toric IOL: choose near or distance vision

I'm facing cataract surgery and my trusted experienced
opthalmologist asked if I wanted near or far vision as the outcome.
This is an agonizing choice and I'd like your opinion.
All my life I've been nearsighted (with bad astigmatism doc says
won't be eliminated completely by IOL).
I can see pretty well unaided at a distance of about 6 inches and
am afraid to lose this vision. But everyone says life after surgery
will be better overall.
Should I pick near vision so I can read, apply makeup, see
computer? Or should I pick distance vision to drive, see TV, watch
people across the street? I realize glasses (or cheap readers) will
be needed to get the opposite vision of whichever I pick, and no
outcome is 100% predictable.
For those of you who've actually picked one or the other, what
were the surprises afterward? For you with medical expertise, what
was the general choice of most folks and what are their regrets
afterward?

Details: I'm mid fifties, retired computer person, cataracts for about
8 years, now using toric contacts for monovision (not fond of mono).
Will get toric IOL with LRI. Not worried about surgery, just the
choice of outcome.

last glasses RX was
R= -8.00 sph, +2.75 cyl, 85 axis
L= -7.5 sph, +1.50 cyl, 80 axis

Dear Silviaelli,

Subject: No one can tell you what you should do.

I had cataract surgery. The man was excellent, and the results good.

I chose "far" vision, since I did not have clear distant vision since
I was eight years old.

The result is that I have 20/20 vision in each eye. I check this
myself.

Further, using my own trial-lens kit, I have a refractive STATE of
+1/2 diopter.

In "normal" words -- this is a perect result -- exactly as I wished
it to be.

Further, I am typing this into my coputer (and reading it) with no
lens
on my face. (Measured distance is 25 inches.)

But, as a matter of choice, and scientific interest, I am wearing
a +2.75 diopter lens for all work less than 25 inches.

This is far better than wearing a minus lens 16 hours a day
seven days a week.

If I do no "close work", then no glasses at all.

Further, I play tennis, and it is great not to have those
negative lenses on my face.

So that was MY choice -- and I was lucky about the result.

Good luck to you,

Otis






On Oct 22, 3:19*pm, silvere2 <sylviaelli...@mac.com> wrote:
> * *I'm facing cataract surgery and my trusted experienced
> opthalmologist asked if I wanted near or far vision as the outcome.
> This is an agonizing choice and I'd like your opinion.
> * *All my life I've been nearsighted (with bad astigmatism doc says
> won't be eliminated completely by IOL).
> * *I can see pretty well unaided at a distance of about 6 inches and
> am afraid to lose this vision. But everyone says life after surgery
> will be better overall.
> * *Should I pick near vision so I can read, apply makeup, see
> computer? *Or should I pick distance vision to drive, see TV, watch
> people across the street? *I realize glasses (or cheap readers) will
> be needed to get the opposite vision of whichever I pick, and no
> outcome is 100% predictable.
> * * For those of you who've actually picked one or the other, what
> were the surprises afterward? *For you with medical expertise, what
> was the general choice of most folks and what are their regrets
> afterward?
>
> Details: I'm mid fifties, retired computer person, cataracts for about
> 8 years, now using toric contacts for monovision (not fond of mono).
> Will get toric IOL with LRI. Not worried about surgery, just the
> choice of outcome.
>
> last glasses RX was
> R= -8.00 sph, +2.75 cyl, 85 axis
> L= *-7.5 * sph, +1.50 cyl, 80 axis

Geez, I would take either one! As my farsightedness progresses, I can
barely see to run without glasses.

Personally I would go with good distance vision. Seems easier to have
reading glasses than driving glasses.

Is splitting it an option? My son has terrible vision in both eyes, but one
is far and the other near; until he had them tested he didn't know he had a
problem.

In article
<e9335c23-f498-4da0-aa14-(E-Mail Removed)>,
silvere2 <(E-Mail Removed)> wrote:

> I'm facing cataract surgery and my trusted experienced
> opthalmologist asked if I wanted near or far vision as the outcome.
> This is an agonizing choice and I'd like your opinion.
> All my life I've been nearsighted (with bad astigmatism doc says
> won't be eliminated completely by IOL).

I was nearsighted almost all my life. I chose distance vision when I
had cataract surgery in both eyes. I have been very happy with it. I
can get out of bed and see.

It depends some on your lifestyle. If you like being outdoors, there
are problems with fogging and mist with glasses. If you need glasses
indoors, fogging and misting shouldn't be a problem.


> I can see pretty well unaided at a distance of about 6 inches and
> am afraid to lose this vision. But everyone says life after surgery
> will be better overall.

Once in a blue moon I miss the extreme close vision, but I just keep a
variety of reading glasses around. One pair lets me see pretty closely.

> Should I pick near vision so I can read,

Once in a while I find myself somewhere away from home and unable to
easily read because I didn't bring glasses. Doesn't happen often, and I
keep spare reading glasses in my vehicles.

> apply makeup

Don't wear makeup, but wearing glasses sounds like a problem.

> see computer?

You will lose all of your focusing ability when the cataract is removed.
This means that you will probably need different glasses for computer
use than reading. This isn't true for everyone, but you should expect
it.

> Or should I pick distance vision to drive, see TV, watch
> people across the street? I realize glasses (or cheap readers) will
> be needed to get the opposite vision of whichever I pick, and no
> outcome is 100% predictable.

Maybe it's not a big deal for you, but distance glasses are *always*
prescription, and reading glasses in your case will normally be OTC.
You can afford to have multiple reading glasses. If you choose near
vision suitable for reading, you may need both computer and driving
glasses (or bifocals, which most people find work poorly for computer
use).

> For those of you who've actually picked one or the other, what
> were the surprises afterward?

Not a big surprise, but the loss in color and sharpness came upon me
gradually, whereas after the surgery, it was all of a sudden back. That
was very pleasing. I had forgotten what grass and trees looked like.

> Details: I'm mid fifties, retired computer person, cataracts for about
> 8 years, now using toric contacts for monovision (not fond of mono).

That's a good thing to know in advance. Some people on this group have
said that they want monovision with their cataract surgery. If you
don't like that, you can choose not to do that.

> Will get toric IOL with LRI. Not worried about surgery, just the
> choice of outcome.

Be aware that if you don't have both eyes done at once, there will be
vision problems when wearing glasses. Contacts will be fine, so if you
get one eye done, just wear your regular contact in the other eye.
Frankly, I wouldn't want both eyes done at once, but that's just me.

--
Dan Abel
Petaluma, California USA
(E-Mail Removed)

Robert Martellaro wrote:

> silvere2 <(E-Mail Removed)> wrote:
>
>>I realize glasses (or cheap readers) will
>>be needed to get the opposite vision of whichever I pick, and no
>>outcome is 100% predictable.
>
> Don't use the "cheap readers" for anything more than spotting a phone number or
> other very short term tasks.

With all due respect, could you explain this comment? When I wear my
contacts (distance) I use cheap (99-Cent-Store, some with those nice
spring hinges) readers in various diopters depending on what I want to
do -- for hours at a time. It's easy enough to hold them up to straight
lines and see if an individual lens is wavy -- and I've never found one
that was, although cheap sunglasses used to be (decades ago) problematical.

--
Cheers, Bev
+++++++++++++++++++++++++++++++++++++++++++++++
"Genius may have its limitations, but stupidity
is not thus handicapped."
-- Elbert Hubbard, American author

In article <(E-Mail Removed)>,
Robert Martellaro <(E-Mail Removed)> wrote:

> On Thu, 23 Oct 2008 18:42:51 -0700, The Real Bev
> <bashley101+(E-Mail Removed)>
> wrote:
>
> >Robert Martellaro wrote:
> >
> >> silvere2 <(E-Mail Removed)> wrote:
> >>
> >>>I realize glasses (or cheap readers) will
> >>>be needed to get the opposite vision of whichever I pick, and no
> >>>outcome is 100% predictable.
> >>
> >> Don't use the "cheap readers" for anything more than spotting a phone
> >> number or
> >> other very short term tasks.
> >
> >With all due respect, could you explain this comment? When I wear my
> >contacts (distance) I use cheap (99-Cent-Store, some with those nice
> >spring hinges) readers in various diopters depending on what I want to
> >do -- for hours at a time.
>
> It's a good bet that the focal length will be equal for each eye if they're
> worn
> over CLs, although it's also a good bet that there will be unwanted prism and
> possibly some residual astigmatism.
>
> It gets worse if you don't wear CLs, with the addition of some disparity in
> lens
> power eye to eye, with the chance for uncorrected astigmatism increasing to
> likely, along with the aforementioned prismatic errors. It would be bordering
> on
> medical negligence to encourage the use of glasses that are the wrong
> prescription for our primary pair of glasses.
>
> It sounds like you can tolerate OTC readers, and can sustain this tolerance
> for
> long term tasks. Have you ever had Rx readers? Ask your doctor to do an "over
> refraction" and try a pair next time.

Some years back, during a routine exam, I asked my OD whether I should
get prescription readers. He did a few minutes of testing, and
recommended +2 OTC readers. He said that if I had any problems, to come
back and he would do more tests and prescribe glasses if he thought they
would be better. These were to wear over my contacts, -10D in the left
eye, and plano torics in the right, with 1.75D for astigmatism. He said
that my actual reading prescription was +1.75D and 2.25D, but didn't
think that would help much. I wasn't so sure, but with all I've read on
this group, about monovision without correction after cataract surgery,
perhaps he had a point (I had had cataract surgery in the right eye,
which is where the "plano" came from).

[Note: My OD wore OTC readers]

--
Dan Abel
Petaluma, California USA
(E-Mail Removed)

Robert Martellaro wrote:

> The Real Bev <bashley101+(E-Mail Removed)> wrote:
>>Robert Martellaro wrote:
>>> silvere2 <(E-Mail Removed)> wrote:
>>>
>>>>I realize glasses (or cheap readers) will
>>>>be needed to get the opposite vision of whichever I pick, and no
>>>>outcome is 100% predictable.
>>>
>>> Don't use the "cheap readers" for anything more than spotting a phone number or
>>> other very short term tasks.
>>
>>With all due respect, could you explain this comment? When I wear my
>>contacts (distance) I use cheap (99-Cent-Store, some with those nice
>>spring hinges) readers in various diopters depending on what I want to
>>do -- for hours at a time.
>
> It's a good bet that the focal length will be equal for each eye if they're worn
> over CLs, although it's also a good bet that there will be unwanted prism and
> possibly some residual astigmatism.

I've always had LOTS of residual astigmatism with my prescriptions
glasses and contact lenses no matter who has prescribed/made them.

> It gets worse if you don't wear CLs, with the addition of some disparity in lens
> power eye to eye, with the chance for uncorrected astigmatism increasing to
> likely, along with the aforementioned prismatic errors. It would be bordering on
> medical negligence to encourage the use of glasses that are the wrong
> prescription for our primary pair of glasses.

It seems like a person ought to be able to tell just by trying. It's
not like it costs a bundle, unlike prescription lenses.

> It sounds like you can tolerate OTC readers, and can sustain this tolerance for
> long term tasks. Have you ever had Rx readers? Ask your doctor to do an "over
> refraction" and try a pair next time.

It turns out I have a pair of bifocals like that, and they make nice
computer glasses. I don't want to drive with them, though.

My prescription glasses -- over the last 30 years -- have ALWAYS had a
2D difference between left and right lenses, and the distance in focus
has always been different. I now regard my left eye as pretty useless
at any distance for anything but providing 3D information because of
residual astigmatism and a foveomacular vitelliform dystrophy, which is
REALLY annoying. To even things out, I have floaters in my right eye :-(

--
Cheers, Bev
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