Surgery next week, Near monofocal both eyes, +2.5

Thank you so much for posting your experiences.

Just like yourself, I’m one of those rare birds who prefers to preserve their near vision and wear eyeglasses for distance post cataract surgery. Likewise, I’m a myope who has worn glasses most of his life and doesn't mind wearing them after surgery. I want to be able to read books, look at a computer screen, shave my face while looking in a mirror, and identify items on a grocery store shelf, all without glasses.

Since I have mild to severe astigmatism my surgeon had recommended a Toric lens, but I’m resisting that suggestion for a couple of reasons. Fist and most importantly, I have been diagnosed with a low “pump” cell count reading of 1700. Although not considered extreme, I do wish to have my procedure done with as minimal a manipulation of the cornea as possible. The insertion of a Toric lens involves it’s proper positioning around it’s axis and tilt, if I’m correct. This additional maneuvering could conceivably end up costing a greater cell loss as opposed to a standard IOL monofocal implant. Additionally, the lens has less tolerance for decentralization, as vision will become blurry much more quickly in comparison to a standard lens. I have also received feedback from a couple of my peers who have had the Toric lens implant, and they are less than satisfied with the results.

As yourself, I’m considering just getting the progressive eyeglasses, but you state that you only need them for distance and tv viewing. Can you share what focal distance you had done for your lenses? I’m thinking of having a set distance of 18 inches and using readers or my smart phone’s magnifying app for very small print. Since I have a correcting sphere of -1.25, -1.00, I don’t think using readers would be a problem. If I go for just distance glasses, my only concern would then be the ability to see the dashboard of my car while using only distance glasses. That I would have to discuss with my surgeon.

Again, thank you for sharing your experiences. It has helped me devise a plan going forward.

Sorry, I have no idea what my glasses' focal distance is. My prescription is -2 in my right eye, -2.5 in my left, both progressing to a +2.5 add for reading (however I almost always have my glasses off for reading.)

I wouldn't advise just getting distance glasses if you want to see very clearly at intermediate distances. When I say I only need glasses for TV and going outside, that doesn't mean everything else is crystal clear, just that I can see well enough (especially in comparison to my pre-cataract vision) to go about my life at home without them.

Right now I'm sitting in front of my computer, and everything on the screen is perfect; the titles of the books on a bookshelf about 3 feet away are somewhat blurry, but still legible. And when I'm in the car I can see the dashboard very clearly without glasses.

Thank you for the reply.

Actually, I was referring to the IOL's focal distance, not the eyeglasses you are currently wearing. The only reason I mentioned using distance glasses as opposed to progressive is that I've had problems adjusting to them in the past. Perhaps if I chose a blended bifocal eyeglass lens to correct for the intermediate and distance vision I might fare better...my main concern is being able to view the car dashboard clearly while driving.

Ah, understood: my vision is perfect between about 12" and 18".

As for glasses, my ophthalmologist told me that people who are only slightly myopic have a harder time adjusting to progressive lenses than (formerly) high myopes like me.

What you would be best to do is look up the defocus curve for the specific monofocal lenses you plan to get, for example a Tecnis 1, AcrySof IQ, or Clareon. A logMAR of 0.2 is considered good vision. And you can get the distance by dividing 1 meter or 39" by the defocus diopter value. If you select an IOL that leaves you -2.5 D myopic then you should have the best vision at 39/2.5 or 15.6". +2.5 D is the normal add that an optometrist would give you for a bifocal or progressive lens.

Both my intermediate and distance vision are perfect with my glasses on. My near vision is great as well, but even crisper when I take them off, since there's no longer a piece of plastic in the way, so that's why I don't wear them for reading.

One very nice thing about going from high to low myopia is that my glasses no longer cost a fortune, since I don't need high-index lenses any more. It's been nearly 3 years since my surgeries, and I'm still stunned at how well I can see, both with and without glasses.

I have probably averaged about -3.0 D for correction most of my life. When I was younger it was up into the -4.0 range, and more recently it improved down to about -1.5 to -2.0. I have worn progressives for about 25 years. They do work, and I really did not have much of a problem adapting to them. I find the biggest issue is that you need to look down to get the best close vision. That means holding your head up to look at a computer screen, unless you can manage to get your monitor lower. I find the most annoying issue is when working over your head so you have to look up and then cannot see close at all. I found that an issue when working underneath my car. I could take my glasses off but then I always managed to get dirt in my eyes. I would often resort to wearing safety glasses but then of course when you look in the distance you can't see. Outside of those odd circumstances I wore glasses full time for 60 years or more.

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It may be a case of the grass looking greener on the other side of the fence, but when I got into cataract surgery, I jumped at the opportunity to get my distance vision back, and go glasses free. So that is why I went for monovision, and have not regretted it.

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One upside of resolving to wear glasses post surgery is that eyeglasses can make the final and most accurate correction for any residual sphere and cylinder you may have. Eyeglasses are a +/- 0.25 D accuracy, while IOL's are more like a +/- 0.50 to 0.75 D process. And switching an IOL is much more difficult than changing an eyeglass prescription. That is why I always suggest waiting 6 weeks between eyes. Then you know where the first eye really ended up, and can make any necessary adjustments for what you want with the second eye. And the surgeon may learn something in the first surgery too that can be applied to the second eye.

I just got my first eye done..had to go with monofocal since i had lasik 25 years ago, in my 40's. I was quite nearsighted, about -6.50. My first eye was set for -1.50 and i love it! Dr advised monovision, with the next one set for distance, but my quality of life is much more affected by having good near and intermediate vision. at this setting i can read all but quite tiny print and see quite well enough distance to drive and function without glasses..though I will get some mildly corrective ones for when I need to see detail at long range. I am going to inform the Dr that I want the second eye set the same, -1.50 and have the relief of both eyes working together.

that is an excellent decision.

Having one eye at -1.25 and the other at 0.00, I would be concerned about having both eyes at -1.50 without eyeglasses. I don't think that it would be safe to drive. I would expect you would be in the 20/40 to 20/50 range. 20/40 might be legal in some jurisdictions, but I am not sure at all about it being safe.

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To my way of thinking having one eye at -1.50 and the other at 0.00 is ideal. You can do 95%+ of things with no glasses at all and are very safe to drive. I had my second eye done 4 months ago and I no longer have a pair of prescription glasses.

thanks for sharing, it's interesting to hear different perspectives, and what priorities we have. My quality of life is more affected by having really good near and intermediate vision..to avoid eye strain with all the reading I do. You are spot on with the 20/40 to 20/50 range, at least in the eye i had done so far...that's fine for me to see well enough to read signs..and I would rather have the glasses for the maybe 5% of the time when distance is an issue and have stereo vision the other 95%. It's great that we can choose..even if we are not candidates for multifocals, the range of vision I am getting is better than I expected. I"ll let you know how it goes..getting the second one done is a few days!

thanks! i think it will be a relief to have both eyes working together..avoid eye strain and have more depth etc..though I can see advantages to various options of course. What is your experience?

I think the value of "matching" both eyes in correction, as well as brand/model of IOL is way over rated. More can be achieved with not matching them. For example if one is sold on a Vivity lens, I think it is best used in a non-dominant eye, with a full distance correction monofocal like the Clareon in the distance eye. The monofocal makes up for the shortcomings in contrast sensitivity of the Vivity, while the Vivity allows closer vision than two matched monofocals for distance.

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With monovision the key is the difference between the two eyes. With a full distance eye, and one eye at -1.25 to -1.50, the loss in binocular depth perception is very minor.

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I am in your surgeon's camp on this one...

can you, and do you, read a lot, do a lot of detail work focusing 12 to 18 inches

with your current settings, without glasses? thanks

Yes, for sure on my computer monitor at 12" to 14" using normal print size on a 24" monitory. My near eye starts to get a little blurry if I try to look at something closer than 12". The useful range extends out to 6-8 feet and helps some when watching TV. But my distance eye does most of the work at that distance. The distance eye starts to get blurry at distances closer than about 18". This is all without glasses, and in fact I don't have any prescription glasses that are correct for both eyes since my near eye surgery in February. There is a chance I may get Lasik to make a small correction to my astigmatism and to try and bring my sphere up to a full -1.5 D. I ended up closer to -1.25 D. I don't see the Lasik surgeon until August so I won't know if they can do that or not. After that is over with I probably will get a new progressive lens in the glasses I now have but never use. I expect they will be little used, and probably only for occasional night driving in the country. In the city I drive at night with no eyeglasses. With both eyes and no glasses I see about 20/15.

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Oh, if I am going to do some really detailed fine work I put on some +1.25 readers. I have threaded a needle with no glasses at all...

thanks..it sounds like you are happy with your decision thus far, for the most part. I've really appreciated reading about the experiences of others and will share my outcome after surgery Thursday. I am seeing my dr tomorrow for pre-op review and we'll see if he has any valuable input.

Yes agree more can be gained from a mono vision or mini monovision approach using monofocal IOLs Ron however not all should go that route especially if you cannot do trials with contact lenses ahead of time. I suffer from migraines as well as vertigo issues in some circumstances (cataracts too advanced for any sort of trial with contact lenses). There are definite benefits as well to having both eyes targeted for same distance. If someone needs close vision for their hobbies targeting both for intermediate and wearing glasses for distance is also a strategy preferred for some.

Then there is the unknown factor. cataract surgery itself can cause a further vision issue as it did in my case with epiretinal membrane. In hindsight glad I did not look at monovision option or I'd be more 'stuck' than I am bow.

I would encourage all to evaluate their vision preferences and unfortunately have to rank them bc cataract surgery is not a win win for people - more do if you are younger with cataracts. There are pros and cons to strategies as well as the lenses you opt for. If anyone has the time get as much info as possible and give dome thought to your preferences and your personality type (it does come into play in your tolerance for imperfection oddly enough).

My learning with mini-monovision is that the difficult part is accurately getting the close eye at -1.50 D. If one already has that, it seems hard to pass up the opportunity to get distance in the second eye. Error is less critical at distance than for a closer eye. If the surgeon goes over on the + side with the distance eye that is not good, but being -0.5 D is not a big deal and may even help close vision a bit.

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But that said, mini-monovision is not for everyone. I think it has gotten a bad name because surgeons were trying to do too much with the close eye and targeting -2.5 and even -3.0 D. I can believe that would be really hard to get used to.

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My other learning has been that if the surgeon is going to miss on the close eye it is better to be left with more myopia, not less. The reason is that Lasik can easily reduce myopia, but increasing myopia is difficult.

Yes. It is something I would have appreciated being able to experiment with. not sure even if I could have tried it out given migraines etc I would have - or at least not more than .50 between eyes. Even with my EM condition if I close my right eye things start to swirl seeing all lines curvy makes me seasick. Really hoping my RE holds up.

Something I think people should do before cataracts affect their lives. Thinking most surgeons do not target true plano - as more distance benefits no one.