasses and just using one contact for near vision.
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So that would be my suggestion while you are waiting for the right time to go ahead with cataract surgery. Give mini-monovision a trial using contacts, and if it goes well, it can be a very good solution to the "do I correct to near, or far?" question. Do one of each! With a cooperative optical tech it is easy to do. I found Costco to be very helpful in getting me set up. As an example if your eyes are at -3.0 D, you would get a contact of -3.0 D for the dominant eye to correct to full distance. Then in the non-dominant eye, you would get a -1.5 D contact. That would leave you under corrected at -1.5 D and you should have good near reading vision.
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And, I think the major upside of mini-monovision is that you end up with two options for vision correction. One is that you should not need eyeglasses for 95% of your needs. And for the ultimate vision correction, you can still get progressive eyeglasses that will correct any errors in sphere or cylinder not corrected by the IOLs. I do that, but only use the glasses for driving at night out in the country where it is very dark. The rest of the time I use no glasses including for driving in the city, day or night.
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So I hope that helps some. You also could use contacts to simulate both eyes set for near at say -2.5 D, and both eyes set for far at 0.00 D. I find Costco quite liberal with free trial contacts. Then you could go into this cataract surgery with a clear vision of what the options really are. It is best to do this while you can still see well.
Dapperdan7 RonAKA
Posted
hey ron. thank you!
more questions:
im at around -6.5 in both eyes so is mini monovision even an option.? i assume i would want plano in my dominant distance eye. if so, what would you suggest in terms of prescriptions? since i have presbyopia, wouldn't my non dominant near vision eye be set as a +IOL?
this may be a dumb question but im confused about the term "under correction". does under correcting for distance vision then give more ability to see closer? can u explain?
thank you again
dan
RonAKA Dapperdan7
Posted
Being myopic at -6.5 D is certainly not an issue for doing an IOL or mini-monovision. To get contacts to correct your vision there is a slight adjustment required to get the contact prescription from an eyeglass prescription once the power gets higher like yours is. If you google "CooperVision OptiExpert prescription calculator" you can find a calculator to determine exactly what power of contact you need. On a quick check it looks like a -6.5 converts to a -6.0 D contact to give plano. So if both eyes are the same you would need at -6.0 D contact in your dominant eye, and a -4.5 D contact in the non dominant eye. That will leave you 1.5 D under corrected compared to plano, or mildly myopic. But, it should be enough to read. Distance is going to look at little fuzzy with this eye alone and probably will give you about 20/40 to 20/50 vision. But, your other eye will make up for this. And without you thinking about it your brain will switch eyes as the distance changes to give you a full range of vision.
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Ophthalmologists will most often talk about a target for correction in terms of what eyeglass prescription will be required to correct your vision to plano. If you are myopic and they leave you 1.5 D under corrected, you would need -1.5 D eyeglasses to correct it. In other words mildly myopic. Does that make sense? Commonly they will target -0.25 D for a plano outcome instead of 0.00 D. They do not want to take you into the + correction range as that starts to impact near vision negatively.
Dapperdan7 RonAKA
Posted
its a little confusing as when one gets bifocals, the correction for near is a plus correction. so im still a little confused if you can elaborate.
also,im assuming with mini monovision, you do lose some depth perception, correct?
RonAKA Dapperdan7
Posted
Think about it like this. If you are presbyopic while being say -6.5 D myopic you will get an eyeglass prescription for -6.5 D with a +2.5 add for the bottom of the bifocal. That corrects the top part of the glasses to 0.00 or plano to give distance vision. The bottom part is left at -4.00 D after the add. That is an under correction of 2.5 D and is what gives you the reading vision.
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While in times past some ophthalmologists would do full monovison with the near eye being left at -2.5 D. That gives excellent reading vision but creates other issues such as loss of 3D vision and depth perception, as you mention. More recently the trend has been to mini-monovision where you are left 1.5 D under corrected, (or needing a -1.5 D lens to correct to plano). The brain seems to tolerate a 1.5 D differential better than more than that. There is minimal loss of 3D vision with a differential of only 1.5 D.
Dapperdan7 RonAKA
Posted
so if i understand correctly, the -4 after the add could also be expressed as +2.5? is that why readers are always expressed in positive + terms?
and.... if i wanted mini monovision i would have my dominant far eye at -6.5 and my less dominant near at -5.0 (which is the 1.5) add? and trying this with contacts is possible?
thank you so much for your patience in explaining..
RonAKA Dapperdan7
Posted
If your eye is plano and you put on a pair of +2.5 readers, it essentially makes you -2.5 D myopic. That is essentially what is happening when you get some -6.5 D eyeglasses. Your vision is being brought to plano. Then the +2.5 addition in the bottom half makes you -2.5 myopic when you look through the bottom.
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Yes if your prescription is -6.5 D in both eyes and you get -6.5 in the distance eye, it is brought to plano. And -5.0 in the other eye leaves you -1.5 D myopic. It is not as good as -2.5 for reading, but it is a good compromise. For sure you can simulate it with contacts. Just tell the contact lens tech that you want to be fully corrected for distance in your dominant eye, and you want to be under corrected in the non dominant eye to leave you -1.5 D myopic.
Dapperdan7 RonAKA
Posted
its making a bit more sense. so if i get glasses for the under corrected eye (which would be -6.5 + 1.5=-5) they would be between -1.25 and 1.5 to get me to plano in that eye? am i understanding that correctly?
thx
dan
RonAKA Dapperdan7
Posted
Yes, I think that is correct. Just to clarify -6.5 D as you will know is moderately high myopia, and you should be able to see very well quite close up, possibly down to a couple of inches. Correct? I you get under corrected so you need -1.5 D glasses to see distance, but don't wear glasses, you will be mildly myopic. You should be able to see down to about 1 foot and then it will start to get blurry. Mini monovision is a strategy to fully correct the dominant eye to distance, and under correct the dominant eye you you are mildly myopic and can see relatively close. In your case, assuming you are -6.5 for glasses in both eyes, you would get a -6.5 (or possibly -6.25 because it is a contact not an eyeglass lens). In your other eye you would get 1.5 D less than that. For contacts assuming -6.25 in the distance eye, you would get -4.75 D in the non dominant near eye. If you explain that to the eyeglass fitter they should be able to help you get the right contacts.
Dapperdan7 RonAKA
Posted
you are correct.
questions:
--when i put something close to my eyes without glasses (say 6" or less) that i see perfectly fine, does that mean im still getting accomodation?
--i have a 1.5 and 1.0 astigmatism. will that be corrected with the contacts? should i ask for no astigmatism correction w the contacts for any reason?
-- can my dominant eye be my WEAKER eye? it appears that way.
thanks for all the info. i think i will try mini monol
RonAKA Dapperdan7
Posted
"when i put something close to my eyes without glasses (say 6" or less) that i see perfectly fine, does that mean im still getting accomodation?"
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Accommodation is very age related. I recall you are younger, 60?, so you should still have some accommodation. Being able to see at 6" or less is more of a statement that you have significant myopia and see well close. The real test of accommodation is having non bifocal or progressive glasses that correct you for distance vision, and then trying to see close. Look out of the top of your bifocals or progressives and check to see how close you can see. A young person will probably be able to see down to 6" or so. But, an older person starts to have trouble at arms length. That is the source of the saying that "my vision is fine, but my arms are too short".
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You should ask for toric lenses to do the contacts trial to correct the astigmatism. That will give you a better idea what monovision could be like. If the astigmatism is in your lens that gets removed in cataract surgery. When they measure your eyes for an IOL they will be able to tell you what your astigmatism will be after surgery with a plain monofocal. If it is more than 0.75 D they will likely recommend at toric IOL to correct it. If your objective is to be eyeglasses free after cataract surgery, it is worthwhile getting a toric IOL. If you plan to wear glasses it becomes unnecessary as the eyeglasses will correct the residual astigmatism.
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Yes, I suppose your dominant eye could be your weaker eye. While most will recommend that the dominant eye be used for the distance eye, it is not essential. And some even recommend the opposite way. That is called crossed monovision. Just due to circumstance I ended up with crossed monovision. It seems to work. If there is a predicted difference in what your corrected vision will be after surgery, I might be tempted to go for distance in the better eye. In most cases they can correct either eye to 20/20 or better. But if there is some issue with the eye, possibly not.
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There is no harm in trying mini-monovision with contacts. You will find out if you like it or not.
Dapperdan7 RonAKA
Posted
yep, when i wear my single vision glasses (i hated bifocals) i cannot read up close at all. i either put on readers over the single vision (and yeah, it sure looks stupid in public) or take glasses of and and put book/ipas up close.
when you mention about being glasses free after surgery, that aint happening since i could not take a chance on a premium lens reputation for glare issues since that is what is driving me nuts now. i will get a single vision IOL eventually and dont care if u have to wear glasses part of the time..so my question in regards to contacts is...
--would u recommend toric contacts with my astigmatism numbers as a way to get better site irrelevant of future goals with IOL?
--will costco let me choose my specifics for contacts? i always got the sense opticians would not do that but that was probably a silly assumption since its the customers money and choice. i guess we all fall prey to the cult of doctor always knowing best
you have NO IDEA how much i appreciate your help. reading articles is great but impossible to clarify certain things as the article wont talk back. i have an appointment in two weeks and you are helping me with knowledge about my choices
RonAKA Dapperdan7
Posted
There is no need to get "premium" MF IOLs to get eyeglasses free vision after cataract surgery. You can do as well or perhaps even better with a mini-monovision configuration that uses standard monofocal lenses.
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Getting toric contacts will give you the best indication of what mini-monovsion with IOLs will look like. I assume you are in the US? If so, based on what I see on line at Costco, I would suggest these contacts in this order of preference for a trial:
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As for dealing with Costco for a trial, that requires a bit of tact. I would be up front with them and explain that you want to do a trial of monovision prior to getting cataract surgery in the future, and you want to try being 1.5 D under corrected in your non-dominant eye. They will check which one that is. In the old days there seems to have been a lot of mystique about getting the right "fit" with contacts. The reality today with soft contacts is that there is only once size for each brand, and the brands only have minor variations between them. The real difference are in how they feel in your eyes and what the price is. I listed them in order of what felt best for me and just as important, how easy they are to handle in getting them in and out of your eyes. The Acuvue Moist for example is terrible to handle. I would not even try that option.
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If you play your cards right and are willing to go back over time, they typically are willing to give out 5 lenses for a trial of each lens type, but probably not all at the same time. So you can get quite a long trial without any cost, and in the process find out which lenses you like the best, if you decide to buy them for a long term trial. Just make sure you stop wearing contacts for at least a week before going in for a cataract surgery appointment where your eyes will be measured. It can affect the shape of your eye slightly. A week is enough with soft contacts for the eyes to return to their natural shape.
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The Costco tech should check that the distance eye gives you 20/20 distance vision, and that you can read with your close eye. And with both eyes they have some legal obligation at least in Canada to verify that you have vision good enough to drive with. That should be an easy hurdle if you have 20/20 in your distance eye.
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Hope that helps some. Any questions, just ask.
Dapperdan7 RonAKA
Posted
good advice. appreciated
Dapperdan7 RonAKA
Posted
ron
another question.
does the doctor just write down the prescription for an undercorrected prescription or do they just write down the true prescription and then give you an undercorrected lens?
all details that help b4 i go in
dan
RonAKA Dapperdan7
Posted
To get contacts at Costco here in Canada you need a current eyeglass prescription (less than a year old). The contact lens fitter uses the eyeglass prescription to determine the prescription for the contacts. In the near eye they will reduce the sphere part only by 1.5 D.
thomas84367 Dapperdan7
Edited
Basically, my optometrist/surgeon's office offered four options:
1.) Standard; Monofocal lenses (Tecnis) with no laser assisted surgery. (Covered by insurance)
Moderate astigmatism correction; Monofocal lenses (Eyehance) with laser assisted surgery and astigmatism correction. ($)
Intermediate astigmatism correction: Toric lenses (Eyehance) with laser assisted surgery and astigmatism correction. ($$)
Premium vision: Multifocal lenses (I'm assuming Symphony) with laser assisted surgery and astigmatism correction. ($$$)
i felt like I was at a car wash.
According to my surgeon, I was borderline between option 2 and option 3 . I believe my astigmatism was 1.5 and 1.75. I decided to err on the side of caution and go with torics. I know my first toric was +1.5 cyl. I haven't received the card yet fir the second. I ended up with zero residual astigmatism in both eyes.
I also had excellent near vision prior to having the surgery done. I thought I still had good accommodation at 56, but what Ron said makes a lot of sense. I must have had some degree of accommodation, but my astigmatisms may have helped my near vision as well.
I got very confused about dominant/stronger, and non/dominant/weaker as well. I didn't know if my left eye was naturally dominant, or if it simply became dominant/stronger because it was sending a much better "signal" to my brain than my right. For what it's worth, it turns out that my right eye was dominant, but that eye landed at -.25 while the left landed at Plano. My mind still seems to be going with the best information it receives. I don't see any difference between using only my left eye for distance or both eyes. I don't see any difference between using my right eye for intermediate/near or using both eyes. However my left eye is clearly better for distance than my right, and my tight eye is clearly better for intermediate/near than my left. My surgeon said that it was unusual to perceive a difference of .25 D and that most start to perceive a difference at .75 D. That may be with both eyes open/uncovered though.
I'm very happy with my outcome, but if could wave a magic wand, it would be my right eye that had a spherical equivalent of zero and then maybe a spherical equivalent of -.75 in the left. Not sure I would need much more than that as I consider my near vision to be "functional" where I am now. That's with two eyehance lenses, though. Also, that's just a guess. If I had a "tuning knob" I might prefer -1.0 to -1.5 for my left eye. Unfortunately, there was no way for me to find out for sure since my cataracts had progressed so far that testing with contacts lenses was not an option.
Dapperdan7 thomas84367
Posted
thanx for the post! im going to try the mono vision experiment with contacts while i can. im not a big fan of contacts though i have worn them over the years but its all about know the myriad of options available.
Dapperdan7 thomas84367
Posted
hi thomas.
so did you NOT do mini monovision with the implants but still got a -.25 difference?
and you actually see ok near/intermediate distance?
is there anything special about the eyehance lens?
if you dont mind, what was your eyeglass prescription before surgery?
thx for any info much appreciated
dan
Lynda111 RonAKA
Posted
Ron
There is much to be admired about the Canadian health care system, but there can be a long wait to see a provider or to have a procedure done.
Thankfully, here in the USA, patients with good health insurance can see a cataract surgeon of their choice at anytime and depending on where they live, there is not a long wait.
Yes, the best and safest choice for most patients seems to be a standard monofocal lens, and for most patients mini-monovision is also probably the best choice.
Dr Ben LaHood, the renowned Australian ophthalmologist, thinks the Clareon is the best monofocal lens on the market. I would like to read more posts about patients who have used it.
RonAKA Lynda111
Posted
Things are changing in Canada. Ontario is the latest province to move toward some privately delivered, but publicly funded healthcare. I think it is a good idea as the bottleneck for cataract surgeries seems to be the facilities not the availability of surgeons. Alberta where I am is in a kind of grey area. If you pay for a premium lens you can go to a private clinic. I have to admit that was my main reason for going with a Clareon which is classed as a premium. That got me in for surgery in 3 weeks, with the same surgeon I got my first lens with.
Dapperdan7 RonAKA
Posted
by premium, what exactly do you mean ron?
RonAKA Dapperdan7
Posted
That is a complicated subject. There are many ophthalmologists that would have you believe that a premium lens is one of higher optical quality than a standard lens. Most often they are lenses that have multi-focal or extended depth of field qualities. Popular examples would be the MF PanOptix and Synergy, or EDOF Vivity and Eyhance. In actual fact they most often trade optical quality of vision for an extended depth of focus. For many that is a good trade off, providing they understand the trade off they are making. If they think they are getting premium vision quality they may be quite disappointed. This can be aggravated by the fact that they sell at a price premium, and that may be the more realistic definition of what premium means - higher price.
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And then there are the toric lenses which correct astigmatism. They also can be called premium lenses because they sell at a higher price than standard monofocals. And they do correct astigmatism so there is some merit to them, if you want to be glasses free.
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And in the context where I used it in that post is kind of specific to Alberta, Canada where I am. Standard monofocal lenses like Alcon AcrySof IQ and Tecnis 1 are covered fully by our public healthcare system. The Alcon Clareon lens is a minor evolution of the AcrySof IQ lens that is made from an improved material, but is still a monofocal. It is not fully covered by our healthcare system, so it is defined for purpose of coverage as a premium lens. One could argue if it is really premium in performance or not. I have one AcrySof and one Clareon and can't tell the difference between them. To be frank going for this lens at an extra cost of $300 got me into the private clinic queue of 3 weeks wait, compared to the full covered pubic hospital queue of many months. The good part of the system in Alberta is that you technically only pay the differential cost between a standard lens and any of the so called "premium" lenses. In some locations if you don't take the standard lens, you pay the full price of the premium lens, not the differential.