Aa
can you get convex-lens glasses that give more 'natural' vision?
A few months ago, I had cataract surgery, and chose monofocal IOLs (Tecnis silicone aspheric). Up until then I was myopic (about -5.5 in both eyes), and at 59 had lost most of my accommodation.
I love the outdoors, but I also love my computer, so the focus setting was a tough choice. Finally, I opted to have my vision set for distance, so as not to have to wear glasses for anything but close work. I thought there'd be no problem with the computer - I reasoned "Up till now I have to wear glasses for outdoors AND my computer, but now it'll be only for the computer. No problem".
Unfortunately, I now don't enjoy being on the computer nearly as much as I used to. Before, I never noticed my glasses when looking at the computer screen, because they were concave, and if I moved my head slightly, it didn't make the screen look unnatural (though of course, this may be partly because I've worn concave lenses all my adult life and am therefore used to them). But with glasses that have convex lenses, there is what I can only describe as a 'swimmy' effect when I move my head. It's like when you move a magnifying glass over a page of type - the page seems to hover and swim about.
I saw this effect with the off-the-shelf readers I bought just after the ops, and reasoned that it was proportional to the power of the lens, so when I got proper prescription glasses for my computer, I made sure they were as weak as possible, which of course means they focus further away. So now I have my computer screen at slightly more than arm's length, and my glasses are (I think) +1.25 dioptres. But I still get this swimmy effect.
So, I'd like to know if there is any way of minimising it. Would lenses made of highly refractive material help? Also, I've heard of lenses such as Zeiss i-script, that give far more control over the refraction in various parts of the lens itself - could they help?
If anyone has any other suggestions, I'd be grateful to hear them.
I love the outdoors, but I also love my computer, so the focus setting was a tough choice. Finally, I opted to have my vision set for distance, so as not to have to wear glasses for anything but close work. I thought there'd be no problem with the computer - I reasoned "Up till now I have to wear glasses for outdoors AND my computer, but now it'll be only for the computer. No problem".
Unfortunately, I now don't enjoy being on the computer nearly as much as I used to. Before, I never noticed my glasses when looking at the computer screen, because they were concave, and if I moved my head slightly, it didn't make the screen look unnatural (though of course, this may be partly because I've worn concave lenses all my adult life and am therefore used to them). But with glasses that have convex lenses, there is what I can only describe as a 'swimmy' effect when I move my head. It's like when you move a magnifying glass over a page of type - the page seems to hover and swim about.
I saw this effect with the off-the-shelf readers I bought just after the ops, and reasoned that it was proportional to the power of the lens, so when I got proper prescription glasses for my computer, I made sure they were as weak as possible, which of course means they focus further away. So now I have my computer screen at slightly more than arm's length, and my glasses are (I think) +1.25 dioptres. But I still get this swimmy effect.
So, I'd like to know if there is any way of minimising it. Would lenses made of highly refractive material help? Also, I've heard of lenses such as Zeiss i-script, that give far more control over the refraction in various parts of the lens itself - could they help?
If anyone has any other suggestions, I'd be grateful to hear them.
Luvtoski, I just reread your:
"it is more likely for those patients to end up a little more hyperopic because of the weakened zonules that hold the capsular sac, which holds our lens".
I wonder if the cataract surgeon took that into account for me, knowing I would be having the retinal surgery in a few months, and thinking that it would be better to under-correct now. I can see that, but still a +2 is more than a little under-correction.With spectacles, I am 20/25 in that eye, but the ERM caused size differential and distortion ,make it functionally much less. If he did indeed plan on that under-correction, he never mentioned it to me.
I have a very well respected and skilled cataract surgeon and glaucoma specialist, but sometimes I have to drill down to get the details. I think part of the problem is that some of us patients are more curious and do our homework more than others, and the doctors need to respond to many different levels of interest and understanding, and with a big patient base, it's hard to develop general answers that fit all situations, and sometimes things do get overlooked unless we persist.
"it is more likely for those patients to end up a little more hyperopic because of the weakened zonules that hold the capsular sac, which holds our lens".
I wonder if the cataract surgeon took that into account for me, knowing I would be having the retinal surgery in a few months, and thinking that it would be better to under-correct now. I can see that, but still a +2 is more than a little under-correction.With spectacles, I am 20/25 in that eye, but the ERM caused size differential and distortion ,make it functionally much less. If he did indeed plan on that under-correction, he never mentioned it to me.
I have a very well respected and skilled cataract surgeon and glaucoma specialist, but sometimes I have to drill down to get the details. I think part of the problem is that some of us patients are more curious and do our homework more than others, and the doctors need to respond to many different levels of interest and understanding, and with a big patient base, it's hard to develop general answers that fit all situations, and sometimes things do get overlooked unless we persist.
Another couple of comments regarding distance vs close choices.
It really depends on lifestyle. My job requires a tremendous amount of both computer work and detail work, and little distance work. If my primary job were outdoors, or if outdoor activity were important hobbies. then distance trumps near for sure. In my case. the answer was not so clear. As you mention, my entire life had been spent myopically (is that a word?), so I didn't know what to expect with the opposite after the implant procedure. Now, I don't know which I would choose, knowing what I do.
There are a couple of pluses to having the distance vision. It's much more pleasant being at the pool, or coaching Special Olympics basketball, as two examples, as (with the exception of one eye needing correction), I see relatively well in those situations without glasses. Another is that if I ever do lose my glasses, or break them, I can get by with a cheap pair of readers until they are fixed or replaced.
In any case, getting rid of the fuzz, green color tint, glare and decreased low light sensitivity were real pluses.
It really depends on lifestyle. My job requires a tremendous amount of both computer work and detail work, and little distance work. If my primary job were outdoors, or if outdoor activity were important hobbies. then distance trumps near for sure. In my case. the answer was not so clear. As you mention, my entire life had been spent myopically (is that a word?), so I didn't know what to expect with the opposite after the implant procedure. Now, I don't know which I would choose, knowing what I do.
There are a couple of pluses to having the distance vision. It's much more pleasant being at the pool, or coaching Special Olympics basketball, as two examples, as (with the exception of one eye needing correction), I see relatively well in those situations without glasses. Another is that if I ever do lose my glasses, or break them, I can get by with a cheap pair of readers until they are fixed or replaced.
In any case, getting rid of the fuzz, green color tint, glare and decreased low light sensitivity were real pluses.
I wish I had learned more, although most of what I have learned would not have applied to me. For example, the multi-focal or accommodating lenses were not mentioned to me. From my later research, I found that with my additional eye problems, they would most likely not been appropriate for me, but I wish I had known about them. I'm sure they were not mentioned as an option due to their inappropriateness in my situation.
Several other comments. Yes, the TOTAL loss of accommodation is in fact more of a problem than appreciated, as the eye can no longer compensate for minute changes in distance, hence the reasons a good spectacle lens, and appropriate IOL are important. I'm having real problems with my new progressive lenses - something that I did not have as a myopic individual with progressives.
Luvtoski, I wish I had your knowledge of optics. I am scheduled for an ERM peel and vitrectomy, and the cataracts were done first so the retinal surgeon would have a clear view of the retina. The problem I have now, is that the "good" eye is at plano with the implant. but the ERM eye requires +2 correction with implant. The surgeon says this is "within the margin of error" given the technology, and the ERM problem. I'm beginning to suspect that's not correct, and would value your opiion.
I've just been paged to an emergency - more later.
Several other comments. Yes, the TOTAL loss of accommodation is in fact more of a problem than appreciated, as the eye can no longer compensate for minute changes in distance, hence the reasons a good spectacle lens, and appropriate IOL are important. I'm having real problems with my new progressive lenses - something that I did not have as a myopic individual with progressives.
Luvtoski, I wish I had your knowledge of optics. I am scheduled for an ERM peel and vitrectomy, and the cataracts were done first so the retinal surgeon would have a clear view of the retina. The problem I have now, is that the "good" eye is at plano with the implant. but the ERM eye requires +2 correction with implant. The surgeon says this is "within the margin of error" given the technology, and the ERM problem. I'm beginning to suspect that's not correct, and would value your opiion.
I've just been paged to an emergency - more later.
Very good and thoughtful response. I would also like to add that it appears no matter what part of the country we live in, the problems with "lack of communication" between the Doctors and their patients is universal. Seems that the Doctors feel the less they tell us, the fewer questions we will ask, therefore the appointments will be shorter.
I went to 6 Cataract specialists before I decided on the one I wanted to do my Cataract surgery. Found out there was a tremendous difference in their "target opinions" anywhere from targeting a -1 diopter to targeting "distance".
Also, what I found out is that they don't volunteer the fact that each Dr. has a "margin of error" with actually hitting their target. I found that a .25 diopter margin of error in either direction was pretty common. Therefore, for instance, one should also factor the "worse case scenerio" in with their decision. So if I wanted to have a -1 diopter target but absolutely no more myopic than that...I might have considered more toward a -.75 ish target to allow for the margin of error in the myopic direction. Of course I would be just guessing that the "error" would be made in the myopic direction, but it is still something to consider.
Hope that I am not confusing things for everyone. I had previous ERM surgery on the cataract eye and read that it is more likely for those patients to end up a little more hyperopic because of the weakened zonules that hold the capsular sac, which holds our lens. Therefore, I factored in the worse case scenerio with potential margin of error in the hyperopic (+) direction and targeted a -.65. I ended up -.50 which gives me a bit of mini-monovision and really like it. (My good/untouched eye is a +1...but when I have that future cataract removed I will target "distance" on it) .
Anyways, I don't want to give too much unsolicited information but if anyone has any other questions I would be happy to try and answer. Information is empowering and helps prevent the "kick yourself later" issue. ;-)
I went to 6 Cataract specialists before I decided on the one I wanted to do my Cataract surgery. Found out there was a tremendous difference in their "target opinions" anywhere from targeting a -1 diopter to targeting "distance".
Also, what I found out is that they don't volunteer the fact that each Dr. has a "margin of error" with actually hitting their target. I found that a .25 diopter margin of error in either direction was pretty common. Therefore, for instance, one should also factor the "worse case scenerio" in with their decision. So if I wanted to have a -1 diopter target but absolutely no more myopic than that...I might have considered more toward a -.75 ish target to allow for the margin of error in the myopic direction. Of course I would be just guessing that the "error" would be made in the myopic direction, but it is still something to consider.
Hope that I am not confusing things for everyone. I had previous ERM surgery on the cataract eye and read that it is more likely for those patients to end up a little more hyperopic because of the weakened zonules that hold the capsular sac, which holds our lens. Therefore, I factored in the worse case scenerio with potential margin of error in the hyperopic (+) direction and targeted a -.65. I ended up -.50 which gives me a bit of mini-monovision and really like it. (My good/untouched eye is a +1...but when I have that future cataract removed I will target "distance" on it) .
Anyways, I don't want to give too much unsolicited information but if anyone has any other questions I would be happy to try and answer. Information is empowering and helps prevent the "kick yourself later" issue. ;-)
I've been wanting to reply to your post for a while, TrapperV, but haven't had the time until now.
As someone who is of a naturally obsessive nature, I've been thinking long and hard about this subject since I had my cataract ops done, and there are a few points I'd like to make:
1) You say that your choice might have been different if you'd been better informed beforehand. In a way, I feel the same - my eye surgeon didn't discuss the pros and cons, but just said "I want to incorporate your glasses into the IOL prescription" (ie: fix me for distance), and because it was what I wanted anyway, I didn't question him.
But the more I think about it, the more I think this was one decision I couldn't really have taken in a 'fully informed' way. What I mean is, with most decisions, you have to imagine experiencing the outcome of each route you take, then take the one that gives you the best experience. In the case of choosing how your vision is set, however, it's very difficult to really imagine the day-to-day experience of living with the result.
I came to my own decision as someone who'd had glasses for myopia since the age of 11 or 12. I never cared about how I looked with glasses, but I was always just a little bothered by the fact that I had to see the world with a frame around it. When confronted by a spectacular view I'd take my glasses off and imagine what it would be like that way - I used to think it would be like being in an Imax movie all day long. That was what drove my decision - the problems about near vision took a back seat. And that was all because I could not experience each outcome before taking the decision.
2) I think another problem is that you can't be prepared for what it's like to lose ALL your accommodation. At 59 I had very little left, and so I was convinced I wouldn't miss it, but now I realise there's a profound difference between 'next to no accommodation' and 'no accommodation at all'.
3) This leads from the previous point. No matter how your vision is set, it's a lousy compromise. Setting for distance means different glasses for both computer work and reading, setting for 'medium close' means glasses for distance and reading, and so on. And if you have a hobby that requires assembly of small components, etc, you could need three pairs of glasses, no matter how your vision is set. And that's all down to having no accommodation.
As someone who is of a naturally obsessive nature, I've been thinking long and hard about this subject since I had my cataract ops done, and there are a few points I'd like to make:
1) You say that your choice might have been different if you'd been better informed beforehand. In a way, I feel the same - my eye surgeon didn't discuss the pros and cons, but just said "I want to incorporate your glasses into the IOL prescription" (ie: fix me for distance), and because it was what I wanted anyway, I didn't question him.
But the more I think about it, the more I think this was one decision I couldn't really have taken in a 'fully informed' way. What I mean is, with most decisions, you have to imagine experiencing the outcome of each route you take, then take the one that gives you the best experience. In the case of choosing how your vision is set, however, it's very difficult to really imagine the day-to-day experience of living with the result.
I came to my own decision as someone who'd had glasses for myopia since the age of 11 or 12. I never cared about how I looked with glasses, but I was always just a little bothered by the fact that I had to see the world with a frame around it. When confronted by a spectacular view I'd take my glasses off and imagine what it would be like that way - I used to think it would be like being in an Imax movie all day long. That was what drove my decision - the problems about near vision took a back seat. And that was all because I could not experience each outcome before taking the decision.
2) I think another problem is that you can't be prepared for what it's like to lose ALL your accommodation. At 59 I had very little left, and so I was convinced I wouldn't miss it, but now I realise there's a profound difference between 'next to no accommodation' and 'no accommodation at all'.
3) This leads from the previous point. No matter how your vision is set, it's a lousy compromise. Setting for distance means different glasses for both computer work and reading, setting for 'medium close' means glasses for distance and reading, and so on. And if you have a hobby that requires assembly of small components, etc, you could need three pairs of glasses, no matter how your vision is set. And that's all down to having no accommodation.
I certainly wish more information like this was presented to patients prior to IOL placement other than "do you want to see far without glasses or close".
My decision might have been totally different. Check my posts for a discussion on this topic. They were made prior to getting glasses, but are still relevant to this discussion.
I keep finding more and more that it's we patients who have to do our own research rather than just accepting what our MDs say. Oftentimes, I guess they assume that since they know an answer, sometimes we should too by osmosis, and don't bother, or have time, to fully discuss things with us. No offense to Dr. Hagan :-) - it's a general statement and does not apply to all.
My decision might have been totally different. Check my posts for a discussion on this topic. They were made prior to getting glasses, but are still relevant to this discussion.
I keep finding more and more that it's we patients who have to do our own research rather than just accepting what our MDs say. Oftentimes, I guess they assume that since they know an answer, sometimes we should too by osmosis, and don't bother, or have time, to fully discuss things with us. No offense to Dr. Hagan :-) - it's a general statement and does not apply to all.
Thank you for your reply, Dr Hagan.
I went to Zeiss's own site and read a discussion with Lars Mendel, one of the people who helped develop iScript, and it isn't good news.
He was asked if this technology would help with close-focus glasses and he said, "Those who need glasses only for up-close applications are actually the exception to the rule. The principle of wave front auto-refraction has been design for viewing objects that are located at greater distances. Close-up applications are subject to different conditions."
So, it looks as though iScript lenses aren't the answer here.
I went to Zeiss's own site and read a discussion with Lars Mendel, one of the people who helped develop iScript, and it isn't good news.
He was asked if this technology would help with close-focus glasses and he said, "Those who need glasses only for up-close applications are actually the exception to the rule. The principle of wave front auto-refraction has been design for viewing objects that are located at greater distances. Close-up applications are subject to different conditions."
So, it looks as though iScript lenses aren't the answer here.
BTW, I'm not knocking Varilux in general. The ones I had for distance vision before the cataracts were exceptional - the absolute best lenses I had ever had. The clarity, detail and low aberration characteristics were top notch. I never had the Zeiss, so I can't directly compare them.
I have the exact same issue with the added "bonus" of progressive lenses, which make it worse by far. I have Varilux lenses, and the "swim" effect and off axis blurriness is much worse than off the shelf readers for me. I was highly myopic, and opted for distance IOLs, but have been really regretting it since having all these issues with medium and close vision. I also miss taking my glasses off and having phenomenal detail vision close up. On a positive note, the Varilux lenses are incredibly clear, but the convex lenses are a mess.
These lenses are going back, and I may end up with 2 pair instead. I do require some distance correction, as the IOL power is one eye is off the mark by a bunch. I believe the problem with my lenses is caused in part by having to have such a wide range of progression - or they just simply were made wrong. As I move my eyes side to side, sizes change, and things start slanting badly. Box shapes become non-parallel top to bottom, and sway from side to side with minor head movements.
Wish I had an answer. I wonder if the Zeiss lenses would be that much better, given the circumstances.
I'm going to check out Dr. Hagan;s article.
These lenses are going back, and I may end up with 2 pair instead. I do require some distance correction, as the IOL power is one eye is off the mark by a bunch. I believe the problem with my lenses is caused in part by having to have such a wide range of progression - or they just simply were made wrong. As I move my eyes side to side, sizes change, and things start slanting badly. Box shapes become non-parallel top to bottom, and sway from side to side with minor head movements.
Wish I had an answer. I wonder if the Zeiss lenses would be that much better, given the circumstances.
I'm going to check out Dr. Hagan;s article.
MEDICAL PROFESSIONAL
Wave front glasses such as Zeiss iScript represent the state of the art and are the type I personally wear. I have written medical articles on the subject which I is from Missouri Medicine medical journal. JHagan MD
“Grinding It Out: Wavefront Spectacle Lens in Clinical Practice”, Missouri Medicine 2011;108:292-295 (first literature report)
The entire article can be accessed by going to www.msma.org looking for Missouri Medicine under the "Communications " Tab and looking in past issue using that reference or likely you can pull it up using a internet search engine literature search.
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“Grinding It Out: Wavefront Spectacle Lens in Clinical Practice”, Missouri Medicine 2011;108:292-295 (first literature report)
The entire article can be accessed by going to www.msma.org looking for Missouri Medicine under the "Communications " Tab and looking in past issue using that reference or likely you can pull it up using a internet search engine literature search.
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