need feedback re: cataract surgery & correcting for near vs far vision

Hi Polyphemos:  You seem to be  in  a situation similar to mine--left eye needs surgery, right eye is years away.  You'll find a lot of people here searching for the magic solution: one surgery that fixes all scenarios.  Right now, I have the IOL Toric in my left eye for 20/20 vision.   Thinking that my right eye would have surgery this year (a year later), I went thrugh all the options and finally settled on having both eyes fixed for distance, figuring I could have a pair of pregressive lenses for glasses to cover all other situations.  

  To my surprise, my surgeon said I may never need surgery on my right eye. that leaves me with 20/20 in my left eye and -6.5 or worse in my right.  I have 3 RGPs I can wear--one that gives me 20/20, one that gives me monovision, and a multifocal that falls somewhere in between.

      All work OK.

       1. The 20/20 solution is best for reading and inside work when coupled with a pair of cheaters.  I use the progressive versions (about $35 from Foster Grant).  In the USA, you can't get over-the-counter progressives with a 0 Rx on top so it's not a good solution for driving, but it's best or reading and computer work as both eyes work together.

      2. The monovision solution is great for "just daily living."  With a bit of effort I can read most anything and the instrument panel when driving.  It's also OK for a short stint on the computer (very short).

      3. I've had the multifocal RGP for about a month.  It's OK for daily living but I can't read as well as with the monofocal solution.  However, there was no "adaptation time" to using it.  My brain accepted it immediately.

        4. Odd notation.  Both the multifocal and 20/20 lenses seem more comfortable when wearing them for long times (10 hours or more).

     The irony is that in my case, after much back-and-forth with the great people on this forum, I concluded that, for me, the distance correction in both eyes would work best (after all, that's what the majority of MDs seem to recommend). Instead, I find myself in this limbo of wearing an RGP into my 70s.

         I have a very good friend who opted for multifocals in each eye and is happy with the result even though he needs glasses at each end of the spectrum--for real clear distance vision  or long stints of reading.

    My conclusion, therefore, is that most folks who've worn glasses all their lives are best with the distance correction coupled with progressive lenses for near work.  I wore them recently when converting my 14-year-old Subaru "radio" to a more modern version with Bluetooth.  The progressive over-the-counter glasses, coupled with the 20-20 RGP let me read instructions, splice wires and deal with small screws and running wires behind panels.

    Anyway, apologies for the typos. The biggest drawback to this forum is its length and the tedious process of posting and trying to edit as you write.

   Again a big shout-out to all who post good real-ife experiences on this space and good luck in your research.

Cannot answer all your questions but if you have zero tolerance for night vision issues you’d best stick with s monofocal which have the least incidence of them (but no one will guarantee you that you won’t).

If your cataracts affect both eyes it will be next to impossible to try monovision or mini monovision in advance with contact lenses.  However most people tolerate mini monovision with no issue.  I myself have a mini monovision with a premium lens.  I hadn’t asked for that but target is sometimes a bit off.  Although not my requested target I am very happy with the end result.

Yes so true - if only we could keep each question pure and address that one issue.  We tend to go on rabbit trails a lot.

Sue.An, thank you for your feedback..

Hi wgriff01950 - thank you for your valuable feedback.   Your comments have opened new directions in my my strategy concerning my cataract surgery.

I thought I would provide an update.  Yesterday (Jan 16) I had a Tecnis toric aspheric monofocal IOL (model ZCT225) implanted in my LE (dominant) and set for distance. Today I went for my post-op exam.  Results: IOP 16, UCVA 20/20, myopia plano, astigmatism plano.  The surgeon hit the target.

?Looking through my operated LE only, distance vision is crystal clear; intermediate vision blurry closer than 4 feet or so; near vision forget it.  This is with one? IOL only.  Without any residual astigmatism in the LE, and if I have the RE implanted with the same IOL and set for distance also, whether I will get a dramatic improvement to my intermediate vision (24-36".  Or whether I will be better served with a

?mini monovision of -1.25D in the RE to boost my intermediate vision.  One other important point - even with about 8D differential between my eyes at this time, I have no double vision and no nausea - with or without my eyeglasses - as was indicated in various forums.  It seems that my brain has synchronized effectively - there is a bit of a blur but nothing ?extreme.  Managed to do some driving during dusk hours yesterday (with my wife complaining at my side) and noticed some very fine/light halos from oncoming headlights with the perimeter very far from centre of the beams which quickly

vanished as the cars came close.  More to follow next week.

 

Wow - you got excellent results only one day after surgery!

I also have a Tecnis toric monofocal IOL (ZCT450, higher cylinder than yours) in one eye implanted almost 3 months ago.  But my vision wasn't too good for the first few weeks, some days worse than 20/40, but about a month after the surgery my eye started to stabilize has been staying at 20/25 or better now for about 6 weeks.  Most days now I'm getting about 20/20 often even a little better like 20/15.

Intermediate vision (24-36" for viewing my computer monitor I need about +0.75D to +1.00D with glasses.  For near (<18" for reading +2.00D works well. This hasn't changed and I don't expect those distances to change much.

My other eye has only a very early stage cataract that hasn't affected vision and probably won't for years.  It has about 2D cylinder astigmatism and slight nearsightedness (-0.5D) so uncorrected gets about 20/50 or so but blurry at all distances, so I use eyeglasses for that eye which corrects it to 20/15 or better for distance.  I use a progressive pair for now with only the left eye lens in (right lens popped out - the one with my toric IOL) and I got new pairs of eyeglasses recently for computer vision (about +0.75D add for each eye) and for close up reading (+2.0D add each eye).  I will order a new progressive pair soon, just waiting to be sure my right eye with the IOL is fully stable which it appears to be now.

I had a full eye exam a couple weeks ago and the autorefraction indicated my right eye Rx was now plano power and only 0.50D cylinder residual astigmatism which is small enough to ignore if it stays like that or eventually reduces further over time.  For the future, I'm considering eventually for my left eye getting the same Tecnis monofocal toric IOL but perhaps set for slight nearsighted for intermediate vision, probably -0.75D to -1.00D target which works for computer distance vision.  I may also consider a Symfony toric IOL for the left eye to get both good distance and intermedate daytime visoin, but I would be concerned about the night vision effects that lens has so its a tough decision but probably years away for me.

I do notice a faint halo effect around lights driving at night in my eye with the toric IOL, not sure if thats due to the lens or the cornea.  If the latter it will probably reduce with months more healing time.  We shall see, but its not a big deal - its less than the nighttime effects some have described with multifocal and Symfony IOLs thats for sure.

It sounds like your right eye is like my unoperated eye, only an early stage cataract that hasn't affected its vision yet?  Perhaps you could try a couple different contact lenses for your right eye, one set for good distance vision and another set for mini-monovision (-1D or so) to see how that works with your left eye.

I used to wear RGP contacts in both eyes until a few years ago, so i've tried one of my old RGP contacts in my unoperated eye to go with my IOL eye thats set for distance vision.  That gets my left eye near 20/25, but not enough for clear intermediate (computer) distance vision or closer without reading glasses.  I preferred using my old progressive eyeglasses with only the left eye lens in, that was good enough for reading and intermediate just using the left eye corrected, similar to what one eye with a Symfony IOL might achieve, or to a lesser degree like mini-monovision.

Sounds like your vision is clear for your target distance very early on - good news.  I too am surprised with difference between your eyes that you aren’t seeing double.   Another piece of good news.  If your other eye is due for surgery sounds like you could consider monovision or at least mini monovision to get intermediate vision.

Very pleased for you with thrse results.  Must be great to have it now behind you and a relief the target was achieved.

Hi Sue 

?I, too, don't have any problem with only one lense in - the brain does seem to adjust, ignoring the rubbish eyesight and just using the good!  No plans to get the other eye done yet, life has returned to normal

?Trust all is well with you.  I believe you are going away soon so have a fantastic time.  I am very jealous - the winter here, although nothing like yours I'm sure, seems to have been long and hard ... and dark ... I need sunshine on the old body!

?Jenny

Hi Jenny - yes it is great you don’t have to think about doing the other eye for some time.  

It is early hours here - just getting over the flu and have a bad cold to contend with.  Really cannot wait to head to southern Caribbean for some much needed sunshine. Weather has been bitterly cold.  Did have a balmy day of +16 but we had a lot of rain with that.  Just hoping weather cooperates for travel.  Been so up and down and

unpredictable this winter.  

Glad life has returned to normal for you and your vision has stabilized in a good spot for you.  Last year this time I was just diagnosed with the cataracts in both eyes so I am especially glad to have this whole thing behind me.  

Take care Jenny.  Hope you get a chance to go someplace warm too . I hear Spain has lots of sunshine - and not far from you.  That’s been on my bucket list.  Hoping to do a Mediterranean cruise sometime!

Glad you are having such good results already.

Just realize, there is a good chance the vision will change; that is very typical. So you might end closer to -0.5D; which is still a great place to be.

I have come to realize, that maybe mono-vision didn't work for me because my dominant eye did not come out close to perfect. Since you has, that is probably why that is also working well for you.

It is great you came out so well!

Hi.  I have posted on here quite a bit leading up to my cataract surgery on 09/09/17.  I was in the same position as xyzxyzxyz.  I have worn glasses all my life (I am 50) and didn't mind wearing them - high myopia at around -10 ish per eye.  For me I wanted to keep the close vision that I had so I opted to be set for -2 rather than 0 in the operated eye.  I am very pleased with my decision.  I had an Acrosoft monofocal lense inserted and my vision is now -1.25 vs the other eye which doesn't have a cataract which is still -12.  I wear a RGP contact in that eye to bring both to -1.25 and can see fantastically for 90% of the things I do.  I pop -2 glasses on top for driving and distance stuff like reading the projector at church.  For me, because I had such poor all round vision before, being able to see to about 4 ft in front me is a miracle!  I think you have to decide if you mind wearing glasses or not - if you really do, then go for 0/0 so that you're not wearing them when out driving, walking etc. but you will need to put them on for anything nearer than a couple of feet.  Then again, we are all different!  Good luck.  Whatever you choose you can work around.

Just wanted to say hi Jenny.  So glad your surgery went well and you are enjoying good vision.  Happy Christmas to you!

Thank you, Sue, and to you.  How's life looking now?!  What a year it's been eh?  Not sure if I posted on here that back in November the consultant said don't do anything with the 2nd eye, just keep wearing the c/lens to balance out and wait til it needs doing.  Such a nice man!

Hope you have something lovely planned for the festive season - are you going on a cruise in January or was that someone else?

Hi Jenny - yes a year I wouldn’t want to repeat.  Glad to be on the other side and life getting back to normal.  Having to have both eyes done want fun.  Glad you aren’t pressed to do 2nd one and able to see well with contacts.   Working for a bank not much time off for holidays but thankful it’s next to a weekend so gives me 4 days off in a row.

Yes doing a cruise out of Puerto Rico end of January and cannot wait.  First time I will be able to snorkel and see everything!

2019 hoping to do a cruise out of UK - chance to visit with family.  It’ll be my saughter’s Graduation year so might be last family vacation.

Happy Christmas- enjoy the time with your family.

Hi Folks:  I'm still in the same boat as Jenny. (Sadly, it's not a cruise ship).  One eye done (20/20 for distance), the other eye healthy (cataract-wise) and -6.5D.  I have 3 RGPs--one for distance, one for monovision, 1 multifocal.  I can get through the day with the monovision lens and no cheaters, but will use one of the others with cheaters for long stints of reading or computer work. We're fortunate that we all seem to be able to adapt to our varied choices and situations.  Happy New Year to all.