Cataract Monofocal Lens - Six Month Follow Up

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I thought I would report back and let you all know I had cataract surgery six months back and had a Alcon mono focal toric lens placed in both eyes.  After the first eye was set for distance, I was very concerned about losing all my near version.  My doctor set my second eye for distance but set it /2 diopter in for slightly better near vision (mini - mono vision).

I have no halos or any night vision issues at all.  My vision is stable and no different than six weeks after each surgery.  My vision (probably like most is slightly better or worse on any given day).  Today it was 20/25 in both eyes (missed a few letters at 20/20) for distance and it was 20/25 for near.  On some days it's 20/20 and other days more like today depending on how windy it is, humidity and other factors.

Personally, I believe it's possible to improve your near vision by trying to use your near vision more.  In other words, for me, I find that holding my phone at the right distance or any kind of reading at the right distance makes it a lot easier.  Instead of 5 inches from my eyes prior to surgery, I now hold my phone 18" to 20" away and sometimes I might need to turn up the brightness slightly but I have a small phone  (iphone 5s).  I haven't bothered to adjust any font sizes in the settings  I'm a creature of habit and it was difficult enough to retrain my brain to find that "sweet spot" 18-20" away rather than 5" after surgery.  But, I almost never need or bother with reading glasses except for really small print or doing something up close.

Overall, I'm very pleased.  I can't stress how important I believe it is to find a really good doctor you trust.  Best to all.

 

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  • Posted

    So glad to hear about your good results, and about the reading!  Seems like a fair percentage of monofocal patients with distance corrections can read fairly well.  I was also very concerned about losing near vision but ended up super happy with my "intermediate" monofocal result at -1D for my first eye about a month ago.  I also finally figured out that I just need to hold things a little further away, as I had a lifelong habit of moving everything closer.  Reading is still quite good, and I haven't needed to use readers yet; just glasses for driving.  Hope others will be encouraged by the excellent monofocal IOL results; these new lenses are amazingly clear. The mini-monovision can really help extend the range a bit, too.  Thanks for posting.

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    • Posted

      Why do you need glasses for driving if you have monofocals set for regular distance or did you have both eyes set for intermediate distance?
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    • Posted

      Just wondering because I would say no one needs glasses for driving after getting monofocals set for distance.
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    • Posted

      nina234, my IOL was set to be more intermediate, as I wanted to preserve near vision and ended up just about right at -1D, as it lets me function most of the day.  I haven't had surgery on the other eye, but will likely aim for something similar to the 1st, since I've been testing "20/20" with glasses and the blurry near vision really bugs me.  Even if I could technically pass the driving test (requirement is about 20/40 or -.75D) I wouldn't compromise on that as it's a dangerous activity.  However, my vision does feel perfectly fine for daytime driving in a pinch.

      Sounds like you and michael74313 and quite a few others (including my Dad) are in the 0 to -.5D range and can still read, too, which is encouraging.  I understand why prospective monofocal IOL recipients are not promised that kind of range, though.  I even got the impression that I'd lose near vision around where I am at -1D, which thankfully turned out not to be the case.

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    • Posted

      Nina - Some people who have an astigmatism and cannot afford extra for a toric lens (not covered by insurance) or just decide against it and get an aspheric lens for distance would most likely need glasses for distance (unless they perhaps try to follow it up with a lasik correction).

       

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  • Posted

    Glad you had a good result Michael especially since you also have astigmatism since you got toric IOLs, so it's good those are working out for you. I have the regular monofocals (both set for distance, not mini-monovision) and it pretty much sounds like we got close to the same results.

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  • Posted

    You guys have gotten some awesome results. It's hard to believe that thats even possible with a monofocal IOL. When you say can see distance down to 18-20 inches onwards is there a drop off in acuity when you go nearer?

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    • Posted

      Yes - I would say there's a slow drop off in acuity as I go nearer.  There was always a "sweet spot" both before and after surgery.  Before surgery it was around 5" away so anything closer or further would not be as clear (I was nearsighted before surgery).

      At present, I can still easily read the numbers on a ruler that's only 5 inches away but it's just not a crisp/sharp but still readable.  I can read 12 point font 8 inches away but again, why should I do that when it's not as sharp and it's a lot easier to just hold it 18" away?

      With that said, I have a flexible silicon protective cover for my iphone and if there's ever anything really small, it takes just a second to pull out my credit card magnifier (3 for $5 on amazon) and it's easy to read anything 8" away with that (something in maybe 4 or 5 or 6 point font).  It comes in handy once in a while when a webpage won't allow you to "pinch and zoom."

      I think my distance vision has stayed the same over the six month period since the surgery.  But, I believe my near vision has improved since the surgery and will slowly continue to improve over time.  I believe this is because I have continued to try to find that "sweet spot" of where I can read my phone and other things.  I never strain or "force anything."  I just try and find that spot and focus on what it is I'm trying to read and it's just gotten easier over time.  Sometimes, if I just have to read some small print (ingredients) on a box or something, rather than immediately run for the reading glasses, I'll try to find that spot and if I can't read it, I'll try turning on the flashlight on my phone to make everything a little brighter which a lot of times makes it easier to read.  If I have to throw on the reading glasses once in a while, it's no big deal but it's not that often that I do.

       

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    • Posted

      If you're asking if reading glasses are needed for small print, the answer for me at least is yes (not for just reading briefly though, then I don't necessarily need reading glasses - for extended reading or reading in low light I would want to use reading glasses though).

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  • Posted

    Michael, so where did your two eyes end up in diopters?

    I see your target was one eye set for distance (near 0D?) and the other for mini-monovision at -0.5D, but could they have ended up as much as 0.5D off from the targets?

    I wonder since you are getting great relatively close reading distance under 20" that I would think would need -1.0D or so to achieve?

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    • Posted

      My dominant eye usually sees a slightly better range of vision all around.  I don't know if it's because it is dominant eye or if it is because the toric lens shifted slightly in my non-dominant eye.  Overall, both eyes are working together and I see better at all distances with both eyes than any one eye individually.

      I think I ended at 0 diopters in one eye and 1/2 in the other as planned.

       

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    • Posted

      If you get that excellent reading ability with -0.5D thats amazing!

      I plan a similar mini-monovision for myself, starting with my right (dominant) eye for distance (-0.25D target) with the operation scheduled for a week from today. 

      In the future I have planned my left eye for about -1.0D but maybe I don't need that much to get good intermediate vision (24" or so)?

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  • Posted

    I postponed cataract surgery until I could pay for the operation and have both eyes done close together and by just one surgeon. I became shortsighted by the age of 12, with about 1 dioptre correction and 0.5 dioptre astigmatism in both eyes. I had been used to seeing things near clearly and wondered how I would adapt to long sight. However, I opted for spherical acrylic IOLs and asked the surgeon to adjust for distance.

    Once the right eye was done I noticed a distinct improvement in colour and clarity. Yellow objects looked somewhat pink. Initially there was a great deal of rainbow halo and starburst, but the halo was gone within a few hours and the starburst reduced gradually. I had the left eye done within 2 weeks of the right and colours were balanced again and close vision was a little clearer. Again halo went away quickly and the starburst reduced somewhat over time.

    On my third aftercare visit the surgeon told me I have vision in the top 1% of the population and I am able to read the Snellen chart from top to bottom without correction. Contrast sensitivity is excellent as well and I have 20/10 or better vision. If I wear the weakest contact lens available in my left eye I obtain the best vision possible and it is as good as ten or more years ago with contact lenses. I have been able to see the HD in HDTV since the IOL insertion.

    The operations went without issue and both lens capsules were left intact. The cataract removal was pain-free and I do not remember much of the procedure. For five days after the operation my left iris remained fully open and I began to wonder if it had been damaged until it started working again. At no stage during recovery did I experience any pain or real discomfort.

    Residual cataract on the lens capsules is minimal and I do not see halos in either eye, with no starburst in the right eye and some starburst when looking at lights in the left eye. If glare and starburst are different, then I do not experience glare. If it might be of interest, I have pale blue eyes and it seems that some of the astigmatism was caused by my lenses - the cylinder angles have changed and the cylinder additions have become smaller, almost vanishing in the right eye.

    When driving I can see into the shadows again and although I do not need sunglasses I tend to wear them in sunshine. Night driving is so easy now and the starburst in my left eye is not great enough to cause any problems. It is great to be able to see so much detail in the distance. With the left eye I can read newsprint in bright light and I wear spectacles only occasionally.

    I found edge flickering quite noticeable in both eyes, but after a year I am unaware of flickering - it has reduced to a level where I usually ignore it. When I am tired and have been staring at the LED monitor for too long I may become more aware of flickering. It is when I look at something close to my eyes that I become aware of the edge of the lens and there is often some flickering.

    Before the cataract removal my right eye often seemed dry. After some months this feeling reduced and I can use the computer or read for hours now without dry-eye problems. That may be nothing to do with having had a cataract, of course. It seems that my brain now recognizes that I cannot focus on objects and no longer makes much of an effort.

    I am pleased I chose to have the operation done privately. A friend used the NHS route and had different surgeons for each eye and has been left with one watery eye with an IOL that was stitched into place. He has to wear spectacles for everything and his vision is not anything like as good as he had before cataracts developed a few years ago. He sees halos and starburst / glare around lights and is conscious of the edge of the IOLs after a couple of years. Talking to my friend was what convinced me to choose what seemed to be the best surgeon.

    The only sympton I notice is the IOL in the right eye is sometimes a little uncomfortable when I look at something I am holding. The discomfort is sudden and vanishes quickly whether I continue looking near or relax to a distance. I can find no obvious link to anything I do - after hours of reading today my right eye is very comfortable.

    I hope this is not too detailed, but I felt it might be helpful to write about my operation that went very well. I am 59. I did not explore more advanced lenses and the result has confirmed that was the right decision - it might not have been.

     

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  • Posted

    Hello to everyone,

    I have been reading and reading and digesting cataract surgery options and still have not reached a final decision.

    Age: 62

    Eye Prescription (Sept 2015)

    Distance:

    Right: Sph -8.00  Cyl +0.75  Axis 100

    Left:   Sph -10.00 Cyl +1.50  Axis 85

    Reading:

    Right: +2.50

    Left: +2.50

    Dominant eye: left

    Left eye: impacted by cataract - vision blurry - ready for cataract surgery

    Right eye: cataract in early stages - vision still clear

    Priorities: 

    1. Clear distant vision without glasses

    2. Clear intermediate vision without glasses (I work daily with computer)

    3. Clear near vision with or without glasses

    4. No tolerance for nighttime artifacts (halos, starbursts, etc)

    Considerations:

    1. Inclined to go with Abbott Tecnis aspherical monofocals with mini monovision in non-dominant eye to get some near vision.

    2. No way to test conclusively my tolerance to mini monovision due to impacted left eye and diopters of myopia to target.

    3. Can the degree (number of diopters) of tolerable monovision be discerned by the myopia in my natural lens?

    4. What is my recourse if I cannot adjust to mini monovision?

    5. Concerned about possible loss of intermediate vision that is important to me for my work with computers.

    6. Some people enjoy a natural accommodation that allows them to enjoy near and intermediate vision using monofocals - how can I determine if I fall in this category?

    7. Do I need toric IOLs for the astigmatism in my case or best to correct it with limbal incisions or glasses?

    I know there are physicians monitoring and commenting in these forums from time to time.  I would appreciate any constructive advice.

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