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How is your vision after Cataract Surgery?

How is your vision after Cataract Surgery?
Please specify whether you got a monofocal or multifocal/accommodative IOL.

I would like to know what distances you are able to see clearly. What distances are slightly blurry, but acceptable, and what distances are just unbearably blurry.

I am particularly interested in those who have received Monofocal IOL set to Distance but I would also really appreciate hearing those experiences with different IOLs. I have heard from several people that with a IOL Set to Distance, they are still able to use the Computer at about 18 inches. This has confused me since I had thought IOL set to distance makes intermediate distance blurry.

Thanks!
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re: "disbelieve what I was told since I wanted the safest"

I think part of the issue is that as with many new technologies, it partly  has different pros and cons than the manual approach, some complications are less and some are more, so it is hard to evaluate.  If someone has any risk factors for a particular complication, that may tip the balance one way or another (e.g. as I mentioned, I gather that if someone has   a very mature cataract and the laser seems to have a clear advantage in that case). Many of these complications are rare and so they require large studies to assess which is better, an individual surgeon may not have enough data (and often may not collect data). And of course things may vary between surgeons depending on their skills.

One thing that happened I think is that prior to extensive studies, many people just speculate about what they intuitively assume will be the benefits of the laser, and they wish to assume the best about a cool new technology. Then they don't personally do enough cases to have data to be sure, so conformation bias can set in.  You'll notice that the AllAboutVision page on laser cataract surgery you link to states: "Using the laser should also result in less chance of capsule breakage.". The "should" indicates they were making an assumption,  but that large recent study indicated more tears:
http://www.ascrs.org/sites/default/files/resources/JCRS_January_2015.pdf
(though the posterior capsular tears difference wasn't statistically significant, just the anterior tears). Of course it may be that improvements in the technology will eventually lead to fewer tears.

All of this is in flux since new lasers and improved software are coming out all the time and it takes time for data on the results to be collected. There may be benefits that aren't yet demonstrated in studies from the latest tech.

That leads to another complication,    since a large amount of data is needed for rare problems, small studies can be misleading if the differences aren't statistically significant, so I don't know if there are other smaller studies that mislead people, the large studies I paid attention to are fairly recent. Unfortunately many doctors are busy practicing medicine and don't keep up with all the latest studies as much as people might hope. Some rely on anecdotal word of mouth from the sales reps (unfortunately) and or the impression they get from other doctors who may also be relying on anecdotes or intuition rather than data.

Some are now trying to eliminate the need for any ultrasound at all, using the laser entirely to break the lens up, as in this article just published in April:
http://crstodayeurope.com/2015/04/using-the-femtosecond-laser-to-eliminate-phaco/
That seems likely to have a real benefit, but there isn't data yet, and there may be unforseen tradeoffs that aren't apparent except with a large number of cases.
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re: "posts on the medications for cataract prep and post."

Unfortunately I hadn't researched that.   I had my surgery in the Czech Republic where costs are much less. The Vigamox was included in the surgery price,  the Tobradex I had to fill before surgery was like $9. I hadn't examined the issue of generics in this case, in most cases generics are the same active ingredient and aren't a concern (even if manufacturers benefit from people believing otherwise). I think the concern over generics arises in many cases since for some conditions not every medicine will work every time, and people look for something to blame the failure on. If its a generic, they can't know that the name brand wouldn't have worked either, and may complain that the generic is bad. That starts other people thinking that may be a cause and so if one ever doesn't work they are more likely to blame that. Unfortunately just as there is a placebo effect, there is a nocebo effect, something can work less well if people are skeptical, which can contribute. (though of course given that the placebo and nocebo factors do exist , if you don't mind the cost and have concerns about a generic, evidence based or not, then you can do the name brand).
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re: "disbelieve what I was told since I wanted the safest possible procedure having only one good eye.  "

This is a few minute video from this week with a surgeon talking about:

http://eyetube.net/series/daily-coverage-san-diego-2015/ohedo/
"The Ethics of Femtosecond Laser Cataract Surgery"

And discussing the issue  for instance of   being careful for instance to distinguish between the differing personal beliefs of surgeons, vs. what the evidence shows. The wording difference can be subtle, and patients are often not going to be paying close enough attention to realize the distinction they are trying to make.


As this mentions explicitly:

http://www.reviewofoptometry.com/content/d/ophthalmic_lenses___and___dispensary/c/50964/
"3. Who Really Needs Femto Laser Cataract Surgery?  
Surgeons disagree on this question, with some advocating routine use of femto, others believing its greater precision is primarily a benefit only to those patients receiving a premium IOL, and still others waiting for more compelling safety and outcomes data to show up in the literature before adopting the technology."
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Thanks for all the information. It certainly does steer me away from doing the laser cataract method (see my comment at the end).  

There is an interesting new development. I have postponed my surgery and  I sought a 2nd opinion on  the use of laser and the lens choices. Unexpected, was that he indicated that the cataracts were not that bad (especially in the good eye) and my issues may not all be cataract related, but may be do to the epiretinal membrane. I've always been a little uneasy that my symptoms mis-matched a bit with what classical symptoms were, but not realizing there could be other causes I did not pay much more attention. The consulting physician suggested I do a retina evaluation first  and could be causing some of my vision issues, aside from the cataract. In all fairness, the original surgeon did also report the epiretinal membrane, but did not suggest that I first check it out before proceeding to do cataract surgery. Also, in fairness to the original surgeon, in the initial visits he did suggest that I wait unless it was interfering with my daily life.  I just wish he had made the suggestion to see a retina specialist before getting this far!  Only today, I was told how they grade the cataract (2.5?), which is not very bad.

So I am going to see a retina specialist next and hopefully, and hopefully will know what to do after that.

By the way, the consulting physician suggested if later I do the cataract surgery, that NOT to use the laser in my case, for some of the reasons that were cited in the literature, as you have so well documented.
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Just read your insightful post. Good to hear that the left eye IOL helped you so much. I'm hoping that the right eye turned out as well.

I'm having my cataracts taken care of in a couple of weeks, one week apart. I'm a very high myope, -14. I'm debating whether to get both eyes set for distance and be farsighted forever (needing reading glasses for computer/reading), or get both eyes doe for something less than full distance correction, and then wear glasses for driving, playing golf, and the like.

Now that some time has passed, I wonder if you'd share your thoughts.
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I too have been researching this issue. My situation is likely very different than yours - I am -14 myopic, and have had a retinal detachment and now a macular hole. So I have elected to have the femtosecond laser procedure, as much less mechanical energy is transferred to the eyes using the laser technique.

That said, I've read a half-dozen posts on the issue of "laser or not". It occurred to me that the vast majority of cataract surgeons do not have the femtosecond laser or the training to use it. I expect they would likely defend their methods as "good, and good enough". And they seem to be doing exactly this. But the question really is - setting aside the cost issue for a moment, which method produces better results? I have yet to ready any studies that claims that the manual method is better. Just "good enough".

Fortunately, I have the money to pay for better results. I'd rather see slightly better, for the rest of my life. than to keep that money for something else. My car is 5 years old, and I'd like a newer one. But I'd rather keep driving it for a couple more years, than skimp on my vision.

Just my two cents.

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This is what I'm thinking I'd do for myself. Pre-surgical consult is now set for this Tuesday. I'm not even sure what to ask for - "mid-distance correction"?
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re: "I  have yet to ready any studies that claims that the manual method is better. "

The incidence of some complications is higher, while others lower. Actually some of the studies I listed  above noted for instance a higher incidence of anterior capsular tears. Anecdotal comments I quoted indicate that they can "read" the capsule better via manual surgery to provide them with clues as to whether there might be a problem with a capsular tear.

Techdeveloper suggests in his case with certain retinal issues, the literature suggests manual surgery is better (I don't recall the details, since I didn't have retinal issues, nor do others I know looking into it, I hadn't paid attention to that). I don't know if its more beneficial in your case or not. I had asked a surgeon if the laser might decrease the risk of retinal detachment  due to less phaco energy being used, and he considered it unlikely since that isn't near the retina. (I was highly myopic so I'm more at risk of retinal detachment, but I've never had any retinal issues). I haven't seen anything published that contradicted his view.

Newer technology isn't guaranteed to mean better initially (even if it has the potential to be so in the future), as I've observed from decades in the high tech world. It is often merely different.  In the case of IOL technology, I felt the newest lens had enough benefit to go to the trouble to travel to Europe to get it. Usually with a new technology, especially one with higher costs, the issue is for it to demonstrate an advantage, which it isn't clear the laser has yet except in certain cases like with a mature cataract. I chose  manual surgery  even though my surgeon offered laser treatment ( for not much more so cost wasn't a factor, since its much lower cost in the Czech Republic where I went), he didn't see any real advantage in my simple case.

Even though people are also led to expect more expensive means higher quality, in a case like this that may or may not be the case depending on the person's situation. Unfortunately the technology is changing all the time, which may mean it has a benefit that isn't yet demonstrated... or a complication (like say due to a new software bug for a laser) that hasn't yet been noticed since its still a rare glitch that will only be noticed in a large statistical study.
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When I sought my second opinion on whether or not to use laser cataract surgery, I went to a major university's eye institute. I was told that even though one of the faculty members was a pioneer of this technology, they still do not use it because there is no clear evidence that it is any better than phaco. An as SoftwareDeveloper pointed  out there were numerous studies shown in the scientific literature that suggest it can indeed cause other issues.  Although expensive, I am not at all considering the cost, rather than the safety and best outcome.  While I am sure a lot of the results depend on the surgeons experience with the laser (as would it with the knife), it may be too early to know whether it indeed is 'better" or not.  I was told or read somewhere (I can't recall which), that it may be a better technique if using an accommodating lens or multi-focal. But that should be researched.  
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I wonder if one of the reasons that "they still do not use it" is because of the huge financial hurdle to get one in the first place.

A surgeon can only recoup the cost of this equipment from the small percentage of his total patients that want or need it - at an upcharge of $1500-2250/eye, Like any new tool, it must justify itself financially. I'm assuming that it is bought on credit as well, which up one's credit line for years.

I can't think of any reason to skimp on the cost of this procedure, but I know several people who have. And regretted it - all just saw one doc, listened to the spiel, and went forward. Others will research and travel to find and get the best.

I sure wish I could wait for the Symfony! From what SoftwareDeveloper reports, it's the best Mutifocal yet.
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re: "I sure wish I could wait for the Symfony! From what SoftwareDeveloper reports, it's the best Mutifocal yet."

I think it was the best choice for me (people's needs vary, some might prefer the trifocals that also aren't approved here for better near with not quite as good intermediate).  I admit now I'm curious how well using a corneal inlay providing extra depth of focus (Kamra or Raindrop) over something like the Crystalens would  work. (though I guess the risks of  Crystalens complications and need for 2 surgeries likely would still tip me towards the Symfony).

I mentioned above the Tecnis +2.75 which looks like a decent bet among US lenses. I know someone from this site who got it last week after he decided not to go abroad for the Symfony, I'm guessing he'll post about it.

I will note again that the Symfony isn't a multifocal, it is a new class of lens, an "extended depth of focus" lens:

http://www.eyeworld.org/article-new-tools-in-the-cataract-surgeon-s-toolbox
"The Tecnis Symfony has an elongated focal point, giving the wearer a continuous, full range of vision. Although the lens has diffractive gradings, it creates only 1 image on the retina, not the 2 images characteristic of multifocal IOLs. "

http://reviewofophthalmology.com/content/i/3110/c/52313/
" The first thing to understand is that the term diffractive optics doesn’t necessarily imply multifocality,” says Daniel Chang, MD, an ophthalmologist from Bakersfield, Calif., who is an investigator for the U.S. trial of the Symfony. “This is not a multifocal lens, but it does use diffractive optics to do two things: First, it corrects chromatic aberration. Second, it uses these optics to extend the range of quality vision.” As Drs. Holladay and Chang explain it, with optics you can’t gain an expanded range of vision without losing something in terms of the sharpness of vision; this is just the nature of the beast. However, by correcting chromatic aberration, even without using diffractive optics to expand the visual range, the lens would have extremely sharp distance vision on the order of 20/12 or even 20/10. The process is not yet done, however, in the Symfony. The diffractive optics are then used to expand the range of vision. Expanding the depth of focus degrades the tack-sharp “starting point” (something must be lost, as Dr. Chang pointed out), but since the lens started with such sharp vision, it only degrades to about the level of 20/20. “So the amount you degrade takes you back to the level of a good monofocal IOL,” Dr. Chang says. "

There are a few other extended depth of focus lenses on the near horizon abroad that there isn't enough data yet to know how they compare, like the Mini Well in studies now in Europe. A bit further out are better accommodating lenses.

In the case of the Symfony, part of the benefit comes from correcting chromatic aberration that even natural eyes have :

http://crstodayeurope.com/2015/01/the-evaluation-of-new-presbyopia-correcting-iols
"The average eye has approximately 2.00 D of longitudinal CA between 400 and 700 nm and 0.80 D between 500 and 640 nm."
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btw, Canada reportedly may have the Symfony available within 1-2 months. The AT Lisa trifocal is available in Mexico now, and there are some clinics that are within walking distance of California that *might* be US quality and just over there to use newer technology. (I didn't check into them once I decided to go for the Symfony).

re: "I can't think of any reason to skimp on the cost of this procedure,"

One reason btw would be to instead spend the money to travel to get a better lens, which is likely in most cases to make more of a difference in the years following surgery than having spent the money on laser vs. regular surgery would (though it depends on the case, some with specific issues like a mature cataract may benefit from the laser noticeably, with others its hard to say when the surgeons are still debating the issue). Though of course insurance issues may raise the costs too much, it depends on things like a deductible and budget.I had a high deductible so it was cheaper to go abroad it turned out  (costs are cheaper in Europe,   due to cost of living or other factors, in the Czech Republic especially. I'd only recommend it though to people willing to do their research to be sure they get good treatment, which should be a higher priority than cost of course if possible).

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I had my retinas examine today. The specialist indicated that while I have epiretinal membrane in both eyes, it's not enough to warrant surgery at this time given my current visual acuity.  He also confirmed the cataracts were very mild and felt cataract surgery would not be advised at this time either - in part both reasons due to having only one good eye to work with.   Although my eye test indicated, surprisedly, a corrected 20/25 today (oddly it was 20/40 a few months ago) using the standard eye chart, I should not have the difficulty in reading far distance traffic signs.  I told him I do, which may be the glare I perceive that interferes with the ability to read the letters.    Consequently, I don't have much faith in the Snelling eye chart results because it's only measuring my visual acuity under certain contrast conditions, and not the real world. He suggested that I try to see a very good optician, who might be able to provide some color filtering that may improve my contrast, particularly for far distant reading. So I will be off to the optician he referred me to and see what happens then.
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re: "He suggested that I try to see a very good optician, who might be able to provide some color filtering that may improve my contrast,"

Also using higher abbe material might make a slight difference. I don't know how much of a difference customized wavefront lenses might make like the Zeiss iScription lenses.   (I wore contacts before my surgery so I decided it wasn't worth it for only rare backup use so I didn't research them in detail)

http://www.zeiss.com/vision-care/en_us/better-vision/products---technologies/i-scription-lenses.html
"i.Scription® lenses by ZEISS offer a new approach for better vision — enjoy clearer vision with better contrast"


re: "Consequently, I don't have much faith in the Snelling eye chart results because it's only measuring my visual acuity under certain contrast conditions,"

Many eye surgeons share that concern since they realize obviously vision can be impacted in ways that aren't tested by that. I don't have links handy, but I've seen a number of articles in the past talking about concerns about testing people for glare&contrast sensitivity issues, and about revising their approach as to how to advice people in terms of when they should get surgery. You might check for the articles and see if a local doctor does other tests, though of course the real concern is when you subjectively think your vision is reduced to the point where you think its worth the risk/benefit tradeoffs to   get the surgery done.

Obviously the longer you wait, the better the lens technology will become, and the more potential there is for say improved laser cataract technology to get to where it makes a demonstrable difference. The other concern is of course whether or not insurance will pay for the surgery since although some have been updating their approval criteria to make them more flexible, many rely  on the Snellen visual acuity test (I don't know how common each approach is now). Hopefully if they go by snellen acuity, then if your vision is fluctuating then if you keep getting tested perhaps on a bad day you'll meet their criteria and get approval.
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You're right - I should mentally separate the Procedure from the IOL's themselves. The Symfony, however it works, would give me a grater "in-focus" range. I'm 6 days away from the having the first eye done with a +5 Tecnis Toric  and I don't think that a Toric Symfony is coming along anytime soon. In fact, if I understand the "diffractive" part of its function, I wonder if it's even a possibility.

I once considered having a non-FDA Approved Hip Resurfacing done in Belgium, back when I was in need of it. I ended up chickening out and limping around for another two yeas til the FDA approved the device here. If I thought that there was something better in the works in a matter of months, I would "limp along" for them as well.

My Cataracts are fairly mild. My biggest, most threatening t visual issue is my Macular Hole. I had an OCT scan done yesterday, and I was actually giddy to learn that it has not increased in size since October. Since the vitrectomy procedure for Macular Hole just about guarantees a cataract, and the surgeon's view is improved by having the clearest possible lens to see thru. I hate to remove my crystalline lens, just to prep for another, later Retinal surgery. But I see no way around it. Pun intended.
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I'm guessing you mean the lens power is +5 (rather low) and a monofocal, rather than that being the add for a bifocal. Hopefully if you are that myopic they got the lens power right, since it isn't an exact formula but is instead based on statistics and for various reasons is more likely to be off for high myopes, as this page explains (somewhat technical):

http://www.doctor-hill.com/iol-main/extreme_axial_myopia.htm

That doctor apparently will consult for other surgeons on lens power choices in unusual cases.

Actually there is a toric version of the Symfony out now, with comparable results. Regardless the estimates I've seen suggest it won't be FDA approved until perhaps 2017, though as I said there are clinics in Canada that expect it to be available there within 1-2 months. Most multifocal lenses use diffractive optics, and many have toric versions.

btw, for those who are considering a monofocal, the Symfony is (or soon will be) in clinical trials in the US but it is randomized with a monofocal so you have a 50-50 shot. Unfortunately such trials usually exclude those with other eye conditions so that wouldn't be an option in your case, and I also don't know if it includes the toric version.

For those using a monofocal where it may be hard to get the lens power right, if the astigmatism is low, one option is the light adjustable lens (not yet available here either) which lets the fine tune the lens power after implantation (though the astigmatism has to be fairly low I seem to recall, but I hadn't checked lately).  The light adjustable lens is available from a prominent surgeon in Mexico, Dr. Chayet, who is just over the border from San Diego (I think there are posts on this site from at least one person who went there).

. Outside the US there are a number of other lens choices in addition to the Symfony like trifocals (which also have reduced halos&glare) and even lower add bifocals like Lentis +1.5D and +2D.

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They are actually studying using an extended depth of focus pattern for the Light Adjustable Lens, an article from January mentions these are the results from Dr. Chayet, whose Mexican clinic   is walking distance from the US border in California:

http://reviewofophthalmology.com/content/i/3110/c/52313/
"In a study of binocular vision results in 20 ABV patients at Dr. Chayet’s practice, 75 percent could see 20/16 or better at distance after lock-in. Eighty-five percent now see 20/20 or better and 100 percent see 20/32 or better. In terms of binocular intermediate vision at 60 cm, 60 percent see J1+ versus zero patients preop, 75 percent see J1 versus 20 percent at this level preop and 100 percent see J2 or better compared to 45 percent preop. Ninety percent see J2 or better binocularly at near (40 cm) versus 15 percent preop. Fifty-five percent now see at least J1, compared to 5 percent who could see that well preop. "
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Thanks again, SD. Yes, i am very myopic. My surgeon uses a system called ORA that allows the surgeon to have a final check on calcs of power and sphere, during the procedure.

www.myalcon.com/products/surgical/ora-system/index.shtml

At least thats what Ive surmised. Reading is kinda tough just now.

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The intraoperative measurements are an area which are still under debate among surgeons, just like with laser surgery.

http://bmctoday.net/crstodayeurope/2014/09/article.asp?f=pointcounterpoint-does-intraoperative
"POINT/COUNTERPOINT: DOES INTRAOPERATIVE ABERROMETRY MATTER?
Point: For those who consider themselves refractive cataract surgeons, this technology helps to nail the target refraction.
By Stephen G. Slade, MD; and Jonathan H. Talamo, MD
Counterpoint: Intraoperative aberrometry is not yet the best answer to guide the surgical refractive plan in cataract surgery. "

http://bmctoday.net/crstodayeurope/2013/03/article.asp?f=pointcounterpoint-is-intraoperative-aberrometry-worth-the-investment
"Point/Counterpoint: Is Intraoperative Aberrometry Worth the Investment?
Surgeons weigh in on the value of this technology in cataract surgery."

The issue is that the eye's state during surgery differs and the measurements some suspect are misleading. Since the results are based on statistical analysis of data (i.e. based on the out come they can compute what would have worked for a particular set of measurements) I would suspect that due to fewer highly myopic people that it might take longer before their results to be good (or perhaps not, if the glitches with myopic eyes turn out to be due to measurement errors which don't apply).

I don't know if the light adjustable lens might something to consider then since it provides extended depth of focus and astigmatism correction (though I don't know for sure if it'll do both at the same time), though its still in trials, there are some reports of patients on this site doing it.

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Well, I have all but given up hope that my Macular Hole would spontaneously close - it's been 10 months since first diagnosis. Now four days to go til cataract surgery. Done by a surgeon that has done thousands of procedure without lasers, and now thousands with. Fairly well settled (committed?) with Tecnis Toric IOL, Catalys femtosecond procedure, with ORA system.  This is based on my research. I am always ready to listen to alternate viewpoints. Pretty settled on a -1.00 correction, which I understand to mean a near point focus of 10 feet. So I'll wear glasses for driving, and different glasses for computer/close work. Maybe, at some point, a single pair of progressive glasses.

Given my high myopia, long eyeball, mild astigmatism, macular hole, and history of retinal detachment, I'm just hoping that I've minimized all the risks that I can. Having just typed all that, I feel lucky to be seeing as well as I am. Retinal Doc says that he can proceed with vitrectomy about 4-5 weeks after cataract surgery.

Most interestingly, my Retinal Doc tells me that he has had cases where Cataract Surgery has triggered a closure of an existing Macular Hole! My own research confirms this, and also that it may trigger a new one!
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Sending best wishes and healing vibes your way.  
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Thanks!
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A bit of a setback. Last Monday evening, I developed a pretty large sty, so Surgery is off for this week. I saw a doc on Tuesday and got some antibiotic/steroidal ointment, and this plus the warm compresses are bringing down the inflammation and swelling. However, I want to be damn sure that this issue is well behind us prior to Surgery. Does anyone have any experience with this issue, before or after Surgery? I'm now 6 days prior to the next surgery date, and the sty is smaller, but still there.

Any replies would be appreciated.
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My optometrist tried all sorts of lenses and astigmatism adjustments, and I tried different color filters, but none really change my visual distance readability in terms of contrast, glare, or clarity.  Interestingly, today's Snellen chart test showed between 20/30 and 20/40.  The optometrist indicated that there is no standard of contrast calibration on the test image and this is one reason it may differ from office to office.  Nevertheless, I still have trouble discerning the road sign text until within 200-500 feet (depending on the sign letter size), especially when you are moving. As with the university eye clinic, he said the cataract was very mild and doing the surgery at this time would not be advised. At some point, I imagine, I will do the membrane removal and cataract to hopefully achieve the vision I had 3-4 years ago.  I have a followup in 4 months with the retina specialist, and await to see if things get worse (or better!).
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My aunt developed a kind of skin condition around her eyes - kind of like white spots..permanant. Not sure if they were related to the surgery.
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I've discovered that I have blepharitis, and possibly MGD as well. So, surgery is postponed until I have healthy eyes, eyelids, tear glands and tear ducts. .

It makes me shudder to realize that my surgeon did not carefully examine my eyes and eyelids during my initial visit. This may not be a big deal to the outcome of the cataract surgery. But, treating blepharitis and/or MGD is much trickier after a cataract surgery - until it is fully healed.

Ultimately, our eyes do not see well without a steady supply of healthy tears - and dry eyes are a very common after effect of cataract surgery.
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re: "This may not be a big deal to the outcome of the cataract surgery"

The rate of postop infection is very low these days so usually blepharitis doesn't impact the outcome so I guess many surgeons will go ahead anyway if the cataract is causing trouble. However apparently since some blepharitis is caused by an infection it can be a risk factor for postop infection. I just grabbed some quick links mentioning it. I don't know if they simply consider it a low risk so they don't worry about it, but it is common:

http://www.healio.com/optometry/cataract-surgery/news/print/primary-care-optometry-news/%7B367caee5-3e70-4bf5-98db-9739c885db58%7D/treat-blepharitis-preoperatively-for-optimal-cataract-surgery-results
"November 2010
A poster presented at the annual American Society for Cataract and Refractive Surgery Symposium on Cataract, IOL and Refractive Surgery earlier this year showed that 60% of patients scheduled for cataract surgery have blepharitis. Considering the prevalence in this patient population, Katherine Mastrota, OD, suggests a careful preoperative evaluation.

'In any surgery, most ocular infection is from the skin’s surface,' Dr. Mastrota said in an interview. 'When you have high bacterial counts on the lids and lashes, the bacteria can invade the small wound. You want to prepare the patient for a successful surgery by having an optimum ocular surface and being sure the area around the eye is clean.'  "

http://crstoday.com/2009/05/CRST0509_14.php/
"THE ENDOPHTHALMITIS LINK
Anterior and posterior blepharitis has often been considered a nuisance rather than a serious medical problem. As our understanding of the condition grows, however, it is becoming apparent that blepharitis is more than an annoyance. In isolated cases, it can lead to permanent scarring of the lid margins and other significant problems. Some of the sequelae include common chalazion or internal hordeolum, dry eyes, punctate keratitis, phlyctenular or pannus formation, corneal ulceration, and most dramatically, endophthalmitis.3 "

http://cdn.intechopen.com/pdfs-wm/42715.pdf
"Case reports have described possibly inadequately treated blepharitis and rosacea associated with cases of endophthalmitis despite the use of good surgical technique."

http://cdn.intechopen.com/pdfs-wm/42723.pdf
"Blepharitis, vitreous loss and wound leak are major potential preoperative, intraoperative and postoperative risk factors for endophthalmitis."


re: "did not carefully examine my eyes and eyelids during my initial visit."

It is important to consider that before surgery, however I don't know what the context of that visit was, it may be the sort of thing they only do immediately preop. Often people wind up at an MD (referred to by an optometrist) regarding a specific issue like diagnosing a visual glitch and discovering it is a cataract and therefore that specific issue is  what the surgeon addresses rather than other issues a non-surgeon usually deals with. Also many people have slowly developing cataracts and wait a long time before surgery, so a surgeon who doesn't know that surgery is imminent may not bother looking at factors that may change before then (figuring some non-surgeon is dealing with them).
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Thought I'd post my experience here.  53 years old.  Hard contact lens wearer for over 30 years.  Cataracts diagnosed at the end of January.  I was getting deterioration of my vision in the right eye, and increased presbyopia (about normal for my age, probably).  Optometrist recommended cataract surgery and made a referral to the ophthalmologist.  Said I might not need contacts or glasses anymore after the surgery.  I had no idea they could do this.

Ophthalmologist confirmed I was an appropriate candidate for cataract surgery.  Scheduled the surgery, along with several pre-op appointments for measurements.  Everything went fine.  Selection of lenses was an issue.  They offered the Alcon standard, multifocal or toric.  I have strabismus (eyes don't focus together) and decided I wanted at least one multifocal.  Right eye had low astigmatism (about 1.00) which doctor thought would be fine untreated.  So they did the right first with a multifocal.  For about the first 24 hours I was worried but both the near and far vision cleared up within a couple days to the point I was pretty amazed.

Selection of lens for the 2nd eye was difficult.  Astigmatism of 1.76 needed to be dealt with.  So the choice was the toric lens, or I could do another multifocal with the surgeon doing LRI (limbal relaxing incisions).  She was confident she could adequately deal with the astigmatism either way.  I decided to go with the toric because my priority was to get the best distance vision and I already had the ability to read a computer monitor, a cell phone, and labels with the multifocal on the right.

I am pretty amazed by the result.  Both eyes tested at 20/20 after the surgery.  Before the surgery my better eye was 20/150.  I can read a smartphone and a computer monitor easily with the right eye multifocal lens.  Absolutely no need for reading glasses.  The right is very good for distance also, but the left is even better.  The contrast is a bit better and there is a bit less glare from lights.  I was worried that the toric without the multifocal would have such bad up-close vision that it would be distracting, but that has not been the case.  I can read the time on my digital watch with that eye.  I can read my computer monitor also, although if I had to depend on that eye for reading I would use reading glasses.

I hope this is helpful to someone.  If anyone has questions, please feel free to post.
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Hi

Which toric and multifocal lens did you use? Tecnis or another brand?

Where did you have surgery?
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They are the Alcon AcrySof lenses.  I am in Madison, Wisconsin.
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Thanks for this thread. It's been very helpful.

I'm 47 and have congenital cataract in both eyes and high myopia as well. Up until the last year and a half, my corrected vision was enough to be 20/40 in at least the right eye but in this past year and a half, I've noticed I'm not seeing nearly as well. Seems the usual cataracts that form at age is progressing and after yesterday's visit, cataract surgery has been scheduled for the left eye (worse eye) in late July with the right 3 weeks later. My initial decision was to go for near distance IOL since I sit in front of computer 12+ hours a day but I'm having 2nd thoughts. I don't care if I'd need to use reading or progressive glasses if they'd allow me to still see what I'm doing at the keys (programming, IT work, 2D/3D CGI, etc) and have clear distance vision without glasses. I'm concerned near focus might make it so I don't see things beyond arm's distance well enough (faces, tv, etc which I don't make out too well now anyway). I also don't know how well distance vision would be with a post-op prescription vs had I gone distance in the first place.

So much to research. So much bouncing in my head. I'm concerned I might make the wrong choice. My pre-op is at the end of June so I have time. Just a bit stressful. :)

My thanks to all that have contributed to this thread. I welcome any advice and information.
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like you, my job requires a lot of reading and computer work.  I chose close and intermediate IOLs.  I also wear progressive glasses which give me clear vision at all distances.  If you opt for distance IOLs, you would need glasses for all close vision, not just when you are at the computer -- think shopping, seeing your phone, etc.  Perhaps you can experiment with contacts before you have to decide.  Best wishes.
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Thank you for the info. I know I'm getting lost and confused. I really don't know what the expectations are post-op with any of the choices compared to how bad I see now or have seen most of my life. I don't now how well I'll see w/ glasses distance wise if I go near/near. Or how well I'd see with readers and close work/computing if I chose distance/distance. Would it be good enough or will I be frustrated with that choice. Or any choice.

I do see it common both here and from an uncle that had one eye done that many miss near when they've gone distance/distance. I don't know if that means glasses don't help them in that case or just a frustration to have to use different strengths depending on what they're doing.

It has been great to see other's experiences as found in this thread. I just hope between my ophthalmologist and I, the right decision is made and I can compute, drive, watch tv and do everything else I normally do and see it all better than what I am now. :)
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Perhaps this article will shed some light
http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You

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re: "I don't know if that means glasses don't help them in that case or just a frustration to have to use different strengths depending on what they're doing."

It is most likely merely a case of frustration since those with an IOL of any kind but with no  other eye problems should be able to use correction to get good vision at whatever distance they need.  I don't know if before the cataract hit you had already needed reading glasses to get a sense of what that is like, or if you managed to avoid it (usually by your age you would have had to deal with that, but not always).

re: "distance vision would be with a post-op prescription vs had I gone distance in the first place"

Overall the corrected distance vision with a near focused IOL should be comparable to vision with an IOL corrected for distance. Obviously if you are a high myope you are used to glasses and perhaps contacts. The corrective lenses don't make that much of a difference in terms of visual quality, its mostly an issue of comfort and convenience (and with glasses the usual tradeoffs you are used to like any anti-reflective coatings, etc).  
    
You don't mention what IOLs you are considering, or whether you are considering monovision (adjusting one eye for near).

It sounds like your vision may be too degraded to get a good sense of what an IOL targeted at a certain distance  is like by using contacts. Otherwise CBCT had a good suggestion to try contact lenses to correct you to whatever target distance you might wish to try out .  If  you can't do even 20/40 in one eye,  I don't know if it would  give you a good enough  idea of what 20/20 vision at that distance would be like (since unless you have other eye issues you should be able to get 20/20 or better with an IOL). Most eye doctors can give you trial soft disposable lenses. If you were going to try that, you might consider going  to an optometrist for that rather than the eye surgeon since they are usually more focused on surgery and medical issues than on trials of different contacts.

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In my case, with congenital cataracts, I've been wearing thick glasses all my life and do have a contact prescription I wear when driving. So either way, either near/near or distance/distance, I'm OK with glasses.

I need to call my ophthalmologist and ask some questions as this past Friday was a blur once he mentioned how I'd like to see and between him, another doctor and myself, seemed arms distance focus would be good. A quick check for astigmatism was enough for them to rule out the need for toric so my guess is they're going with monofocal. Wasn't much discussion mostly because I did I know any questions to ask at the time. This visit surprised me.

It usually takes 3 weeks to get a contact prescription filled with my prescription so that rules out trying monovision. But then I feel I sort of have that going on now with my left eye being so bad compared to the right.

I've got time. The pre-op measurements and consulting is in late June and then late July for the left eye. You and CBCT have given me some piece of mind, wonderful advice and this thread has given me a slew of questions I can ask. I feel far more informed, some anxiety lifting and look forward to perhaps seeing better than I have ever seen since birth.
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re: "It usually takes 3 weeks to get a contact prescription "

Your profile indicates you are in the US, at least in Colorado most optometrists keep a supply of disposable soft lenses for trials in their office. Mine kept trial lenses up through -10, the odds are low you are more myopic than that. If your usual doctor doesn't, perhaps just pick a doctor at a large chain (.e.g one with an office at a Walmart or something) and due to high patient volume they are likely to have trials.  Had you tried multifocal contact lenses?

I'm not sure if I have your preferences right, but it sounds like you wish to have good computer vision, and that close-in reading distance, and driving distance, are less important.  If you are going with a monofocal,  if you are having one eye set at arms length to handle the computer well, you might consider setting the other at perhaps 2 meters out for a slight bit of monovision to give you good vision at social and household distances, in meetings and getting around  home/office, TV, etc. (I'm guessing those would be focused at like 1.25D-1.5D myopic for computer distance, and 0.5D myopic for 2 meters out).  I don't know if reading a smartphone is also a factor for you. I'd posted earlier on this page I think a link to a chart&formula for converting distances to diopters:

https://www.slackbooks.com/excerpts/67956_3.pdf

I would suggest you  consider whether you might want the Crystalens or a multifocal (  in my case I preferred to go abroad to get the Symfony).

I will add one additional approach to consider if you do go for a monofocal. There are new techniques for giving presbyopic people more near vision if their eyes are adjusted to distance. They  have also been tested on patients with monofocal IOLs. They have just approved the Kamra corneal  inlay in the US, and the Raindrop corneal  inlay is in wide use outside the US and is working on getting FDA approval (and may have less reduction in contrast sensitivity since they will implant it in 2 eyes if desired, whereas the Kamra usually just goes in 1). Those are lenses inserted in the front of the eye, which can be removed if they don't work well. In that case you would get your eyes set to distance, and use glasses/contacts for closer in, until you got an inlay in the future.
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Regarding Crystalens -- I would not recommend them.  I had them implanted in both eyes.  The surgeries were one week apart.   Accommodation was minimal and I had very severe positive dysphotopsia and light sensitivity.  A year later I had both lenses exchanged for monofocal lenses and I am much happier.  Good luck with your decision.
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My current contact prescription is -11 left, -12.50 right. That, at best, gets me 20/40 in the right eye. Due to where the congenital cataract is in the left eye, I don't see anything clear with it regardless of strength. Just got by with what I could.

I may be getting confused with the options, the pros/cons of each and which would be right for me with most activities I do now and the future. I do compute more than anything else so, initially, the thought of seeing that most clearly at arm's length seemed good. But now I think some answers to some questions first so I scheduled some consulting time.

Thanks again for the info.



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I should probably create another thread vs hijacking this one so to speak.

Another visit with the ophthalmologist this past Friday. Still targeting intermediate/intermediate via monofocal IOLs. When I asked for IOL details, they claimed they won't know for sure until the day of surgery with ORA  used after lens extraction. I know they attempted to use one machine to do some eye measurements that was hampered by the congenital cataracts and go in again this week where another machine will be used.

I'm having doubts on going intermediate vs distance. The decision on intermediate was based on my lifestyle (12+ hours per day computing and low driving working from home). But I wonder if targeting distance and wearing glasses for computing/near is a better option. They discussed mono-vision options as well (like the suggestion w/ the right eye 2 meters out) and they seemed to think that decision could be made after the left eye was done and how I respond/like the corrected eye.  

I also plan on drilling them on IOL details. I still have time. Just want to make sure I'm making the right choices in a land of confusion. :) Can't thank SoftwareDeveloper & CBCT for the info and insights.
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re: "But I wonder if targeting distance and wearing glasses for computing/near is a better option."

Its all personal choice, what is best varies for each person. It  depends on how much you'd like to get rid of correction and when (and since you are a high myope, the risk that they may be slightly off in the lens power since it isn't an exact thing, even with ORA which some are skeptical will do better, so you may need to rethink the 2nd eye after the first is done).

The nice thing about having good intermediate vision is (depending on the exact range you target) that in addition to being on the computer, its useful for most household tasks, social distance at a meal or meeting, and TV (depending on distance). After having been a high myope and needing correction all my life, its nice to not need glasses/contacts around the house. Though I went with the Symfony to get a larger range, most of my vision tasks are in the intermediate range so I appreciate that aspect the most.

However in your case with monofocals to target that,  you may  need both distance glasses, and reading glasses for anything near. If  you do target distance, you can then get one pair of  progressive glasses to help with intermediate&near both, but are going to be wearing them more often.
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Best wishes!
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Lots of excellent information here, I will be copying for reference. Please tell us about your Symfony experience?
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A little background, I enjoyed good vision all my life without glasses until my 40's when presbyopia set in...went to progressively stronger readers to the point where I was wearing +1.25 for driving, +2.25 for intermediate, and doubling them up for near. In the past 6 mos the left eye developed cataracts so I met with the surgeon today. I have healthy eyes and negligible astigmatism, so from my research, I thought the crystalens might be right for me. When it came to q&a, I quickly learned  he no longer implants CL, says he doesn't think they work, and all he does is monofocal or Restor, in fact he ran a clinical trial for restor in the past. I hadn't researched restor and was ill prepared to discuss them.

My objective is good far vision (driving w/out glasses), and good intermediate (computer, smart phone), I'd be ecstatic if I could accomplish this and only need readers for near...not sure how best to accomplish this yet, a second opinion will be next. Problem is, most of the forum discussion on iol's seems to be from myop's, Would love to learn more from some hyperop's experience....? With readers, I'm more comfortable undercorrected, as soon as I approach overcorrection, it gets uncomfortable.

Thanks for all the great info shared here.
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I highly encourage you to experiment with trial lenses and then contact lenses that simulate your proposed outcome.  That way you will be able to determine your tolerance for monovision or mini monovision. Best wishes.
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ty, I will be discussing this with my surgeon on Thursday
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re: "and only need readers for near"

The older multifocals were bifocals with  adds that targeted near and had lower quality intermediate vision. Just this year the US has approved lower add multifocals from both Tecnis and Alcon that do a better job of intermediate vision, while still leaving decent near with just a small chance of needing readers.  The Symfony (if you go outside the US) is a better bet for excellent distance&intermediate with a slight chance of needing readers for near. Trifocals (not available in the US)  give good vision at all three ranges, with perhaps not quite as good intermediate as the Symfony but very near might be better. There are a few models of trifocal, the Zeiss AT Lisa Tri and the Finevision trifocal are the most common (generally rated as being comparable, with some sources giving one or the other a slight edge in different ways depending on the patient), with major vendor Alcon just having gotten approval a few weeks ago for the Panoptix trifocal that I haven't seen any data on yet to see how it compares.


re: "Please tell us about your Symfony experience?"

I've already posted about that in perhaps too much detail in a thread here:

http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258

Your profile indicates you are in the US (which hasn't yet approved the Symfony). If you aren't going to go outside the US, there is a thread here by someone who received the new Tecnis +2.75D lens:

http://www.medhelp.org/posts/Eye-Care/Tecnis-275D-MF-IOL-Experience/show/2597910

He is one  of the rare people bothered by halos with the low add lens (which can happen even with a monofocal) but they may go away with time, often they disappear in the first few months for those who have them initially. Although the Tecnis lenses seem to be better in certain ways than the AcrySof Restor lenses (less chromatic aberration for instance) I just recently saw a video indicating that the new Acrysof +2.5D low add lens has a different design than the Acrysof +3D lens and isn't merely a different lens power:

http://www.healio.com/ophthalmology/refractive-surgery/news/online/%7B543dce4e-252f-4ad9-821d-30961b045e35%7D/video-speaker-discusses-acrysof-iq-restor-25-iol
" VIDEO: Speaker discusses AcrySof IQ ReSTOR 2.5 IOL"

Halos may be less of an issue with that design than with the +3. That video shows   simulated halos, but unfortunately the only Tecnis lens they show   is the +4 and not the low add Tecnis lenses. That is the only simulation of halos I recall seeing comparing the Restor and Tecnis showing the sort of difference I see there (though it may be I hadn't paid enough attention to the halo descriptions of those lenses  in the past, I think its more that they usually aren't shown).
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I'm having cataract surgery this coming Thursday with Toric implant in my right eye and will have the left eye done probably within one month.  I'd like to hear more experiences with toric lenses.  I work in accounting and have been very near-sighted all my life.  I'm having my vision set to distance, so I'm hoping my vision with reading glasses will be good. Otherwise, I guess there could be trouble.

Thx,

Nancy
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It's been a little over a week since cataract surgery on my left eye. The target distance was less than I had figured which I would classify as more near than intermediate. I guess I was figuring more on my "arm's length" vs normal. :) They were targeting 18" and nearly got that. Last week's follow-up had me seeing 20/25-20/30 with correction which is better than this eye has  ever been my entire life with a best correction of 20/70. I'm pretty happy with the results as are the doctors involved. I can sit much further back than 4-6" away from the monitor. I can also see the dashboard & center console in my car again.

The right eye is scheduled in another two weeks and they're going to try and target a little further out.  I could tell the wheels were turning in the doc's mind when he mentioned my right eye had a bit of a cone shape to it so the capsulorhexis will be a little more challenging.

The only complications were from anesthesia. I was put fully under and coming out of it had me groggy for a bit. Other than that, I don't know why I was worrying so much about and I'm REALLY looking forward to the right eye getting done!
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I had the lenses replaced in both eyes ten days ago
My distance is great I can also read a news paper and the very small print on the back of my eye drop bottles
My vision is better than it was when I was a teenager

I was awake throughout the op which lasted just over an hour
I could see everything that was going on but no pain
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