Myopia, astigmatism, subcapsular cataract. Any way to maintain near vision after surgery?

I went to Newsom Eye and it was as if they dropped the ball after I saw him, I was escorted to a desk and handed a print out for $3000. I had no idea about these things and was stunned. When I asked the girl at this desk, she said didnt anyone tell you? I said no. She then ran down hall and gave me a commercial folder on toric lens. Then another girl handed me care credit stuff. I went home home and called the person who said call anytime we are always here for you. That was 10 days ago. I asked my questions on the phone explaining to voice mail why I was calling etc. No ans. No follow up or telling me what my next step was, nothing. Its like I was making an appt to get my nails done or something, not surgery on my eye for thousands of dollars..

Friday I see St Lukes Cataract.

your first consult sounds just like mine! I cancel my followup appointment, and wrote a bad review on their Facebook. All they wanted to do was to sell me premium lens. had second opinion, great md. I have a cornea condition , was never a candidate for premium lens. i now have monovision with monofocal . So so good!

bascom palmer, baptist, or sight trust @ ft lauderdale might be a good second or third opinion...i chose sight trust, as i had lasik with their sister company

bascom palmer was ranked # 1 for years they still might be

basscom palmer still is #1. followed by Wills and Johns Hopkins.

did you have to pay since you went to 3? I know we are entitled to 2nd opinion but imagine a 3rd might be pricey? My vision is going fast with the type cataract I have.

I'm lucky to have had good insurance and only had to cover co-pays. Looking back, i didn't really need three opinions. I imagine if I'd gotten a fourth, it would have been yet another option to consider! This forum provided me with the information I really needed in making my own personal choice. Trust yourself in knowing what works for your lifestyle, then go with the reputable surgeon who is on the same page as you.

Where in Denmark are you? I lived in Odense 6 years and Copenhagen for 1.

Not ever having used bifocals, I Think Id be lost with trifocals i do hope the dr takes some time with me

ara21947 - IOLs whether EDOF or trifocals are not like bifocal or progressive glasses. I had only just started wearing progressives when I was diagnosed with cataracts. I wasn't adjusting well to those glasses. My optometrist when presbyopia first set in said to start progressive glasses before they become really necessary to get used to them.

IOLs are completely different - no getting used to the vision at all. Very seamless vision.

I live 30 km north of Copenhagen 😃

But Like Sue is explaining, trifocal iols is different than trifocal glasses.

With the trifocal I have continuous clear vision from far to about 30 cm. Closer than 30 cm it gets more and more out of focus.

But no iol can give you the same vision as a 25 year old healthy eye, so it is a matter of weighing pros and cons on the different lenses, and choose what fit you best from the options available.

As Danish and Sue are saying, a Tri-focal IOL doesn't work like bi-focal or tri-focal or progressive prescription glasses.

Whereas with glasses, different areas of the lens provide vision at different distances, with a tri-focal IOL, the lens is sending three images to the brain at all times.One image is focused for near, and one for intermediate, and one for distance, and the brain is able to process the three images (one focused and two unfocussed) into a single clear image.

I used progressive prescription glasses before cataract surgery, and tri-focal IOLs are nothing like prescription glasses.

Take your time ara. Can't speak for everyone here but I was blindsided the day I was told I had cataracts. I knew nothing it or shat was entailed in surgery or even that my natural lens would be replaced with an artificial one let alone there are lens options.

I would suggest looking at what each kind of lens offers (EXOF trifocal or monofocal) and then do up a spreadsheet of where you spend most of your time, type of work you do, hobbies you enjoy, sports and maybe a lust where vision due to glasses has limited you and you'd like to do.

The more you read and research and dialogue with people here on forums the more you'll get comfortable with options and steer towards what you want.

Technology has changed IOLs greatly and offering better vision than ever before.

So take a breath and don't feel rushed inti the decision - cataracts aren't life threatening and you can take your time to decide.

Did this latest consult say you were a hood candidate for whatever lens you want?

I fully agree with Sue, try to take your time to take it all in, even that it can be difficult.

About astigmatism, for correcting astigmatism, you need what is called a toric lens.

Monofocal lens, Symfony lens and Panoptix trifocal lens can all be toric.

So you have the option of correcting the astigmatism with a toric lens no matter what lens you are choosing.

yes im definitely going with a toric monofocal lens its BASCH and Lomb im trying to imagine a life where i put on glasses to read yet see distance without i usually dont wear glasses in my home since i know my way about Today i put on my glasses and saw my house is a mess I need to make the decision soon since my surgery is Oct 23

Take some time and read some posts on here. Also look up diopter conversion charts. With a monofocal, many say you can get an additional -1 diopter of usable vision. Some get less, some get more. I think I get less. So with both eyes set to distance with monofocals, most people need readers for ranges up to 3-4 ft in. You say you don't want monovision and I do believe it's not for a lot of people; some do great with it. Another option is mini monovision. You can even go with a slight difference (some call it micro mono). I had both eyes set to distance and ended up more far sighted than plano (20/20). Which meant I ended up blurry at distances up to about 5-6 feet. I ended up doing a lens exchange (for another problem) and asked the doctor to go slightly myopic in my nondominant eye. I still need readers but can "get by" for basic tasks closer in (not near). I will say in doing this that my distance vision is not as crisp, but everything is a trade-off. Given your history of near-sightedness, I'd strongly consider going at least a little myopic in some fashion. I have been farsighted my whole life and can't imagine the adjustment I'd go through reversing that.

I think the majority of people who wear glasses wear them primarily for distance (i.e. it's more common to be near-sighted than far-sighted).Then as people age, often the eye is less able to focus for near (so many people end up needing readers or bi-focal glasses or progressive glasses).

So you decision is not really that different from what the majority people are with cataracts are facing.

Your options include:

(1) go with a premium tri-focal lens. The PanOptix has been approved in the US, and had been in use in Canada for two years (with extremely good results), and in Europe for longer. And Europe has even longer experience with two older tri-focals that provide similar results as the PanOptix.

(2) Go with mini-monovision, where you don't have a huge difference between the two eyes. W-H and his wife did a lot of research and are going with the mini-monovision option. This will expand your range of vision, but you will likely need glasses for reading.

(3) Go with mono-focals set to distance. Here you would probably want to aim for less than perfect distance vision (i.e. aim to be slightly myopic so that you still have some function vision for near).

(4) Go with mono-focals for near/intermediate.

If you are going with mono-focals, it is hard to decide which distance is most important for you and the answer will be different for each person. On the one hand, I think many people underestimate how much of our lives are lived at the near distances. But on the other hand "distance" vision covers a very very large range -- anything beyond about 6 feet is considered distance. Intermediate vision is arms length to computer monitor distance, and near is closer than arm's length. So if you go for near vision, you are getting good vision for a fairly narrow range -- that range may be most important for some people, but you are giving up a lot of vision at a very wide range of distances. And that is why if people have to choose, most do end up picking good distance vision.

If I wasn't going to go for a premium lens, I probably would have gone with option 2 (mini-mono) or 3 (distance, by aim for slight myopia) based on my lifestyle.But I didnt have to choose, as the PanOptix had excellent results in Toronto for two years before I had my surgery done. So after researching the lens, I went with the premium tri-focal so did not need to decide if distance or near was more important for me. , and am very happy with the results. I've posted my experience.

i agree Deb. always go myopic. even if planning plano go -0.5 in both eyes.

The reason for planning a little myopia is that the IOL will settle in the eye, about 0.25 to 0.5DD either way. (Forward or backward.

The toric lenses are simply to correct the astigmatism and are available in nearly all types of IOLs. They don't really have much to do with maintaining near vision, as you posted elsewhere. They just sharpen your vision at whatever range, removing blurry lines or "double vision".

I think i "definitely" made up my mind quite a few times before gathering enough info to actually devise the perfect plan for me. 😉

Unfortunately, many doctors and their office helpers have a habit of pressuring patients to make a fast decision, when it's not really necessary. It's only a part of their sales technique, much like a car salesman. They get you to commit to a surgery date sooner than necessary, in order to make you feel locked in. Don't be fooled by this! You obviously have many choices in Florida.

in contrast, my younger surgeon has done so many custom solutions for patients, using many different brands and IOL types, that he had zero problem with my plan. Also, he's done eye surgery on over 100 eye doctors, so - well recommended.

As SueAn said, cataract may be disconcerting but it's not life threatening - unless you're an airline pilot.:)

If cost is a major factor for you, as it is for many people, then you still have options besides the toric monofocals in both eyes set for distance. Most people can adjust to "micro-monovision" with absolutely no problem, as this is a difference of only about 0.5 Diopters between eyes. This would automatically give you a little better near vision. It's quite common for people to have such a difference between eyes without even knowing it.

Again, I stress that older surgeons tend to push their patients into the prison of "Readers for Life" when it's not necessary. This is partly because they want to avoid any unsatisfied customers and partly because that's what they've been doing for 30 years. But if you can afford $4000 for 2 toric monofocal IOL's, you may be able to afford a different solution that would give you much better vision in all ranges. Don't sell yourself short just because some doctor talked you into it. See if you can find a middle-aged or younger surgeon who isn't locked into the past for a 3rd opinion.

Best wishes!

If I wasn't going to go for a premium lens...

Btw here they call SOME Monofocals Premium lens too 😃

So for example my wife's Zeiss Aspherical Asphina 509 Monofocal IOL is classed as Premium IOL and not covered by insurance.

btw, what is the difference beside cost? better vision?

Why was your wife's Zeiss Aspherical Asphina lens considered a premium lens? Curious. why insurance would not cover it.

Here in Denmark insurance only cover spherical non-toric lenses, why I don´t know.

Although I know that Zeiss have higher prices on aspherical lenses compared to spherical lenses, again I don´t know know why that is.

I believe its because univetsally its been decided since astigmatism can be fixed by glasses it is not a medical problem but cosmetic This is ehat I was told so any lens that fixes that is considered extra cost

Sue/Mutti

Talking of IOL cost only first-

**1) Standard Spherical (Non-Aspherical) IOL- **

No idea of what it costs. Must be dead cheap. Insurance pays for it. Lot of people just go for this one. They rather spend their money on drinks and stuff! In some cases maybe people just can't afford it, no idea. Lot of the people just take anything anyway.

**2) Premium Aspherical Monofocal IOL - **

Dr Zeiss charges $500 for both eyes IOL, other surgeons charge $700-800 for similar premium monofocal IOLs. Comes 100% out of our pocket.

3) Premium Aspherical Mulifocal IOL (Lisa/Lara)

Around $5000 for both IOLs. Patient has to pay 100%.

Spherical vs Aspherical IOL

• The vision from Aspherical IOL is significantly better than normal Spherical IOL.
• Better sharpness and contrast sensitivity.
• Aspherical IOL is more expensive to manufacture too, compared to Spherical IOL.
• Aspherical IOL is also more similar to our natural eye lens.

As far as total cost of both eyes treatment is concerned. Our costs-

$500 for IOLs- We pay 100%

+

Surgery + surgery clinic costs + all clinic visits + meds + rejected surgeons and their visits = Guesstimate currently- $7000.

From $7000 we pay first $1500 (our insurance franchise)

Amount left to pay = $5500

From $5500, 80% will be paid by insurance company and 20% by us = $1100

So $500 + $1500 + $1100 = $3100

I am not sure how many doc visits we have had this year before cataract issue so final cost could be less if we already used lot of our franchise contribution for the year.

So my guess is that this cataract would cost us anywhere from $2500 to $4000.

If all goes well then it would have been well worth it!

It isnt life threatening unless its fast growing and day by day you realize its getting harder to read signs and drive. My glasses help me see at 20/40 and 20/50 at this time and they can no longer be corrected to give me safe driving lenses. I cant see into my closet without a flashlight. When the sun hits y eyes, Im blinded and when its dark I cant see where 1 step ends and the next oe starts. 6 months ago I felt fine visionwise. Now its scary to be honest. Its not clear why I gotthis kind of cataract. Im not diabetic, had only a steroid or 2 my whole life, and no known eye trauma.

Hate this forum's lack of editing feature and also showing stuff bold when I type but screwing it up when it actually gets posted!!!!!!!

Here in Denmark insurance only cover spherical non-toric lenses, why I don´t know.

...because the spherical one gets the job done and they think our eyes are not worth it and get glasses to correct astigmatism 😃 It is all about $$$$

Although I know that Zeiss have higher prices on aspherical lenses compared to spherical lenses, again I don´t know know why that is.

Cost of manufacturing in higher, I remember reading when I was researching.

Can't speak for everyone here but I was blindsided the day I was told I had cataracts.

I was mentally looking for Edit > Undo key on my mental brain keyboard when the doc told my wife that she has fast spreading cataract in both eyes and that she can't wait around!

It isnt life threatening unless its fast growing and day by day you realize its getting harder to read signs and drive.

Catarat is never life threatening anyway. It will just make you blind if left untreated.

Yes you don't want to die due to having an accident!

On another forum their is a surgeon who replies a lot. According to him people who are used to near vision all their life should not give it up by their IOl choice!

He could be right or wrong, I don't know.

We have one Canadian province covering all premium lenses now. Rest of Canada we pay the additional cost so regular monofocal lens is $300 so you'd pay the difference. The toric monofocal lens at time of my surgery was $600 so cost was $300. My Symfony lens was $1,200 but I paid $900 per lens.

In Canada cataract surgery, consults, follow up all covered by our medicare system. They will also cover a monofocal lens $300. Even if you want a premium lens surgery, etc is still 100% covered. I got a credit of $300 towards my Symfony lens and paid $900 per IOL. I believe surgeons are paid roughly $3,500

for the surgery by our healthcare system. One of our provinces (Quebec) will cover premium lenses as well.

I agree many spend for pricey car and vacations every year but begrudge paying for a better IOL. Makes no sense. There are some that cannot afford but many can and choose not to.

Not the most user friendly system and frustrating. Wish it was instant chat too.

I was nearsighted since age of 12. Red measles and fever brought it on - no one in my family wore glasses including my siblings till age set in and reading glasses were necessary. I was vaccinated too - but I know my immune system isn't normal.

The thought of losing my near vision let me to EDOF lenses. Been wondering ever since whether targeting monofocals for near would have been a viable option. However wearing normal sunglasses is totally awesome now too. I thinking target a little near is ideal as you don't want to end up too farsighted but the closer you target you give up more range so that wouldn't be acceptable to me.

They are debilitating for sure but you won't die from cataracts like other medical problems. Unless you drive and have an accident,

It is very worth your while to consider your options to get the better outcome for you. It isn't something easily undone like changing your socks so if at all possible get several consultations and ask questions - do some research as it is hard to even know what questions to ask at first.

It is an extremely hard decision to make. Right now realizing my far vision is a haze and I live in a visual dream state is getting to me, readng how so many actually see what is 2 feet in front of them. I am considering the drastic change of exchanging my near vision to distant and using reading glasses for close up. Either way there will be costs above the $4000 for both eyes, since I will prob need new glasses for some distance? plus reading glass plus I must pay for each refraction visit I have no idea why the first Dr said my lens is $3000 each.

How long does it take for the mind to accept such a change going from near vision to far, do you think?

ara21947

yes, it is a very difficult decision to make, but this forum has much a wealth of information. i was nearsighted since i was 8 years old. Developed cataract slowly over 10 years. i obtained 2 different opinion before surgery, I choose the one who had a excellent reputation.

The lens choice was a different matter, my options was standard iol lens. Have ABMD of my cornea. Started with left eye set at intermediate range. Then i had 6 weeks between surgery to decided what to do next. Choose distance for right eye. ONly 10 days post op right eye.

i do use +1..25 readers to sharpened close . REad all the " sage advice " from this forum. you will make the correct decision.

Ara once the IOLs are implanted there is no big adjustment to get used to vision from near to far. Your vision will be seamless with today's IOLs - just some IOLs will give you more range of focus than others.

I am surprised how much if opting for monofocals your surgeon is quoting. I had thought these were covered by healthcare in the USA. I recall someone on the forums last year inquiring for her ago g mother her need cataract surgery saying it should have been free for her mom but on the questionnaire there was something about correcting astigmatism and once that box was ticked the surgeon could charge her for all the expenses as he used laser vs traditional surgery. There is much debate whether it is better or not but if you decide on monofocals and not correct astigmatism or they do limbal relaxing incision to correct smaller amount of astigmatism you should not need laser expensive surgery.

However if you are going to correct with a toric lens then the surgery could cost more and in my opinion worth the extra money as you would not need to wear glasses all the time to correct for astigmatism.

Premium EDOF lenses like Synfony or trifocals like PanOptic have toric versions of their IOLs which would leave you far less glasses dependent (possibly glasses free).

Decision will lie in which decisions you'd like to see clearly at - I would not worry too much whether it is an adjustment to go from nearsightedness to being farsighted. At the moment with your cataracts affecting all ranges - your brain is adapting to that and will be just fine adapting to an IOL's vision.

Personally I would not target near first (if at all as the range you'll get won't be very satisfying. I would consider premium lenses but if you have ruled those out it would be important to know which eye is dominant and target that one for wither best distance (not plano but more for -0.25 to allow for settling. Better to be slightly near sighted than farsighted). Let that heal 4 to 6 weeks before targeting the other eye .50 nearer than first operated eye. Of course if intermediate vision is more important then target that dominant eye for intermediate vision -1.0 to -1.50.

Take the time to explore all your options and understand equally what you are saying yes to as with every yes you say no to another option and accept those trade-offs.

I am not very familiar with USA medical system but if you are paying thousands of dollars for monofocals anyways please do investigate PanOptix trifocal IOLs. Personally those would greatly interest me as my desire after wearing glasses since 12 would give me the opportunity to be rid of them - of course knowing there are no guarantees. I went in realistically thinking I would need readers with Symfony but 95% of the time I don't wear glasses. At this moment can't recall last time I even wore them.

But everyone is different in their preferences.

Another important aspect is finding the right surgeon so if you have to make several consultations do that. No one is going to care more about your vision than you and you'll have to live with the decision not the surgeon. Somethings we don't need to put much thought into but this is not like our usual purchase.

So wish you the best ara.

My surgeon seems to think like that but I will know more tomorrow. IM not sure if the fact that its posterior subcapsulated will play a role? I will see how the one eye goes before deciding what to do on the 2nd eye

Seeherenow49806 I cant find the post where you said exactly what you did with your numbers. I was set at 1.5 for whatever reason but so far do not (4 days post) have the near vision I had. I went with the toric lens and definitely see sharper but cannot read labels or books or menus or playbills etc close up. Are you saying you can? I have no issue wearing glasses for distance but dont want to get worse near vision. I dont know why he didnt set it closer.

can you see the labels, books etc if you hold them a little bit away from the eyes%? also astigmatism correction makes near a little bit worse. you have corrected your astigmatism with toric lens which would have made your near a little bit worse but made distance sharper.

Hi Ara:)

I hope you mean that your eye was set to (Minus) -1,25D (not Plus)and that it is your non-dominant eye. That should give you VERY good near vision in that eye alone, so hopefully you are just in the healing phase. Remember that the eye drops cause blurriness, so try waiting a little while after putting them in before testing visual range.

I chose to aim for -0.5D in my dominant monofocal eye. After 4 months it had settled at slightly better distance of -0.25D. So my (2nd) surgeon chose to aim for -1.0D in my non-dominant eye with the Toric Symfony (EDOF) lens. That eye eventually settled at -0.75D for best distance. This leaves only a half diopter difference between eyes, barely noticeable and easy for the brain to adapt to. NOw, over a year later, I almost never wear any glasses at all.

Yes, I have excellent near vision in both eyes. I may be unusual, possibly related to having severe myopia beforehand, meaning the eye is extremely long. The astigmatism is uncorrected in my dominant (monofocal) eye, which may give me some more near vision by the eye focusing from slight internal angle. (Not sure exactly how that works, but don't care enough to research it.:)

Occasionally, I use one of those pocket credit-card size magnifiers (very cheap on Amazon for pack of 20) if I need to read some insanely small print for my work.

Take it one day at a time and expect the best - that goes a long way!:)

Hi seeherenow - are you able to read even with monofocal set for distance? That's amazing! How does that eye compare to Symfony for reading?

Hi SueAn:)

Yes, it is amazing - a gift for which I'm extremely grateful. I can easily read small print at about 8 inches with both eyes, The Toric Symfony eye is slightly clearer, partly because the toric IOL corrects the astigmatism, making crisper lines compared to the astigmatic monofocal eye, and partly because the IOL was set for slightly more myopia. I truly have the best of both worlds in every way with this option.:)

Very pleased fir you.

Do you recall Andi on the forums? She had trouble with her ID/user name and was formerly nina prior to Andi

She got 2 monofocals targeted for plano and claimed to see all distances frim about arm's length. Wore glasses just for tiny print. She posted several articles saying that it wasn't that unusual and her brother got same results.

Anyways it does sound like you got best of both worlds! Excellent!

Today my eye is clearer with toric lens reading. What I thought was intermediate -- arms length from computer is considered edge of near apparently. The ID card they gave me says 😒ct 150, 13 mm, 6 mm

diopte +20 se 1.5D cyl

Any distant vision I have is thanks to toric lens. I wish insurance did cover it because I, and most of opthalmic community believe astigmatism is a medical condition but insurance believes it cosmetic since it can be fixed with glasses. Its like saying a broken leg isnt medical because it can be splinted.

thats ZCT. Not sure why it got autocorrected to emoji. Its johnson&Johnson

Agree Ara and called my insurance company to fight for coverage on premium lenses but to no avail. Saying it is cosmetic surgery although they cover lasik surgery up ti what they cover for pair of glasses (that to me is cosmetic surgery!!!)

So my revenge on them every 2 years is buying expensive designer sunglasses (now have 2 Coach frames) for the astigmatism I gave of .75 in one eye.

And I will continue to add to my collection. Have my eye on a cute pair of Michael Kors next year - lol

"arms length from computer is considered edge of near apparently." -- unfortunately that's true. Symfony advertised distance is 60 cm and they still called it presbyopia correcting lens. I remember the surgeon at Wills Eye clearly told me that it would be at arms length. ZCT00 is the non toric version. ZCT150 is the toric version for correcting 1.5 cylinder astigmatism. knowing what you know now would you just go for distance with astigmatism correction or would you go trifocal/edof or would you go more near with no toric and wear glasses for distance and astigmatism?

in the us we believe that cosmetic surgery such as hair transplant is covered by insurance in Canada. Sun Glasses are now allowed by my insurance is but a frame is covered so I buy frames every year.

Can never figure out why some things allowed while others aren't. Prescription glasses regular or sunglasses are covered in Canada if you have private health insurance.

THanks, SueAn.:) I vaguely recall Andi, but no details. Yes, my sister got similar results with 2 monofocals, but even better near. Only needs readers occasionally. Again, she was extremely myopic, which may or may not have something to do with it.

Im still learning but knowing what i now know for the right eye Id still go for near like i did. For very close up - my original concept of near sighted Im still using more of my left eye that still has cataract. Otherwise the corrected eye is better. I taught last night and still coukdnt see the last row of people without glasses but at least they werent in silhouette anymore; That was scary. Correcting astigmatism is wonderful despite the cost. Ill talk with surgeon Friday about other eye. Since its also a posterior subcapsulated cataract it will grow quickly but Im not eager to fix it yet The eyes work ok together

ZCB00 not ZCT00.