Need Advice on Cataract IOL

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I am 71. I am nearsighted and astigmatic and have worn eyeglasses since I was 12. Ten years ago before I had bilateral cataracts by eyeglasses Rx were -4 and -5. Now with my dense (+3 NSC cataracts), my Rx is -7 and -9. I have never worn bifocals or progressives in my life. Tests show I have 2D of astigmatism. I also have mild ptosis in both eyes. My opthalmologist likes to use the Eyhance IOL. She said she could use the Eyhance toric to fix my astigmatism or she could implant a regular Eyhance monofocal. She said either way I would still need eyeglasses.

  1. The toric IOls will cost me $1,300 each. From what I have read, the toric IOL calculations have to precisely right and some patients don't do well torics.
  2. The other optiion is the regular Eyhance monofocal. It's cheaper and easier to implant.
  3. Which option should I choose? I am leaning towards the regular Eyhance monofocal.
  4. My opthalmologist said she could set either IOL for distance or near, but she recommended near for me. Does that mean that if I got the Eyhance monofocal I could read a computer without eyeglasses? Could I see my cellphone?
  5. She said whatever option I choose, I would need progressives for really good vision. I have never worn them and dread using them. Thank you all for your advice.

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  • Edited

    I got Eyhance in both eyes Oct and Nov 2021. I asked for -1.25 myopia im lifelong myopic didnt want lose some near. I can see near close and far. For total crisp distance clarity i can use the lowest script contact multifocal -50 with low near.

  • Edited

    Hi

    I wanted to let you all know I had my cataract surgery done on both eyes and it went really well. I decided on the Tecnis ZCBOO monofocal and had it set for intermediate distance in both eyes. My surgeon said my astigmatism decreased from 2D to about 1D. I have almost 20/20 in my left eye (done 3 weeks ago) and 20/40 in my right eye done last Wed. I can see my watch, dashboard and computer and everything else easily without eyeglasses. I only need readers to read a book. I have no trouble driving at night. I want to thank Ron for all his advice and also Bookwoman whose experience with intermediate made made me want to try it. My surgeon said my cataracts were "very dense." I am just surprised that I am seeing so well. My surgeon was too. I just hope it lasts. What do you all think? This forum made me a better informed patient. I appreciate all the advice and experience of others. I also did my own research online. Thanks again to all.

    • Edited

      Sounds good. I also targeted intermediate (-1D and -1.3D) and ended up with decent distance (20/20 most of the time) and good reading if the light is good. I went with the Eyhance which might have given me a bit better reading that a standard monofocal. The cost of the better near vision is probably somewhat weaker intermediate vision in dim lighting. The peak of the defocus curve is somewhat lower with Eyhance than the ZCBOO and the only time you'd notice the difference is in low light at intermediate distances. I'm a real believer in targeting intermediate, especially if you are willing to risk wearing glasses if the surgeon misses the target towards myopia.

    • Posted

      It is good to hear that everything worked out well for you. 20/20 and even 20/40 is an amazing outcome when you don't target for distance.

    • Posted

      Greg. I might have gone with the Eyhance but I was told I had 2D of astigmatism and would need probably need eyeglasses to correct that unless I had a toric IOL. I didn't want to have to have a toric IOL for a number of reasons, and I read here that the Eyhance might make it more difficult to correct astigmatism with eyeglasses, so I went with the Tecnis I piece. It seemed to have turned out well for me, at least so far. My right eye was only done last Wed. I hope it lasts. My surgeon said I had much less astigmatism after surgery because of the axis. Whatever that means. My surgeon also that refractive results after cataract surgery vary from person to person.

    • Edited

      Lynda - I read those "difficult to correct" vision with Eyhance posts as well. And was a bit concerned. I had 1.4D of corneal astigmatism, a toric was recommended and like you I rejected it. I chose to make that eye my "near" eye (by 0.4D) and try to make use of any residual astigmatism with extended depth for near (if I can train my brain to make use of the ghost image on the retina.) The limbal relaxing incisions probably reduced my astigmatism by at least half to 0.5 to 0.75D, somewhat noticeable in a few conditions but not bad overall. If it can't be cured with glasses, it won't be that bad. I'm not sure that I'll get glasses anyway. I don't feel like I need them but might get prescription sunglasses for driving since I'd be wearing sunglasses anyway. It's been 2 weeks since my 2nd eye surgery and I've still not bought readers or used any type of helper glasses. With bright daylight, I can read anything but not so much in dim light. I can drive easily at night without glasses.

      But targeting intermediate with just about any type of monofocal seems to be a good way to reduce the need to constantly carry around readers/glasses.

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