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9424748 tn?1405130441

Cataracts & Toric IOL for Astigmatism

I am scheduled for cataract surgery in a few weeks. It appears I cannot have anything but the Toric Astigmatism IOL if I want clear vision. My vision is a -4.25 in one eye and a 5.00 in the other and they are setting me up for a - 2.5 so I can keep my close vision. Will I have any variance to my vision at all or will I only see at about 14-16"? Will I be able to see any closer CLEARLY than 14", or any further than that too? At the present time I do a lot of detail sewing, artwork, jewelry, computer work. This concerns me greatly. I do not want to wear glasses to thread a needle, paint the details on a painting, or do jewelry work (that type of tiny stuff). I was told that if I got a multifocal IOL that there would be a yellow tine, decreased contrast and possible halos. I threw that idea out right away but I am still having doubts about the decision to keep the close vision (as I've always been). Any advice would be immensely appreciated. I also wondered if my 'blurry' distance vision will be worse than my blurry is now (without glasses) and the blurry will be the same amount  whether it's 15 feet or 100 feet. Lastly, if I did opt to get the IOL set for distance, just how close up could I see without glasses. Thank you!
48 Responses
7765252 tn?1395096028
All I can tell you is my experience. I don't know if it will be the same for you.

I opted for two close vision monofocal IOLs. Wanted to keep my vision without glasses as close as possible to what I had before surgery. I also do a lot of close work and don't mind wearing glasses for distance.   Before surgery I could see things clearly about 8 inches away from my eyes without glasses and would always take them off for very close work.  The last of the two surgeries was completed about 2 months ago.  

The surgeon targeted the first IOL for a +3.0 add. The clearest focus afterward turned out to be about 14 inches from the front of my eye.  He targeted a +3.5 add on the second eye, and the clearest focus is now about 10 inches from that eye. I can still thread a needle without glasses but it takes some getting used to.  You have to learn to move the needle *farther* away rather than closer.

As the focal target gets closer to your eye, the range of acceptable clear vision seems to get much shorter.  For example my range of crisp vision is less than 6" plus or minus without glasses.  If you opt for distance vision, you will be able to see clearly without glasses for a longer range.  My guess is the range is the distance you sit from the eyechart (20 feet?) out to infinity.  

There is an intermediate range also, like sitting 10 feet from a TV.  I'm sure others who chose the distance option can answer your questions about that. Success seems to vary between individuals.  Or maybe some are more particular than others.

Unfortunately just because they target a certain distance, doesn't mean they will hit it exactly.  

As to your other question, my distance vision also improved slightly.

Before surgery:

OD -4.25 -0.75 020 Add +2.75
OS -4.25 -0.50 175 Add +2.75

After surgery:

OD -2.75 -0.75 180 Add +2.25
OS -2.25 -0.75 180 Add +2.25

I question the two Adds being the same on the new prescription, but my old glasses are clearly too strong, especially for intermediate distances.  I hope all this helps.  I went 'round and 'round on this decision myself.  
9424748 tn?1405130441
Thank you Nancy for your detailed input about your eyes. First of all, it is nice that someone else wanted to keep their close vision (I'm not crazy!). I suppose you are happy with that? And...you are happy with the outcome? Do you see clearly close up then? Is your blurry distance "look" like it did before? I wondered if it would be worse. It sounded like you see a bit better.  I do wonder what you did during the month your were healing to see. They told me I'd have to wear my old glasses even though they might be stronger (until all heals).
Basically I want to keep my eyes very near to what they are too (like you said you wanted to). The nurse assistants seem to think that I don't want to have to look 8" in front of my face but they don't understand I've been doing that all my life!
9424748 tn?1405130441
Nancy, I somehow hit 'enter' and I wasn't finished....so....
After reading your response I think I may see if I can talk again to the Doctor (& not assistants) if that is possible and  see if she might set my eyes up for a -3.00 instead of -2.50. I don't want it to be set out 14-16". That will be too far (I think). When you said what they targeted on the IOL for you, did you mean to say "+3" or "-3"? I wasn't sure and wanted to be. Do you know why your Dr. targeted the second one as a 3.5?
I may think of something else I'd like to ask you, but for now THANK YOU so much for taking the time to talk with me about this. It has helped! Blessings!
7765252 tn?1395096028
Without glasses, my actual distance vision is no worse than it was before, in fact slightly better, but it's hard to distinguish the degree of blurriness, LOL.  Probably the blurriness is worse the farther out you go, but I can't tell a difference.
  
The adjustment was definitely a plus number.  The surgeon told the assistant to record a +3.0 add for the first eye.  The reason he went to +3.5 on the second eye is that I wasn't happy with the 14" focus for the first eye.  It was like pulling teeth to get him to go even to +3.5.  Just like you, no one could believe anyone would want to see closer than reading distance.

I am still wearing my old progressive glasses because of procrastination.  They have been just right for distance and driving. I can read road signs now because the cataracts are gone.  Reading a book is perfect without glasses. I have an old set of single vision computer glasses that still work for the computer. Only a little problem with intermediate distance, like shopping or watching TV in a small room.
    
Am I happy with this decision?  Not entirely, because I didn't really get the close vision I wanted.  But it's probably not possible to reproduce that close vision that I had before surgery.

I think the formula is 39.4 (inches in a meter) divided by the "add" number, to get the focal point.  So it would take a +5.0 add to get 8 inches (39.4/5=7.9").  But the range would probably have been miniscule---maybe only from 6-10 inches and outside that it would be blurry?  There is no accommodation at all with monofocal IOLs.  Maybe that wouldn't have been so good.  Who knows?
  
There were a lot of factors to consider for me.  I knew I wouldn't like to carry reading glasses and sunglasses around everywhere.  Even these computer glasses are a nuisance.  Progressive glasses don't work for  looking at something close overhead.   My face looks plain without eyeglasses and I would miss them.  On the other hand it would be nice to be able to get up in the middle of the night and not have to search for your glasses to use the bathroom. And it would be an exciting experience to be able to see clearly at a distance for the first time in your life.    
  
I really don't want to influence you one way or the other.  I hope this is a fair assessment.  I will be happy to answer any questions if I can.
9424748 tn?1405130441
When I was quizzing the Dr's assistants (that's who I got to see the 2nd time I went since I needed a few more tests), they said 'You don't want to have to look at something THIS close, do you?" (and they were holding a book about 5-8" from their face. Inside of me I was a bit upset because all I was trying to tell them was that I didn't know if 14-16" wasn't a bit too far for me and I'd rather have about 12" but really I wanted more like 10-12" and no more than 14" if that would be possible (not an exact science). I got a bit nervous talking to them and I felt like they might be a bit frustrated with me so I went ahead and scheduled, BUT my questioning is not over. I have pretty much decided that I want to talk to the DOCTOR one more time before the surgery and try to tell her what I want, and be SURE of what they are going to do even if I have to pay out of pocket to do so. They sort of tried to 'convince' me about that reading distance too. I'm not saying I really want 8" but 10-12" would be nice for seeing things close up and for details! My Dr. seemed to think I wouldn't want to paint a painting any closer than 14-16", and truthfully I'd use my progressive lenses for paintings anyway, it's the tiny jewelry work I do that I need the super close stuff. I drill tiny 1mm holes in coins!
Thank you for the description of your blurry vision. That sounds good. And to know you are seeing well helps me too.
The lack of accommodation thing is scary sounding but in a way that is what I have now so it won't be that much of a problem. What did you mean when you said you couldn't see things closely with progressives overhead? Also, what did you mean about not seeing intermediate things --- was this with or without glasses?
If you don't mind me asking, at 14" can you see well to put on makeup or pluck an eyebrow hair --- I mean TRULY clearly? (without glasses) 14" just sounds so far away when I've been doing it at about 8" all my life.
Thanks again SO MUCH and I'll try not to pester you to pieces!
I thought of something else, just how bad was your vision BEFORE you had surgery? Was it mostly in one eye? I sometimes think I should wait. The only problem I have WITH glasses is that to look at the computer, my left eye is really good at the very bottom of the lens, and with the right eye, I have to tilt my head down and look through the top! It's because one of the cataracts is centrally located (my take on that)
Also...in your first post to me you said " For example my range of crisp vision is less than 6" plus or minus without glasses." -- Does this mean you DO see up to 6" close out to 14".
Sorry for so many questions! But THANK YOU SO MUCH!!!!!!!!!!
7765252 tn?1395096028
I'm glad you asked for specific numbers.  I needed to get them down more precisely anyway and I also learned some things.  I used a standard telephone book, white pages, smaller name entries, to the nearest half-inch.  I hope this helps answer your questions.  
  
(1) Crisp focal point
(2) Clear range, no blurring
(3) Range where I can still make out the names but with some blurriness
  
Left eye (targeted +3.0)
(1) 14"
(2) 12"-15"
(3) 11"-17"

Right eye (targeted +3.5)
(1) 11.5"
(2) 10"-13"
(3)  9"-15"
    
Yes I can pluck eyebrows and apply makeup with either eye without glasses.  No I couldn't squeeze bumps on my face [I know, you're not supposed to do that ;) ].
  
I can't see intermediate distance things very well right now with my *old* progressive glasses. That was in answer to your question about what to do during the recovery period.  That will not be an issue with new glasses.  
  
How bad was my vision?  I assume you mean because of the cataracts?  My eyes were not that bad except for night driving.  Glare and haloes at night because of the cataracts made it too dangerous to drive so I had to do something.  Both eyes were about equally affected.
  
Finally, you asked what I meant by needing close vision overhead. I recently retired and decided to take on some do-it-yourself remodeling on my house. I'm not near finished yet.
  
Four specific examples:
1) Painting the line between the ceiling and the walls in a room
2) Installing vinyl panels on a porch ceiling
3) Installing new ceiling light fixtures
4) Replacing a sink faucet

Progressive lenses drove me crazy for these jobs.  I could look over top of the glasses directly overhead fine, provided I was at the right distance away, but as soon as the distance increased a little, the only way to see overhead with progressive lenses was to throw your head back at a 90 degree angle.  That made me nauseous and dizzy.That probably won't change much but at least I'll still have that one close distance.  Can you imagine taking readers on and off while painting?

Sorry to be so long-winded.  I enjoy talking with you.
7765252 tn?1395096028
Butterfly, thanks for making me think about all this again in an organized way.  I just found out they make progressive glasses called "office glasses."  The top of the lens is set for computer distance (or any distance you like) and the bottom is set for reading distance. That would be much better than readers, and might solve my problem.  Would they work for you?
9424748 tn?1405130441
Nancy, that does sound pretty good! At least if you are working at a desk and you have variable distances (with progessives) you'd be seeing well. The only thing would be the distance (greater distances). I wonder how that could work for watching television too. A person could have lenses set up for 10 or so feet away  and then you could have the bottom part be for seeing your remote control. It might seem silly to do at first but then possibly there would be a larger amount of vision in that lens because they wouldn't be trying to squeeze all your vision into one pair. But.... I am thinking that possibly for you, if you get your new pair of glasses made, they'll be made for your 'new eyes' and you may see just fine for reading and computer (if you get progressive).How long has it been since you've had surgery? At the present moment, I have progressives and if I were seeing as well as I did before cataracts came on me, I could see up to about 12" at the bottom of my lenses and they all the way out far away (hope that makes sense). (of course without specs I saw as close as 6-8")With you, maybe that is all you need. Are you trying to read a book closer than computer distance? I would say my computer screen sits about 20-23" away from my face and I can see it ok in my good eye still.  If I tilt my head to look out of the top of my glasses my bad eye still sees pretty good.
I enjoy talking with you too, Thanks! Erin
7765252 tn?1395096028
Here's my latest thought.  The highest add power of any progressive lenses is +4.0, most only go to +3.5.  BUT, if a person already had a +3.0 because of the target of the IOL, and then got progressive lenses with a +2.0 add, wouldn't that make it +5.0 and give you 8" focus at the bottom of the glasses?  Then you would have the accomodation on out.  

If that's true our problems may be solved.  I hope that is true.  I'm going to call for an appointment tomorrow with another optometrist and ask him.  I can see another situation coming where the doctor thinks the patient is nuts, but I'm not going to be intimidated.   ;)
9424748 tn?1405130441
Nancy I would definitely not be intimidated! You know what you want and I think they'll be willing to work with you. Surely some Dr. would! I remember one of my Drs. suggesting (several years back) that I could have glasses to use for my close up work that would magnify some more (in a progressive). I'm not sure I totally understand your numbers because I always thought that nearsighted people had a MINUS before their number not a PLUS. I thought the plus was for the 'add'. So if my targeted number post surgery was a -3.00, I would not be able to see as close as my -4.00 eyes. I have a +2.5 add for my bifocals.  I understand your addition of the numbers (& that does make sense by the way), I just don't understand the plus and minus factor. I still think that if you tell him you want to see that close in your progressives (at the bottom) they'll work with you.
I'm going to call my eye surgeon's office tomorrow and set up a consultation to work on my questions. I am hoping I can get in soon or I will just reschedule my surgery for later until I can talk to her. I think that is reasonable. They should be willing! I am having to pay more for the astigmatism lenses, surely they can set me up with an appt. I just don't know if I put it off for a month if the measurements will remain the same. Let me know how it goes with you when you go to see your optometrist.
Have you read many of the blogs & such on this medhelp site? It has been helpful with much in addition to hearing of your experience.
Let's stay in touch! Thanks for all your help, Erin
7765252 tn?1395096028
Thought I'd let you know what happened to my idea of getting higher add power to progressive lenses.
  
Went back to my old optometrist because he is familiar with the situation and wants near distance IOLs for himself when he has cataract surgery.  Turns out it's not so simple. You have to add both lens values (near and far) together to get a start point. Maybe the distance lens is layered in there all the way through from top to bottom?  

So, for example, for my right eye -2.75(distance) +2.25(add)= -0.5.  I would need a +5.5 add to get a total +5.0 and 8 inches focus, which they don't make.  For the left eye -2.25+2.25=0 so I would need a +5.0. He agreed to go up to a +3.0 add.  He has done it before, but warned it may mess up my reading a little.  It's a gamble.  I went for it and ordered new progressives today.  

How is it going for you?  Did you get to talk to your surgeon?
9424748 tn?1405130441
Oh Nancy, I am thinking that this might not make you too happy that they are unable to make glasses to suit your close up needs. I am going to copy what you said and take to my Dr. today and see what she says since I will be in a similar eye situation after surgery.(unless I change my mind)

Did he say why it would mess up your reading? because it would be too close OR it would not be clear? I almost cannot believe that they can't get the close up lense to be 8" because I've seen surgeons, jewelers with those little close up lens additions they put over their glasses so I don't see why they can't do this.

I am curious if your eye Dr is nearsighted. What kind of lenses does he want -- near distance, as in multifocals??

Do you think you could have just gotten 'normal' progressives and gotten a separate pair of some type of magnifying readers for close ups? Sort of like those office glasses you mentioned but with only a closer focal point.

I go to talk to my eye Doc today with my many sheets of questions. I hope that her assistant is not in there because she makes me nervous. Actually the whole thing makes me nervous.
7765252 tn?1395096028
I don't think he knows for sure what will happen, something about it might mean I'd have to hold reading material out farther away.  He is nearsighted worse than me, and would go with the near vision monofocal lenses if he had to do it today.  
  
Good luck with your questions for your surgeon. Let me know what he says.
9424748 tn?1405130441
It's nice to know that even an eye Dr values their close vision!

I hope your new glasses work for you. I guess they'd redo them if you couldn't see well. Most places will work with you on that (normally). Do you know today I tried on my husbands cheap-o readers OVER my regular bifocal glasses and I was amazed that the add on of +2 would make things so much closer and clearer, so I'm guessing this is something for us to do to see closer and better.

I'll write you later and let you know what happens.

Did you tell me that you had an astigmatism Toric lens or not?
9424748 tn?1405130441
I just got back from my appointment. My Dr. seems to think that because I am analyzing it so much that perhaps I should wait because she thinks if my sight was so bad that "I'd take anything to see better" that I wouldn't be so concerned/worried about getting an exact measure. She also explained to me why there is no 'exact science' to it -- it is because of our own individual eye and where they put the lens in the eye. That is why sometimes it corrects closer or farther.

BUT....she did say that she would be willing to  target the worst eye with a -3 (even though she originally wanted to do a -2.5)if I wanted to wait to do the 2nd eye,  and then I could probably see just fine with the -3 and  my good -4 eye for now (until it gets worse). I really still see well out of my 'good' eye. SO, it's kind of up to me to either wait on both until I'm REALLY bad or I can have just one done. She said if I didn't like the first eye at -3, I could still later do the 2nd at a -2.5 and do ok. Since I have had all the testing I almost hate to NOT do the one eye.

Since both of your 'fixed' eyes are a little bit different, do you see ok with them together (without specs) since one sees closer than the other or are you always just using one eye when trying to see close things?
7765252 tn?1395096028
That sounds like a good plan to me--- to do one eye and see how it turns out. The only reason I would not do that is if there was any doubt in my mind that I wanted the near vision option.  You won't experience the difficulties, with one eye done and one not, in the interim period, like those that go for distance vision do.  I waited 2 months between with just minor inconvenience.  Your surgeon sounds much more reasonable to work with than mine.  She's probably right, sometimes too much information just causes more worry.
  
There has been some adaptation with my close vision without glasses. Both eyes working together seem to do better than each one separately.  For example using both eyes with no glasses, tiny print looks clear for the full range of  9-17 inches. But if I close either eye that doesn't work.   I guess that's a mini version of what they call monovision.  
  
As to your previous question:  No toric lenses, just plain monofocals, for me.  I read some people experience haloes around bright lights at night with toric lenses, and was not willing to gamble on that.  Night driving problems were what started all this in the first place.  Keep us posted.
9424748 tn?1405130441
That is interesting what you said about your eyes working separately & together. That vision from about 9-17" is also encouraging. I don't think I have any more doubts about keeping my close vision. I called them last Thursday to tell them I had decided to do one eye but they've not called me back yet. I'm thinking they will today (hopefully). Back on the 'doubts', I think I doubted I could be happy with NOT seeing close up. That is what seemed bad to me! It's funny how people are different and I'm glad that you wrote me on this medhelp site. It has helped me a lot. :-)

When will you get your new glasses? I just noticed today that you said you waited 2 months in between first and second eye?
7765252 tn?1395096028
Erin, you may be sorry you asked about glasses. Ha!   Just got new ones this morning.  I finally understand what the"swimming" effect is, and why some folks hate progressive lens glasses.  It's my fault for asking the Dr if he would consider bumping up the add power. I don't know if *all* the problems are due to that, but I sure won't take a chance again.  I only gained about a half inch in near vision anyway.
      
Let us know when your surgery is finally scheduled.  I'm anxious to hear how it goes.  

BTW, the assistant at my surgeon's office guesstimated that about 1 in 50 people at their facility who get monofocal IOLs opt for near vision.  
9424748 tn?1405130441
Nancy, don't give up too soon on those glasses....you might get used to them! It took me quite a while to get used to progressive lenses but once I did it was fine enough. I did think a couple of times I'd never get adjusted but I did. If after a reasonable amount of time you aren't adjusted, you might want to ask them if they'll redo them. A lot of places will do that.

News-- my surgery is put off! I called and asked about doing just the one eye and my Dr. said she still thought I should wait. If I really wanted to proceed I'd have to talk to my surgeon about it (which I didn't know we ever would be talking to the surgeon prior to surgery) so I said just schedule me for my 4 month check (as they wanted to do). So meanwhile, I'm going to try to be happy the way it is (for now) and be sure of what I want to do (which I thought I was but who knows!). I think because I wanted to go in and talk with the Dr. with all my questions, that they perceived it as I wasn't bad enough and not ready or I wouldn't be so worried about what type of lens.

Wow, 1 in 50.....it must just be the creative types that want to keep their close vision. I have thought a time or two that the reason I want to keep my close vision is because I've never seen clear in my bifocals at a very close range -- only about as far as my dinner plate or book would be and no closer, so how in the world would I be able to ever see a detail again if they set my IOL at 14-16".

I suppose I should keep a positive 'note' on all this -- at least I CAN see! :-)

Keep me posted how you are doing with your new specs. I pray they'll work out for you.
7765252 tn?1395096028
Once I make up my mind to do something, I want to get it over with.  How are you with this delay decision?  I disagree with their perception of why you have so many questions.  They are probably just not used to folks having *any* questions.
  
I see now your doctor and your surgeon are two different people.  I wondered how you were able to talk to the surgeon so many times.  My surgeon talks to you twice for about 2 minutes---once before the surgery, and once the day after.
    
About the 1 in 50...I think the main reason the number opting for near vision is so low is because most don't know there even is such an option.  If it weren't for my optometrist casually mentioning he was going to do that, and my mother complaining about reading glasses, and this forum, I'd have had the distance lenses too, and been sorry.
9424748 tn?1405130441
Nancy, in a way I wanted to get it over with and was disappointed to some degree, then I sort of felt better about it. I know my right eye is lousy, but since 'lefty' is carrying me through, I can surely make it 4 more months. I have my first grandchild coming in early October so at least I'll be seeing them close up!! :-)

Yes, my Dr. and surgeon are 2 different people. I haven't seen the surgeon at all and was really surprised when they said something about talking to him because they never said I would at any point. It was actually the Dr. I had spoken with 2 times, and their surgery associates (nurses?) one time (only because I had to do a test at a different office, otherwise I wouldn't have talked to them at all an additional time).

I will agree with you about that 'option' thing.. I don't think that option IS know much. My regular optometrist (when I asked him) didn't think that I could keep my near vision. That's why I was so 'into' getting multifocals in the beginning before I knew I had too much astigmatism to have them. That is why it became such a big decision for me since mentally I had myself all prepared for multifocals (and my cousin had them with pretty good results). I think I didn't know what to do and thought I was losing my near sight forever!

So your Mom had trouble with reading glasses? I am supposing she was nearsighted prior to cataract surgery? I'm sure glad that your optometrist knew that surgeons could do that.

Are you doing any better with your glasses?
7765252 tn?1395096028
Congratulations on the coming grandbaby.  I think you made a good decision to wait.  You don't want to be bothered with eyedrops, appointments, and new glasses right when the baby first comes.  Do they live near you, or will you have to travel?

The glasses are not doing so good, but I've been doing a lot of reading, and I think I figured out what is wrong.  At least I can go back with *some* knowledge this time, although too late.  I guess better late than never.
9424748 tn?1405130441
They live about 50-60 minutes away. We are going to try to babysit 2 days a week (go there and stay overnight). It's going to be a big change!

I hope that your Dr. will fix your problem with your glasses and redo them for you. What is the major problem with them (that you said you've figured out?  and....  Can you still read easily without them?
7765252 tn?1395096028
1) Bumping up the Add to +3.0 narrows the intermediate vision corridor (in that hour-glass shaped diagram) substantially. I think these fancy Hoya lenses she picked out already have a  shorter corridor to begin with.
  
2) More important, the Segment Height is set way too high.  So vision with my head in normal position is through that narrow corridor, rather than through the bottom part of the distance vision region. The girl who took the measurements sat a lot shorter than me.
  
Intermediate vision is the second most important thing to me, after near vision. But where the problem shows up the worst is crossing the streets walking. I walk a lot for exercise. You have to look quickly side to side, and then down at the curbs.  It makes me dizzy and want to fall forward.

Computer vision is very narrow.  I can still read just fine without them.
  
I gave them 9 days to adjust.  Nothing changed after the first 24 hours. I thought maybe the IOLs and the lack of any adaptation might be causing this, but I tried my two-pairs-ago cheapie glasses from Walmart last night and they worked great instantly.  Glad I saved all these old glasses.

More than you wanted to know?  :)  
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