Cataract monofocal IOL far or near?

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I am 67 yrs old, I have cataracts both eyes, left eye cataract level 3.5, right eye 2.5, the doctor asked me can you read with out glasses I said yes then he picked nearsighted at -2.50 for monofocal IOL. He says I will be able to read at 16" not more or less without glasses.

He discuss about arm's length he thinks to add from -2.50 to 2.75 so I can read alittle bit closer to 13" without glasses.

Sadly, I know I will not be able to see close up as I can see upclose to 6" without glasses, both eyes are different, left eye at 5" and right eye at 6". I believe it is because with cataract it can cause to have second sight. so maybe I am not really nearsighted??

I am not sure which is best near or far for momofocal IOL.

Right now I can not read without glasses at arm's length and I can take off my glasses read upclose at 6" not farther I need my glasses to read or cook or read computer.

I read some here on this site and find some people prefer far distance rather than near.

I am confused which is best? I don't mind wearing glasses after surgery.

Help me understand what is IOL power, is that RX?

If you choose far distance is it required to add eyeglasses RX on IOL? can you have without eyeglasses rx in IOL? Is the IOL power is same as rx eyeglasses?

I don't understand how it works the IOL power for far distance?

Is it possible to have iol inplanted wthout rx correction and then wear correction glasses?

Thank you, I am just learning and just want to make the right choice.

oh here is my RX

OD Sph -2.75 Cyl -2.00 Axis 070 add +2.50

OS Sph -3.00 Cyl -2.00 Axis 093 add +2.50

Am I myopia? thank you,

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  • Posted

    Most people want to be able to drive without glasses, but don't mind using reading glasses for reading. Others like you may want to be able to read without glasses, but won't mind using glasses for driving. There is no right or wrong answer here. Thus, based on your life style, if it makes sense for you to be able to read without glasses after you have the cataract surgery, the choice of aiming for -2.50 for monofocal IOL (as suggested by your doctor) will be the right choice for you.

    Personally, rather than going from -2.50 to -2.75, my personal preference will be to even consider going from -2.50 to -2.25, if you want to be able to look at a computer screen without glasses (this usually requires being able to read well at about 18 inches compared with reading well at 16 inches for books). Any way, the choice is still yours to make.

    Hpwever, please be aware that your eyes have quite a bit of astigmatism, which may require use of toric lenses. Also, the IOL prescription calculation can be easily off by about +0.5 to -0.5 from the desired prescription. The doctors do their best to do it right, but it is hard to get it completely right.

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    • Posted

      Hi at201,

      Thank you for your info,

      Most people I talked to chose far distance for monofocal IOL and are happy with it and one person I talked to chose near and she was ok with it but not able to see far far like her husband (no cataract) can see far infinity but reads readers glasses, and other person told me she was told by several people who have chosen near have regret it wish to have chosen far, so I don't know.

      If I chose near I will be able to see at 16" to 18" with -2.25 without glasses, if so I would need reading glasses or progressive lens for upclose at less than 16" and below and plus rx glasses for far distance?

      Will I loose 5" upclose if I chose near? I would still need reader's glasses or progresive lense for that.

      I do cooking, gardening, watch tv read closed captioned most of the time.

      I also drive and will be traveling I may want to see clear, too.

      My current glasses I am able to read computer, cooking with my right eye, I read newspaper with my glasses with progressive lens only at 10" inward but can take off glasses read at 6". I am not sure if reading lens is correct since last time eye exam 3 years ago is reading at 10" normal?

      My concern is that my RX precriptions is 3 years old and I am pretty sure it has changed, unable to do eye exam because cataract got worse, how do they know my correct RX as of today?

      If Dr put my old rx right eye as -2.75 and left eye -3.00 in the IOL for far distance that will be wrong rx, how do they firgure out to make it right? I don't understand that.

      I am sure my astigmatism is not accurate now, 4 yrs ago it was -2.50 then down to -2.00 3 yrs ago, what if it has changed?

      My husband recently went to see dr and he has early cataract and said He would chose far distance for him. He will wait.

      I am confused. near or far.

      If I chose far I would not be able to see intermediate distance, like cooking, computer, etc? I would need progressive lens for both intermediate and reading, tri-focal?? bi-focal?? and will not be able to see upclose.

      I am just learning.

      thank you

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    • Posted

      I think that even though you are used to being able to read at 5 to 6 inches away, practically everyone typically reads books at about 16 inches away and computer screen at 17-18 inches away. Thus, if you choose to get the monofocal lenses set for reading at 16 to 18 inches away, you should be able to read practically all material one encounters on daily basis (this assumes that you don't have astigmatism after cataract surgery). For example, my left eye is set for about 17 - 18 inches distance and I can read practially everything (I have used a reading glass or a magnifying lens only once in the last 3 months to read the very fine print on a tiny eye-drops bottle).

      With the eyes set up for 16-18 inches focus distance, you will definitely need glasses to see well anything which is more than about 2 feet away, unless you opt for monovision with one eye set for reading and the other one set for distance (I have this, but it requires some getting used to. So, you may not want to go that way).

      As you have found out, most people prefer to be able to see well at distance without any glasses and then use reading glasses when they need to. You can't go wrong with that choice either. But, it is your choice to make.

      If you do choose to get the eyes set up for distance, you won't have the best vision at less than about 6 feet, but you will find that most of the daily activities like cooking or watching TV don't require you to have the best vision. If you want to be able to see well down to about 3 or 4 feet as well as at distance, you can set one eye for best focus at about 6 feet.

      Your doctor should be able to help you make the choice which will fit your life style the best.

      As a side note, in answer to your other question, the IOL power is completely different from your prescription glasses, because the IOL is going to replace the power of the natural lens as well as the prescription glasses. The doctors can figure it out by taking measurements of your cornea, distance to the retina etc.

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    • Posted

      Hi at201,

      Thank you for your info, it helps.

      I still have not decide which near or distance. still thinking back and forth near or distance, pro and cons.

      Two choices: monofocal IOL for near at -2.25 to -2.50 for both eyes close to intermediate for cooking,read computer, gardening and hope I won't need progressive lens for reading. If I do loose close up vision then get progressive lens for near and glasses for distance from 2 feet to 20 feet? right?

      Hopefully I will have 20/20 vision if i choose near. Read somewhere if you want closer / nearer vision you loose good vision distance.

      I have a friend who chose near with -2.56 one eye and -3.08 other eye her IOL 18.5D and 19 D and she said eye test, she cant see well at distance out of 5 lines she can see clear 2 top lines bottom 3 lines not clear. That concerns me to choose Near.

      re: For example, my left eye is set for about 17 - 18 inches distance and I can read practially everything (I have used a reading glass or a magnifying lens only once in the last 3 months to read the very fine print on a tiny eye-drops bottle).

      with that set to 17"-18" do you wear glasses for distance is it good as 20/20?? How good is your distance vision? 20/30? D?

      what IOL you use? monofocal?

      OR

      Go for distance and wear glasses for near and intermediate, and I will miss out close up vision.

      Most people chosse far distance so maybe I should go for that and be over with it. I dont know. I drive and would like a good distance vision.

      RE: If you do choose to get the eyes set up for distance, you won't have the best vision at less than about 6 feet, but you will find that most of the daily activities like cooking or watching TV don't require you to have the best vision. If you want to be able to see well down to about 3 or 4 feet as well as at distance, you can set one eye for best focus at about 6 feet.

      Ok pick one eye set at about 6 feet and what other eye set to be at? and no glasses for distance but still wear glasses for near  and maybe intermediate?

      My surgery date is March 9th. I will call the dr to change when I make my decision. It's hard to decide.

      Thank you for your info and help.

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    • Posted

      It is always tough to make a decision on something with which one has to live with the rest of our lives. But in this case, at least you know that with good surgery and choice of lens, you may need the help of glasses at certain distances but will be able to see well overall.

      Before I answer your other questions, my suggestion will be to pick one of these choices:

      a. Get one monofocal lens set for best focus at about 16-18 inches and the second one at about 26 inches. This will require a slight monovision adjustment for your brain, but this much difference is easier to deal with compared with if the second one is set at distance (with the first one set for 16-18 inches). With this combination. you will be able to read, work on the computer, and see quite well to about 3 feet. You will probably be able to see the 20/50 line or the 20/40 line for distance, but will need glasses for distance (all this assumes that your astigmatism is corrected).

      b. Get one monofocal lens set for best focus for distance and the second one at about 40 inches. This also will require a slight monovision adjustment for your brain, similar to choice "a". With this combination. you will be able to see well at distance and at intermediate distances down to about 26 inches. However, you will need glasses to read and work on the computer.  ( this also assumes that your astigmatism is corrected).

      Your selection out of  the above 2 choices depends on your life style and your desire about when you will prefer to wear glasses.

      In answer to your questions about my experience, I had a cataract surgery in my left eye about 18 years back, had the monovision lens adjusted to about 17-18 inches for reading (was used to this with contact lens before the surgery). In the mean time, I had my right eye set to distance with contact lens. (My adjustment to monovision took probably less than 5 minutes, although some people need longer to adjust to it. ) As I grew older, my intermediate vision became worse because of the progressive loss of the natural adjustment in my right eye. But, the only time it bothered me was in very specific situations such as reading  picture description on a museum wall from 2-3 feet away.

      I did have a cataract surgery in my right eye also about 3 months back, set for distance using the Symfony lens. It has provided me a better intermediate vision than what I was getting lately with my contact lens. Thus, I am happy with my day vision. However, I have a night vision issue because of seeing multiple concentric circles around lights, as many other people also seem to have. There is a different discussion on that under "Has Any One Else Noticed this Unusual Vision Issue with Symfony Lens." Thus, if you don't mind using glasses for some activities, my suggestion will be to go with monofocal lenses for both eyes.

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    • Posted

      a. above "You will probably be able to see the 20/50 line or the 20/40 line for distance, but will need glasses for distance"

      Will I be able to see the 20/20 line or the 20/25 line with glasses?

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    • Posted

      Yes. Unless you have some other vision issue (which you have not mentioned), if you have one monofocal lens set for best focus at about 16-18 inches and the second one at about 26 inches, you should be able to see 20/20 with glasses. If you are lucky, you may even see 20/15.
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    • Posted

      ok good thanks.  i have closed angle glaucoma, and got some visual field damage on the right eye 4 years ago but nothing is affecting my vision and is under control, the cataract surgery will help open the angle and should lower iop more.
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    • Posted

      If people chose monofocal lens set for best focus at about 16-18 inches for both eyes will they be able to see 20/20 with glasses?  and will need glasses for intermediate and distance 19" to 20'

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    • Posted

      Just to be clear, with both monofocal lenses set for about 16-18 inches, in the absence of any other visual issues, a person should be able to read 20/20 at that distance without glasses, and will need glasses to see well at distance or at intermediate distances (with 20/20 attainable at distance or the intermediate distances with the correct glasses prescription).
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    • Posted

      ok...previous post above about reading, used to being able to read at 5 to 6 inches away, should be able to read practically all material one encounters on daily basis,  I won't know till after surgery if i will be able to read between 10"-16" like you can?

      I hope I can still have the same nearsighted vision after surgery. if not then will need glasses to read between 10"-16" (if I choose lense set reading at 16 to 18 inches) For some people as cataract develop they became nearsighted maybe like I am, temporary improvement in near vision? just wonder about that. I don't know. I have not talk with other people who have had surgery with nearsighted. You know other people with were able to read upclose after surgery?

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    • Posted

      Practically, all the reading material is designed / meant  to be read from 16 to 18 inches away. That is why even when people get bifocal glasses, the top part of the glasses is typically for the distance correction, while the lower part is for reading at about about 16 to 18 inches. Even though you were able to read about 6 inches away, there is no practical reason for one to have that capability.

      If you try to get the monofocal lens set to have the capabilty to read at about 10 inches, you will need glasses for everything above about 12 inches away, which is not very desirable. You probably won't be able to read even the top line on the vision chart from 20 feet away. I will definitely recommend against this choice because you will be trading off the capability to be able to see well at the range where you need it for the abiity to read it for 10 inches, which hardy any adult has it or needs it.

      If you are still uncomfortable with the choice 'a' above (i.e. "Get one monofocal lens set for best focus at about 16-18 inches and the second one at about 26 inches"wink then just go for the choice 'b' above (i.e. Get one monofocal lens set for best focus for distance and the second one at about 40 inches." As I said before, with this combination. you will be able to see well at distance and at intermediate distances down to about 26 inches. However, you will need glasses to read and work on the computer  (this also assumes that your astigmatism is corrected). You can then try reading glasses of various powers available without a prescription (in the drugstores in United States and most other countries) to see which one you like best and pick one accordingly for daily use.

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    • Posted

      I have no idea why a "wink" was replaced with a smily face in the above response.

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    • Posted

      Did it again! Replaced a closing parenthesis with a smily face! Terrible and annoying automatic editing!
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    • Posted

      with 16-18" choice I would not be able to read between15" to 13" without glasses? will need glasses for that then? with progressive lens? right now I can read at 9" slightly blur with out glasses that will be lost?

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    • Posted

      Right now, you have lot of astigmatism. That is why you feel like you have to bring it very close to be able to read it without glasses (and with a high degree of nearsightedness, you can do it). If you get corrected for astigmatism (and you will have to get good vision) at the time of or after you get a lens, there will be no need for you to be able to see well closer than 16 inches or so.

      In any case, if you are still nervous about it, then then just go for the choice 'b' above (i.e. Get one monofocal lens set for best focus for distance and the second one at about 40 inches"wink  As I said before, with this combination. you will be able to see well at distance and at intermediate distances down to about 26 inches. However, you will need glasses to read and work on the computer  (this also assumes that your astigmatism is corrected). You can then try reading glasses of various powers available without a prescription (in the drugstores in United States and most other countries) to see which one you like best and pick one accordingly for daily use.

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    • Posted

      re: the smily face, that keeps happening to me also. I just thought I'd add that in addition to being annoying, it seems a particularly inappropriate "feature"/bug for a medical discussion forum since when replying to some people with problems there are definitely times when a smily face would give someone the wrong idea, like you aren't taking them seriously or giving the wrong connotations. 

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    • Posted

      Hi at201, softwaredev, sue13546,

      FYI I didn't get the surgery yet, just not ready for it, couldn't decide which near or distance.

      My appt was reschedule to April 6. I may ask few questions later before i decide. thank you.

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    • Posted

      That is a good plan. This is a big decision for you. So, you should be clear in your own mind about the reasons for your decision. Will be hapy to answer any additional questions, which you may have.
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    • Posted

      Hi at201 and softwaredev,

      Haven't decide yet,  the dr says if I go for distance it will be a bigger change for me that I will need reading glasses, he said either way is ok but he chose near in the first place before.

       if I choose near or distance I may be wearing glasses for either one anyway because the dr had not said anything about toric lense which means glasses to correct my astigmatism for either near or distance.I think he have said i have mild astigatism at one time. the decision is still going back and forth, near or distance. I wish to hear more from other people's stories.

      someone gave me medscape article about accommodation iol, see the link article back in 2008 has this been done? is there one out there? have you heard about this? http://www.medscape.com/viewarticle/579850_2

       recent advance has been the creation of aspheric lens technology that not only corrects the patient's focal length but also corrects some optical aberrations that naturally occur in the cornea due to aging.[17] The prime goal for lens developers in recent years has been to create a lens that will restore quality distance and near vision without the need for glasses. The initial attempts involved the creation of multifocal lenses that have concentric rings of different optical strengths so that light from different distances is focused on the retina. These complex lenses are associated with some optical aberrations that are not always tolerated. This has led to limited adoption of these lenses in North America.

      A variety of new lens technologies are being developed that use moving monofocal lenses that attempt to restore natural accommodation by harnessing the shift in lens location when the ciliary muscles constrict (Figure 2).[18] This promising technology is now available, but these early versions result in only a limited degree of accommodation so that people still rely on reading glasses for prolonged reading or seeing fine print.

        see figure 2 I couldn't copy and paste here.

      has it been done what company name or brand??

      thanks

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    • Posted

      My wife had a Crystallens (the accomodating lens) installed in her left eye more than a year back. While there was some small focus accomodation provided by the lens, it also resulted in significant Posterior Capsule Opacification within 1-2 months after surgery. Found out then that the chances of this side effect with this lens is much higher than with that with monofocal lenses. Because of her experience, I did not seriously consider Crystallens after my cataract surgery a few months back.

      I tend to agree with your surgeon's comment that your life style will require less adjustment if you go for best focus at 16-18 inches instead of getting the best focus at distance. But, either choice should be fine.

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    • Posted

      Since you quoted part of that article, I'll mention that this: "recent advance has been the creation of aspheric lens technology" is actually pretty much the standard now, most IOLs are aspheric. In terms of the rest, the state of accommodating lenses hasn't improved much since then. The Crystalens is the only one available in the US (and any options elsewhere aren't any better, and may not be as good) and I'd seen a number of sources say that about half of Crystalens users need readers, at least for extended reading, which is more than the other premium IOLs.

      Technically the average near acuity data makes that level of need for readers seem odd, but since it relies on your eye's ability to accommodate the eye can temporarily manage to accommodate to read a line off a chart but can't maintain that level for a longer time to actually read much text without  strain. Also a decent minority only seem to see the lens provide the same range of vision as a monofocal, it doesn't seem to accommodate. The way the lens works leads to more potential complications, like z-syndrome (which is reportedly reduced in the latest model, but not gone).   As someone noted, it may have a higher incidence of PCO (though I hadn't checked stats on the newest model).

      Although its technically a single focus lens, oddly the risk of problematic halo&glare issues based on some studies is higher than the Symfony. I hadn't checked figures for contrast sensitivity, but I had an odd anecdotal comparision. Someone about my age has the Crystalens and gets less near than I do, but also sees more of a reduction in low light. We met after  a lecture in a well lighted auditorium and looked at a near vision chart. He held a file folder over the chart and he lost some lines of near vision.. but it didn't impact mine at all.  That may be  personal variation, rather than the IOL, though he doesn't have any eye health issues that he knows of. 

      If I hadn't gone for the Symfony then a trifocal, or a bifocal, would have been my next choices, with the Crystalens my last choice other than a monofocal. Those who can't tolerate other premium lenses for some reason might consider it rather than a monofocal. 

      There are various next generation accommodating lenses in early trials now, but none that are approved anywhere yet. I'd read that the Fluidvision applied for CE mark approval in Europe, but since I hadn't seen anything in quite a while its unclear if they were perhaps told to do more trials before approval or required to make changes, or if its merely taking a long time. I hadn't seen enough data to know if it is an improvement over trifocals or the Symfony, some of the data suggests it might not be much of an improvement. 

      I'd also be cautious about using any new accommodating lens until its been well tested since the movement issue means it may be more prone to potential complications over time due to wear on the lens, or on the eye due to its movement. There was an accommodating lens, the Synchrony, which was approved and sounded promising, but was taken off the market when a substantial minority had issues. 

       

      Even once something is approved in Europe and proves itself, those reading this in the US will likely have to wait some years longer for our more cautious FDA approval process. (its unclear if political changes here will have an impact on that or not). 

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    • Posted

      yes, mine are aspheric made by alcon.  i think that waiting is a good idea also. 
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    • Posted

      PS, looking at that again, I should have said re: the contrast sensitivity of the Crystalens, that this fellow "held a file folder over the chart to cast a shadow over it", I left off the reference to a shadow, it  may not have been obvious that the point was even that tiny a reduction in light reduced his near, but not mine.

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