Cataracts, astigmatism and basic cataract implant (very limited budget.
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I have recently been diagnosed by my Optometrist with cataracts which have developed to the degree that she cannot correct my vision with glasses any more. I'm 75 years old and I have worn glasses all my life. So far as I know, I've had astigmatism all my life, and I have no problem wearing glasses for the rest of my life.
Subsequent (and consequent) to that visit I have seen a well known and highly experienced Ophthalmologist who specializes in cataract and other corrective eye surgeries. I received the full presentation from him regarding all the reasons I'll be happier with premium multi-focus implants I cant afford, but will allow me to see like I was 45 yo again, without glasses. I had missed lunch, my blood sugar was low, I was processing slowly, and all I could do was endure to the end of the presentation.
The thing is, 1. I have to go for the least out of pocket option Medicare and BC/BS Advantage will provide, 2. as long as my vision can be corrected for long and short distance with progressive lens eye glasses as it is now (especially in light of my astigmatism.)
So that is my question:
With the basic single-focus implant lens that Medicare and BC/BS Advantage will cover, will my general vision and astigmatism be correctable with eye glasses as it is now?
Thank you in advance,
John
0 likes, 18 replies
RonAKA jflookbc
Edited
Yes, based on the information you provided your vision should be quite correctable with progressive glasses after you get basic monofocal IOLs implanted. I would get more information on what your expected astigmatism will be if your simply get non toric monofocals. Their computer program will tell you what to expect. If astigmatism is relatively low, lets say under -1.0 D, you may even get good vision with no eyeglasses. If that is the case you may want to ask about mini-monovision. If you get your dominant eye targeted to full distance (-0.25 D), and your non dominant eye set for closer (-1.50 D on a spherical equivalent basis when combined with your astigmatism) you may see very well from close up to distance, just like the expensive MF lenses would do. Sometimes doctors do not offer this as mini-monovision uses the standard least expensive monofocal lenses. Some examples to ask about would be the J&J Tecnis 1, Alcon AcrySof IQ or Clareon, or the B+L enVista. The least expensive of those options should be just fine. You could get them set to see distance, or close, or as I suggested one close and one far. All combinations can be corrected with eyeglasses, so all you are picking is how you will see without progressives.
Bookwoman jflookbc
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Yes it will. Money was no object to me when it came to my eyes, and I opted for plain monofocal lenses. I wear progressive glasses as necessary, and can see beautifully at all distances. Don't let them try to 'upsell' you with lenses that many find problematic in terms of visual artifacts.
thomas84367 jflookbc
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Since you're perfectly fine with wearing glasses and need to stay within Medicare and BC/BS Advantage guidelines, all you're really out to accomplish here is to replace your cloudy natural lenses with clear monofocal iol lenses.
That's actually the reason why most public and private insurance companies won't pay for "premium lenses". Any vision issues after cataract surgery with standard monofocal iols can be corrected with glasses. If you want to achieve some form of spectacle independence through premium lenses that's on your dime.
Even with standard monofocal iols and glasses, you will get a substantial benefit out of the surgery aside from clearing your vision up. Colors will be bright and crisp, and as 56 year old that just got his first lens replacement, I can tell you that there's a big "WOW" factor there.
Do look into Ron's suggestion though, because if you're a candidate, it won't cost you any extra money, and at least you will know you explored all of your options. My astigmatism was over the threshold, so achieving any sort of spectacle independence meant going with a premium lens (which I did). I'm still waiting for the final billing, but I'm probably looking at $3,000 to $3,500 per eye once it's all been said and done. I'm just fortunate that I was in a position where was able to afford it.
Grand_Dad_TH jflookbc
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"Subsequent (and consequent) to that visit I have seen a well known and highly experienced Ophthalmologist who specializes in cataract and other corrective eye surgeries. I received the full presentation from him regarding all the reasons I'll be happier with premium multi-focus implants I cant afford, but will allow me to see like I was 45 yo again, without glasses. I had missed lunch, my blood sugar was low, I was processing slowly, and all I could do was endure to the end of the presentation."
You're like me. I've worn glasses all my life. I have no problems with wearing them for the rest of my life. Personally I want inexpensive monofocal lens and which can then be corrected to the best possible vision with glasses.
If my Ophthalmologist had presented me with a marketing ploy like that? I'd have walked out with the one sentence: "You Are Not Listening To Me," and "I Don't Appreciate The Sales Pitch."
I consider the doctor - patient relationship to be a partnership.
If the doctor side isn't listening to the patient? You have a problem.
And I simply detest "hard marketing" sales pitches.
If you asked for an inexpensive monofocal IOL/Glasses solution and they was pitched the muli-focus (expensive) upgrade? If I had been you, he'd had lost me as a patient.
He is not listening to you.
Best of luck.
jflookbc
Edited
Thank you all - these are exactly the kind of thoughtful and experience driven responses I had hoped for!
I was told by the Ophthalmologist that my astigmatism was beyond the threshold for monofocal IOLs. The latest prescription I found is 3 years old, and indicates cylinder values of +1.00 in both eyes, and axis values of 175 in one eye (OD) and 25 in the other. I am not conversant with the impact of these numbers.
But, until and unless persuaded otherwise, I will be going forward acting on the belief that the basic monofocal lenses I want will require astigmatism correction via eyeglasses, and will be able to be corrected with eyeglasses. Having that direction established, I will now ponder whether I want one eye focused long and one eye focused short, or both eyes focused at the same range (probably long, but not sure yet.)
I am excited by the prospect of sharper and brighter colors. I enjoy a fair amount of recreational pocket billiards and have found lately that it is very easy for me to mistake a darkly colored ball (like the 4 ball) for the 8 ball. Acting on such a mistaken perception can sorely mess up a runout. Ask me how I know...
Thanks again, and I intend to keep the forum posted.
John
RonAKA jflookbc
Edited
I would ask for the predicted residual astigmatism if torics are not used. This is easy for them to give you as the IOLMaster computer program predicts it. Ask them for the IOL Calculation Data Sheet. That will tell you how much astigmatism you can expect without toric IOLs.
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Eyeglass prescriptions are helpful, but with astigmatism it is hard to predict the residual astigmatism or the need for torics based on the eyeglass prescription. With my first eye here is what I was before surgery and after when a non toric lens was used:
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OD Right;
Before: Sphere -2.75 D, Cylinder -2.75 D @ 108 deg
After: Sphere 0.00 D, Cylinder -0.50 D @ 80 deg, 20/20+
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The issue is that astigmatism can be in the lens as well as the cornea. With cataract surgery the lens astigmatism is removed as the lens is removed. The residual is what is in the cornea. Obviously in my case with this eye the large majority was in the lens.
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My point is that you can't make an informed decision on the real need for torics unless you have the computer predicted residual based on your eye measurements. The usual guidelines used is that a residual of 0.75 D or more is worthwhile correcting with a toric. But, that 0.75 is on the margin. My left eye which is my close eye is an example of the marginal situation. Here is the before and after with a non toric monofocal:
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OS Left;
Before: Sphere -1.25 D, Cylinder -1.25 D @ 77 deg
After: Sphere -1.0 D, Cylinder -0.75 D @ 67 deg, Jaeger J1 in bright light
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Without eyeglasses I do see the impact of this -0.75 D cylinder, but the total result with both eyes is quite good. I am without glasses for at least 95% of the time. I have not done it, but I am quite sure I could play pool and table tennis quite well without glasses. With glasses both of the eyes are probably 20/15 or close.
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So, in summary the key bit of information you need to make a decision is the predicted residual astigmatism. But, to your original question, no matter if you choose near, intermediate, distance, or one distance and one near, eyeglasses should correct you equally well.
thomas84367 jflookbc
Edited
If your astigmatism would require laser assisted surgery and/or toric lenses to correct (neither of which is covered by insurance), then I don't think you gain anything by having one eye set for distance and the other set for intermediate or near. I would just have both of them targeted for distance.
I almost envy how straightforwad your decision is. Having a wide range of options available to eliminate or greatly reduce spectacle dependence that all come with various compromises is, of course, a blessing, but it's also been quite maddening.
RonAKA thomas84367
Edited
I am not sure I could agree that having one eye corrected for distance and one for close would not provide any gain. If astigmatism correction is required and a non toric is used then no matter what distance the eyes are corrected for, will leave some compromise in vision without glasses. You are going to end up with a no glasses condition no matter what you do. The real question is what do you want to see with no glasses. I think I would be happier with a less than perfect full range of vision compared to a less than perfect close or distance vision.
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And, I suspect one could see quite well with a moderate amount of astigmatism. When I was simulating monovision with a contact in my left eye, I got slightly better vision with a toric contact, but I found the toric less comfortable. So, I used a non toric contact while having -1.25 D astigmatism. It was not quite as good, but was quite acceptable. The OP's eyeglass cylinder of 1.0 D is not all that bad, and better than what I had. I think it is fairly rare for astigmatism to go up after cataract surgery unless it was exceptionally low before surgery.
Night-Hawk jflookbc
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I have the same cylinder amount of astigmatism in my right eye after cataract surgery a few years back. 1.00D cylinder isn't a lot, even with that I can get see about 20/25 (one line above 20/20) at 20feet distance without eyeglasses. With eyeglasses correcting that astigmatism I can get a little better than 20/20.
My left eye has not needed cataract surgery yet, so it has higher 2.0D cylinder astigmatism and so has poor distance vision, but with eyeglasses it too gets better than 20/20 distance. I use progressive eyeglasses to also get clear near/reading vision as well as distance vision.
Prior to getting my right eye cataract surgery, I went to 3 different eye doctors and compared their opinions and prices, there was quite a variation between them - so I suggest getting several eye doctor opinions and compare them. Like others have said, avoid the doctors that push the premium expensive IOLs, that indicates they are most concerned about the profit they can make.
jflookbc
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I thought I had a rope around this thing, but now I think I just got a little more confused.
Here is where I'd like to find I can go: I'd like to find that given I have astigmatism and given I am prepared to wear eyeglasses all the time (in fact prefer to wear eyeglasses all the time), I can have basic monofocal IOLs implanted and plan to rely on progressive (not bifocal or trifocal, but progressive) eyeglasses to give me correction for both astigmatism and acuity at all focal ranges.
Hoping I have articulated clearly what my hopeful goal is, have I described an achievable outcome?
Thanks again, John
RonAKA jflookbc
Edited
The short answer is that you can do any of these options below and end up with exactly the same progressive glasses corrected vision. There is no wrong choice for an eyeglass corrected solution. An astigmatism correction is applied to the whole lens even in a progressive lens. So within the limitations of progressives (mainly needing to look down to read) it really does not matter which of these options you pick. They will all provide the same visual acuity when wearing the progressives. But, what you will see without glasses will be quite different. Here are the basic options and what to expect without glasses:
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All of these options cost the same as a basic non toric monofocal lens is all that is needed in both eyes. If it were me I would go with option #3 as there is no down side. Without progressive glasses you are likely to see very well, and with them you will see even better. You might be surprised if the impact of the remaining astigmatism is minor, how well you see, and how much you will like going without glasses. I find when driving I have much better peripheral vision without glasses compared to progressive glasses.
Night-Hawk jflookbc
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Yes you should be able to get good vision using progressive eyeglasses (probably a new pair with an updated Rx) after cataract surgery with monofocal IOL. Thats what I am doing now after cataract surgery in my right eye a few years ago.
You can also with the monofocal IOLs decide for yourself at what distance you want the best focus vision without eyeglasses: distance(20ft+), intermediate(2-4ft), or near (under 24"). Some prefer the near focus so they can use non-progressive eyeglasses for distance and just take off their glasses for reading up close.
thomas84367 jflookbc
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I think you can rest assured that you will have a positive outcome because you have very modest and reasonable expectations. It's the desire to reduce spectacle dependence that makes this complicated. The fact that you're not only willing to wear glasses full time, but would prefer to, essentially puts you in a no lose situation. I'm a big advocate of exploring all of your options, and that certainly includes the suggestions that others have made here, but whatever you choose, I truly believe that you will be pleased with the final result.
I have to add the disclaimer "barring any pre-existing eye issues or complications arising from the cataract surgery itself", but the former has likely already been established while the later is either rare or can usually be easily corrected (and is covered by insurance), so I wouldn't lose any sleep over it.
Lynda111 jflookbc
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As far as your astigmatism is concerned, if it is less than 2 diopeters, limbal relaxing incisions (LRIs) can correct your astigmatism. It is done while you are having your cataract surgery. However, some surgeons don't do them or don't like doing them. You would need to find an experienced surgeon and ask their opinion. In my case, I lucked out, I guess. Even though I had 2D of astigmatism, I didn't get a toric IOL and I wasn't a candidate for LRIs. My surgeon that because she targeted both eyes for intermediate vision and the axis it was on, it somehow reduced my astigmatism. It was a pleasant surprise for both of us.
christophe51059 jflookbc
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halloo. I'm 62 and just completed my 2nd surgery yesterday. i struggled with lens choice, too. hae worn glasses for 47 years so not opposed to keeping them in perpetuity.
All my friends who've corrected with a standard lens covered by insurance or medicare, either for near or far, wear glasses and are very much satisfied with the results.
i do design work, lots of reading and text correction, on screen and on paper. doc presented the multi-focal option, and i considered. those who love it, LOVE it. those who hate it... HATE it, for the reasons I probably would have.
I talked it over with my regular optometrist, who I've visited for years, and he assured me my decision-making process was sound. So we opted for a standard lens to correct for near vision - better for my work - and I'll wear glasses for distance, driving etc.
I am very pleased so far - the color correction is amazing with a new clear lens - and the focal distance is great for me - and more generally-better than i expected. I'll wait a few weeks to get new prescription for distance. I will manage to drive somehow - just stay off the roads near my house. 😃
Bookwoman christophe51059
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christophe, welcome to the near-vision IOL club. My work also involves a lot of close work, both with physical books and on the computer, and getting these lenses was a perfect choice for me. So glad it's working out for you as well!
Calin christophe51059
Posted
Hello,
My needs are similar to yours in terms of vision. However, I only have one large cataract; the other isn't too bad. Do you know if it's possible or desirable to only change out one eye for near vision and use glasses to fix whatever the result is?
Thanks.
jimluck Calin
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Calin, the only issue would be if you ended up with a big difference in the lens power needed for one eye vs. the other. If the surgeon targets an outcome similar to the existing condition of the other eye, no issue. Glasses change the perceived size of the image, with greater myopia correction (or less hyperopia correction) making the image smaller than the opposite. The brain does not like the two eyes disagreeing too much on the size of the image. Contact lenses do not change the image size, so they can handle big differences in correction power.