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9424748 tn?1405130441

Cataracts & Toric IOL for Astigmatism

I am scheduled for cataract surgery in a few weeks. It appears I cannot have anything but the Toric Astigmatism IOL if I want clear vision. My vision is a -4.25 in one eye and a 5.00 in the other and they are setting me up for a - 2.5 so I can keep my close vision. Will I have any variance to my vision at all or will I only see at about 14-16"? Will I be able to see any closer CLEARLY than 14", or any further than that too? At the present time I do a lot of detail sewing, artwork, jewelry, computer work. This concerns me greatly. I do not want to wear glasses to thread a needle, paint the details on a painting, or do jewelry work (that type of tiny stuff). I was told that if I got a multifocal IOL that there would be a yellow tine, decreased contrast and possible halos. I threw that idea out right away but I am still having doubts about the decision to keep the close vision (as I've always been). Any advice would be immensely appreciated. I also wondered if my 'blurry' distance vision will be worse than my blurry is now (without glasses) and the blurry will be the same amount  whether it's 15 feet or 100 feet. Lastly, if I did opt to get the IOL set for distance, just how close up could I see without glasses. Thank you!
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Avatar universal
I wondered if you still think your distance vision improved some, even though your Toric IOLs are set for close.  I am having cataract surgery in a month or so and am seriously considering having the Toric lenses set for close.  Or I may have one eye for close and one eye for intermediate.  I have been nearsighted all my life.  Are you happy you went for the close vision?
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Avatar universal
I think your doctor is wrong about not being so concerned when you wait longer.  I would not wait too long, because that is what I have done.  It puts me in a higher risk of surgery category.  Still, I am having a hard time deciding between Toric mini-monovision of close & intermediate or Toric mini-monovision of intermediate & distance.  I have found this forum very helpful and have got a lot from your conversation with Nancy.
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9424748 tn?1405130441
I totally agree with you on this---- " My friends who like their distance vision without glasses do not have the same demands of excellent, detailed close-up vision that you and I have. They are okay with so/so, slightly blurry close-up vision and will throw on a pair of readers when necessary. You and I have higher expectations for our near vision. They would rather see the leaves on the distant trees without their glasses, and I would rather be able to cut my fingernails without my glasses."

You have said this very well. It is very important to me to have close up vision and I have no regrets with keeping the close up lens.

I just wanted to mention that with the toric lens you evidently can either have a crystal clear one or a tinted one. They gave me the clear one because they knew I wanted my colors to be 'true' (as an artist). I will say that they are the most clean colors I've seen in a long time. The tinted lens has a uv built in, but with the clear one, I have to be sure to have that put into my glasses/sunglasses (my surgeon told me this).

I'll mark on my calendar to say a prayer for you about your upcoming surgery. Please let us know how it all goes.

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Avatar universal
I have been told by two trusted cornea specialists that I am not a candidate for any premium lenses other than the toric. The toric is not a basic lens, and I will be paying an additional $1,500 for each eye. Salzmann's causes the eye to have irregular shaping and extreme astigmatism. It is more challenging to get measurements on the irregularly shaped eye, and lenses do not fit on it as well as they fit on normally shaped eyes. Many ophthalmologists would not use a toric lens with a Salzmann's patient. My ophthalmologist claims to have had success with it. He actually specializes in repairing bad cataract surgeries. He does about 100 of those a year in addition to other cataract and cornea surgeries.

I don't mind wearing glasses, so it is not important to me to be able to see at all distances without glasses. When we have to make a choice of whether we will be able to see well either near or far, that is a very important decision that will affect us for the rest of our lives. I have read of numerous patients who made their decisions without adequate information. Some of the others might benefit from the Crystalens that you have mentioned.

I had Salzmann's surgery in my right eye in Sept. I will have cataract surgery in that eye on Jan. 15. I will have Salzmanns surgery in my left eye on Feb. 5. After that heals, I will have cataract surgery in my left eye. I will be using a lot of eye drops!! I can no longer see through my old glasses, and I can't get glasses until all of this is done, so this is a very long time period for me to have very poor vision.
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Avatar universal
I have to wonder if the Crystalens is an option since it is basically a monofocal lens that accommodates if it works, and just a regular monofocal if it doesn't. I'd also noted on the thread for a 35 year old looking for IOL choices that not all monofocal lenses are created equal.

This page seemed to have become partly about the issue of getting lenses adjusted for near rather than distance, so I figured I'd put the comment out there regarding premium lenses for others reading it, whether or not it was useful in your particular case.
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Avatar universal
Nancy, It would be great if people could try out eyeglasses for a few weeks that simulated what their vision would be like after cataract surgery.
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Avatar universal
Hi SoftwareDeveloper,

You have made great suggestions, but I have to have surgery for Salzmann's Nodular Degeneration in both eyes before I have my cataract surgery, and that severely limits my choice of lenses. My choices were a basic monofocal lens or a toric monofocal lens to correct my astigmatism. The toric lens has an 80% success rate in Salzmann's patients as opposed to a 96% success rate in "normal" patients. I chose the toric lens. If it does not work for me, I will have another surgical procedure and will likely have to wear glasses for all distances.
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Avatar universal
We are all going to have to wear glasses for various distances. The deciding factor for me was whether I would rather wear glasses to see close-up or far away. I have always worn glasses for distance and taken my glasses off to see close-up, and it was a no-brainer for me that I would prefer that my vision stay that way. My friends who like their distance vision without glasses do not have the same demands of excellent, detailed close-up vision that you and I have. They are okay with so/so, slightly blurry close-up vision and will throw on a pair of readers when necessary. You and I have higher expectations for our near vision. They would rather see the leaves on the distant trees without their glasses, and I would rather be able to cut my fingernails without my glasses.
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Avatar universal
For those who wish to see more in the near range, I thought I'd suggest that they might consider the idea of a premium lens set to focus at near rather than distance as an option (if is worth spending money on it) and not merely monofocals. The lenses are usually intended to get a broad visual range from far to near, but offhand I can't think of a  reason they couldn't be used to get an expanded visual range from near to very near.  Unfortunately the nearer you get, the more diopters of correction it requires to get just a little bit closer so I don't know how much it would expand the range, but I would guess it is worth considering even though I hadn't read about anyone doing this to confirm it.  

Even if you don't wish to risk the potential visual side effects of a multifocal lens, you could consider an accommodating lens like the  Crystalens which is worstcase then like a monofocal if it doesn't accommodate,  or those getting a lens outside the US could consider an extended depth of focus lens.

It could be that with a multifocal you might consider getting the nearpoint set very near and then at least get some intermediate vision out of the "far"  point.
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9424748 tn?1405130441
Renee, I understand TOTALLY what you were saying and I also had 2 friends that did the distance vision (they were nearsighted) and they acted like it was so great, but that little voice inside me kept telling me that I'd never be happy not being able to see those tiny details. Even some family members said they couldn't understand why I wouldn't be ok with wearing glasses for close up, and I kept going back to my original thoughts about putting on makeup, threading a needle, drilling tiny holes in my jewelry items, etc, etc.. It seems you have a good outlook on life with all you've been through and I suppose whatever we go through we can learn to accept and adjust to it (like you said).

Keep us posted with what happens and your surgery! Praying for all to go well!
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9424748 tn?1405130441
Nancy....really! We do need each other ;-)
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7765252 tn?1395096028
Maybe there should be a support group for "People Who Choose Near Vision IOLs"  It's difficult sometimes when folks, keep telling you you are crazy.  ;)
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Avatar universal
I had gone to a different ophthalmologist for many years for annual eye exams. He thought that I just had cataracts. He is old and no longer does surgery, so he referred me to his partner for cataract surgery. I was shocked when the partner told me that I had Salzmann's Nodular Degeneration and that I had to have surgery for that before he could do the cataract surgery. Salzmann's is a very rare, benign eye disease that almost no one has ever heard of. It is nodules or callouses on the cornea that change the shape of the eye and interfere with vision. If they don't scrape the nodules off first, they will be doing cataract surgery on a mis-shapen eye, and the patient will never have satisfactory vision. I went for a 2nd opinion to Wilmer Institute at Johns Hopkins University, and the cornea specialist there said exactly what my local cornea specialist had said. Wilmer has more than 100 ophthalmologists, and it is one of the top eye clinics in the world.

My Wilmer ophthalmologist told me that he would correct my vision for distance. I asked him about correction for near vision because of what my local ophthalmologist had told me, and he agreed. The distance choice was about a 1-minute conversation. He did spend time discussing my Salzmann's issues, that I would need to wear glasses for some distances after surgery, that there was a 20% chance that the toric lenses would not work for me, and that he might have to do a surgical correction on that. I called Wilmer on Dec. 31 because I was having some 2nd thoughts about getting corrected for near vision, and I wanted to talk to someone about the pros and cons. Fortunately, they were closed for New Year's Eve. I spent all day on New Year's Day reading everything that I could find about correction for near vision. I copied excerpts and information from many sites. When I reviewed all of my notes at the end of the day, I was 99% convinced that I was making the best choice for myself. I called two friends who had recent cataract surgery. They are both thrilled with their great distance vision and don't mind that they sometimes need reading or computer glasses to see things closely. They have different lifestyles than me. I work with computers, contracts, and other paperwork every day. I like to read, sew, and do other needlework. I know that it would bother me a lot more to have to wear glasses for close work than to wear glasses for driving and distance. My adult daughter has been nearsighted all of her life, and I had a long conversation with her today about this. She also would want to keep her vision the way that it is. I am now 100% confident about getting corrected for near vision. I am glad that I did my homework before the surgery rather than after. I think that more than 5% of people would opt for near vision if they were given a better explanation prior to surgery.

Regardless of whether you correct for near or distant vision, it is a change in your eyesight and requires an adjustment period. Because I am a 2-time cancer survivor, I don't stress out about health issues that do not have the potential to kill me. I am hoping for good vision and understand that I may have to get used to my new eyes. I am glad to be alive and grateful that they can remove my cataracts and improve my vision.

It sounds as though you have had a good result. I hope that you are happy with your vision.

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9424748 tn?1405130441
Dear Realtor Renee,
   I appreciate your post! It was very interesting reading about your experiences and the other things (statistics). I've not heard of the Salzmann's surgery but am glad it has been successful for you. About 'going against the flow'....I totally understand what you mean! I doubted myself SO much and now that it is done, I'm glad I asked for a little more near-ness. They wanted to do a -2.5 and I upped it to -3(as you probably read above in my zillion posts lol). I am still healing and there might be improvement yet, but I sort of wish I would have done a -3.5! I was used to it also as you mentioned since I was very young. I would have truly been sad for my world to turn upside down and NOT have my close vision. I do so many things (sewing, jewelry work , artwork) and like to see clearly and closely. At first, after the surgery it hit me quite hard that I wasn't seeing as closely as I wanted but I've accepted it now. Worse comes to worse I'll have readers for those kinds of details I need for my work. My left eye doesn't need to be fixed yet so I'm still enjoying seeing closer because of it. Overall though, I must say I like these toric lenses. I go back Monday for my 2 week check up. Again, like you, I went around and around with this decision.

My 'new' eye....I cannot see close enough to see details on my face so I need a slight magnification which is strange! I can't imagine not seeing anything within 3 to 6 feet if I'd opted for distance and as you probably know a lot of people say they cannot see anything closer than at least arm's length. Of course I cannot tell you what to do but go with what you love to do most and what you need your eyes for the most. We nearsighted people like seeing things clearly :-) Like you, I read of many devastated people who were not told that they would NOT see closely and I am grateful my opthamologist (sp?) listened to what I wanted and took me seriously. My Dr. even told me that 2 people he knew (both were professionals) opted to keep their very close up vision instead of distance with their cataract surgery which made me feel good about my decision. He said it was a personal decision and each person is different. I appreciated him not treating me like I was crazy.

I think my eye is improving but I do not know that I will ever see any closer clearly than 11". I can see at about 12" now and this morning it was about 11". My non fixed eye sees at about 8-9" clearly. Together they work pretty well and I can see a little closer. My fixed eye was set at a -3 (it used to be a -4.5 with astigmatism), and my unfixed eye is about a -4.25 prescription. When I need to fix that second eye I am definitely going to be sure I can see something CLOSE up. I have to use a slight magnification when  putting on my makeup if my unfixed eye is closed. I still hope it improves. Thanks for asking!

Please keep us posted on how you are doing and what you decide to do. I know whatever you do, you will love seeing better.
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Avatar universal
I have been looking for information about correction for near vision for cataract patients, and I came across your posts. I have cataracts, Salzmann's Nodular Degeneration, and astigmatism in both eyes. I have been nearsighted since I was 15 year old. I am accustomed to wearing glasses for driving and distance and taking them off for reading, computer work, sewing, etc. I have been very comfortable with this arrangement.

A local ophthalmologist who is fellowship trained in cornea and external diseases did surgery in my right eye in September to remove the Salzmann's nodules. It takes several weeks or months for the eye to heal before it can be measured for cataract surgery. This ophthalmologist said that patients who have always been nearsighted are usually happier if they are corrected for near vision. He then got sick, went out of town for a month, and I changed doctors.

I am now seeing a cornea specialist at Wilmer Institute. I am scheduled to have cataract surgery on my right eye on Jan. 15 and Salzmann's surgery on my left eye on Feb. 5. After my left eye heals from the Salzmann's surgery, I will have cataract surgery on that eye. I will be getting toric lenses that correct for near vision. He said that toric lenses are successful 96% of the time with "normal" patients and 80% of the time with patients who have Salzmanns. I understand the risk, and I am willing to give it a try. If they do not work for me, I will have to wear glasses for all distances.

I read on the web that 90% of monofocal patients get corrected for distance vision and 5% get corrected for near vision. I had to think long and hard about going against the flow, but I think that near vision is best for me. After reading many posts on the Internet, it appears that some cataract patients were not told that they had an option to be corrected for near vision. I am grateful to my first ophthalmologist who initially told me of this option.

I hope that your vision is getting better.

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9424748 tn?1405130441
Hi Nancy, I TRULY appreciate your input. I really 'get' what you are saying about how hard it is to try to see closer (clearly). I keep thinking I can bring something closer and I cannot. Actually today my sight seems worse! I can't see anything close up very clear. I can hardly wait to get new glasses. That should help. Worse comes to worse, I'll get readers like you said you had to. I HOPE that I can at least see 9" but at this point....pray, pray, pray!!!!
What you said about the 4 and 4.5 -- I think I know what you mean about range of vision. With this fixed eye, it's a VERY SMALL 'window'/range where I can actually see perfectly clear. I hope that improves.  I will definitely ask about that what you said because it could be that range shrinks if I get closer.
Are you definitely doing better with your progressives now?
Do you remember if it took quite a while after your surgery to see perfectly clear up close?
Thank you!
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7765252 tn?1395096028
Erin, I'm glad the surgery went well for you.  That incident testing the pressure would sure make a person's heart beat a little fast, wouldn't it? Ha!  Here's the best answer I can come up with to your question:
  
Left eye (targeted +3.0)
Best focus about 14"
Clear range (reading small print): 11"-17"

Right eye (targeted +3.5)
Best focus about 12"
Clear range 9"-15"

So yes, with both eyes open the range *does* go from about 9" to 17".
  
For close quick reading, like labels in the grocery store, I just look over the tops of my glasses, like I had always done before.  Nine inches is sufficient for most things.  What is hard for me to get used to is that getting any *closer* than 9" away makes it worse.  I'll learn eventually.

Before you go with 4.0 or 4.5, ask someone if the range of vision doesn't shrink as you get closer. I think it might.  In other words it might not be so good to be able to see at say 8" if you can't see clearly closer than 7" or further than 9" (or whatever it would be).  Just something to think about.    

You said you do sewing and jewelry. As I said before, I can thread a needle, but I couldn't sew a buttonhole comfortably without readers.  But that is very close work and takes a long time.  And I don't do it often, maybe once a year.
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9424748 tn?1405130441
Hi Nancy, I just wanted to let you know that my 'fixed' eye is now at about 12". I regret to say I was hoping on 10" and I've still got some healing to do, but I understand what you meant now by lots of things you said in your posts. I only wish I had listened to myself ( ha ha) and went ahead and asked for -3.5 or even -4. I sure won't do the next eye that far away. I am hoping I'll get used to it. I've had some up & down feelings with this change and am trying to not think that I'm 'ruined' so to speak. At least I can see! I do have a question for you. Did you tell me that your eyes (being that they are different prescriptions) can focus together well without glasses when working closely?
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9424748 tn?1405130441
p.s. on that 2nd last sentence I should have said 'I am really looking forward to getting the new "eyeglasses" right lens.....(etc)'
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9424748 tn?1405130441
Hi Nancy, I appreciated seeing your last nice message. Well, here I am alive and well ha ha after the surgery! They did my right eye, set target at -3.00. I'm having the usual fluctuation but right now I'm seeing good at about 12". It's a little farther than I like (I was hoping 10") but it's not bad with my left eye which sees at about 8". Together my eyes can see at about 9". If my left eye's cataract ever gets worse, I think (or at least at this time) I will set it for a -4.00 or a -4.5. I would hate losing that super close up vision.  I am still hoping that when it heals my right eye might come in a little more. That is life I guess if it doesn't and I'd better be thankful for sight at all when I read some of these horror stories about vision that some have after cataract surgery. I suppose my new glasses will be a little thinner with a lesser prescription and no astigmatism which is a plus. The positive thing is that whites are very white -- I knew my cataract was making things very dim before. I truly appreciate the brightness. The surgery was a bit scary and I was awake through it. I'm glad it's over. I have to tell you something funny that happened to me at my 3 day check up. The associate took me back to check the pressure on my eye and have me look through the optical machine, and she asked me if I could read the letters and I said 'no'. Then she changed it, asked me again, I still said 'blurry'. Then after the 3rd time(getting a little worried)and I still couldn't read the letters, I said, 'they have me set up for close vision'. At that moment she asked me my target and I told her -3, she set up the machine that way and I could read all the letters. Boy was I relieved! Anyway I guess they expect everyone takes distance.
So....I am REALLY looking forward to getting the new right lens because it's hard seeing when the prescription isn't right but good old lefty eye takes over as it has been for quite some time!
How's it going with you? Hope to hear from you.
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7765252 tn?1395096028
Good luck tomorrow, Erin.  Let us know how it goes.
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9424748 tn?1405130441
HI Nancy, Sorry it has taken me so long to get back with you. I hadn't realized that you wrote me. I have been truly busy with the grandbaby. It wears the body out and even makes it hurt but he's so cute and gives me so much joy, I don't care!

I don't understand why you've had so much trouble getting glasses to work properly for you. I truly feel for you and I may in in the same boat.  I just don't know why they can't set you up with what is right.

I have been going back and forth all week (surgery is this Friday the 19th) wondering if I've made the right decision to keep nearsightedness. I cannot think of life with never seeing anything close up. If the first eye can't get close enough after surgery, if I ever do the 2nd, I will make sure it is closer. I'm hoping the -3.00 will do the trick. My Dr. acts like that will be about 10-12" or so. I hope not a whole lot more than that. Actually I hope I'm not giving up MORE by NOT having lenses put in for distance instead, but I'm sure that would really drive me crazy.

Do you regret not going for distance vision (only) or are you still happy you chose to keep your close(r) vision?

Thinking of you, Erin

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7765252 tn?1395096028
Hey Erin!  I was afraid you'd never come back and tell us what happened.  Got a new grandchild now?  
  
So you're doing one eye on the 19th.  Are you still going for the toric lens?  I probably should have.  
    
I'll update a little...
Got those Progressives changed one time.  Everything is OK now except the computer distance, but I expected that.  I've never had progressives that work well for the computer.  I see starbursts from headlights at night, but no glare or haloes.  I think that has to do with the cornea, not the lens.  Actually I think now that the haloes before might have been just starbursts that looked fuzzy because of the cataracts. Ha!  I can live with starbursts.

Some observations you might be interested in:

I already had a pair of single vision glasses set to focus at about 19 inches out (for the computer) for my *old* eyes and I can see almost everything inside the house clearly with just those now.   Outside at a distance, no, but not too bad surprisingly.   Whenever I get some free time I'm going to try a pair of single vision glasses set to focus about arms length away this time for the computer and see what happens.  

When I got retested for the progressives I told the doctor I wanted to see *crisp* at a distance, for driving.  He did the usual thing with the chart 20 feet away, and said 20 feet is visual infinity and good enough.  I argued that I now have zero accomodation and didn't quite believe it. I think he was anxious to get rid of me by then, so he took the lenses out in the hall and tested my eyes looking across the street.  It made a 0.75 diopter difference in the prescription.  So I can read road signs clearly far out now. I really like that.  
  
Finally, I can read just fine without glasses and thread a needle pretty good, but for *very* close lengthy work (like the other day I was sewing a buttonhole by hand) I had to drag out my dad's old readers. I hated them.

Good luck!  And please update.
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9424748 tn?1405130441
HI Nancy, I was thinking about you lately and was wondering how you've been doing. How are your eyes and your new glasses?

I'm going for surgery December 19 to do my one eye and it's going to be done at a - 3.00. I HOPE and pray I can see somewhat close up afterwards. I am waiting to do the 2nd eye when it gets bad. My Doctor agreed to this (I had to have a different one than the last time). I like him almost better than the first Dr.! He was going to do my eye at a -2.5 and I asked about a -3.00 and he was agreeable to do that if I wanted to.

So say a prayer for me if you think of it. I hope I can see perhaps 10-12" when it's done. I'm looking forward to a new pair of glasses! :-)

Let me know how you are.
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