toric IOL: near or distance result

  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 is 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.
recent glasses RX was:
R= -8.00 sph, +2.75 cyl, 85 axis
L=  -7.5   sph, +1.50 cyl, 80 axis

[Harold14370]

I will be interested to see the responses to this question as I too am nearsighted and will probably need cataract surgery in the not too distant future.

I think the computer would require intermediate rather than near vision correction.

I always assumed you would want far vision, because that would allow you to be spectacle free for a lot of activities, like just walking around, doing outdoor activities, or watching TV. Being nearsighted, I need my glasses almost all the time, and have to grab them and put them on as soon as I get up in the morning.

[berrywoo]

I too am interested in this question. Just from observations it seems that many patients opt for distance correction in a monofocal IOL, and it also seems like many surgeons advocate this for their patients.

However, I do seem to recall that Dr. Hagan said he would go for near correction.

I too would go for near correction and when my eye is stable enough to recieve an IOL that would be my choice. I liked being nearsighted and miss it terribly at the moment.

However, everyone is different and you have to consider your lifestyle and figure out what you feel is best for you.

Good Luck.

[John C Hagan III, MD, FACS, FAAO]

Everybody is different so there is no universal answer. I also am myopic and able to read all my life without glasses. I'm use to distance being blurry without glasses and it doesn't bother me.

If I had cataract IOL surgery I would ask for a post op expected refractive error of -2.50 in my reading eye and -1.25 in my intermediate eye. I would plan on wearing progressive bifocals almost all the time.

Many people however prefer just the opposite in which case most surgeons find --0.25 and -1.25 works nicely.

JCH MD

[mmrudy]

It "is" a personal decision. For me it involved deciding what I like to do best--mostly working with the computer and weaving. These activities suggest a field of focus in the range of 26-30". So, I've requested a toric lens with a -1.25 goal for my non-dominant eye.

I did have one sleepless night thinking about the loss of my excellent near vision. It felt, almost, as if I faced blindness. With daylight I realized that glasses could give me good near vision just as they now give me reasonable distance vision. It's a matter of adjustment, a wee bit difficult as I age! :)

When it comes time to remove cataracts from the right eye, I think I'll request  -.25 to -.5 that will give some distance range of focus, I estimate 12-15'. Legal driving in this state.

Overall, I hope to have good intermediate and tv viewing vision w/o glasses. I'll happily wear glasses to read, sew, and drive, and use a magnifying make-up mirror for grooming.

[John C Hagan III, MD, FACS, FAAO]

Good luck. As I said "different strokes for different folks"

JCH MD

[FredZq]

I would recommend near vision as Dr. Hagan recommends for himself if he needed cataract surgery.

I had my non-dominant (left)eye done like Dr. Hagan would do for himself. Five months ago the cataract was removed and a Tecnis aspheric acrylic lens implanted. The focus is at 11 inches from the tip of my nose. Without glasses, can do chores in the kitchen and bathroom just fine this way and I can read too.

The other eye cataract has progressed much more quickly than we expected, so I was back at the Docs office a couple weeks ago to get set up to do the other eye. It (I hope) will have a focus at intermediate distance good for computer work and OK for reading too.

I was mildly nearsighted and astigmatic when I was young, progressing through plano to mildly farsighted as I entered the 40's. I reasoned that most of what I do is at close and intermediate distance and I'm used to wearing glasses all of the time.

Seems to me that nearsighted without glasses is just a lot less uncomfortable than farsighted without glasses, and i like to be able to read the clock on the night stand or read something without glasses.

My experience with the Tecnis has been fine. No problems driving at night, peripheral vision seems as good as the other eye. I'm still amazed at the state of medical art that can restore excellent vision to us who would be otherwise basically becoming blind.

Good Luck!

[John C Hagan III, MD, FACS, FAAO]

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