Confused

First thank you for your response.

The technician did say that they want to get the net prescription to a 0. 

Is what you described above considered monovision (where one eye is adjusted for distance and the other for near)?  Will my depth perception be difficult?

I do think it would be wise for me to try different strength contact lenses to try to obtain optimal vision for me.  Would you agree with that?

May I ask what your area of expertise is? Are you an opthamoligist?

No. I am not an opthamologist. I just became more knowledgeable about the cataract surgeries, IOLs, and eye prescriptions in general  when I went through the same experience myself (and during my contact lens wearing days before that).

Geting back to other questions:

Achieving a net prescription of 0 for the first eye will be excellent. However, it is better to end up with -0.25 than ending up with +0.25. That is why I suggested aiming for -0.25 to zero.

Assuming that your first eye does end up at the desired target (and you should wait for 1-2 weeks after surgery to make sure that that has been achieved before doing anything to the second eye), you can try using a contact lens in the other eye for the best focus at about 40 inches. This means that if you are using -6.0 D (for example) to get the best distance vision, you should use the -5.0 D lens. You will be then using micromonovision (which is in the -0.75D to -1.5D difference between the eyes, compared with -2.0D to -3.0 D used for monovision), which is easy to adjust to. If needed, you can try changing it slightly by 0.25D either way. Having the ability to use a contact lens will make it easy for you to do the trials. You will then know the desired target for the second eye before the cataract surgery for that eye.

 

What would your guess be as to if I would be able to see my phone at arm's length (approx 24" with micromonovision vs. both eyes corrected for far distance? The counselor at the eye surgeons felt I would need glasses for anything closer than arm's length with far distance correction.

I have determined that currently wearing contact lenses - I can sometimes see my phone or laptop around 12" and farther.  Other times I need readers.  I am ok with this scenario and would like to get as close to this as possible.  I am, however, going to miss when I need to tweeze eyebrows or polish nails I take off my glasses and can see very near perfectly  I know there is nothing to do about that except wear glasses for those tasks or go to an electrolgist.

Also, thanks to this discussion I have decided to have a talk with my surgeon regarding micromonovision.  

 

If you have one eye set for distance (-0.25D to 0.) and the other one for the best focus at about 40 inches (-1.0D), you should be able to see your phone fine at arm's length (about 24 inches).

You are lucky in that you are used to contact lenses and can thus try other combinations, such as the best focus at about 32 inches (-1.25D). With that you should be able to see well down to about 22 inches. Of course, you will have fair vision even somewhat below those distances: it may just not be good enogh to read fine print.

The above distances assume that the toric lenses take care of your astigmatism.

Can you comment on different brand names of lenses.  Is one better than another?  I have not had that conversation with my doc.  Is that something I should be concerned with?  Could I get halos, etc?

As far as the toric lenses, all I know is that I have astigmatism in both eyes.  I do not now any more than that.

I am so happy I found this forum.  Have learned a lot.

If you have your eyeglasses prescription, there should be a cylinder and axis number for each eye - thats the amount of astigmatism.

For example for my eyes, the eyeglasses Rx has:

left eye: -0.75D spherical/power -2.0D cylinder 178 axis

right eye: -0.75D spherical/power  -2.75D cylinder  170 axis

So I need Toric IOLs that cover 2D+ cylinder astigmatism.

In my research, the Tecnics brand claims their IOLs (Symfony Toric, monofocal Toric, etc) has improved contrast sensitivity, no glistenings, and reduced spherical and chromatic abberations compared to other popular IOL brands such as Alcon.  They also don't have a blue filter like the Alcon IOLs have.

I desire the best possible contrast sensitivity especially for my weaker right eye, so thats why I have been looking for local eye surgeons that specialize in all the Tecnics brand IOLs.  I've found a lot that only do the Alcon IOLs for monofocals/torics which I'd rather avoid.

All I have is my contact lenses information:

Right eye:BC 8.7,  DIA 14.5,  PWR -6.00,  CYL -1.75,  AX - 180 (Biofinity toric)

Left eye:   BC 8.5,  DIA 14.2,  PWR -6.00, (1 day Acuvue)           

The contact Rx would indicate you have astigmatism cylinder -1.75 & axis 180 for the right eye, but none in the left eye.

Does that seem correct, that you have significant astigmatism only in the right eye?

If so you would probably need a toric IOL in the right eye.  But you may not require a toric IOL for the left eye.

Fortunately Tecnics Symfony IOLs are available in toric and non-toric versions and the toric models cover up to 2.57D cylinder too.  The Tecnis monofocal toric IOLs can cover up to even higher cylinder values.  A monofocal non-toric IOL would be significantly cheaper than a toric IOL, if you don't need a toric in your left eye.

Since you were leaning towards monofocal toric lenses, I did not want to bring up other types of lenses and thus cause you additional confusion.

In any case, here is a quick summary of my thinking about the various lenses:

1. Of the various types of monofocal lenses, Tecnis and Alcon brands are the most common, with each of them having some pros and cons. The various surgeons work with either one or the other, depending on their personal preference. My personal preference is Tecnis.

2. I will stay away from multifocal lenses. They provide good focus at 2 or 3 discrete distances; but over a vast range in between, the vision is not good. The day vision is not that sharp. They also have the most night vision issues, such as halos and glare.

3. The only other lens, I would consider is Symfony lens, which is an extended focus lens (even though many opthamologists lump it with the multifocal lenses). If you were going to consider them, I would suggest using it for the second eye only while using the monofocal lens for the distance vision. Also, my recommendation for its power will be exactly the same as I have given above for the monofocal lens for the second eye. Compared with the monofocal lens for the second eye, use of the Symfony lens should enable  you to be able to read without any glasses. It should not result in night vision issues, such as seeing multiple circles around lights in the distance associated with using a Symfony lens for far distance. The main disadvantage compared with a monofocal lens is its cost.

i have been recommending the above combination of a Symfony lens and a monofocal lens after my experience (rather than repeating the material here, if interested, please see my post, “Has Any One Else Had This Very Unusual Vision Issue with Symfony Lens?” on this forum. You should be able to find it by clicking on my name and then looking under “Discussion”.

As you will notice, the lens combination being considered by Night-Hawk is very similar to my suggestion. I am pleased to see that he/she is doing that.

 

As Night-Hawk has mentioned, if you are seeing fine with the current contact lens indicated by you, you don't have significant astigmatism in your left eye and you need not get toric lenses for that eye.

What are your thoughts on the fact that I had tears (detachments)  in both retinas which have been "glued" (I do not know the correct terminology) to stop the tearing.  Has that been shown to happen again or be detrimental after cataract surgery?  Should I be concerned? I was told that it could happen again.

 

About 1 to 2 % of people have an incidence of retinal detachment after a cataract surgery. You may have a slightly higher chance of that happening, but that should not stop you from having a cataract surgery. All that means is that you should pay more attendtion to any sudden floaters, flashes, or a cloud in your vision and see a retina specialist right away, if that happens.

I met with the surgeon and a technician today to discuss my upcoming procedure.  I had printed out all of my concerns and questions and all the details I have learned from this site, specifically you and a couple of other users.  Kudos to you all.  You all are "right on the money".  Details are perfect and the technician was impressed by my knowledge.

A few of my details: the surgeon will be using Tecnis Toric lenses in both eyes.  The right eye (although my current contact lens does not correct for astigmatism) has a slight astigmatism to the point that I will benefit from a toric lens in that eye.  They will set my R eye for distance, striving for -0.25 to 0.  Now for my question....the tech felt I would do well with the L eye set to intermediate and striving for -1.0 to maybe -1.25.  I asked about possibly of getting -1.5, he did not think it was necessary, but the surgeon felt that since my current vision with contac lenses is a modified monovision and I am used to it, I would do better and gain more with -1.5.

If you would comment on this I would appreciate your thoughts.  Thx again.

Having used monovision for many years and since you say that you are used to monovision,  this is my personal opinion:

1. You won't have any problem adjusting to monovision whether you get the second eye set for -1.0D, -1.5D, or even 2.25D.

2. Depending on the choice you make for the 2nd eye (with the first eye set at 0 to -0.25D), you will be able to see well at distance of most importance to you and will have to use glasses for the best vision at other distances. The range of the distances may be slightly different with an IOL than with your natural lens, which may still have some small focus adjustment capability.

a. You will be seeing fine at far distance for any of these options.

b. With the lens corresponding to -1.0 D, you should be able to see fine from about 26 inches to far, but will need glasses for reading. This will probably be my first choice.

c. With the lens corresponding to -1.5 D, you should be able to see fine from about 20 inches to about 40 inches, have only fair vision from 40 to 80 inches, and then see well at more than about 80 inches. You will still need glasses for reading, although you may be able to read bigger print at arms length fine.

3. With the lens corresponding to -2.25 D, you should be able to see fine from about 15 inches to 23 inches and thus, you won't need glasses for reading. But your vision may be only fair (or even poor) from about 23 inches to 80 inches. This works fine for most situations, except for example, when I had to read captions next to a painting in a museum.

Thus, it becomes a matter of personal choice and you are the best judge of what you may find most convenient with your life style.

I am leaning towards your options B and C. The technician in the surgeon's office (who did all the measurments and knows alot of the details of the surgery) seems to think I'd be best aiming for -1.0D to -1.25D, while the surgeon is leaning towards -1.50D.

After the first eye is done for distance - will I be able to try a variety of contact lenses in the second eye and try to achieve the actual "feeling" of what I will be able to see after the second eye surgery?

It is much easier to understand what my vision will be by a trial.  The numbers are good to know but there's nothing like "hands on".

Trying out the contact lenses with different powers is the best way to judge the best target prescription for the 2nd eye. Please just make sure that the vision in your first eye has settled and provides good distance vision before you try the various combinations with contact lenses in the second eye.

Would you have any idea what the prescripton would be for a contac lens in my left eye, once the right eye is corrrected for distance?  Currently I wear a -6.0.

If you are using a  -6.0 contact lens to see well at distance, then you will need to use a -5.0 lens to be able to see well at about 40 inches (this correponds to aiming for -1.0D after surgery), a -4.75 lens to be able to see well at about 32 inches (this correponds to aiming for -1.25D after surgery), and a -4.5 lens to be able to see well at about 26 inches (this correponds to aiming for -1.5D after surgery)

I want to thank you for all your help.  I don't know how you have this all figured out, but I do know that you have been perfect with all the previous details I have asked about.  My doctor has confirmed everything you have said.  I would definately be in an entirely different spot without your knowledge so again thank you.

I am having surgery on my R eye tomorrow.  Should I expect to be able to wear a contact lens in my L eye comfortably or will there be an imbalance?  

The L eye is scheduled for surgery in 3 weeks.

I am interested in your thoughts on possibly having only the R eye done.  If I can get along with a contact lens in my L eye (no surgery), is that a possibility?  I do have a cataract in my L eye, so eventually it will have to be done, but I am not opposed to holding off for a while if my eyesight is ok for a while.

 am having surgery on my R eye tomorrow.  Should I expect to be able to wear a contact lens in my L eye comfortably or will there be an imbalance?  

The L eye is scheduled for surgery in 3 weeks.

I am interested in your thoughts on possibly having only the R eye done.  If I can get along with a contact lens in my L eye (no surgery), is that a possibility?  I do have a cataract in my L eye, so eventually it will have to be done, but I am not opposed to holding off for a while if my eyesight is ok for a while.

My best wishes for a successful surgery in the right eye tomorrow. Hope that everything goes smoothly.

There is no reason for you not to use a contact lens in the left eye right away (am assuming that you see well at distance with that). This should not cause any imbalance unless the right eye vision is much different from what you are hoping to achieve with that eye.

Once the right eye vision settles down in a week or so and you are happy with your distance vision in that eye, that will be the time to try slightly different contact lens powers in the left eye to determine the combination which works out best for you.

You want to be completely happy with the vision in the right eye before you have cataract surgery in the left eye. This is to ensure that if the right eye vision is different from what you are targeting, you can compensate for that in your target for the left eye.

Other than the above, you can have the cataract surgery for the left eye whenever you feel like that you are ready for it. If you were wearing glasses instead of contact lenses, that would have been hard to do because the difference in the power of the 2 eyes would have made it harder for the brain to deal with 2 significantly different image sizes. However, the "different image sizes" issue does not happen with the contact lenses.

 

Right eye is done!  It feels a little scratchy and there is a halo sometimes.  I know this is all normal for now and both should go away.  R eye is somewhat blurry but I can see the tv very clearly about 15' away with both eyes..  The phone and various computers are another story right now - pretty blurry.  Currently I am using the -6 contact lens in my L eye. I will be trying -5 and possibly -4.75 in a couple of weeks, but it is hard to believe that they should be able to give me some decent vision overall.  

Am glad to know that your surgery has gone well. The right eye will get better over the next few days. If it provides you good distance vision at that time, please go ahead with your plan to try -5 and possibly -4.75 in a couple of weeks. You will be pleasantly surprised to see how well the combination can work.

Just got back from the eye doctor.  She said my R eye is almost 20/20.  She said when the swelling goes down the starlights and the rings that I am currently seeing would go away and I would be looking directly through the center of the lens.  

She also said that with my current contact lens of -6.0 in my L eye I am at about -0.75D.  It is hard to be exact because of the cataract in the L eye.  I am having a hard time syncing my eyes together, because of the different sizing as well as the difference in colors.  

Her recommendation is the same as yours: go for -1.0D for the future surgery.  Se also said that her husband's final results were -.75D and he was happy and almost never needed glasses.  

You have given approx. distances on -1.00D.  Could you tell me what -0.75D would be equated to?

 

Glad to know that you are making good progress with the vision in the right eye. That is wonderful!

A prescription of -0.75 D corresponds to the best focus distance of about 53 inches.

I also think that aiming the left eye for -1.0 D will be a good choice.

Here is my update....both eyes are done!  No problems at all...I hope they stay problem free.  

R eye was set for distance and the final number was 20/25.  They told me it is -0.25.

L eye was done 2 days ago.  Yesterday's first check up looked good and the technician said the L eye was -1.0.

The doctor was aiming for -1.25D (the computer said I would likely get -1.32) - do these numbers mean the objective was satisfied? Yesterday things were pretty clear and sharp, today even more so.  I almost want to say "too sharp".

I know I am only 2 days out but as of right now I cannot look at the computer or the iPhone for too long because I get a headache and my eyes hurt.

In any event so far I am very happy with what I can see, although it does take getting use to...in the past when I couldn't read something I would move it in closer to see it....now it's just the opposite!  Haven't had to use reading glasses yet.  I could even read a newspaper at a comfortable distance without glasses.

Congratulations. Great to know that the cataract surgeries for both of your eyes have worked out very well and that you are happy with your vision.

Yes. It looks like your doctor did a good job of meeting the targets.