Getting a lens for distance

Thanks so much for the response. So mid range (like 2-3 feet +) you can see really well? Where would you say your perfect vision is distance wise?

Actually it is perfect near and far. My concern is eventually I think Iget tired, however it has only been 5 days, so it will likely improve. I wore one contact for distance for many years, so I know the body or brain adjusts, but in the past when my eye began to tire, I took the lens out and either used glasses for distance or nothing to read. All that changes with permanent fix. WHAT to do?

Pat what was your vision before cataracts, did you have good vision, were you nearsighted, farsighted? That does impact what you will see afterwards.

Thanks

HI Mady, I actually was near sighted for many years and had worn a lens for distance in one eye for years. The permanency of this is what had me so confused. I was always able to revert to both eyes being near sighted if I took my lens out. That was nice for long term reading. My surgeon has convinced me I will have the same flexibility if I need that by putting on glasses so I decided at this morning 's appointment to proceed tomorrow . Thanks for the discussion.

I will be reporting back . Fingers crossed. PAT

Hi Pat - is your 2nd eye's surgery going to be same target ad first eye surgery? If yes you will likely need asses for intermediate and near vision for reading. Not sure what flexibility surgeon is referring to. Once your natural lens is removed you lose all accommodation. If your surgeon is going to target your 2nd eye a bit closer then you will have more range of vision.

Sorry - was just confused about what was meant. If surgeon meant with glasses you will have flexibility then I get that but you will lose near vision you have now with that eye if he targets for distance.

JL824, I'm glad to hear your brain adjusted to one eye for distance, one eye for near/intermidiate, as this is what I had done recently. However, I'm having issues adjusting with this 2nd near vision left eye...seems to have a film over it but hoping it will get better. It has been almost 4 weeks healing now, so I'm a little discouraged. It seems worse in high light areas. Dr. said this eye was doing fine, just need brain to adjust. But he offered prescription for distance driving, which I figured would be good, and if I liked it better and could not adjust to near and far vision, I could have Lasik in the near eye to make it for distance (but then would need readers). Not sure I want to go through another surgery just yet.

Hello Andaloosa,

So good to read your post.

I have the Symfony in my RE, great range of vision, but lots of starbursts, glare, even with daytime overhead lights. So, decided against the Symfony for my 2nd eye, going with a monofocal for my LE.

its good to hear that the combination works for you and you adjusted well. I expect to use reading glasses for near vision. Did you set your monofocal for distance or something else?

Oh no. How is your vision today?

Hi.

I dont drive anymore. Rarely. I cant see clearly on dim days. i wish id never had the trifocal lenses in. My eye sight wasnt that bad but i was fed up needing readers and mid range. I could see really well long distance.

I had one trifocal replaced with a monofocal which helped with blurriness on dim days.

I dont need glasses now but find it comfortable with +1 when im on my phone sometimes, just for clarity looking at photos.

In my opinion if you try varifocal contact lenses and hate them, then trifocal lenses probably wont be for you.

Anyone reading this have monofocal lenses as my husband has. No issues at all and only needs +1 for reading and no halos.

I am really sorry to hears this. Our vision is such an important factor when it comes to joy of life.

Did the post YAG dysphotopsia improve on the eye with clareon, or did the YAG worsened your vision for good?

I also have the at lisa in one eye; almost five months ago (the other eye can wait a year or two before surgery).

Because of severe dysphotopsia , the surgeon and I are considering a replacement for the clareon mono. So that is the exact same iol situation as you.

Are you happy you did the replacement? And may I ask why you only got a replacement in one eye instead of having clareon in both?

Hi

I wanted both exchanged. After i had the tri swapped for single lens, i still wasnt happy, i saw a shadow when i looked straight ahead. That was the single lens. I had to return to Prague where one of the other eye specialists performed laser telling me it would eliminate that shadow. She also performed laser on the trifocal because i told her about the halos. I trusted her!! Bad mistake. Once lasered it cant be exchanged. Too risky. I see better with 1 single and 1 trifocal than with 2 x trifocal. If i hadnt had laser on top, i would have had the other trifocal swapped for single.

If i cover the tri eye, the colours are more vibrant with single lens, too.

ps I had healthy eyes, i just didn't want to wear glasses!!

My advice is get the single lens in asap. Give it 3 months and see if its ok with different ones like me, if not, get the trifocal exchanged.

Thank you so much for your reply and advice. It was also my initial thought, but the problem is that my pupil is larger than the iols on the market (I am 38), so there is a risk that I will also get light disturbances with the Clareon lens because of edge glare.

And I can't stand the thought of how horrible it must be to have this on both eyes.

Therefore, I would like to postpone the surgery on the left eye as much as possible in the hope that in the meantime they have become technically more skilled at producing lenses.

I think it is a very difficult decision. My vision is really good, apart from the light disturbances . But they are very up in my face (not just around the light sources) and I am saddened by the thought of having to see these rings for the rest of my life.

I'm curious, did the shadow on "the clareon eye" go away after you had YAG laser?

And what about the huge starbursts around lights you got on the Clareon lens after YAG? Do you still see these?

Was the clareon lens better or worse after YAG?

Hi Maria

The shadow was still there for some time, perhaps a few months, it was like a small dark arc shape when i looked straight ahead. I believe it was the edge of the lens and it may have rectified itself and that the laser didn't cure it. Anyway its gone now thank goodness.

The Clareon single lens has 4 prong star bursts, they are not as bad as the AtLisa trifocal lens. I hate this AtLisa lens. It has also deteriorated! The blacks are like grey and washed out. If i could get that out safely i would do it tomorrow! They have blurriness, spiders web and starburst around lights.

I know some people may be happy with trifocal, but i am giving my honest opinion on my experience, because if i can save someone from the misery it has brought to me, I will.

Many thanks! black is also dark grey with the At lisa in my eye.

I am curious how bad my "reading vision" is going to be with a monofocal / How strong reading glasses will I need...

Do you know how much help your "clareon eye" needs?

I mean is it around. +1 or +3

A person with a standard monofocal set for distance is in about the same situation as an older person with presbyopia. Standard add for a prescription eyeglass is a +2.5 D. A reader of that power can be used too.

Many thanks, Ron! that sound totally tolerable. Is that the power you need with the Alcon monofocals? And do I understand it correctly; that one doesn't need glasses from a distance of 1 meter and "out there". Is the vision as sharp at 1 meter as for example 6 meters.

Vision will start to get fuzzy at 2 to 3 feet. Each person will be different even with the same monofocal. I can see a computer monitor at 18" reasonably well, but than may be an exception. I have no trouble with my car dash, but that may be the start of the fuzzy point for some. The important thing is not to go positive or far sighted. That is why you target -0.25 D, for some safety instead of going for plano.

sounds good.

Do you see as clearly at three feet as at ten or twenty feet? Or is it gradually getting better?

For me I can see as clearly at 3' as at 20 feet or 100 feet. The fuzzyness for me starts to set in around 2' and gets noticeably fuzzy at 18" but still readable on a compter screen. Not practical to read/use my iPhone with that distance eye though. I use my other eye for that, without thinking about it.

Ah you have monovision.

Thank you so much for answering all my questions. I need to make a decision soon whether I want a iol replacement or not.

Hi Maria. As you know i have one trifocal and one monofocal. There is no point asking about each eye separately, (covered up) as we use both eyes to see, however, as said before, with the different lenses in, i dont need glasses for any distance, BUT for comfort i will use +1 to look at my mobile phone. This is because i spend a lot of time on social media on my phone, rather than my computer or laptop and as the print is smaller its more comfortable.

At work, i use a computer for 8 hours a day and do not wear glasses.

If i cover my trifocal lens eye, then i cannot read any script with my single lens eye until i put it at arms length BUT as above, we use two eyes.

My husband has monofocal in both eyes and like me, does not need glasses, but wears +1 for use on his mobile phone.

He drives about a lot and does not need glasses.

Clarity for me is better having that single lens in. I wish I could switch the other.

Can you ask your optician to put a single lens contact lens in the other eye for you to test how your vision would be, or is that not feasible?

How is it for you to see with both eyes now that the clareon is tinted (yellow/warm) and the AT LISA is clear?

Do you mean that I can try a standard contact lens on the other eye? Or do you mean iol surgery ?

A person with a monofocal set for -1 has about twice the depth of focus of one with a monofocal set for distance (emmetropia),

May have functional distance and reading at about 2 feet. When you set for emmetropia you discard half the usable range of depth of focus.

Hard to translate what twice means when the scale is so non linear. Is 2 feet to infinity half as much as 1 to 2 feet?

andaloosa,

What was your husband's prescription before his cataract surgery? And what Target IOL did he get? thank you.

Hi Julie

Unfortunately he cant find his info, it is over 15 years ago.

He was unable to drive or see far in front, nor read, but he didn't have cataracts. He was around 55-60 years old.

He has no documentation now unfortunately so cant remember much.

He now has 20/20 vision.

He has just said he believes he has 1 single lens for distance and one single lens for near.

He doesn't need glasses for anything except print smaller than text on a mobile phone, but wears +1 for 'comfort'.

He sees minimal starbursts, but they dont affect him.

I hope this helps. Dont do anything drastic because we are all different. Do your research.

Don't end up like me!

Although its true that most monofocals in most people set for distance will start to get fuzzy at 2-3 feet, once again what it always lost in these discussions is lighting conditions. That rule of thumb assumes good lighting.

.

I have one Eyhance set for distance (that ended up going slightly far sighted) and outdoor on a sunny day I can see the tiny complications on my Apple Watch clear as day. Sharp. That's 18". Caveat, I also have 0.75D of astigmatism helping me out.

.

Now put me in a room during the same sunny day with south facing windows but OUT of the direct sun and the watch isn't great. I can maybe only just make out the smaller text (barely if at all). And I can see the computer just fine in the same ambient lighting (not direct sun) but a +1 really sharpens things up.

.

And at the farthest extreme, in bed in a pitch black room reading the iPad with the screen dimmed almost all the way down I can't see anything on screen. Nothing at all. Total blur. But pop on some +3 readers and the screen is amazing.

.

It's all about lighting. With the human lens we can change our focus point to gather as much light as possible at that distance. With an implant you cannot do that. It's always set to the same focus point. So the functional focus RANGE will depend enormously on the amount of light available. Consider your lifestyle. If you spend a lot of time in the woods at night using a compass or GPS for example, I'd say all bets are off. Remember all those defocus curves are based on good lighting,

,

Google Photopic, Mesopic, Scotopic.

unfortunately, i can't read your reply. would you mind replying again? (i asked if it bother you that you have one yellow tinted and one clear lens).

I am also curious -- since my surgeon is now suggesting YAG laser for my PCO instead of a lens replacement (he suspects/hopes my large halos are due to the PCO) -- did the yag laser at all help with your dysphotopsia on the AT LiSA?

I have not had this exact situation, but I have had one eye operated on with a blue light filtering AcrySof IQ lens, and the other eye with a cataract. The cataract eye was noticeably yellow/brown in colour balance. In comparison the IOL eye was bright white to blue. But, with both eyes open it was just a blend of the two colours and was not a problem. The differential in colour balance between a blue light filtering lens and a clear lens will be much less than this, and I am quite sure you would not notice any issue in colour.

Hi Maria.

If you are able to try a contact lens in your other eye, that might help in determining what works best for you.

I tried a varifocal contact lens before i had iol surgery and it disturbed me so much i had to take them out after 30 minutes. I should have known then that i wouldn't be able to tolerate trifocal iols.

My clareon is clear, the colours are brighter.

The At Lisa colours are more muted.

The slight starbursts on the clareon don't bother me.

The yag was only for that shadow, that's gone.

The giant halos and spiders webs and starbursts on At lisa were horrendous, i was suicidal, thats how debilitating they were, but after yag not as big, but there's fuzziness around lights etc and if i could swap it i would.

Also, unless its a bright day, its like looking through clingfilm. There's no clarity after 6 foot with AtLisa and because I still have one in, im still experiencing this.

Just remember that if you have yag, you cannot have that lens exchanged (without more risk). I'd wait 6 months before deciding what to do.

RonAKA, by "twice" I meant 2 diopters instead of 1. A typical monofocal has a potential not-quite 2-diopter range of vision at logMAR 0.2 or better. Half of it is lost if you target emmetropia. You get 1 diopter of useful range. But all 2 diopters of the 0.2-or-better range is available for use if you target -1.0 or more myopia. Yes, the conversion from diopters to units of distance on a measuring tape is nonliner (inverse).

The importance of sharp glasses-free vision at various distances is also nonlinear. Try drawing a graph with inches on the horizontal axis and the importance to you of seeing sharply without glasses at the given distance, on the vertical axis. Not sure what your graph will look like but I bet it's not a straight line.

True that you get more OK range of vision with some myopia offset. However, the sacrifice to get that is losing 20/20 distance vision. Not willing to even think about that. To me the reasonable compromise is to target full distance (-0.25) in the distance eye, which still gives 20/20 in most people, and get the nearer vision from the other eye. Yes, you give up some distance binocular vision and potentially can't get 20/15. I recall I can see about half of the 20/15 line, but again that to me is a minor compromise. Just came back from a one week 2,400 km road trip and never wore glasses of any kind once. I did not drive at night, and would have put glasses on, if I had.