Cataract surgery: Pros and cons of correcting for near vision

November 16, 2017 8:16 PM

I'm having cataract surgery soon in both eyes. I'm getting monofocal lenses. I'm trying to decide whether to have the correction set to favor near vision (no glasses needed for reading, but glasses required for driving) vs. distance vision (will need glasses for reading).

I had a pre-operative meeting with a nurse. She discussed different options. She said that most patients choose to have the focus set so that they can see distant objects without glasses, but need glasses for reading.

I spend at least 10 hours per day sitting in front of a computer screen. And I only spend about 40 minutes a day driving. I told the nurse that I think it would be better to set my focus to favor near vision. She seemed to think that this was a bad idea, but she couldn't clearly articulate the reasons why. She just repeated that most patients choose the opposite. She offered to have the eye surgeon call me tomorrow for further discussions.

Am I missing something? It's puzzling to me why the majority of patients choose to forego glasses for distance vision while using glasses for reading. I would have expected the opposite. Am I missing something?

I'll be speaking with the surgeon soon, but I'm looking for feedback from others.

posted by alex1965 to Health & Fitness (12 answers total)

As you get older and presbyopia sets in, you might find that even with your focus adjusted surgically for screen distance, you'll need reading glasses for closer-in reading. And you may always need glasses to drive. Your choice now might come down to future nuisance avoidance.

When I had cataract surgery, I went with distance. This means that driving is never an issue, and off-the-shelf sunglasses are inexpensive. I keep +1.00 reading glasses at work for computer use, +1.25 readers on the bedside table and in my travel bag, and have a pair +1.50 bifocal safety glasses for soldering and close-in work. The slight variations matter noticeably to my older eyes. Reading glasses are inexpensive if you shop around (check Amazon for prices).
posted by dws at 8:45 PM on November 16, 2017

A computer screen is middle distance, not really near vision. You need your distance vision to walk around and do everything, not just to drive. Before I had lasik, I couldn’t see far away and I was useless without glasses or contacts 24/7. I now have one eye that’s had cataract surgery and can no longer focus close up - I can totally get around and do whatever, cook, watch tv, shower, no problem, since both eyes have great distance vision. When I was near sighted, I couldn’t do any of that. I don’t know if you’d be as near sighted as I was. My close vision with the cataract eye is pretty crappy but I don’t notice it until I try to read. I can just read with the other eye though, so I’m not in the same boat as you’d be yet. But I much prefer not needing glasses to just walk around and see stuff. I can still read large type close up with the cataract eye and my hand at arm’s length is only slightly blurry. I have a slight refraction error in that eye, so yours might even be better. I have a lot of extra bonus bad eye stuff going on, so YMMV.
posted by artychoke at 8:49 PM on November 16, 2017

Best answer: I don’t have cataracts, but i do need reading glasses, though my distance vision is fine. On the other hand my wife is short sighted, and though she can read OK at close disances without glasses, the anything at a greater distance is a blur to her without them. You’re right, in a practical, everyday sense, that our situations are the same. We even both wear glasses for computer use.

But if I lose my glasses, I can litterally go to the dollar store and find a pair that will work, while hers must be prescription and she would either have to wait or pay over the odds to replace them. If it’s raining, I’m fine; she has to deal with raindrops obsuring her vision. Same story with cold weather and misting up. If she’s swimming, the world’s a blur… Emergency situations, though rare, are probably safer if you can see the world around you OK without glasses.

It is a matter of preference and for day to day living it probably won’t make a bit of difference, but you can see why the general recommendation would be the way round it is.
posted by Quinbus Flestrin at 9:11 PM on November 16, 2017 [2 favorites]

I cant see far without glasses, but I can see close. I get along just fine. I am an artist who does a lot of work on the computer and Im happier having my close up vision.
posted by WalkerWestridge at 9:16 PM on November 16, 2017

If it's an option, you might consider doing one eye close and the other far (a la artychoke). This is a common approach for treating prespiobia–one contact that allows close vision, and another for far. In my case, I wear a contact in one eye that allows reading. My far vision is fine, so nothing in the other eye.

I'm surprised that the nurse didn't offer that as an option, as many people with presbyopia are opting for lasik in one eye to make the effect permanent. I'm doing the contact to decide if I like it before committing to lasik. So far, so good. The neat thing is that your brain just "gets" it. You don't notice that one eye is seeing one distance and not the other. You just "see".

Brains. They're crazy.
posted by qwip at 12:10 AM on November 17, 2017 [1 favorite]

Best answer: You might do most of your money-making and recreational work at a computer screen, but the majority of your important basic activities are done away from it. You drive, shop, walk, garden, mow the lawn, watch TV and movies, visit with friends, eat out, attend concerts, etc., with greater dependence on your distance vision.

I chose to favor distance vision for my retinal implants even though it has meant I currently have to use a variety of reading glasses for working and reading, with the addition of a heavy-duty magnifying glass when I work on crafts. Glasses are less of a burden when I'm doing those things, because I'm sitting still and have a table or desk to rest my glasses or glass case on. I am not reliant on my peripheral vision when I am reading, but I want it when I am outdoors.

Without reading glasses I can see things reasonably clearly from about 4 feet away and beyond; I can drive safely without glasses and while the dashboard console is not fully in focus, it is clear enough for me to accurately read the display with a quick glance.

The way near vision lenses were explained to me: Favoring near vision means my focal range would only be a couple feet in front of my nose, the near and far points of that range are not fully manageable. I was informed that getting near-vision lenses were not a guarantee that I would not need reading glasses anyway.

If you are getting cataract surgery in both eyes, you might have the option of having one lens for near vision and one lens for distance vision. My doctor had mentioned this as something other patients occasionally opt for.
posted by Subaru drwxrwxrwx at 3:35 AM on November 17, 2017 [2 favorites]

Best answer: As a nearsighted person, I would strongly suggest getting distance lenses. You need distance vision for eeeeeeeverything - finding aisles in the grocery store, driving, ordering at a cafe, walking down the street and reading signs, looking at anything out your window ever, and just, like, not feeling disoriented in your everyday life. I cannot imagine ever choosing to have near vision instead of distance vision - having the world around me be even slightly blurry is something I find very unpleasant and unsettling and I always wear glasses or contacts from the moment I get out of bed until the moment I go to sleep even though I dislike the feeling of glasses on my face. Obviously (see above) people have different feelings about this, but anyway that's my two cents.
posted by Cygnet at 5:17 AM on November 17, 2017 [4 favorites]

My parents have both just gotten their cataract surgeries, and both had their vision fully corrected for near and far vision. My mom has one near eye and one far eye as said above - she wore contacts like this for years.

I'm really surprised you were not offered full correction as I was given to believe from my parents' experience that it's totally standard to have your cataracts fixed and also have your vision corrected to basically 20/20 or better. They were not told they had to choose between near and far correction. I'd ask more questions and figure out if you can just have your vision corrected fully, because I'm not sure you should have to choose.
posted by Medieval Maven at 7:29 AM on November 17, 2017

When I did it, I preferred having far vision, and now I wear readers. The near/far option (one eye one way, the other the other) interferes with the perception of distance and I don't need that. You can't get your vision corrected to 20/20 with both eyes; it's one eye one, the other the other, because the lenses they implant don't flex enough.

Have never regretted the choice.
posted by Peach at 7:32 AM on November 17, 2017

I have had cataract surgery in both eyes, and my lenses are good for intermediate and distant vision. I can get away with not wearing glasses at all for 99% of the time unless I'm reading something small/up close.

If my lenses were good for near vision only, I'd have to wear glasses for grocery shopping, cooking, driving, watching TV, etc., which would probably take up most of my time.

I carry reading glasses around at home, and wear Rx bifocals for extended periods of reading or crochet. IMO, this is less of a hassle than only having near vision (which was my experience prior to the surgeries).
posted by cp311 at 8:56 AM on November 17, 2017

What's your vision like now? You might ask your doctor how easy it would be to adapt to different vision than you're used to.
posted by still_wears_a_hat at 2:42 PM on November 17, 2017 [1 favorite]

As you get older and presbyopia sets in, you might find that even with your focus adjusted surgically for screen distance, you'll need reading glasses for closer-in reading. And you may always need glasses to drive. Your choice now might come down to future nuisance avoidance.

I like this answer. You can have your vision corrected for distance and it is likely to last you for life. You will need glasses for close up but not for distance.

If you have your vision corrected for close up, it may not be permanent because close up vision typically deteriorates further with age. You may later find that you need glasses for both close up and distance -- that is, bifocal or multifocal lenses at all times.
posted by JackFlash at 7:25 PM on November 17, 2017