Cataract surgery

Thanks very much for your reply. As i said I am getting both eyes done the same day. What I am most interested in knowing is what my vision will be like in the interim between the the surgery and getting prescription lenses. Even if I just get the covered monofocal lenses without the astigmatism corrected does the surgery improve my vision? Thanks again.

First I would highly recommend against getting both eyes done at the same time. Your surgeon will learn a lot about your eyes when he/she does the first eye, but only if they find out the outcome of the first eye (at 6 weeks), before the second eye is done. That said if you are travelling a long way for the surgery and have to stay overnight or longer, that becomes a practical consideration. Second I would highly recommend an exam the day after each surgery. If the lens is not placed properly in the eye that is the time to adjust it, or if necessary put another lens in.

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What your vision will be like will depend on your choice of correction. Most target a lens that leaves you needing a correction of -0.25 D sphere. But power selection is not a precise art. Most will end up within +/- 0.5 D of the target. -0.25 D will give you 20/20 vision at distance. The amount of astigmatism will determine how much that is compromised. As a general rule most surgeons will not attempt an astigmatism correction with a toric lens unless the residual astigmatism is expected to be over 0.75 D cylinder. At this point only your surgeon can tell you how much astigmatism to expect after surgery. You should ask them how much is estimated. They estimate it based on measurements of your eye. Astigmatism (cylinder) compromises vision at about 1/2 the amount that sphere compromises it. Say for example you are left with -1.0 D cylinder that is about equivalent to - 0.5 D sphere. That might take vision down a bit, but you are most likely still legal to drive.

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And of course for sure with a monofocal lens you will need drug store reading glasses to read.

I should mention that most people choose to be corrected for 20/20 distance vision without glasses. That leaves you needing reading glasses for sure to be able to read. Some choose to be left near sighted at about -2.5 to -3.0 D sphere. Then you can read without glasses, but will need glasses for distance. But, either way progressives will fix your vision. What you are really choosing is how you will see without glasses. There should be no extra cost to be left near sighted. They use the same type of monofocal lens, but just a different power.

Thanks Ron. I asked the following question in another post.

"If I get the covered free monofocal lenses for distance on both eyes will I be able to see as well as I now see with no glasses."

The answer to this is crucial to my decision. Again thanks.

I am not sure what you are comparing. Are you asking if you will see as well without glasses as you see now without glasses?

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Do you know what your current eyeglass prescription is? There should be a sphere and cylinder number for each eye.

I see well enough to drive or play tennis without glasses.

OD +075 -100 x 120

OS +100 - 075 x 090

ADD +250

OK, that helps a lot. You appear to be mildly far sighted, and the IOL lens will correct that and bring you back down to about -0.25 D sphere if your surgeon hits the usual target. I think combined with the elimination of the cataract you will get a significant improvement in distance vision without glasses.

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Your astigmatism is also somewhat mild and in the borderline area where a toric IOL might be considered. But, since you plan on wearing glasses, astigmatism should not be an issue at all. Astigmatism before cataract surgery is the sum of astigmatism in the cornea plus that in the natural lens. The natural lens is removed in the surgery and will be gone. Unless the cornea and lens astigmatism were offsetting each other, the sum is likely to go down. However, asking the surgeon is the best way to know what the residual will likely be. They determine that by the shape and topography of the cornea.

Thank you very much. That is very reassuring. In fact the surgeon is redoing the biometry next week and due to your explanation I realise it to reassess if I actually need the toric lenses.

I will just get the monofocal and correct the modest astigmatism and reading issues with progressive lenses. You have been most helpful, thanks again.

Correcting the astigmatism is only going to help you see better without glasses. If that is a priority then you may want to reconsider getting a toric lens. It may only be needed in one eye, which would reduce your cost. Alcon makes a toric AcrySof lens which corrects down to about 0.75 D cylinder. That is the minimum power available.

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And even if you get a toric lens your eyeglasses will still likely make the vision better still as eyeglasses have smaller increments of corrective power than IOL lenses.

As @Myope_PSC points out below, I overlooked that your astigmatism is negative and will to some degree offset your positive far sighted (hyperopic) sphere in both eyes. The rule of thumb is that the sphere equivalent translates to about 50% of that as sphere. So for your right eye (OD) you are +0.75 D sphere and 50% of the -1.00 D cylinder would give you a net equivalent sphere of about -0.25 D vision. That is should give you very good vision.

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In the left eye (OS) the math works out to be +1.00 D and 50% of -0.75 D for an estimated sphere equivalent of +0.62 D. Not as good as the right but not bad either.

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There are lots of unknowns in estimating what vision will be like after surgery, but I agree with @Myope_PSC that your right eye is likely to be about the same for vision after surgery. And your left eye may be somewhat improved. Cylinder or astigmatism is likely to go down in both eyes, but you never know for sure. If you are going for another consult it would be worth asking what the expected post surgery astigmatism will be. It almost certainly will change as the astigmatism in the natural lens will be gone, and the incision to remove the lens and insert the IOL will likely cause some astigmatism too.

Thanks. Here's my question in a nutshell. If I get the covered free monofocal lenses for distance on both eyes will I be able to see as well as I now see with no glasses.

I see well enough now to drive without glasses. I only need my progressive lenses to sharpen my vision, correct my astigmatism, and allow me to read. Thanks.

If you see well enough to drive now without glasses you should be able to see as well or better after your get monofocal IOL lenses set for distance. Depending on what your current prescription is, you will probably see better for distance after cataract surgery. Each person is different, but sphere is likely to improve, and astigmatism is likely to go down. I say likely because in some cases astigmatism will go up instead of down. You should ask the surgeon for an estimate of what astigmatism will be after surgery.

Ron sums it up well. My guess is also that you'll end up about the same after surgery. There is a chance your vision would be a bit worse due to what's known as spherical equivalent that Ron mentioned above. Your current astigmatism offsets your hyperopia (far vision) somewhat. Your astigmatism will probably reduce after surgery assuming some of it is lenticular but your hyperopia will also likely be corrected so the spherical equivalent refraction could end up a bit more myopic. No more cataracts though.

A $700 or so toric could be an Eyhance monofocal lens in Canada.

Thank you as well. tremendous help.

I have decided on the monofocal lenses not only due to the extra $1,400 for the two toric lenses, I have been wearing glasses for over fifty years and odd as it may seem I would be uncomfortable without them. Again, thank you.

I'd say regular monofocal non toric IOLs is a good choice for you based on your current eyeglasses Rx.

I got a monofocal toric IOL in my right eye since it had a lot more astigmatism (about 3.0D cylinder) but even so it only reduced the remaining astigmatism in that eye after the surgery to around where your eyes are (0.75D to 1.00D cylinder) - but thats a small amount and only appears to reduce distance vision by one line on the eyechart. So I get around 20/25 instead of 20/20 with that right eye now without eyeglasses.

My left eye didn't need cataract surgery but has 2.5D cylinder astigmatism still so I continue to wear progressive eyeglasses mostly for correcting the left eye but the right eye with the toric IOL is also corrected for the small remaining astigmatism similar to your eyes to get 20/20 or better.

Thanks, monofocal non-toric is the route I will be taking. I will also get progressive lenses for the astigmatism and obviate the need for reading glasses. Cheers!