What if you have zero vision problems *other* than cataracts? Lens choice? Outcome
Posted , 13 users are following.
I am very confused. I'm 41, and like many I spend my working time in front of a computer. My main problem with cataracts is that I experience glare, especially from a bright computer screen, daylight, and so on. My vision is affected, but not that badly. I play baseball, and struggle to see clearly during the day. Less so at night, but it's not perfect. I experience lots of glare (starbursts?) when driving at night. I don't know what to call them, but I've dealt with them for a long time.
During my initial consultation, the doctor established that yes, I have cataracts, yes, they are worse in my right eye, yes, I suffer from significant glare, and all of that. However, I have essentially no problems with eye geometry or refractive errors. I was specifically told that there is no difference in my distance vision and near vision. I can't seem to find any information on what this means for surgery. Most people seem to have either astigmatism or refractive errors when they get cataract surgery. All I know is that during optometry tests my left eye is still approximately 20/20 (mild cataracts) while the right eye cannot be corrected with any lenses because it's just blur and glare, no refractive or spherical errors.
I have read about people that have gotten monofocal implants for distance only, yet don't use or need reading glasses for anything other than microscopic print on a pill bottle. I would love to be able to see archery sights clearly, street signs, baseball, a computer screen, and all of that. I'm wondering whether that rare group that can get away with basic lens implants and need no glasses is related to eye geometry? Is it better that I have no eye problems? Worse? No change? Is it that uncommon to have only cataracts with no other problems?
1 like, 39 replies
Lynda111 eric48353
Posted
I believe strongly in getting second opinions. I would do that, and make sure it's with a fellowship trained cornea/anterior segment ophthalmologist They are specialists in the cornea and in cataract surgery.
stephen53955 eric48353
Posted
Monovision IOL configuration where one eye is set for distance and the other eye is set the other one for closer vision is not without its own set of risks. Despite the use of monovision for targeting higher levels of myopia for near vision to offer high levels of spectacle independence for reading; it can cause issues in patient neural adoption, stereoacuity, contrast sensitivity, depth of field perception, and ocular dominance. Some people (about 10-15 %) do not adapt well to monovision. They may experience a feeling of being somewhat “off balanced” or will develop eyestrain and frequent headaches. The more significant impact could be the catastrophic loss of visual field benefit provided by a single eye all together in the event of disease or damage. Monovision problems can be significant, and one should discuss them with an eye doctor, before opting for this treatment option.
maura04015 stephen53955
Posted
From reading here and other sources, the downsides of monovision are why many cataract surgeons don't do it unless the patient has previous successful experience with it, which seems like a wise way to go. Also why mini-mono is favored over full these days. As to the danger of losing one eye, that's always a tragedy. So long as the remaining eye can be corrected by glasses or contact, I don't see why it would be any worse than in other circumstances. Post-cataract surgery limitations would be there, but that's the joy of aging.
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My father was blind in one eye from birth and had cataract surgery in the good old days when they removed the cataract and you wore bottle glass type glasses after and some people were all but blind with them (had an aunt in that category). Being pigheaded and vain, my father insisted on a contact lens and continued to manage just fine till death, including driving. Had to use readers on top of the contact for close work of course.
RonAKA stephen53955
Edited
My thoughts on the issues you raise.
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Published 1 May 2011
stephen53955 RonAKA
Posted
Neural adoption is the brain’s adjustment or interpretation to new visual field input.
Reports or trials do not always reflect real world evidence or outcomes within a population or individual variability.
Fixing or readjusting EDOF or Multifocal IOL optical parameters with eyeglasses or contacts is not without other potential issues.
RonAKA stephen53955
Posted
Yes, I think simply jumping into mini-monovision without a trial is a very small leap of faith, and it is better to simulate it with contacts first. But, even if you don't you are not painting yourself into a corner. There is always a plan B eyeglasses option, which is not at all complicated when you use monofocal IOLs.
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On the other hand going with a MF or EDOF is painting yourself into a corner. It either works to your satisfaction, or you have to learn to live with it, or you explant it and replace it with a monofocal.
amy99928 eric48353
Posted
Eric and Riz,
I have a reply to both of you. Ron's comments and others have been guiding me here. I am only 49 and have perfect 20/15 all my life. Never needed glasses. I think these cataracts came from UV radiation laying out in the sun and swimming with clear goggles when I was growing up. They are/were so bad I can not test-drive contacts or glasses like Ron suggested to Eric. There is no way of predicting because they are/were too cloudy to evaluate what the vision is like in reality. My opthalmologist said for my age she would def go with Vivity and she balked at monovision (seemed to refuse?) so for the first/worst eye I went with Vivity. This week about 2 months later I am getting the other eye done and it seems at this surgical center their inventory choice for my basic free IOL is the AcrySof IQ aspheric. It will be a regular distance IOL. It says +21.0 D and I do not know what that means but I thought it was maybe diameter and was the wrong one last time bc the Vivity was that also. I am afraid of getting another Vivity even though it's nice that I do not need glasses to see any distance and have 20/20 in that eye. Things are colorful like a nice camera and gorgeous. I can sit at the computer and I can read my phone and I can drive. BUT everything has a little border around it (even covering the bad eye). A fuzzy border that I notice if I ask myself, do I see the edges of that? or if I am looking at text like now, when it is obvious. Even mustard flower fields each flower has a little echo of itself in yellow above like a ghost image. The lines on the road have a duplicate shadow line to the left of them. Every light has a huge halo even in the day. My surgeon's answer is either I see her colleague (who will probably say the same) and that I need a capsulotomy which is laser through the capsule to let in more light, but there is plenty of light, even at night. The optometrist says there is no prescription needed and maybe I should just use moisture drops. I think that the IOL was measured wrong. I probably should hold off on the second one until I confirm that. I am getting remeasured tomorrow at my request but they won't want to admit the measurements were wrong if they are different tomorrow. She says if I am 20/20 and it looks set so well then the measurements were accurate. Ron says it's because the Vivity has layers to it and I may be seeing those two images. The Vivity is so high tech that everything is very intense and it's nice. I love that I do not need glasses. I am afraid about having things be blurry up close. When I told my surgeon I want to go with the basic IOL for the other eye she instantly said, oh so you'll need glasses. I feel like I could live with two Vivity lenses just to not need glasses but I am sad about this and disappointed. I think I am a minority to have the fuzzy letter borders and light halos be this bad. It's like monocular dyplopia or nothing is one single image yet from that eye. Regarding distance IOL, all the people I know got those and don't need regular day use glasses and are happy. They say, "I just went with what they gave me" with a shrug. They may have readers but don't mind. I want borders of letters and lights and objects to be sharp and defined and if this is a Vivity problem I am not getting another.
RonAKA amy99928
Posted
On the borders around objects and letters, is it uniform all around them, or is it offset to one side or the other? The reason I ask is that I have some astigmatism and it gives me a drop shadow effect on letters. It is not uniform around the whole letter or object. In my case it is offset to the lower right side at about 4:00 o'clock. If it is uniform all around, then I would go back to saying it is a effect caused by the extended depth of focus of the Vivity lens.
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"I need a capsulotomy which is laser through the capsule to let in more light". That sounds like a YAG procedure which is cutting a hole in the capsule to get rid of PCO. Unless you are sure (get a second opinion) it is PCO do not do it. PCO will give a fuzzy vision all over and is sometimes called a second cataract. That is not going to cause a secondary image all around a letter.
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If you go with another Vivity it may just double down on the effect you have now. If you go with a monofocal set for distance then it could improve your distance vision, but is not going to do anything for your close vision. You could also set the monofocal for a closer distance, targeting it to -1.25 to -1.50. That will improve close vision to avoid needing glasses for most reading. But, it will not improve distance vision. But, if what you have with the Vivity eye now is ok, then that may not be a concern. It sounds like you may have to go to another surgeon to get the mini-monovision though if the current one is objecting to it.
eric48353 amy99928
Posted
I'm not sure if this was the intent, but things like this have talked me into delaying correction. When I went last year, that doctor didn't think surgery would do much, and he said that if I can still see well enough to play baseball (I can) then there's no real benefit. This doctor didn't really recommend for or against, but at least diagnosed the reasons - worse in one eye, with glare causing the issues. But given the tradeoffs evident with all lenses (apparently) it doesn't seem worth it to correct until it actually is needed.
RonAKA eric48353
Posted
I agree that there is no need to rush into cataract surgery if your vision is still being corrected well and is stable with eyeglasses. What many run into is that the eyeglasses prescription requires frequent changes to allow good vision. That can get annoying and expensive.
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However, knowing cataracts are coming gives you some time to research the kind of lens you want, what surgeon you want, and if you are interested in monovision, time to give it a trial with contacts. Some defer surgery until the cataract gets to the point you can't see well enough to do a contact trial of monovision.
eric48353 RonAKA
Posted
I think the confusing thing is that my vision itself is stable. My left eye remains about 20/20, while my right eye has a natural geometry of about 20/25. This is fine and I have never worn glasses or contacts because I've never needed to.
10 years ago was when I first noticed the issues. They didn't say much about the cataracts then. But correction was not really possible because of them, at least in my right eye.
Basically with no cataracts I am in the 20/20-20/25 range. The cataract in my left eye doesn't affect anything (yet), while depending on glare the right eye is somewhere between 20/40 and 20/60. This still isn't enough to require glasses or anything.
I see OK with no glasses and am not restricted. Some things would definitely be nicer with razor sharp vision, but it sounds like it would be a small benefit and a larger risk. Whatever increase in visual acuity I would gain is offset by the need for glasses and the potential for complications. Simple risk/reward.
amy99928 eric48353
Posted
Eric I would wait if I were you because these IOLs are constantly advancing like the Vivity is only a year old(?) and I heard there's one in a few years coming that will be good. Once you do it the switch-out is risky and highly discouraged if you want to upgrade later. I HAD to do this now. My eyes were/are both so foggy there's nothing any glasses can do.
amy99928 RonAKA
Edited
Hmm thanks I really don't know. The echo letters seem to be at 2:00 but the echo road lines are at 7:00 and the echo flowers are at 12:00 and the light halos are most flourished at 9:00 (these are directions on a clock face not times of day lol) Definitely glare and halos. I realize now I'm stuck because a distance IOL in left will mean that I have to put on glasses at the computer but they will have to be expensive prescription because now if I put on readers at the computer the Vivity can't handle it. The Vivity is already computer and phone and distance savvy. Or the readers would have to have one pane popped out I guess but that's not always easy to do? There was some slight prescription they thought might make things sharper but I think that was just their denial that Vivity failed to work with my eye and is having bad effects. I just had measurements today and she says I do not have astigmatism.
RonAKA eric48353
Posted
It sounds like you have some time to wait, but use it to come up with a plan. I had a similar progression where the optometrist was reporting that he could see some development of a cataract, but it was not really a pressing issue. Then at age 70 it developed quite quickly. But, you are a long way from that age. I think for now I would just watch the progression and keep a plan for IOLs in your back pocket. I used some of that time to test drive monovision with contacts. It is quite easy to do, even though you don't need contacts or glasses for distance vision. You would get a contact (if necessary) for your dominant eye to correct to plano, and another contact for the non dominant eye that leaves you -1.5 D myopic. Even if you don't like contacts for a longer term solution, you will know if mini-monovision is an option in the future.
amy99928 RonAKA
Posted
This is great advice Ron. I do like the idea of keeping long distance? May I can just rely on my right eye for close up reading like I do now. I could ignore the borders like I do now.
RonAKA amy99928
Posted
It may be possible to get your close vision with the Vivity eye, and your distant vision with the monofocal. That is called hybrid monovision.
amy99928 RonAKA
Posted
Yes! I am going to get AcrySofIQ aspheric Friday for distance and use my Vivity for close like I do now. 😃 I'll post how it goes. Thank you!
RonAKA amy99928
Posted
Do you have an option to get the newer Clareon instead of the AcrySof IQ? It is not a major point, but the Clareon may have a little better resitance to PCO. I have one of each, so I hope they both work. So far I can't see any visible difference.