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
Update on my appointment yesterday...
The surgeon (who was a very nice man) told me that he didn't think it was right to do surgery on me due to the fact that my eyes are not stable. He felt that doing cataract/RLE surgery on me now could result in me being unhappy in the future if my eyes continue to change and I end up having to wear glasses again.
My prescription has changed by -1 in the left eye between April 2014 and December 2016 (the last two times I got glasses). According to my test yesterday, they have changed a bit since my December 2016 prescription (although I'm not sure it really has - I think my current glasses aren't correct for my eyes which is partly why I can't see properly through them).
The other issue was my keratoconus - I was diagnosed with forme fruste keratoconus by a surgeon in Cape Town in 2011 (as a result he refused to do Lasik on my eyes). I got a second opinion in Auckland and they agreed and offered me PRK which I didn't want to do. A few years ago I went to see two different surgeons in Singapore hoping to have RLE but they both said I was too young (I was about 46/47) and they didn't want to do it. Their orbscans showed borderline keratoconus and yesterday the scans showed that it had got slightly worse (VERY slightly which could just be a difference in results of the scan rather than an actual deterioration).
The surgeon I saw yesterday has recommended that I have collagen cross linking to fix the keratoconus and in a years time he'll consider doing the cataract/RLE surgery if my keratoconus and vision have stabilised.
Now I'm not sure what to do - do I get a second opinion or do I just go for the collagen cross linking (which is rather painful I understand - I'm not keen to do anything that causes me pain!)? The collagen cross linking will require me to take time off work for recovery time which isn't an ideal situation.
The good news is that there is evidence of cataract in both my eyes so I will be able to claim the cataract/RLE operation on my insurance.
Anyone had collagen cross linking? Any advice from anyone about how I should proceed from here?
Sue.An CaroZim
Posted
Hi CaroZim
I haven't even heard of collagen cross linking so I am not much help.
I am sure you can find a doctor to go ahead with RLE however not all of them have your best interests. Some are motivated by money. If you have the beginnings of a cataract if it were me I would wait till cataract surgery can be performed. With your new glasses prescription are you able to see better?
Guest CaroZim
Posted
Sorry, I have never heard of collagen cross linking either. I would definitely seek more than one opinion, if possible, and hold off any surgical intervention without more information. I'd look for someone with sub-speciality expertise, but with 'big-picture' mentality, who can recommend what's best for your own functionality and long-term eye health. Best of luck.
CaroZim Sue.An
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Hi Sue.An
I've made an appointment with another surgeon to get a second opinion. I'm seeing Dr Por Yong Ming - he's the Singaporean doctor with the really useful blog site you mentioned in another conversation (I think it was you who mentioned his blog site...). He's a cornea and refractive/cataract specialist so he should be able to advise me about the collagen cross linking as well as RLE/cataract surgery.
My understanding is that if/when I have the surgery it will be documented as cataract surgery (not RLE) so my insurance company will cover most of it. Technically I do have early cataracts in both eyes but if I were to have them done on the NHS (or Medicare or whatever the government funded medical system is called in other countries), they wouldn't do it yet because my cataracts are not advanced enough.
Anyway, my appointment is on Friday after work so I'll update at the weekend.
CaroZim Guest
Posted
Thanks BellaD
I have made another appointment (see my response to Sue.An on this same conversation). His expertise is in cornea and refractive/cataract surgery so he is qualified and skilled in what I need more information about. He has a really good blog called "All things eye" - although he doesn't seem to have put much on recently, but as of August this year he was still replying to people's questions so it's still an active site. From reading his replies to some of the questions, he certainly seems knowledgeable (and the fact that's he's prepared to answer so many questions for free in his own time says a lot about him!).
He seems to have "big-picture" mentality so hopefully he'll be able to give me some good advice.
The first place I went on Saturday seemed really efficient (and the doctor was really nice and very professional and ethical) but it was a bit of a factory - lots of customers coming and going with only the one doctor (but lots of other staff doing all the tests etc) so I felt a bit rushed when I finally got some time with the doctor. Given that this is a private practice and I could potentially be spending a lot of money I felt that I didn't get enough attention and time with the doctor.
So we'll see what transpires after my appointment on Friday afternoon.
Sue.An CaroZim
Posted
Two amazed how quickly you can get an appointment- here in Canada can take a month or so - at least province I live in.
Please do let me know how that appointment goes. I had read through Dr Por Yong Ming's blog and comments on Symfony lenses as he had been implanting these IOLs a year ahead of Canada. Found his comments useful in helping me make the decision.. one of the few doctors online that would personally coommentbandvanswer questions.
Wishing you all the bes - he sounds like he had an awful lot of education and experience combined with the fact I that he dialogues with patients.
Sue.An CaroZim
Posted
Will be curious how you find him in person.
CaroZim Sue.An
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Hi Sue.An
I'm doing this all privately so it's relatively easy to get appointments - there are so many eye doctors to choose from that it was really useful having the tip about Dr Por Yong Ming.
Singapore doesn't have a "free" health system like some other countries - although Singaporeans do get it slightly subsidised but they still have to pay for part of it. Foreigners like me have to have medical insurance (which my employer pays for thankfully!). It's a very efficient system but very expensive compared with other countries in the region. I think there's a fair bit of medical tourism too which probably increases the prices further.
I thought I'd gone as far as I could on his blog comments and didn't see anything after August. I'll have another look to see if I can find his latest comments.
I'll update you over the weekend!
Sue.An CaroZim
Posted
Yes if you go back on his blog till the end you will see "load more". I totally missed it too as I was following some of the responses. Accidentally I scrolled down further and noticed I could load more.
Our system for cataracts if deemed bad enough in Canada - usually eyesight affected 20/40 or worse cataract surgery is covered. But long wait times. I was diagnosed in Jan and only got to see opthamologist in March - surgeries in July and August.
Good luck - I will be keenly interested in how you find this specialist. He seems by his blog like someone that would want best outcome for patients and will to discuss and explore options.
Guest
Posted
1-week post-op update:
I was aiming for about -1.5D in my right eye, and was implanted last week with Alcon AcrySof IQ 19.5D (I guess these will vary according to your biometry so interpret w/ caution). My main goal was to preserve most near-vision, giving up only a little in order to get a bit more distance.
After my original post, I looked up the diopter equivalent for 20/40 (measured 1-day post-op) and it said it was -.75D! Was I overcorrected by that much? Not sure, but it really feels like my distance vision is fairly clear. Yikes! I was concerned about losing near vision, but thankfully that has so far been no worse than I anticipated. Looked at a Snellen chart today and it seemed like I could barely read 20/50 (-1.0D) — waiting to find out the numbers when I get my comprehensive optometry exam.
Here is my current functional assessment for RIGHT eye only/uncorrected (using BOTH eyes is far better in every situation, considering added depth, peripheral range, and the fact that my Left eye is currently pretty ideal for mini-monovision: between -1.5 and 2D):
Newspaper (short-term reading): Good (all print size). iPhone7(reg): Very good. Looks crisp and clear. Have to get used to holding it farther away, though. Can obviously adjust distance and zoom, if necessary. 12” Laptop: Excellent. Screen is super crisp and clear. As with phone, can adjust distance and font. Find myself using zoom more late at night. Paper book: Fair (legible, but a strain for long-term). Experimenting with readers. Sheet Music (18-20”): Excellent. Makeup application: Good (better with 5X magnifying mirror) Eyebrows(10X mirror as before): Good to Very Good. TV (Big Screen): Good (likely need glasses for smaller screen). Auto Dashboard: Excellent. Daytime Driving: Fairly good with both eyes — would feel comfortable for local or emergency driving, but have to wait to see if it will be “legal.” Night Driving: Fair to poor (both eyes) due to halos. Fairly good with an older pair of glasses to bring eyes around 20/20. Hiking: Very Good. Everything looks so sharp and the colors are so vibrant. Will end up with Rx sunglasses, which will be even better. Mountain Biking: won’t attempt for several weeks, but always wear protective Rx eyewear anyway. Night halos are still present with both outdoor and indoor lights, similar to my left eye with small cataract. Vision in very low light is dimmer in the right eye.
Summary: Considerably more distance vision than I was expecting, and significantly greater range of vision than I expected. Likely need glasses for most or all driving, and some fine-print reading. Persistent halos and dimmer low-light vision.
Biggest Gain: Being able to go out in social situations at night without the single monovision contact lens (that irritated my eye anyway), or walking around in a blur. Biggest Loss: Will need readers for long-term reading without eye strain (I know, no big deal), and a magnifier for some of the tiny objects I use at work. I am trying to get used to moving things away rather than closer; had no idea how much lighting helps. So far it’s been more than a fair “trade-off;” it’s been a vast improvement. Is this range typical? Or did I just “luck out?” I really don’t know, but this result has reinforced my opinion that multifocals would definitely not be worth the risk (if I were a candidate), since the nuisance of using glasses part-time seems far outweighed by the risk of chronic distortion, even if slight. Not sure what target I’ll aim for in the other eye, but if it progresses like the right one, I have a built in test for varying degrees of monovision. Likely will aim for slightly more myopic than right, but not too asymmetrical.
Sorry I did not discover this forum sooner, as I see there are other similar threads, but I hope my info. is helpful to someone else, even understanding that results obviously vary considerably, and need to be discussed with your surgeon. My pre-cataract myopia (about -2D) seems much less than many other contributors here, and astigmatism negligible. I stressed out for 2 years before finally getting the cataract removed because I had a frightening retinal detachment with emergency surgery in the other eye and I was nervous about operating on my “good” eye until it became virtually useless! I will post actual Rx in the next week or two, after my eye exam.
Sue.An Guest
Posted
Thanks BellaD I am sure a lot of people will find your post useful. I am 53 and also nearvsighted since early teens. Not a strong prescription: -3 in right eye and -2.25 in left with little fluctuation in that for last 20 years. Didn't need readers and then diagnosed Jan with cataracts both eyes that impacted vision and if I was to continue driving needed cataract surgery sooner vs later.
Before I settled on Symfony lenses I was leaning toward monofocals for near as I found it easier to accept what I already knew and that was glasses for distance. In the end chose Symfony lenses and have been pleased - have 6 week check up tomorrow. So will know more about my numbers then. But other than regular sunglasses haven't needed glasses at all.
Night-Hawk Guest
Posted
I think the range of vision you are getting with your right eye with the monofocal Alcon IOL seems about right if you ended up around -1.0D or -1.25D in that eye. Of course its still very early at only one week, the vision could change a bit over the next month or two as the eye heals and stabilizes.
The eye surgeons have told me they shoot for getting within +/- 0.50D of the desired target and achieve that about 90%+ of the time. So If the target in your right eye was -1.5D then -1.0D would be just within that range and you might be closer to -1.25D if your eye would correct to a little better than 20/20 distance at best correction. My own eyes pre-cataract could correct to 20/15 or a little better, so that could allow better distance vision than expected, like instead of 20/40 with -1D I could get 20/25-30 when I tested that with eyeglasses.
CaroZim Guest
Posted
Thanks BellaD
Keep the updates and comments coming - they are very useful and will help me if/when I eventually get my eyes done. Great that you seem to have good vision for nearly all distances.
Don't know that I'll be quite as lucky as you have been given that I have -5.5 in both eyes with astigmatism as well (-1) and borderline keratoconus in both eyes. Still, if I can get vision that only requires me to wear glasses for driving/watching movies then I'll be happy.
I just don't want to have to wear glasses for close up - I don't really read "real" books anymore as I travel a lot and it's easier to download books from the library onto my iPad and so I can adjust size, brightness etc as required. Sounds like I may have to compromise on this though for real close up stuff in low light situations.
Keep the updates coming!
Sue.An CaroZim
Posted
at201 Guest
Posted
I hope that you share the actual prescription you end up with in the right eye and the best corrected vision you achieve in that eye.
As a side note, there is no single diopter equivalent to 20/40 or 20/50 vision. It depends on the amount of astigmatism or cylindrical correction which one may need in addition to the spherical correction (most people end up with some astigmatism after cataract surgery). Also, usually, there are other minor visual issues which prevent the corrected vision from being 20/15 (while 20/20 is a good vision, one can do better if there are no visual issues).
Guest Sue.An
Posted
Guest Night-Hawk
Posted
Night-Hawk, I think you're right. The actual calculated target with that particular Alcon lens ended up -1.39, so results might end up fairly spot on. Regardless of the number, I just can't get over the distance clarity -- the detail and colors are amazing! That was not expected at all. Hope it stabilizes here.
Guest at201
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Guest CaroZim
Posted
Carol, I don't know what I would have done without my iPad mini! For the past year I just read eBooks and made the font so big I had to scroll every few seconds. These things are a godsend to anyone with low vision. They can make life easier for those who end up with less post-op near vision than expected, too (as an alternative to readers).
Sue.An Guest
Posted
CaroZim Guest
Posted
Update on my second opinion visit to Dr Por Yong Ming.
So yesterday I went to see this doctor (of the blog "All things eye" fame!). What a nice man he was - very down to earth and obviously very knowledgeable and experienced! He wasn't busy (late afternoon on a Friday) and took the time to fully explain my options to me and was happy to answer my many questions. I didn't feel rushed which was very nice. The other place I went to was very much a money-making venture (although they were all very professional too).
He partly agreed with the other doctor I saw last week - collagen cross linking to stabilise my keratoconus. I'll be having that mid-October and will probably be bed bound for 2 days with my eyes closed. Not looking forward to that as it's quite painful apparently.
He differed on my options after the cross linking operation though:
1. Three to six months after the cross linking, cataract surgery to replace my lenses (some form of monovision or mini-monovision) - he didn't recommend multifocals because of my keratoconus and irregular astigmatism. Of course there are no guarantees I will get the vision I want but there are options for laser tweaking after the operation (my corneas aren't as thin as I'd been led to believe). I could claim the operation through my insurance.
2. Scleral contact lenses which should give me really good vision and apparently these are way more comfortable than the old gas permeable lenses and because they are made for people with keratoconus they should be very comfortable. Downside - they are more expensive than glasses, they only last for 1-3 years and I'd only be able to wear them during the day so I'd still need my expensive progressives when I'm not wearing them. Can't claim anything on insurance so it would all be at my own expense.
3. Stay as I am with wearing glasses (not much of an option really!).
Whilst researching the scleral lenses I came across Ortho-K and realised that I may be able take advantage of Ortho-K technology (you wear a lens overnight that reshapes your cornea so that during the day you can see properly without lenses or glasses - your eye reverts back to normal after a few days of not wearing them so it's a temporary and reversible procedure). I looked into Ortho-K when I was in my early 40's when I lived in New Zealand but was told I wasn't a suitable candidate for it (can't remember why but probably due to my keratoconus that I wasn't aware of then). Seems that the technology has moved on in the last 8 years or so and it may now be possible for people with mild keratoconus to use them. I wouldn't need to wear glasses if I had a multifocal or monovision option so I'd be glasses free. Disadvantage is the cost but I don't have enough info at this stage to know how expensive they'd end up being when compared with the scleral contact lenses.
Anyway, for now I need to get the collagen cross linking done, let my eyes heal and then consider my other options.
at201 CaroZim
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Wish you the best for a successful collagen cross-linking procedure.
Sue.An CaroZim
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Hi Cao-Zim - I was thinking of you yesterday knowing g you were going to see "the all things eye" surgeon. Thanks for the update. Your situation is rather unique and it's great you are posting as I am sure someone else will
benefit.
Sounds like you have a plan for the collagen cross linking procedure. Is your original doctor going to perform it?
I wish you all the best.