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
Guest
Posted
3-Weeks Post-Op:
After living with the new monofocal IOL at -1.00D (zero Cyl.) along with -1.5D/-.25 Cyl. vision in other eye (with sm. cataract & retinal buckle), things are seeming “normal” now. Near vision seems better now than first few days post-op. The newspaper at 16-18” is very easy to read (even without the -1.5 eye) and books are fine in good light. I still can’t get over how sharp my phone screen looks. The 0.5D asymmetry is not at all noticeable with both eyes open, and barely discernible comparing each eye separately. Distance overall looks pretty good: I can see blades of grass, individual leaves in distant trees, flower petals, etc. Comparing it to some of those online vision simulators, my vision seems less blurry than the simulated -1.0 vision (for what that’s worth). Maybe it’s this aspheric lens, but the colors seem more vivid and details are sharper than ever. Night halos are much less evident than week 1. No discernible artifacts. Early floaters disappeared.
TESTING “20/20” GLASSES: Brand new distance glasses definitely sharpen up the far end, as expected, though not as dramatically as when my vision used to be -2D. Street signs and license plates are visible farther away; night sky far better w/ glasses, of course. Looking around the house (up to 20 feet or so) is pretty good unaided, but a little bit sharper (dustier!) with the distance correction. TV (large screen) is more like “HD” with the lenses, but acceptable without.
Laptop computer screen (18-20” away) is definitely worse with the distance correction. I cannot hold the screen far enough to really clear it up. I guess this isn’t surprising, but I should note that the computer is blurrier with the +1.0 readers, as well. Therefore, my current unaided vision seems ideal for computer use (and sheet music at 18-20”). iPhone is somewhat blurry at arm’s length, though I can make it somewhat legible with bold, larger, font, etc. Small newsprint; forget it. If this approximates what my vision would be like with 0D IOLs then it basically would wipe out a good deal of my near vision. I would likely need readers many times during a typical day; a total PITA for me.
TESTING +1.00 READERS: I can hold the newspaper closer (around 12”), and fine print (down to No. 1 - .37mm) is more legible. Without them, I can also read very fine print if I move the page out further in very good light, but it is more of a strain. Will I need readers? So far they still have the tag on them so I’m not sure, but keeping them around just in case.
GLASSES USAGE 1st 3 WEEKS: Day and night driving; seeing a slide presentation at the far end of a gymnasium; a couple of TV movies. Will definitely use protective Rx distance sunglasses when I get back on the mountain bike. Readers not really needed so far, but might reduce eye strain for long-term reading. My biggest concern that ending up smack dab in the middle between 0 and -2 meant bifocals all the time seems to have been unfounded.
Overall: The -1.0/-1.5 combination is very good; allowing more spectacle-free vision than I expected or desired. Originally aiming for -1.5, but happily ended up gaining some important far vision with the extra .5D. For me, going from -2.0 to -1.0 provided a significant gain for functional (i.e. “walking around without glasses”) distance, without sacrificing much near vision, and that going from -1.0 to -0D would afford only a little distance improvement, while eliminating a good deal at the near end (0-2 feet).
Interesting anecdote: eye surgeon mentioned that a colleague had just received a monofocal -1.25D correction and was super happy with it. Hmmm . . . interestingly close to my experience. It was just an anecdote, but the number did capture my attention, as it was deliberately selected by an MD.
Lots of eye issues in the family (including blindness) so am very happy to have vision at any range for as long as I have it.
(Adding the usual disclaimer; individual vision factors vary greatly, so please discuss your goals and details with your surgeon. Just reporting my own pre and post-op thoughts and experiences).
Night-Hawk Guest
Posted
The result you are getting with good intermediate vision with the -1.0D makes sense, as does the worse intermediate vision with 0D or -2D.
So it sounds like with the 0.5D steps the IOLs are available in, you only real choices within the range you desired turned out to be effectively -1.0D or -1.5D.
So -1.0D turns out to be better overall for you then -1.5D would have been?
Due to the 0.5D IOL steps, I guess as patients we can only target a window 0.5D wide, so perhaps if -1.0D is desired, the window could be -0.75D to -1.25D
If you weren't asked if you wanted the ORA option (it costs extra about $300-$500) then I would assume your surgeon didn't offer it or didn't think it was needed for your case. ORA does allow for more precise measurement of the actual refraction result in realtime during surgery, but you apparently didn't need it since the result you got was within the 0.5D step of the target. In my case I have the added complication of significant 3D astigmatism and a toric IOL will be needed, so ORA can help to get that correction more precise for me so I will pay the extra for the ORA equipment to be used.
Guest Night-Hawk
Posted
Very interesting info. I was not aware of the .5 lens denominations (I would have thought maybe .25). If I had known, I would have most definitely wanted to see the exact options before surgery day. I was already leaning to a target better than -1.5D, knowing it was my dominant eye, and that I could tolerate some monovision with the 2nd surgery (I'd used a single contact lens on occasion). I came up with -1.5 on my own, thinking that it wouldn't end up being worse than -2 (familiar territory, good reading) or better than -1 (unknown territory; loss of near vision??). What I really wanted was the "least amount of myopia that would still preserve a good deal of near vision." I couldn't really get a good answer, but fortuitously I think I landed right about there in the end, and notice a huge functional improvement I feel that -1 (vs. -2 before) means not accidentally snubbing people at the gym, not squinting to locate the lavatory at a restaurant, not "needing glasses to find my glasses," (ha, ha), not squashing the temple of my glasses by watching TV w/ head on a pillow, etc., etc. It seems so clear, in fact, that putting on my distance glasses for anything other than very far distance seems sort of "meh." (Life-long emmetropes probably wouldn't share this perception!).
Regarding the ORA, I don't know anything about it, but if it prolongs or complicates the surgery in any way, the accuracy would have to be tremendously better for me to risk extra monkeying around during the procedure. Just my initial reaction. Modern cataract surgery is pretty amazing. If your surgeon really feels it is needed in your situation, then go for it. It's not that much money if it really improves your vision long-term.
If you have had your biometry appointment, then please share what the choices are, and how it ends up. How long between surgeries? Seems like you know what you're doing. Hope it goes well!
Night-Hawk Guest
Posted
My biometry cornea measurements appointment is next week Monday morning, one week before the scheduled surgery for my right (dominant) eye which has the worse cataract.
My left eye has only a very early stage cataract so it doesn't affect my vision in that eye yet, it was only detected years after the right eye's cataract, so could take years more before surgery is needed in that eye unless I detect too much of an imbalance between the eyes after the right eye surgery. However I could probably go back to using an RGP contact in the left eye if I don't get surgery for a year or more in that left eye and I could try mini-monovision of about -1.0D or -1.25D in that eye with a contact too if the right eye achieves the target of good distance vision.
at201 Guest
Posted
Some lenses come 0.5D apart and the others come 0.25D apart. If one looks up the lens information on the manufacturer's web site, it should be there.
Guest at201
Posted
Very interesting, at201. I don't think I had a choice of mfr. with my HMO but I really didn't know or think about the denominations at all. I will pay more attention when it comes time for the 2nd eye. Is it odd that my 2 closest matches (calculated with my biometry) were .36D apart (as opposed to .25 or .5)? (Alcon AcrySof IQ)
Guest
Posted
Yes, -1.0 ended up being better than -1.5, but if I had 'known' that ahead of time, I would have selected a target closer to -1.0, then may have ended up at -.5 which may have been too hyperopic . . .
Sometimes it's better not to know too much, I guess.
at201 Guest
Posted
Guest
Posted
As a follow-up to my last comment -- In other words, -1D may be a great result for me, but not such a great "target" if I didn't want to risk losing more near vision. Maybe a -1.25 target as I think you mentioned awhile back.
Sue.An at201
Posted
Night-Hawk Guest
Posted
Thats why I'm now thinking a 0.5D wide "window" target may be better than a single value target since due to the 0.5D steps on the IOL model I'm interested in will limit the choice to a window range.
So perhaps -0.75D to -1.25D, or -1.00D to -1.50D.
Guest at201
Posted
Guest Night-Hawk
Posted
Yes, I was assuming a margin of error from that target value. Better to express it as a window to avoid confusion. What % of outcomes, then, fall in that 0.5D window without ORA? And with ORA? Or does it depend on all the other factors (astigmatism, etc.)?
Let's say your ideal outcome (maybe you've tried various contacts or whatever) is -1D (or your ideal window is -.75 to -1.25), and your available lens choices (with your biometry) are Lens A: -.75 and Lens B: -1.25. Which would you pick? Are you saying that with Lens A the outcome will likely be between -.5 and -1, and with B will be likely between -1 and -1.5? Not trying to sound like a kook, just super curious about this now!
Another question (anyone?); does the outcome error on one eye have any predictive value on the 2nd eye of the same individual? So if my first eye ended up .39D 'better' than the calculated value, is the 2nd eye more likely to also end up more on the + side as well? Just wondering! Thanks in advance.
at201 Guest
Posted
at201 Guest
Posted
Guest at201
Posted
All good info. Hope I don't have to think about it for a couple of years. Not nearly as worried about the refraction for the 2nd, as the 1st is my good eye and it ended up just about right. The extra myopia in the 2nd seems to be helping for now despite its other issues so I may stick with something like that.