Choosing Intermediate/Near Monofocal Cataract Lens -- My (Positive) Experience So Far
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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
Guest
Posted
2-week post-op update:
My optometry exam showed -1.0D (zero astigmatism) in the right (surgical) eye; and -1.5D with minimal (.25) astigmatism in the left. My last stable Rx from a couple of years ago (pre-cataract and retinal tear) was -2.0D R/L (Left weirdly improved after laser repair of retina, but left other residual compromises). Super happy with vision overall. My 1-week functional summary is still fairly accurate (see last week's post), though halos are diminishing R a bit (surgeon says it is from the inflammation) and close-up vision seems improved. Felt my vision had drifted a little more myopic, though -1.0D is similar to initial exam. I think it has also helped to "discover" that moving very fine print away makes it legible (duh!). I can still read very tiny print (like on the eyedrops bottle, for example) with the right eye if I move it away. The two eyes together provide even better vision, obviously, given the mini-monovision. Current plan: Distance Rx glasses (single vision) for driving, biking, conferences, movie theater, etc.; remove for reading. May use readers for long-term small print, and to minimize eye strain as necessary.
Overall, I am thrilled with my current mild myopic mini-monovision outcome. In hindsight (no jokes here. . .) I was too conservative in thinking -1.5D was pushing the 'hyperopic' end, mainly because I was so afraid of losing near vision, and could not figure out how to predict what range I would end up with. As it turned out in my case, I lost very little near vision with a -1.0D outcome (even without adding the better near vision of the other eye), and gained a huge lifestyle improvement; being able to socialize at night without glasses! So my revised opinion is that somewhere between -.75 and -1.5D, with about .5D asymmetry/monovision is likely an ideal range for me (i.e. I don't think I would need to be more myopic than -1.5D to maintain decent near vision, and could tolerate possibly as little as -.75D myopia in my better eye). When/if I need the left cataract removed, I will likely aim for no poorer than -1.5D, and be ok with maybe -1.0D, even if I need readers more often (gulp!). Please discuss your lifestyle preferences and expectations with your surgeon to come up with your own best numerical targets, as each situation is unique. (Night-Hawk - anxious to see how your plan works out!)
Final thoughts; just remember that 1) With monofocal lenses, whatever vision you may lose at one end, you will gain at the other. 2) Glasses/contacts aren't really a handicap, just an inconvenience 3) If the cataract gets really bad (as in my case), you will be thrilled to get back distance at any range! If you are like me, you aren't looking for perfection, just the best choice for a "permanently imperfect" outcome. Good luck.
Sue.An Guest
Posted
I am pleased for your results. It certainly is a help for many just beginning this journey to know that either road you choose is more likely than not going to work or fine.
My 2 cents - be aware of your personality type (read some opthamologists offer a questionnaire which aids them in determining your personality type as well as your visual preferences). The more of a perfectionist you are steer away from multifocals and some would say Symfony (EDOF) lenses.
If you do want to pursue premium lenses - research your surgeon. Ensure he has done many of these surgeries and believes in them.
For me glasses/contacts were more than inconvience. All my life with a smaller head optometrists steered me more to children's frames - not much selection or style. As I looked further to when I would need progressives - a small sweet spot. During allergy season can not tolerate contact lenses.
Just know yourself and research lots - this is an opportunity to change some things.
CaroZim Sue.An
Posted
Very useful advice Sue.An - I'm a bit of a perfectionist so (if I go ahead with the operation) I think I'll be going for monofocals for close up vision like BellaD has done.
I'm going for the collagen cross linking on Tuesday 16th October with Dr Por Yong Ming (not the first surgeon I saw as I felt more comfortable with Dr Ming as took a lot of time to talk me through my options) - not looking forward to having to keep my eyes closed for two or three days (due to the pain) but if it helps to stabilise my eyes then hopefully it will be worth it in the long run.
I e-mail Dr Ming about the Ortho-K and he wasn't a fan of it (said it's risky for people with keratoconus) so I probably won't do it. I'm also not keen on the idea of scleral contact lenses because I'll still need expensive progressives when I'm not wearing the lenses - I'll be paying as much for the lenses as I will for the glasses - so I'll be spending double what I'm currently spending and probably having to buy new lenses every two years. I also just don't want the hassle of contact lenses.
So I think once my eyes have stabilised after the collagen cross linking (6 months or so) I'll go for the refractive lens exchange/cataract operation with Dr Por Yong Ming. It will be covered by my insurance thankfully as there aren't "levels of cataracts" and so even if you have mild cataracts it will still be put through as cataract surgery and that is covered by my insurance. This is my preferred option partly because it's the much cheaper option for me (both short and long-term) but also because I just don't want the hassle of contact lenses or glasses anymore.
I will have to have the operation in the future when my cataracts develop further so I may as well get it done now and hopefully have the rest of my life mostly glasses free.
Sue.An CaroZim
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Sue.An CaroZim
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CaroZim Sue.An
Posted
Hi Sue.An - yes I had the procedure on Tues 17th Oct - thanks for asking!
It wasn't much fun and half way through having the first (right) eye done I really regretted doing a bilateral procedure! Now that it's done and my eyes are healing well, I'm glad I got it over and done with in one go.
It was very painful for the first 24 hours and then moderately painful for the next 48 hours. My husband had to feed me like a baby on the first night as I couldn't open my eyes at all! I had to stay in my bedroom with the curtains closed and eye covers over my eyes for 3 days to block out the light which really hurt my eyes. During that time I discovered the joys of audio books!
My eye sight was really bad last week (I had to get my school to give me a big external monitor to hook my MacBook up too as the screen was just too small). This week so far my eye sight is a bit better (I think the air con at work makes it worse though so by the end of the day my sight is pretty bad). I will use eye drops this week as I think the air con is drying my eyes out.
So in a months time or so I will start a trial for monovision using contact lenses to see if I can adjust to it. If not, then I'll do a trial for mini-monovision. That should give me some idea as to what I should go for when I have the lens replacement surgery around April next year.
I decided not to go for the scleral contact lens option mainly due to cost and just the hassle of wearing contact lenses. They cost around SG$2000 and only last for 2-3 years if you're lucky and at the same time I would also need glasses - two pairs as I also need sunglasses (the ones that change colour outside don't work well in Singapore because it's often overcast and they don't work for driving either) - they cost around $2000 every 2-3 years as well. That's a lot of money if I have to continue doing that until I'm in my 60's or 70's. Better to get the lens replacement and then get one pair of distance glasses that I only wear occasionally (and that will be much cheaper because the prescription will be much lower than my current prescription).
Hopefully by the time I turn 50 (end of May '18) I'll be seeing reasonably well without glasses. My birthday present to myself!
Guest CaroZim
Posted
Hi CaroZim, thanks so much for the update. Glad to hear it's behind you and that you are on the mend. All the best for your recovery!
Sue.An CaroZim
Posted
At least you’ve got some time as you heal to consider what’s next step. In the meantime are you able to see quite well with regular glassses?
I find work environments do tend to make my eyes drier plus we have carpets which I don’t have in my home. So allergies too come into play. I use Systane drops which I find work well.
Wish you all the best as things heal. Keep in touch!
CaroZim Sue.An
Posted
Hi Sue.An
Yes Dr Por did the surgery. He was very good - chatting to me to take my mind off what was happening to my eyes - he could see I was nervous and uncomfortable. Hopefully lens replacement surgery won't be anything like as painful!
I can see probably 90% with glasses - my reason for wanting lens replacement is really just because I'm so tired of wearing glasses full time because they annoy me (more so now that I have the reading close up issue as well!). I'm a swimmer/scuba diver and I find that I've just stopped doing these things because I can't see. I also enjoy photography but my glasses are always getting in the way which frustrates me no end.
I figure I'm going to need cataract surgery one day so I might as well have it done now and hopefully have the rest of my life mostly glasses free. My sister has had the same op and she is very happy with it and only ever wears glasses for very small text - she's so glad she had it done.
CaroZim Guest
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Thanks! I'll update again when I'm ready to have the lens replacement surgery.
Guest
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Night-Hawk Guest
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Did you get the "-1.39D" estimate lens that resulted in your current -1.0D refraction in that eye?
Of course it could still change a bit as it heals more I believe.
Do you know if your surgeon used the ORA equipment during surgery that can check the actual refraction result after the IOL is implanted in real time then?
Guest Night-Hawk
Posted
Night-Hawk, yes, the Alcon AcrySof IQ 19.5D that I got implanted was the one that matched up (after factoring in my measurements) to the -1.39 target on the pre-op graph I saw. So the result so far is -0.39 better than the target. Sorry I have no answer for the last question, as I don't know what ORA equipment is or whether she used it.
Guest
Posted
Maybe "target" is not the right word here, but a predicted value or something like that. . .
miguel20862 Guest
Posted
Guest miguel20862
Posted
Overall the color and clarity are excellent. Not sure about the tint, but comparing that eye to my other eye with a small cataract; the eye with the cataract is a little more yellowish, and the eye with the new IOL less so. Bright daylight was a bit overwhelming the first couple of days but fine now. I wasn't aware of the special tint but overall it seems very sharp, clear, with better color than I recall previously. As before, I will wear prescription sunglasses for protection (and best distance vision) nearly 100% of the time I am outdoors. Interesting info. about that tint. . I'll look into it!