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9424748 tn?1405134041
Cataracts & Toric IOL for Astigmatism
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!
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7765252 tn?1395099628
All I can tell you is my experience. I don't know if it will be the same for you.

I opted for two close vision monofocal IOLs. Wanted to keep my vision without glasses as close as possible to what I had before surgery. I also do a lot of close work and don't mind wearing glasses for distance.   Before surgery I could see things clearly about 8 inches away from my eyes without glasses and would always take them off for very close work.  The last of the two surgeries was completed about 2 months ago.  

The surgeon targeted the first IOL for a +3.0 add. The clearest focus afterward turned out to be about 14 inches from the front of my eye.  He targeted a +3.5 add on the second eye, and the clearest focus is now about 10 inches from that eye. I can still thread a needle without glasses but it takes some getting used to.  You have to learn to move the needle *farther* away rather than closer.

As the focal target gets closer to your eye, the range of acceptable clear vision seems to get much shorter.  For example my range of crisp vision is less than 6" plus or minus without glasses.  If you opt for distance vision, you will be able to see clearly without glasses for a longer range.  My guess is the range is the distance you sit from the eyechart (20 feet?) out to infinity.  

There is an intermediate range also, like sitting 10 feet from a TV.  I'm sure others who chose the distance option can answer your questions about that. Success seems to vary between individuals.  Or maybe some are more particular than others.

Unfortunately just because they target a certain distance, doesn't mean they will hit it exactly.  

As to your other question, my distance vision also improved slightly.

Before surgery:

OD -4.25 -0.75 020 Add +2.75
OS -4.25 -0.50 175 Add +2.75

After surgery:

OD -2.75 -0.75 180 Add +2.25
OS -2.25 -0.75 180 Add +2.25

I question the two Adds being the same on the new prescription, but my old glasses are clearly too strong, especially for intermediate distances.  I hope all this helps.  I went 'round and 'round on this decision myself.  
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9424748 tn?1405134041
Thank you Nancy for your detailed input about your eyes. First of all, it is nice that someone else wanted to keep their close vision (I'm not crazy!). I suppose you are happy with that? And...you are happy with the outcome? Do you see clearly close up then? Is your blurry distance "look" like it did before? I wondered if it would be worse. It sounded like you see a bit better.  I do wonder what you did during the month your were healing to see. They told me I'd have to wear my old glasses even though they might be stronger (until all heals).
Basically I want to keep my eyes very near to what they are too (like you said you wanted to). The nurse assistants seem to think that I don't want to have to look 8" in front of my face but they don't understand I've been doing that all my life!
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9424748 tn?1405134041
Nancy, I somehow hit 'enter' and I wasn't finished....so....
After reading your response I think I may see if I can talk again to the Doctor (& not assistants) if that is possible and  see if she might set my eyes up for a -3.00 instead of -2.50. I don't want it to be set out 14-16". That will be too far (I think). When you said what they targeted on the IOL for you, did you mean to say "+3" or "-3"? I wasn't sure and wanted to be. Do you know why your Dr. targeted the second one as a 3.5?
I may think of something else I'd like to ask you, but for now THANK YOU so much for taking the time to talk with me about this. It has helped! Blessings!
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7765252 tn?1395099628
Without glasses, my actual distance vision is no worse than it was before, in fact slightly better, but it's hard to distinguish the degree of blurriness, LOL.  Probably the blurriness is worse the farther out you go, but I can't tell a difference.
  
The adjustment was definitely a plus number.  The surgeon told the assistant to record a +3.0 add for the first eye.  The reason he went to +3.5 on the second eye is that I wasn't happy with the 14" focus for the first eye.  It was like pulling teeth to get him to go even to +3.5.  Just like you, no one could believe anyone would want to see closer than reading distance.

I am still wearing my old progressive glasses because of procrastination.  They have been just right for distance and driving. I can read road signs now because the cataracts are gone.  Reading a book is perfect without glasses. I have an old set of single vision computer glasses that still work for the computer. Only a little problem with intermediate distance, like shopping or watching TV in a small room.
    
Am I happy with this decision?  Not entirely, because I didn't really get the close vision I wanted.  But it's probably not possible to reproduce that close vision that I had before surgery.

I think the formula is 39.4 (inches in a meter) divided by the "add" number, to get the focal point.  So it would take a +5.0 add to get 8 inches (39.4/5=7.9").  But the range would probably have been miniscule---maybe only from 6-10 inches and outside that it would be blurry?  There is no accommodation at all with monofocal IOLs.  Maybe that wouldn't have been so good.  Who knows?
  
There were a lot of factors to consider for me.  I knew I wouldn't like to carry reading glasses and sunglasses around everywhere.  Even these computer glasses are a nuisance.  Progressive glasses don't work for  looking at something close overhead.   My face looks plain without eyeglasses and I would miss them.  On the other hand it would be nice to be able to get up in the middle of the night and not have to search for your glasses to use the bathroom. And it would be an exciting experience to be able to see clearly at a distance for the first time in your life.    
  
I really don't want to influence you one way or the other.  I hope this is a fair assessment.  I will be happy to answer any questions if I can.
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9424748 tn?1405134041
When I was quizzing the Dr's assistants (that's who I got to see the 2nd time I went since I needed a few more tests), they said 'You don't want to have to look at something THIS close, do you?" (and they were holding a book about 5-8" from their face. Inside of me I was a bit upset because all I was trying to tell them was that I didn't know if 14-16" wasn't a bit too far for me and I'd rather have about 12" but really I wanted more like 10-12" and no more than 14" if that would be possible (not an exact science). I got a bit nervous talking to them and I felt like they might be a bit frustrated with me so I went ahead and scheduled, BUT my questioning is not over. I have pretty much decided that I want to talk to the DOCTOR one more time before the surgery and try to tell her what I want, and be SURE of what they are going to do even if I have to pay out of pocket to do so. They sort of tried to 'convince' me about that reading distance too. I'm not saying I really want 8" but 10-12" would be nice for seeing things close up and for details! My Dr. seemed to think I wouldn't want to paint a painting any closer than 14-16", and truthfully I'd use my progressive lenses for paintings anyway, it's the tiny jewelry work I do that I need the super close stuff. I drill tiny 1mm holes in coins!
Thank you for the description of your blurry vision. That sounds good. And to know you are seeing well helps me too.
The lack of accommodation thing is scary sounding but in a way that is what I have now so it won't be that much of a problem. What did you mean when you said you couldn't see things closely with progressives overhead? Also, what did you mean about not seeing intermediate things --- was this with or without glasses?
If you don't mind me asking, at 14" can you see well to put on makeup or pluck an eyebrow hair --- I mean TRULY clearly? (without glasses) 14" just sounds so far away when I've been doing it at about 8" all my life.
Thanks again SO MUCH and I'll try not to pester you to pieces!
I thought of something else, just how bad was your vision BEFORE you had surgery? Was it mostly in one eye? I sometimes think I should wait. The only problem I have WITH glasses is that to look at the computer, my left eye is really good at the very bottom of the lens, and with the right eye, I have to tilt my head down and look through the top! It's because one of the cataracts is centrally located (my take on that)
Also...in your first post to me you said " For example my range of crisp vision is less than 6" plus or minus without glasses." -- Does this mean you DO see up to 6" close out to 14".
Sorry for so many questions! But THANK YOU SO MUCH!!!!!!!!!!
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7765252 tn?1395099628
I'm glad you asked for specific numbers.  I needed to get them down more precisely anyway and I also learned some things.  I used a standard telephone book, white pages, smaller name entries, to the nearest half-inch.  I hope this helps answer your questions.  
  
(1) Crisp focal point
(2) Clear range, no blurring
(3) Range where I can still make out the names but with some blurriness
  
Left eye (targeted +3.0)
(1) 14"
(2) 12"-15"
(3) 11"-17"

Right eye (targeted +3.5)
(1) 11.5"
(2) 10"-13"
(3)  9"-15"
    
Yes I can pluck eyebrows and apply makeup with either eye without glasses.  No I couldn't squeeze bumps on my face [I know, you're not supposed to do that ;) ].
  
I can't see intermediate distance things very well right now with my *old* progressive glasses. That was in answer to your question about what to do during the recovery period.  That will not be an issue with new glasses.  
  
How bad was my vision?  I assume you mean because of the cataracts?  My eyes were not that bad except for night driving.  Glare and haloes at night because of the cataracts made it too dangerous to drive so I had to do something.  Both eyes were about equally affected.
  
Finally, you asked what I meant by needing close vision overhead. I recently retired and decided to take on some do-it-yourself remodeling on my house. I'm not near finished yet.
  
Four specific examples:
1) Painting the line between the ceiling and the walls in a room
2) Installing vinyl panels on a porch ceiling
3) Installing new ceiling light fixtures
4) Replacing a sink faucet

Progressive lenses drove me crazy for these jobs.  I could look over top of the glasses directly overhead fine, provided I was at the right distance away, but as soon as the distance increased a little, the only way to see overhead with progressive lenses was to throw your head back at a 90 degree angle.  That made me nauseous and dizzy.That probably won't change much but at least I'll still have that one close distance.  Can you imagine taking readers on and off while painting?

Sorry to be so long-winded.  I enjoy talking with you.
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7765252 tn?1395099628
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?
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9424748 tn?1405134041
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
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7765252 tn?1395099628
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.   ;)
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9424748 tn?1405134041
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
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7765252 tn?1395099628
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?
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9424748 tn?1405134041
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.
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7765252 tn?1395099628
I don't think he knows for sure what will happen, something about it might mean I'd have to hold reading material out farther away.  He is nearsighted worse than me, and would go with the near vision monofocal lenses if he had to do it today.  
  
Good luck with your questions for your surgeon. Let me know what he says.
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9424748 tn?1405134041
It's nice to know that even an eye Dr values their close vision!

I hope your new glasses work for you. I guess they'd redo them if you couldn't see well. Most places will work with you on that (normally). Do you know today I tried on my husbands cheap-o readers OVER my regular bifocal glasses and I was amazed that the add on of +2 would make things so much closer and clearer, so I'm guessing this is something for us to do to see closer and better.

I'll write you later and let you know what happens.

Did you tell me that you had an astigmatism Toric lens or not?
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9424748 tn?1405134041
I just got back from my appointment. My Dr. seems to think that because I am analyzing it so much that perhaps I should wait because she thinks if my sight was so bad that "I'd take anything to see better" that I wouldn't be so concerned/worried about getting an exact measure. She also explained to me why there is no 'exact science' to it -- it is because of our own individual eye and where they put the lens in the eye. That is why sometimes it corrects closer or farther.

BUT....she did say that she would be willing to  target the worst eye with a -3 (even though she originally wanted to do a -2.5)if I wanted to wait to do the 2nd eye,  and then I could probably see just fine with the -3 and  my good -4 eye for now (until it gets worse). I really still see well out of my 'good' eye. SO, it's kind of up to me to either wait on both until I'm REALLY bad or I can have just one done. She said if I didn't like the first eye at -3, I could still later do the 2nd at a -2.5 and do ok. Since I have had all the testing I almost hate to NOT do the one eye.

Since both of your 'fixed' eyes are a little bit different, do you see ok with them together (without specs) since one sees closer than the other or are you always just using one eye when trying to see close things?
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7765252 tn?1395099628
That sounds like a good plan to me--- to do one eye and see how it turns out. The only reason I would not do that is if there was any doubt in my mind that I wanted the near vision option.  You won't experience the difficulties, with one eye done and one not, in the interim period, like those that go for distance vision do.  I waited 2 months between with just minor inconvenience.  Your surgeon sounds much more reasonable to work with than mine.  She's probably right, sometimes too much information just causes more worry.
  
There has been some adaptation with my close vision without glasses. Both eyes working together seem to do better than each one separately.  For example using both eyes with no glasses, tiny print looks clear for the full range of  9-17 inches. But if I close either eye that doesn't work.   I guess that's a mini version of what they call monovision.  
  
As to your previous question:  No toric lenses, just plain monofocals, for me.  I read some people experience haloes around bright lights at night with toric lenses, and was not willing to gamble on that.  Night driving problems were what started all this in the first place.  Keep us posted.
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9424748 tn?1405134041
That is interesting what you said about your eyes working separately & together. That vision from about 9-17" is also encouraging. I don't think I have any more doubts about keeping my close vision. I called them last Thursday to tell them I had decided to do one eye but they've not called me back yet. I'm thinking they will today (hopefully). Back on the 'doubts', I think I doubted I could be happy with NOT seeing close up. That is what seemed bad to me! It's funny how people are different and I'm glad that you wrote me on this medhelp site. It has helped me a lot. :-)

When will you get your new glasses? I just noticed today that you said you waited 2 months in between first and second eye?
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7765252 tn?1395099628
Erin, you may be sorry you asked about glasses. Ha!   Just got new ones this morning.  I finally understand what the"swimming" effect is, and why some folks hate progressive lens glasses.  It's my fault for asking the Dr if he would consider bumping up the add power. I don't know if *all* the problems are due to that, but I sure won't take a chance again.  I only gained about a half inch in near vision anyway.
      
Let us know when your surgery is finally scheduled.  I'm anxious to hear how it goes.  

BTW, the assistant at my surgeon's office guesstimated that about 1 in 50 people at their facility who get monofocal IOLs opt for near vision.  
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9424748 tn?1405134041
Nancy, don't give up too soon on those glasses....you might get used to them! It took me quite a while to get used to progressive lenses but once I did it was fine enough. I did think a couple of times I'd never get adjusted but I did. If after a reasonable amount of time you aren't adjusted, you might want to ask them if they'll redo them. A lot of places will do that.

News-- my surgery is put off! I called and asked about doing just the one eye and my Dr. said she still thought I should wait. If I really wanted to proceed I'd have to talk to my surgeon about it (which I didn't know we ever would be talking to the surgeon prior to surgery) so I said just schedule me for my 4 month check (as they wanted to do). So meanwhile, I'm going to try to be happy the way it is (for now) and be sure of what I want to do (which I thought I was but who knows!). I think because I wanted to go in and talk with the Dr. with all my questions, that they perceived it as I wasn't bad enough and not ready or I wouldn't be so worried about what type of lens.

Wow, 1 in 50.....it must just be the creative types that want to keep their close vision. I have thought a time or two that the reason I want to keep my close vision is because I've never seen clear in my bifocals at a very close range -- only about as far as my dinner plate or book would be and no closer, so how in the world would I be able to ever see a detail again if they set my IOL at 14-16".

I suppose I should keep a positive 'note' on all this -- at least I CAN see! :-)

Keep me posted how you are doing with your new specs. I pray they'll work out for you.
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7765252 tn?1395099628
Once I make up my mind to do something, I want to get it over with.  How are you with this delay decision?  I disagree with their perception of why you have so many questions.  They are probably just not used to folks having *any* questions.
  
I see now your doctor and your surgeon are two different people.  I wondered how you were able to talk to the surgeon so many times.  My surgeon talks to you twice for about 2 minutes---once before the surgery, and once the day after.
    
About the 1 in 50...I think the main reason the number opting for near vision is so low is because most don't know there even is such an option.  If it weren't for my optometrist casually mentioning he was going to do that, and my mother complaining about reading glasses, and this forum, I'd have had the distance lenses too, and been sorry.
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9424748 tn?1405134041
Nancy, in a way I wanted to get it over with and was disappointed to some degree, then I sort of felt better about it. I know my right eye is lousy, but since 'lefty' is carrying me through, I can surely make it 4 more months. I have my first grandchild coming in early October so at least I'll be seeing them close up!! :-)

Yes, my Dr. and surgeon are 2 different people. I haven't seen the surgeon at all and was really surprised when they said something about talking to him because they never said I would at any point. It was actually the Dr. I had spoken with 2 times, and their surgery associates (nurses?) one time (only because I had to do a test at a different office, otherwise I wouldn't have talked to them at all an additional time).

I will agree with you about that 'option' thing.. I don't think that option IS know much. My regular optometrist (when I asked him) didn't think that I could keep my near vision. That's why I was so 'into' getting multifocals in the beginning before I knew I had too much astigmatism to have them. That is why it became such a big decision for me since mentally I had myself all prepared for multifocals (and my cousin had them with pretty good results). I think I didn't know what to do and thought I was losing my near sight forever!

So your Mom had trouble with reading glasses? I am supposing she was nearsighted prior to cataract surgery? I'm sure glad that your optometrist knew that surgeons could do that.

Are you doing any better with your glasses?
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7765252 tn?1395099628
Congratulations on the coming grandbaby.  I think you made a good decision to wait.  You don't want to be bothered with eyedrops, appointments, and new glasses right when the baby first comes.  Do they live near you, or will you have to travel?

The glasses are not doing so good, but I've been doing a lot of reading, and I think I figured out what is wrong.  At least I can go back with *some* knowledge this time, although too late.  I guess better late than never.
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9424748 tn?1405134041
They live about 50-60 minutes away. We are going to try to babysit 2 days a week (go there and stay overnight). It's going to be a big change!

I hope that your Dr. will fix your problem with your glasses and redo them for you. What is the major problem with them (that you said you've figured out?  and....  Can you still read easily without them?
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7765252 tn?1395099628
1) Bumping up the Add to +3.0 narrows the intermediate vision corridor (in that hour-glass shaped diagram) substantially. I think these fancy Hoya lenses she picked out already have a  shorter corridor to begin with.
  
2) More important, the Segment Height is set way too high.  So vision with my head in normal position is through that narrow corridor, rather than through the bottom part of the distance vision region. The girl who took the measurements sat a lot shorter than me.
  
Intermediate vision is the second most important thing to me, after near vision. But where the problem shows up the worst is crossing the streets walking. I walk a lot for exercise. You have to look quickly side to side, and then down at the curbs.  It makes me dizzy and want to fall forward.

Computer vision is very narrow.  I can still read just fine without them.
  
I gave them 9 days to adjust.  Nothing changed after the first 24 hours. I thought maybe the IOLs and the lack of any adaptation might be causing this, but I tried my two-pairs-ago cheapie glasses from Walmart last night and they worked great instantly.  Glad I saved all these old glasses.

More than you wanted to know?  :)  
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9424748 tn?1405134041
HI Nancy, I was thinking about you lately and was wondering how you've been doing. How are your eyes and your new glasses?

I'm going for surgery December 19 to do my one eye and it's going to be done at a - 3.00. I HOPE and pray I can see somewhat close up afterwards. I am waiting to do the 2nd eye when it gets bad. My Doctor agreed to this (I had to have a different one than the last time). I like him almost better than the first Dr.! He was going to do my eye at a -2.5 and I asked about a -3.00 and he was agreeable to do that if I wanted to.

So say a prayer for me if you think of it. I hope I can see perhaps 10-12" when it's done. I'm looking forward to a new pair of glasses! :-)

Let me know how you are.
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7765252 tn?1395099628
Hey Erin!  I was afraid you'd never come back and tell us what happened.  Got a new grandchild now?  
  
So you're doing one eye on the 19th.  Are you still going for the toric lens?  I probably should have.  
    
I'll update a little...
Got those Progressives changed one time.  Everything is OK now except the computer distance, but I expected that.  I've never had progressives that work well for the computer.  I see starbursts from headlights at night, but no glare or haloes.  I think that has to do with the cornea, not the lens.  Actually I think now that the haloes before might have been just starbursts that looked fuzzy because of the cataracts. Ha!  I can live with starbursts.

Some observations you might be interested in:

I already had a pair of single vision glasses set to focus at about 19 inches out (for the computer) for my *old* eyes and I can see almost everything inside the house clearly with just those now.   Outside at a distance, no, but not too bad surprisingly.   Whenever I get some free time I'm going to try a pair of single vision glasses set to focus about arms length away this time for the computer and see what happens.  

When I got retested for the progressives I told the doctor I wanted to see *crisp* at a distance, for driving.  He did the usual thing with the chart 20 feet away, and said 20 feet is visual infinity and good enough.  I argued that I now have zero accomodation and didn't quite believe it. I think he was anxious to get rid of me by then, so he took the lenses out in the hall and tested my eyes looking across the street.  It made a 0.75 diopter difference in the prescription.  So I can read road signs clearly far out now. I really like that.  
  
Finally, I can read just fine without glasses and thread a needle pretty good, but for *very* close lengthy work (like the other day I was sewing a buttonhole by hand) I had to drag out my dad's old readers. I hated them.

Good luck!  And please update.
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9424748 tn?1405134041
HI Nancy, Sorry it has taken me so long to get back with you. I hadn't realized that you wrote me. I have been truly busy with the grandbaby. It wears the body out and even makes it hurt but he's so cute and gives me so much joy, I don't care!

I don't understand why you've had so much trouble getting glasses to work properly for you. I truly feel for you and I may in in the same boat.  I just don't know why they can't set you up with what is right.

I have been going back and forth all week (surgery is this Friday the 19th) wondering if I've made the right decision to keep nearsightedness. I cannot think of life with never seeing anything close up. If the first eye can't get close enough after surgery, if I ever do the 2nd, I will make sure it is closer. I'm hoping the -3.00 will do the trick. My Dr. acts like that will be about 10-12" or so. I hope not a whole lot more than that. Actually I hope I'm not giving up MORE by NOT having lenses put in for distance instead, but I'm sure that would really drive me crazy.

Do you regret not going for distance vision (only) or are you still happy you chose to keep your close(r) vision?

Thinking of you, Erin

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7765252 tn?1395099628
Good luck tomorrow, Erin.  Let us know how it goes.
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9424748 tn?1405134041
Hi Nancy, I appreciated seeing your last nice message. Well, here I am alive and well ha ha after the surgery! They did my right eye, set target at -3.00. I'm having the usual fluctuation but right now I'm seeing good at about 12". It's a little farther than I like (I was hoping 10") but it's not bad with my left eye which sees at about 8". Together my eyes can see at about 9". If my left eye's cataract ever gets worse, I think (or at least at this time) I will set it for a -4.00 or a -4.5. I would hate losing that super close up vision.  I am still hoping that when it heals my right eye might come in a little more. That is life I guess if it doesn't and I'd better be thankful for sight at all when I read some of these horror stories about vision that some have after cataract surgery. I suppose my new glasses will be a little thinner with a lesser prescription and no astigmatism which is a plus. The positive thing is that whites are very white -- I knew my cataract was making things very dim before. I truly appreciate the brightness. The surgery was a bit scary and I was awake through it. I'm glad it's over. I have to tell you something funny that happened to me at my 3 day check up. The associate took me back to check the pressure on my eye and have me look through the optical machine, and she asked me if I could read the letters and I said 'no'. Then she changed it, asked me again, I still said 'blurry'. Then after the 3rd time(getting a little worried)and I still couldn't read the letters, I said, 'they have me set up for close vision'. At that moment she asked me my target and I told her -3, she set up the machine that way and I could read all the letters. Boy was I relieved! Anyway I guess they expect everyone takes distance.
So....I am REALLY looking forward to getting the new right lens because it's hard seeing when the prescription isn't right but good old lefty eye takes over as it has been for quite some time!
How's it going with you? Hope to hear from you.
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9424748 tn?1405134041
p.s. on that 2nd last sentence I should have said 'I am really looking forward to getting the new "eyeglasses" right lens.....(etc)'
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9424748 tn?1405134041
Hi Nancy, I just wanted to let you know that my 'fixed' eye is now at about 12". I regret to say I was hoping on 10" and I've still got some healing to do, but I understand what you meant now by lots of things you said in your posts. I only wish I had listened to myself ( ha ha) and went ahead and asked for -3.5 or even -4. I sure won't do the next eye that far away. I am hoping I'll get used to it. I've had some up & down feelings with this change and am trying to not think that I'm 'ruined' so to speak. At least I can see! I do have a question for you. Did you tell me that your eyes (being that they are different prescriptions) can focus together well without glasses when working closely?
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7765252 tn?1395099628
Erin, I'm glad the surgery went well for you.  That incident testing the pressure would sure make a person's heart beat a little fast, wouldn't it? Ha!  Here's the best answer I can come up with to your question:
  
Left eye (targeted +3.0)
Best focus about 14"
Clear range (reading small print): 11"-17"

Right eye (targeted +3.5)
Best focus about 12"
Clear range 9"-15"

So yes, with both eyes open the range *does* go from about 9" to 17".
  
For close quick reading, like labels in the grocery store, I just look over the tops of my glasses, like I had always done before.  Nine inches is sufficient for most things.  What is hard for me to get used to is that getting any *closer* than 9" away makes it worse.  I'll learn eventually.

Before you go with 4.0 or 4.5, ask someone if the range of vision doesn't shrink as you get closer. I think it might.  In other words it might not be so good to be able to see at say 8" if you can't see clearly closer than 7" or further than 9" (or whatever it would be).  Just something to think about.    

You said you do sewing and jewelry. As I said before, I can thread a needle, but I couldn't sew a buttonhole comfortably without readers.  But that is very close work and takes a long time.  And I don't do it often, maybe once a year.
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9424748 tn?1405134041
Hi Nancy, I TRULY appreciate your input. I really 'get' what you are saying about how hard it is to try to see closer (clearly). I keep thinking I can bring something closer and I cannot. Actually today my sight seems worse! I can't see anything close up very clear. I can hardly wait to get new glasses. That should help. Worse comes to worse, I'll get readers like you said you had to. I HOPE that I can at least see 9" but at this point....pray, pray, pray!!!!
What you said about the 4 and 4.5 -- I think I know what you mean about range of vision. With this fixed eye, it's a VERY SMALL 'window'/range where I can actually see perfectly clear. I hope that improves.  I will definitely ask about that what you said because it could be that range shrinks if I get closer.
Are you definitely doing better with your progressives now?
Do you remember if it took quite a while after your surgery to see perfectly clear up close?
Thank you!
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I have been looking for information about correction for near vision for cataract patients, and I came across your posts. I have cataracts, Salzmann's Nodular Degeneration, and astigmatism in both eyes. I have been nearsighted since I was 15 year old. I am accustomed to wearing glasses for driving and distance and taking them off for reading, computer work, sewing, etc. I have been very comfortable with this arrangement.

A local ophthalmologist who is fellowship trained in cornea and external diseases did surgery in my right eye in September to remove the Salzmann's nodules. It takes several weeks or months for the eye to heal before it can be measured for cataract surgery. This ophthalmologist said that patients who have always been nearsighted are usually happier if they are corrected for near vision. He then got sick, went out of town for a month, and I changed doctors.

I am now seeing a cornea specialist at Wilmer Institute. I am scheduled to have cataract surgery on my right eye on Jan. 15 and Salzmann's surgery on my left eye on Feb. 5. After my left eye heals from the Salzmann's surgery, I will have cataract surgery on that eye. I will be getting toric lenses that correct for near vision. He said that toric lenses are successful 96% of the time with "normal" patients and 80% of the time with patients who have Salzmanns. I understand the risk, and I am willing to give it a try. If they do not work for me, I will have to wear glasses for all distances.

I read on the web that 90% of monofocal patients get corrected for distance vision and 5% get corrected for near vision. I had to think long and hard about going against the flow, but I think that near vision is best for me. After reading many posts on the Internet, it appears that some cataract patients were not told that they had an option to be corrected for near vision. I am grateful to my first ophthalmologist who initially told me of this option.

I hope that your vision is getting better.

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9424748 tn?1405134041
Dear Realtor Renee,
   I appreciate your post! It was very interesting reading about your experiences and the other things (statistics). I've not heard of the Salzmann's surgery but am glad it has been successful for you. About 'going against the flow'....I totally understand what you mean! I doubted myself SO much and now that it is done, I'm glad I asked for a little more near-ness. They wanted to do a -2.5 and I upped it to -3(as you probably read above in my zillion posts lol). I am still healing and there might be improvement yet, but I sort of wish I would have done a -3.5! I was used to it also as you mentioned since I was very young. I would have truly been sad for my world to turn upside down and NOT have my close vision. I do so many things (sewing, jewelry work , artwork) and like to see clearly and closely. At first, after the surgery it hit me quite hard that I wasn't seeing as closely as I wanted but I've accepted it now. Worse comes to worse I'll have readers for those kinds of details I need for my work. My left eye doesn't need to be fixed yet so I'm still enjoying seeing closer because of it. Overall though, I must say I like these toric lenses. I go back Monday for my 2 week check up. Again, like you, I went around and around with this decision.

My 'new' eye....I cannot see close enough to see details on my face so I need a slight magnification which is strange! I can't imagine not seeing anything within 3 to 6 feet if I'd opted for distance and as you probably know a lot of people say they cannot see anything closer than at least arm's length. Of course I cannot tell you what to do but go with what you love to do most and what you need your eyes for the most. We nearsighted people like seeing things clearly :-) Like you, I read of many devastated people who were not told that they would NOT see closely and I am grateful my opthamologist (sp?) listened to what I wanted and took me seriously. My Dr. even told me that 2 people he knew (both were professionals) opted to keep their very close up vision instead of distance with their cataract surgery which made me feel good about my decision. He said it was a personal decision and each person is different. I appreciated him not treating me like I was crazy.

I think my eye is improving but I do not know that I will ever see any closer clearly than 11". I can see at about 12" now and this morning it was about 11". My non fixed eye sees at about 8-9" clearly. Together they work pretty well and I can see a little closer. My fixed eye was set at a -3 (it used to be a -4.5 with astigmatism), and my unfixed eye is about a -4.25 prescription. When I need to fix that second eye I am definitely going to be sure I can see something CLOSE up. I have to use a slight magnification when  putting on my makeup if my unfixed eye is closed. I still hope it improves. Thanks for asking!

Please keep us posted on how you are doing and what you decide to do. I know whatever you do, you will love seeing better.
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I had gone to a different ophthalmologist for many years for annual eye exams. He thought that I just had cataracts. He is old and no longer does surgery, so he referred me to his partner for cataract surgery. I was shocked when the partner told me that I had Salzmann's Nodular Degeneration and that I had to have surgery for that before he could do the cataract surgery. Salzmann's is a very rare, benign eye disease that almost no one has ever heard of. It is nodules or callouses on the cornea that change the shape of the eye and interfere with vision. If they don't scrape the nodules off first, they will be doing cataract surgery on a mis-shapen eye, and the patient will never have satisfactory vision. I went for a 2nd opinion to Wilmer Institute at Johns Hopkins University, and the cornea specialist there said exactly what my local cornea specialist had said. Wilmer has more than 100 ophthalmologists, and it is one of the top eye clinics in the world.

My Wilmer ophthalmologist told me that he would correct my vision for distance. I asked him about correction for near vision because of what my local ophthalmologist had told me, and he agreed. The distance choice was about a 1-minute conversation. He did spend time discussing my Salzmann's issues, that I would need to wear glasses for some distances after surgery, that there was a 20% chance that the toric lenses would not work for me, and that he might have to do a surgical correction on that. I called Wilmer on Dec. 31 because I was having some 2nd thoughts about getting corrected for near vision, and I wanted to talk to someone about the pros and cons. Fortunately, they were closed for New Year's Eve. I spent all day on New Year's Day reading everything that I could find about correction for near vision. I copied excerpts and information from many sites. When I reviewed all of my notes at the end of the day, I was 99% convinced that I was making the best choice for myself. I called two friends who had recent cataract surgery. They are both thrilled with their great distance vision and don't mind that they sometimes need reading or computer glasses to see things closely. They have different lifestyles than me. I work with computers, contracts, and other paperwork every day. I like to read, sew, and do other needlework. I know that it would bother me a lot more to have to wear glasses for close work than to wear glasses for driving and distance. My adult daughter has been nearsighted all of her life, and I had a long conversation with her today about this. She also would want to keep her vision the way that it is. I am now 100% confident about getting corrected for near vision. I am glad that I did my homework before the surgery rather than after. I think that more than 5% of people would opt for near vision if they were given a better explanation prior to surgery.

Regardless of whether you correct for near or distant vision, it is a change in your eyesight and requires an adjustment period. Because I am a 2-time cancer survivor, I don't stress out about health issues that do not have the potential to kill me. I am hoping for good vision and understand that I may have to get used to my new eyes. I am glad to be alive and grateful that they can remove my cataracts and improve my vision.

It sounds as though you have had a good result. I hope that you are happy with your vision.

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7765252 tn?1395099628
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.  ;)
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9424748 tn?1405134041
Nancy....really! We do need each other ;-)
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9424748 tn?1405134041
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!
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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.
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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.
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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.
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Nancy, It would be great if people could try out eyeglasses for a few weeks that simulated what their vision would be like after cataract surgery.
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I have to wonder if the Crystalens is an option since it is basically a monofocal lens that accommodates if it works, and just a regular monofocal if it doesn't. I'd also noted on the thread for a 35 year old looking for IOL choices that not all monofocal lenses are created equal.

This page seemed to have become partly about the issue of getting lenses adjusted for near rather than distance, so I figured I'd put the comment out there regarding premium lenses for others reading it, whether or not it was useful in your particular case.
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I have been told by two trusted cornea specialists that I am not a candidate for any premium lenses other than the toric. The toric is not a basic lens, and I will be paying an additional $1,500 for each eye. Salzmann's causes the eye to have irregular shaping and extreme astigmatism. It is more challenging to get measurements on the irregularly shaped eye, and lenses do not fit on it as well as they fit on normally shaped eyes. Many ophthalmologists would not use a toric lens with a Salzmann's patient. My ophthalmologist claims to have had success with it. He actually specializes in repairing bad cataract surgeries. He does about 100 of those a year in addition to other cataract and cornea surgeries.

I don't mind wearing glasses, so it is not important to me to be able to see at all distances without glasses. When we have to make a choice of whether we will be able to see well either near or far, that is a very important decision that will affect us for the rest of our lives. I have read of numerous patients who made their decisions without adequate information. Some of the others might benefit from the Crystalens that you have mentioned.

I had Salzmann's surgery in my right eye in Sept. I will have cataract surgery in that eye on Jan. 15. I will have Salzmanns surgery in my left eye on Feb. 5. After that heals, I will have cataract surgery in my left eye. I will be using a lot of eye drops!! I can no longer see through my old glasses, and I can't get glasses until all of this is done, so this is a very long time period for me to have very poor vision.
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9424748 tn?1405134041
I totally agree with you on this---- " 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."

You have said this very well. It is very important to me to have close up vision and I have no regrets with keeping the close up lens.

I just wanted to mention that with the toric lens you evidently can either have a crystal clear one or a tinted one. They gave me the clear one because they knew I wanted my colors to be 'true' (as an artist). I will say that they are the most clean colors I've seen in a long time. The tinted lens has a uv built in, but with the clear one, I have to be sure to have that put into my glasses/sunglasses (my surgeon told me this).

I'll mark on my calendar to say a prayer for you about your upcoming surgery. Please let us know how it all goes.

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I think your doctor is wrong about not being so concerned when you wait longer.  I would not wait too long, because that is what I have done.  It puts me in a higher risk of surgery category.  Still, I am having a hard time deciding between Toric mini-monovision of close & intermediate or Toric mini-monovision of intermediate & distance.  I have found this forum very helpful and have got a lot from your conversation with Nancy.
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I wondered if you still think your distance vision improved some, even though your Toric IOLs are set for close.  I am having cataract surgery in a month or so and am seriously considering having the Toric lenses set for close.  Or I may have one eye for close and one eye for intermediate.  I have been nearsighted all my life.  Are you happy you went for the close vision?
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