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Not sure what to do!

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limagee
limagee

I have surgery scheduled in 2 weeks for first eye and week after for next. Without the cataract my vision is actually very good. Near vision has never been an issue and a slight correction for details at distances but could drive without glasses. I've been blessed!

Now - I have to choose what I want to see. I don't want to have haloes at night - I'm trying to get rid of that!

I am really struggling with what distance to choose and it's honestly making me very sad. I work at a computer every day so that's a bigger concern than up close reading. If I get either close or distant vision can I see the dashboard of the car and my computer screen? ) I'm used to wearing contacts for distance so wondering if close is the way to go? I'm fine wearing lenses for up close if needed where I can see far and computer.

Thanks so much for any thoughts or experiences you can share.

0 likes, 9 replies

9 Replies

  • RonAKA
    RonAKA limagee

    Edited

    The first bit of advice I can give you is to NOT schedule your surgeries one week apart. Why? Cataract surgery is not like getting eyeglasses where 0.25 D accuracy in correction is routine. Cataract surgery accuracy is more like 0.5 D, and sometimes "surprises" can happen which are even worse. The responsible way to do surgery is to schedule the second eye a minimum of 5 weeks after the first eye. In that length of time your eye will have fully recovered and an eyeglass refraction will let you (and the surgeon) know what the actual outcome is. A responsible surgeon will use this information to refine their calculation procedure for the second eye to correct any "miss" on the first eye. The other thing to insist on is an exam 24 hours after surgery. This is a check to see that the lens has been correctly implanted. At this point in time the incision will still be open and an adjustment is possible. Keep in mind that a miss with an IOL is not nearly as easy to correct than a miss with eyeglasses. Exchanging one IOL for another one is not a simple procedure and has risks that are best avoided.

    .

    To avoid halos and other optical side effects you are best to stick to monofocal lenses. The downside of that is that a monofocal lens cannot give the full range of vision from close to far. You have to pick the optimum distance they are set for, and it sounds like you already know that. There are three basic ways to go with monofocals:

    .

    1. Distance Vision in both eyes - This gives the best distance vision for driving, day and night, without risk of any significant side effects like halos or spiderwebs. However reading glasses are going to be needed for near vision. At what point varies from person to person, but it is in the range of 2 to 3 feet. I suspect most can see their dash, but computer work is not likely unless you use a very large screen monitor at 3 feet or more away. 90+% of people choose this option. To see well without glasses it is best to use toric lenses if astigmatism is predicted to be more than 0.75 cylinder.
    2. Near Vision in both eyes - The usual target is about -2.0 to -2.5 D of myopia. This option allows you to be eyeglasses free for near vision tasks like computer work, reading books, or sewing etc. Far fewer people select this option, and it requires bifocal or progressive glasses for sure. One upside is that any refractive error or astigmatism can be corrected by the eyeglasses, and this option probably does not require a toric lens unless cylinder is predicted to be quite significant.
    3. Near Vision in one eye and Distance Vision in the other eye - This is called monovision, and those who do it most often select a differential of 1.5 D between the eyes (mini-monovision). This option is attractive to those who want to see both near and far without glasses while still using monofocal lenses. Torics would be indicated if astigmatism is predicted to be greater than 0.75 D. In this option it is best to simulate the outcome using contacts and is best done before cataracts progress to the point where they impact vision. If this seems of interest there is a lot of discussion at this thread about the Pros and Cons of Mini-Monovison.

      https://patient.info/forums/discuss/the-pros-and-cons-of-mini-monovision-798485

      One of the issues with mini-monovision is that some surgeons do not want to be bothered with it as there is no extra money in it for them. It does require a little more care on their part in hitting the correct targets, and some don't want to do that. The only solution to that is to find a more sympathetic (and confident) surgeon.

      .

      Hope that helps some. If you have any questions, just ask. Your dilemma is a common one when getting cataract surgery. We have all been there with it...

    • aspen88
      aspen88 RonAKA

      Posted

      thank you, Ron. very helpful summary.

  • trilemma
    trilemma limagee

    Edited

    Did you discontinue contacts for a period (month?) before you got your eyes measured? You should have.

    The topic that you are asking about is very common on this forum. Many of us think mini-monovision is the way to go. Others like multi-focal lenses, but that would not work for somebody who wants to avoid haloes . Then there are EDOF lenses... not sure of what to make of that. I think I would avoid that for my distance eye. Looking thru past postings should be useful.

    Dashboards don't have fine print, so they are usually not a problem. Computer montors can be had that are larger. For up-close considerations to me it is phones, product packages, paper books.

    To postpone deciding finally, get the first eye done for distance. Then based on how that performs, consider what to make the other eye. Having a close eye targeted at -1.5D is popular.

    There are many things that you did not say that could have been relevant. You did not tell us your eyeglass prescription if you have one.

    • RonAKA
      RonAKA trilemma

      Edited

      Soft contacts should not be worn for 1 week before measurements, and hard contacts are more like 4-6 weeks. Another precaution would be to use dry eye drops 3-4 times a day for two weeks before measurements.

    • Lynda111
      Lynda111 RonAKA

      Posted

      . "Another precaution would be to use dry eye drops 3-4 times a day for two weeks before measurements."

      That is very important, and something many patients don't do but should do for the best possible measurements.

    • RonAKA
      RonAKA Lynda111

      Posted

      Yes, I think surgeons can be lax on these points. My surgeon said nothing about wearing contacts before measurements but I knew enough to stop using them before. There was no mention of dry eye drops and I did not use them, but would if I had to do it all over again. This said my surgeon's measurements and calculations seemed to be as accurate as they could be.

  • Guest
    Guest limagee

    Edited

    I'm unclear… are you saying you have excellent vision now? If so, what is the reason for doing the surgery now? As for the end result, I think most people that target "first minus" distance with the Alcon Clareon Monofocal or JnJ Eyhance Monofocal will have little or no problem with dashboard vision (altho' it may be a little more challenging at night in low light).

    .

    I think single vision glasses are a great solution for the computer (if you are not lucky enough to end up with glasses-free computer vision which isn't likely but also isn't unheard of) because A) computer use tends to be a prolonged activity (so you don't have the pain of constantly putting readers on an off as you might with an activity like grocery shopping) and B) computer use usually happens in one place that doesn't change so it's easy enough to just leave your computer glasses on the computer desk all the time (so you don't have the pain of always looking for your misplaced glasses again as you might have with activities like shopping where you're carrying glasses around with you from place to place).

    .

    For me (1 cataract eye + 1 Eyhance set for distance) the only thing that can be a pain is shopping. For that I often use the magnifying glass feature of my iPhone (to read a small label or shelf price details). Your mileage may vary.

  • limagee
    limagee

    Posted

    I appreciate the feedback. I have not worn contacts for some time. As I mentioned aside from the cataracts my eyesight is actually very good which is the frustrating part.

    I also have been using drops daily for several weeks.

    • RonAKA
      RonAKA limagee

      Edited

      Still having good vision and being ok with wearing contacts is a plus. It allows you to test drive mini-monovision. Many leave their cataracts until their vision is too poor to do a test, and/or are afraid to try contacts to do a monovision test. To do it is quite easy. You just add 1.50 D to the contact prescription for the eye that you want to use as the near eye (usually the non dominant one). If it is -2.0 D then you would use a -0.5 D instead.

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