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

Hi Miguel.  I decided very quickly that I  didn't fancy a multifocal, so that left the monofocal.  I got passed around several consultans on the NHS and finally ended up going private.  The consultant told me he didn't do multifocals, only monofocals, and added that anyway he wouldn't consider me a suitable candidate for m/f.  He told me he would be using an Alcon Acrosoft lens.  I was happy to trust his judgement.  AAt the moment I don't have prescription sunglasses so when it's sunny I have to choose between +2 to make things a bit sharper or normal sunnies.    I actually chose the +2 as the sunlight doesn't seem to bother me too much.  In time I may get prescription sunni but I am only 3 weeks post-op so need to see what the eye settles at long term.

Hi David.  As you can see I have posted on this forum quite a bit.  I am only just 50 but had a bad cataract in one eye which was operated on almost 4 weeks ago.  I have always been very short sighted and was told with the cataract surgery I had a choice of whether to go for distance vision or just short of 0.  I didn't understand the ramifications of each option and this forum has been so useful in helping me decide.  I went for just short of 0 and have ended up with -1.75 in the operated eye.  At this distance I can see to about 3'" clearly so I can function around the house and at work without wearing specs.  I have a cheap pair of glasses (+2) which i put on for driving and watching TV and sometimes walking depending how I feel.  I felt that having worn glasses all day every day all my life it would drive me insane having to be putting them on and off constantly to look at anything nearer than 3', e.g. reading, typing, phone, computer, threading a needle, make up, reading a use-by date when I am standing by the fridge, looking at my plate when eating my dinner, looking at medicine instructions, the list is endless.   I am almost 4 weeks done and am very happy with my decision.  I am balancing my vision with a contact lens in 2nd eye which feels less comfortable as the day goes on and as there is a cataract beginning on this eye I am thinking of getting it done to match next year.

I know many people opt for good distance vision and this is more the more common option here in the UK, certainly on the NHS it is expected that you will be set for 0 but it is personal choice.

Arrgh!  Not 3".  3 feet!!!!

Just so David has accurate info:

?You were shooting for -2D, I would not call that "just short of 0" :-)

So the -1.75D, you ended up with, was close to your -2D target; which is great.

?Also, the glasses you have (to get you to distance) are not technically +2; they would be -2.

?A person with a negative D, get glasses in the negative range.

That is why you had to get glasses made and not use readers.

?

?Readers come in positive D, and help you see up close.

?So a person at 0D (or full distance, or 20/20), then puts on a +2 reader, it makes their eyes see as if they are -2D person.

?It can get a little confusing, that is why I wanted to help clarify.

Thanks Mark.  You'd think by now I would know my stuff wouldn't you!  Now I shall look very informed when I see the optician and not like a numpty!

Hi Mark, I have been learning via this site for a week or so......

I found your comment about the readers interesting.  I was told that if I were to be corrected for distance (to 0D) that a Plus 2 reader would work for my close vision?  I actually bought a plus 2 progressive pair of readers and am going to put in my contacts (which when I wear I cannot see up close (2 feet or so) and wear the progressive readers to try to get a preview to things to come. Currently I can see unaided clearly with my left eye at about 16 cm plus or minus 1 cm, and with my right eye (cataract eye) about 9 cm plus or minus 0.5 cm.   That's it!  So I wear glasses all the time.

My eye glasses are -6.25 on the left eye and -6.5 (before the cataract)  on the right eye.  I have had progressive lenses for about 10 years. The current plan is to place a Symfony IOL in my right eye and then wear a contact on the left eye (to balance the eyes), and use the progressive readers. I.E. wear glasses all the time.   I think I'd rather go the contact way to balance my eyes rather than Lasix on the left eye since I'll need a IOL placed on that side within a few more years (slight cataract there).

So can you go into more detail on 'readers' and the proper power to expect once an eye is corrected for distance with an IOL. Thank you.

Mike

I had my right eye cataract surgery early last week and got close to the 0 to -0.25D target for good distance vision around 20/20 now.

I experimented with some different OTC reading glasses I had around the last few days with the right eye now getting good distance vision, but blurry up close vision.

For computer screen viewing about 2 to 3 feet away, +0.75D to +1.00D glasses worked for a clear focus.

For comfortable smartphone viewing about 16" to 22" away, +1.25D to +1.50D glasses were needed for clear focus.  +1.00D wasn't quite enough, I had to extend the phone as far as my arm could go to get decent focus, so it wasn't comfortable there.  +2.00D glasses worked as well, just a few inches closer which some prefer.

For very fine print like on medicine bottles, +2.00D or +2.25D glasses worked well.

From what I've read the Symfony IOL if set near a target of 0D should provide a focus range of nearly 1.50D, so from my tests could work fine for smartphone and computer screen use while still getting good distance viewing.  To get a bit more near like for finer print or closer smartphone use, the Symfony may work for that as well if targeted a little closer like -0.5D and still should provide decent distance vision say about 20/25 or perhaps better (varies with each person).

Mike,

The reader power is really based on how far away you are from the thing you are reading. There is a calculation that they do for that (e.g. if you told them you wanted computer readers and sat X inches away).

I feel, it is more trial and error.

Computers have different font sizes, so that would impact things.

But in general, you need a higher +D for reading a book, than you need for the computer; as the computer is further away.

I find that +1.5D works for me for the computer. I can use them for my phone as well; phone just isn't super close.

A friend that had cataracts is also using +1.5D.

In my car, I find +1D works best for seeing the dash, but almost never do that, just deal with it being slightly blurry. It is about equally blurry if I use my +1.5D readers or nothing at all.

I think it might also depend on the type of readers you get. You can get $150 dollar 'gamer' ones (with yellow lenses) and the lens material is clearer, then the $10 readers at Walmart. I just use the $10 ones.

The other factor is that while you shot for 0D (i.e. far distance) it will not be exact. You might -0.25D (which is still great), you might have a slight astig as well. The astig can have the 'effect' of being slightly more -D.

Of course, the IOL can have some impact as well.

So with all that in play, and how far you are from the thing you are looking at, will impact the readers. That is why some people are ok with -1.25D while another wants -1.75D. It really is what you are comfortable with.

Hope that helps.

That is why anything from a -1 to -1.75 could

For my, the doctor says my glasses adder is +2.5D; but that is really more for reading things up close. So if you do that, they need to be progressives in my opinion.

Thank you for the reply. 

I am trying to sift through the thousands of posts to get an idea of what range of vision I can expect after a Symfony IOL implant.  I have been trying to find a review article showing larger numbers than the original 31 patients in the early studies.

My quick trial with the progressive reader (i.e. progressive lens with no correction on the top half) and a contact lens (yes, old prescription not strong enough) was a failure. Could not see up close with my left eye, and given the prescription was under powered (-5.5) and the progressive was +2 at the bottom I expected much better results.  

I did this because one of the options is to leave my left eye alone, implant a Symfony in my right eye (the one that is about useless due to the cataract) and balance the two eyes with a contact on the left side, then use readers for my close work, with the contact still in. 

The big question for me is what will my closest focus be in the right eye after a Symfony IOL set for a goal of 0D (as opposed to deliberately under correcting and staying myopic on that side - i.e the other option).  

I don't expect perfect vision from the tip of my nose to the moon but if the extra $3000 for the Symfony does not add much close distance usable vision then it is not worth it, since I'd be using readers (hopefully progressive readers) for everything form working, to eating, to driving, etc.....anyway.  

Let me clarify.....if with the normal Monofocal IOL I could see clearly from 4 feet in front of me to infinity and with the Symfony IOL I could see clearly from 3 feet in front of me to infinity, then that extra usable 1 foot of vision is NOT worth 3k, or 6k after the second eye! LOL.

Mike

I guess I misunderstood what you wrote.  I thought you were saying that after correction to 0D, the reader power needed would be -2D as opposed to +2D.   I re-read your post again, so big deal!

Mike  

Another option you might want to consider is s monofocal set for distance then when it comes time forb2nd surgery opt for a Symfony targeted for nearer (0.50) or maybe there is something better by them on the market.  

Thanks Sue,

That minimal focus number is key!  18 inches is pretty impressive and I'd be VERY happy with that result.  What was your starting point?  How myopic were you?

And with the addition of readers how is your very close vision, say 6 inches......

Mike

Symfony appears to provide as much as a 1.5D focus range, so a Symfony IOL at 0D could provide reading similar to using +1.5D reading glasses, probably as near as 18" or so (1.5feet).

If it was set for a little nearsighted like -0.50D you might get a few more inches closer probably similar to using +2.0D readers with a 20/20 distance eye.

But the Symfony or Symfony Toric IOL pricing was only around $600 more than a toric monofocal IOL which I needed due to my moderate/high astigmatism.  So the price delta between a toric monofocal and the Symfony toric IOL is not that huge if it provides the about 1.5D focus range I found I could use to get glasses free for good distance and computer and smartphone use, which is my goal. The tradeoff however is probably night vision artifacts including halos/circles around some lights with the Symfony vs a monofocal.

I read a PDF on the Symfony which has been very helpful.  Your comments are also very helpful!  That 18 inch mark is what I would like! That way I could work without readers at that distance if need be, but hope to use progressive readers to fill in the distance from 18 inches to close.

Sharp vision from the base of my thumb with arm extended in front of me, to infinity would be ideal for one of my hobbies. It's just very hard for me to imagine 'great vision' after years of 'meh' vision. My right eye has been degrading for the past 5 years perhaps more.

My unaided close vision in my 'good' eye is sharp at about 6 inches in front of me.  So I don't think I am sacrificing much 'close vision' if I can read my beeper without glasses at 18 inches.  

My last concern is seeing well through the viewfinder of my camera or through a scope.......we shall see.

Mike

I think if thats important, using a good monofocal for distance in the dominant eye would be perfect for that, and then perhaps a Symfony in the other eye to get decent distance vision as well as intermediate and some near vision.

Thats my current plan.

Mike

I don’t have trouble reading and haven’t bothered at all with readers since surgery.  Will make an appointment soon to see where exactly my eyes have wind up.  At 6 week checkup with surgeon could read J1 off snellen chart at 14 inches / distance surgeon had me read at but at home here my iPhone is 11 inches away.

Sue, the prescription for correction with your natural lens in place has more to do with the shape of your eye then the lens itself (until a cataract begins).   That is why correction is needed. The lens/cornea complex is either too far away or too close to your retina, making the focused point not in the plain of the retina, and thus 'out of focus.'  Corrective lens (eyeglasses) correct your vision by adjusting the focal point so it hits the retina correctly.  So after IOL placement that new IOL power is based on that distance to the retina!  I suspect that the minimal focal distance that one ends ups with is related to that actual corrective power needed.  I am learning more each day. 

Mike