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

Barbara,

Thanks for your reply! It is interesting that I just got off the phone with the doc's office- I called to ask about correcting for near/near or near/intermediate (I suppose that would be the "micro-mini" with bias toward "near"). The person I spoke with told me that with cataract surgery "you're ALWAYS corrected for far vision". Huh? Always? (obviously not, since I just read your reply, which clearly states you were corrected for near!) I kept asking her why that is the case & if there is a reason to never correct for near, what that reason is; also what people do if they get something in their eye, if they need to apply mascara, etc, if they no longer have even remotely decent near vision. She replied that those are things they just have to get used to not being able to do anymore. I'm REALLY becoming frustrated with this whole cataract surgery thing, because it seems that no matter who you talk to, you get totally differenet (& sometimes totally crazy) answers! I told her I really expected, after my eval appt last week, the doc to tell me, "Based on your situation, X is going to be the best choice for you", rather than telling me to do some reading & internet searching & let them know which way I want to go. I am REALLY frustrated! Barbara, how soon is your 2nd surgery scheduled? I will be very interested to know exactly what you end up doing with the 2nd eye & what you think afterwards. 

If you get something in your eye put refresh eye drops in to get it out.  I don't think I have ever known anyone asking for   close up vision.  but some have ended up with it. When you  have distance sometimes you get close up also in one or both eyes or you need reading glasses. If the distance doesn't come out that good you end up seeing close up.   Its just a crap shoot at what you get.

When is your next surgery scheduled? I'm very interested in knowing if you go for mini-mono & what you think about it afterwards!

I am also most interested in clarity. And extremely apprehensive about giving up my near vision. I need to be able to deal with it myself if I get a foreign object in my eye, need to apply mascara, etc... I would love to be able to see my computer screen without having to "cock" my head up & down like I do now, in order to find a spot in my eyeglasses where I can only BARELY read the screen! Not to mention the horrible aching neck that results from all of that.

Hello again.  I am commenting on your recent post following your remark after getting off the phone with your doctor's office and being told that all corrections are for long distance vision!  That sounds eerily familiar.  My doctor who did the cataract surgery I'm not happy with apparently considers the long distance single vision lens the "default" as he ignored our ore-surgery conversation in which I said 90%+ of my life is reading and computer.  Later in my post-surgical appts when I said the long distance lwna was causing a problem for me he first  dismissed my concern, then finally said he could replace it with an intermediate lens. I asked whether that was a safe procedure. A few minutes later he became agitated and upset and said "good vision is good vision, people don't seem to understand that!" He then  stormed out of the room.  So my impression was that most of his patients pretty much follow his direction and he felt I was making waves by not being happy with the outcome.  I guess I'm telling you that because that may be a prevailing opinion with surgeons. Don't know yet. I'll find out though. I have two appointments coming up for second opinions. The first is this week. These discussions have been helpful.  I'll be interested to know what happens after you tell them about your research.

Carolyn, oh my, that would certainly be distressing! From everything I've read, apparently the majority of people DO get corrected for far vision in both eyes. I don't know if that's just a hold-over from the past, or what. Maybe before there was more technology that's just how it was done? But apparently quite a few people have 1 eye corrected for far & 1 corrected for near...a possibility that the doc I saw definitely mentioned to me. Since that sounded a bit strange, I started researching what the pros & cons might be of doing that, especially since it seemed to me that one might lose some depth perception. I also wondered about eye strain & headaches or dizziness. That's what led me to more research & even more questions. Obviously, NOT everybody is only corrected for far vision in both eyes! I'm not sure if the person who returned my call today from the doc's office just happened to also be the village idiot, or what. But I intend to find out! I spent my career in the medical field, so I'm not intimidated by doctors or anybody else. Certainly not by the village idiot who happens to return my phone call. I'd LOVE to hear what is revealed with your upcoming 2nd opinions!

Diane, I've read the opinions of a couple of opthalmologists who were/are also cataract surgeons & who eventually became cataract patients themselves. Both were nearsighted prior to surgery. One of them said if he had it to do over again, he'd have 1 eye set for "near" & the other set "a bit farther out", & just wear glasses to correct anything else that needed to be corrected. The other said he'd have both eyes set to "near" & wear eyeglasses to correct everything else. Those comments coming from ophthalmologists who were/are cataract surgeons AND cataract patients gave me reason to REALLY think about doing what they suggested. There are also a couple of people on this thread who have corrected for near & report that they have been pleased.

re: "if they get something in their eye, if they need to apply mascara, etc"

I'm a typical male who doesn't have need for mascara/makeup, but I'll note that the issue is the same as for people with presbyopia so they make products like magnifying mirrors that can be used for people without as good near vision. For those comfortable with technology, I imagine there are apps for tablets that will use the selfie camera to give a magnified image.  Reading glasses would get in the way, but perhaps they make reading monofocals (hadn't checked) to use one eye to look at the other. 

It does seem like other opinions are advisable and using a difference surgeon if possibel for future work. It is almost always  possible to do a lens exchange, but the best option depends on the person. Sometimes they prefer to make small refractive tweaks using a laser (some docs say PRK is better than LASIK for post-catarat surgery tweaks). Other times adding a 2nd piggyback lens is a better option than replacing the existing lens, it depends on the patient and the doctor what the best option is (and perhaps the country, depending on what technologies are approved). 

i thought it was only my doctor

please make sure you get all your questions answered before you proceed 

I wish I did not do mine 

Monovision is definitely an option people should consider, though I am guessing that your results are above average for only having what sounds like -0.5D of monovision with a monofocal lens, since usually I hear of people getting those sorts of results with more like full monovision, -1.5D. The  level of near vision people get depends on their eye's natural "depth of focus", which can vary quite a bit. A tiny minority can read a bit even with monofocals set for distance, but that isn't something to count on. People should plan for average results  (or below average if being cautious) and then just hope they'll be pleasantly surprised with better than expected results.

Ideally  doctors should encourage people who are presbyopic to test out possibilities before they develop cataracts (and people should encourage their friends/family to do so if doctors haven't). They should  try out   contact lenses in monovision and  try mulitofocal contacts, even if they usually don't wish to wear contacts, to have some sense of what the options will be like when they do get cataracts. Unfortuantely that isn't full test of the experience of course  if their eyes still have some accommodation left so the "depth of focus" is effectively larger, they will have more near vision than with IOLs. However it at least gives some sense of whether they can tolerate differenecs in focus between the eyes, or tolerate multifocal vision. Of course as a side effect some who don't usually wear contacts may decide they prefer them, I much preferred multifocal contact lenses to progressive glasses. 

 

Great idea. Could not agree more with what you're saying, softwaredev. If only I had tried these options before the surgery which left me far-sighted with now more limited and risky options for redo, tweaking and corrections to surgery already completed. I hope everyone reads your wise words and tries out these options before their surgery.

Nope. What I'm leaning toward is the standard lens (not the so-called "premium") in both eyes. And for some reason, everybody seems to be hung up on how much time they can go without glasses post-surgery. Since I have worn glasses EVERY waking hour for almost 40-years now (or rigid contacts for a FEW of those years), nobody seems to understand the fact that I DON'T CARE if I have to wear glasses post-surgery = I really don't remember what it's like to NOT wear glasses! I want the sharpest vision possible (which pretty much excludes multifocals) post-surgery, even if it means continuing to wear glasses all the time!. If I go with torics (which are monofocals), I'll have to wear glasses to correct near (or far, depending on which way I go with the correction), so why spend a lot of extra money on torics if I'll still be in glasses? Why not also use the glasses to correct the astigmatism if I have to wear glasses anyway? Since I've worn glasses most of my life, I'm not accustomed to carrying around readers...I put glasses on as soon as I get out of bed & keep them on until I go back to bed. I don't have to remember to carry glasses with me every time I leave the house...they're already on my face. I don't mind continuing to live that way another 3 decades. I'd rather do that than carry a bunch of readers around with me "just in case I need them"...I would NOT remember to grab them on my way out the door anyway. So, for me it is NOT about being independent of glasses, it's about having the sharpest vision possible, no matter how I have to achieve it. I may (MAY, mind you) consider mini-mono, depending on what the doc says after my next appt (after all the precise measurements are made), but I'm definitely NOT leaning toward full monovision, at least not at this point.

I think softwaredev is on the right track, suggesting docs have you "test" monovision with contacts BEFORE developing cataracts, so a plan is already in place. But that doesn't seem to be the route the vast majority of docs take. It certainly was never mentioned to me & I never thought about it...& I spent a career in the healthcare industry!

So, what I'm struggling with now is simply the decision to correct both eyes for far (& correct everything else with glasses), correct both for near (& correct everything else with glasses), do mini-mono with far bias (correcting everything else with glasses), or mini-mono with near bias (correcting everything else with glasses). The doc says no matter WHAT I choose, I'll most likely need to wear glasses most of the time (due to multiple issues), in order to get EVERYTHING corrected. And I've checked this doc out thoroughly over the past couple of weeks = highly regarded in the medical community in the field of cataracts.

My questions STILL revolve around erring toward far vision or near with the surgery, & the pros/cons of each. I'm still particularly interested in the experiences of those who have spent the majority of their life nearsighted, especially if they erred on the side of preserving near vision with their IOL's (since there seem to be fewer of those people out there). Because things almost NEVER work in real life the way they work "in theory"! I want to know what real people think down the road & what they would have done differently.     

OOPS!!! I made a typo in that last post...should have said I've been in glasses every waking moment the past FIFTY years (gulp! am I that old?!) not 40!

 

i won't try to talk you out of glasses then.  I can only tell you that I've worn glasses for over 50 years and hated them.  I never really saw clearly out of them (I have, or had, astigmatism and two prisms) since the slightest movement of the glasses changed my vision.  Now with torics, one at 20/20 and the other somewhat less, with both eyes open, I have 20/20 vision for distance and can read the tiny printing on medicine bottles without glasses.  I think there is an understandable reason why docs don't initially inform pts of the possibility of this outcome.  If I had been offered the option initially and the first eye had not resulted in such a good outcome, the doc would be in the uncomfortable position of needing to tell me that despite what we talked about, I would, in fact, need reading glasses.  At anyrate, I hope you're satisified with the outcome and get what you want.

Yeah. Near or far (or a bit of both), it's not an easy decision. There is no right or wrong answer, it's just going to be about personal preference. I'm impressed with your intiative in seeking out answers before surgery, since doctors don't always lay everything out as thoroughly as they might. 

I also wore glasses all the time, for over fifty years.  Like you, I virtually never forgot my glasses because they were always either on my face or on my nightstand.  And now, I do indeed often forget my reading glasses or bifocals, because I rarely need them. In fact I generally just keep the bifocals at home for fear of leaving them somewhere.  I very rarely need either readers or distance glasses - I've been fortunate that the doctor hit a very good medium in each eye, where distance is fairly sharp (but not quite 20/20), and reading is also not bad (computer distance, as right now, is just fine). 

I do need readers for very close vision, which is ok - it's rare that I really need them, just for fine print.  I actually have to read things all day long (and am able to without glasses), so I guess that's a testiment to the possibility of having good all round vision with single focus lenses.  I feel pretty lucky. With the wider field of vision I get without glasses, and the sort of "larger" appearance of the world without wearing those lenses - which I've noticed before with contacts - though I was uncomfortable with those - my vision is now the best it's ever been.  So that can happen. 

As we see in these forums, cataract surgery is a bit of a crapshoot, whatever one chooses.  I've ultimately had a good result, but had to go through about 6 months of very annoying "flashing" in my left eye, which finally resolved itself, thank god.  Apparently there is a somewhat higher risk for this in people who are nearsighted, so that's one more possible complication to factor in. 

Personally, I would have been ok with still neading glasses after surgery, having been used to this for decades, but I will say that I like it better without them, my vision is better than it was with glasses, EXCEPT for that very close vision, which I do miss on occasion. It used to be nice, having a sort of built in magnifying glass.  I don't lnow if this is helpful, but it's all grist for the mill, so to speak. Best of luck!

had I done it I would have had no surgery 

now number 2

Please talk to me about tweaking I am seeing b

very blurred and not satisfactory at any distance  10 days after Symphony

please advise

Also I have developed opacity apparently common and will need YAG ? Can anyone comment on that will it make clinical improvement yo my vision 

can I have tweaking and Yag?

when I asked my surgeon who has become not nice at all what if this did not work ( Meaning Symphony ) she said you may need to have again the Tori for Lind distance and to the other eye for long distance too

i am terrified as I hated not being an

ble to read and it would just be worse with both eyes for distance 

keeping positive but when I hear you say the results with symphony are almost immediate I am accepting it just did not work for me ?.