cataract surgeon plans to keep near same myopia
Posted , 4 users are following.
first post. I've been reading this cataract forum for weeks, as I'm about to have surgery this Friday, July 16th. So far, I have not found anything that addressed my particular concern. I told my surgeon that I would like to retain my near vision, as I do a lot of close-up work, such as painting fine detail, sewing, cooking, reading books, etc. I'm 67 years old, lifelong myopic, glasses since 6th grade, then contact lenses until developed dry eye in 2008, then back to glasses. I've always worn either glasses or contacts for distance/driving, and don't mind continuing to do so. prescription has fluctuated alot over the years, but is currently at RE: -1.75, LE -2.75. Surgeon says small amount of astigmatism, but not enough to need correcting. He said he plans to try to bring LE, which is to be done first, up a bit to -2.50, though not exact science and it could be off by as much as 4 inches of near focus. He said my eyes are currently focusing about 14 inches out. Plans to leave the RE as close to where it is now as possible.
To be honest, I don't entirely understand the mechanics behind how all of this works. I do realize the new IOL will not have the accommodative abilities that natural lenses do. He says he is keeping my vision as near to what it is pre-surgery, as he can. I'm having a hard time understanding what my vision will be like post-surgery. I have always been able to see well close-up, and believe I would still be able to without the ghosting/double vision caused by the cataracts, and a sense of looking through a dirty windshield. (I've been putting this surgery off for years). I sometimes go for days without even putting on my glasses if I'm not driving or otherwise needing sharp vision for distance. I'm perfectly fine walking around the house with no correction at all. It doesn't bother me to not see sharply in distance, I can see well enough to function and I'm used to it. I'm wondering if this will stay the same after surgery?
Does this sound like a reasonable plan for my circumstances, intentionally giving me -2.50 myopia in first operated eye? I do trust this surgeon's surgical expertise, but he is man of few words, and only responds to direct questions, and I've already had 2 extra pre-surgery consults asking him questions. (they've now written anxiety in my chart, lol!) I've gotten answers to all of my other questions about anesthesia, eye drops choices, etc. But I still feel a bit iffy on the power calculations. btw, it will be a regular medicare-paid-for monofocal lens. I wouldn't consider a multifocal even if it were given to me for free, because of other family members negative experience with them.
Since there is already a refractive difference between my eyes, and I spend most of my time without correction, does this mean that I'm already seeing with a mini-monovision setup naturally? Sometimes when I put my glasses on to go out after not wearing them for a few days, I can feel a pulling sensation as if my eyes are trying to adjust to them somehow. More recently, I sometimes even drive without them, as they don't seem to be helping as much as they used to.
thank you to anyone who has any insights about this.
0 likes, 16 replies
Night-Hawk jettesun
Posted
At age 67, your natural lenses probably have lost their flexibility for adjusting focus so monofocal IOLs will act the same. So if indeed the IOLs power are selected to closely match your existing nearsightness it should end up giving you the same vision but clear not cloudy and also color and white will look better since old natural lenses get more yellow and the IOLs will be clear or less of a yellow tint.
But remember its not an exact science and though the surgeon may target a specific Rx for an eye, it can end up being off due to the unpredictability of how the eye heals and the IOLs are only available in 0.50D steps. Also the incision in the cornea can often introduce a small amount of astigmatism, but if its under 1.0D it won't affect vision significantly especially for a nearsighted target. Your eyeglasses for distance vision can correct any refractive errors that are left after surgery for driving anyway.
jettesun Night-Hawk
Posted
Thank you Night-Hawk. So what I'm getting from what you said, is that I can expect pretty much the same vision I have now, excepting for possible small changes due to how close he hits the target refraction and how my eye heals. And that those possible changes can be corrected with a new eyeglasses prescription after both eyes are done. This sounds acceptable to me. 2nd eye to be done in 4 weeks. Thanks for your comments as it helps me to feel more comfortable with proceeding. I'm most afraid of losing my close-up vision, but it doesn't seem like a big deal to me if driving glasses prescription is changed a little. As long as I can see without glasses around the house. I was afraid there might be a curtain of blur when looking across the room, if my IOLs were set for detail-work.
RonAKA jettesun
Edited
I am half way through this process to IOLs to correct cataracts. My first eye has been correct to full distance. My second eye is not that bad yet and I am simulating a monovision by using a contact in my remaining non operated eye. It leaves me at about -1.25 D myoptic. I find with one distance eye, and one nearer vision eye, I can go without glasses 95% of the time. If I need to see really clearly close up I just use reading glasses. For driving, TV, computer work, and even my iPhone 8+, I do not need glasses. It is an option, but not everyone adapts to it.
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With monofocals you can get near vision, or distance vision, and correct for everything else with glasses. What I would think about is what you want to do without glasses.
jettesun RonAKA
Posted
Thank you Ron. I am a bit confused about what constitutes natural monovision. My eyes seem to work together quite well right now, without correction (glasses), and they are different refraction powers. I feel like I can see reasonably well except for cataract symptoms, although I do have glasses for driving. I can drive without them, they don't make that much difference. Sounds like the surgeon is planning to give me the same thing I have, and wouldn't that be monovision since each eye will have a different power?
How much difference is there between your corrected distance eye, and your simulated monovision slightly myopic non-operated eye?
RonAKA jettesun
Edited
Monovision normally refers to having one eye corrected for distance (20/20), and the other eye (usually the non dominant one) corrected for closer up. It used to be that as much as 2.5 D difference was used. More recent practice is to use less. One recent study compared full corrected for distance in one eye, and them the other eye left with -1.0 D myopia, and also -1.5 and -2.0. The difference of -1.5 D was selected as the optimum. I have tried -1.25 and -1.5 with contacts and prefer the -1.25, but -1.5 would be OK too. Since lenses come in 0.5 D increments one has to accept a range rather than a single exact power. When my turn come to get the second IOL I will as for an outcome in the -1.25 to -1.5 D range.
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Setting both your eyes to a myopic power will work, and you certainly will need glasses for good distance, and may even need them for sharp TV watching. There is an opportunity to see better than you are now by going for full distance in the dominant eye, and -1.25 to -1.5 D in the non dominant eye.
jettesun RonAKA
Posted
Ron: If I do what you suggest, in last sentence above, will I be giving up some of my near vision quality? That is perhaps the most important question. also, my dominant eye is RE, 2nd to be done, but surgeon hasn't even mentioned anything about dominant eye to me, I just happened to already know about it, from my research. I plan to ask my surgeon about your suggestion, as it seems to me that I am already operating on about 1D of monovision, if my thinking is correct.
RonAKA jettesun
Posted
For me the -1.25 myopic vision is pretty good up to a point. I manage with my iPhone 8+ with most screens and normal fonts. However if I want to read the really fine print on OTC medication labels etc, I do need readers. It is not the same as when I was near sighted with -3.0 or so eyeglass correction and all I had to do is take my glasses off to see the small stuff. Now I have to find a pair of readers. I get caught every once in a while while out shopping, but not very often.
jettesun RonAKA
Posted
Ron, Thank you so much for this comment... this is exactly the information I was looking for. It sounds like our situations are similar, in regards to the previous nearsighted correction of -3.0, except instead of taking my glasses off to read the fine print, I just wouldn't wear them. Other people would be asking Me to read the fine print for them, and I could readily do it. Until cataracts interfered, with ghosting and double vision, glare, fading colors, and loss of contrast. I am an artist of sorts, super enjoy painting detailed scenes on furniture, murals on walls and such. It seems like giving up a huge part of who I am to lose the ability to do that. It's totally Not worth it to me to risk my close-up vision. As it is, I haven't painted anything for at least a year because of failing vision, and it's driving me nuts.
I kept reading people saying that the sweet spot was somewhere in between, like -1.50 or -1.75. And of course, I want to explore all my options Before surgery day. I hadn't read of anyone whose surgeon was aiming for -2.50/-1.75, so I had this niggling uncertainty about it. But now I'm understanding why he's targeting that. I didn't want to be giving up something I could have had if I were more educated about it and knew what to ask and say.
RonAKA jettesun
Posted
Monovision is always going to be somewhat of a compromise. What I am finding is that my -1.25 D monovision is a compromise on distance vision. This may be partly due to the fact that I have crossed monovision where my dominant eye is the close eye rather than the conventional way where the distance eye is dominant. I think over time my brain will adjust. I am about 6 months into this now. Since I can read my iPhone and easily read text on a computer screen without glasses I don't find my close vision to be a compromise at all.
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I was recently on a road trip with 4 days of driving. I did the first three days with no glasses, just my contact simulated monovision. I though that reading road signs could have been crisper, so on the last of the 4 days I left my contact out and used my new progressive glasses instead. Surprisingly that did not have a real dramatic effect on my distance vision. It was better, but not super good. I should have easy 20/20+ vision with the progressives. Perhaps the cataract in my non operated eye is starting to get worse.
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On the amount to get, with no contact I have about -2.0 monovision. While I can get by without a contact, I much prefer the -1.25 which I get with a -0.75 D contact. But each individual will be different. I think what you have to watch is what people consider to be intermediate vision. With my distance IOL I can see 20/20 in the distance, and read a computer screen at 18" or so. If anything my vehicle dash instruments are easier to read with the IOL distance eye than with my -1.25 monovision eye. My close eye starts to jam out as I go over about 3 feet or so. I would not enjoy watching TV with that eye alone, but with my distance IOL eye, TV is just fine. With the -1.25 eye I can read down to about 12" quite clearly. That said it is highly dependent on lighting levels. Where my close eye jams out to some degree is in really dim light. This makes me think I am getting my close vision due to my pupil constricting down (pinhole camera effect). If I had to thread a needle in dimmer light I would need reading glasses. I need to get a pair of the proper power ones, but I use them so seldom I have not bothered yet.
jettesun RonAKA
Posted
Ron: Interesting that you seem to be getting your best intermediate vision from the distance IOL. From what you've said, I'm thinking that the cataract in your non-operated eye may in fact be getting worse and interfering with the close-up vision you could be having with the eye you're now wearing the -0.75 contact in. You should have stellar vision after the 2nd eye is done, having adjusted so well to monovision.
I don't watch TV at all, but I do alot of other activities at that range. That is another thing that has confused me... what exactly do people mean when they talk about "intermediate" vision. Some people seem to be referring to looking at computer screen, while others mean TV viewing (which is across the room). I have worried that I might be setting myself up for only having crisp vision at say, 6-8" out, and a wall of blur further out than that, which doesn't seem like a good way to live. But surgeon says that will not be the case, as other parts of the eye also contribute to accommodation and focus. And as was earlier pointed out, I've probably already lost the flexibility in my natural lens, at age 67.
Right now, as I look at the computer screen, I have double vision/ghosting so bad that it tires my eyes out quickly. I have to rest them between close-up activities; my eyes feel strained and I get a headache.
I'm thinking when I get the next eye done in 4 weeks, the -1.75 he plans to give me in that eye will give me a bit more intermediate. But I'm fully expecting to have poor distance vision and to have to wear glasses to drive. Also expecting the starbursts of glare to go away, and to have improved contrast. Right now, I don't see much of anything in shadowy dark areas. A person could be under some trees and then step out into the sunlight, and I wouldn't have seen them there at all (this particular thing happened just yesterday).
If he hits his target, I will be -1.75 in my best distance eye (2nd to be done), and you are effectively at -1.25 in your close-up eye right now, with the contact. It will be interesting to see how our ranges of vision compare after I have the surgery (3 days to go ), as we are trying for a balance that works for us from opposite ends of the spectrum. My goal is to still be able to see fine painting detail, but have enough intermediate vision to function around the house without glasses.
Night-Hawk jettesun
Posted
For reference, my right eye with monofocal toric IOL set for distance vision gives me good vision from about 4-5feet and beyond, so its fine for say TV watching at 6-8 feet.
However its too blurry for working at the computer, monitor is about a full arm's length away so 2feet or so. I use a +1d reading glasses for that distance, it also barely works for reading my smartphone held 18" or more away.
For closer up reading I use a +2 to +2.5 reading glasses correction with progressive eyeglasses.
With these results, whenever my left eye needs cataract surgery (probably still not for several years) I would probably want to target it for -1.0 to -1.25d for good computer and smartphone intermediate vision like I get now with +1d glasses. I rarely need to read fine print in lower light which is when I can use higher correction reading glasses.
Night-Hawk
Posted
However I've been reading about the new Tecnics Eyhance monofocal IOL (available in standard and toric) that extends a bit more into the intermediate distance focus range yet still has all the good features of a monofocal, no extra artifacts like with multifocals.
With the Eyhance monofocal it looks like I could target only -0.5D and get similar results for intermediate vision that a plain monofocal would do at -1.0D or more! With only a -0.5D offset that eye could still have decent distance vision perhaps 20/25 too while getting decent computer/smartphone vision.
This new IOL could also reduce the difference between eyes for all mini-monovision combinations too.
jettesun Night-Hawk
Edited
Night-Hawk: Thanks for this additional info. It is sure sounding like a YMMV thing, which makes sense as our eyes are all different. Glad for these responses, as I'm seeing that while close-up vision after being corrected for distance does always seem to suffer, the range of usable near vision varies. And leaving just a little bit of myopia in one eye, is still not the same as having good clear uncorrected near vision. Also, as Ron points out, distance vision also suffers a little bit with that arrangement.
Both my cousin and older sister recently had cataract surgery, with my cousin paying thousands for panoptix lens. My sister got the standard monofocal lens, but opted for the laser incision. Sister is Way happier with her outcome, as my cousin still has to have readers (which she mistakenly thought she'd be free from), but also deals with alot of other unpleasant issues from the panoptix. My sister doesn't mind readers as she has never been myopic and has used them for many years already. Their experiences really make me distrust all the new kinds of fancy lenses. They seem to be hyped up by the manufacturers but don't necessarily deliver what they tout, or have built-in issues that are glided over before they're installed. I understand the Eyhance is not the same, not a multifocal, but still, I don't trust. The standard monofocal has been in use for decades, and is alot more predictable.
RonAKA jettesun
Posted
Most seem to think of "intermediate" vision as being 2' to 8' or so. I would define it to be 1.5 feet to 2 feet. My view is that our pure distance vision should get us down to the 2' range or a little less.
bob38868 jettesun
Edited
As I've mentioned before with the Eyhance torics I appear to be at +.25 and -.25 in my eyes 3 month out. I can read small computer fonts on my 15" laptop at 38" away so that would suggest I am getting some extended depth of field over a mono focal lens. I defocus at 22"and closer from the laptop and when I wear +.5 reading glasses. I can turn the glasses sideways and just correct the near eye and still retain that distance.
I'm going in for a complete eye test on Thursday to see where both eyes actually are and then setting up a contact lens trial at +.75 in the non dominate which would put that eye at approximately + 1.
Everything just feels more natural and relaxing with the +.5 glasses on so it would suggest we just know when things look correct...call it homeostasis.
No problems with the Eyhance lens. I suspect they are very close to mono focal lens in most other characteristics. I was marveling today on a long drive how nice it was to not require glasses and how clearly I could read street signs at a distance.
I've been eating a lot of pineapple and taking bromelain for my floaters which became visible once my cataracts were removed. 1 month in and I'm already noticing improvement. Look up the Taiwan study.
jettesun bob38868
Posted
bob: glad you are doing well with the Eyhance lenses. I know what you mean about things just feeling correct and comfortable. It sounds wonderful to be able to see road signs at a distance, with no glasses. Maybe in another lifetime for me, haha.
Interesting what you say about the floaters. I do see those from time to time, when looking at the sky especially. Hope they don't become a problem for me, but if they do, I will look up the study you mention.