Can contacts be an option after cataract surgery?

[03Maddie]

I am 56 yrs. old, and I had cataract surgery last Monday, with a toric implant.  I'm seeing so very well 20/20 the next day!  However, I'm quite concerned that I'll never have the close vision I had prior to surgery.  I'd worn a rigid gas perm lenses in both eyes for years, with a mono vision, when I required reading glasses.   Prior to surgery, I was put in soft lenses, again with a mono vision, but these lenses didn't correct my astigmatism as well.  

I will be having my right eye cataract surgery next Monday, and the surgeon will be placing another toric implant, however, it will be less power (mono-vision), to hopefully enable me to read menus, computer screens without reading glasses.  I am afraid that they will not be able to under-correct this eye enough.  I spoke with the optometrist about my concern.  He said that he thought the surgeon would only be going one step down, which would require me to use reading glasses.   I hate searching for a pair of glasses each and every time I need to read something--including things that are two feet and nearer from me--which is what I've been doing since the cataract surgery.

If this next lense isn't accommodating for close vision, (I've always been very myopic)  will I be able to wear a contact lense in either eye to accomplish this, or both eyes if necessary?  If so, will it need to be a soft lense or a rigid gas perm lense.   Does anyone know?   I probably need a professional opinion, or someone who has also been through this.   Thank you!!

[Timothy D McGarity, M.D.]

The left eye distance vision is 20/20 without any correction. That's great! What to do with the right eye? It sounds like the plan is to have intermediate vision corrected (computer, smart phone, menus). This means your right eye vision will have a residual -1.25 D correction (roughly); you'll have -1.25 diopters of myopia/nearsightedness remaining (to correct your distance vision). To see close (fine print, small print, soft backs, etc) you'll need an additional 1.25D of add/near correction (thus making your total eye myopia at that point -2.5D) in a contact lens or glasses for that eye, but the left eye would roughly need 2.5D of add/near correction in contact lens or glasses.

The other option is to correct near vision in the right eye. This would require leaving your right eye with -2.5D of myopia. The problem is that you'll need to move all those intermediate vision tasks closer to your face. Without glasses or contacts you'll have good distance and good near, but not perfect intermediate. The other problem with this much "separation" between the eyes in decrease of depth perception and/or difference in the visual perception of image sizes between the eyes (anisokonia).

Monovision works great, but it only correct 2 of the 3 visions (D & I, D & N, or I & N). Toric IOLs will correct the astigmatism "all the way through" (D, I, to N).

You could ask to have the right eye corrected to give you near vision (target -2.5D), but you run those risks discussed above paragraph. On the other hand, I've done this for many patients and it works great. If it doesn't work well, then you would need a lasik surgery to correct or have IOL exchange for a intermediate focused toric IOL.
Best wishes,
Timothy D. McGarity, Medical Doctor, Ophthalmologist

[Craig10x]

Sounds great! -1.25 should be fine...i ended up -1.0 but not much difference in -.25 diopters...Should work out fine...

And yes that is about how it works out for me...i am glasses free like 90% of the time...Only need the readers (very mild...like +1.25) for extended reading or if i want to read closer...don't need for computer at all...

I actually have 2 pair so glasses...1 for the reading (the +1.25) and 1 for ultra sharp distance purpose (for me a -1.0 diopter correction)...most of the time i use neither but they are there for me in case in want them...

You are very welcome and good luck...give time to adjust and for things to settle in and please do post back in a few weeks and let us know who it is going...

[03Maddie]

After meeting with my ophthalmologist this afternoon, I am sure that he will be doing the "mini-monovision"--in fact, that is the term he used.  He plans to have my right eye at a -1.25.  

He was very open and helpful in some of my other questions regarding the usage of reading glasses, or glasses for night driving.  He said that he's planning that I should be able to be without glasses for about 90-95% of the time, but would probably need them if I were planning to read for any length of time.  He also said that some people prefer to have a light prescription for long night driving trips.

I asked about contacts if needed or lasik.  He said that after cataract surgery that I would be a candidate for either--if I decided I needed a little tweeking.  At this point, he doesn't think we should think in terms of needing either.  

Anyway, thank you for sharing your experience, and I'll keep you posted in a few weeks how it went and how my sight is.  I'm keeping fingers crossed and saying prayers for another successful result!    Thanks!

[Craig10x]

When you get the toric lens iol with the -1.0 diopter correction it should be a lot better then the contact lens you have been using with that correction which doesn't correct astigmatism (i am sure the doctor would agree)...

With mini monovision (which is often called "blended vision" i think you will find that it is much easier to adjust to then full monovision and the distance and mid range while perhaps not quite razor sharp like 20/20 will be much better then the full...

Yes, you do sacifice a bit on the reading side and like i mentioned, i do have to hold things further away...Only if i was going to sit down and read a whole newspaper or do a lot of book reading would i feel i need to pop on my readers...for doing routine light reading stuff like:

looking at the mail, reading labels in the supermarket, writing notes, shaving, reading menus, seeing my food, cooking, etc...no problem...
and Computer at normal distance is GREAT (which i where i do most of my reading anyway...lol)....

so, yeah, i think your doctor was steering you right when he says he wants to do -1.0 diopters of the other iol (blended vision)....

just do not expect perfection with everything though....not possible i realized and i am just as a fussy as you are! (Lol)...

good luck and i am sure the doctor will be along to post his response to your new questions about it....

By the way, on the distance chart, my distance eye is 20/20 and my under corrected eye (with the -1.0 diopter) is 20/30...And as i mentioned, i can read clearly from about 12 to 14 inches depending on the size of type...
If i was 20/20 in both eye, i would have to hold things 2 to 2 1/2 feet away to see them clearly....quite a difference!

[03Maddie]

Thank you for your expert opinion!   I will be discussing the right eye implant this afternoon with my ophthalmologist.   I believe that he was planning to place a lense with a -1.0 power difference, but I was concerned that it would be quite limiting, requiring reading glasses for the majority of the time.  My optometrist was thinking (due to my high expectations) that perhaps I would want to have more mono-vision than the -1.0 would give me, thus the confusion/controversy on my part.  

After hearing from you and also Craig10x and his experience with full mono-vision, I've decided that my ophthalmologist must know what he is doing!!   I still have a question for you, however:

I was told several years ago by a difference ophthalmologist, that I'm not a good candidate for lasik surgery due to irregular corneas.  So, with that in mind, I was wondering whether I would still be able to wear contacts with a reading prescription in them after my cataract surgery.   I would prefer to wear a contact lense in either eye or both over having to search for a pair of reading glasses.    What are your thoughts?    Thank you again for your prompt and expert advice!!

[03Maddie]

Thank you so very much for your great, timely response.   I have an appointment this afternoon to discuss the power of implant with him and what my vision expectations are or hope to be with my right eye surgery.  

I also received a Acrysof IQ Toric lense in my left eye with my recent cataract surgery.  I still cannot believe how great it is to see so well with it!   I'm presently wearing a soft contact in my right eye, which has been powered down -1.0, but this lense is not a toric lense, thus a lot of distortion. This contact lense is a temporary 2-week "fix" (until the surgery). My left eye is my dominant eye, but prior to surgery the mono-vision with my contact lenses was done with the opposite eyes. (sorry--a bit confusing)  

I think your experience of having done the full mono-vision and not being happy with it, was exactly what I needed to hear to confirm that in my mind.  I believe that my ophthalmologist was planning to do only a -1.0 between my eyes.   When I saw my optometrist, who works at the same clinic, he was concerned that it wasn't enough mono-vision difference for my expectations.  (My expectations tend to be high!!)  

Anyway, your help was greatly appreciated!  Thank you!!

[Timothy D McGarity, M.D.]

Didn't see the post from Craig10x. I kinda of totally agree with this person. It's typically a "slam dunk." It just takes some understanding and that's why you are here asking questions. Kudos to you. Just some simple math optic relations. Diopters (D) = 1/meters. A diopter is the power or focal length of a lens or the remaining uncorrected focal length of the eye. So, if your eye is -1.0D, that means you'll have a focal length of a meter. Likewise, -2D is 0.5 meters (50cm), -2.5 D is 33cm, etc. The (-) number indicates minus lens or myopic or nearsighted correcting lens.

[Craig10x]

Before the doctor comments...i just wanted to mention about my experience...i have acrysof toric lenses and originally was set for full monovision...While it is true you can read very close with it, the distance and midrange vision, i found, was some what lacking...wasn't very happy that way...

I then had a lasik touchup about a year ago to go to mini-monovison (which is between -1.0 and -1.25 diopters (i ended up at -1.0) and much happier...my distance and midrange is much better, computer distance vision is even better this way and can still do light reading...

You would have to hold things further away (in my case about 12 to 14  inches depending on the size of print) but it's very useful for reading menus, grocery labels, writing notes, checking your mail....lengthy reading i put on very light readers, so i am about 90% glasses free...

If i had gone for the full 20/20 correction in the non dominant eye...computer work would have to be done further back and reading (even light reading) would be totally out....

I'd highly recommend you tell him to go for the mini monovision approach...aim for about -1.0 diopters...