Cataracts & Toric IOL for Astigmatism

[CurlyButterfly]

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!

[RealtorRenee]

Hi SoftwareDeveloper,

You have made great suggestions, but I have to have surgery for Salzmann's Nodular Degeneration in both eyes before I have my cataract surgery, and that severely limits my choice of lenses. My choices were a basic monofocal lens or a toric monofocal lens to correct my astigmatism. The toric lens has an 80% success rate in Salzmann's patients as opposed to a 96% success rate in "normal" patients. I chose the toric lens. If it does not work for me, I will have another surgical procedure and will likely have to wear glasses for all distances.

[RealtorRenee]

We are all going to have to wear glasses for various distances. The deciding factor for me was whether I would rather wear glasses to see close-up or far away. I have always worn glasses for distance and taken my glasses off to see close-up, and it was a no-brainer for me that I would prefer that my vision stay that way. My friends who like their distance vision without glasses do not have the same demands of excellent, detailed close-up vision that you and I have. They are okay with so/so, slightly blurry close-up vision and will throw on a pair of readers when necessary. You and I have higher expectations for our near vision. They would rather see the leaves on the distant trees without their glasses, and I would rather be able to cut my fingernails without my glasses.

[SoftwareDeveloper]

For those who wish to see more in the near range, I thought I'd suggest that they might consider the idea of a premium lens set to focus at near rather than distance as an option (if is worth spending money on it) and not merely monofocals. The lenses are usually intended to get a broad visual range from far to near, but offhand I can't think of a  reason they couldn't be used to get an expanded visual range from near to very near.  Unfortunately the nearer you get, the more diopters of correction it requires to get just a little bit closer so I don't know how much it would expand the range, but I would guess it is worth considering even though I hadn't read about anyone doing this to confirm it.  

Even if you don't wish to risk the potential visual side effects of a multifocal lens, you could consider an accommodating lens like the  Crystalens which is worstcase then like a monofocal if it doesn't accommodate,  or those getting a lens outside the US could consider an extended depth of focus lens.

It could be that with a multifocal you might consider getting the nearpoint set very near and then at least get some intermediate vision out of the "far"  point.

[CurlyButterfly]

Renee, I understand TOTALLY what you were saying and I also had 2 friends that did the distance vision (they were nearsighted) and they acted like it was so great, but that little voice inside me kept telling me that I'd never be happy not being able to see those tiny details. Even some family members said they couldn't understand why I wouldn't be ok with wearing glasses for close up, and I kept going back to my original thoughts about putting on makeup, threading a needle, drilling tiny holes in my jewelry items, etc, etc.. It seems you have a good outlook on life with all you've been through and I suppose whatever we go through we can learn to accept and adjust to it (like you said).

Keep us posted with what happens and your surgery! Praying for all to go well!

[CurlyButterfly]

Nancy....really! We do need each other ;-)

[Nancy_in_GA]

Maybe there should be a support group for "People Who Choose Near Vision IOLs"  It's difficult sometimes when folks, keep telling you you are crazy.  ;)