Received intermediate IOL - Would a distance IOL have been a better?
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I recently took my 65 year old mother in for a cataract removal with IOL replacement procedure on one of her eyes. We made sure to go to a very well regarded surgeon. During the initial evaluation my mother was asked about her lifestyle - due to mobility issues she spends most of her day sitting, with activities including cooking, watching tv, using her phone, and spending time with family. Taking her lifestyle into consideration and factoring in her astigmatism in both eyes, the surgeon recommended that my mother go for an intermediate distance IOL in both eyes, and then use glasses to fine tune her far distance vision and readers for anything very close. My mother decided to go with the recommendation and had her first eye done last week (Technis Monofocal +19.5D IOL was used)
The procedure has improved her vision in the 1ft-8ft range on her operated eye. She can now see blemishes and white hairs on her forehead/face when looking in the mirror, as well as read better at 6 ft (versus just 3 feet on her non-operated eye), and read license plate numbers at ~ 8ft (versus blurry in non-operated eye). When it comes to street signs however and seeing in the far distance, things seem to have slightly improved but looks like glasses will be required for full clarity. To see very close (1 feet or less), it looks like readers are needed.
Post-surgery I started feeling like maybe my mother should have opted in for a distance lens. I brought this up with the doctor, and was told that had we chose a distance lens, she should have needed glasses for the intermediate range as well as near activities. I asked if monovision would be a possibility (use a distance lens on the non-operated eye), but was told this was not recommended for my mothers case since it may confuse her. The doctor reiterated that once a second intermediate lens is placed in her other eye, things will balance out even more and that with some distance glasses for fine tuning, everything will be nice and clear in the far distance while allowing my mom to go about her daily lifestyle activities without the need for glasses.
I know I might be overthinking this, but hoping to get some thoughts regarding the following questions:
- Should my mother have chose a distance IOL?
- If a distance IOL was used, would she have needed to wear glasses for intermediate range? I stumbled across a thread from someone saying that they opted in for distance and it ended up making their intermediate range clear as well, and now they only need readers.
- Should we hold off on the other eye and get a second opinion?
0 likes, 6 replies
RonAKA seeker2
Posted
There is a contributor here that has a correction similar to what your mother has been recommended, and seems to like it. Perhaps they will comment on your question.
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I am on the road to monovision with only the distance eye done so far. So, if it were me, I would get a distance lens in the second eye. It is surprising how close I can see with the distance eye. On a bright computer screen I can read at about 18", and the dash instruments on my vehicles are no problem at all. I get better dash distance vision with my distance IOL than I do with my close eye which I simulate with a contact.
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I think a starting point would be to get an optometrist eye exam to determine where the IOL eye is. An under correction of about -1.25 to -1.50, in my opinion is ideal for the near eye.
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It is best to simulate monovision before you actually try it with an IOL. However that needs your eye to be good enough to be suitably corrected with a contact lens. Not everyone reacts well to monovision.
Pifutoast seeker2
Edited
I am your mom's age. I decided on a distance mono focal in my right dominant eye and an intermediate mono focal in me left eye. I am about two months out from surgery.
The surgeon slightly over corrected my distance eye, which decreases the nearer focus for that eye, without any benefit to distance, which I am still at 20/20. So thing could have been even better
For me, that put my focus for the distance at about 3 feet out. I can read line 8 of the Jaeger eye chart at about 36"
The left eye intermediate is focused around 15" - 26 ". If I had both for intermediate I would need glasses for close reading and more for distance. If I close my right eye, everything is out of focus at past 3 feet. I would need glasses for watching TV, and all distance past 3 feet. Everything blurry just walking around, no thanks.
I personally would be miserable with both set for intermediate. Both for distance would have been fine, would have put me back where I was 18 years ago, where I needed glasses for close range.
Where I'm at now with both eyes open, I can read line 1 of the Jaeger eye chart(pdf available online), at about 18". I have not worn glasses since the surgery, text and use the computer with no issues, I can drive at night and compared to my cataract eyes, it's fine. If I had to drive more frequently at night I might get glasses for that, and was thinking of maybe getting a pair of readers if needed for fine print, but I am doing fine without and may not.
So I am mostly glasses free all the time. This option was never offered by my eye doc or the surgeon. I had to educate myself and with the help of others on this website I was able to make a good decision. I would recommend continue your research, since there is no going back.
Guest seeker2
Edited
From what you've said I think you made the right decision. And yes as long as you are using monofocal IOLs you will always need glasses for some activity or another as they can only be optimized for one distance. So you consider your lifestyle and choose the distance that would be best for you. Which is what you did. And yes once both eyes are fixed and they can work together overall vision will improve somewhat at all distance due to binocular summation.
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There is no such thing as a "distance" IOL or an "intermediate" IOL by the way… they are the same IOL just in different powers. And yes there are some IOLs that use some funky optical tricks to try to spread the light out over a greater focus range to reduce the need for glasses but they all come with tradeoffs in vision quality and so they are not suitable for all patients (like if your mother also has macular degeneration or something a "premium" IOL may be contraindicated anyway). Also if you live somewhere with public healthcare standard IOLs are paid for but a "premium" IOL would not be. You'd have to go to a private clinic and expect to pay as much as $7000 or more.
RonAKA Guest
Posted
A monofocal lens is a bit of a misnomer in my view. For example a lens that is optimized for distance will let you see down to about 2 feet quite clearly or perhaps less. That is quite a wide range - from two feet to infinity.
Guest RonAKA
Edited
Yes. It basically means that it is optimized for one zone with one single 20/20 peak. For the most part they attempt to focus all the light at one point. Multifocal IOLs on the other hand have multiple 20/20 zones but there are quality trade-offs. But you don't really need 20/20 vision at all distances. Depending on font size you may be able to read at 20/40 or even worse. And 20/25 or 20/32 is still good functional vision. As you say it's not like you're suddenly blind to anything closer than 6 feet. It's just not as sharp and then at SOME point it's too blurry (which on average is within about 3 feet for most people but there are wide deviations from person to person). Basically with a monofocal IOL set for distance they best they can PROMISE you is usable vision from 3 feet out with very sharp distance. You may end up with a better or worse result.
vic64836 seeker2
Posted
I am a 66 year old woman. About three years ago I got an intermediate IOL in my left eye and I am very satisfied. I can read my phone and my computer, and any labels if I hold them far enough away. I see clearly for reading recipes and cooking. I could read a book without readers, though I prefer to read smaller print with weak reading glasses. As I had to read with reading glasses before, that did not bother me either. Objects at a distance are somewhat blurry but really not very blurry. Of course signs are blurry, but in an emergency I could get myself home without glasses. When I take walks, I don't wear glasses and I don't even pay attention to the mild blurriness of things at a distance. I have worn glasses for TV and driving for years so I don't care that I will continue to. Coincidentally, I had my right eye done early this morning. I was thinking about doing "mini monovision," and set the right eye for distance, but I was worried that I would be bothered by the range difference and would not get used to it. After talking with the doctor, who told me that many people get intermediate IOLs in my both eyes, and since I had been satisfied with the intermediate range in the left eye, I had an intermediate range IOL implanted in my right eye as well. When I have healed up and gotten used to the new intermediate lens, I will report back.