Cataract surgery on one or both eyes?

I had to rush out just now.  Neighbor wanted to borrow our heater.    Your age group can help others in examples more relevant to you.

Contact Lenses - Yes, they should completely eliminate anisometropia, at least in the correction range you are taking about. I'm personally corrected (via contact) to -4.75 in my left eye and plano (via IOL) in my right. Object sizes appear identical to me. If I wear an old pair of glasses (with the right lens removed) the difference in size is very large and I cannot tolerate this for more than a few minutes. Also, I opted for a multifocal IOL in my right eye (to get some near vision) and I paired this with a multifocal contact lens in my left and the combination works very well together. 

Lasik vs Cataract Surgery - First, I'd advise trying contacts to see if you can acclimate to them (give it some time). If it works for you, you can easily change your prescription and even simulate the mini-monovision setup that at201 is suggesting to see how you adapt. However, if contacts do not work and you can't adjust to the image size difference, then you'd need to decide between something like Lasik or cataract surgery. You may get differing opinions here on this but Lasik isn't as invasive and, assuming your natural lens is in good condition, you will likely retain some accommodation (which will mean an expanded range of focus). Lasik can complicate a future cataract surgery, however, but doctors understand this much better now and can take detailed measurements to aid a future cataract operation. There are side effects to both Lasik and cataract surgery so make sure you understand them before you choose one or the other. 

 

I forgot to add that I have a toric implant from my cataract surgery, not a multifocal. I had heard too many complaints about the multifocals. 

JoanneinCA:

It sounds like you have the information you need to make this decision. I don't know exactly how bad your left eye is now, but you can clearly tell the difference in how your two eyes work together with the IOL in the right eye and both glasses and contacts in the left. If your left eye isn't too bad, wearing different contacts set for near/intermediate/far should give you a decent preview of what your vision would be like if you did the surgery and targeted your left eye for the same vision range (as the contact). Glasses are really not very good at simulating this as you can already tell.

If I were you (and assuming your left eye is good enough) I would take my time and have my optometrist give me several sample contacts with different corrections (one to match your right eye, one for maybe +0.5D to +0.1D off your right eye, and another for close). Spend a few weeks with them and see what you think. These should be free as most doctors get lots of samples and 1-day wear are relatively inexpensive and very convenient for testing. Make sure you always have some contacts that correct close to your IOL though so that you'll have no issues driving.

Everyone is different. In my case, I can tolerate a difference of maybe 0.5D to 1.0D between my eyes MAX. My IOL is set for plano and my other eye requires -4.75D contacts (so it's natural focus point is pretty close in). I take my contact out only right before I go to bed as the difference between my eyes drives me nuts very quickly. 

Derek, my contacts prior to surgery were 6.50D on my right eye And 4.00D on my left. This worked very well for me. (plus a bunch of correction for astigmatism) I read with my left eye and used my right for distance. My brain switched eyes seamlessly depending on whether I was looking near or far. I’m not sure what my right eye is corrected to now. I had never heard the term plano before, except in reference to a town in TX. 

What would be the advantage of not exactly matching the right eye if I’m going for distance? The contact I’m using in my left eye for distance now is actually the one for my right for before the surgery. Vision is sharp with it and maybe a little over corrected. It works pretty well but not perfect. 

The cataract in my left eye is bad enough that insurance will cover it but I really don’t notice it if I don’t compare the color and brightness with my right eye. Surgery is set for late Nov. so I have time to decide.

You’ve given me more to think about.

Congratulations on your right eye being better than 20/20 two weeks after your cataract surgery. Will you be having the same Toric lens for your left eye, when it will be operated on this coming November?

Some can see at all distance without glasses after both eyes have been implanted with Toric lenses.

I too have not heard of "plano" until I learned it from this site.   But I have been to Plano TX.

The advantage of not exactly matching the left to the right would be that you can extend your range of clear vision. You need to test this for yourself as everyone will be different. Ideally don't make a final decision until you're 6-8 weeks post surgery as your vision can change (hopefully for the better). What you want to see if how does the vision in your right eye change with distance. For example, you might be 20/15 at 20ft, 20/20 at 10 ft, 20/40 at 6 ft and similar (looking only through your right eye). If you corrected your left eye to match, then you'd end up with similar binocular vision. However, if you under-corrected your left eye by a small amount, maybe +1.0D, then the left eye would get clearest vision at maybe 10ft and you'll end up extending your overall clear range of vision. The theory is that your brain won't notice the slight under-correction in the left eye when both eyes are open (although you'd probably notice it with just your left eye open). 

You can test this yourself by reading objects at different distances to see where it starts getting blurrier. Since you already wear contacts, you can ask your optometrist to give you some samples to see what this would look like. You are saying that you're left eye contact prescription is -4.00D (I'm assuming it's minus). So, maybe you try samples of lenses that are -3.50D, -3.00D and -2.50D and see what your combined vision looks like. What you want to decide is: 1) Does it help your intermediate range vision (3 ft to 10ft)? and 2) Do you notice the reduction in clarity at distance?

The goal is to extend the range at which you don't need to wear glasses without causing any noticeable degradation. You might be able to enjoy TV more clearly or use a computer without glasses. It's worth spending some time on this before making a major decision on your other eye. Since your left eye is still functioning reasonably well AND since you can wear contacts, you have an opportunity to test some of these options (not everyone is lucky enough to be in this position). 

 

Derek, my right eye is between 20/20 and 20/15 at 20 feet using an eye chart hanging on the wall. The closer I get to it, the better my vision until I get to about arm’s length, and then it begins to deteriorate. This is the eye with the surgery. With my left eye, no surgery yet, I can read small print from about 6 inches away, but need glasses or contacts to read further away. With my right eye, I can’t read anything at 6 inches. But at arms length I can just make out fairly small fonts on my iPad Mini. So I take it that the distance is more fixed with the IOL, right?  How much does vision typically change beyond 2 weeks out from surgery? Is it likely to get worse? Where I am now is where I’ve been since about day 2 or 3.

 I can already read my desktop monitor with my right eye, probably because I sit back a ways from it. Far distance, like on a freeway aren’t as crisp as closer, but much better than where I was before surgery. 

I like your your idea of trying different contact lenses on the left eye, regardless of whether I go for distance or reading with that eye. I’ve been happy with monovision with contacts and glasses, but the IOL’s seem to be a little different. Is that a correct assumption?

Hello Joanne:

It seems like you are getting really good vision from your IOL. For your description, it sounds like you ended up a little bit nearsighted but that's really excellent range. You are still healing though so you need to wait longer to make a final assessment.

If you end up this way and you wish that the far distances could be a little sharper, the surgeon could target that with your left eye and you should not experience any problems with your blended vision because they would be so close. You'd have to wear reading glasses of course.

If reading your Ipad more clearly (at arms length) is more important than you could go the other way with your left eye and have it undercorrected a bit more to get clear vision on the Ipad. Try contacts at -3.00D and -2.50D to see if you like the blended vision. 

If you corrected your right eye to -2.0D you MAY be able to see clearly continuously from 30cm (left) to ~60cm (right) but you might also notice a dip in clear vision between the two eyes. Based on your description above that the clear vision in your left eye is only 30-35cm (which is pretty narrow), I think it's likely that you would notice a drop in focus at some point in this range but you'd still be giving yourself a lot more options in terms of seeing in this range without glasses (if this is where you spend most of your time visually). This would be a type of monovision and 1.25D is in the range where some people would be bothered by the difference between the eyes.

I don't believe that there is any way to determine this conclusively in advance. The good news is that the 1.25D difference between your eyes is small enough that you should do fine with glasses, even progressives if you wanted (customized for this difference between the two eyes).  

When I said 30-35 cm clear vision in my left eye, with no glasses, I meant it was the sweet spot. That's where I'd normally hold a book to be able to read it without glasses on my left eye. The range is probably a bit wider, by I don't think by much.

Speaking of progressives after the surgery, that could probably be the best option, if possible. Lots of times I find myself working on a computer, while at the same time there is a game going on TV. So being able to focus on both at the same time, without the need of removing and putting the glasses on all the time, would be the best. That is what I have now with these progressive lenses, even with this cataract developing. Do you think I might be able to do the same after the surgery, obviously with changed prescription for progressives?

Thanks!

Have you considered a premium lens for your cataract surgery?  It would give you the range you are looking for, although there is a trade-off of more night time glare &/or halos.  I have a Symfony Lens and enjoy being able to read and look up at the TV without glasses.  I don’t need glasses for anything however I do see multiple concentric rings around certain light sources at night.

P93570, I think for regular or toric lenses they can make them to any strength you prefer, just like a contact lens. For me the key would be to get the best vision that I can without glasses for the things that I spend the most time doing. Then, if I have to add glasses for some things, I would want them to be the simplest glasses prescription (cheapest) in case I would lose them or break them. But there is still one unknown, and that is how good of a correction they can get with the left IOL. I’ve been very lucky with my first surgery as I can see distances very well and as of last night outdoors, no halos or glare. I’m hoping since it’s been 2 weeks that they would change. But I can see from reading the posts on these forums, that isn’t always the case. The other question is, if the left eye was corrected for reading, would there be similar ranges of clear vision like there are in the right eye? I think that’s what you’re wondering too. If I could get an IOL in a toric lens to react exactly like my contact lens does, then I’d probably go with that since monovision lenses have served me well for many years. Then again, how hard is it to put on a pair of magnifying glaces when I want to read?

Derek, you seem to have been around here for a long time. How common is it for people with an IOL to be perfectly satisfied with it and not have to wear glasses? My eye doctor didn’t seem to want to give me unrealistic expectations and didn’t give me a percentage. But an assistant said that most people can get by without them after surgery.

Correction: ”that after 2 weeks they would not change...”

Hi JoanneinCA - I think a good percentage of people are satisfied with outcome of surgery.  Unfortunately not many come on the forums unless something is amiss so you cannot get a true sense here of that.  With monofocals though I don’t think the expectation is you can be glasses free.  With monovision you likely can get to where you need them only for reading or distance depending on target chosen.

Premium lenses won’t guarantee glasses free but much less glasses dependant.  I have Symfony lenses and don’t need glasses for anything.  But I do have the trade-off of night vision - see multiple concentric circles around some light sources.  There is no perfect lens so you need to decide for yourself what you prefer and accept compromise.

Agree with Sue.An's statement completely.  I am happy with my standard IOLs and post-Op refractive outcomes. My husband is absolutely happy with his bionic "Symfony" eyes.  I accidentally came onboard while searching on other health issue that has since resolved, and decided to stay a bit to learn from the others here. From what I read up, premium lenses are for people with healthy eyes. Not all eye problems can be detected by hi-tech ophthalmic equipment; possibly that is why say 2% are in this category. The rest are more straight forward, i.e. refractive errors, etc.

But if I went with one toric lens for distance and the other for reading, they should work like my contact lenses, shouldn’t they? I didn’t have to wear glasses with my contacts.

Jantje, do you have monovision IOL’s or are they both set for distance? (Or reading?)

JoanneinCA, mine are standard IOLs set for near and intermediate, I think. Because I have pre-existing eye condition, my LE is "low vision" or has damaged nerve. No matter what IOL Power is set, I cannot read with my damaged eye but it is functional in other respects.  My good eye is the one doing all the work, and I knew right before the cataract surgery that the eye-surgeon would not target it to be 20/20.  After surgery my very myopic good eye can see clearly up to 20 feet and I have good near vision J1.  My intermediate vision is reasonably good as I do not need glasses crossing busy roads and shopping for groceries, or biking in the neighborhood. I only need Rx glasses when I drive.

Have you read pyllis31515's discussions? She has Symfony Toric lens on her LE, and Symfony EDOF Lens on her RE with amazing results. Very encouraging indeed.

Joanne:

You'll get a lot of opinions on here regarding the number of patients who don't need to wear glasses. I think that most surgeons would tell you that with monofocal IOL's the number of patients who never need glasses is pretty small. Doing some type of monovision strategy (targeting the eyes for difference regions) will help, of course. Even those of us with multifocal of EDOF IOL's who are happy with the results (I think both Sue An and I fall into that category) still have to wear glasses for certain tasks. For example, I'm not wearing glasses now but I was repairing an elliptical machine about 30 minutes ago and I needed reading glasses to align the small fasteners.

Keep in mind too, that not everyone would be satisfied with the same outcome. For example, a person with a single computer monitor, set close to their face at relatively low resolution might term their computer vision "good" while a person with the same correction using multiple, high resolution monitors with very small text (such as myself) would not be satisfied with the same level of vision.

My personal opinion is that it's easier to achieve satisfactory results if your goal is to see without glasses/contact in two overlapping ranges, such as far and intermediate or intermediate and close but not to try for all three (or near and far). The other thing I think about is that technology has changed how we use our vision and I think that close vision is much less important than it would have been 20 years ago. In 2018, most of the reading I do is electronic and pretty much everyone carries a smartphone with a bright LED light source and built-in magnifying program. You can also easily scale text and images as needed. My vision is very good now at computer and arm's length but when reading a book for a long time, I usually will wear reading glasses (unless I'm outdoors or have very bright lighting). However, if I'm reading a book on a tablet via Kindle or another reader app, I can read for hours without needing glasses at all. 

With current technology I find that I only need glasses when reading very small print, in situations where I cannot control the level of light, or when doing something that requires very close vision (removing a splinter for my hand or threading a needle for example).

 

I'v found that there are 3 focus ranges, distance(approx over 4feet), intermediate(2-4 feet), and near(<20" or so)

With monovision with one eye set for good distance focus and the other eye for good near focus, you would cover the distance and near/reading focus ranges but each with one eye only, for driving might want better depth perception by using eyeglasses to correct the near eye to distance.  In that scenario with glasses reading a computer monitor at 2-3feet typically may be difficult at least for longer time periods, so may need weak reading glasses for that. Some people can't handle that much difference between the eyes however.

Another option that I prefer is mini-monovision where you set one eye say for distance and the therother eye for intermediate (or near plus intermediate) that is much easier to get used to than full monovision.  This too would require glasses for one focus range say for near/reading or for distance.

I currently have a monofocal toric IOL in my right eye for distance, but it ended up with a little astigmatism so I get 20/25 or so instead of 20/20 or better without glasses. I can get 20/20 or better with glasses though.  My other eye doesn't need surgery probably for years and it has 2D astigmatism so I need glasses for that eye anyway now. But I may consider a Symfony toric IOL for that eye in the future to get both distance, intermediate, and maybe a little near from that eye plus the OK distance focus from the right eye. I would then hopefully only need reading glasses for fine print which would be not often for me.

But now I need distance or progressive glasses for distance/driving, a different pair of glasses for computer work, and either a reading glasses pair or progressive glasses for near reading like smartphone.

Night-Hawk, distance and intermediate are both corrected very well (20/20) with my toric monofocal lens in my right eye. The only thing I can’t see is closer than about 16 inches. I’m almost at 4 weeks out from surgery so it should be pretty stable now, right? I’m probably going to go with a close up correction in my left eye. I’ve been wearing monovision contacts and glasses for around 30 years without any problem. The only thing I worry about is that the IOL would end up a little off and I would have to wear glasses for reading anyway and not have the advantage of distance in my left eye. I was very lucky with my right eye, but I can see from reading here that it isn’t always an exact outcome. 

Yes that’s always the concern.  At 16 inches though are you able to read - even if you need to hold things at a little further out than before?  If you aim for a .50 diopter in you’d likely get decent distance anyways even if not as far as  right eye.   Most experiences posted here are from those where it hasn’t worked out.  Percentages are likely more on side of success.