Cataract - I Should Have Chosen Near Vision

Wow - that's quite a change.  Maybe if you had a toric lens that it shifted a little.  I know for me as each day passes I'm more thrilled with how great and clear my right eye sees.  It's slightly better than 20/30 and I can see pretty clear about 12 inches away.  Reading small print is too much of a struggle but that's okay for me.  I'm getting my left dominant eye done next week and I'm going to choose distance.  As we all know it's not just the numbers but the clarity is just amazing.  I look at the moon with my right eye and it's a beautiful bright white.  I then look at it with my left eye (with or without glasses) and it has a hazy yellowish tint all over  (a cataract would you say    .

Your results in that post sound like quite a change, your initial post talked about blurry fingers 12 inches out, now you can see pretty clear 12 inches out? Does the "Reading small print is too much of a struggle" imply you can read larger print? If so it sounds like your results have gotten to the point where they are far above average since few people with a monofocal get somewhat decent distance vision and some reading vision.Do you know what your refraction currently is, how myopic you are in that eye?

I'd also be curious what your best corrected distance vision is, since I'm curious if its perhaps like better than 20/15  which lets you be a bit more myopic and still have 20/30 vision and some reading. 

I just figured I'd remind  others reading that most people getting a monofocal shouldn't expect these sorts of results, that they should plan for a more typical "blurry from 6 feet in" average result, while hoping for the best like a tiny minority like you get, and preparing just in case for the worst  a minority get who struggle from even 10-12 feet inward.

Just curious. When you say that now you can see pretty clear about 12 inches away, is it using the right eye only or it it when you both eyes? How well can you see at about 12 inches away, when you use one eye at a time?

Hello - Let me be clear on a few things.  When I said my vision is clear from about 12 inches out, I'm referring to basic things like seeing my fingers, and basic everyday items.  I'm EASILY typing on the computer about 2 feet away with no problem at all.  Maybe it's because my right eye was set at 20/30 or slightly better and not 20/20  (it just happened that way).

I can read bold print 12 inches out as well as regular 12 point font about 2 feet out (a good arm's length) BUT it's NOT as easily as just comfortably using reading glasses and it is somewhat blurred (but I can read it but wouldn't choose to).

at201 - I'm referring to my right eye only.  My right eye sees better at 12 inches out than my left  (my left eye is very nearsighted).  Now, I will say that I do see better with both eyes 12" out even though my right sees better than my left at that distance.   I have to place it about 7" from from my left nearsighted eye for it to be perfectly in focus.

I was wondering how I would do at the market the other day having to constantly put on and take off my reading glasses to see the tags.  To my surprise, I didn't have to bend over or anything.  I could easily read the print with my left eye while standing (because I was at a distance).  I'm still learning but I'm currently a nearsighted person who is being converted to loving my mid-range to distance vision.  I still don't think I have good near vision by any means but that's for really up close reading I'll certainly need reading glasses and that's okay.

The main thing is that you don't have to use glasses for everything. You must be really happy!

Good luck on your cataract surgery on the left eye next week. Are you getting a toric lens for the left eye since that seems to have quite a bit of astigmatism?

Software developer I can easily read large print from 12" out.   I'm certainly not 20/15 neither for distance nor for near.  I can easily read 18 point font from 12".  I can easily see my Consumer Reports magazine title (a bit larger than 18 point though).  I cannot easily read 12 point and I would struggle a lot to read the small type on my phone even 2 feet out (but I have not set the fonts larger either which I suppose I could do in the settings).  I'd rather see more information and just use reading glasses for now.  Habits are ingrained and tough to break and I'm not about to change the size of the fonts on my phone.  I suppose changing default fonts on my phone is a tougher habit to break than just throwing on reading glasses.

By corrected vision I'm not sure if you meant with a laser?  I would think it could also make my near vision worse if they tried to improve on the better than 20/30 I have now.

Yes - I'm getting a toric lens set for distance. Hopefully it all goes well.  

I seriously considered monovision as well as symfony but decided against it.

By the way, have any of you heard about the new IOLs they will be coming out with soon?  Supposedly they will allow doctors to adjust the lens AFTER the cataract surgery.  So, if someone decides weeks later they don't like it being set for near or distance, the doctor can tweak it and set it different or just simply easily fine tune it after.  Look up "light adjustable lens."  Then I also read about the fluid lens but didn't quite get the details.  I suppose maybe in 10 years, IOLs might have better near, mid range and distance vision than in a normal human eye.

QUESTION - I just noticed something tonight and this is no joke.  If I try to read some instructions on a box with small print about 14 inches away (probably around an 8 point or maybe smaller) it's very blurry and impossible to read (without reading glasses).  I kept staring at it and all of the sudden it would come into complete focus and not the least bit blurry at all (I covered my left eye so only my right eye was trying to read it).  At first, I thought maybe I was squinting so I tried it again to make sure.  In fact, when it went out of focus I simply tried squinting and I still could not read it.  So, I just stared at it again maybe for like 15 -30 seconds but I'm not sure now long because I didn't time it.  It would again come into focus for at least 10 seconds and this is small print.  How is this possible?

Correction - probably closer to 20-24 inches away but I'm still baffled.

re: "not 20/15 for distance"

My reference to that was for your *best corrected* distance vision, *not* your uncorrected distance vision.  By that I mean when wearing glasses. The best corrected vision impacts how good your uncorrected vision will be. If you have two people who are -1D myopic, and one has a best corrected distance vision of say the rare level of 20/10 and another has 20/20, that means its likely even the uncorrected distance vision will differ as well, perhaps by that same degree (though their eye's depth of focus also plays a a part), and the same with their near vision.  The best corrected visual acuity relates to how good your visual system is overall. 

Yes, if you correct your vision to make it better for distance, it'll make it worse for near. 

The Light Adjustable Lens has been approved outside of the United States for a while. Its a good thing to look into for those who are highly myopic who are at higher risk of the lens power being off. I think I recall hearing it might finally be in clinical trials for approval in the US, but I'm not positive (and it may take a while). There are even tests where they are adjusting the lens surface to provide multifocal or extended depth of focus patterns and not merely single focus, but I don't know whether they are approved anywhere or only in clinical trials, I hadn't seen data on the results. 

The FluidVision lens is one of those that attempts to actually move or change shape to accommodate using the same muscles that cause a natural lens to accommodate. There is a lot of hype, but I'm unsure the results are much better than the current generation of lenses (though I assume eventually they will have something that'll provide the range of vision an 18 year old has). I'd heard the FluidVision is trying for approval in Europe, but since its been a while I don't know if the process is just slow or if they were told to make changes or get more data. I'd be cautious about trying any newly approved accommodating lenses since the movement of the eye leads to more potential for complications. There was one accommodating lens that appeared promising in trials, the Synchrony, but after it was approved a significant minority had problems and they pulled it from the market. With static lenses they can test everything well on an optical bench and small human trials can confirm factors like night vision artifacts that can only be known from human trials, but accommodating lenses can only test their major feature when they are actually in use in humans so it makes sense to be a bit more cautious about being an early adopter.

I should add that although the Light Adjustable Lens isn't approved in the US, it is approved in Mexico and one of the prominent researchers is at a clinic just over the border from San Diego and I'd heard will shuttle people from hotels in San Diego if they fly in for treatment. 

re: "I kept staring at it and all of a sudden it would come into complete focus"

That is puzzling, but also reinforces the suggestion your results may be atypically good, even if it takes you a while to see this clearly, it suggests the possibility you may get faster at it, unless the result is due to one factor I can think of that would only work in certain situations temporarily.

 Although I see you wrote that you don't feel you have any dry eye issues, when people stare at something sometimes they are blinking less, which might lead the tear film to reduce. The tear film actually has a large impact on the lens power of the eye. Unfortuntely I won't take time now to try to figure out whether by default a drier eye would be more myopic (which might explain it) or less myopic (which would mean this can't be a factor).

Some folks say that we do have a limited ability to learn to improve our near vision for reading (though that most of the programs people pay for that   claim to do so are overhyped scams). Our brains are good at spotting patterns, and can learn to take fewer clues to be able to identify letters, and once a letter is identified the brain can essentially give the illuson of sharpening the image it has recognized. Like when you are searching for something in a scene in front of you, or an image, and once  you spot it then it begins to stand out more clearly.

Another potential  factor is that we only actually have a very small area of good vision, the visual field that falls on the fovea of the retina. Most of our visual sense of having good quality vision of a large scene in front of us is an illusion, the eye moves to bring different areas into focus, especially while reading. Our brain behind the scences knits together the trail of good images the eye sees as it moves.  Perhaps you are moving your eyes more slowly than usual and its able to knit together more high quality images while you are focused on it. 

Hello - with regards to my "best corrected vision" I don't know yet.  I know the day after surgery I was better than 20/30 uncorrected and they had me look through the machine that tests for vision correction and they only showed me one section of letters to read and I easily read it and I asked and they said that was 20/20.  They didn't even try to go for more at that time perhaps because it was just a day after surgery and things obviously will change.

On another note - it seems to be happening again today only now I can read text on my phone for a moment and then it blurs. I'm not sure if the phone has to be in that "exact" right position but I'm not even holding it that far away, probably about 16 inches.  Sometimes there's like a ghosting effect from the letters  (kind of like I can see them clearly but there's like a double vision ghosting offset).  I'm not sure if that is due to the astigmatism.  Maybe my eyes are still healing.  I don't know but I must say I'm quite intrigued and pleased by it. But, I still would not choose to read the phone that way because it's just way too much effort and it's easier to just use reading glasses.  But, I only need plus 1 glasses and then everything is in perfect focus.

DONE!  Just had my second eye surgery today.  I was seeing better in the distance immediately after the surgery.  Naturally my vision is a little hazy from my eye being so dialated but that is temporary.  Like my first surgery it was a breeze. I'm not sure how my near vision will end up when both eyes are fully healed and working together.  But, I can read my phone and standard 12 point font. It's obviously not in perfect focus a foot away but it is readable.  So, for quick simple things it's no problem.  But, if I were reading several pages of small print I would probably just throw on some reading glasses unless my left eye gives me even better near vison than my right.  Either way, I'm glad I chose distance.  It might not have worked out that way since I have read for some vision can be blurry 6 feet out or more.  Perhaps even worse if the distance is set further out than 20/20 but it worked out for me.  I'm not sure where my near and distance vision will end up for both eyes working together but technolology is amazing.  I can remember years ago in the 70's when my grandmother had the surgery I think back then you had to almost always be on your back in bed for at least a week or more and here I am typing on the computer no more than a few hours after surgery.  Best to everyone.

Please keep us informed on your progress.

One more thing I gotta share - I LOVE these "credit card magnifiers" I got on Amazon 3 for $5.  I have a silicon case for my phone and it's really easy to remove all or part of the case to easily put the maginifier between the case and the phone.  I just keep one of the magnifiers in the back between the case and my phone and another one in my wallet.  It's really easy to read the smallest print on my phone without reading glasses and they are always with my phone as well as in my wallet.  

One day after surgery my left eye tested better than 20/15 for distance.  My right eye was at 20/20 today and both eyes working together are at 20/30 for near.  The thing is when they test for near they have me read a sentence and I can easily do that but it's possible my brain is filling in some of the pieces.  It's not like you have to see every letter when you are reading words. I can read the texts on my iphone but upclose details like clarity when I look at my fingernails or putting eyedrops in my eyes are still fuzzy.  I can live with that.  I'm happy I waited almost a month between both eyes.  I was monovision during that time and I started to adapt to that quite well.  I would never choose that for a lifetime but it just showed me that with patience I was able to adapt.  Patience is important which allows both the eye to heal and the brain to adapt to new situations.  Overall I'm very pleased that I chose distance and my doctor said my vision should continue to improve.  I'm still waiting for someone to wake me up from what seems like a dream.  I keep wanting to grab my glasses when I go just about anywhere.  I keep reaching up to my face to adjust my glasses habitually only to realize I'm not wearing any.  However, glasses or no glasses, my vision is so clear now and that's the miracle of cataract surgery and the most important thing of all.

Wow,  congrats, if both eyes have monofocals (since you don't mention otherwise, I'm assuming that was the choice), your results are well above average. A minority of lucky people's eyes have a noticeably larger depth of focus than average. I'd be sure when talking about the results to caution people that they may not be anywhere near that lucky if they get monofocals set for distance. Its best they don't go in expecting those sorts of results and then winding upset if theirs are far worse. They should plan on more average results, be ready to accept even worse, but obviously hope they are as lucky as you.

 Your results are only a bit below mine with the Symfony, which seem fairly typical,  unless the near chart didn't have a 20/25 line in which case in theory you might be better than 20/30. On charts that have it, I'm  20/25 at near, though one eye wound up farsighted. If I get a laser tweak for my slightly farsighted eye, +0.5D, it should be 20/20 near at least, since with  distance correction for that eye  I can read the 20/20 near line with both eyes.

Frankly, after reading some posts on different threads on this board, for my Left eye, I was just hoping for good distance and relatively the same as my right eye so that both eyes work together and more importantly a good healthy result with no problems.  I will say that without a doubt, I can read my phone and read papers better now than I did before the surgery to my left eye  (both eyes have monofocal IOL lens).  The reason I believe is that my eyes are now working together.  Before the surgery yesterday, I could not read clearly out of my nearsighted left eye unless my iphone was no more than about 7 inches away otherwise it was totally blurred.  But, for my right eye with the IOL I had to hold the phone or papers around 16" away.  Now that my eyes are working together, I can definitely read a lot easier.  I read the 20/30 line for near vision, but it was too difficult to read below that (had I stared at it for a minute or two then it might have come into focus for a short time but that's another mystery that I mentioned earlier in this discussion).  I will say that when they tested me for distance, they tested each eye individually, but for near they let me use both eyes together.  Also, I would like to point out, just because I can read it, does not mean it is in perfect focus, because it is not.  It's more clear with 1.5 diopter reading glasses (then I can easily read all the lines).  If I were reading a long article on my phone, I would choose to either turn the phone sideways (where the fonts enlarge on some sites) or I would have to enlarge the font or just use reading glasses.

Maybe I'll get even better results in time as my left eye heals more, but I'm considering myself lucky and if I need to use reading glasses for certain things then that's perfectly okay.  I have the credit card magnifier in my phone all the time so I don't have to run around to find reading glasses or put them on if I just need to read something that's too small.  I might not always have my reading glasses, but chances are I'll always have my phone and that means I'll always have my magnifier should I need it.

You all have been very helpful and this entire process has been very educational. Thank you all for your support and feedback.

In addition to the credit card magnifiers btw, I've also seen foldable readers that fit in a tiny case that either are part of a keychain or in a pocket you can stick   the back of your phone/phone-case, or come with a phone case that has a pocket on the back for them. The brand I noticed, ThinOptics doesn't have arm pieces, they just perch on your nose, I don't know if others come with arms (though that adds to bulk). I just noticed them online, I've never actually seen one in person or tried them. There may be other brands that attach to phones and keychains also, I hadn't checked to compare, I just happened to notice this one.  At Barnes&Noble I'd seen foldable readers that'll fit in your pocket (and include arms) but they weren't this small, I don't know if they or other physical retail stores might have something like this to look at.

In addition to the physical magnifying glass you have with your phone, which helps read the phone, there are magnifier apps for phones  that use the camera (and flash if more light is needed) that'll let you read small hardcopy print or see other small things.   I don't have any recommendations since I hadn't tried them (I downloaded some when browsing apps one day, but hadn't had a need for one yet so I hadn't tried them). 

Actually a quick glance at the ThinOptics website shows they list some common retail chain stores, I just hadn't bothered looking for them. (and again, I have no idea re: quality, etc,or if there are better brands).

Usually when btw when I comment on my overall vision its both eyes, partly since as with you they just test near vision with both (and its mostly coming from one eye anyway since the farsighted one has noticeably less near) and in the real world  we are looking with both eyes. Its only if there is enough difference between the eyes that its monovision and steropsis may be  reduced that it matters much what each eye is seperately.

I saw thinoptics.  But, in addition to the magnifier cards (3 for $5), I discovered credit card reading glasses.  Kind of like an emergency pair you can easily carry in your wallet if you ever need a pair.  I ordered the 1 diopter but they come in 1 and 3 diopters and they are only around $5.  Just search amazon for: 3.00 Diopter Opticard Emergency Reading Glasses.  They're pretty cool because you can easily keep them in your wallet like a credit card.  I don't think I will need them often since I can read most things up close but if the print is really small then they will be convenient to have and they are reasonbly priced.  But, you do have to "hold them" while reading.  They don't stay on automatically like glasses would.  But, if you have a wallet, they will always be available and I don't see how you can go wrong for around $5.

I should have pointed out, they might not be the most "stylish" things but for your wallet, they do work.

SoftwareDev - I should have mentioned that for me, because my eyes are set almost the same and my near vision is slightly better with both eyes even though my left seems to see better both in the distance and up close.

Hello everyone - I had my follow up for my second eye today (11 days post op).  So, my left eye sees better for both distance and up close than my right eye.  But, my right eye is not too far off and so my eyes are working together.  I was seeing better than 20/20 for my left eye and 20/25 for my right eye today  (they didn't test more when I got to 20/20).  For near vision, I was at 20/25 today.  It's definitely not easy to read the 20/25 line and I certainly would not choose to read a lot in that small of print, but it was readable.

I would be curious if they ever did a study on monofocal lens set for distance and what vision people have for near.  In other words, I think it would be good if people knew for example that say 80% of the people set for distance are say 20/80 for near or maybe 5% of the people set for distance can read at say 20/30 for near.  But, I have no idea where I fall in the percentile range and I would be very curious.  Again, I would like to emphasize that just because I can read the 20/25 line, I would not choose to read paragraphs like that.  But, I will also say, I feel very fortunate because I rarely ever use reading glasses except when the print is really small. But, when I do and then take them off, it's wierd.  It's like my eyes take a moment to adjust to any size print up close (like it takes time to refocus which seems wierd because I didn't think I had any ability to focus with a monofocal).

I'll consider myself very lucky as to how things turned out.  But, either way, I think we are all quite lucky given the time we are living in and how they can fix these things so easily these days.  Imagine what the future brings? Perhaps my kids or kids' kids won't even need sunglasses anymore and the "lens of the future" will have auto adjustments for that also as well as a wider range of vision and maybe infrared (bionic eye anyone)? Maybe have an internal gigabye SD card where we can load pictures to view them anytime internally.  I'm not sure I'm ready for that, but just imagine what the future might hold? For now, I'd be curious if there have been any distance lens studies on monofocal as to statistically what one could expect for near.  Best to all of you out there in the forums.

In terms of what the future will hold,  that is part of why I pay attention to IOL developments out of curiosity, since I figure at some point we'll have something worth a lens exchange. I do expect within the next 20-30 years (though I've no idea when) we'll have something with the   level of vision of an 18 year old, and likely with an inbuilt display. Hopefully it'll be closer to half that time for the visual range of an 18 year old part.

I don't know which IOL you recieved, the most common one is the Alcon monofocal. Usually they only report monofocal results for near when used as a control for a test of a premium IOL, and usually they only report on average results vs. a breakout by different acuities.  If you do a search for:

"Figure 1. The ReStor has two points of sharp focus, far and near, while the monofocal lens is designed for distance acuity, as shown by the peaks of the graphs. Intermediate distances are between the two humps, in inches."=small You'll see a chart of visual acuities at various distances. The average near at the standard near distance, i.e. at 40cm = -2.5D, is about 20/63. 

I found an old table of data looking at the FDA data trying to find the most recent approval for an Alcon multifocal, and it links back to an old approval document for an earlier multifocal, where if you google for:

Premarket Approval Application (PMA) Number: P040020 Date Filed: April 19, 2004

You'll find a file with the safety and effectiveness summary which has a breakout of vision for  near that does list comparisons for different categories for the monofocal and the multifocal:

"Table II: Cumulative Binocular Photopic Near Visual Acuity by Lens Model,"

Where it says at the standard near distance (40cm is standard, I don't know if that is where you were measured) for uncorrected vision that only 2.5% have 20/25 or better, near, while 73.9% have worse than 20/40.  

You likely have better near in part due to just being lucky with your eyes having a larger than typical depth of focus. Also I would be curious what your refraction is, your prescription required to get your best distance vision, and what your best corrected distance vision is. The point of that is that if your best corrected distance vision were say 20/12 or something, then that would mean the 20/25 eye could be more myopic than you might guess while still retaining 20/25 distance vision. I suspect you essentially have a bit of monovision, or both eyes slightly myopic, which is boosting your results.

Your results are far better than average, with the Symfony I should an extra diopter of focus compared to what I'd have   gotten with a  monofocal, yet I only get 20/25 or so , though its not much of a struggle (I can make out a bit on the line below if i struggle), though that is also while getting at least 20/15 vision (they didn't have a line below that to test, and that was easy). 

If you'd gotten the Symfony you'd likely have an extra diopter of visual range and have even better results.

oops, I left off a word, you can probably figure out the intent, I meant my near is "while getting at least 20/15 distance vision", i.e. I didn't sacrifice distance at all (though admittedly 20/20 isn't much of a "sacrifice", its still nice to have the >= 20/15 distance vision, its  been amazing to have better distance vision than I can ever recall having before, which some highly myopic people notice since the correction we had to wear before surgery reduced the image size, reducing what we could see). .

It is great to read that you are very happy with the results of your surgery and the vision which you are getting with your monofocal lenses.

If you are happy with your vision, you should not do anything to change it. But, it is possible that your right eye is really set for the best focus at  about 32 inches and that you also have some astigmatism. Both of these factors can keep you from having 20/15 vision at distance, but can help you have close to 20/25 vision at reading distance.

Regarding the published data about the vision at different distances when the monofocal lenses in both eyes are set at far distance, Technis' data for their lens indicates that in the absence of astigmatism or other vision issues, one can expect to see 20/15 at far distance, 20/25 at about 4 ft, 20/35 at 26 inches and about 20/70 at 16 inches.