Myopia, astigmatism, subcapsular cataract. Any way to maintain near vision after surgery?
Posted , 13 users are following.
hello
im glad i found you. ive been researching on my own after first surgical consult left me with questions ( and the promised " will return all calls", never materialized )
Has anyone who started with terrific near vision been able to maintain that after IOL IMPLANT? i was told it wasnt possible because i need a toric lens unless I opt for monovision and use one eye to read and the other for distance which sounds dizzying.
ive worn glasses for distance most of my life and taken them off to read. Ive never had an issue wearing glasses for distance.The thought of reversing this scares me. Im used to reading a lot and to suddenly need help seeing phone or books or computer is scary . Was this an issue for anyone else?
Thank you
1 like, 101 replies
soks ara21947
Posted
this is a current issue for me. i did not need reading glasses prior to the surgery. i do not have astigmatism. astigmatism actually helps with the near vision.
in my opinion a lot of diopters are needed for near vision with an IOL. so the range of sharp vision you get is small. so it is better to set them for far at around -0.5. that will give good binocular distance vision and also some intermediate / near vision.
on the iol eye i need +2.5 to see HD quality video on phone. but this is HD quality only from 8 inches to 12 inches. the rest of the vision is not that great.
i know thats not what you want to hear and i know it sucks. there are good trifocals that will give you decent near and far but there could be night time artifacts. this process is really prioritizing what u want.
ara21947 soks
Posted
Thankyou so much for sharing. I read opthalmic articles on the importance of the pts lifestyle but basically if your lifestyle is seeing close up, the choices diminish, IT seems a mind tilt to go from perfect near vision to almost perfect far vision that ive never had to miss . I was asked didnt i want HD quality in distance? I dont know since Ive never had that but i have had near vision no matter how small the text or how dark the room
soks ara21947
Posted
i have been myopic all my life. -2.5. so i would never remove my glasses until before bed. at 40 when presbyopia kicked in i started removing my glasses. with that i could read, see my dinner plate and also see someone sitting across the table. i could also see the computer. i could not see tv distance. my near vision was J1+. this near range is a lot more than the near range you would get by setting iol to near. so while you want to be the way you were before it may not be achievable. i am no doctor so this is just my opinion.
ara21947 soks
Posted
soks, I should have read your notes more clearly before my surgery since you are 100% correct.
phyllis31515 ara21947
Posted
I had terrible vision at all distances and wore progressive lens glasses every waking hour prior to my cataract surgeries in August and September of 2019. I previously had lasik surgery approximately 12 years ago. I had good vision for a few years and then it got bad again. I also suffered from severe dry eyes. I had an astigmatism in my left eye. I had a Toric Symfony lens implanted in left eye and a regular Symfony lens implanted in my right eye. I now have great vision at all distances. I have not needed to wear glasses since the morning of my first surgery. My vision was 20/20 at my last appointment in July of this year.
Sue.An2 ara21947
Posted
Hi ara - keep researching and reading and considering your options till you have a good understanding of the trade offs with the IOL options available. Also think where you spend the most time to determine which distance you'd like to see sharply at (more important if going with monofocal IOLs. Even if you do some type of monovision you may get 2 distances where you see well - but usually need a pair of glasses for one of those distances. Surgeons usually recommend or go with a best corrected distance in your dominant eye and then target the 2nd eye closer to give you intermediate distance (computer).
I work on a computer 90% of my workday so I too wanted more than distance vision. I was nearsighted all my life and wore glasses for distance since childhood. I live in Canada and trifocal options were not available at time of my surgeries 2 years ago but we do have one option now. The Symfony lens had just come on the market (they do have a toric version which corrects astigmatism). I ipted for Symfony and have had good vision since my surgeries - typically do not wear glasses at all. I do have a pair of readers +1.25 which I will occasionally use if I can't read a label or fine print or do extended reading (novel). But those occasions are rare and honestly don't carry them with me or have a pair at work.
I suffer from migraines and did not try contacts prior to having cataracts to simulate any type of mini micro or full monovision (was 53 at time of my surgeries - cataracts developed very rapidly). I worried having that set up would bring on more migraines or induce headaches.
Trade off with premium lenses are night vision issues. More glare and halos. For some people they aren't worth having better range of vision during the day.
Wish you well on this journey.
ara21947 Sue.An2
Posted
thanks for your story its a bit frightening to think about a permanent vision change when it has to be done and isnt what you want at all although the way this rapid cataract is growing , i need to do something
Sue.An2 ara21947
Posted
Take your time though in making the decision and as Seeherenow said get several consults as different doctors have their 'go to' lenses and strategies and you may find one surgeon more to your liking than another and more flexible in discussing strategies. Get there opinions on monofocals (and if you want to be more glasses independent) really think you should consider a toric lens whether monofocal or premium lens. Ask each surgeon you consult with their views on monofocsls EDOF and trifocals (newly available in USA). I would not bother with multofocals - 2 focal points as there are better lenses now with EDOF and trifocals to choose from.
I failed my vision test for even holding a driver's lic in Jan 2017 and my surgeries were supposed ti be sooner but I was undecided and pushed those to July and August. I believe I had same type of cataract as you -very fadt developing. Year prior no mention of cataracts and glasses were correcting my vision. The changes were very noticeable that year.
It is possible to be much more glasses independent than ever before - even glasses free. For me at 53 and working full time and active this was a major consideration and not sure if I was usual cataract age I would have paid extra for premium lenses but with many years ahead (I hope) it seemed like a good calculated investment. Everyone has different priorities so please don't substitute my opinions for your surgeon's who will have the skill training and knowledge to better advise you and have the data of your particular situation on file. But these forums are great for support, providing you with options you may not have thought of and sharing of info. Also really helped me to not feel alone in this.
ara21947 Sue.An2
Posted
I kept looking for something like this forum and am appreciative. So much in life we go through alone.
Sue.An2 ara21947
Posted
Well we were in same boat as you and many just boarding the boat. It's been 2 years since my own surgeries and I am still on the forums. Just want to help as I was helped when going through this. I had no idea my vision issue with cataracts. My optometrist could have knocked me off my chair with a feather.
I believe Julielyn had lens exchange done in south Florida (can't recall name - might be Sight Trust?) She can confirm. Sounded like it was a caring place with experienced surgeons.
seeherenow49806 ara21947
Posted
Hi Ara:)
Yes, I succeeded in doing exactly what you're hoping for! I just had my final post-op visit after having original surgeries in June and October 2018 and just having YAG procedure in each eye over the past month, about a year after original surgeries. (YAG is a simple laser procedure to treat "PCO", something that commonly happens after the original surgery.)
My optometrist is astonished at how great my near vision is - better than 20/20 (or line J1 , the last line on the near vision test chart)! I did this by using what has come to be called "micro-monovision" and using 2 different types of IOL's and 2 different surgeons.
If you search here for threads on monovision or mixed IOL's, you may find some of my posts on this subject. Many older surgeons have been stuck in the past, recommending that all patients end up wearing readers for the rest of their lives. FORGET that! I recommend getting one or 2 more surgical consults to learn your options and take your time, if possible. Of course, I don't know what country you're in, or what financial constraints you may have. Also don't know if you have cataracts in both eyes or not, Also, there are some newer IOL's which may give you even better options than I had available last year.
In my case, I was extremely myopic with astigmatism in both eyes. Living in Southern California, I had many choices of surgeons. After research on this forum and elsewhere, I chose to get a monofocal IOL in my dominant Left Eye set for slightly less than perfect distance (-0.5 Diopters), NOT a Toric lens in order to save the extra $1500 that would have cost, not covered by insurance. (And also knowing that I'd been wearing contact lenses with no correction for the astigmatism for many years without any problem.)
The older surgeon who did this for me was an excellent surgeon and I ended up with even better distance vision than expected, at -0.25 D in this Dominant eye. But he wasn't on board with my plan, so I had a younger surgeon with more experience in EDOF (Extended Depth of Field) Symfony IOL's do the Right Eye.
I purposely waited 4 months for the first eye to completely heal before getting the Symfony Toric in my Non-dominant Right Eye, done by the 2nd surgeon. (This cost me $3500 beyond insurance coverage, hence the reason for skipping the Toric in the monofocal IOL.) The reason for waiting is that I wanted to have the best possible power calculation by this surgeon. He aimed for -0.75D to give me slightly more near vision in the non-dominant right eye. Also, this was to minimize the common "night time driving visual artifacts" many people experienced with Symfony IOLs, especially "spider webs" and halos around lights. For some people this was very pronounced and distracting, so I purposely chose to have this in the non-dominant eye. This worked very well for me. In the end, this eye settled at -0.5D, so still very good distance.
My doctors say that the remaining astigamtism in my sominant eye actually helps to give me better near vision in that eye. And of course, the Symfony Toric IOL has corrected the astigmatism in that eye, so I enjoy crystal clear near vision with that eye as well.
I see clearly in a continuous range from near to far. From phone to book to iPad to computer to TV to trees outside to hills in the distance. I was just feeling amazed and grateful about this again today - such a miracle! Don't settle for anything less than possible! Best wishes!
ara21947 seeherenow49806
Posted
i live in florida and will have my 2nd consult friday . i will try to share some of your points i know everyone is different. The toric lens recommended is $3000 per eye. i womder if your results are unusual?
seeherenow49806 ara21947
Posted
Is that $3000 for Toric monofocal IOL? If so, that's way over-priced. But it may be a toric premium IOL, in which case it's about the same as here. You need to know the name/brand/type of the lens/IOL they are recommending so that you can learn more about it online. The brochures and doc visits can't tell you as much as you'll learn on this forum about the various IOL's.
Judging from the lack of follow up at your first consult, I'd say they may not be your first choice.;-) Most insurance will pay for more than 2 consults for this surgery. If you're over 65, Medicare definitely does, since most cataract patients are that age. Definitely worth getting the info you need for something that will affect your vision for the rest of your life.
My first surgery/eye was completely covered by insurance as it was a plain monofocal IOL. The toric monofocal IOL was not covered, so would have cost me $1500 and I knew I wouldn't need it if I got the Toric EDOF in the right eye. The eyes and brain work together brilliantly to give us the best possible combination of vision. I used Credit Care for the 2nd eye/surgery with 0% interest over 2 years. A lot of surgeons offer that to their patients. Eventually the premium IOL's will all be covered by insurance, because they will be best for the patient. In the meantime, we all make choices to best fit the options to our lifestyles and budgets.
The result in my left eye may be better than most for a simple monofocal lens. But the right eye result with the Symfony lens is not so unusual, as 2 other people on this thread have already said that they have great vision at all ranges with the Symfony IOLs. The EDOF IOL's offer continuous range of vision.
Once you have more info and can begin to form a plan that fits you in particular, you will begin to relax a little. Once that happens and you have confidence in your plan, your positive attitude goes a long way to give you the best possible result.:)
seeherenow49806
Posted
Oops! I meant Care Credit. Wrote it backwards.;)
Sue.An2 seeherenow49806
Posted
You are right about insurance companies covering premium lenses eventually. A friend of mine said Quebec Medicare is now covering the premium lenses. So no extra expense for patients living in Quebec Canada.
My personal belief these premium lenses are better than monofocals for most people and the data is slanted towards monofocals primarily due to the expense. Given age most people get cataracts there isn't the demand to pay that much for IOLs. But whether it's medications, climate change etc there seems to be a rise in younger cataract patients - even those wanting (or promoting Clear Lens Exchange) will drive the premium market.
Danish I am not as convinced those that see well with EDOF have better brain adaption. I think it could be one of the factors but I think shape and how well the surgeon has hot the target plays a role too. Wish more data on it could be found.
ara21947 seeherenow49806
Posted
i didnt know there was a toric monofocal only the toric premium i wasnt given any other option . Thanks for telling me
Deb03 ara21947
Posted
Many times toric monofocals are referred to as premium lenses because insurance doesn't cover the cost of them in the US. I agree that $3000 per eye is expensive. Perhaps that is including laser assisted surgery as insurance doesn't cover the cost of it. I do not recommend setting lenses to distance if you want and are used to near vision. Don't rush in to this. Take your time and visit multiple doctors.
ara21947 Deb03
Posted
ACTUALLY the 2nd consultation quoted me $2000 for monofocal toric lens so not sure about premium lens which they say are multifocal even trifocal
i am still weighing getting distance setting since i realize i walk around in a haze a lot othet than doing close work IT will definitely be a major lifestyle change so i appreciate hearing from others who suddenly became farsighted after a lifetime of near sightedness