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Bad IOL lens choice? - Please help
Just went for my first ophthalmology exam for my cataract problem. I received a strange recommendation...
I'm in my mid 50's. In one eye I wear either a -2.00 high add multi-focal contact or use progressive glasses. The other eye has developed a bad cataract and is also very nearsighted.
I was interested in an accommodating lens, but the Dr. says they don't work ("snake oil"). He recommends only a mono-focus IOL. But, what I find more strange is that he will not fully correct my vision with the IOL. Rather, he will implant a lens which will make both eyes "match", i.e. the IOL will be selected to deliberately result in nearsighted vision. He says I will not be HAPPY if he corrects the eye to 20/20 distance vision.
Does this make any sense?
Thanks for your help,
Sallie
I'm in my mid 50's. In one eye I wear either a -2.00 high add multi-focal contact or use progressive glasses. The other eye has developed a bad cataract and is also very nearsighted.
I was interested in an accommodating lens, but the Dr. says they don't work ("snake oil"). He recommends only a mono-focus IOL. But, what I find more strange is that he will not fully correct my vision with the IOL. Rather, he will implant a lens which will make both eyes "match", i.e. the IOL will be selected to deliberately result in nearsighted vision. He says I will not be HAPPY if he corrects the eye to 20/20 distance vision.
Does this make any sense?
Thanks for your help,
Sallie
Hi Sallie007 and all,
I read all your posts and wonder how you are today? I am having my right eye done tomorrow. Set for distance vision. I am 54 and nervous.
John
I read all your posts and wonder how you are today? I am having my right eye done tomorrow. Set for distance vision. I am 54 and nervous.
John
Had cataract surgery on my second eye and again everything went very well.
Had a little scare when I first took off the bandage. The vision in the operated eye was tilted about 20 degrees to the left and the image was hazy. I was imagining that perhaps the lens had shifted position. And, I and was hoping that it was only some inflammation of the cornea. Turns out it was only because the local anesthesia for the eye hadn't worn off yet. Vision was great in the morning.
I think there are some Thank You's in order:
First to Dr. O. for the best advice I could possibly have received; the suggestion to "...see another doctor". The difference between practitioners was like night and day. I'm so glad that I switched.
Thanks to Caren and Jodie for sharing your monovision suggestions and experiences. I went with a small amount of monovision and I'm very glad that I did. I've already been driving both day and night without any problems. We were targeting about a .75 diopter difference. We'll see where it ends up as my eye continues to heal. And yes, baggyrinkle, I took you up on your suggestion and did both eyes.
And thanks to the providers of this forum and all of the posters who contributed their comments. I don't know anyone around my age who had recent cataract surgery so the information that I found here was invaluable. I'm glad that I went with the standard aspheric lenses and a little monovision. I couldn't be happier.
Sallie
Had a little scare when I first took off the bandage. The vision in the operated eye was tilted about 20 degrees to the left and the image was hazy. I was imagining that perhaps the lens had shifted position. And, I and was hoping that it was only some inflammation of the cornea. Turns out it was only because the local anesthesia for the eye hadn't worn off yet. Vision was great in the morning.
I think there are some Thank You's in order:
First to Dr. O. for the best advice I could possibly have received; the suggestion to "...see another doctor". The difference between practitioners was like night and day. I'm so glad that I switched.
Thanks to Caren and Jodie for sharing your monovision suggestions and experiences. I went with a small amount of monovision and I'm very glad that I did. I've already been driving both day and night without any problems. We were targeting about a .75 diopter difference. We'll see where it ends up as my eye continues to heal. And yes, baggyrinkle, I took you up on your suggestion and did both eyes.
And thanks to the providers of this forum and all of the posters who contributed their comments. I don't know anyone around my age who had recent cataract surgery so the information that I found here was invaluable. I'm glad that I went with the standard aspheric lenses and a little monovision. I couldn't be happier.
Sallie
Hello everyone,
Had my surgery and I'm happy to report all is well!
To recap, I decided to avoid the specialty lenses and had a standard IOL. I dropped my first Dr and went with a well respected surgeon who presented me with a full range of options. Had the surgery at one of the top rated ophthalmology hospitals and I would have to say that the whole procedure was, in many ways, easier that some of my past dental appointments.
On day 1 after surgery my pupil was still fully dilated. I was a little worried about this, but my doctor was not concerned. Sure enough, on day 2 my pupil is back working normally again.
As caren123 suggested, we didn't come out with exactly the vision I had hoped for. But, it's such a huge improvement over my prior pre-surgical vision, I'm still delighted. On day 2 after surgery I have optimal vision focused at just beyond arms length. My far distance vision is close to 20/30. This is not the perfect distance vision I had expected, but still not bad. Up close, I can read standard print at arms length (which is nice) but to be comfortable reading I will need readers. So now I will be able to try different lens combinations on my "non-surgical" eye to see what works best. However, now that I know that the lens selection is not an exact science, I'm a little confused about what to do with my second eye. But, I still have some time to figure that out...
Sallie
Had my surgery and I'm happy to report all is well!
To recap, I decided to avoid the specialty lenses and had a standard IOL. I dropped my first Dr and went with a well respected surgeon who presented me with a full range of options. Had the surgery at one of the top rated ophthalmology hospitals and I would have to say that the whole procedure was, in many ways, easier that some of my past dental appointments.
On day 1 after surgery my pupil was still fully dilated. I was a little worried about this, but my doctor was not concerned. Sure enough, on day 2 my pupil is back working normally again.
As caren123 suggested, we didn't come out with exactly the vision I had hoped for. But, it's such a huge improvement over my prior pre-surgical vision, I'm still delighted. On day 2 after surgery I have optimal vision focused at just beyond arms length. My far distance vision is close to 20/30. This is not the perfect distance vision I had expected, but still not bad. Up close, I can read standard print at arms length (which is nice) but to be comfortable reading I will need readers. So now I will be able to try different lens combinations on my "non-surgical" eye to see what works best. However, now that I know that the lens selection is not an exact science, I'm a little confused about what to do with my second eye. But, I still have some time to figure that out...
Sallie
Caren & Jodie,
Thank you so much for your comments. You have been a great help to me.
I've read about the 2 diopter limit for monovision, but I don't have a way to try it out until after the surgery because my vision in one eye is so poor. I've been nearsighted all my life so not being able to see anything up close without glasses or multifocal contacts will be an adjustment. I'm scheduled for surgery next week so we'll see what happens.
Thanks again and I'll let you know how it goes.
Sallie
Thank you so much for your comments. You have been a great help to me.
I've read about the 2 diopter limit for monovision, but I don't have a way to try it out until after the surgery because my vision in one eye is so poor. I've been nearsighted all my life so not being able to see anything up close without glasses or multifocal contacts will be an adjustment. I'm scheduled for surgery next week so we'll see what happens.
Thanks again and I'll let you know how it goes.
Sallie
Yes, Now I remember. With monovision they had my eyes 2 diopters difference at first, but it was too much to adjust to and I felt more comfortable with 1.75 diopters difference.
I assume I went in the direction of mini-moovision.
I assume I went in the direction of mini-moovision.
Addendum to Caren123's informative post:
My comments apply to monovision with contact lenses or LASIK (results for monovision with IOLs may differ). According to a paper by Dr. Burton Kushner (and verified by my personal experience), monovision can provide the sense of continuous crisp vision from near to distance if the difference in refractive error between the eyes does not exceed 2 diopters (e.g., plano and -2D). This works well for most people in their 40's. However, most people in their 50's need more near vision power than +2D in order to see small print. At this point, something must be sacrificed--either some distance vision or some near vision (or accept a gap in crisp vision in the intermediate zone). When I had monovision contacts, I sometimes wore glasses over them (which eliminated monovision) to improve my night driving ability (but my near vision was excellent). Some of my 50-something colleagues who have monovision with contacts or LASIK use reading glasses for seeing small print. I suspect that greater compromise might be necessary for monovision users in their 60's and beyond, with some individual differences.
Again, I don't know how the above comments would translate to full monovision with IOLs. However, it's a fact that none of the "premium" IOLs provide a full range of crisp vision. Several months ago, Dr. Hagan sited a study which found that near vision with monovision was actually superior on average to near vision with ReStor (probably because the ReStor lens doesn't work in some cases.)
My comments apply to monovision with contact lenses or LASIK (results for monovision with IOLs may differ). According to a paper by Dr. Burton Kushner (and verified by my personal experience), monovision can provide the sense of continuous crisp vision from near to distance if the difference in refractive error between the eyes does not exceed 2 diopters (e.g., plano and -2D). This works well for most people in their 40's. However, most people in their 50's need more near vision power than +2D in order to see small print. At this point, something must be sacrificed--either some distance vision or some near vision (or accept a gap in crisp vision in the intermediate zone). When I had monovision contacts, I sometimes wore glasses over them (which eliminated monovision) to improve my night driving ability (but my near vision was excellent). Some of my 50-something colleagues who have monovision with contacts or LASIK use reading glasses for seeing small print. I suspect that greater compromise might be necessary for monovision users in their 60's and beyond, with some individual differences.
Again, I don't know how the above comments would translate to full monovision with IOLs. However, it's a fact that none of the "premium" IOLs provide a full range of crisp vision. Several months ago, Dr. Hagan sited a study which found that near vision with monovision was actually superior on average to near vision with ReStor (probably because the ReStor lens doesn't work in some cases.)
First I want to say that Jodie's advice is really good and so is your plan. It is all very well thought out. It is sincerely hoped that adding my experiences will help reinforce your decisions and do nothing to confuse things.
Full monovision -
I had full monovision (one eye distance, one eye close) with contact lenses and was happy with it for many years before my cataract developed, At the time, I did not know about mini-monovision - I think it is a great option to know about. Using contacts and no glasses, I could read phone book, see to drive, and both eyes overlapped at dashboard distance which gave me seamless range of vision. But, the excellent result took several requests for changes of contact lenses after not being quite comfortable with the doctor's original suggestions. In the end, It was my choice (not my surgeon's) to see less well way into the distance, but still good enough for me to feel comfortable driving, so that I could have an area where both eyes overlapped, seamlessly, and I gained ability to read tiny print, which I really wanted to be able to do. I was able to adjust to lack of depth perception (seeing 3-D), probably due to the fact that this was my chance to be glasses-free, but I did have to be very careful to leave more room between me and the car ahead of me. Sacrificing a little distance vision so both eyes could see the dashboard was my choice and felt comfortable for me. Sounds like your surgeon is suggesting less perfect distance vision for you - but it has to be your choice and you would need a good reason to do it, and you haven't tried it out first to see how much less.
When cataracts need removing, it is another story. You do not have several tries to make it right as I had with contact lenses. It becomes important, I think, to decide how much time you spend on close as opposed to distance (driving, sports) activities. Because rather than being able to avoid glasses altogether, you will probably need glasses for certain tasks. You don't want to keep track of/ misplacing many pairs of "readers" if you read a lot, or end up wearing them at the end of your nose, (which is not the end of the world)...You might prefer needing a pair of glasses to drive instead. On the other hand, If you like to play golf or tennis, there would be different considerations.It is a personal decision. Sometimes surgeons just assume everyone wants good distance vision without glasses.
It is not easy for surgeons to hit the target exactly. My surgeon's measurements were off leaving me much more nearsighted than we had planned, and I wonder if he should have measured more than once, perhaps a series of measurements over several days - I don't know.. You are in a good position to get the one eye done and see how close that comes out, then choose target for other eye, having already considered the choices of monovision, mini-monovision, or both eyes the same. With planning, it should all work out fine. It sounds like it will. Hope I haven't confused the issues. Best of luck!
Full monovision -
I had full monovision (one eye distance, one eye close) with contact lenses and was happy with it for many years before my cataract developed, At the time, I did not know about mini-monovision - I think it is a great option to know about. Using contacts and no glasses, I could read phone book, see to drive, and both eyes overlapped at dashboard distance which gave me seamless range of vision. But, the excellent result took several requests for changes of contact lenses after not being quite comfortable with the doctor's original suggestions. In the end, It was my choice (not my surgeon's) to see less well way into the distance, but still good enough for me to feel comfortable driving, so that I could have an area where both eyes overlapped, seamlessly, and I gained ability to read tiny print, which I really wanted to be able to do. I was able to adjust to lack of depth perception (seeing 3-D), probably due to the fact that this was my chance to be glasses-free, but I did have to be very careful to leave more room between me and the car ahead of me. Sacrificing a little distance vision so both eyes could see the dashboard was my choice and felt comfortable for me. Sounds like your surgeon is suggesting less perfect distance vision for you - but it has to be your choice and you would need a good reason to do it, and you haven't tried it out first to see how much less.
When cataracts need removing, it is another story. You do not have several tries to make it right as I had with contact lenses. It becomes important, I think, to decide how much time you spend on close as opposed to distance (driving, sports) activities. Because rather than being able to avoid glasses altogether, you will probably need glasses for certain tasks. You don't want to keep track of/ misplacing many pairs of "readers" if you read a lot, or end up wearing them at the end of your nose, (which is not the end of the world)...You might prefer needing a pair of glasses to drive instead. On the other hand, If you like to play golf or tennis, there would be different considerations.It is a personal decision. Sometimes surgeons just assume everyone wants good distance vision without glasses.
It is not easy for surgeons to hit the target exactly. My surgeon's measurements were off leaving me much more nearsighted than we had planned, and I wonder if he should have measured more than once, perhaps a series of measurements over several days - I don't know.. You are in a good position to get the one eye done and see how close that comes out, then choose target for other eye, having already considered the choices of monovision, mini-monovision, or both eyes the same. With planning, it should all work out fine. It sounds like it will. Hope I haven't confused the issues. Best of luck!
You could try out both full monovision (near vision in non-dominant eye) and mini-monovision (intermediate vision in non-dominant eye) with contacts to see which works better for you. (Remember that it takes many people a week or longer to get used to full monovision.)
The above suggestion assumes that your surgeon will come close to hitting your distance vision target with your dominant eye.
The above suggestion assumes that your surgeon will come close to hitting your distance vision target with your dominant eye.
Dr. O, JodieJ, & baggyrinkle,
Thank you so much for your help.
As you had suggested, I have found a new doctor that I am very happy with. Both Crystalens and reStore were presented as possibilities. However, I will go with standard mono-focal IOLs. My decision is primarily due to the relative level of dissatisfaction reported on this forum for the accommodating and multi-focal IOLs.
I will correct the cataract eye to "Plano" for good distance vision. I will plan to have an IOL in my other eye soon after. This will also give me the opportunity to try monvision with a single contact lens in the interim and to possibly change my mind on the second surgery.
Does this sound like a good plan?
Thanks again,
Sallie
Thank you so much for your help.
As you had suggested, I have found a new doctor that I am very happy with. Both Crystalens and reStore were presented as possibilities. However, I will go with standard mono-focal IOLs. My decision is primarily due to the relative level of dissatisfaction reported on this forum for the accommodating and multi-focal IOLs.
I will correct the cataract eye to "Plano" for good distance vision. I will plan to have an IOL in my other eye soon after. This will also give me the opportunity to try monvision with a single contact lens in the interim and to possibly change my mind on the second surgery.
Does this sound like a good plan?
Thanks again,
Sallie
In your place, I'd definitely go for good distance vision in my dominant eye. Even if you can't adjust to full monovision (and you probably can), you could wear a contact lens in your non-dominant eye. Almost everyone can adjust to mini-monovision, and you could correct your non-dominant for intermediate vision with an IOL (if full monovision doesn't work) when you need to.
Yes! After reading the 100's of posts on this (excellent) forum, I'm thinking that mono-focus is a safer choice.
Don't want to "mess" with my "good" eye if I don't need to. I'm quite happy with contacts.
Thanks, Sallie
Don't want to "mess" with my "good" eye if I don't need to. I'm quite happy with contacts.
Thanks, Sallie
Yes, the cataract is in my dominant eye. When I read your post, I had this crazy idea of asking my optometrist of 20+ years (who I love) to try to fit me with a trial pair of contacts to simulate this. But I'm afraid my cataract is quite bad now and the vision too poor for this.
I don't mind wearing glasses on the computer at all. Would like to go out to dinner without them. Just hate to deliberately correct the vision in this eye to less than optimum.
I don't mind wearing glasses on the computer at all. Would like to go out to dinner without them. Just hate to deliberately correct the vision in this eye to less than optimum.
Could you explain in more detail why a person with -2.00 is hardest to make happy? Is it because their near vision is good to begin with and they will need readers after an IOL.?
Challenge your doctor and insist on more information. Your doctor is taking the easy way out to basically duplicate your current vision expectations. But, he may be right about the "snake oil". Any thought about doing both eyes now and achieve a balanced outcome.
If your cataract eye is your dominant eye, then correcting it for distance vision would give you a nice version of monovision. About 75% of the people who try monovision can adjust to it successfully. I don't think you'd have any problem using a computer without glasses. (Monovision is more difficult for many people to adjust to when the non-dominant eye is used for distance vision.) Yes, you could reverse the monovision with a contact or glasses.
Actually, I would do the IOL only in the eye with the cataract.
What I don't understand is why I wouldn't want to correct the cataract eye to 20/20 for distance? This would leave me with one nearsighted eye requiring -2.00 correction.
Then, couldn't I still read, put on makeup, go out to dinner and maybe even drive without glasses or contacts if I needed to? Couldn't I still wear either glasses or contacts?
BTW, I work on a computer all day.
Am I missing something here???
Seems as though the practitioner is either making thing easy for himself or is making assumptions about my preferences without explaining/discussing them with me. So, I will try to find a doctor who does a wide range of IOL's and get a second opinion.
What I don't understand is why I wouldn't want to correct the cataract eye to 20/20 for distance? This would leave me with one nearsighted eye requiring -2.00 correction.
Then, couldn't I still read, put on makeup, go out to dinner and maybe even drive without glasses or contacts if I needed to? Couldn't I still wear either glasses or contacts?
BTW, I work on a computer all day.
Am I missing something here???
Seems as though the practitioner is either making thing easy for himself or is making assumptions about my preferences without explaining/discussing them with me. So, I will try to find a doctor who does a wide range of IOL's and get a second opinion.
You are used to being able to read, put on makeup, etc. without correction. If you had 20/20 vision in both eyes with monofocal IOLs, everything within arm's length would be blurry, and you probably wouldn't be happy. I think this is what your doctor meant. But I agree with Dr. O--get a second opinion.
MEDICAL PROFESSIONAL
I would see another doctor. I am not a fan of multifocal IOLs. However, you seem to be doing well with a multifocal contact lens in one eye. You could consider using the multifocal contact lens and consider a multifocal IOL. It is best to see a doctor who does all types of IOLs and then get their recommendations. -2.00 person is the hardest to make happy with a presbyopic correcting IOL because the preop near vision is quite good.
Dr. O.
Dr. O.
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