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Close vision and Toric lens set for distance

I am having cataract surgery on both eyes.  They recommend a Toric IOL.  I have always read without glasses.  If Toric in one eye is set for distance and Toric in other eye is set for intermediate, will I lose this ability to read without glasses?
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Avatar universal
I had have toric IOL's with one eye set for distance that is slightly under-corrected and theother eye set for near. I can read my iphone perfectly and computer vision is ok. I wear computer glasses if I'm going to be on it for a while. Distance vision is fair, I wear glasses to drive. Most of the time I don't wear glasses at all. I am having problems with glare and starbursts which I'm going to post about in another thread. I'd suggest reading this article "My Standpoint on Monovision as a Cataract Surgeon"
http://crstodayeurope.com/2009/10/1009_12.php
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Had not considered that.  Thanks for pointing that out.
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The toric lenses need a capsular bag..so if there is risk for a ruptute, you might want to have a back-up available
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Medicare and health insurance will cover 2nd opinions (and 3rd or more) as needed before any surgery is done.
I would select a surgeon that has done many types of lenses, rather than a 1 trick pony.
If you have a university eye center near you, that would be a good place to start.  
Since the cataract is removed, the "advanced" stage of the cataract should have no bearing on the type of lens you and your surgeon select.
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I am in the U.S.
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Yes, my cataracts are quite advanced.  I appreciate so much the time you took to help me.  I think I may talk with another doctor to get a second opinion.
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Avatar universal
re: "They say I am not a candidate for the Crystalens because my cataracts are advanced.  "

Perhaps someone with more knowledge about the Crystalens might be familiar with this, but to me that sounds odd since usually the details of the cataract have no impact on the replacement lens you use. The natural lens with the cataract is removed, and then the artificial lens is inserted afterwards. So it isn't clear why any attribute of the natural lens would impact the choice of artificial lens.

The only thing that comes to mind is whether the cataract is of a type where there is a risk that when it is removed the capsular bag that holds the lens might be torn, and if it can't be repaired the lens might need to be placed outside of the capsular bag, sutured/glued to another part of the eye. I would suspect the Crystalens can't operate like that. However in that case presumably what they would do is to hope for the best, that the capsular bag will be fine, but merely have another backup lens ready in case it has to be placed outside the bag. I would check with the surgeon to be sure they consider the option that is best for you, not merely the option that is easiest for them.

Even if you go for a toric monofocal, I'd also suggest checking on the model since not all monofocals are created equal, e.g. some improve vision by using a material that has less chromatic aberration and some have more risk of "glistenings". Hoya now has a monofocal lens that has some improved "depth of focus", though I don't know if they have a toric version, or how it compares regarding the other attributes since I didn't consider a monofocal.  Are you in the US? That effects the lens choices available.

re: "They won't do close and distance because I have never done this with contacts."

I take it your cataracts are too advanced now to be able to do a contact lens trial now (or to try multifocal contacts)? The larger the difference between the eyes, the more likely the brain might have trouble adapting to the difference so it is lower risk to just make it far and intermediate (or intermediate and near). If you don't mind being nearsighted and needing glasses to drive, the intermediate&near combination may make sense for you.  There is a thread or two on this site from some people that have even had  both their lenses set for near so they need correction for anything else, people's needs will vary.
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Avatar universal
I am sorry I did not mention in my question that I have always worn glasses for distance
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Thank you so much for your answer.  They say I am not a candidate for the Crystalens because my cataracts are advanced.  I just wondered if I might be better off with  the Toric set at close in one eye and Intermediate in the other.  That way I would keep my natural nearsightness.  I would need glasses for driving.   (They won't do close and distance because I have never done this with contacts.)
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Avatar universal
The ability you have now to read without glasses comes from the ability of your eye to accommodate, to change focus from far to near. Once your natural  lens is replaced with a monofocal artificial lens, you loose that ability to change focus. Since you say a "toric" lens, that only corrects for astigmatism, so I'm assuming you are just talking about a monofocal toric lens, a lens set only for one distance.

That is the reason they might suggest setting one eye for intermediate distance, since otherwise it would be set for far and you would likely have trouble seeing closer in. How close people can see with a monofocal lens (whether set for intermediate, or distance) varies with the person since each has a different "depth of focus", the range of focus the eye can see without changing its focus. If I recall correctly, only like 8% of people can read even with a monofocal set for distance, so its not something to bet on. If you have it set for intermediate, presumably a higher percentage, but still likely a small minority, will be able to read without glasses.

If you are concerned about having better odds of reading without glasses  you'd need to consider a "premium lens". There are accommodating lenses like the Crystalens that mimic a little bit of the natural accommodation of the eye.. but they don't always work and are therefore sometimes just like a monofocal lens, though when they do work they can give you some better intermediate and near vision.  There are  multifocal lenses: bifocals are available in the US to cover 2 distance ranges (usually either far and near, or now new ones that do far and intermediate with a lower add) and cover the 3rd less well, or  outside the US there are trifocals to cover 3 ranges better. There is a small risk of visual artifacts with multifocals like halo and glare that might interfere with night vision... or might not. The new Symfony extended depth of focus lens available outside the US seems to reduce those, while also providing better intermediate and near vision than a monofocal.
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