choice of near or far vision after surgery?

Discussion in 'Laser Eye Surgery' started by JR, Sep 6, 2006.

  1. JR

    JR Guest

    I've been nearsighted since I was about 11 years old. Now at age 54 I
    am having cataracts removed from both eyes. The doc says it's common
    for people who have been nearsighted all their lives to want an implant
    that leaves them a little nearsighted - they still need glasses to
    drive - but able to read without glasses. I'm not sure I want that. I
    think I want to see distances clearly and put on reading glasses. I am
    very nearsighted - i can't see the line below the "E" on the eye chart.
    Does that mean I really can't get an IOL that will give me good
    distance vision and the doc doesn't want to say that?
    What has been your experience? What did you choose and are you happy?
     
    JR, Sep 6, 2006
    #1
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  2. JR

    otisbrown Guest

    Dear JR,

    I will probably need cataract surgery. I am also "nearsighed".

    At "our age", you will get a choice -- clear distant vision (pass the
    DMV),
    or clear near vision -- as you state.

    The operation aims at a refractive STATE of zero -- and can "err" on
    either the plus of minus side. (Never perfect).

    You have a choice. If it were me, I would choose to pass the
    DMV (at 20/40 or better) and use a mild +1.5 to +2 for
    reading.

    But that is your choice.

    Good luck,

    Otis
     
    otisbrown, Sep 6, 2006
    #2
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  3. JR

    p.clarkii Guest

    thats really not very nearsighted. just moderately so.
    not in the least. it would be easy to get you good distance vision
    after cataract surgery with a much higher prescription than you
    apparently have.

    a caveat however is astigmatism-- that can gum things up a bit.
    although it can be improved during surgery it is hard to completely
    eliminate. how much of your refractive error is due to astigmatism?

    sounds like the surgeon is telling you straight-up. you have a choice
    at this time (i.e. before surgery) to choose the type of prescription
    that you want them to aim for-- there's no guarantee that you'll get it
    exactly but you can tell them now and they can include your request
    into the formulation of the implant power and most decent surgeons can
    get pretty close.

    patients are happy both ways. i would say most of my patients are
    happy at a refractive state of about zero in both eyes (=focused on
    distance, not nearsighted or farsighted) but some enjoy being slightly
    nearsighted (about -0.50 to -0.75 in both eyes). at that amount of
    nearsightedness you can still see pretty good far away without glasses
    (~20/30) and still see good enough to read briefly at near (newsprint,
    etc.). prolonged nearwork would require readers.

    another possibility is to get your dominant eye focused perfectly in
    the distance and then get your non-dominant eye slightly undercorrected
    (about -1.00D)-- that approach can allow you to "have your cake and eat
    it too" although you would still need readers for prolonged reading and
    for fine print.
    i am an eye doctor (optometrist) and have not had cataract surgery.
     
    p.clarkii, Sep 6, 2006
    #3
  4. JR

    Fidelis K Guest

    I had cataract sugrery about 4 weeks ago. I've been highly nearsighted all
    my life and chose to set my eye at 16 inches (-2.00D) because I didn't want
    to rely on reading glasses. With distance glasses, my distance vision is
    perfect for me. Actually, I can do most stuff without wearing distance
    glasses.

    I sometimes miss my old myopic vision, though. Before the surgery I could
    see things up close in amzing detail at 4-5 inches and that was great for me
    (e.g., seeing all those dots in a photo). But those days are gone. Probably,
    I'll buy a pair of reading glasses to turn back time.

    After all, the choice of the focal distance is totally up to you.
     
    Fidelis K, Sep 6, 2006
    #4
  5. I was nearsighted with astigmatism. In my first eye, we targeted -.50
    knowing that there is about + or - .50 error. Ended up with -1.00 with
    a little astigmatism. Just enough to read ordinary print. So we shot
    for -.25 on the other eye and ended up plano. So I have mild monovision
    and it's just fine. I still like glasses for various reasons, so wear
    progressives most of the time, but I can function without them. I'm
    happy and recommend this approach for anyone except those who might miss
    being myopic (i.e. want clear uncorrected vision in both eyes up close,
    and want to wear glasses for far vision only) and those who want to go
    without glasses at far and don't mind being totally dependent on reading
    glasses.

    w.stacy, o.d.
     
    William Stacy, Sep 6, 2006
    #5
  6. JR

    JR Guest

    My right eye is
    -575 -175 x175
    left is
    -650 -125 x020
    bifocal is
    +225

    Is it possible to correct that nearsightedness with the IOL?
     
    JR, Sep 6, 2006
    #6
  7. JR

    JR Guest

    And, that only corrects my vision to 20/60 (Don't tell the DMV) This is
    the best I can get until the cataracts come out.
     
    JR, Sep 6, 2006
    #7
  8. JR

    JR Guest

    I spend about half the day on the computer. Over the past couple years
    I've had to pull the monitor a little closer every month. I don't do
    any outdoor exercise, just a treadmill and weights while I watch TV.
    I used to read without glasses until I needed bifocals. Now I have to
    hold the book about 4 inches from my nose to see it.
    I posted my scrip in anothere message. It changed about -75 in the
    first number in both eyes over a period of 1 year.
     
    JR, Sep 6, 2006
    #8
  9. JR

    retinula Guest

    Certainly. Your myopia should be fully eliminated if you choose to go
    that route rather than leave yourself slightly myopic in 1 or both
    eyes.

    you have a significant amount of astigmatism. is the astigmatism due
    to corneal surface irregularity? we could tell by seeing the
    keratometry readings (look something like "OD: [email protected] [email protected]").
    residual astigmatism after cataract surgery can be an aggrevating
    source continued blur. ask your doctor about the source of your
    astigmatism, and whether he anticipates he can largely eliminate it
    during surgery.
     
    retinula, Sep 7, 2006
    #9
  10. That would certainly be true, but -4 is pretty strong blur at distance.
    I would suggest in your case, shooting for maybe -2, so you could not
    only see at a normal reading distance, but could see a computer monitor
    clearly without shoving your face into it. To be sure, I miss the
    ability to see a tiny temple screw without reaching for the readers, but
    really, it's a pretty small part of my life. Being able to get up and
    walk around the house in the mornings without putting on glasses is also
    kinda nice. Anyway, go for what you want.

    w.stacy, o.d.
     
    William Stacy, Sep 8, 2006
    #10
  11. One reason I don't care for your approach is the eye safety issue. You
    take your glasses off to work on something up close, and that something
    flys up and hits you in the eye, you can injure, even lose an eye. Just
    about the only activities I would consider doing without the eye
    protection offered by ordinary glasses are couch potatoing and swimming.

    w.stacy, o.d.
     
    William Stacy, Sep 8, 2006
    #11
  12. JR

    Dan Abel Guest

    I chose far vision. Since there is some uncertainty about how accurate
    the final vision will be, that's taking a chance. I got lucky and the
    doctors got it perfect in both eyes. I no longer wear glasses except
    for reading and computer use.

    There are advantages and disadvantages to both. It is a personal
    preference decision. I like to hike and it's nice to go without glasses
    and not have to wipe off moisture and fog. Unless you read in the
    bathtub, your reading glasses won't fog up.
     
    Dan Abel, Sep 8, 2006
    #12
  13. JR

    Ace Guest

    Robert Martellaro:

    yea, I am -4.5 and cant even see the 20/400 E! In fact I can only see
    clear from 9 inches! You do NOT want to be a -4 unless you read fine
    print all day for a living! If you want good reading vision, ask to be
    -2 to -2.5 then you *never* will need reading glasses. Your distance
    vision will be anywhere from 20/100 to 20/200 but good enough to do
    many things without glasses and you wont need glasses around the house.

    Thats because the LED clock is about a foot and a half from your face.
    Mine is 4 to 5 feet away and I can barely see it without glasses. Most
    high myopes -6 and up wont see the clock unless its right in their
    face.


    I do the same. Youve been presbyopic since 36! I am starting to become
    presbyopic and also take my glasses off or look under them. Never
    needed readers thanks to my myopia but I dont want to be -4.5 thats too
    much!


    Well they at least have good distance vision if plano. The really lucky
    ones are mild myopes that dont need distance glasses most of the time,
    and yet dont really need readers! Best of both worlds! This should be a
    good hint to the OP to chose a slight undercorrection in his IOLs. Some
    surgeons strongly reccomend you be -1.5 because they know people are
    happiest that way. Some surgeons even make you -1.5 without telling you
    and almost everyone is very happy, even if initially disapointed, they
    become happy when they can see without those stupid readers!
     
    Ace, Sep 10, 2006
    #13
  14. JR

    serebel Guest


    Where do you come up with this bull? This is so untue it's downright
    retarded.
     
    serebel, Sep 10, 2006
    #14
  15. JR

    Dan Abel Guest

    Hard to argue with that one. Of course, some people do work with
    dangerous machines and materials up close. These people need eye
    protection, but perhaps reading glasses aren't the answer for that
    either.


    In my opinion, personal preference (and usage and habits) are the
    strongest reasons to choose one or the other. I believe some strong
    arguments have been made by professionals on this group as to why it is
    better to choose glasses for close and set normal vision at distance.
    There is much more of a problem with glare, fogging and wet lenses
    outside. In addition, the blocking of peripheral vision is more of a
    problem for most people outside. Inside, people use glasses for close
    vision for reading and computer use. None of these factors are much of
    a problem indoors.
     
    Dan Abel, Sep 11, 2006
    #15
  16. I think that myopes tend to get really close to their work. The problem
    with that is if they are not wearing glasses, stuff can fly into their
    eyes. Reading is not an issue. You are not likeley to catch a foreign
    body from reading. But myopes might get really close to a drill bit,
    for example, while watching it's progress, and a high speed particle can
    take an eye out in an instant. Opticianry is a good example. Say you
    are myopic and take your glasses off to screw in a particularly
    troublesome eyewire screw. The screwdriver slips and out goes your
    UNPORTECTED eye.

    I think everyone should wear protective eyewear. Hey, I'm an
    optometrist. It works for me.

    I say glasses for everyone, even ace and otis!

    w.stacy, o.d.
     
    William Stacy, Sep 11, 2006
    #16
  17. JR

    The Real Bev Guest

    How good are the relxing incisions all by themselves? I think I would
    be a lot happier with contacts if I didn't have to worry about the
    finely-tuned (and rarely successful) astigmatism correction.

    --
    Cheers, Bev
    =====================================================================
    A: Because it messes up the order in which people normally read text.
    Q: Why is it such a bad thing?
    A: Top-posting.
    Q: What is the most annoying thing on usenet?
     
    The Real Bev, Sep 11, 2006
    #17
  18. JR

    Dan Abel Guest

    And everyone agrees that a starving man will be satisfied with just
    about any kind of food you give him.

    I'm happy with being plano after cataract surgery. I would have been
    satisfied with -1.00 but not happy. Of course, if I ended up hyper I
    wouldn't have been happy either. Before the surgery I wore readers for
    reading and computer use. After the surgery is very little different.
    I wear glasses to eat, although I could manage without, and sometimes do.

    The amount of time that it would be nice to see up really close is such
    a small part of my life that it doesn't count. I have powerful reading
    glasses and magnifiers for that.

    I was -12 and -10 at my worst before surgery. I lived most of my life
    being very myopic. I'm happy to be rid of that. I still have my LCD
    alarm clock with the bright red 1 3/4 inch digits, which reminds me of
    what it was like.

    For those who know what will happen, and want to be myopic after
    surgery, that's great. I really doesn't matter that much whether you
    wear correction for distance or far.
     
    Dan Abel, Sep 11, 2006
    #18
  19. JR

    The Real Bev Guest

    My ophthalmologist said I probably would never need cataract surgery (no
    idea how she determined that, but I have faith in her), and the idea of
    a simple foolproof operation that would allow me to be able to NOT have
    each individual contact lens fit by trial and error as is the case right
    now is really attractive.

    OTOH, one of my son's friends had PRK about 10 years ago and for the
    first year he said his vision was so awful that he actually considered
    suicide. He's still alive and has a web page so I figure he changed his
    mind, but I'd like to avoid anything that traumatic if possible. I can
    understand how he must have felt -- being unable to read easily
    certainly seems suicide-worthy to me, although it might not to some people.

    Very interesting, thank you. Something that makes me say "Huh?" --
    "Placing the incision precisely on axis is not as critical because the
    incision is 9 mm in length." That's roughly a third of an inch! Am I
    missing a dot? They talk about blade settings of 500 and 600 mm.
    THAT'S OVER 19 INCHES! I don't have that much head, much less eyeball!

    Another "Huh?" -- "Regular astigmatism can be caused by the following:
    the weight of the upper eyelid resting on the eyeball that creates
    distortion, surgical incisions in the cornea, trauma or scarring to the
    cornea, the presence of tumors in the eyelid, or a developmental factor."

    But: "Cultures are not necessary because astigmatism is usually present
    at birth and is believed to be hereditary."

    They also say that you can see stuff for free if you register, but the
    registration page demands money.

    --
    Cheers,
    Bev
    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
    "If anyone disagrees with anything I say, I am quite prepared
    not only to retract it, but also to deny under oath that I
    ever said it." -- T. Lehrer
     
    The Real Bev, Sep 12, 2006
    #19
  20. She's either optimistic about your eyes or pessimistic about your life
    expectancy. Most people who make it to age 60 have some degree of
    cataractous changes, even if not bad enought to demand surgery. Many
    people who make it to age 70 have enough to warrant surgery. Most
    people over 80 who haven't had it would benefit from it.
    It's a circular incision near the limbus and concentric with it. And I
    think they mean mu not mm (microns not millimeters).

    All true. Mostly just how your eye grew as an infant.
    Now I'm saying huh? Sounds like GWBspeak.
    Yep, GWB probably helped build the page.
     
    William Stacy, Sep 13, 2006
    #20
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