Post cataract lenses set for near vision

[maryfair]

I am a 62-year-old woman about to have surgery to remove cataracts.  Until recently all I knew about cataract surgery was that after the surgery people are usually able to go without glasses except for reading. I looked into the multifocal lenses and have decided against them.  I asked my doctor's technician if I could get my "free" lenses set for near vision instead of far and was told I could.  She said that would give me good vision to arms' length but I would need glasses for driving, watching T.V., etc.  

Has anyone had this type of post-cataract lenses implanted?  How do you like them?  Are you able to read a book and a computer screen without glasses? If you are a passenger in a car (without glasses), is everything a blur?  Do you need your distance glasses to walk around in the grocery store or a shopping mall?

I think that having my lenses set for near vision would be good for me because I spend 6 to 8 hours a day reading but I really have no idea what my distance vision would be like with those lenses.

[John C Hagan III, MD, FACS]

You can research your options using "mini-monovision" to search and archives.  Also mini-monovision with near bias.

JCH MD

[maryfair]

Thank you for your suggestion.  I have read dozens of posts on here about mini-monovision.  My surgeon does not do it for patients who have not had experience with monovision.  I never needed glasses until I became far-sighted at about age 50.  Then I wore half-eyes for about 8 years.  The first time I needed a distance correction was after the cataracts started to develop and I then started wearing bifocals.

I guess I need a third opinion--my present surgeon is the second one I've seen--the first one did not take any questions so I dropped him.

I was trying to find out if anyone on this board has had both eyes implanted with near vision lenses and how it works.

  

[LynneAV]

If you are not very, very used to being near-sighted, I would strongly urge you not to do this. I think it is best to stay as close as possible to what you have been used to all your life -- radical changes in your "vision life" are very difficult to process.  Personally, I just had cataract surgery that turned me from being near-sighted and needing glasses for distance vision, to having good distance vision and needing glasses for extreme close up (tiny print, threading needles). While I am overjoyed to be able to walk around, drive, etc., without putting on glasses, I have not been able to adjust to reading glasses. I cannot stop myself from looking through them to scan the room or when I stand up; therefore they make me dizzy and sick to my stomach. I have thrown three pairs of reading glasses across the room and then stomped on them in frusrtration, since my cataract surgery two months ago.

Again, my surgeon made the correct decision for me (won't go into all the details here), but my point is how difficult it can be to suddenly have a major change in vision.

[John C Hagan III, MD, FACS]

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[maryfair]

Thank you so much for your response to my question. That is exactly the kind of information I was hoping to get.  The only problem is that I guess my "vision life" is mostly that I was lucky enough to have perfect vision until the presbyopia of old age got to me.

What kind of lenses do you have?  I would be very happy if I got lenses that allowed me to see well at a distance and only needed glasses for "tiny print, threading needles."

[JodieJ]

Get aspheric monofocal IOLs.  (The new model Tecnis is supposed to be especially good.)  If both of your eyes were set for distance vision, you'd have about the same vision as you did before cataracts, i.e., readers for the computer and all near vision tasks.  Another option would involve setting your dominant eye for distance and your non-dominant eye for intermediate vision (i.e., mini-monovision).  This should not be much of an adjustment (if any), and with a little luck you'd only need glasses for prolonged reading or seeing small print.

[LynneAV]

I have an Acrysof IQ, which I believe is an aspheric monofocal. I am just about your age, almost 61. What is a little different about my case is that I only had the cataract in one eye, due to uveitis and resulting steroid treatment. Before the surgery, I was nearsighted in the cataract eye, which is my overwhelming dominant eye. I have worn glasses or contact lenses since I was 18 months old. What was a huge surprise to me, after all these years, was to find out that my other, non-cataract, eye, has almost normal vision, not enough near-sightedness to even require glasses. I had no idea! (Some optometrists from long ago have some answers as to why I was putting a hard contact lens in that right eye, but that is another story for another time.) Because my left eye is so overwhelmingly dominant, I always believed I was near-sighted in both eyes. Talk about a shock at age 60.

Anyway, after my cataract surgery, I can see well for the first time in my life without glasses. I can see better than I did *with* bifocal progressive glasses!  I also have much better intermediate and close vision than I did with my hard contact lenses that were set for distance (after age 44 I stopped wearing them for that reason). My depth perception has improved immensely and driving is much ... easier, for lack of a better term. I am overjoyed by the results. I have excellent intermediate vision and adequate uncorrected near vision except for small print and tasks like sewing, filing my fingernails. But all the things I was very worried about -- putting on make-up, seeing the bedside clock, etc -- are no problem whatsoever.

Even though I have to make adjustments due to my loss of nearsightedness, I would NEVER go back to being nearsighted if I had to make that choice. Good distance vision is better -- much, much better. I don't think you would like to be suddenly thrust into the land of the nearsighted, honestly.

[maryfair]

Thank you for your suggestion regarding the aspheric monofocal IOLs.  These lenses were not mentioned to me by my surgeon and I don't know if that is because he routinely uses them or if you have to ask about them to even find out they are a possibility.

Also, the surgeon said he does not do lenses set at different distances for people who have not had successful experience with that in the past. I obviously need to find another surgeon but this time I want to be armed with a lot more information.

Regarding what you said about getting mini-monovision with my dominant eye set for distance and my non-dominant eye set for intermediate -- that sounds perfect (or as close as I'm going to get at my age) but I'm not sure what you and others mean when you say I'd only need glasses for "prolonged reading" or fine print.  I get the fine print part -- I can't read the fine print on a map or OTC medicine labels with the reading part of my bi-focals now.  However, I frequently read for hours at a time, both on the computer and in books and journals without any difficulty. Is there a reason this would change?  

[maryfair]

Again, thank you for all the information.  Putting on makeup and seeing the bedside clock are two of the things I've been concerned about.  For the last three years I have not been able to see my face well enough even to apply eyebrow pencil, much less eyeliner.

In your original response to my post you said you only needed reading glasses "for extreme close up (tiny print, threading needles)" but that you had been unable (thus far) to adjust to them because when you look up or stand up you get dizzy or sick to your stomach.  First, I was wondering if you can use half eyes because they would enable you to look up and scan the room without looking through the lenses.  Second, I was thinking you must do a lot of sewing or reading of fine print to have gone through three pairs of reading glasses in two months!  Or are you using the reading glasses for all reading?

The doctor I saw spent about five minutes with me and when I left his office I thought I was going to get two post-cataract lenses set for near vision.  I can see now that that would have been a terrible mistake and I really appreciate your advice.  

[farmerjon101]

I have just had a  Aycrosof aspheric  monofocal IQ lense set for distance and love it, I can see everything. I took Dr Hagans and JodieJ advice, studied it well and then went for it and it's the best thing since sliced bread. I must admit the eye is still adjusting but the vision I have is fabulous. I am aware that every one is different so it may not be what you want or need.  Hope this helps.
farmerjon101

[JodieJ]

Mini-monovision (distance/intermediate) generally requires no adjustment time--adjustment is automatic for most people.  It gives you a wider range of vision than a distance/distance correction.  You should do fine on the computer (intermediate vision), but your near vision is not going to be perfect.  You'd probably do all right without glasses with most restaurant menus, magazines and price tags.  But if you were starting "War and Peace" or threading a needle, you'd definitely be more comfortable with readers.  There's somewhat of a luck factor involved in how well you do with mini-monovision, because predicting the correct IOL power is not an exact science.  Having smaller pupils and no astigmatism would be helpful.  I believe that most surgeons are using aspheric IOLs today, but it's a good idea to ask anyway.  The newest one-piece Tecnis acrylic model is supposed to be especially good.  

[JodieJ]

By the way, stores like Bed, Bath & Beyond, Target, and Ulta sell mirrors that magnify 10x to 15x at relatively low prices.  Invest in one--it's great for makeup application.

[maryfair]

Did you only need one lens replacement?  

I thought the adjustment everyone talks about had to do with the eyes learning to work together when they were set for different distances. What am I missing?

I am very glad that you are so pleased with your vision--it pays to do your homework!

[maryfair]

Your last post really helped to clear something up for me.  You wrote: "You'd probably do all right without glasses with most restaurant menus, magazines and price tags.  But if you were starting "War and Peace" or threading a needle, you'd definitely be more comfortable with readers.  

Before I read that, when someone mentioned reading, I thought of reading a novel or a journal article.  Stupidly, I never really thought of menus and price tags as things you actually read although when I became far-sighted I needed my reading glasses for menus before I needed them for almost anything else (probably because of the lighting in restaurants).

Now I think I understand why people keep making the distinction between reading and extended reading -- when they say reading, they are talking about looking at a menu, checking the TV Guide, or looking at price tags.  When they say extended reading, they are talking about reading a book?

[LynneAV]

Mayfair,  half glasses are what I meant by reading glasses, the same thing. I only intended to illustrate how incredibly difficult and frustrating it can be to have to try to change a habit of 60 years. For six decades I very deliberately looked through my glasses for distance vision ... and now I have been trying to break that habit and learn the new habit of deliberately looking over the top of glasses for distance vision. The habit of finding the lens to look through before looking up is unconscious and extremely ingrained. I was telling you this as a warning in case you were planning to change your own vision habit and switch yourself from good distance vision to poor distance vision.  

Actually, I only put each of the trashed pairs of reading glasses on maybe a couple times before I threw them across the room, ha.  Am I real patient, no ...  I don't do leisure reading and only a very small amount of sewing, so it isn't an enormous problem for me. I have a magnifying glass in the kitchen for recipes and another in the office for paying bills.

[farmerjon101]

I had one cataract removed and need the other eye done, but I'm going to wait until after Christmas to get the other one done. I am using readers to work at the computer but I can see without them but it's just a bit faded for me on the computer. Both eyes are working well together but will work better I suppose when the other one gets done. So far.. I have had no problems..touch wood.
best of luck what ever you decide.