Exploring cataract surgery: any experience with new all-distance lenses?

December 30, 2022 10:29 AM

I need to have cataract surgery. Medicare will pay for one-distance lenses but I don't know which distance to pick. My doctor also says I could pay for newfangled lenses that supposedly cover all (?) distances. Looking for personal experiences (or expertise)...

So yeah I would be willing to pay the large amount of money to get the new kind of lenses that cover all distances IF they're really good. I would like to know:

1- Does anybody here have experience with them? how are they working out for you?

2- I MOSTLY sit with a laptop, so that's neither "near" ("reading") or far. The Medicare-covered lenses would have to be either near or far -- I don't believe "computer" is an option, so would I do better with these fancy expensive lenses as a person addicted to her laptop?

3- Do you know of an online forum where I can read about people's experiences with cataract surgery and the different types of lenses? Horror stories welcome.

NOTE: I haven't had an initial consultation with The Cataract Guy yet, but my regular opthalmologist told me a little about the fancy lenses, but not enough. I want to learn as much as I can BEFORE I go to the Cataract Guy, so I can ask intelligent and personalized questions (i.e. I'm not looking for answers here that will substitute for professional consultation).

posted by DMelanogaster to Health & Fitness (10 answers total)

Most of what I’ve read (and doctors I talked to) says don’t bother with the fancy lenses. I went with good distance vision for my cataract operations, and I wear 2.5 readers when I need to see up closer. I do have, long-term, some side effects (primarily floaters) and had to have a couple follow up operations many years later.
I use my computer just fine.
posted by Peach at 10:42 AM on December 30, 2022 [1 favorite]

Response by poster: Peach, do you wear glasses to see your computer? I don't need any for that now. (not that I see perfectly, but good enough)
posted by DMelanogaster at 11:03 AM on December 30, 2022

I had cataract surgery in October and my surgeon did mention the option of multifocal lenses but he was not encouraging on the subject and really kind of glided over it. I asked a followup question and at that point he basically said they weren't great, that they're hard to fit, result in more return visits for post-surgical corrections, and are not really worth the trouble or expense. He was much more positive about monovision (where you have one eye corrected for distance and the other corrected for reading) but I decided I wasn't a good candidate for that based on my experience with uneven vision before the surgery. I decided on having both eyes corrected for distance, and I'm happy with the decision. But I've heard many reports of people (friends' parents or parents' friends) who chose monovision and like it, so that choice is really up to you. I personally don't mind wearing reading glasses, but I had about twenty years of not seeing that well with contacts and not being able to wear them all day anyway, so glasses feel like part of my face as it is. You may feel differently.

I will say that post-surgery my required reading power went up quite a bit. Before the surgery my progressive lenses had +1.50 reading power. The surgeon's office recommended a +2.50 reading power for me after the first surgery, and I bought some +2.50 readers at Target. I don't love them, though, and it turns out that they base their recommendation on a standard reading distance of 14". I'm tall and I have long arms, and it turns out I generally hold my reading material about 17" from my eyes. I bought a test pair of +1.75 readers for books and I like them, but the surgeon's office subsequently said I might like a +2.00 better than that (based on testing me at 17" instead of 14"). I do still use the +2.50 readers as emergency backups or when reading in bed, when my Kindle is closer to my face than if I'm sitting up.

My old (pre-surgery) pair of +1.25 readers are now exclusively my laptop glasses. My even older pair of +1.00 readers are my desktop computer glasses. And this is a thing people do. My mom likes to make beaded jewelry, and she wears +3.00 glasses for that, but she uses lower strength readers when she's using her iPad or paying the bills. (I'd say "for reading" but I don't think my mom reads. She stopped getting the paper and I couldn't tell you when I last saw her with a book). In the end this decision comes down to what you're comfortable with and what you're happy with (which may or may not be exactly the same thing). I'm happy leaving a pair by the iMac and a pair on the coffee table next to the laptop, a stronger pair by the bed, and then having one pair I actually carry around and use for everything else. That might drive another person crazy though.
posted by fedward at 11:36 AM on December 30, 2022 [1 favorite]

I have had cataract surgery, but I got traditional mono distance lenses. If remember there being different options, to the effect that I don't think anyone could advise you without knowing the specific "model". I have a little card that's kinda like a product info card of exactly what's in my eye somewhere for example.

Comments:
1.) I need different strength glasses for my desktop computer, my laptop, and my phone/books/etc. I believe by looing some some lens physics you can estimate which strength glasses you would need for different distances. Or just try different kinds. But the range of what's comfortable for my reading glasses is such that there's no one pair that works for everything that's near enough to be blurry.

2) I don't know which kind but I know at least one person who opted for a newer, less-traditional model and they aren't happy. However I think that was each eye set at a different distance, not mono near.

3) When I am on a computer, as I am now, I'm stationary. I'm wearing glasses now and the experience is exactly the same as if I weren't wearing glasses because the screen is a fixed distance from my face, except I can see the rims in my peripherals. So personally I would see no benefit from not having to wear glasses right now while typing this. I would question the reasoning that because you mostly look at screen distance that's where you would want the focus set. To me that would be a reason to get fixed distance. I'm having difficulty imagining a situation where I would prefer to be nearsighted than farsighted, except for the difference of always wearing glasses and can take them off to read a restaurant menu vs having a pair of reading glasses in my pocket.

4) My reading glasses are cheap and come in a 6-pack and can be bought anywhere. I think distance glasses would need to be prescription and/or are more expensive and less widely available?

I don't mean to convince you one way or the other, this was just my reasoning for why I got mono distance and I am happy I chose distance because all those reasons proved true.
posted by firefly5 at 11:44 AM on December 30, 2022 [1 favorite]

A close friend, a painter, had bilateral cataract surgery a few of years ago. She was extremely concerned about how to proceed because as an artist she depends on her vision and ability to perceive depth, and didn't want to constantly have to wear readers for close work. After researching, she had one lens replaced with a close distance lens, and one lens with a far distance lens. She finds that she automatically shifts from one to the other eye seamlessly and now does not need glasses for painting, reading, driving, or landscape painting en plein air. It sounded confusing to me when she first told me about her choice, but it's been several years now and she doesn't even notice which eye is focusing. Everything, at any distance, is in focus. She is very pleased with how it worked out.
posted by citygirl at 12:42 PM on December 30, 2022

There's not a lot of discussion, but there's a Reddit forum. I'm going to be getting fancy new lenses soon. When I went to talk to the surgeon we discussed my activities, what I hoped to achieve from the surgery, etc and he felt the Vivity lenses would be a good fit for me. I'll probably need reading glasses, as I care more about not wearing glasses for distance vision than for close-up. (My current glasses are something like +5, for context.)
posted by The corpse in the library at 1:30 PM on December 30, 2022

This was my response to a similar question after I had Extended Depth of Focus lenses implanted.

After I had my left eye done (which was my weaker eye with bad astigmatism) I find I get a tiny bit of glare/halo around street lights. But compared with how bad it was before (enough to make me not want to drive at night), it's negligible.

I'm glad I didn't go for monovision with one eye for close-up, and I'm happy with cheap readers as and when needed (mostly in low light). I was warned that, with the EDOF lenses, it can result in issues around depth perception, which is (I understand) less of an issue with standard lenses. I'm happy with having better than 20/20 distance vision, excellent intermediate vision and being able to read small print in good light without readers.
posted by essexjan at 3:00 PM on December 30, 2022

I sometimes wear glasses for computer work and sometimes not, depending on how I’m sitting or for how long. I don’t have different glasses for computer work.
posted by Peach at 3:41 PM on December 30, 2022

My mom got the fancy lenses earlier this year and has been really happy with them so far, except that it’s so weird to be able to just see - she’s worn glasses since she was a small child. It took a few days for her brain to adjust to her new eyes. Her doctor advised that her vision probably won’t stay this good long term, which is more a feature of the surgery than the EDoF lenses. When deciding, she also talked to a friend who got the fancy lenses and was very pleased. She also got a rec to get some different readers from the Dollar Store while her vision settled and she figured out what worked for her. She’s worn monovision contacts in the past, but I don’t think monovision lenses were a good option for her for unknown reasons.

She did have a hard time getting anyone on her medical team to give her advice on what lenses to choose. She’s an experienced nurse and still had a hard time figuring this out. Good luck!
posted by momus_window at 8:20 AM on December 31, 2022

Best answer: I just had cataract surgery three weeks ago in my right (dominant) eye. I got the "premium" PanOptix trifocal lens, which I like quite a bit, and I'm one of the lucky people who now no longer have to wear glasses after the surgery. (My left eye is healthy and only slightly nearsighted, I'm leaving it alone for now.) It was both an easy decision and a tough decision.

It was an easy decision because ever since I hit my mid-40s, I have absolutely hated wearing reading glasses or multifocal glasses. Just loathed them. I felt like I was engaged in continual glasses-switching or re-focusing or turning on lights to see small print close-up or making other adjustments. The cataract just made things worse, turning almost all attempts to sit down and read into a comedy of corrective errors.

On the other hand, it was a tough decision because some people who get these lenses end up really hating them, and they are vocal on the various forums. These trifocal lenses do have some visual artifacts due to their design that a single-vision lens doesn't have, and it is a tradeoff that some people just don't seem to like. There are some scary stories, and it's pretty tough to make a decision as permanent as this one (it is technically possible to explant them if it goes especially badly, but that's not a great situation) without being able to "try before you buy".

Forum posts about the PanOptix are almost all divided along two lines: a quick "these are great, don't have to wear glasses anymore!" and long "these are the worst thing ever" posts that go into a litany of problems that may or may not be about the inherent limitations of the lens. So, here's something a little different, a very positive but also fairly critical review.

The day after the surgery, I could see 20/20 in the distance. Not bad! Three days after the surgery, I could see 20/20 at both distance and close up without glasses. A minor miracle. I've worn glasses virtually all my life, and hopefully that's over. I'm very, very glad I didn't get the single-vision implants and keep negotiating the need for reading glasses. I go walk outside and read signs, then look down and read my phone, no juggling glasses, no need to hold the phone at the perfect distance, just wonderful. I can look from my laptop and then up at the TV and everything's clear on both.

The new lens is indeed not perfect, however, and the trade-offs are some minor, slightly annoying visual artifacts in a few specific situations.

* Car headlights and bright "pinpoint" lights (like Christmas lights) have two glowing concentric rings around them, kind of like a wifi symbol. It's created by the rings at different corrective strength in the lens that allow it to work at all distances. (It's nowhere near as bad as the glowing globs of glare that my cataract was creating.) It looks roughly like this.

* With close vision, text on bright screens can have a little bit of "halo" or "ghosting" that comes from the eye still seeing the text out of focus through another of the three lenses. The text is still clear, but text can look like it has a kind of glowing greyish drop shadow. Reading text on paper or packages close-up isn't like this, it's mostly a bright screen thing.

* While my vision from around 6 to 36 inches is quite good, and extremely good from about 7 feet into the distance, the "intermediate" zone around 4-6 feet is not as sharp. I've encountered few situations where it's been necessary to read small text in the 4-6 foot range, though, so I don't usually notice this. If you sit 4-6 feet away from a monitor, though, it might be necessary to move it forward or back for clarity. I found this chart that shows the corrective strength at various distances and it roughly matches my experience.

* Contrast in very low-light situations (like in a hallway with a night light, or in moonlight without other illumination) is a little worse than in my natural eye. Extreme darkness is "more shadowy". Night driving or watching a bright screen in a dark room hasn't been a problem, though.

Finally, it is strange to catch glare - such as from the sun or a bright light in the periphery - directly in the eye. This is likely to happen with any corrective implant, though - and, of course, it happens in glasses too, just not in your eye. I'm getting used to it.

From doing a lot of reading of various posts and opinions online, it sounds like young people (who were used to perfect vision before their cataract) or the very old have the most trouble adapting to these lenses; conversely, people like me who were wrestling with presbyopia, myopia and a cataract and suddenly find all of those issues corrected with a single change seem to generally be enthusiastic. Personally, the artifacts have been a very minor tradeoff for getting rid of glasses, a massive quality of life improvement for me.

I think finding the right surgeon is crucial here, and I don't think any decision can be made until your surgeon believes that your specific eye or eyes are good candidates for specific lenses or strengths. It sounds like eye health, dryness, pupil size and other factors all play in to whether or not various lenses will work well, and you want a surgeon with a great deal of experience as well as confidence in both the lens choice and the procedure. It sounds like these more complicated lenses just literally aren't a good fit for some people, but it should be possible with the right surgeon to limit the risk or be steered away from something that won't work well.

I found this forum to be helpful for reading about a variety of other people's experiences with different types of lenses.

Best of luck!
posted by eschatfische at 10:13 AM on January 3, 2023 [4 favorites]