Cataract surgery in two weeks. Help
Posted , 9 users are following.
i am 56 with a cataract in my right eye. have been wearing mono vision contacts for years that im happy with. my right eye for distance. my eye doctor wants to put in a toric iol beside the out of pocket cost i am really concerned that i wont be able to see close anymore i prefer to be able to look at my phone and ipad without the help of glasses as i can do with contacts and if need be use glasses for driving. anyone have this situation. im thinking of not getting the vision correction but the doctor thinks thats crazy
0 likes, 21 replies
RonAKA valerie53406
Edited
You are probably in the perfect situation for getting into monovision with an IOL. If I understand you correctly you currently correct for distance with a contact in your right eye, and you correct for closer vision with your left eye? If so, all you need to do for the right eye cataract is ask for a distance power IOL in the right eye. Then you continue to wear the same closer vision contact in your left eye. That is exactly what I am doing now; distance IOL in right eye, and a contact in the left eye that leaves me about -1.25 under corrected to allow reading in my left eye only. I can read my phone, the computer, and watch TV all at the same time with no eyeglasses.
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Whether or not you use a toric lens in your right eye is largely a separate issue. It corrects for astigmatism which impacts vision at all distances. Getting a toric in your right eye should improve your chances of getting 20/20 distance vision in that eye without glasses. The only real downside is cost. Where I am in Canada a toric IOL costs an extra $1,000. The basic lens is covered by our government healthcare. The other common way of correcting astigmatism is with eyeglasses, but since you want to be eyeglass free, that is not as good an option for you.
rwbil valerie53406
Posted
You say you are thinking of not getting the vision correction. So what is your current vision with cataracts. I am a procrastinator and if your vision is still correctable and not that bad you might wait. I took years after first developing cataracts until I had surgery. New lens, materials and devices are in the works, so if you can still see pretty good I would wait.
Second you say you currently are doing monovision. How great is the monovision. You need to know your Plano Prescription and then what prescription you have.
Third at 56 you probably have Presbyopia otherwise there would be no need for monovision with contacts, but you still are getting some adaptability with your natural lens combined with mono vision which is giving you close vision.
It is all about knowing the tradeoffs and which ones you are most comfortable accepting. You can go with diffractive IOLs, like myself, and then get dysphotopsias, you can go with the Premium monofocals IOLs and get a little bit more intermittent and close vision or you can go with a monofocal and do monovision. But unless you do full monovision you probably are not going to get "Great" Close vision. But maybe you don't need 20/20 at 13".
So it is all about accessing what you need, knowing the different IOL capabilities and making a decision.
If you provide more information such as what activity is most important. If reading a book at close distance without glasses is your goal that might be tough without a diffractive IOL.
valerie53406
Posted
thank you for ,your response . my vision in the right eye currently is pretty bad with the cataract. in order to see at any distance i am wearing glasses to correct my left eye to see far especially to drive . i do currently wear two toric monovision contacts currently distance in right eye and reading in left eye. its $1200 out of pocket for the toric lens but since i havent met my insurance deductible it will be an additional $1300 for the basic surgery
i just dont know if its worth it
RonAKA valerie53406
Posted
Whether it is worth it or not depends on how well you will see with a non toric IOL. That is a bit hard to estimate. Your current amount of Cylinder correction used in your toric contact is not a good indicator of what your astigmatism may be after a non toric IOL is put in. Your surgeon should have measured your eye and based on that measurement they should be able to tell you how much astigmatism is there to correct. The general recommendation is that if you have more than 0.75 D astigmatism (Cylinder), you should correct for it. Keep in mind that what you currently have is the sum of the astigmatism in your natural lens plus the astigmatism in your cornea. They may be additive or one may be offsetting the other. The astigmatism in the lens will be gone after the surgery. The impact may be more astigmatism or less. Your surgeon should be able to tell you what amount you can expect.
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One thing to keep in mind is that an IOL is generally for life. It is a difficult procedure to exchange one. So, it is something that really should be done right the first time....
rwbil valerie53406
Posted
I can be a bit slow and I am a bit confused. Your right eye has a cataract and you are saying it is pretty bad. So I am assuming even with correction you do not see very well out of the right eye and are now having to use your left eye for distance.
Do you know what your best corrected distance vision is out of your right eye?
Second I am confused about what your main concern is. At first I thought was the fact you would lose natural lens adaptability for close vision. But from what I understand you were using the left eye for close vision and the right eye for distance, at least until the cataract in the right eye got so bad that you had to use the left eye for distance. Can you clarify this.
Or maybe you main concern is about getting a Toric IOL. Well you have come to the right place as I have recently become a self-appointed expert.
I had cataract surgery done on my left eye with a non-toric IOL, but for my right eye the doctor wants to use a Toric IOL, so I have been reading up on it a lot lately.
There is Cornea Astigmatism, Lenticular Astigmatism, and Surgery Induced Astigmatism. Being the lens is being removed Lenticular astigmatism will not be an issue.
The doctor would have used an IOL Master (or equivalent machine) to get your Axial Length and For Astigmatism your steepest and flattest Meridans. The measurements should show the Corneal Astigmatism and expected surgery-induced Astigmatism. Do you have a printout of those results. If not call and get it and see what your Astigmatism amount is. Also the doctor should have used a machine to look at your cornea and make sure the Astigmatism is regularly and not irregular. When the eye is more football shape you get Astigmatism, but it it is not symmetrical then harder to correct for it.
My Astigmatism is slightly less than 1 (D). The minimum Power is 1.5 (D) (at the lens Plane) but at the corneal plane that is about 1 (D) so it works perfectly for me. I went in for several measurement as the angle was not consistent.
I was hesitant with my minor astigmatism on getting a Toric IOL, but my doctors said Astigmatism can be a bigger problem with a diffractive IOL. As for the $1200. You have to think of this as a one time expense to allow you to have better vision for the rest of your life.
The first thing you need to decide on is which IOL you will be getting. Are you planning to use the basic Monofocal?
valerie53406 rwbil
Posted
My eye doctor has really not explained anything to me. beside the large expense i was nervous that after i permanently correct my right eye for distance i wont get the close vision even with my left eye seeing near maybe that doesnt make sense and im worried for nothing. I plan on calling and discussing things with my doctor tomorrow. Also i heard stories of people having their vision corrected and not being happy. My system of two different contacts was working fine and i guess i figure why mess with it. Also i assume that after cataract surgery if i dont want the enhanced lens my vision will what it was before the cataract
RonAKA valerie53406
Posted
Valerie,
I think you may be misunderstanding things a bit. First if you get your right eye corrected for distance with a monofocal IOL lens, it will not be significantly different than what you have now using a contact to correct for distance. Your left eye will continue to give you close vision with a contact. Now this assumes you are using a standard toric but not multi focal contact lens. There are some contact lenses (which I have never used) which claim to correct for distance and still allow you to see close up. But, if you have not been using that type of lens, then things should not change much at all when you get a distance IOL.
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" Also i assume that after cataract surgery if i dont want the enhanced lens my vision will what it was before the cataract"
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No, that would not be correct if you are using a toric contact now and do not want to continue to wear a contact in that eye. If so, you will lose the astigmatism correction of the toric contact, unless it is replaced with a toric IOL. But on the other hand if you want to continue to wear a contact to correct the astigmatism only, then you probably can do that. Most people when they get an IOL want to be free of wearing a contact in the eye after the surgery. If you consider the cost of contacts, over the longer term it is also likely less expensive to get a toric IOL instead of just wearing a contact to correct for astigmatism.
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If you look down the road to when you need to do your left eye for a cataract, you will have the opportunity to correct it for closer vision with an IOL like you are doing now with a contact, and also correct the astigmatism. Then you can be done with wearing a contact in either eye if you go for a toric IOL in both eyes.
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I currently have an IOL in one eye and see really well with it, and don't need a contact. However, I need a contact in the second eye which has not had cataract surgery yet. I can't wait until the second eye can be done with an IOL and I can be free from wearing glasses or a contact in either eye.
rwbil valerie53406
Edited
i heard stories of people having their vision corrected and not being happy
The overwhelming number of people who have a “BAD” cataract are more happy after cataract surgery. For example I cannot even see 20/200 out of right eye.Having said that, it is true that no man made IOL is going to be as amazing as the natural lens. It is about understanding what the different IOLs can do and the tradeoffs associated with each IOL.
******My system of two different contacts was working fine and i guess i figure why mess with it. **
The key word here is “WAS”. Is it still working fine with the cataract? If you are able to correct your vision even with the cataract to the point you are OK with you vision then certainly put off surgery to you have more time to do research and feel comfortable about your decision
I assume that after cataract surgery if i dont want the enhanced lens my vision will what it was before the cataract
Hmm, I am confused about what you are referring to when you say, “Enhanced Lens”. Do you mean a Toric IOL? I never have thought of that in terms of Enhanced Lens, but instead think of the Premium Monofocal IOLs when I hear the term enhanced lens. If you have a great deal of Astigmatism and don’t correct for it will affect your visual acuity. Again you need to find out how much Astigmatism you have.
Let’s start with basics. You will be replacing your Nature Lens that adopts; muscles make your natural lens change shape; with a piece of plastic and physics only goes so far. There is no Man-Made IOL that is as good as the Nature Lens. It is about getting vision quality better, hopefully very good vision, than the cataract vision you currently have.
Having said that if you have cataract surgery for your right eye with a Toric monofocal and set it for Plano (Distance Vision) and use a contact monovision approach for the left eye to get close then you will probably be fine. Remember your left eye still adopts which is giving an extra boost to the close vision. But I cannot say for certain as I don’t know how much adaptability your older right lens still was providing for close vision.
But my overall advice is unless there is a dire emergency delay surgery and do some research. This is not a simply do over. Lens explantation is serious surgery. I think at a minimum consider the Eyhance and Light Adjustable IOLs and if you are willing to trade some contrast sensitivity for a bit more close vision look at the Vivity IOL. And if you are OK with dysphotopsias in order to be glasses or mostly glasses free then look at Synergy and PanOptics.
In full disclosure, if all goes well, I will be implanting the Synergy IOL in my eye this month.
Let me add one more thought. When I had my first eye done, none of the Premium IOLs were available. If I were doing both eyes Today, I would give serious consideration to getting the Eyhance set for Plano in my dominate eye and the Eyhance or Vivity set for -0.75 (D) for my non-dominate eye. I think that would give you functional close; able to read your cell phone and the like. But to do any serious up close reading you would probably need a good light and readers.
Beth-R valerie53406
Posted
I have an astigmatism and had cataract surgery three days ago. My surgeon said that if I don't get a Toric lens I will always need glasses. I wore tri-focals before the surgery. If you can afford the additional $1000, I'd go ahead and get the lens, as the decision is basically for life. It is complicated to change the lens later and risky for your eyes, with more chances of damage to the eye. My premium lens (PanOptix) was $2500 more and well worth it. I was seeing 20/20 out of the operated eye the day after surgery. Now I can't wait to have the other eye done next year!
Guest valerie53406
Posted
If only the right eye has a cataract and the left one is fine I think I'd get an IOL in the right eye to correct for distance and the astigmatism and then use a contact in the left eye if you want to keep doing monovision. I wouldn't "bake in" the monovision at this point if you only need one eye done. Your brain should be able to switch dominance pretty easily if the offset isn't too extreme. Then when it comes time to do the left eye you have options. You could go with monovision OR if it's 5 years from now maybe the Juvene IOL or some other "holy grail" IOL will be commercially available by then and you could go with that to help with near vision. That would be way better than monovision as that eye could focus 100% of the light from 14" to infinity. Not sure how likely if is that we will see such a lens in 5 or even 10 years but yah… I'd personally stick with distance correction and keep using 1 contact for monovision and hope there is better technology available by the time the left eye needs to be done… rather than "baking in" the monovision now.
RonAKA Guest
Posted
I agree for sure on deferring the second eye. It will also defer spending some money. But, the big opportunity is that continued use of the contact in the left eye will give more opportunity to evaluate monovison and decide how much monovision is ideal.
valerie53406 Guest
Posted
hi what do you mean by "baking in"
My left eye doesnt have a cataract i use a contact for seeing close in that eye
Guest valerie53406
Edited
I mean committing to the monovision surgically… not via a contact lens. I personally would keep the monovision outside my eye as long as possible before surgically committing to it. Mostly because you still have one good eye so your IOL options for near vision in that eye might be better years from now as technology improves.
mathdoc valerie53406
Edited
I'm in a similar boat to yours, needing cataract surgery in only one eye... with the main difference being, it's my non-dominant (left) eye (NDE) that needs surgery, whereas your right eye should be dominant (DE) (as it's currently set for far vision with contacts). I am mainly considering Vivity & Eyhance, along with some trifocal diffractive & zonal refractive backup options.
Based on what you've written (in the post & comments) and the knowhow I've gleaned regarding IOLs (MTF plots, VAs, defocus curves) etc in the recent months, it sounds like Vivity Toric with a small myopic offset in your RE should work out well for you. If you & your doc are able to target and achieve a refraction strictly in the -0.3D to -0.5D range (assuming your astigmatism is corrected effectively alongside), your near vision should continue to work great with the contact in your LE and your distance vision may at worst need basic driving glasses. If you have your biometry data at hand, you can even check online if a Vivity IOL falls in the above range of target refraction (pls remember that they only come in 0.5D steps and so you may or may not be able to target the [-0.5D,-0.3D] range). You may also want to lookup Alcon's Toric power calculator and play with it using your biometric data. Please discuss with your surgeon, and please feel free to ask questions. Hope this helps.
RonAKA mathdoc
Edited
I have also looked at the Vivity for my second eye which I plan to use as the closer eye in a monovision configuration. My distance RE has already been done with a non toric monofocal IOL and an outcome of 0.00 D Sphere, -0.75 D Cylinder. The predicted outcome was -0.35 Sphere, and less than 0.5 D Cylinder. I am quite happy with the results as I have 20/20 distance vision and can see down to about 20". I would have been much less happy with a +0.25 or more outcome. It was obviously good luck that it hit 0.00 D and didn't go over.
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My understanding of the target for distance vision is that it is a nominal -0.25 D, but each eye will be different when you consider the standard 0.5 D steps of the lenses. It will almost always come down to a choice between two powers. Most surgeons are going to target the lower one, if there is a risk of going over into the + side. The big risk here is in how accurately the surgeon has measured the required power. It is not a part of the field that is as precise as one would want it to be.
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I was originally very interested in the Vivity, but after more research less so. I will still ask the surgeon about it, but am pretty sure now that I will go for another monofocal lens in the second eye, but with a planned myopia of -1.25 to -1.50 D. If I was going to do the Vivity I would ask for a -0.75 D under correction. The issue with the Vivity is that it has relatively poor MTF, or contrast sensitivity. I think that could be mitigated to a large degree by using a standard monofocal in the distance eye and the Vivity in close eye only. I have prepared a number of MTF and defocus curves for the various possible combinations. For closer distances I believe the two monofocals with a -1.25 under correction will give equal or better closer vision than the one monofocal plus a -0.75 Vivity. The difference is in the distance vision. The Vivity will give better distance vision when off set by 0.75 D than the monofocal offset by 1.25 D.
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And while the Vivity is supposed to have minimal risk of halos and flare at night, some users here report that they have it. Overall this is what is giving me pause on the Vivity option and more consideration of the standard mini-monofocal with monofocal lenses. The other aspect is that I am simulating the -1.25 mini-monovison with a contact in my non IOL eye, and like it a lot. There is no real way of simulating accurately what a Vivity lens would look like. The cost is not a consideration for me, I just want the best overall vision.
mathdoc RonAKA
Posted
Thanks for your detailed response. Sorry for not replying earlier,
NeluG RonAKA
Posted
"And while the Vivity is supposed to have minimal risk of halos and flare at night, some users here report that they have it."
"There is no real way of simulating accurately what a Vivity lens would look like."
I'll try to describe it for you, Ron.
As you might already know, I have both eyes done with Vivity, one with mini-monovision at -0.5D and the other one plano.
First eye was done on November 3rd, the second one last Monday, November 22, 2021.
For me everything inside the house looks great, I can see clearly at any distance, from my phone to the furthest and darkest corner.
Outdoors is the same during the day but when night falls here come the gremlins 😃
It seems only the lights that are further away than let's say 100m, 150m are affected, in two different ways.
With my left eye I can see a light streak, almost vertical, maybe more like on the direction of 11 o'clock. I see no halos with that eye and that light streak is not really annoying.
My right eye has halos at that distance only, lights closer than that are not affected. I only see one ring, so I should say I see a "halo" around the light sources at night. That annoys me like hell...
I don't have glare with any of the eyes.
The contrast is OK and night driving is not an issue or debilitating for me. Yes, it could be better but I'm not 20 years old any more 😃