Cataract - I Should Have Chosen Near Vision

I'm very happy with the results.  The best advice I can give anyone is to find the best doctor you can.  My doctor is excellent and has done a lot of these surgeries and has a lot of experience with the laser.

I originally chose distance for my Right eye because that's what everyone said to do.  I did NOT do the research or discover these boards until AFTER I completed surgery on my right eye.   I was so used to seeing things up close that I didn't consider the psychological adjustment phase one goes through.  Usually and logically one would think the closer you are to something, the easier it is to read.  After all, it's easier to read words in a book right in front of you than if the book is a mile away.  There's an adjustment phase and you notice little day to day things that you never thought of before.   When I would go to adjust the thermostat, I used to be maybe 4-6 inches away and I could see the temperature clearly.  Now, I have to be maybe 16-18" away to see it (because those numbers are small).  Same with my phone, I used to have it maybe 4-5" from my face now I have to have it maybe 16-18"  These are things we do all day long (like reading your phone) and you instinctively hold it at that "sweet spot" and your brain just knows where that is.  Now, all of the sudden, you have to reprogram your brain when you are writing, reading your phone or doing anything up close.  For many, they might need reading glasses because there's not clear enough spot at all in that "near range."  For me, it worked out great.

DOMINANT EYE:

With regards to your comment about the dominant eye and distance, you are spot on and that was a HUGE concern before doing my left eye because I had started to do all this research.  BOTH my eyes were VERY nearsighted before the surgery.  I wanted to get back my near vision without having to resort to reading glasses.  My doctor said that it would not be a problem that my right non-dominant eye was set for distance.  He was correct.  Perhaps this is due to the fact that my Left eye was ALSO set for distance but only 1/2 diopter in (so we planned for it to be just shy of 20/20 and hope for slightly better near vision in the left eye).  My left eye sees literally almost as well if not just as well as my right eye in the distance on any given day.  My near vision in my right eye has improved over time but it's not quite as good as my left.  But, because my eyes are adjusted "closely" both eyes see better at all ranges than one eye alone.  So again, because they are so close, the dominant eye for distance isn't a factor.

 

I have a set of eyeglasses which add +0.75D in both my eyes that has worked for me for intermediate distance viewing like for computer screen at 30" or so.

I tried it recently with an eye chart and found my left eye could still see barely to 20/20 @distance even with that 0.75D near sighted offset, due to the fact that my left eye can correct best to a little better than 20/15 @distance.

With that pair, in the car I could get clear vision of the dashboard and LCD text and still decent distance driving vision just with the left eye alone.

So if I figure if I target best distance correction for my dominant right eye (say -0.25D to avoid getting far sighted) which might get 20/15-20/20 and then target the left eye for close to that -0.75D I tested at to hopefully still get near 20/20 but good intermediate distance vision.

It would be nice to get sufficent near vision to read my larger size smartphone at least at arms length (20-24" too without reading glasses.  For fine text reading I don't mind using reading glasses - my top priorites are distance and intermediate distance without glasses.

No - that test will not work.  Right now the lense in your eyes are accommodating  (your lens has accommodation which of course will get worse as people age).  You will lose all that with a monofocal lens.  But, you will gain clarity since your cataract will be gone.

The tricky part for you is not knowing what range you will have in both eyes but you will lose the ability to accommodate with a monofocal lens.  Personally, I think if you have a good doctor and you choose a distance lens, you should not have any problem seeing in the distance or reading a computer (unless you are 5 inches away from the computer screen).

I have an iphone 5s  (smaller iphone because I like to easily operate it with one hand and it's easy to hold).  Anyways, I read it just fine except for some articles that come up in really small print.

 

I think your targets are good but personally if you target -.25 for your first surgery and it's off slighlty at -.5 then what?  Why not target distance 20/20 to start? 

I think it's best to use the SAME brand lens in both eyes if you are happy with your current eye that has already been done  (in other words ideally my doctor does not recommend mixing Alcon with symphony or mixing brands so to speak).  But, in answer to your question, he chose an Alcon monofocal lens in both of my eyes.

If it's only been a week, you still have time to figure out where your eye settles at before deciding whether to go full distance or mini-mono.  if you can read "alright" then you should be able to read even better even if both eyes are set for distance.  You might consider setting the second eye in 1/2 diopter so it has a very slight biased to near.  If everything goes right then you should still have at least 20/30 distance vision or better along with even better near vision.  Check with your doctor on all this.

For me, I rarely ever use glasses up close and never at the computer or at a distance.  Before surgery, I needed glasses for all distances except up really close.  I only use reading glasses once in a while and it's more for convenience than anything else.  Both my eyes (working together) see BETTER at ALL distances than any or either eye separately  (this would definitely NOT be the case if I had full mono vision).  1/2 diopter difference is so minuscule that it's not noticeable at all to me but does give me a better all around range.  I've read that people with full mono vision lose depth perception and are more prone to slips/falls especially in their senior years.

I will say this though - you CANNOT test it with a test contact lens.  It's NOT accurate because the cataract makes your vision WORSE at all ranges. Therefore, your result could be much better than a test contact (depending on the severity of the cataract).

I think for me I realized that if I WANT to not use reading glasses, then I don't have to.  I had to reprogram my brain to hold things a bit further from my eyes.  I used to hold my phone, papers, a book, etc. maybe 5-7 inches from my face (before surgery).  That was the "sweet spot."  Now, I hold items more like 16-18 inches away and I can see them just fine at an arm's length. Also, I used to have the brightness on my phone turned almost all the way down before surgery (probably because it was so close to my face) and now I have it turned to about 3/4 of the way up (the light probably dilates my pupil more, making the phone a lot easier to read). But the phone is also a lot farther from my eyes so I experience no dry eyes or any problems whatsoever.

Good luck to you and I'm glad to hear your first procedure went well.

 

Thanks for all the info Michael - I see my doctor soon and will discuss with him then and of course will be updating here.

One more thing to consider - I saw that you wrote in another text that you can't see texts on your phone in the smallest print.  There are several solutions for this.  One of course is reading glasses.  Second, your second surgery might enable both eyes working together to easily be able to read the texts (as did my second surgery).  Third, you can turn the brightness up and hold the phone further away.  Four (I didn't need to do this) but in the phone settings there are options to make the font larger  (many sizes to choose from).  Fifth, I have a flexible silicon protective phone case and I carry a super thin credit card flexible plastic like magnifier in between my phone and the case for easy access for any super small print either on a phone or anywhere that I might need to read once in a while.   Since I carry my phone everywhere, I have the magnifier as well.  I don't use it too often, but it does come in handy once in a while.  You can google credit card magnifier on amazon.  I think they are around $3.  It's really cheap and convenient.  I bought something like 3 or 4 of them for $10 and gave a few away to family.

 

One more question, just to clarify, did you have an Alcon AcrySof IQ lens?

From what I'm reading, I figure that's what you have. It's similar to what I have.

Thanks, I just wrote a whole lot of stuff about what I did with my iPhone 7 Plus to make it easier to read on the thread I started about the studies I found comparing monofocals with the Symfony and also with multifocals and how they found people's intermediate vision was almost always as good without glasses with monofocals set for distance as with multifocals and the Symfony lens. I just adjusted the settings under "accessibility" and I also ordered a credit card magnifier with a light after I read what your wrote. My iphone also has a built-in magnifier in the camera.

Yes - Acrysof IQ but I have a Toric lens so for that you want a doctor with a LOT of skill so as to perfectly align the lens.

 

I just have a credit card magnifier and if I need light then I use my iphone (just swipe up from the bottom of the phone).  I don't use my camera magnifier because it's too inconvenient so I just use the credit card magnifier and if I need extra light then I use the phone LED light.

Also, with regards to symphony and other multifocal lens I've read studies that say that contrast can be reduced compared to a monofocal IOL.  Even in spite of that, you still have the risks of halos and other night artifacts with multifocals.  These are things that can't be fixed (short of a lens exchange).  At least with a monofocal, glasses or other remedies are easily available.  I know for me I made the right decision and I'm glad I chose distance with mini-mono at 1/2 diopter shy of distance.