Upcoming cataract surgery - wondering which lens to get for "best" near vision?

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My story - cataract in right eye, developed last summer, somewhat corrected by glasses, but barely. Trouble seeing at night. Very blurry close up until about 5-6 inches. And it's getting worse, so I'm ready for the surgery. Also a high degree of astigmatism in the right eye (but not the left), so I'm getting the Toric IOL.

My left eye is -2.5. I was originally thinking of going for a 0 in the right eye - wouldn't that be nice, to be able to see distances without my glasses? But I was told the difference in diopters is too great, and I'd have to wear a contact lens in my left eye (at least until that one needs the surgery as well, which could be anywhere from 6 months to 10 years). And that sounds horrible.

Then I realized that what I REALLY want is what I've been used to my whole life - perfect near vision. I like to read (a lot!), and I'm also a (semi-retired) software developer, so I spend lots of time in front of the computer, on the phone, etc. Until I was about 40, I had perfect near vision to about 2-3 feet - so I never used my glasses for either reading or the computer. In a perfect world, I'd be able to regain that ability after the surgery.

My left eye (which is dominant) still sees perfectly well at about 12 inches, so I can "sort of" read, but it's not very pleasant - even with the reading glasses I got a few months ago to correct the right eye.

I was originally told my choices were "distance, intermediate, or near" - meaning 0, -1 or -2. I was leaning towards getting -2, because even with a -1, there would still be a 1.5 diopter difference between left and right, and I understand that's pushing the limits - although apparently my all-around vision will be better by getting rid of the astigmatism. I guess the doctor doesn't want to confuse people, but after a little research, I asked about numbers in between those, and she said, "Sure, we also offer a -1.6."

So what I'm wondering about is, what would be the difference between a -2 and a -1.6 toric IOL in my right eye, with the left eye at -2.5? Would I be able to both read at "normal" book length (12 inches or so), and read the computer screen (24-36 inches) without glasses? That would be my dream... Or, if I go for the -2, would I still need computer glasses (or progressives), as I've been using the last 15 years? (And which I hate...). Above all, I REALLY don't want to have to wear any glasses when I'm reading. My entire life, I've enjoyed taking off my glasses and getting in bed with a book...

As they said in Fast Times at Ridgemont High, "I'm soooo confused!" Any thoughts or ideas are appreciated! Surgery is scheduled for April 17, so I have about 5 days to figure this out!

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8 Replies

  • Posted

    Hi Bernard - I was in a somewhat similar situation as you. Needed cataract surgery for my left eye (side effect of a vitrectomy). It was really exciting thinking about being able to see distance without glasses since I'd been nearsighted nearly all of my life! Alas, the difference between my two eyes needed to be at or under 1.5 diopter. Otherwise it's likely I'd have to deal with double vision and other sorts of problems. Could have been corrected with lasik on the right eye, or a contact - but I seriously didn't want anyone messing with my "good" eye if they didn't need to. I'd also read a lot of comments from people who have always been nearsighted wishing they'd gone with a near vision lens. They missed being able to easily put on makeup, sew, read, pull out a splinter, shave, etc. etc. So I ended up with the Alcon AcrySofIQ for near vision. Surgery went well and both my eyes are "in sync." I wear progressive glasses. Without my glasses, I can only see out 10 inches out, but my prescription is 4.25 (L) and 4.75 (R). You may have better luck seeing a bit farther than I can since you're current prescription is better than mine. I would ask your surgeon (or an optometrist) for an estimate knowing that there is no way you'll really know until after the surgery. Everyone's eyesight responds so differently. The good news is that you'll be pleased with how clear everything will look once you've had that cataract removed!

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  • Posted

    Hi Bernard:)

    I would probably postpone the surgery if I were you, until you have more info. Some surgical offices like to rush you into surgery, almost like a car salesman, before you have time to think or research your options and go to someone else. If you've waited this long, you can probably wait another month without any danger.

    Also, I highly recommend getting a 2nd opinion. There are MANY options available. Your doctor doesn't seem to have mentioned many of them.

    First, I would research "mini- mono-vision" on this forum. That means you purposely get a slight difference in vision between eyes so that you can see well at more than one distance without glasses. The results vary, but generally you can expect near perfect vision in 2 ranges, i.e., near to intermediate, or intermediate to distant.

    Also, if you have funds for a premium lens, you can get a Symfony EDOF IOL in your non-dominant eye (to minimize night time driving artifacts) and a regular monofocal lens in the dominant eye (for better distance). That's what I did and I have near perfect vision in all ranges. Important to find a surgeon who "gets" the desire for mini-mono-vision and who has experience with Symfony IOL

    Not sure why wearing a contact lens in one eye for 6 months or more sounds horrible. I did so with no problem.

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    • Posted

      OK, I'll ask my doctor about the Symfony EDOF IOL. And will consider postponing surgery. I obviously need more information about what kind of lens we're going to use, etc.

      Mini-mono vision is exactly what I was hoping for with my left eye at 2.5 and my right at 1.6...

      And yeah, I wore contacts when I was younger and didn't like them at all - and it might be 10 years, not 6 months!

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    • Posted

      Please do take your time to research this well. Lens exchanges although possible within 6 months still more trauma than you'd want and a more skilled surgeon is needed. Always best to check out all the options and know what pros and cons are before proceeding. Seek out more than one expert opinion as each have their go to IOLs they like to implant.

      I opted for EDOF lenses (Symfony) Surgeries 6 weeks apart. After surgery on first eye I could see from 16 inches to distance with it and very pleased with the result. Although I poked the lens out on that side of my glasses for the weeks in between surgeries I managed without them for driving. After 2nd surgery reading distance was even better and I see well from 11 inches to distance - seamless no drop in vision.

      But as soks says outcomes vary person to person and no surgeon can guarantee you glasses free. I think when asked today about premium lenses I would say that eyes have to be very healthy - no underlying issues. Ask any surgeon you consult with if there is anything he or she sees that would give them pause to implanting a premium lens.

      Lastly not knowing your age - be aware IOLs are 6mm in diameter. The younger you are the more your pupils dilate in low light /dark conditions. Some beyond the 6mm IOL causing one to see arcs etc however that would be the case for any IOL not just a premium lens but it may not be something you want on too of added halos that premium lenses being. As a trade off to my great day vision I do see multiple concentric circles around some light sources at night. As much as doctors like to say your brain adapts you still will notice them - I do and it's been 18 months.

      Good luck and take your time to research and ask questions.

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  • Posted

    I got Symfony in my left eye and -2.5 glasses for right eye. Took about 3 weeks to adjust. I miss my near vision for the Symfony eye.

    However do keep in mind that a lot of diopters are needed for near vision. For my Symfony eye I needed multiple glasses for reading. +2.5 if I want to hold my fone very close to my face 6-8 inches. +1.5 if I am reading small font and for a long time and in dim light about 24 inches away.

    Having said that results vary from person to person and it is difficult to predict individual outcome.

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  • Posted

    Welp I had the surgery 2 mornings ago - got a -1.9 diopter Toric Acrysof in my right eye. Eye was dilated for the first 2 days. Still a little bloodshot and swollen - but so far I am loving it! My left eye is a -2.5; between the two, I can see crystal clear from about 8-9 inches to about 24 inches - and (with the "new" right eye) pretty well to about 6-8 feet away. Without the astigmatism, my vision in the right eye, uncorrected with glasses, is by far the best it's ever been. I can read SO much better - and I can do near-vision things like computer work, cook, eat (see what's on my plate, see my friends across a table), see myself clearly in a mirror, etc. without glasses. And it's like a veil was lifted - colors are so much brighter! Very, very happy with the results, and hoping it gets even better as the eye heals and my brain adjusts...thanks to everyone for their support.

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    • Posted

      Pleased for your successful surgery. Thanks for updating us. Sounds like you got the results you want with near and intermediate vision and wear glasses for distance.

      You'll notice small changes over course of next few weeks as that eye heals.

      How is the night vision with your new lens? Yes always a welcome sight to see vivid colours again!

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    • Posted

      Thank you for the update! It's great to hear that all went well. Surgery is nerve wracking, especially when it involves our vision. The miracle of modern day science!

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