Near vision after surgery

Yes, a monofocal for near vision.

About 14" to 27" seems clear.

Also, they can't guarantee people who get premium IOLs like Symfony or trifocals will be able to read without glasses and plenty of people can't.

And monovision (including mini-monovision) compromises depth perception and contrast sensitivity.

And I have read about quite a few cases of people with monofocals set for distance who don't need glasses at all, not for any reading or anything else.

And my vision is 20/20 in one eye and close to 20/20 in the other eye, so my distance and intermediate vision are also excellent. My first operated eye is the 20/20 eye and I could see fine basically at all distances even before I had my 2nd eye surgery. I only needed over the counter mild readers for very small print right after my first surgery (and that improved over time). I drove to the doctor the day after my first surgery and could see my car's speedometer and the rest of my dashboard perfectly with no glasses (it was crystal clear).

So I hope people reading this don't buy into the hype about premium lenses and save their money and stick to standard non-toric monofocals set for distance (and if you have bad astigmatism you can just wear glasses for that, it's not worth the risk of having toric IOLs).

That's what my sister got and she needs reading glasses for EVERYTHING. I didn't want that.  I wonder why you have such a different experience.

 

Yes, I know that but I've had monovision contacts for 20 years and did fine with them. I considered getting the Symphony but my dr actually recommended monovision for me and  I have a sister and a father with macular degeneration. if i were to get it, I was told my vision would be better with this than a multifocal or extended depth of  focus IOL.

I agree on the toric comment. Andi, what was your pre-surgery, pre-cataract prescription?

She's one of the 5% of people with monofocals set for distance who have that outcome. The other 95% have the outcome I have.

I was pretty nearsighted but I had Lasik 15 years or so ago.

And even though my Lasik turned out ok, I wouldn't advocate anyone doing it after I have met lots of people online who have serious complications (some can occur many years later).

Same goes for other forms of refractive surgery (just writing this for anyone who might read it later on at some point).

I know lots and lots of people who had the same outcome I had if not better.

Hi susan44499 - I do not think a surgeon can predict exact outcomes after surgery whether it is with a monofocal or multifocal or EDOF.    Some may not need glasses except for tiny print after a monofocal lens implant and some do.  I would question the % that don’t need glasses though.   After my surgery at 24 hour checkup (waiting with 12 others) I was the only one who opted for Symfony lenses everyone else had standard monofocal lenses.   They weren’t able to read at all.  I was the only one who could.  Since we were waiting together and watched each other do the reading tests prior to private consult with surgeon they asked me how come I could read..  they didn’t know that there were different lens options.

The ability to see better without glasses using a standard IOL is entirely dependent on the shape of the patient's eye, not on your surgeon's skill alone. For example, if you go into a shoe store and measure your foot as an 8.73 shoe size, you already know that you will have to pick a size 9, not a size 8.73. And this is because they only carry standard sizes on the shoe shelf. In the same respect, if you have a size "8.73" eye, there is no "8.73" on your surgeon's IOL shelf. So a "9.0" must be chosen thus the vision may not be perfectly clear without glasses. On the other hand, just like some people can happen to have a perfect 9.0 sized foot for a 9.0 sized shoe, similarly a cataract patient may be fortunate to have a "9.0" sized eye. When he/she receives a "9.0" sized IOL on the shelf, the vision can be clear without glasses for a specific distance. These patients can see fairly well without glasses even with a standard IOL.  There are no two eyes that are alike just as no two people are alike. You will have to speak with your eye surgeon for more detailed information about the specifics of your eye. 

Thanks for your very well-thought out reply. I really like the analogy of shoes because it honestly describes my situation. I've done a LOT of online research, talked to my doc, etc, etc, and finally made a decision that I felt was the right fit for me. What I find so amazing is how pedantic some get over their own particular choice. It's a bit like saying that hiking boots were his best fit so we should all get hiking boots in his size. Just as I know hubby's amazing outcome will probably not be mine, I still feel comfortable enough in my decision that I'll proceed. For those of you that don't agree with the decisions that others make, unless you know that particular situation inside and out, it helps to simply give your opinion in a calm manner and then accept that you may not be right. JMHO

Thanks britkennels.   So true there is no one size fits all.  And I do believe there are many options that would make an individual very content with their choice.   We obviously cannot get back our natural lens but the options available - although not perfect are so much better today than our grandparents and will only continue to improve.

Thanks, Sue.An. I suspect you are correct in that most with two monofocals for distance will need readers. That's why I chose not to go that route. And I suppose though my husband doesn't need readers with his multifocal IOLs (Symfony, actually EDOF) there likely are people who will need them more than he does.

Susan, with a Restor 2.5D multifocal, I can read the 4pt type line on my chart, which I believe corresponds to J1 (and the 3 pt line below that) with good lighting from about 14" to 28". At 36" or 10", I've regressed to 8 pt (about J5).

 

Sue, you've done a lot of research on the predictive outcome issue. I would think that there would be a correlation between corrected vision (pre-cataracts) and a monofocal IOL set for the same distance (post-surgery). The overall structure of your eye shouldn't change, correct? For example, if before you developed cataracts (when correct for distance) you could see clearly from infinity to 6 ft, I would think that that would be the best case outcome post-surgery (since you might have had a little accommodation left in your eyes). 

I can't understand how someone who needed reading glasses before they developed cataracts would no longer need them after surgery with a monofocal IOL set to the same correction point as they had earlier. My eye seems to almost exactly follow the defocus curve for my IOL so maybe that means my eye structure is average, but it's impossible for me to believe that anywhere near 95% of the population isn't going to follow this curve since it's based solely on optical measurements.

Yes been looking into this as some claim they can see near to far with both standard monofocals targetted for distance.  And I do think it is possible but not the probable outcome based on a number of factors.  Power calculation and surgeon’s ability  (and even with healing process we all experience flutuations as that IOL shifts back and forth and then adheres/stabilizes at about 6 weeks.

With IOLs coming in .50 diopters that could be another reason for target not being fully achieved and each eye has it’s unique curvature  (reason for shoe analogy). Difficult  to make a blanket statement.   

95% is what Andy is quoting.  I have not read it anywhere to be a standard outcome.  All doctors say that you will lose accommodation till 5ft with monofocal set for distance.  I test with a coworker who just got monofocal and he had no accommodation for 5ft.  I also met my doctor's husband this weekend who had gotten Symfony and he had no accommodation for 2ft.  And he see the circles at night but he didn't find them bothersome.

Having said all that my mother got her cataract surgery in 1987 with an IOL and she claims to not need any correction for near or far after the surgery.

Did your mom have monovision surgery with standard IOLSs or mini monovision?   Those strategies Wouk provide best scenario for those wanting more usable vision with standard lenses and not wanting night time issues.

I can’t see 95% of people getting those results either.  It’s possible just not probable.

I wonder if those who can read with monofocal IOL's needed reading glasses before their surgery (when corrected for distance) or were they truly "cured" of presbyopia with a monofocal IOL? 

With no ability for the eye to physically alter the lens anymore, I don't see how this is possible for the majority of people without the tech used in EDOF/accommodating/multifocal IOL's or some amount of monovision. On the other hand, being younger, our pupils are larger which reduces depth of field. I would like to see a study where they take a sample of patients with monofocal IOL's, apply any correction needed so that both eyes are plano and then test vision at different distances (summarized by age as well).

 

That's a good question.  She just had one eye done and says that she had great vision near and far from it after the surgery,

It may have been possible that the brain was using her un-operated eye for near vision.

It may depended on the size of the eye.  After all the monofocal gives clear vision for at least 5ft to infinity.  May be if the ye was smaller this range would be 1ft to infinity.  The question really is how do you predict this success.

You do bring up an interesting point about age though.  One of the Singapore top surgeons told me that loss of accommodation is a far more shock for younger patients than older patients who have already lost it.

Yes that could very well be the reason.  If she had good near vision prior to cataract surgery then her unoperated eye could be doing the reading.  She’d have to cover u operated eye and test her ability to read.