Monofocal set for near, are my expectations too high?
Posted , 12 users are following.
Hi all, I have some questions regarding monofocal lenses set for near. I am a fairly young patient for cataracts (32 years old), and am having some trouble imagining what my vision will be list after surgery. My eyesight pre-cataracts wasn't great to begin with. I have a prescription of -9 and -10. Currently, with correction, I can no longer achieve 20/20 vision. So I have decided it's time to fix these cataracts.
From what I have gathered, looking through personal experiences online, is that there are a lot of patients who just do what their surgeon recommends when it comes to lens options. The surgeons I met with did not seem too surprised at my request to remain nearsighted. What we didn't do, however, was talk about the lens brand they may be using or any numbers as far as how nearsighted I'd remain after surgery. I am regretting not asking those questions now.
I have read a lot of positive experiences from people who have chosen to remain nearsighted (including Bookwoman and Mike2.5 on these forums), so I am feeling confident in my choice to remain nearsighted. I am, however, still another confused cataract patient. So here are my questions:
1.) I am imaging that after surgery my eyes won't be that much different, but it will be as if I have a decreased prescription to get to 20/20 vision. I know I will lose accommodation, but I don't know how to account for it in my post-surgery imagination.
2.) Those of you who have chosen near, what is your eye glasses prescription like? If I get set for -2 does that mean that my new eyeglass prescription for distance will be -2? I keep reading about progressives, and I am not sure if cataract surgery means I will automatically need progressives. This part is confusing me.
3.) If I tell my surgeon I would prefer to have good, clear vision at a range of say 8 inches to 20 inches, is this a reasonable goal?
4.) When you have to wear your glasses because things are blurry, what does "blurry" mean? I know there probably won't be a sudden and dramatic drop in my visual acuity, but right now I am picturing "blurry" as what my -9/-10 eyes see without any correction.
0 likes, 27 replies
rwbil ChristaHere
Edited
I think one of the confusion is that you are ripping out your natural lens which adopts, changes shape to focus the light where it is needed, and replacing it with a piece of plastic that does not do that.
So lets say you go with a monofocal. And I am doing this quickly so please double check my numbers.
When you go from distance all the way down to 25" or so it is 1.5 Diopter. Forget 8". Lets say you set your vision to be 20/20 at 10". To go from 10" to just 16" is 1.5 Diopter. And you vision will degrade quickly.
Now maybe this is what you want, but my advice is to see a Top Ophthalmologist, now some friend recommended one. I am talk top in the country who has a lot of experience with this and spends time making sure you understand the tradeoffs.
If this was me I would consider the Eyhance and do micro monovision to get you down to maybe cell phone distance with "Good" vision and learn to live with glasses for close up work. This way you would see from your cell phone out to distance pretty clearly.
IMHO if you set for 20/20 at 10" you will not even be able to see your TV at home clearly without glasses. I am not even sure you would be able to see the computer clearly.
Guest rwbil
Edited
Yes there is a big difference between being myopic and having the ability to re-focus while wearing single vision glasses (accommodation) and being myopic and having NO ability to re-focus without putting glasses on and off and on and off. The loss of accommodation is the issue. With a distance target you will be able to live life most of the time without glasses… for sure everything from infinity to 3 feet. Or a bit better with Eyhance (maybe 2 feet with a bit of micro monovision). That covers off a lot of vision… most things other than sustained reading or recipe reading, labels, etc. And progressives are still an option to make life more convenient if you wish but they would not be REQUIRED just to exist in the world outside. With a near target set to 8" you'll only see well within a small range of that 8". Accuity will drop off pretty fast on either side of that 8".
RonAKA ChristaHere
Posted
There is one other option to consider as well. That is mini-monovision where your dominant eye is corrected fully for distance and your non-dominant eye is corrected to leave you at -1.5 D. This is not going to give you super close vision but good enough for 95% of things. This is what I have and while I keep; some +1.25 D readers around, I may only need them once a week. The rest of the time I do not wear glasses at all for my iPhone, computer monitor, TV screen, or outside driving. It just requires basic monofocal lenses and the only trick is to under correct the non dominant eye by -1.5 D. It does you reading and close vision, while the other eye does from 2 feet out to infinity. The -1.5 D eye gives reasonable vision out to 10-15 feet so you retain binocular vision from 2 feet out to that distance. This can be simulated with contact lenses too, and that is the advisable way to test drive it before having it done with IOLs.
Hope that helps some,
ChristaHere
Posted
I discussed some possible outcomes with my surgeon, and she suggested aiming for -1.75 in my first eye. Because of the possibility of refractive error, she said it may end up a -2 or -2.5. From there, we will decide what to target for the second eye. I am hoping it goes well and I get the outcome I am expecting.
lucy24197 ChristaHere
Edited
Hi ChristaHere,
I have monofocals set for minimonovision, and my near eye targeted -1.75.I don't have the crazy good near vision that some people get. I've got some underlying conditions that may affect it and I've also seen some folks say those who are quite myopic before the surgery end up with better near vision, but there's no telling how any person will end up. There's a lot of black magic and pixie dust involved. My eyes before the cataracts were quite similar to my IOLs--about -1.75 and -0.5.
As far as getting around the house safely without glasses--it should be no problem. I can look from where I'm sitting to a window a couple of rooms over--about 45 feet. The window has blinds with slats that are about 3" tall. With my -1.75 eye I can see there are individual slats from here--they are not sharp at all but I can see that there are distinct slats. There are some bushes with medium-sized (about 3") leaves outside that window. I can't see the leaves clearly, but I can see that there are leaves rather than just a green blob. I could probably pick my husband out in a lineup (assuming I wanted to.) When I stand up I can see paper clips on the carpet. Not sharp, but I can tell they're paper clips. I can read my digital clock next to my bed (the numbers are probably 3/4" tall.) I can read most regular mail if I hold it out about 19". I can read it a little closer than that, but it starts getting blurry. Fine print varies from day to day and depends on lighting conditions and contrast. If I hold my hand a couple inches from my nose, I can see the lines on it, but they are blurry and don't start to get sharp until about 15" out. I can cook and do most prep tasks with no problem. Computer is fine with no glasses. I would probably wear glasses to watch TV, depending on how close it is. Speedometer in car is sharp.
I have a Jaegar chart taped to the wall, and at 30" I can read down to J4-J5. At 24" the whole chart is pretty sharp. At 20" things start to soften, and at 16" I can't read anything smaller than J3.
For extended reading, medicine bottles, and low contrast print, I use readers. If both eyes were -1.75 I might use glasses around the house, but I've always had better vision than that so a lot depends on what you're used to. I could function without them. Something to consider besides progressives is bifocals with clear glass in the bottom--you'd still have your -1.75 for near and single corrected vision for distance.
For makeup with my results, the bathroom counter puts me too far away from the mirror to do eyes. A mirror where I can stand closer would work--one of those lighted magnifying mirrors works great. Again, individual results vary greatly. I can do my hair without glasses, although for something finicky like a perfect part a mirror closer than the bathroom mirror at counter distance would be preferable. Depending on how close your door is and if you don't have a white dog against a white door, you should be able to avoid accidents--and may even be able to tell one doggie end from the other. Going to the bathroom at night--no problem. Like Bookwoman, I had a rude awaking the first time I showered after surgery--there was some grout scrubbing that needed doing. I can use the phone and read messages.
Once you get the first eye done, you'll have a better feel for life with no accommodation. You can get some cheap readers to see what a nearer target is like, and if you have some lower power distance glasses you can check those out too if you want to consider some degree of monovision.
ChristaHere lucy24197
Posted
Hi Lucy, thank you for such a detailed response. I saw that you had responded and that it was waiting to be approved by a moderator. I know you said that you have some underlying conditions that may have changed your outcome, but it still sounds like you got good results.
Currently, I am wearing glasses that are not updated to my newest prescription, so my vision isn't as good as it could be. But with surgery coming up (next week!) I haven't wanted to spend the money on new glasses. I have at least a 1 diopter difference in my eyeglass prescription. I am going to ask my doctor if this would also translate to different powered lenses (ie, mini-monovision). I keep reminding myself that my vision is going to be better than it currently is, even with losing accommodation.
A few years ago I could take my glasses to do things, but now I can mostly only see things that are within a few inches of my face. If I were to look out the window now, I would definitely only see green blobs. If I look in the dresser drawer I have no idea what I am looking at unless if I put my face in the drawer. If I want to do my hair, I wear my glasses. At night, if my dog gets up I cannot see her by the door, I can only hear her until I put my glasses on. Putting makeup on means getting my face close to the mirror--but the alternative of having my face be a blur up close is scary. I do have a habit of using my phone while watching TV. Right now I just look through my glasses for the TV and for reading on my phone.
If someone else were to wake up with my vision, they'd probably not be very happy. It's funny how we get used to what we have. So far, the responses I've gotten have made me much more optimistic than I previously was. I was imagining a very small chunk of distance that I'd be able to see well and then a sudden drop-off to basically being blind.
I am so grateful for this community.
ChristaHere
Posted
I just got back from my post op. My distance vision in my operated eye is currently 20/50. I see really clear and crisp when I hold things out and away from my face. When I'm sitting down I have to hold things out to about my knee. My distance vision is a huge improvement. I can see so many things now!
Unfortunately, I had an allergic reaction to the medication they put into my IV, which resulted in an overnight hospital stay.
Now, I have to decide if I'd like to move forward and have my other eye operated on (I'd aim for better near in my second eye) or if I want to wear a contact lens in that eye since I am getting good correction and don't have many cataract symptoms in that eye. Surgery, of course, makes me nervous. But I also don't have much experience with contact lenses and worry that I would have to wear it from the time I wake up until I go to bed. I have my next surgery scheduled for the week after next but my doctor said it's up to me what I want to do. It's a lot of pressure to make the right choice!
Bookwoman ChristaHere
Posted
Christa, I'm sorry to hear about your reaction, but glad you're happy with your vision so far. What power of lens did you wind up having implanted? Whatever it was, I would wait for at least 6 weeks until your eye has healed to get the other eye done, especially as it doesn't have a bad cataract yet. At that point you'll have a better idea of exactly what you can see, and how much more near power you think you might need. Don't let anyone rush you!
ChristaHere Bookwoman
Posted
I am not sure what the power ended up being, but my surgeon aimed for - 1.75. She said everything went well and my eye looks great so far. Currently, I am struggling with the difference between my eyes. They are not working together at all... Which was to be expected. I can only look out of my operated eye for so long before it gets tired. I have been trying to cover one eye and look out of the other. The difference is making me sick to my stomach... Which in turn is making me want to go forward the other surgery so my eyes can work together.
Bookwoman ChristaHere
Posted
Yes, I understand this completely. I had my eyes done 2 weeks apart because the discrepancy was just too great for me to handle, plus the second eye had a pretty bad cataract in it. I walked around like a drunken sailor after the first eye, and thankfully my husband was able to do all the shopping, cooking, etc. that I couldn't.
I think it might be worthwhile to try a contact lens, and if that helps you could wait on your second surgery. If not, then you could go ahead and have it done sooner.
ChristaHere Bookwoman
Posted
I am going to try to find some more first hand accounts of what it's like wearing a contact lens in one eye. I am curious if one eye is fully corrected with a contact lens if it will work well with my -1.75 eye , or if my doctor would opt to under-correct my other eye and have me wear glasses with the same prescription in them. I have read that multifocal IOLs in one eye isn't an option, so as much as I want to regret my decision I can't find too much room for regret.
ChristaHere
Posted
It looks like my operated eye, so far, is measuring a -1.5. I have two different contact lenses to try out, one that more closely matches my operated eye and one that simulates -2.5 vision. The contact that simulates -2.5 is more uncomfortable and my eyes don't really want to work together (but it's only been one day). When I close my operated eye and look through my -2.5 contact I am much happier with what I see. I am hoping my operated eye gains a little more near. Since I was so nearsighted to begin with I didn't really care about distance vision at all. Just a bit annoying holding my phone so far out in front of me and not being able to see my face very well in the mirror. Next week I meet with my surgeon to talk about options moving forward.