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Near vs. intermediate setting for IOLs

Posted , 14 users are following.

judith93585
judith93585

I'm deciding now whether to go with near or intermediate toric monofocals. I have tentatively chosen Clareon over Eyhance due to less rotation and PCO risk. That said, Eyhance seems to have a slight edge in terms of near and intermediate vision. Leaving that aside, has anyone else struggled with the choice of near versus intermediate IOLs? I do not have much experience with monovision so may choose near or intermediate rather than both, with the understanding that monovision may choose me! As background, I have been near sighted since childhood and started wearing glasses full time at the age of 12. I also have astigmatism, hence the toric lenses. Many thanks for any shared experiences.

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  • jimluck
    jimluck judith93585

    Edited

    I am very myopic, 73 years old with astigmatism and cataracts. My favorite glasses are undercorrecting by 0.75 diopters. This give me good computer vision and good enough distance vision for driving and TV watching and good enough near vision for reading. If I need to see something really near, I take off my glasses. So, I am thinking of targeting -0.75 for both eyes and wearing progressives for very far and very near.

    Progressive don't work well for me now, if they are made for my full distance prescription in the top area, because they don't give useful intermediate. But if my eyes were intermediate without glasses, I could take off the progressives for intermediate, and put them back on for near and far.

    I arrived at the -0.75 by doing experiments with trial lenses. I put on glasses with full distance correction, and held up plus lenses of various powers in front of the glasses until I found the most versatile add power. +0.75 proved best. Then I ordered glasses that undercorrected by that amount. Since those glasses arrived, I've used almost nothing else. I have full distance correction glasses, but will go for weeks without using them. And I have a pair of 2 diopter undercorrecting glasses for reading, and I don't bother with them either.

    I should add that my corneas probably have high-order aberrations that make them somewhat multifocal (I have keratoconus) so my experience may not be relevant to others. When I put on scleral contacts to simulate having spherical corneas, I lose the multifocal effect and my presbyopia is much worse. Hard contacts that undercorrected by 0.75 would not work as well as glasses for me. Hard contacts take the relatively flat defocus curve of my natural corneas and turn it into a spike. But, after cataract surgey I will still have my wonderful weird corneas, so I think a -0.75 target for my IOLs will be pretty versatile.

    So, my advice is get a few plus lenses to try in front of your glasses and find out what you like. I don't find that being 2 diopters myopic is very useful. There are times when I need that, but they are rare. I think 0.75 to 1 is the most useful range. You don't have to buy a full trial lens set like I did. You can order individual plus trial lenses very cheaply online. $10 per lens. Or you could buy or borrow cheap drugstore reading glasses of various powers and try them over your glasses.

    • Dapperdan7
      Dapperdan7 jimluck

      Posted

      hi jim. good info though you do have a different situation than myself.

      do you see the trial lens set as superior to just getting a large set of different power contact lens to do your own experiments? is it because you can work with cylinders and axis' etc which gives you way more info on potential iol choices than the selections you would likely get at your optometrist (even costco was going to give me the option of both toric and non toric on the free samples? thanx again. knowledge is power

    • Dapperdan7
      Dapperdan7 jimluck

      Posted

      and why did you not get cheap trial lens frames instead of holding the lens in front of your glasses?

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