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!

[CurlyButterfly]

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.

[Nancy_in_GA]

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?

[CurlyButterfly]

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

[Nancy_in_GA]

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.   ;)

[CurlyButterfly]

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

[Nancy_in_GA]

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?