Choosing Intermediate/Near Monofocal Cataract Lens -- My (Positive) Experience So Far
Posted , 18 users are following.
I’ve had mild to moderate myopia since high school (approx -1.75 diopters; no significant astigmatism). I have always worn glasses for distance, but have generally not worn any correction otherwise.
After age 50 I really started to appreciate my myopia, as I observed all my friends and husband struggle with multiple sets of reading glasses. All I had to do was to remove my glasses to see up close. To me it was not much of an inconvenience to wear distance correction, as in many of the situations where I really needed correction (daytime driving, hiking, biking, etc.) I would choose to wear protective sunglasses anyway (hence, I always have had Rx sunglasses).
At age 56 I was diagnosed with a cataract in my right eye, that was causing halos and blurry vision; especially at night. I was very apprehensive about surgery, since my left eye had a retinal tear about a year earlier. For two years, the vision in the cataract eye continued to get worse, and night driving more and more problematic. Further, a small cataract had started to develop in my left eye.
In considering lens options, I was not a candidate for a multi-focal lens. Given the potential for halos, etc., I would not select this option even if I were a candidate.
That left monofocal lenses, which required me to select which distance I would prefer to have my best vision without glasses. After much consideration, I concluded I would definitely not want to be corrected to 20/20, as that would leave me unable to see up close as I was accustomed to. The thought of picking up a newspaper, book, menu, or smartphone and not being able to see it was extremely disturbing. Applying makeup would also be problematic.
Somewhat troubling to me was that in talking to dozens of friends, acquaintances, and family members, I could not find even one person who had deliberately selected a near-sighted target (though a few had selected monovision or multi-focal lenses). I discussed this concern with my surgeon, and she assured me that some patients do get near-sighted correction and are very happy with it. I had to take her word for it.
We opted for a -1.39 diopter target (the odd numbers are based on individual biometry). I figured that would be slightly better than my other eye, and give me fairly good close to intermediate vision.
I am two days post-op and couldn’t be more thrilled with the result. My phone, computer, and sheet music are crystal clear, and I am able to read every size font in the newspaper. Most surprising is that my range of vision is far greater than I expected. As of yesterday, my vision in the surgical eye (20/40) would technically allow me to pass a driving test without glasses (good to know in case of emergency). I realize it can take a few weeks for things to stabilize, but so far I am confident I made the best decision. In a few weeks I will get a new prescription for distance, and expect there will likely be occasions that I need magnification for very fine print.
Bottom line: If you are getting monofocal cataract lens implant(s), carefully consider your lifestyle and needs before surgery. Take note over several days or weeks of how often you urgently need to see far away, vs. how often you urgently need to see up close. Many people are seduced into a 20/20 distance correction in hopes of “getting rid” of their glasses, only to find they have to trade them in for readers. Although monovision is also an option, consider that you can always attain temporary/reversible monovision by using one contact lens, when desired, if you decide to keep both eyes slighty myopic. That way, you are not permanently left with asymmetrical vision.
In my opinion, needing glasses to drive is far less inconvenient than needing glasses every time I need to see up close. For my lifestyle, a target between -1 and -2.0 seems to offer the best “glasses-free” vision range. I hope this is helpful to those of you considering what type of correction is best, especially if you are accustomed to being myopic.
6 likes, 128 replies
CaroZim Guest
Posted
This is so useful - thank you! This is exactly what I'm thinking of doing and its really good to know that you have done it and are pleased with it. There are a few others on this site who have indicated that they don't want to lose their close up vision either so I'm sure they'll find your experience useful.
I don't have cataracts (although I'm hoping that when I see the eye surgeon tomorrow they will find some evidence of a cataract in one or both eyes so I can claim it on my insurance!) so my operation would be refractive lens exchange (or clear lens exchange) and is obviously elective surgery.
I'm so fed up with wearing glasses - been wearing them since I was 14 and I'm now nearly 50. I wore contact lenses for most of my 20's and 30's but I find them so uncomfortable now that I can't wear them anymore (I have to wear toric ones which are thicker than non-toric). I now wear progressive glasses and I find I can't see distance, intermediate or close up properly any more. Thankfully I can take off my glasses for reading which is great as I'm a real bookworm! I do have to hold the book about 20cm away from my face though!
I can't see signs in the distance and my eyesight is pretty bad at night (dusk/dawn is the worst) - good thing I don't drive at the moment as I'd probably be a danger on the roads (I live in Singapore and can't afford a car!). My eye sight has deteriorated in the last year and is now approximately -5.50 in both eyes with some astigmatism (-1 and -1.25 I think). I also have thin corneas and borderline keratoconus which is why I've never been able to have Lasik. I'm a swimmer/diver and enjoy being outdoors but find that I just don't enjoy those activities as much anymore because of my eye sight.
My hope is to only have to wear glasses for distance (driving or watching movies) and to be able to be glasses free for everything else. I have been trying to decide between trifocals, multifocals, extended depth of field, mini-monovision, full monovision or just having monofocals with both my eyes set to -1.5 or thereabouts. It's overwhelming and exhausting trying to differentiate between them all!
I wasn't sure if monofocals set to -1.5 would be good enough for both close up and intermediate reading but it sounds like it is from your experience. Given that I currently can't see very well into the distance even with my glasses - I suspect I'm probably seeing at around -1 anyway - so I won't notice much difference in distance vision. If I get glasses for driving I'll probably be amazed at the clarity!
My main concern is the close up - I can't compromise on that. I can't bear the thought of having to put glasses on to see close up - I think that would drive me crazy. From your experience it sounds like monofocals set for mild myopia is a good option for me. I will discuss with my surgeon tomorrow and see what he thinks - if he's pushy with the premium lenses then I'll get a second opinion.
Thanks again for posting this. It's really helped me to focus on the monofocal option (pun inteded!)!
Guest CaroZim
Posted
Carol, I am happy you find this useful. I tried to find similar information for the past year or two with no luck! I have concluded that many doctors are sort of biased in thinking "20/20 = normal," when in fact it means "blurry up close" unless you are under age 40 with natural lenses! I admit to subconsciously worrying I was making myself permanently "sub-normal," but I thought long and hard about it over two years and kept coming up with -1.5 as the best compromise so I picked the closest match with my biometry.` I don't know how the astigmatism factors in, but trust me, if your vision ends up around that you will be amazed! If close-up vision is super important, you might want to err on the minus side a bit more. As far as swimming goes, you can even buy over-the-counter swim goggles for myopia (I think I have a -2d set). Good luck!
CaroZim Guest
Posted
Thanks again - I'll discuss having one eye set a bit more myopic than -1.5 which is a mini-monovision option. Maybe the surgeon can simulate it for me so I can see. Don't think I could handle full monovision as I tried it with contact lenses once and I gave up after a few days - it was just awful.
I have -5 $40 swimming goggles for pool swimming but of course when I take them off I can't see a thing around me. I can't wear cheap swimming googles for diving/snorkeling and have never wanted to invest in prescription googles as they are very expensive so I've just stopped diving and snorkeling which I'm sad about.
I'll update you once I've had my appointment and know what my options are and when I'm having the op (assuming I'm a suitable candidate for it).
at201 Guest
Posted
One possible caution, which will probably be of interest to others also in your situation. Most probably, you have good near vision in your left eye (if not, please let me know). Thus, you are reading primarily with your left eye right now. This is exactly what one achieves with mini-monovision. If in the future, when it is the time to have a cataract surgery in the left eye, picking a target of -1.0D to -1.5D for that eye will not be a good choice. If you do that, you will be needing glasses not only for distance, but also for reading.
Guest at201
Posted
I appreciate your comments. My two eyes are very close right now for reading and distance (after continually comparing them separately over the past 2 days)!. The left technically measures -1.63, so a bit more myopic, but also compromised by a retinal buckle and a small cataract so my right is better overall (including close up at the moment). I agree that -1 would not likely be ideal for reading -- I had really settled on -1.5 target, hoping it would be fairly good for reading all but very tiny print (not really expecting great distance vision, and not having any idea what the final "fixed" range would be) Then, depending on how things level off between now and the time I need the left cataract removed, aiming for some mini-mono blend exactly as you described (likely in the minus direction) to maintain better range overall. (There are never guarantees for any surgical outcome, of course!). I mainly wanted to help others in my situation feel more confident in selecting a myopic correction if that is what they are used to, since I couldn't find anyone else who had chosen this option. You are right that having both eyes better than -1.5 might necessitate the reading correction some of us myopes are trying to avoid! Thank you.
sandimacd Guest
Posted
I have been searching on this forum and another one. I found much useful information in this article:
I had my left eye cataract removed and replaced with a single distance IOL. At 4 weeks post op I cannot see clearly beyond 4 feet. So my opthamologist has referred me to a specialist with experience in replacing IOL of different types and LASIK offering. Evidently insurance covers replacing the IOL because I need more than a 1.75 correction for distance.
Your discussions have been very helpful.
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Night-Hawk Guest
Posted
I am getting my right (dominant) eye cataract surgery next month and plan on a target of good distance vision but avoid farsighted so -0.25D for that eye with a Tecnis monofocal toric since I have nearly -3D cylinder astigmatism.
In the future for my left eye which only has an early stage cataract, I was considering mini-monovision with maybe about -1D for good intermediate vision. I had thought it would need -2D or more to get good reading vision which would be too much of a difference between the eyes for me. Your experience might imply I could get some reading vision with around -1.25D or so which would be OK I think with the right eye for best distance vision. Other than that I also considering a Symfony toric IOL for the left eye in the future to get a wider focus range in that eye for intermediate and decent near as well, but that might cause night vision artifacts compared to a monofocal toric in that eye.
Guest Night-Hawk
Posted
Night-Hawk, I am not sure what you mean about "some reading vision," but personally I would be uncomfortable with a -1.25D target in the "reading" eye, with good distance in the other, especially considering that with a margin of error you might end up with -1D or so. If you mean occasionally reading a computer or smartphone with zoom capability, maybe, but I really don't know. I can only speak for myself, but after considerable deliberation over 2 years I concluded that a -1.5D in my dominant/better eye would be pushing the limits of my own tolerance for losing some close-up vision, then planning on a similar or more myopic correction in the other (as it is now, actually). Seems about what I expected so far. Maybe someone else who chose closer to your plan could comment. I also don't know how the astigmatism and multi-focal lens factor into the equation. Anyone else?
Sarah1662 Night-Hawk
Posted
I decided to do something similar to you. I was nearly blind in the right eye and had to stop driving at the beginning of this year due to a cataract. Also had one in my left eye, but not as bad. My surgeon talked me through the options and decided upon distance correction for the right eye, as I do a lot of driving and also driving at night. I also enjoy reading and at one time used to be able to read without glasses and would take them off to read.
My surgeon used a toric monofocal lens and the distance correction for the right eye is fantastic and is actually better than 20/20. I did complain that I could not see my phone without glasses now so he suggested that I have my left eye set for -1D to give me better intermediate vision. I went ahead with that with another toric monofocal lens, but unfortunately 7 months down the line, it has not really worked out like that. I can only really see large print without glasses and can just see my phone - anything more detailed and I need glasses and I also need glasses for the computer, which I never used to, so all in all, it is not that good - I need to ensure that I have glasses with me at all times as I really can't see to read anything without them.
I wish now that I had had both eyes set for distance.
Night-Hawk Sarah1662
Posted
How long did it take for your right eye to settle and stay at 20/20 or better permanently after the surgery?
My right eye still has varying vision, each day its gone back and forth, since my surgery in the right eye 4 days ago. It was getting pretty good yesterday hitting 20/20 at times but more like 20/30 most of the time, however today its been more blurry at all distances and more like 20/40-50. I hope it gets stable at the best I've seen out of it for short periods the last couple days when it got 20/20 or a little better for short times - I know its capable of that at least, if it could just stick there!
Sarah1662 Night-Hawk
Posted
What I have done with glasses is to pop the right hand lens out of then and just use them with the left lens correction.
Night-Hawk Sarah1662
Posted
Amazing that your right eye was 20/20 right from the start and didn't vary!
This varying vision worries me since each morning I wake up and its different and also varies for short periods during the day.
Just a few minutes ago it did suddenly get clear and I could see 20/20 for about 30sec but went right back down again. Very frustrating for me - I can only hope it will eventually stabilize at a point close to 20/20 that it seems capable of doing...
So your left eye did end up at -1D and you can correct it to 20/20 distance vision with glasses? If so, odd that it doesn't give good intermediate 2-3feet focus though, how much more correction do you need to add to that eye for computer viewing vs the right eye?
Night-Hawk Sarah1662
Posted
I have a progressive pair, a computer pair, and a close up reading pair. Basically just getting my unoperated on left eye to do the work with those and the right eye adds its blurred view to that for all the distances. Though at times the right eye has clear vision 20/30 or better can add to the distance vision of the left eye with the progressive eyeglasses on.
Sarah1662 Night-Hawk
Posted
Yes, I can correct my left eye for perfect 20/20 distance vision for driving with glasses - have popped the right eye out, so I have no correction in the right eye, but just the left eye corrected with a -1D lens.
I can see in the mid distance quite well, so the instruments in the car and then prices in supermarket shelves, but it is mostly reading - books are hopeless.
I have computer glasses with intermediate and near prescription which is +1.75 and +2.75 for the right eye and then +0.50 and +1.50 for the left eye, with an add +1.50 for intermediate and then an add +2.50 for near. This works well, but I did go for a contact lens trial and the optometrist there just check my reading prescription and told me to buy a pair of ready readers in a +2.25. I had a pair of +2 which were not strong enough, but a +2.5 were slightly too strong and gave me a headache.
I do have the option of glasses now or a contact lens in one eye, but it takes me forever to get the lens in and it is very uncomfortable. Put one in the other day and went out and it was never in the right place, so I had to take it out when I got in the car and wear glasses for driving instead.
Guest Sarah1662
Posted
Sarah1662 - So sorry that the monovision did not work out well. Are you saying that the -1D left eye does not add any improvement for intermediate/near vision when combined with your 20/20 right eye? Were you able to test it with a contact lens ahead of time? Seems so hard to predict. I am wondering now why more doctors don't recommend testing different corrections while the cataract is small. No one mentioned it to me, anyway. So far the -1D IOL is working out for me (decent reading; glasses for driving), but this is my "better" eye, with my other cataract eye that is slightly more myopic (-1.5D). I think I probably wouldn't feel comfortable relying on this eye for reading either, if my other eye were 20/20. Not 100% sure yet, but won't likely aim for any better than -1D when the 2nd eye needs surgery. I'm going to see how I feel after living with it a while and testing a few different contacts.
lin59 Sarah1662
Posted
at201 Sarah1662
Posted