To Do or Not to Do
Posted , 9 users are following.
I am a 65 years old male and had a multifocal IOL placed in my left cloudy eye 4 weeks ago. The vision was improved from -800d to -275d. My right eye isn't cloudy, but has cataracts. The right eye is -700d. I'm wondering if I should wait or have the immature cataract removed and replaced with an IOL so that the vision may be corrected to approximately -200d?If I don't remove it then I'll have anisometropia. Perhaps glasses can correct this difference. Not sure. Any comments?
0 likes, 42 replies
acc925 Eye-Kan-Sea
Posted
Although my situation is different from yours, I too had a pretty severe prescription (it sounds like yours may be). I was +9 in one eye and +10 in the other (farsighted). I also had immature cataracts. I was much younger than most when mine began to form. Apparently, extremely farsighted people have a tendency to develop cataracts at an early age. I chose the surgery to minimize my risk for narrow angle glaucoma (another perk of being extremely farsighted). That being said, my surgeon didn't want me to wait more than a week between each eye because the difference in each eye would be too great to function - neither glasses nor contact lenses were an option. Basically, I was rendered handicapped until the second eye was corrected. In fact, during the one week period between surgeries, I thought it a good idea to go for a walk - I subsequently broke my ankle. Double handicap! Your surgeon can best answer your question, but if your prescription is as severe as mine was, having the second eye done sooner rather than later might be the way to go. Good luck.
Eye-Kan-Sea acc925
Posted
Acc925,
Thanks for your answer about your eye prescription being severe and because of that you had both eyes operated on to even out the vision. Yes that's a point to consider. Currently I'm not wearing glasses and rely on the one IOL eye to carry my vision. Consequently the non-IOL eye waters more and occasionally there's a light headache on the right side.
Cheers
EKS
michael74313 Eye-Kan-Sea
Posted
There are pros/cons to waiting (aside from coverage that Sue already mentioned). It's always best to wait some time after your first surgery to see where your first eye settles.
Traditionally (40 years ago) the advice was usually to wait as long as possible due to it being major surgery at the time. Today, I've read it's better to do it sooner rather than later because it's easier to remove a minor cataract than a major one. I'm not sure if there is a greater risk of problems to the lens capsule with a major cataract or just slightly more risk of some complication. Because of this, I've read that today, getting it done sooner is better than later. On the other hand, because cataracts usually develop slowly, if one can wait years, there are always new IOLs on the horizon and better technologies awaiting us in the future.
For me, I was nearsighted and I had one cataract where my vision could be corrected to 20/50 at best and in the other eye 20/25 before surgery. However, after my first surgery, I did not like how bad my mono vision was, so I decided to get the second eye done which my doctor recommended. My doctor used a mono focal lens and set the second lens 1/2 diopter in (both set to distance) so as to have mini mono vision so that I would have a better range of vision. I almost never need to use glasses for anything. Once in a while for really small print I might use reading glasses or a magnifier.
r28705 michael74313
Posted
I am awaiting a cataract op for the 2nd eye, and wondering whether or not to request slight mini monovision, to give more range of focus with a monofocal iol in both eyes.
My first eye came out +1/2 - +3/4 of a diopter over, so the difference between the two eyes would be 1 diopter if the 2nd eye came out at 0.5 - that might be too much difference for the eyes to work together comfortably?
michael74313 r28705
Posted
Yes - my first (non dominant) right eye was set at 0 for distance. I originally planned to set both for distance because that's just what everyone said to do. Being nearsighted for over 30 years, I didn't really think about how it would affect me psychologically given that everything would be so "flipped around" and I wanted my near vision back. Most say to set the dominant eye for distance. However, subsequent to the first surgery, my doctor did not think it would be a problem to set my left (dominant) eye for distance but slightly in (biased for near vision 1/2 diopter). He was correct - my eyes are great and I don't even notice the ever so slight difference with my mini mono vision.
I've read that there can be a 1/2 diopter error factor which my be why your first eye came out 1/2 over. From what I have read, some people can tolerate a 1 diopter difference and not even notice it at all. Personally, I would want my eyes as close as possible so that they work together and my dominant eye seems to have better all around range than my other eye so 1/2 diopter works great. You can test this by having your doctor give you a "test" soft contact lens to wear for a week in the non operated eye. I think it might help you to figure out if you can tolerate the mini mono vision at that setting. However, I don't think it's always a good test on how clear or how well you will see after surgery. In other words, my doctor gave me two test contact lens to test (mono vision) on my non-operated eye. One lens was at +1.5 and the other at +2. I could read my phone with the +2 but with either, the mono vision was just too bothersome. So, we decided to just set for distance and go in just a little bit (1/2 diopter) so as to have mini mono vision and I would just deal with reading glasses. To my surprise, I could see better up close with a 1/2 diopter IOL after surgery than a +2 test soft contact lens. The reason is that I attribute this to the cataract which makes vision worse at all distances. Now I see around 20/20 and my near vision is around 20/25 or 20/30 depending on the day, lighting and other factors. But, if I need to use reading glasses once in a while it's no big deal. Usually, I just hold my phone or papers about 18" from my eyes and I can read them with no problem (rather than 5" from my eyes prior to surgery when I was very near sighted.
So, you can try a "test contact lens" to see how well you can tolerate mini mono vision perhaps at .5.
The other thing is your first eye can probably be fixed with a laser tweek to bring it to 0 rather than +1/2. I'm not sure if it makes sense to explore laser before or after the second cataract surgery. Check with your doctor. My doctor also used ORA during my cataract surgery for a better result. Best advice I can give is to select a really good doctor.
michael74313 r28705
Posted
Yes - my first (non dominant) right eye was set at 0 for distance. I originally planned to set both for distance because that's just what everyone said to do. Being nearsighted for over 30 years, I didn't really think about how it would affect me psychologically given that everything would be so "flipped around" and I wanted my near vision back. Most say to set the dominant eye for distance. However, subsequent to the first surgery, my doctor did not think it would be a problem to set my left (dominant) eye for distance but slightly in (biased for near vision 1/2 diopter). He was correct - my eyes are great and I don't even notice the ever so slight difference with my mini mono vision.
I've read that there can be a 1/2 diopter error factor which my be why your first eye came out 1/2 over. From what I have read, some people can tolerate a 1 diopter difference and not even notice it at all. Personally, I would want my eyes as close as possible so that they work together and my dominant eye seems to have better all around range than my other eye so 1/2 diopter works great. You can test this by having your doctor give you a "test" soft contact lens to wear for a week in the non operated eye. I think it might help you to figure out if you can tolerate the mini mono vision at that setting. However, I don't think it's always a good test on how clear or how well you will see after surgery. In other words, my doctor gave me two test contact lens to test (mono vision) on my non-operated eye. One lens was at +1.5 and the other at +2. I could read my phone with the +2 but with either, the mono vision was just too bothersome. So, we decided to just set for distance and go in just a little bit (1/2 diopter) so as to have mini mono vision and I would just deal with reading glasses. To my surprise, I could see better up close with a 1/2 diopter IOL after surgery than a +2 test soft contact lens. The reason is that I attribute this to the cataract which makes vision worse at all distances. Now I see around 20/20 and my near vision is around 20/25 or 20/30 depending on the day, lighting and other factors. But, if I need to use reading glasses once in a while it's no big deal. Usually, I just hold my phone or papers about 18" from my eyes and I can read them with no problem (rather than 5" from my eyes prior to surgery when I was very near sighted.
So, you can try a "test contact lens" to see how well you can tolerate mini mono vision perhaps at .5.
The other thing is your first eye can probably be fixed with a laser tweek to bring it to 0 rather than +1/2. I'm not sure if it makes sense to explore laser before or after the second cataract surgery. Check with your doctor. My doctor also used ORA during my cataract surgery for a better result. Best advice I can give is to select a really good doctor.
r28705 michael74313
Posted
Many thanks. In fact the left eye that has been operated on is the non-dominant eye, so slightly more complicated. It isn't easy to work out in advance which arrangement will be the most comfortable and convenient !
Maybe the safest is just to request a conservative -0.25 diopter monofocal iol in my right eye, so as to allow for a degree of tolerance either side in the result. Then decide whether to have a laser adjustment in one or the other eye based on how the iol comes out. (Both to correct the astigmatism and the over-correction).
The surgeon also specialises in vitreo-retinal work, so will be very aware of the degree of risk with a laser adjustment.
Incidentally, do you find you can now read at an arm's length distance without wearing specs? I think that distance would need about +1.5 diopter glasses.
Eye-Kan-Sea michael74313
Posted
Michael74313,
Interesting to hear about your experience. I tried contacts a few times to rid of the bloody thick lenses and improve the vision, but failed because the eyes got bloodshot. I heard that if you try contacts before 40 years old, it's easy to adapt. However if you try after 40 (which is my case), then it's not suitable. My near vision for the IOL eye is perfect. However from intermediate onwards it gradually becomes less focus. The doctor is intending to set the other dominant eye for distance. If you don't mind, you'll have to explain the 1/2d or 1.5d, etc. "Russian."
Cheers
EKS
michael74313 r28705
Posted
Targeting -.25 for your right eye is probably what I would do given where your other eye is at. Check with your doctor. Does your doctor also use ORA?
I have no trouble at all reading at an arm's length. Just for fun, I went into Microsoft Word and printed out a sentence many times in both normal and all capitals at fonts 12, 10, 8 and 6 point. I was able to read all of them both on my computer (mid-range distance) as well as the print out at about 18" away. It was not easy to read the 6 point normal case font, but let's keep in mind that when reading we are not trying to read each and every single letter but rather reading words and I was able to do that even in 6 point. Only the 6 point normal case was difficult to read
I then tried turning the flashlight on my phone and reading it with only the flashlight (even though it was day) and it was a lot easier. I then put on 1.25 reading glasses and it was again a lot easier to read the 6 point. So, if I had to read a paragraph then it's no big deal but if I had to read 10 pages of 6 point or really small print, I would just use reading glasses. For some reason the print appears a lot lighter on the page without the reading glasses which also makes it harder to read.
My IOL at 1/2 diopter works better than before surgery with my test contact at 2 diopters (probably because the cataract makes things worse at all distances).
michael74313 Eye-Kan-Sea
Posted
1/2D is 1/2 diopter (which allows for slightly better near vision than 0 diopter but 0 allows for slightly better distance).
The soft contact lens I meant to wear as a test to see (before surgery) how your vision might look if there's a mini/micro mono vision you are considering.
r28705 michael74313
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Eye-Kan-Sea michael74313
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michael74313 Eye-Kan-Sea
Posted
I waited three weeks. By that point I knew what I wanted to do and the mono vision was driving me crazy (because the first eye was set for distance and I was very nearsighted in my second eye). They removed one lens from my glasses after the first surgery but everything was still "off."
michael74313
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Sue.An michael74313
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Sue.An michael74313
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Night-Hawk michael74313
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michael74313 Night-Hawk
Posted
Actually, my doctor made my left (dominant) eye +0.5 otherwise I would have been slightly farsighted if it were set to -0.5. Both eyes see great at intermediate and distance. It's SO easy to read the computer and before the surgery it was getting REALLY difficult (even with glasses). My left eye sees slightly better up close and sometimes (depending on the day) better at all ranges. There could be several reasons for this. It could be because (1) the toric lens in my right eye shifted slightly after surgery and I still have a minor astigmatism which could be fixed with the laser but it's really slight (2) my right eye has endured trauma in the past (3) my left eye is dominant (not sure if it matters or not).
For smartphone viewing I don't consider that 2-3 feet (intermediate vision) but rather consider that less than an arm's length or near vision. I can read my smart phone which is an iphone 5s (believe it or not / smaller phone). For my left eye that is +0.5, I'm still getting 20/20 for distance and for both eyes (that's how they have me read the near chart) I'm getting around 20/25 or 20/30 for near, but I hold the chart about 18" away whereas before surgery I would read 5" away. I had to reprogram my brain to hold things further away so that they were clear. Print starts to get a bit blurry once it's closer than 12" but the "sweet spot" seems to be around 18"
Night-Hawk michael74313
Posted
Sounds like you got excellent focus range with the monofocal toric IOLs!
I must have long arms because I tend to hold my smartphone (a larger screen model, Samsung Galaxy Note 4) about 24" away and my PC monitor screen is about that distance, maybe a few inches more, too.
I also plan to go with monofocal torics, starting with my right (dominant) eye target for good distance focus - the doctor says he usually targets slight 0.25D nearsighted to help avoid ending up overshooting to farsighted. Later I would want my left eye target for mini-monovision if I get a toric monofocal IOL for that eye as well, maybe 0.5 or 0.75D nearsighted.
The doctor also told me he usually tries to leave a slight residual astigmatism since as the eyes age the astigmatism cylinder can reduce a bit. That would also slightly increase the range of focus he said.
I really hope I can achieve similar to what you did, and get good distance and intermediate focus without eyeglasses, only needing them for some reading. Right now at my computer I have to keep switching between a computer (intermediate) eyeglasses pair and my progressive pair when trying to work on the computer but also having to read something on a paper alternately. It would be great to just have only pair of eyeglasses for reading.