iol decision

[cay77]

I am 57 and have bilateral cataracts which have negatvely affected my vision enough that I am more than ready to have surgery. Because I wore gas perm contacts for many years, I stopped wearing them and have had several corneal topographies in the last few months to see whether my corneas are back to normal shape.  In the interim time, I have been reading this forum regularly and it has been a big help to make my iol decision.  Initially I was excited about multifocal iols and thought it might be a wonderful solution.  I am still mightily tempted, but have in the end decided that it is not worth the risk of the problems with multifocals and makes more sense to go with the standard implants.  Here are my questions: If I opt for the standard iols and blended monovision, can I reasonably expect to see sharply at distance, be ok to see intermediate things (computer, grocery store shelves, dashboard) without glassses and only need them for really close work and reading?  Also, I am left eye dominant; can I choose to have my right eye be the one for distance and the left slightly undercorrected, or does the dominant eye have to be the distance one?  I'm having the right eye done next Monday, the left somewhat later.  Thanks so much.

[cay77]

Since your original answer to me (much appreciated), I have had my right (non-dominant) cataract removed and a standard  (acry sof IQ) iol implanted. Astigmatism is not an issue with me.  My surgeon targeted a -.75 for that non-dominant eye (and at my first post-op app't it was as targeted) with plans to do the dominant left eye in a few weeks targeted for plano.  First, I am delighted with the sharp clear vision in my "new eye".  What a thrill after years of fuzz (one down side--I see wrinkles on my face I was blissfully unaware of!!).  If I close my left, myopic eye, I'd say my vision in the newly operated right eye is best from approximately 18'' to 15 or 20 feet.  So the intermediate vision I was so interested in preserving is good with that eye.  Can I expect to still have this good intermediate vision once I get my dominant left eye done for plano? I guess I worry that the dominant eye will somehow take over and negate the intermediate vision. My ultimate goal is  for the ability to see the intermediate things (kitchen counter tasks, grocery store shelves, maybe even price tags, etc) without having to wear a pair of reading glasses around my neck.  I fully expect to need reading glasses for truly close work. Though I have to admit feeling a little bit of mourning for my about-to-be-lost ablilty of an uncorrected myope being able to read without glasses. I hope that is more than off-set by exciting clear,sharp vision that I haven't enjoyed for a long long time.  

[jojokiki]

How does an opthamologist determine astigmatism?  Can it be picked up with IOLMASTER?

[Michael J Kutryb, MD]

Suggest dominant eye for distance - that means right eye for distance (around plano) and consider leaving left eye about -1.50 or so nearsighted.  These are just rough numbers and don't take into account any astigmatism which can seriously affect your results.  You need to have an extended talk with your surgon about your expectations, desires, and he.she can tell you what you can reasonable expect.  Discuss astigmatism in detail.  Make sure your IOL measurements are done with IOLMASTER.  If everthing goes just right you should have fairly good distance vision and reasonable abillity to see price tags, magazines, some computer work - but please understand that you may very easily still nead to wear glasses.  Your vision might not be as good as your used to see in past with contacts.  Make sure you have done mono vision or blended vision in past to understand what you are getting into.  If you have never tried either then your doctor should give you a contact lens trial to simulate what you would have with lens implants.  I spend a great deal of time with patients like you - well worth it because you can very easily be disappointed.

MJK MD