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Cataract surgery: Two close distance monovision lenses?
Going for first surgery in the left eye soon. I am 67 years old, nearsighted, and have always worn glasses, but could always take off my glasses to see very close up (8 inches away currently). I had to be persistent in letting the doctor know I did not want give up the close vision, so he is giving me two monofocal near vision lenses. I know the chance of doing away with distance glasses is remote, so I figured, why give up the close vision too, and then have to wear glasses to thread a needle or remove a splinter. I assume I'll have to wear progressive glasses afterward, but that is fine with me.
I'm getting nervous about this because in my experience when you do something different from what everyone else does, you are usually making a mistake, and I can't find anyone who has ever done this, except my optometrist (different from the eye surgeon) said he is going to have two close vision lenses implanted when the time comes. I'm hoping to be no worse off than I am now, plus the cataracts will be gone. If I'm wrong I may have wasted a chance to at least get better far vision.
The surgeon said he would make the lenses +3.5. Sound reasonable?
Did anyone have experience with two close vision IOLs?
I'm getting nervous about this because in my experience when you do something different from what everyone else does, you are usually making a mistake, and I can't find anyone who has ever done this, except my optometrist (different from the eye surgeon) said he is going to have two close vision lenses implanted when the time comes. I'm hoping to be no worse off than I am now, plus the cataracts will be gone. If I'm wrong I may have wasted a chance to at least get better far vision.
The surgeon said he would make the lenses +3.5. Sound reasonable?
Did anyone have experience with two close vision IOLs?
MEDICAL PROFESSIONAL
This is not a question of right or wrong. It is a personal choice based on individual needs. Most myopes (nearsighted people) really like being able to read without glasses, as they have been able to do all their lives. Implanted monofocal intraocular lenses (IOLs) for distance will require that you wear reading glasses. You are not doing the wrong thing by having the monofocal IOLs set for near, so you are able to read without glasses, and then wearing glasses for distance.
At least 16 inches isn't too bad, in terms of how near you are able to see clearly.
I use single-vision glasses around the house that give me clear vision in my good eye at about 16 inches so I know exactly what your vision is like in the operated eye now. It's a pretty nice option although if I sit too far back from the computer I have to squint or lean in. Not the best choice ergonomically but at least I can read the monitor.
Your mom's situation is interesting. My parents had the opposite reaction - they already wore glasses for mild nearsightedness before surgery, and chose IOLs for 20/20 distance vision for their cataract surgery. Frankly, I'm not sure if this was an active choice, or if the doctor just defaulted to giving them single-vision IOLs calibrated for distance vision, but that's what they got. They use progressive eyeglasses for intermediate and near vision now and are very happy.
The 'right' IOL really does depend on what each patient is used to before surgery, their individual eye health, and what lifestyle they want to have after surgery (e.g. at which distance to they want their clear vision to be glasses-free).
You wisely were proactive in assessing your lifestyle and pursuing a lens that would best align with your vision goals. I hope more patients will read threads like this and realize they have the same choice and options.
I use single-vision glasses around the house that give me clear vision in my good eye at about 16 inches so I know exactly what your vision is like in the operated eye now. It's a pretty nice option although if I sit too far back from the computer I have to squint or lean in. Not the best choice ergonomically but at least I can read the monitor.
Your mom's situation is interesting. My parents had the opposite reaction - they already wore glasses for mild nearsightedness before surgery, and chose IOLs for 20/20 distance vision for their cataract surgery. Frankly, I'm not sure if this was an active choice, or if the doctor just defaulted to giving them single-vision IOLs calibrated for distance vision, but that's what they got. They use progressive eyeglasses for intermediate and near vision now and are very happy.
The 'right' IOL really does depend on what each patient is used to before surgery, their individual eye health, and what lifestyle they want to have after surgery (e.g. at which distance to they want their clear vision to be glasses-free).
You wisely were proactive in assessing your lifestyle and pursuing a lens that would best align with your vision goals. I hope more patients will read threads like this and realize they have the same choice and options.
flossy93, best focus in IOL eye *has* changed some since last post. Now seems to be about 16 inches, rather than about 12 inches two weeks after surgery.
My mother is a good example of why it's important to inform (especially older) patients of the near vision option. All her life she could see close without glasses. After cataract surgery (at 85 years old) she couldn't. Her far vision is probably good enough to go without glasses, but since she has worn them for 70 years, she can't get used to not wearing them, or having to have readers. Old habits die hard. LOL.
My mother is a good example of why it's important to inform (especially older) patients of the near vision option. All her life she could see close without glasses. After cataract surgery (at 85 years old) she couldn't. Her far vision is probably good enough to go without glasses, but since she has worn them for 70 years, she can't get used to not wearing them, or having to have readers. Old habits die hard. LOL.
Thanks for the update! It's great to hear that you've had such a good outcome with your first surgery.
I was just thinking about you yesterday, and wondering if you had good luck discussing your preference for near vision with the surgeon for your second surgery, and what target refraction you wanted in that eye. Hopefully if he shoots for +4 you will end up at something close to your first eye's outcome, so combined you will have very good near-vision performance.
With your originally operated eye (the one that came out at +2.5), what would you say is your near vision distance? Twelve inches as it first appeared after surgery? Or did it heal to a final distance that's different?
It's so great that you started this discussion here, because there have been a few more patients posting since your first surgery who are considering a different refractive choice than the 'default' of 20/20.
There seem to be many patients who do not realize or are not told that they HAVE a choice, and don't know to research their options ahead of time and be proactive in their IOL and target refraction selection. Hopefully having more of these discussion threads out there will help patients go into their appointments as prepared as possible to discuss options with their surgeons.
Best of luck in the next surgery - I'm looking forward to your feedback on the second procedure.
I was just thinking about you yesterday, and wondering if you had good luck discussing your preference for near vision with the surgeon for your second surgery, and what target refraction you wanted in that eye. Hopefully if he shoots for +4 you will end up at something close to your first eye's outcome, so combined you will have very good near-vision performance.
With your originally operated eye (the one that came out at +2.5), what would you say is your near vision distance? Twelve inches as it first appeared after surgery? Or did it heal to a final distance that's different?
It's so great that you started this discussion here, because there have been a few more patients posting since your first surgery who are considering a different refractive choice than the 'default' of 20/20.
There seem to be many patients who do not realize or are not told that they HAVE a choice, and don't know to research their options ahead of time and be proactive in their IOL and target refraction selection. Hopefully having more of these discussion threads out there will help patients go into their appointments as prepared as possible to discuss options with their surgeons.
Best of luck in the next surgery - I'm looking forward to your feedback on the second procedure.
Initial appointment for the right eye surgery was today. Dr. was much easier to talk to this time. Maybe because their schedule seemed lighter than before. Or maybe it was because I could demonstrate now, with the left eye already done, why I really wanted near vision.
He said he shot for 3.5 add on the left eye but it came out +2.5. He said he will shoot for +4.0 this time. He said it rarely misses target on the positive side.
Got a chance while waiting to fool around with their near distance eye chart. I can read smaller print with the IOL than with the cataract eye, but it has to be held farther away. I can read the J1+ (bottom) line without glasses. With a magnifying mirror, I may be able to make everything work just fine. I do notice I can read the clock next to the bed in the morning without glasses. That's a nice benefit.
Surgery scheduled for next Thursday, May 8th. I'm going with the LenSX laser method again. Will update at that time.
He said he shot for 3.5 add on the left eye but it came out +2.5. He said he will shoot for +4.0 this time. He said it rarely misses target on the positive side.
Got a chance while waiting to fool around with their near distance eye chart. I can read smaller print with the IOL than with the cataract eye, but it has to be held farther away. I can read the J1+ (bottom) line without glasses. With a magnifying mirror, I may be able to make everything work just fine. I do notice I can read the clock next to the bed in the morning without glasses. That's a nice benefit.
Surgery scheduled for next Thursday, May 8th. I'm going with the LenSX laser method again. Will update at that time.
Just thought I'd do an update, because it is disappointing to me to search for a topic here and the thread just drops off and you never find out what happened.
I never included my statistics (prior to surgery). Left eye had the surgery:
OD -4.25 -0.75 020 Add +2.75
OS -4.25 -0.50 175 Add +2.75
BTW, as far as the surgery experience itself, as soon as the pupil became undilated (next day) it was like nothing ever happened. I could feel a slight ache when I tried to focus close up with the corrected eye for the first 3 days, but I'm guessing that has to do with the muscles that used to change the natural lens. Maybe they learned to give up trying?
One week after surgery the 10/4 o'clock diagonal line has almost completely disappeared. Other rays of light at night from bright lights appear to be directly related to the progressive lenses in the eyeglasses. Tilt the glasses and the rays tilt. That diagonal line only moved if I tilted my head. So I think the rays and the halos mostly have to do with needing a slightly updated prescription in the glasses, but I'll wait until the other eye surgery, because left eye distance vision and night time driving are so much improved even with the old glasses Rx.
Green stoplights in the day look blue-green from the eye with the cataract, and green-green in the eye with the IOL. At night there is no difference---they both look blue-green. Evidently the blue light filter only matters when there is also some sunlight.
I'm very happy I chose near vision, but it looks like 12" is the best I'm going to get. I don't think I would like monovision or even mini-monovision. The only idea I'm slightly toying with is getting the other eye to focus at computer monitor distance (+3.0?). But with the possible expected margin of error that has been discussed here extensively, I think I'll just go with another 3.5 lens. Maybe I'll get lucky and that lens will end up closer than the first one, or focused at computer distance anyway, and if both eyes end up with exactly the same focal point, that would be good too. Whatever it comes out will be fine.
Guess it's true, you can't teach an old dog new tricks. ;)
In the follow-up my optometrist said the space on progressive eyeglass lenses for very near vision is very small and hard to make disproportionately larger, and some folks have difficulty finding the spot. That was my experience, and why I tended to just look over my glasses to see very close up.
I'll update again when I get surgery in the other eye. Could be a couple of months because I need to finish a project that requires some heavy lifting (literally) first. Hope this information helps someone.
I never included my statistics (prior to surgery). Left eye had the surgery:
OD -4.25 -0.75 020 Add +2.75
OS -4.25 -0.50 175 Add +2.75
BTW, as far as the surgery experience itself, as soon as the pupil became undilated (next day) it was like nothing ever happened. I could feel a slight ache when I tried to focus close up with the corrected eye for the first 3 days, but I'm guessing that has to do with the muscles that used to change the natural lens. Maybe they learned to give up trying?
One week after surgery the 10/4 o'clock diagonal line has almost completely disappeared. Other rays of light at night from bright lights appear to be directly related to the progressive lenses in the eyeglasses. Tilt the glasses and the rays tilt. That diagonal line only moved if I tilted my head. So I think the rays and the halos mostly have to do with needing a slightly updated prescription in the glasses, but I'll wait until the other eye surgery, because left eye distance vision and night time driving are so much improved even with the old glasses Rx.
Green stoplights in the day look blue-green from the eye with the cataract, and green-green in the eye with the IOL. At night there is no difference---they both look blue-green. Evidently the blue light filter only matters when there is also some sunlight.
I'm very happy I chose near vision, but it looks like 12" is the best I'm going to get. I don't think I would like monovision or even mini-monovision. The only idea I'm slightly toying with is getting the other eye to focus at computer monitor distance (+3.0?). But with the possible expected margin of error that has been discussed here extensively, I think I'll just go with another 3.5 lens. Maybe I'll get lucky and that lens will end up closer than the first one, or focused at computer distance anyway, and if both eyes end up with exactly the same focal point, that would be good too. Whatever it comes out will be fine.
Guess it's true, you can't teach an old dog new tricks. ;)
In the follow-up my optometrist said the space on progressive eyeglass lenses for very near vision is very small and hard to make disproportionately larger, and some folks have difficulty finding the spot. That was my experience, and why I tended to just look over my glasses to see very close up.
I'll update again when I get surgery in the other eye. Could be a couple of months because I need to finish a project that requires some heavy lifting (literally) first. Hope this information helps someone.
I think I figured out the colored halos have something to do with how soon you look at the lights after using those eyedrops.
And flossy93, I forgot to thank you for the information about the lenses. I don't know as much about what the numbers mean as most on here do. I'll go off and study it some more.
And flossy93, I forgot to thank you for the information about the lenses. I don't know as much about what the numbers mean as most on here do. I'll go off and study it some more.
I hope your halos do stabilize after your surgical trauma has healed.
One last comment about ways to deal with closeup vision after cataract surgery:
Another MedHelp patient and I were corresponding about this, and she said she had gotten a very powerful magnifying mirror and that it was helpful to see details on her face and eyes at the distance closer than she can now see with her IOLs.
In her case I think she had a 20X mirror, which is indeed powerful and probably has to be a countertop or wall-mount model (e.g. not handheld, as one's hand moving would make that level of magnification difficult to use).
If you end up with 12-inch distance vision and decide to get the same in the other eye, you may be able to use a strong magnifying mirror to see the details you could previously see by removing your glasses. It won't help you paint the ceiling, but it might be good for looking at your eyes (for putting on makeup, removing eyelashes, etc).
Good luck with the decision about the next lens, as well as with your current healing. I hope you ultimately reach the vision goal you set for yourself going into the surgery. :-)
One last comment about ways to deal with closeup vision after cataract surgery:
Another MedHelp patient and I were corresponding about this, and she said she had gotten a very powerful magnifying mirror and that it was helpful to see details on her face and eyes at the distance closer than she can now see with her IOLs.
In her case I think she had a 20X mirror, which is indeed powerful and probably has to be a countertop or wall-mount model (e.g. not handheld, as one's hand moving would make that level of magnification difficult to use).
If you end up with 12-inch distance vision and decide to get the same in the other eye, you may be able to use a strong magnifying mirror to see the details you could previously see by removing your glasses. It won't help you paint the ceiling, but it might be good for looking at your eyes (for putting on makeup, removing eyelashes, etc).
Good luck with the decision about the next lens, as well as with your current healing. I hope you ultimately reach the vision goal you set for yourself going into the surgery. :-)
Thank you for your encouraging words, flossy93. I really appreciate it. I forgot about digging something out of your eye. Yes! And painting the line between the ceiling and walls in a room. Try bending your neck back with progressive lenses to do that, or switching between reading and distance glasses while painting.
I've been taking evening walks to check the eyesight at night in bright lights. First night colored halos going through the whole spectrum of colors, second night halos were gone but a diagonal ray going from 10 o'clock to 4 o'clock position appeared. Third night back to halos. Hope it settles down. Want to be able to drive confidently at night again. Higher probability of halos and glare was why I didn't go with premium multifocal lenses in the first place.
I've been taking evening walks to check the eyesight at night in bright lights. First night colored halos going through the whole spectrum of colors, second night halos were gone but a diagonal ray going from 10 o'clock to 4 o'clock position appeared. Third night back to halos. Hope it settles down. Want to be able to drive confidently at night again. Higher probability of halos and glare was why I didn't go with premium multifocal lenses in the first place.
Nancy, don't feel like your desire for near vision is not valid. You understand and accept that you will forego uncorrected distance vision, and will need lenses for intermediate to distance vision. This choice may not be what the surgeon typically advises for most patients, or what most patients would choose. But that doesn't mean it's not right for you.
I've always been extremely nearsighted and when I have cataract surgery I may also opt for near vision with glasses or contacts needed for intermediate and distance vision. I've worn contacts and glasses all my life so it's normal for me. And right now when I need to remove a splinter or fish an eyelash out of my eye, I take off the corrective lenses and can see quite clearly a few inches away, so that's what is normal to me. If it's the same for you I can see why you might want that, esp if your lifestyle doesn't require crisp distance vision without corrective lenses.
Re the SN60WF lens, according to the Alcon product information PDF it is available in a diopter range from +6D to +30D: http://www.alconsurgical.com/pdfs/NIQ11352PI.pdf
Please keep us posted here about your outcome, and thank you for bringing your IOL decision process to the board to share with other patients. Good luck!
I've always been extremely nearsighted and when I have cataract surgery I may also opt for near vision with glasses or contacts needed for intermediate and distance vision. I've worn contacts and glasses all my life so it's normal for me. And right now when I need to remove a splinter or fish an eyelash out of my eye, I take off the corrective lenses and can see quite clearly a few inches away, so that's what is normal to me. If it's the same for you I can see why you might want that, esp if your lifestyle doesn't require crisp distance vision without corrective lenses.
Re the SN60WF lens, according to the Alcon product information PDF it is available in a diopter range from +6D to +30D: http://www.alconsurgical.com/pdfs/NIQ11352PI.pdf
Please keep us posted here about your outcome, and thank you for bringing your IOL decision process to the board to share with other patients. Good luck!
Searched for the meaning of the 3.5 for near distance vision, and I believe it means the focal length would be (1/3.5)(39.37) = 11.25 inches. Please correct me if I'm wrong. So for 8 inches I'd need something like a 5.0.
This was an AcrySof IQ SN60WF lens with power 19.0. Don't know if they even make them that extreme. Can't find the information anywhere. Maybe my optometrist will know. From the brief conversation with the surgeon last time, I suspect he may refuse, even if there is such a thing.
This was an AcrySof IQ SN60WF lens with power 19.0. Don't know if they even make them that extreme. Can't find the information anywhere. Maybe my optometrist will know. From the brief conversation with the surgeon last time, I suspect he may refuse, even if there is such a thing.
Thank you Dr. Fazio. That helps a lot.
What I want is near vision at about 8 inches, and crisp vision with the help of progressive glasses at all other distances.
I guess my question should have been, "Is what I want even achievable, or am I asking too much?"
It was just that I couldn't find *any* information about doing this, and the surgeon was so difficult to convince, that I thought maybe it couldn't be done. I'm at 12 inches now, so maybe it will work. Fingers crossed.
What I want is near vision at about 8 inches, and crisp vision with the help of progressive glasses at all other distances.
I guess my question should have been, "Is what I want even achievable, or am I asking too much?"
It was just that I couldn't find *any* information about doing this, and the surgeon was so difficult to convince, that I thought maybe it couldn't be done. I'm at 12 inches now, so maybe it will work. Fingers crossed.
Had the first surgery done on left eye yesterday. Interesting thing is I can see better with my old glasses than before the surgery, so probably won't need a new temporary left lens for my glasses until the other eye is done. I still don't have as close a near vision as I wanted yet. It appears to be about 12-14 inches today, but nurse said give it a week. I'm skeptical.
Follow up was today, and I asked the surgeon about the idea of one near and one far vision lens, and he said if I wanted the crispest vision possible, I'd keep both lenses focused the same distance. Then he added, "But don't get the next one even closer." (That is exactly what I'm tempted to do if this doesn't pan out on the left eye.) It seemed like he was too much in a rush to ask any more questions, so I'll save them for my regular eye doctor next week for the next follow up.
What is amazing is how white the whites are. I painted my kitchen cabinets white a few years ago and now I almost need sunglasses to go in the kitchen, it's so bright white. My dominant eye is the one that had the surgery, so the brain has blocked out the dingy yellow side.
Follow up was today, and I asked the surgeon about the idea of one near and one far vision lens, and he said if I wanted the crispest vision possible, I'd keep both lenses focused the same distance. Then he added, "But don't get the next one even closer." (That is exactly what I'm tempted to do if this doesn't pan out on the left eye.) It seemed like he was too much in a rush to ask any more questions, so I'll save them for my regular eye doctor next week for the next follow up.
What is amazing is how white the whites are. I painted my kitchen cabinets white a few years ago and now I almost need sunglasses to go in the kitchen, it's so bright white. My dominant eye is the one that had the surgery, so the brain has blocked out the dingy yellow side.
If i were you i'd either go for 20/20 in both eyes and use readers for close...or mini monovision with 20/20 in dominant eye and have them do about 1.0 diopters for the non-dominant eye...that should give you a blended vision of about 20/30 and you should be relatively glasses free except to read very close or very fine print where you would probably want to pop on weak readers...
I think going close for both lenses would be a big mistake...
Also, if you have significant astigmatism, get torics....it's worth the difference you have to pay...
That's what i'd do....but let's see what the doctor recommends...
I think going close for both lenses would be a big mistake...
Also, if you have significant astigmatism, get torics....it's worth the difference you have to pay...
That's what i'd do....but let's see what the doctor recommends...
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