Cataract surgery and shooting pistols and rifles.

[SEOklaShooter]

I am 64 with single vision, only see out of one eye at time, and the cataract in my right eye is to the point it need to be removed. I had corrected 20/20 both eyes before the cataracts. About my only hobby is target shooting both pistols and rifles with open sights. I have wore glasses since I was 3 and wouldn't mind warring them after the surgery. I would like to be able to see rear sight and scope on a pistol at arms length. Also I need to be able to see both the rear and front sight on a rifle. I have heard people have trouble with the multi focus lens. What do you recommend.

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

I can't tell. Your information will need to come from your surgeon.

JCH MD

[hipwr223]

Just a quick follow up.  My Cataract Surgery went well, no weakened zonules from the initial trauma, uneventful surgery.  I'm post op a full week and sadly my vision is very blurry still at all distances.  I think the  traumatic iridoplegia at this point is causing most of my shooting related vision problems.  With the pupil being about 6-7mm on average you would think that I would be getting more light than I needed even looking through a .040 aperture on my rifle but the reality is that it always looks dark, even when I switch out apertures to much larger dia like .046.  I would have assumed that a large pupil would let more light in and I would need to use a smaller aperture but I am seeing quite the opposite.  I'm not sure what to make of it.  

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

You're welcome. Best of luck and straight shooting.
JH MD

[hipwr223]

Thanks Doc!  This conversation has removed some of the anxiety I had over this upcoming procedure.  Much appreciated.

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

1. Cataract surgery generally lowers IOP
2. The trauma may put you at increased risk of RD but the PVD itself doesn't.
3. Could be worse, eye could be blind.  Have taken care of people that have lost all sight in auto accidents, gun shot wounds, etc.

Hang in there
JCH MD

[hipwr223]

I have been very focused on my IOP.  Post injury I was around 40 in the right eye.  It may have been slightly elevated from the Pred drops as well, but even after tapering off the steroid and all the inflammation subsided, (Hyphema, Iritis, Uvitis) my IOP was about 28.  Staying on the Combigan keeps it about 17-20 which is higher than my eye was prior to injury but within safe limits.  I have thick corneas so the actual pressure might be slightly lower.  Does the artificial lens for the cataract replacement compromise aqueous flow?  Can it contribute to my already compromised outflow to the schlemm?  The PVD probably puts me at a slightly elevated risk of retinal detachment after surgery too I suppose?   Unfortunate how one hit to the eye has dramatically changed my life...

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

I just moved up from FWB 600 to 800. Sweet.

Yes watch the IOP carefully. Femtosecond surgery is state of the art and you should do well.

Protect both eyes from another injury.  

JCH MD

[hipwr223]

BTW, I cut my teeth on 10m air rifle with a FWB300S when I was a kid.  

[hipwr223]

Excellent Sir, I will review this link.  When I say I am slightly myopic it really is just in regards to competitive shooting.  I wear no daily glasses and never have... yet.  I charted 20/20 uncorrected and simply used a slight minus diopter lens in my shooting glasses frames.  The astigmatism was always the more critical aspect of my vision to correct for.  My left eye is I chart 20/15 and need no correction, I have terrific accommodation in it and can shift focus from as close as 5 inches to infinity so I truly do not believe I am presbyopic yet and neither does my eye surgeon.  Truthfully the males on my fathers side all maintained good accommodation much later than the average.  My other issue from the injury has been angle recession and continued elevated IOP due to damaged trabecular meshwork as well as a tear in the retina that was repaired well and is holding but I am still getting symptoms of PVD.  My primary concern with this surgery is  the potential for weakened zonules due to the trauma and the possibility of capsule bag issues.  I am going to one of the very best surgeons in the Phila area and they are recommending the Femtosecond(sp) laser for the emulsification of the old lens to minimiaze zonule/capsule bag issues.  Does this sound right?

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

http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ;

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

At age 44, you are presbyopic.  The reason you have not noted it is that the "Slightly myopic" refractive error helps you focus up close. If you were not myopic you would not be able to read or see up close.

Go to my expert website and read the posting I just made on considerations on IOL surgery/post op refraction.

You might want to talk to the really excellent iron sight competitive shooters you know that are in their late 40's and 50's. They can help you understand what is happening as you age.

You need to "match" the refraction in the other eye especially since it likely does not have a cataract.  This is also covered in my blog post.

Assuming this is your shooting eye you might want to consider aiming for post op refraction 0.00 to -0.50  With "peep" aperture sights you should be able to get a good sight picture. That's what I do with my 10 m air rifle target shooting (FWB 800).

JCH

[hipwr223]

Dr. Hagan,  I am having a traumatic cataract removed in a few weeks and have opted to go with a fixed distance lens (Alcon SN60WF)  I am a competitive Service Rifle Shooter, National Match Course shooting.  All iron sights 200-300-600 yards from positions.  Prior to my eye injury I was slightly myopic with an astigmatism, even at 44 I had very good accommodation and was not at all presbyopic.  Now with the injury I am faced with a cataract that has ruined my vision.  I am hoping that with  fixed distance focus that I can shoot with a slight amount of positive correction in my glasses and create depth of field with a small aperture on my target sights to get a crisp front sight without complete loss of target definition.  In your experience does that sound like a reasonable approach to this problem and can I expect to achieve the desired effect with that line of thinking?  Thanks in advance, John

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

If you are left myopic post IOL surgery your situation will be like me. I don't have cataracts but am in my 60's.  If I remove my glasses I can get a great sight picture with pistols or long guns but the target is blurry. If I put my shooting glasses on (distance only) the target is clear but the iron sights are blurry. If I wear my progressive bifocal by raising or lowering my chin I can change the focus from clear near to clear distance but can't get both.

That's why practically everything I shoot has some type of optical sight on it.   I use an airgun and an indoor range in my basement and use peep sights or the on the glasses peep sights and co reasonably well.

JCH MD

[SEOklaShooter]

As I said in the first post I have amblyopia. I look out of my right eye or left eye but not both at the same time. When I read a book I read the left page with left eye and right page with right eye. I can't have one eye with near vision and one eye with far vision.
I agree with John I can't and won't be able to see clearly  the rear sight, front sight on the rifle and target at the same time. I think I should be able to see front sight and target clear rear sight fuzzy. Also I would like to be able to see clearly rear, front sight and target on pistol at arms length. Could I have a stronger lens for my right eye made just for shooting with the focus starting at arms lenght?
Guy

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

I am a shooter all my life.  You cannot use open sights and have a good sight picture like when you were young (clear front, rear and target) no matter what type of IOL you chose, even multifocals (which are liable to bother you due to glare  (dysphotopsia).

Older shooters can do reasonably well with "pinhole" peep type sights on the long gun or a suction cup stick on the glasses pinhole peep sight like made by Merritt (spell?).

The answer for middle age and older shooters including those with IOLs are optical sights.  There are many types, target acquistion is quick, parallax is eliminated and they come with short or long sight relief (how far you are away from the sight).

JCH MD

[cwatt1]

My post assumes you plan at some point to have both eyes done.  Another alternative might be one eye set for distance and one eye set for intermediate (arms length) vision.

[cwatt1]

You need to discuss with your eye surgeon, but assuing you do not have astigmatism my inclination is that you might be better off with monofocal lenses with one eye set to distance (for seeing the target) and one eye set to near if you'd like to be able to target shoot without glasses.  With multifocals you still might need some near correction and your distance vision might not be quite as sharp.

Since you state you don't mind wearing glasses, it really would be your preference as to when and for what purposes you would want / need your glasses.  You could also opt for very good distance vision but need to continue to wear [progressive glasses for target shooting.

Good luck!