Confused and delaying cataract surgery
Posted , 9 users are following.
This is my 1st time posting. I have been delaying cataract surgery for over a year. I am nearsighted.
My current prescription: RT -2.75 with +.75 astigmatism 112 Axis and LT -3.00 with +.75 astigmatism 164 Axis. The cataract is worse in my left eye than my right eye. I had been leaning towards the LAL IOL but now I am not sure. If someone could explain to me: if the ophthalmologist targets my current prescription using monofocal IOLs, will I see the same intermediate and distance that I do now? Or will intermediate and distance be blurrier with monofocal IOLs? I want to maintain my nearsighted eyesight. I don’t mind wearing single focus glasses to watch TV or drive. I have not adjusted to progressive lenses in the past – though I have not tried progressives for a long time. I am a bookkeeper. Right now I have my computer screen 16’’-18” away and the paperwork I read about the same distance. My calculator readout is large enough to read. I am 73 years old, and I would like to continue working.
I have read all of the post on the LAL cataract surgeries. Thank you to all who post.
0 likes, 71 replies
trilemma julie66167
Posted
You can have one lens set to a closer focus and plan on setting the other to distance. That is probably what I would do, but I am still mulling that. Distance eye is done, but not stable. Happy with progress.
Would that make you see better or worse at computer screen distance? I would certainly hope better, but maybe your eyes have some accommodation ability still remaining, but probably not much.
3 D of astigmatism correction is right at the border of what LAL is rated for.
If the cataract is worse in the left, I would think starting with the left is good. You could leave time between.
Do you know if your right or left eye is dominant? From those who express a preference, they suggest the dominant eye be tuned to distance. Yet studies that check on performance when the non-dominant eye is the one set for distance, and I think there is no significant advantage shown either way.
trilemma julie66167
Posted
The "Crossed versus conventional pseudophakic monovision for high myopic eyes: a prospective, randomized pilot study" says
In other words, in monovision, they did not see an advangage to having the dominiant eye for distance, vs the other way.
trilemma julie66167
Posted
If he targets to match current prescription, I expect the astigmatism will be tuned out. So I expect your near vision to improve. But you will need glasses for farther out, especially driving. But you would need glasses even for watching TV in a group setting. Watching TV by your self, you can sit 20 to 30 inches away if you like.
I would make one of the eyes at least 1 diopter farther focus than your unaided eyes currently do. That will still let both eyes contribute to near stereo vision.
I expect others will have a different view. Keep reading. And feel free to get one eye done first, and take your time deciding how to get the other eye tuned.
julie66167 trilemma
Posted
trilemma, Thank you for your help. This is very overwhelming and many of you are so knowledgeable. If I target both eyes -2.0 - why would my astigmatism go away? I have had astigmatism for many years. The strangest thing happened, though. Just recently, I went to an optometrist who has a great reputation and she could not see any astigmatism. Not sure what to think. I went to her for a prescription for progressive lenses - so I could trial them. She ordered contacts ( mini monovision ) instead. My cataracts are bad enough that I could not see any better. I did not ask my prescription. Finally, for glasses she wrote -2.0 for both eyes. My refractions have not been consistent.
trilemma julie66167
Posted
If you get the LAL, regardless of what the focus is set to, they would normally eliminate the astigmatism. They are supposed to have a resolution of 0,25D of astigmatism.
There are other lenses that can cancel astigmatism. The resolution is typically 0.5 D, and the doctor has to get the lens with the right orientation on it. With the RxLAL, the astigmatism is adjusted about 3 and more weeks after implant.
Lynda111 julie66167
Posted
The two leading monofocal IOLs, the Alcon Clareon and the J&J Eyhance, are acrylic
You can read more about IOL material at
"Eyewiki Comparison of IOL Material "
June 2023
julie66167 Lynda111
Posted
Lynda111, I did "attempt" to read this article. I did not understand it. I am hoping someone on the forum will have an answer - specifically - will the clarity last? Also, I don't understand "pitting".
Lynda111 julie66167
Posted
I wouldn't get too lost in the weeds. The two leading monofocal IOLs are acrylic and so is the older Bausch and Lomb enVista that Ron often recommends. I think acrylic is the preferred material for IOLs
jimluck julie66167
Edited
julie61667,
May I suggest a simple solution?
Target -2.0 in both eyes with a monofocal IOL and plan to wear -1 or - 1.25 glasses most of the time.
Result: Glasses on for daily activities. Glasses off for reading.
Keep a pair of -2 glasses in the car and another by the TV if you want sharper far vision for those 2 activities.
This solution will give you the best vision with least fuss.
There is a loss of acuity and other aspects of visual quality with any kind of EDOF or monovision.
The Eyhance gets a little bit of EDOF without measureable loss of acuity, so that's the one exception -- do that one if you like.
Glasses are wonderfully fixable -- just get a new pair with a new prescription -- unlike fancy IOLs. A bit of residual astigmatism? No problem. Add a little cyl to the glasses. Refractive miss? No problem. Add or reduce the sphere in the glasses.
But glasses for near are a pain -- the need for near vision is often unexpected and brief. You reach for a measuring cup and are unsure whether it is 1/3 or 1/4 and the marking is small and faint. Do you now want to have to go find your reading glasses? No! You want to be able to just peer over your glasses and call upon that wonderful -2 vision. The gift of myopia!
Don't be swayed by emmetropia chauvinism. Near vision rocks!
The need for far vision is predictable and tied to 2 places -- car and TV. Easy to have far-vision glasses stationed there. Plus, you don't really need better vision than -1 or -0.75 for far unless you're a sniper. That last bit of distance acuity is overrated.
Progressive glasses add to risk of falling as you get older. So don't make them part of the plan. One study found a 40% reduction in falls among elderly who do outdoor activities just by replacing their progressives or bifocals with monofocals.
So my suggestion is keep it simple. Go for the best vision without compromise -- monofocal IOLs with equal targets. Yes that means using glasses, but it doesn't have to mean needing glasses for near. Target near. That way you avoid the most inconvenient glasses dependence, which is glasses for near. I can't imagine choosing to need glasses for near.
julie66167 jimluck
Posted
jimluck,
Yes, you are correct. I just finished typing 10 more EDOF questions for my surgeon and I am tired of not understanding. I am in Kansas and if you google "extended depth of focus in the light adjustable lens" I think you will find my opthomologist. I will have a new hero - Bookwoman! I will pray my results are as good as hers because what she sees is what I see now. I wanted to target both eyes-2.0 with the LAL and try micro-monovision to see the computer but I will find some computer glasses instead. What you describe has been my visual life until cataracts. RonAKA has told me the same thing as well as Lynda111. Thank you! Please let me know what you decide to do.
Are progressives made that are clear on the bottom so you can look at your feet and go up and down stairs?
trilemma julie66167
Posted
You can get custom progressives for not much more than some of the no-prescription progressives I have see. Maybe I was only seeing the expensive ones.
But if you hit your target, your progressives might be prescription -2.0 with an add of 2.5 D or -2.0 D. -2 with a 2 add would be like clear glass at the bottom.. Your feet will be in that range regardless. I expect your vision with no glasses will be fine for stairs.
Lynda111 julie66167
Posted
Ok Julie. Do it Bookwoman's way.. Go for near\ intermediate vision and don't mess around with progressive glasses. You go, girl!
trilemma julie66167
Edited
Regarding progressive lenses, I think there is a significant differences among these glasses.. One magic word is freeform, but I expect there are significant difference among those who make that claim.
You may or may not have some accommodation left, and there will be none after the IOL. On the other hand, you will not have the cataract working against you. So my non-educated guess is that aspect would be similar. But sure not sure.