Frustrated after recent cataract surgery UK, how to cope with loss of near vision

My solution was to wear a contact in my non operated eye that left me at -1.5 D so I could simulate monovision, before trying it with the IOL in my second eye. Then I did get min-monovision and like it a lot. Have been essentially eyeglasses free since my second cataract surgery.

I could not get the lens out of my Rx glasses so I took them back to Costco where I got them, and they took the lens out for me. But, I found the better solution was to get contacts for the non operated eye that left me at -1.5 D myopic. For example if your normal prescription for that eye is -4.0 D, you get a -2.5 D contact. It allows you to simulate whether that is an option for you with the second IOL lens.

I suspect like the NHS in the UK, Canadian healthcare only offers monofocal lenses for no cost. Most people choose to have their vision corrected for distance. However, this is not mandatory. Your can choose to use the same monofocal lens but with a different power to leave you under corrected to give closer vision. A common mini-monovision strategy is to choose a monofocal power in the dominate eye to give you full distance vision, and then under correct the non dominant eye to leave you at -1.5 D. There is no extra cost to this, and no need to go to a private clinic. It is just a matter of the surgeon choosing different targets for outcomes.

I always thought when I finally could get them fixed I would opt for the very best lense

Bear in mind that "the very best lens" is not necessarily the most expensive, but rather the lens that works best for you.

Can you email the surgeon or the consultant ahead of time to explain your situation? Simply using the word anisometropia should wake them up a bit. 😃 And if the consultant doesn't give you satisfactory answers, insist on speaking with the surgeon.

A couple of questions. What is your current eyeglass prescription for each eye, and are you now going without glasses and getting along well, other than the cataract impact on vision?

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Keep in mind that having astigmatism now does not necessarily mean you will have enough to make it worthwhile to correct it with a toric lens. That is one of the key questions you should ask when they take measurements. What will the residual astigmatism be in each eye if you do not get a toric lens. This cannot be determined from your eyeglass prescription as it includes the correction needed for astigmatism in the natural lens which will be removed when you have cataract surgery.

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"I have considered monovision with right eye seeing distance and left for reading since that is what I have had all my life" - That is important, as mini-monovision is likely a viable option for you. It lets you use standard monofocal IOLs without the risks of optical side effects associated with the so called "premium lenses". Having the dominant eye as the distance eye is also optimum.

Thanks for replying, I see the counselor on Monday morning so I can't really give them advanced information. However, when they don't know what I am talking about I will ask to speak with the surgeon and or postpone surgery until I can get a better grasp on what might work best. Lots of good info on this forum (some of which is beyond my understanding ;0 )

I have read that the monovision lenses usually give the clearest vision and least problems maybe the right eye distance and left eye for reading might be my best option. I am already familiar with the depth perception issues already so I don't think that adjustment would bother me. It is just so much to decide and they don't really want to spend a lot of time discussing it with you.

Sorry, I have had trouble logging in to this sight. I do wear my glasses all the time.

My Right eye is +1.00 -1.00 85

left is -1.50 -1.25 70

I believe mini monovision is good for me also. Distance right eye dominant and left near.

However after deciding on a traditional mono lens in right eye and toric mono in left (with the surgery consultant not the dr.)

after she spoke with the surgeon he said he thought that would be good but would like to use eyehance in right eye and eyehance toric in left eye for optimum vision. (no extra cost to me )

thank you so much for responding.

Also after speaking with the surgery consultant she was very knowledgable and knew the answers to all my questions. I was very impressed. She did tell me she would personally discuss this with the dr. and she did, and called with the info about the eyehance.

I felt very well taken care of and informed.

Keep in mind that the Eyhance will not give you nearly as good close vision in your left eye as a monofocal targeted to -1.5 D. That is unless the surgeon is going to target something like -1.0 D with the Eyhance in the left eye.

He is targeting my left eye for intermediate and near vision. I do not know the numbers.

Hmmmm.

Girlfran61:

I gave my doctor a few paragraphs about my preferences and my daily life as it relates to vision. Boiling it down, I said I'm a lifelong myope and I value my great extreme-closeup vision. I don't mind wearing glasses for distance. I'm on the computer a lot and my work includes close work on metal fabricating.

He consulted 4 other ophthalmologists, showing them my data and my essay. The consensus was to target -0.75 in the dominant eye (slightly myopic, sharpest at long end of intermediate range) with a toric monofocal lens and -2.00 (typical reading focal length) with a toric Eyhance in the non-dominant eye.

Eyhance in the dominant eye is not an option because it does not come in a high enough cylinder power for that eye. That eye will get a Zeiss.

I have not had surgery yet.

I was leaning towards having my second (left) eye being done in December undercorrected by 1.5 D. Ron says he has that and is very pleased with it. I saw my optometrist last week and told him that I wasn't seeing very well with the two different contacts I'd tried. He thought I should think seriously about monofocal, get a second distance IOL. Like Jim, Mam and Freddi, I'm quite bothered at the thought of losing what close-up vision i have left, but I realize I still won't have that even if i get mini-monovision. So, I'm trying to wean off using my left eye to read close up (about 3-4" away; I'm a high myope). I'll just wear progressive glasses all the time and celebrate having excellent distance vision. I think having relied on close-up vision for over 55 years may have a lot to do with the angst about losing it. I'll probably need 3 strength readers because even with the contact, I haven't been seeing my computer screen clearly with 2.5 strength. The contact is under by 1.5 but I still need readers to read computer print.

"The contact is under by 1.5 but I still need readers to read computer print."

That seems strange. If you are left at -1.5 with the contact correction, computer distance should be easy to read. Is there astigmatism and is that being corrected with a toric contact?

I have a small amount of astigmatism in the left eye, the optometrist said. I think he said .25? if that makes sense. Maybe the cataract is contributing too?

0.25 D of astigmatism is a very small amount and should not impact vision at all. It must be the cataract that is causing the issue.

Thanks Ron.

I'm resigned to wearing glasses to see closer than about 20" if I end up getting a second distance IOL

It was my understanding that mini monovision would allow me to read, see my watch and my cell phone. I do realize outcomes are varied by many different things, however that is what I am aiming for and my dr. knows that.

Am I mistaken?

I really appreciate all the help I have found on this forum, it has been super helpful. My surgery on dominant eye is sept 26th.

Thank you for that info. 😃

I think everyone must be different. My doctor told me I would not be able to read with minimonovision, and another doc confirmed that. Yes I could see better to do things like cook, but for reading I would need glasses. And my monovision lenses would be plano in one eye and -1.5 in the other.

Thank you,

have you had your surgery? I told them I don't mind readers for extended periods of reading etc but as of now I can see my watch and phone and read normal print without my glasses and I don't want to lose that at all. If I can't do that I will wait to get the left eye done. All of this is so difficult to decide.

My doctor said the eyhance in right dominant eye will be set for distance and the left (my nearsighted eye) will be set for near and intermediate with a toric eyhance.

According to defocus curves a standard monofocal targeted to -1.5 D should get 20/32 vision at 0.33 meter or about 1 foot. I am about -1.5 D and on a computer I cans read easily at 12" or a little less. In bright outdoor sunlight I can read J1 on a Jaeger chart easily, and in poorer indoor light about J3 easily. The defocus curves of course are an average of many people, with some seeing better and some worse than the curve.

I had one surgery and distance lens. I am waiting for prescription reading glasses. I rely on my cataract eye for close and middle distance vision. I want to be sure to have glasses that allow me to read with distance vision eye before surgery on the other eye. I am happy with the distance vision but also need to figure out what to do to have good near vision. I chose distance vision knowing I would lose near vision.

It seems indisputable that if one eye is set for a distance no greater than the length of your arm, you'll be able to read your phone and your watch with that eye without glasses (barring residual astigmatism or a retina problem). Worst case, you close the other eye. A contact lens trial might not confirm that if your cataract is bad.

First, I am very short and the optometrist has joked that I would have better mid range vision if I had longer arms. And I do have some residual astigmatism even with the toric lens. I dont know how that will turn out in the other eye. But thanks.

I am one day post surgery for distance in my right eye with eyhance. Still a bit blurry but doing great according to my checkup and of course sunlight bothers me, and I have had some flashes towards the outside of my eye but not super bothersome.

I spoke with my surgeon at todays visit and explained that with no glasses I can see my phone and watch and also to read normal print. I told him I didn't want to lose that.

He said he had targeted me for 1.5, but now he will target me at 1.75.

Anyone have thoughts on that.

I appreciate all the info shared on this forum.

I am scheduled for 2nd surgery with a toric eyhance on Oct. 17

That will improve your reading vision but do nothing for your distance vision. Your other option would be to target full distance vision with your second eye. -1.5 D is pretty much ideal for a close eye.

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But it all depends on what your priorities are.

RonAKA

thanks for helping. The goal is for mini monovision. My eyes are naturally that way. I am trying to not have glasses as much as possible.

I would do distance in the other eye then.

Results vary widely from person to person. I have my near eye at -1.75D (monofocal). I can read pretty well holding things at a distance. Nearer than about 16" and things get quite blurry.

Based on my results, I'd strongly disagree for -1.5D for being "ideal" for a close eye. If you're looking to optimize distance vision with mini-monovision, it might be ok. If you're a person who values near vision, not so much. The defocus curve for my lenses (ZCB00) has "good" vision for -1.5D at distances greater than 17". For some of us, that's not a good result.

Thanks for that information Lucy24197 .

What I told the Dr is that I didn't want to lose the ability to look at my phone or watch or normal print without glasses... that is when he said 1.75 would be better. My R eye is already done and is for distance.

so, can you see a watch or your phone without readers? at 16 inches?

also he is using the multifocal eyhance in a toric .

Being only able to read J7 or J8 on a Jaeger chart, as you reported in another post, seems unusual for a -1.75 D near eye. Do you have any astigmatism or other issues that might be affecting your vision? I have a spherical equivalent of between -1.25 and -1.5 D including astigmatism but can see J1 on the Jaeger chart at 14" in full sunlight and J3 with normal indoor lighting. I just have a standard Alcon Clareon monofocal lens with no EDOF.

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I did a lot of testing with contacts and reading glasses and my conclusion was that -1.5 D was the optimum for me. -1.25 was ok with contacts simulating monovision but -1.50 was needed with an IOL in place. The natural eye lens still had some accommodation and did not need as much myopia for close vision.

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Here is the name of a study that concluded that -1.5 D of anisometropia was ideal for monovision. Unfortunately the complete article has been taken down, but the graphs are still there. If you click on the graphs you can see an explanation for each one of them.

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Semantic Scholar Optimal amount of anisometropia for pseudophakic monovision.

Ken Hayashi, Motoaki Yoshida

Do you have a sense of how well your two eyes work together? That is what concerns me about minimonovision. And I would have -1.5 and plano. so close vision would be less acute than -1.75. I want to avoid reducing contrast or depth perception and also the potential for any dizziness. I also dont want to be constantly aware that my eyes are different than one another.

There are two issues too look at when considering monovision. First is the amount of myopia in the near eye. Somewhere in the range of -1.25 to -1.50 is enough for most people to meet 95% of their reading needs. The second issue is the difference between the two eyes or the anisometropia. The anisometropia is what is responsible for the potential for dizziness or loss of 3 D vision, and depth perception. When you go over 1.50 D between the eyes, it starts to be a problem.

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I think it is best to so the distance eye first, and the usual target is -0.25 D. If for example you come at exactly that, then you would still target -1.50 D, but your anisometropia would only be 1.25 D, and not likely to be a problem. If you come out at -0.5 D then you would not adjust your near eye target to -2.0 D. You would still target -1.50 D and your anisometropia would be even less.

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If you end up on the dreaded + side with hyperopia with the first eye, then you might want to back off on the second eye a bit to maintain the anisometropia at 1.50 D. This is going to reduce your reading vision some. And if you are too far on the plus side, you might want to abandon monovision as an option.

I believe my distance eye is plano, per consult with another doc. That doc says I won't read with 1.5, but will see a little closer, so to be more comfortable cooking and other things that sound like mid range, not close. I do have astigmatism, though a lot less than before. I cannot use reading glasses; had to get prescription to correct astigmatism before I could read and reading is still difficult. This reading issue is what keeps me from going forward with the other eye until I read very comfortably with the first eye. It is definitely the glasses, because when my eye has been refracted, I read beautifully including the very smallest letters on the reading eye chart. I have not gotten the same result with actual glasses, whether progressive or reading glasses. And the prescription was checked for both and found to be correct.

I am not sure what is going on. I am told I will do better after the second iol, but I think I should be able to read with the eye that already has had the surgery. My eye that still has a cataract is able to read both with and without glasses. I don't understand this situation.

Based on my experience and with mini-monovision in general you should read quite well if the surgeon leaves you -1.5 D myopic in your second eye. If you have more than 0.7 D cylinder (astigmatism) then you should get a toric. Reading vision with -1.5 D is not going to let you read very small print, especially in lower light levels, but you should be able to read normal sized print in good light and even an iPhone. The issue you can have if you go over -1.5 D in the near eye is loss of 3D vision and depth perception. It can also make you feel dizzy.

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I agree that you should be able to read with the eye that already has an IOL if it has corrected your astigmatism, providing you use reading glasses or progressives. Do you know what the residual astigmatism is in this eye? It would be the cylinder number on your current eyeglass prescription for this eye.

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If you are able to see with the eye that has the cataract what you may want to consider is trying a contact in that eye that would correct the astigmatism and adjust your prescription so you are at -1.5 D with that eye. That would give you a reasonable approximation of what vision would be like with mini-monovision and no glasses. Your optometrist should be able to help you with the selection of a contact to do this. I would suggest the J&J Acuvue Oasys or the toric version of it if needed. These contacts are reasonably easy to handle. Stay away from the Acuvue Moist ones. They are horrible to handle!