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Medical Forum / General / Vision / October 2008toric IOL: choose near or distance vision
I'm facing cataract surgery and my trusted experienced opthalmologist asked if I wanted near or far vision as the outcome. This is an agonizing choice and I'd like your opinion. All my life I've been nearsighted (with bad astigmatism doc says won't be eliminated completely by IOL). I can see pretty well unaided at a distance of about 6 inches and am afraid to lose this vision. But everyone says life after surgery will be better overall. Should I pick near vision so I can read, apply makeup, see computer? Or should I pick distance vision to drive, see TV, watch people across the street? I realize glasses (or cheap readers) will be needed to get the opposite vision of whichever I pick, and no outcome is 100% predictable. For those of you who've actually picked one or the other, what were the surprises afterward? For you with medical expertise, what was the general choice of most folks and what are their regrets afterward? Details: I'm mid fifties, retired computer person, cataracts for about 8 years, now using toric contacts for monovision (not fond of mono). Will get toric IOL with LRI. Not worried about surgery, just the choice of outcome. last glasses RX was R= -8.00 sph, +2.75 cyl, 85 axis L= -7.5 sph, +1.50 cyl, 80 axis Dear Silviaelli, Subject: No one can tell you what you should do. I had cataract surgery. The man was excellent, and the results good. I chose "far" vision, since I did not have clear distant vision since I was eight years old. The result is that I have 20/20 vision in each eye. I check this myself. Further, using my own trial-lens kit, I have a refractive STATE of +1/2 diopter. In "normal" words -- this is a perect result -- exactly as I wished it to be. Further, I am typing this into my coputer (and reading it) with no lens on my face. (Measured distance is 25 inches.) But, as a matter of choice, and scientific interest, I am wearing a +2.75 diopter lens for all work less than 25 inches. This is far better than wearing a minus lens 16 hours a day seven days a week. If I do no "close work", then no glasses at all. Further, I play tennis, and it is great not to have those negative lenses on my face. So that was MY choice -- and I was lucky about the result. Good luck to you, Otis > I'm facing cataract surgery and my trusted experienced > opthalmologist asked if I wanted near or far vision as the outcome. [quoted text clipped - 22 lines] > R= -8.00 sph, +2.75 cyl, 85 axis > L= -7.5 sph, +1.50 cyl, 80 axis Geez, I would take either one! As my farsightedness progresses, I can barely see to run without glasses. Personally I would go with good distance vision. Seems easier to have reading glasses than driving glasses. Is splitting it an option? My son has terrible vision in both eyes, but one is far and the other near; until he had them tested he didn't know he had a problem. I wrote you a whole long thing about this and eventually edited it out of existence. Three things you probably don't want: "Perfect distance vision" means you're disabled up close when you don't have reading glasses. Duplicating what you have now (6 inches) is only desirable if you spend hours putting on makeup. Remaining more than -2.50 myopic in either eye is ill-advised. Striving to make both eyes exactly the same after surgery isn't generally useful. Many people can't tolerate cookbook "monovision," but most people can tolerate a half-diopter or more of difference between the two eyes. That little compromise can eliminate the need for glasses in many environments. -MT, OD In article <e9335c23-f498-4da0-aa14-516bc6dc8519@u75g2000hsf.googlegroups.com>, > I'm facing cataract surgery and my trusted experienced > opthalmologist asked if I wanted near or far vision as the outcome. > This is an agonizing choice and I'd like your opinion. > All my life I've been nearsighted (with bad astigmatism doc says > won't be eliminated completely by IOL). I was nearsighted almost all my life. I chose distance vision when I had cataract surgery in both eyes. I have been very happy with it. I can get out of bed and see. It depends some on your lifestyle. If you like being outdoors, there are problems with fogging and mist with glasses. If you need glasses indoors, fogging and misting shouldn't be a problem. > I can see pretty well unaided at a distance of about 6 inches and > am afraid to lose this vision. But everyone says life after surgery > will be better overall. Once in a blue moon I miss the extreme close vision, but I just keep a variety of reading glasses around. One pair lets me see pretty closely. > Should I pick near vision so I can read, Once in a while I find myself somewhere away from home and unable to easily read because I didn't bring glasses. Doesn't happen often, and I keep spare reading glasses in my vehicles. > apply makeup Don't wear makeup, but wearing glasses sounds like a problem. > see computer? You will lose all of your focusing ability when the cataract is removed. This means that you will probably need different glasses for computer use than reading. This isn't true for everyone, but you should expect it. > Or should I pick distance vision to drive, see TV, watch > people across the street? I realize glasses (or cheap readers) will > be needed to get the opposite vision of whichever I pick, and no > outcome is 100% predictable. Maybe it's not a big deal for you, but distance glasses are *always* prescription, and reading glasses in your case will normally be OTC. You can afford to have multiple reading glasses. If you choose near vision suitable for reading, you may need both computer and driving glasses (or bifocals, which most people find work poorly for computer use). > For those of you who've actually picked one or the other, what > were the surprises afterward? Not a big surprise, but the loss in color and sharpness came upon me gradually, whereas after the surgery, it was all of a sudden back. That was very pleasing. I had forgotten what grass and trees looked like. > Details: I'm mid fifties, retired computer person, cataracts for about > 8 years, now using toric contacts for monovision (not fond of mono). That's a good thing to know in advance. Some people on this group have said that they want monovision with their cataract surgery. If you don't like that, you can choose not to do that. > Will get toric IOL with LRI. Not worried about surgery, just the > choice of outcome. Be aware that if you don't have both eyes done at once, there will be vision problems when wearing glasses. Contacts will be fine, so if you get one eye done, just wear your regular contact in the other eye. Frankly, I wouldn't want both eyes done at once, but that's just me.  SignatureDan Abel Petaluma, California USA dabel@sonic.net > I'm facing cataract surgery and my trusted experienced >opthalmologist asked if I wanted near or far vision as the outcome. It's good to here that they gave you a choice! >This is an agonizing choice and I'd like your opinion. > All my life I've been nearsighted (with bad astigmatism doc says >won't be eliminated completely by IOL). > I can see pretty well unaided at a distance of about 6 inches and >am afraid to lose this vision. But everyone says life after surgery >will be better overall. With the exception of complications, your BCVA (best corrected visual acuity) should improve after surgery, but will not necessarily be as good as before the cataract diagnosis. > Should I pick near vision so I can read, apply makeup, see >computer? Or should I pick distance vision to drive, see TV, watch >people across the street? It depends on the type of close tasks- a numismatist might keep a moderate amount of myopia, a walker might prefer the best uncorrected distance VA possible. I read in bed at night, work with small items at work and home, and strongly prefer removing my glasses instead of using a loupe or magnifier, so I'll keep my present minus four diopter prescription. >I realize glasses (or cheap readers) will >be needed to get the opposite vision of whichever I pick, and no >outcome is 100% predictable. Don't use the "cheap readers" for anything more than spotting a phone number or other very short term tasks. > For those of you who've actually picked one or the other, what >were the surprises afterward? For you with medical expertise, what >was the general choice of most folks and what are their regrets >afterward? I have yet to hear a myope complain about their the decision to keep a moderate amount of myopia, probably because it's usually a well thought out decision. I've heard plenty of complaints about not being able to read or see really small objects without glasses, primarily because they were not given a choice in advance of the surgery. >Details: I'm mid fifties, retired computer person, cataracts for about >8 years, now using toric contacts for monovision (not fond of mono). [quoted text clipped - 4 lines] >R= -8.00 sph, +2.75 cyl, 85 axis >L= -7.5 sph, +1.50 cyl, 80 axis You should discuss this with the refractionist and/or optician and have them show you how you will see postop by using a trial frame with and without the CLs. Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical Wauwatosa Wi. ~~~~~~~~~~~~~~~~~~ "Science is a way of trying not to fool yourself." - Richard Feynman >>I realize glasses (or cheap readers) will >>be needed to get the opposite vision of whichever I pick, and no >>outcome is 100% predictable. > > Don't use the "cheap readers" for anything more than spotting a phone number or > other very short term tasks. With all due respect, could you explain this comment? When I wear my contacts (distance) I use cheap (99-Cent-Store, some with those nice spring hinges) readers in various diopters depending on what I want to do -- for hours at a time. It's easy enough to hold them up to straight lines and see if an individual lens is wavy -- and I've never found one that was, although cheap sunglasses used to be (decades ago) problematical. SignatureCheers, Bev +++++++++++++++++++++++++++++++++++++++++++++++ "Genius may have its limitations, but stupidity is not thus handicapped." -- Elbert Hubbard, American author >>>I realize glasses (or cheap readers) will >>>be needed to get the opposite vision of whichever I pick, and no [quoted text clipped - 7 lines] >spring hinges) readers in various diopters depending on what I want to >do -- for hours at a time. It's a good bet that the focal length will be equal for each eye if they're worn over CLs, although it's also a good bet that there will be unwanted prism and possibly some residual astigmatism. It gets worse if you don't wear CLs, with the addition of some disparity in lens power eye to eye, with the chance for uncorrected astigmatism increasing to likely, along with the aforementioned prismatic errors. It would be bordering on medical negligence to encourage the use of glasses that are the wrong prescription for our primary pair of glasses. It sounds like you can tolerate OTC readers, and can sustain this tolerance for long term tasks. Have you ever had Rx readers? Ask your doctor to do an "over refraction" and try a pair next time. Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical Wauwatosa Wi. ~~~~~~~~~~~~~~~~~~ "Science is a way of trying not to fool yourself." - Richard Feynman > On Thu, 23 Oct 2008 18:42:51 -0700, The Real Bev > <bashley101+usenet@gmail.com> [quoted text clipped - 30 lines] > long term tasks. Have you ever had Rx readers? Ask your doctor to do an "over > refraction" and try a pair next time. Some years back, during a routine exam, I asked my OD whether I should get prescription readers. He did a few minutes of testing, and recommended +2 OTC readers. He said that if I had any problems, to come back and he would do more tests and prescribe glasses if he thought they would be better. These were to wear over my contacts, -10D in the left eye, and plano torics in the right, with 1.75D for astigmatism. He said that my actual reading prescription was +1.75D and 2.25D, but didn't think that would help much. I wasn't so sure, but with all I've read on this group, about monovision without correction after cataract surgery, perhaps he had a point (I had had cataract surgery in the right eye, which is where the "plano" came from). [Note: My OD wore OTC readers] SignatureDan Abel Petaluma, California USA dabel@sonic.net >>>>I realize glasses (or cheap readers) will >>>>be needed to get the opposite vision of whichever I pick, and no [quoted text clipped - 11 lines] > over CLs, although it's also a good bet that there will be unwanted prism and > possibly some residual astigmatism. I've always had LOTS of residual astigmatism with my prescriptions glasses and contact lenses no matter who has prescribed/made them. > It gets worse if you don't wear CLs, with the addition of some disparity in lens > power eye to eye, with the chance for uncorrected astigmatism increasing to > likely, along with the aforementioned prismatic errors. It would be bordering on > medical negligence to encourage the use of glasses that are the wrong > prescription for our primary pair of glasses. It seems like a person ought to be able to tell just by trying. It's not like it costs a bundle, unlike prescription lenses. > It sounds like you can tolerate OTC readers, and can sustain this tolerance for > long term tasks. Have you ever had Rx readers? Ask your doctor to do an "over > refraction" and try a pair next time. It turns out I have a pair of bifocals like that, and they make nice computer glasses. I don't want to drive with them, though. My prescription glasses -- over the last 30 years -- have ALWAYS had a 2D difference between left and right lenses, and the distance in focus has always been different. I now regard my left eye as pretty useless at any distance for anything but providing 3D information because of residual astigmatism and a foveomacular vitelliform dystrophy, which is REALLY annoying. To even things out, I have floaters in my right eye :-( SignatureCheers, Bev ============================================================= "On the other hand, I live in California so I'd be willing to squeeze schoolchildren to death if I thought some oil would come out." -- Scott Adams Hi, I agree with the above that A) it is great that you have a choice, and B) that no one can answer this for you. It depends on too many variables that only you can no. And besides, who cares what would work for others, you will be the one doing the seeing! :) Cataract surgery usually has great results. What you aim for though is most important. If you are unsure, and the cataract doesn't have to come out right now, I would think it over and not go with what others think...its your cataract surgery. Cheers, VFG p.s. why do you have to choose? check out the last section on "lens options" (http://cataractsurgery.accommodatingiol.com/) |
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