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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!
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.
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.
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.
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.
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.
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.
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!
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!
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.
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.
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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