Monofocal IOL Vision After Cataract Surgery for Near Vision

I appreciate your reply Bookwoman! I should have also mentioned that I have some astigmatism. My Rx is OD Sphere -4.50 Cylinder -1.50

Axis 72 Add +2.50 (progressives). OS is Sphere -4.75, Cylinder -1.25, Axis 104 Add 2.5. I also have some mild pucker (epiretinal membrane) in my left eye (saw retinal specialist)

Cataracts are 1 in left eye and 2 in the right eye (senile cataracts). I don't mind wearing my progressives all day but at night I like to take them off to surf and read on my phone at around 12 inches which is most comfortable while laying on the couch or even in bed.

I am so glad I found this forum. My first ophthalmologist did not want to discuss cataracts/IOL because my appointment was for refraction. He wanted me to schedule a pre cataract surgery

appointment to talk about cataracts which I did but even then I wasn't getting much, if any information about what type of IOL to get. He was more interested in scheduling a second pre op/measurement appointment and the surgery itself. His assistant even said that they like to schedule the

surgery before patients change their minds.

Needless to say I went to a new ophthalmologist. What a night and day difference. He told me he's had good results with patients with my Rx with diopter of -2.0.

Because he wasn't rushing me at all with the surgery I didn't ask him a lot of questions at the appointment. I intend to research about the D-2.0 on my own then followup with him at my next appointment which is where I'm at. He scheduled my next appointment for 6 months.

I welcome any other experiences and suggestions. I fully realize results could be difference among different patients based on many factors.

It sounds like you're going about this in just the right way. So many people just accept what their doctor says without investigating further, and have no idea of what the different type of lenses are and how their vision might be afterwards. Of course there are no guarantees, but being armed with as much information as possible is the best way to proceed.

Eyeglass astigmatism values prior to surgery and those needed for an IOL are not the same thing. The eyglasses need to correct for the sum of the astigmatism in the cornea as well as in the natural lens. The cataract itself may also cause some astigmatism. As the natural lens with the cataract is removed in cataract surgery the IOL only needs to correct the astigmatism in the cornea. One of the measurements taken before surgery and before you select your lenses is to determine what astigmatism will remain after surgery. In general more than 0.75 D can justify a toric IOL, but only if you want the best vision without eyeglasses. After measurements are taken you should ask your surgeon what the estimated residual astigmatism will be. If you wear eyeglasses they will correct any remaining astigmatism.

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Virtually everyone I know that gets progressives ends up with a +2.5 D add. If you are used to the vision you get with a +2.5 Add in glasses, a residual -2.5 D after cataract surgery should give you the same thing. Both a -2.0 or -2.5 will require glasses for decent distance vision so I would choose based on the close vision you want. My view would be that -2.5 would be better than -2.0 D.

Thanks Ron about the residual astigmatism explanation. Since I intend to wear progressives most of the time after my cataract surgery I was thinking about foregoing toric lenses? Do you think that's a good idea? I think you also posted in response to another question that you are able to see fairly well from 67 cm all the way down to 33 cm with your near vision. Do you find this to be typical or not as common? Thx.

I would defer your decision on toric lenses until after you have had the measurements taken to determine what your predicted astigmatism will be after surgery without a toric. If it is less than 0.75 D cylinder then a toric is not indicated. If it is more than 0.75 D and you want the best vision without glasses then it may make sense to go with a toric - obviously at a price. But, either way you go, any residual astigmatism will be corrected with progressives.

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I think my distance eye which has 0.0 D sphere and 20/20+ that I can see down to about 18" is a bit unusual. But, my near vision eye which is at about -1.25 with astigmatism is not doing anything unusual. I think it would be better at -1.5 D and no astigmatism. And the 18" is on a monitor which is bright. I do not see that well with lower light trying to read text on paper. That is one thing you find with an IOL. Lower light levels are an issue.

Thanks once again Ron! Your reply about deferring decision about the toric lenses until after measurements for predicted astigmatism makes perfect sense! I've read conflicting information about toric lens from no risk in trying them to if the surgeon doesn't place them perfectly there could be issues. What are your thoughts on that?

I have diminishing near vision in low light with my natural eyes even though I have very good vision under decent lighting

I think the risk of a toric is low providing you can benefit from it. If you have a prediction of less than 0.75 D of astigmatism a toric is not appropriate. The other issue you should ask about is whether the astigmatism is regular (symetrical) or irregular. Symmetrical or regular astigmatism is well corrected with a toric lens, while irregular may not be.

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The issue with a toric is that the surgeon has to determine the correct angle, mark your eye, and then get the lens in that angular position, and have it stay there. The lens should be checked the day after surgery to ensure it has not moved and is still in the right position.

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You would want to be sure that you have a surgeon that is comfortable doing toric lenses. If they are not, then they should refer you to one that is.