Getting cataract surgery. Freaking out about distance of new lenses.
February 24, 2023 6:11 AM Subscribe
I'm having cataract surgery, first one eye, then the second two weeks later.
I'm set to have the new lenses for distance. I'm also getting "toric" lenses for astigmatism. I'm freaking out about if I made a mistake or not. The first eye will be done in ten days.
Right now I really don't see badly. But the two eyes are different colors now and they can't correct my vision completely.
I wear glasses just for distance. I am on my laptop all day without any glasses. My vision isn't perfect but I'm used to this blur. Reading is not easy at this point.
The issue is: my whole life I've been myopic. But not so myopic that I can't pad around my house without glasses. In fact, I only wear my glasses to watch TV and when I go outside. I haven't driven a car in years.
So now I've told the opthalmologist that I want the new lenses for distance. Which now seems weird. Why, now, will I have great distance vision (which I don't really need in my house and can wear my glasses when I go outside) and have to wear glasses to be on my laptop and to read? I will always be reaching for glasses when, now, I rarely reach for glasses.
I don't want my new lenses to be for "close up" because that's not my main distance -- my main distance is laptop (maybe 18"? I haven't measured). Does anybody get their new lenses for this weird "computer" distance? (It's also piano distance, and reading the music on a music stand distance, when I play the guitar). Those are the main activities in my life, in addition to drawing on my iPad (close distance).
I can also get one near and one far, but that scares me. I just don't know if I can adjust to that, and the opthalmologist was not that optimistic about it, although I know lots of people get that. He says I can try out the concept after the first surgery, because then I'll have one "far" lens (the operated-on eye) and one "near" (my natural lense, pre-op) for the two weeks between surgeries.
I don't know what to do. This doctor has taken lots of time with me already. I think it's a matter of my own choice (I know it is) and I'm in an obsessive maelstrom about this.
I don't want the fancy super-expensive all-distance lenses and I think he said I'm not a candidate for them anyway (I guess because of my astigmatism, which will be corrected with the toric lenses -- which are going to cost me $5000 anyway).
I have to make this decision NOW because surgery on the first eye is in 11 days. ANY information or personal stories welcome! I'm going to call the doctor's office later today to tell them I need an additional consultation before I go through with this. thanks
I'm set to have the new lenses for distance. I'm also getting "toric" lenses for astigmatism. I'm freaking out about if I made a mistake or not. The first eye will be done in ten days.
Right now I really don't see badly. But the two eyes are different colors now and they can't correct my vision completely.
I wear glasses just for distance. I am on my laptop all day without any glasses. My vision isn't perfect but I'm used to this blur. Reading is not easy at this point.
The issue is: my whole life I've been myopic. But not so myopic that I can't pad around my house without glasses. In fact, I only wear my glasses to watch TV and when I go outside. I haven't driven a car in years.
So now I've told the opthalmologist that I want the new lenses for distance. Which now seems weird. Why, now, will I have great distance vision (which I don't really need in my house and can wear my glasses when I go outside) and have to wear glasses to be on my laptop and to read? I will always be reaching for glasses when, now, I rarely reach for glasses.
I don't want my new lenses to be for "close up" because that's not my main distance -- my main distance is laptop (maybe 18"? I haven't measured). Does anybody get their new lenses for this weird "computer" distance? (It's also piano distance, and reading the music on a music stand distance, when I play the guitar). Those are the main activities in my life, in addition to drawing on my iPad (close distance).
I can also get one near and one far, but that scares me. I just don't know if I can adjust to that, and the opthalmologist was not that optimistic about it, although I know lots of people get that. He says I can try out the concept after the first surgery, because then I'll have one "far" lens (the operated-on eye) and one "near" (my natural lense, pre-op) for the two weeks between surgeries.
I don't know what to do. This doctor has taken lots of time with me already. I think it's a matter of my own choice (I know it is) and I'm in an obsessive maelstrom about this.
I don't want the fancy super-expensive all-distance lenses and I think he said I'm not a candidate for them anyway (I guess because of my astigmatism, which will be corrected with the toric lenses -- which are going to cost me $5000 anyway).
I have to make this decision NOW because surgery on the first eye is in 11 days. ANY information or personal stories welcome! I'm going to call the doctor's office later today to tell them I need an additional consultation before I go through with this. thanks
I asked essentially the same question about five years ago. The majority of opinions, including the opinions of my eye doctor and a nurse in his office, was to get lenses that favor distance vision (so you'd need to use glasses for reading and looking at a computer screen). Frankly, this view didn't make much sense to me, but I went with the majority opinion anyway because I didn't really trust my intuitions. I figured I must be missing something, and I might regret it if I went against the prevailing view.
After my surgery, I have to wear weak reading glasses (+1.25), but my distance vision is near perfect. I can't say I exactly regret my decision, but it is a little inconvenient to keep putting on glasses every time I need to do computer work (which is essentially every day, for the major portion of the day). On the other hand, I've gotten used to it, and I don't think about it much anymore.
I'm not sure if my answer really helps you. But for for whatever it's worth, I've adjusted well and am not suffering any significant consequences from my decision.
posted by alex1965 at 6:30 AM on February 24, 2023 [5 favorites]
After my surgery, I have to wear weak reading glasses (+1.25), but my distance vision is near perfect. I can't say I exactly regret my decision, but it is a little inconvenient to keep putting on glasses every time I need to do computer work (which is essentially every day, for the major portion of the day). On the other hand, I've gotten used to it, and I don't think about it much anymore.
I'm not sure if my answer really helps you. But for for whatever it's worth, I've adjusted well and am not suffering any significant consequences from my decision.
posted by alex1965 at 6:30 AM on February 24, 2023 [5 favorites]
My mother got one near and one far because that was what she'd always had with contacts - apparently your brain kind of adjusts and lets both eyes see far and near. But the permanent implanted lenses did not do the job for her for some reason and she wishes she hadn't made that choice.
posted by wisekaren at 6:30 AM on February 24, 2023
posted by wisekaren at 6:30 AM on February 24, 2023
Just a suggestion: Could you try contact lenses for one near and one far before the surgery to give you an idea? Many people can’t tolerate that application.
posted by serendipityrules at 6:35 AM on February 24, 2023 [2 favorites]
posted by serendipityrules at 6:35 AM on February 24, 2023 [2 favorites]
Response by poster: This just in: I called the doctor. Apparently I misunderstood and I AM a candidate for panoptic (all distances) PLUS toric lenses, at an additional cost. I'm going back to him on Monday for more measurements, BUT I don't know if I want to go through with it. I haven't read perfectly great things about toric lenses. Anybody have any opinions on this? (they cost a lot more, too)
and the idea that I could choose (non-panoptic, just mono-optic) toric lenses that are closer distance is apparently something I made up. They don't exist. Toric lenses JUST come in "distance" and you need reading glasses.
So now I don't know what to do. GAH. I'm really nervous about this.
posted by DMelanogaster at 6:45 AM on February 24, 2023
and the idea that I could choose (non-panoptic, just mono-optic) toric lenses that are closer distance is apparently something I made up. They don't exist. Toric lenses JUST come in "distance" and you need reading glasses.
So now I don't know what to do. GAH. I'm really nervous about this.
posted by DMelanogaster at 6:45 AM on February 24, 2023
I went with distance vision, which I'm overall happy with. I really like being able to drive without glasses and also being outside if there's rain or snow and not having those get on my glasses. Also not having my glasses fog up all the time when I come inside or when I'm wearing a mask. I use a very large monitor for most computer work, so I don't need glasses for that. It is annoying to have to deal with reading glasses all the time, but I'm pretty used to it. I frequently wear flannel shirts with front pockets and keep the glasses in those. One thing I like is that since they're just for reading and are pretty cheap, I feel comfortable getting wacky colors.
I have one post-surgery tip. They will give you a big plastic cover for your eye that will be taped on and that you'll need to wear for a few days, but you can take it off to shower. Take a picture of yourself wearing it so you'll know how it's supposed to go back on.
posted by FencingGal at 6:58 AM on February 24, 2023 [6 favorites]
I have one post-surgery tip. They will give you a big plastic cover for your eye that will be taped on and that you'll need to wear for a few days, but you can take it off to shower. Take a picture of yourself wearing it so you'll know how it's supposed to go back on.
posted by FencingGal at 6:58 AM on February 24, 2023 [6 favorites]
Best answer: I think correcting for laptop distance and wearing glasses for distance makes perfect sense if that's what you're used to and it fits your lifestyle.
posted by fritley at 6:59 AM on February 24, 2023
posted by fritley at 6:59 AM on February 24, 2023
I had my right eye (which had both a severe cataract and astigmatism) corrected with a PanOptix in December, and I'm glad I went that route. I wrote the experience up here, partially because online reviews of the PanOptix differ so greatly, generally alternating between people saying "they're great" with no details, and other people having very serious-sounding difficulties.
In my case, I no longer need to wear glasses, even with my left eye, which has a minor cataract, astigmatism, myopia and prebyopia, uncorrected. (If I'm going out, I can currently just pop a toric contact in that eye and everything's great. The surgeon has offered to do that eye as an elective surgery, but I'm not sure I want to spend the money before I have to.)
The issues I mentioned in my previous post with contrast and bright screens have improved greatly as I've adapted to the lens. Vision has remained excellent, and I'm still 20/20 both distance and near. The halos around headlights and bright "pinpoint" lights remain annoying, although they're not nearly as bad as the glare I was experiencing with the cataract. If you're not driving, it probably wouldn't be an issue.
I was at the age where before the surgery I was having to lean heavily on reading glasses or progressives, both of which I hated and resented wearing, and to me the freedom of not having to deal with them is priceless. The PanOptix lens are expensive and not exactly perfect with the halos around bright pinpoint lights, but the overall benefit is remarkable and I'll gladly take them over having to go back to relying on reading or distance glasses any day.
posted by eschatfische at 7:20 AM on February 24, 2023 [3 favorites]
In my case, I no longer need to wear glasses, even with my left eye, which has a minor cataract, astigmatism, myopia and prebyopia, uncorrected. (If I'm going out, I can currently just pop a toric contact in that eye and everything's great. The surgeon has offered to do that eye as an elective surgery, but I'm not sure I want to spend the money before I have to.)
The issues I mentioned in my previous post with contrast and bright screens have improved greatly as I've adapted to the lens. Vision has remained excellent, and I'm still 20/20 both distance and near. The halos around headlights and bright "pinpoint" lights remain annoying, although they're not nearly as bad as the glare I was experiencing with the cataract. If you're not driving, it probably wouldn't be an issue.
I was at the age where before the surgery I was having to lean heavily on reading glasses or progressives, both of which I hated and resented wearing, and to me the freedom of not having to deal with them is priceless. The PanOptix lens are expensive and not exactly perfect with the halos around bright pinpoint lights, but the overall benefit is remarkable and I'll gladly take them over having to go back to relying on reading or distance glasses any day.
posted by eschatfische at 7:20 AM on February 24, 2023 [3 favorites]
What FencingGal said. I had cataract surgery before Xmas, and had lenses for distance fitted. It did give me pause for thought inasmuch as I have always been extremely short sighted, to the point where it was a big part of my identity, and effectively losing that aspect of my sense of self has been something I have needed to adjust to. However, for me the positive parts of the experience have outweighed the negatives. For example, I didn't realise that I had been seeing the world through a somewhat unpleasant nicotine-yellow haze (apparently the cataract itself) until I had my first lens done. Being able to see things at a distance without uncomfortable contacts or ill-fitting glasses has been a boon, and I definitely feel safer as a driver, especially at night.
With regard to managing afterwards, I now have a pair of what I know of as enhanced readers, but which probably have a much more accurate name in reality. They are effectively varifocals, both for reading and close-up work and with a section for reading a computer screen at a slightly further distance. I now have a good optician I go to, which helps as the glasses I have are probably the best I've ever had given the purpose for needing them.
In terms of feeling anxiety about undergoing the surgery and the outcome, I was somewhat concerned about the surgery itself and the recovery from it, but it was very quick, painless and recovery involved sitting at home for two weeks per eye, so no great shakes there.
It's overall been a good experience for me personally.
posted by Martha My Dear Prudence at 7:26 AM on February 24, 2023 [2 favorites]
With regard to managing afterwards, I now have a pair of what I know of as enhanced readers, but which probably have a much more accurate name in reality. They are effectively varifocals, both for reading and close-up work and with a section for reading a computer screen at a slightly further distance. I now have a good optician I go to, which helps as the glasses I have are probably the best I've ever had given the purpose for needing them.
In terms of feeling anxiety about undergoing the surgery and the outcome, I was somewhat concerned about the surgery itself and the recovery from it, but it was very quick, painless and recovery involved sitting at home for two weeks per eye, so no great shakes there.
It's overall been a good experience for me personally.
posted by Martha My Dear Prudence at 7:26 AM on February 24, 2023 [2 favorites]
On the question of toric IOLs, at least in my case my surgeon was pretty wishy-washy. Often just getting an IOL at all will reduce the amount of astigmatism in that eye, and he said that they aren't even offered below a certain threshold. My astigmatism was right on the threshold and he advised me (because of that expected reduction) that I probably didn't really need it (also my insurance wouldn't pay for it, so I'd have been out of pocket for the difference). If you're above the threshold the advice from your surgeon may be different than the advice I got.
FWIW my astigmatism was indeed reduced by the surgery to the extent that both the surgeon's office and my own regular doctor said it's low enough they wouldn't bother to correct it on its own. My distance vision tests at 20/20 even without correction for astigmatism, and I get by just fine with OTC readers except for how they all fall off my face because my nose is really narrow. I just ordered a pair of progressive lenses for a pair of frames I already owned, which are reading power at the bottom and "plano" (0.00 power) on top, basically to try them for all day wear without having to deal with the on-and-off thing of reading glasses (and also to capitalize on the money I previously spent on fancy frames that fit me well). Because of that I know that my astigmatism in one eye now requires only a +0.5 prescription and the other eye doesn't need any correction at all. The lenses haven't arrived yet so I can't give you a review. But again, my astigmatism before the surgery may not have been as bad as yours.
Also, even though I didn't pay out of pocket for toric IOLs, I did pay for ORA, which allows the surgeon to correct/confirm your IOL prescription immediately before implantation. Nobody can prove that I wouldn't have been 20/20 without it, but I am definitely 20/20 having done it. I consider it a worthwhile upgrade, even out of pocket.
And on your original question about whether they can correct primarily for that near-intermediate distance: can't hurt to ask. In your scenario I personally would ask if it would affect whether my insurance would still pay for it. If they said they could do it that way but insurance wouldn't pay for it, I'd think really hard about what's important to me.
posted by fedward at 8:18 AM on February 24, 2023 [2 favorites]
FWIW my astigmatism was indeed reduced by the surgery to the extent that both the surgeon's office and my own regular doctor said it's low enough they wouldn't bother to correct it on its own. My distance vision tests at 20/20 even without correction for astigmatism, and I get by just fine with OTC readers except for how they all fall off my face because my nose is really narrow. I just ordered a pair of progressive lenses for a pair of frames I already owned, which are reading power at the bottom and "plano" (0.00 power) on top, basically to try them for all day wear without having to deal with the on-and-off thing of reading glasses (and also to capitalize on the money I previously spent on fancy frames that fit me well). Because of that I know that my astigmatism in one eye now requires only a +0.5 prescription and the other eye doesn't need any correction at all. The lenses haven't arrived yet so I can't give you a review. But again, my astigmatism before the surgery may not have been as bad as yours.
Also, even though I didn't pay out of pocket for toric IOLs, I did pay for ORA, which allows the surgeon to correct/confirm your IOL prescription immediately before implantation. Nobody can prove that I wouldn't have been 20/20 without it, but I am definitely 20/20 having done it. I consider it a worthwhile upgrade, even out of pocket.
And on your original question about whether they can correct primarily for that near-intermediate distance: can't hurt to ask. In your scenario I personally would ask if it would affect whether my insurance would still pay for it. If they said they could do it that way but insurance wouldn't pay for it, I'd think really hard about what's important to me.
posted by fedward at 8:18 AM on February 24, 2023 [2 favorites]
If it helps you at all, I had great vision until about a year ago, when, in my late 40s I had to start wearing readers for the first time. I got lenses with reading glass at the bottom, fading up to clear glass at the top, and putting them on and off isn’t a fuss at all, much less of a bother than I would have expected.
The clear glass bit means I don’t have any trouble wearing them about the house if I want to, so I don’t have to take them off the minute I look up from my screen/book. I take them off to leave the house, sometimes take them off at home if I know I won’t need close vision for a while, but it’s just not a big deal.
posted by penguin pie at 8:19 AM on February 24, 2023 [2 favorites]
The clear glass bit means I don’t have any trouble wearing them about the house if I want to, so I don’t have to take them off the minute I look up from my screen/book. I take them off to leave the house, sometimes take them off at home if I know I won’t need close vision for a while, but it’s just not a big deal.
posted by penguin pie at 8:19 AM on February 24, 2023 [2 favorites]
The sweet husband was cleared for all activities last week after getting monofocal distance lens surgery for his right eye.
No astigmatism was found.
Putting it off any longer was not an option.
Sometime in a few months he will need "second cataract" laser surgery for a clouded area behind the lens, which is not uncommon. It is a quick office procedure, then all should be done.
There will be no need to "correct" the lens if it shifts in the decades to come.
The surgery is covered for the most part by our health insurance.
No more two or three eye drops per day (28 days). That was the only difficult part of the whole process, since he hates drops. They did sting for a few seconds/minutes after application.
I am so thankful that we opted for a single compound instead of three different medications.
He still uses the full coverage sunglasses from the kit during daytime driving to reduce the light. No halos on streetlights reported.
He is back to doing carpentry, working cattle, and currently is taking down a huge pecan tree over the neighbors' fence.
My husband worked at a computer for 32 years before retirement and still uses his laptop and the desktop most days.
Reading glasses are cheap and easy to obtain without a prescription. He is accustomed to wearing them.
Near vision often gets worse with age.
With this surgery, my husband will just need a stronger set of readers, instead of more powerful, expensive bifocals or trifocals.
He has his appointment scheduled with our regular optometrist. A new prescription lens will be added to his old set of glasses.
The left eye is not a candidate for surgery yet. He will have the same monofocal distance lens surgery.
Avoiding future surgery wins out against fancy lenses that may not work properly until his nineties.
The surgery itself is quick. What my youngest daughter and I did not anticipate was that two doctors had several surgeries lined up and were waiting for all the medications to take effect.
Also, the clouded area behind the lens had gotten worse by the time my husband agreed to get surgery. This took an additional procedure so that he could see clearly through the new lens and experience the difference.
Therefore, we were in the waiting room for an hour and a half.
No, they don't use general anesthetic. Yes, he had some awareness of what went on.
They gave him the good drugs. Very good drugs.
But he came out of surgery like a champion.
And he is happy to see... everything.
It's a big step. It is scary. But I have a relative who kept putting in off and now can't have the surgery because of other health issues.
His hearing is poor, his eyesight is poor, and his quality of life is drastically reduced.
My husband tried to put off cataract surgery until it was covered by Medicare. It wasn't possible. And it left him extremely frustrated by the things he could no longer do.
Now he's back to his old tricks, and I am happy to see him enjoying each day.
Good luck.
posted by TrishaU at 3:15 PM on February 24, 2023
No astigmatism was found.
Putting it off any longer was not an option.
Sometime in a few months he will need "second cataract" laser surgery for a clouded area behind the lens, which is not uncommon. It is a quick office procedure, then all should be done.
There will be no need to "correct" the lens if it shifts in the decades to come.
The surgery is covered for the most part by our health insurance.
No more two or three eye drops per day (28 days). That was the only difficult part of the whole process, since he hates drops. They did sting for a few seconds/minutes after application.
I am so thankful that we opted for a single compound instead of three different medications.
He still uses the full coverage sunglasses from the kit during daytime driving to reduce the light. No halos on streetlights reported.
He is back to doing carpentry, working cattle, and currently is taking down a huge pecan tree over the neighbors' fence.
My husband worked at a computer for 32 years before retirement and still uses his laptop and the desktop most days.
Reading glasses are cheap and easy to obtain without a prescription. He is accustomed to wearing them.
Near vision often gets worse with age.
With this surgery, my husband will just need a stronger set of readers, instead of more powerful, expensive bifocals or trifocals.
He has his appointment scheduled with our regular optometrist. A new prescription lens will be added to his old set of glasses.
The left eye is not a candidate for surgery yet. He will have the same monofocal distance lens surgery.
Avoiding future surgery wins out against fancy lenses that may not work properly until his nineties.
The surgery itself is quick. What my youngest daughter and I did not anticipate was that two doctors had several surgeries lined up and were waiting for all the medications to take effect.
Also, the clouded area behind the lens had gotten worse by the time my husband agreed to get surgery. This took an additional procedure so that he could see clearly through the new lens and experience the difference.
Therefore, we were in the waiting room for an hour and a half.
No, they don't use general anesthetic. Yes, he had some awareness of what went on.
They gave him the good drugs. Very good drugs.
But he came out of surgery like a champion.
And he is happy to see... everything.
It's a big step. It is scary. But I have a relative who kept putting in off and now can't have the surgery because of other health issues.
His hearing is poor, his eyesight is poor, and his quality of life is drastically reduced.
My husband tried to put off cataract surgery until it was covered by Medicare. It wasn't possible. And it left him extremely frustrated by the things he could no longer do.
Now he's back to his old tricks, and I am happy to see him enjoying each day.
Good luck.
posted by TrishaU at 3:15 PM on February 24, 2023
I had cataract surgery just over a year ago, each eye a month apart. I have Extended Depth of Focus (EDOF) toric lenses. They are amazing, giving incredible distance vision, excellent medium vision and, when the light's good enough, I can read and use my phone without readers (in lower light, I need readers, just cheap ones are fine).
I decided not to go with a different lens in the other eye for close-up, because my surgeon said it can cause a slight issue with depth perception if the other eye has an EDOF lens.
I still have a tiny bit of astigmatism, but it's fine, and I don't have any problem with night vision while driving or anything like that. Before the surgery, even with glasses I'd get really bad halo and starburst around street lamps and car headlights, but it's nothing like that now.
For more details about the lenses I had implanted, this is my answer to a previous question.
I was freaking out about the surgery, but it truly is nothing at all - about an hour of drops, 15 minutes apart, to numb the eye, a very light sedative to relax you and the op itself is ten minutes where you feel nothing at all.
posted by essexjan at 3:56 PM on February 24, 2023 [2 favorites]
I decided not to go with a different lens in the other eye for close-up, because my surgeon said it can cause a slight issue with depth perception if the other eye has an EDOF lens.
I still have a tiny bit of astigmatism, but it's fine, and I don't have any problem with night vision while driving or anything like that. Before the surgery, even with glasses I'd get really bad halo and starburst around street lamps and car headlights, but it's nothing like that now.
For more details about the lenses I had implanted, this is my answer to a previous question.
I was freaking out about the surgery, but it truly is nothing at all - about an hour of drops, 15 minutes apart, to numb the eye, a very light sedative to relax you and the op itself is ten minutes where you feel nothing at all.
posted by essexjan at 3:56 PM on February 24, 2023 [2 favorites]
TL;DR: "All focus lenses" are probably what are known as accommodating lenses - they adjust their focus, just as our (younger) natural lenses did - by using the same muscles that already know how to do it! Crystalens is the only accommodating lens I know of, and is what I have in my eyes.
Pros:
- A very good range of focus from near to far.
- Glasses-free vision over a significant range of distances.
- The whole lens is used all of the time, not just one part that specializes in a given distance range.
Cons:
- Their focal range is a bit less than what our natural lenses had. Not really a "con" compared to other IOLs, but something to be prepared for.
- They're expensive: $8K to $10K *per eye* (in 2018), over what Medicare will pay. Some "twinkling" or halos around oncoming headlights. Not all ophthalmic surgeons are prepared to implant them.
My own experience, now 5 years since cataract surgery:
I asked for the sweet-spot to be at social distances (indoor gatherings) and I was willing to wear glasses to read or to drive to achieve that, if necessary. I was, by that time, very far-sighted and wore progressive lenses full-time for all activities.
I was given a week's worth of contact lenses to focus at social distances to try out before I committed to the change, but I knew in less than an hour into the trial, that it was exactly what I wanted.
Crystalens' makers say you can expect to read 12pt type without glasses and that some people will be able to do better. My experience is that I can read nearly anything except pill bottles, glasses-free, in good lighting. I routinely read books on my phone in considerably smaller type than that, and am glasses-free from moderately close up to night-time driving. I do wear readers for small work like making circuit boards, or small type if the lighting or contrast are poor. I don't have the sharpness at far distance that I used to have, but that was a trade I made willingly, and even at that, I got better results than I was prepared to expect. I'm probably in the high end of the curve in that respect, but having been prepared to need glasses to read and/or drive, I had a lot of wiggle room.
Oh, and at the last minute (like, on the table!), my surgeon chose to give me a slight increase in power (closer focus) on my better eye, to give me just a bit more overall range!
Accommodating lenses won't be everyone's first choice, either for compatibility or cost, so my real point is that you can choose where your best focal distance will be, and try it out beforehand, to have the confidence going into surgery, that you've made a choice you'll be happy with. And that goes for trialing mono-vision (one for near and one for far), or a reduced version of that, as well as for "shall I become near-, middle-, or far-sighted, and will I be comfortable with that?"
This is a "forever" choice and worth getting right! I wish you the best possible outcome!
posted by TruncatedTiller at 2:18 PM on February 25, 2023
Pros:
- A very good range of focus from near to far.
- Glasses-free vision over a significant range of distances.
- The whole lens is used all of the time, not just one part that specializes in a given distance range.
Cons:
- Their focal range is a bit less than what our natural lenses had. Not really a "con" compared to other IOLs, but something to be prepared for.
- They're expensive: $8K to $10K *per eye* (in 2018), over what Medicare will pay. Some "twinkling" or halos around oncoming headlights. Not all ophthalmic surgeons are prepared to implant them.
My own experience, now 5 years since cataract surgery:
I asked for the sweet-spot to be at social distances (indoor gatherings) and I was willing to wear glasses to read or to drive to achieve that, if necessary. I was, by that time, very far-sighted and wore progressive lenses full-time for all activities.
I was given a week's worth of contact lenses to focus at social distances to try out before I committed to the change, but I knew in less than an hour into the trial, that it was exactly what I wanted.
Crystalens' makers say you can expect to read 12pt type without glasses and that some people will be able to do better. My experience is that I can read nearly anything except pill bottles, glasses-free, in good lighting. I routinely read books on my phone in considerably smaller type than that, and am glasses-free from moderately close up to night-time driving. I do wear readers for small work like making circuit boards, or small type if the lighting or contrast are poor. I don't have the sharpness at far distance that I used to have, but that was a trade I made willingly, and even at that, I got better results than I was prepared to expect. I'm probably in the high end of the curve in that respect, but having been prepared to need glasses to read and/or drive, I had a lot of wiggle room.
Oh, and at the last minute (like, on the table!), my surgeon chose to give me a slight increase in power (closer focus) on my better eye, to give me just a bit more overall range!
Accommodating lenses won't be everyone's first choice, either for compatibility or cost, so my real point is that you can choose where your best focal distance will be, and try it out beforehand, to have the confidence going into surgery, that you've made a choice you'll be happy with. And that goes for trialing mono-vision (one for near and one for far), or a reduced version of that, as well as for "shall I become near-, middle-, or far-sighted, and will I be comfortable with that?"
This is a "forever" choice and worth getting right! I wish you the best possible outcome!
posted by TruncatedTiller at 2:18 PM on February 25, 2023
Response by poster: Today, inspired by these posts, I went to a second doctor. What a difference! I couldn't believe it (I guess I'm really naive.)
First doctor: You have quite bad astigmatism -- you need toric lenses.
Second doctor:Your astigmatism is WELL below threshold for toric lenses, and (as said by someone above) your astigmatism is going to be corrected by the laser surgery ITSELF.
First doctor: You have to choose between "far" distance or "near" distance -- nothing in the middle.
Second doctor: You can absolutely have "computer" ("intermediate") as your single focal point!
First doctor: You can have one far and one near if you want to (monovision)
Second doctor: You can get the "Mini" monovision (or maybe some other word besides "mini") with one far and one computer distance
First doctor: We don't recommend monovision because people only usually like it if they've been doing that via contact lenses for a long time
Second doctor: The Mini Monovision is great because we will put in Extended depth-of-focus (EDOF) lenses, which limits the distance between the "near" (in my case, intermediate) distance lens and the "far" distance lens because, in addition to the fact that the distance between them is literally smaller, the EDOF lenses will extend the depth of focus for BOTH lenses.
First doctor: We sort of put you out under "twilight" anesthesia, so here are the pre-surgical clearance forms for you to take to your primary care physician, including EKG, blood work, etc.
Second doctor: We do this under local anesthesia, no "pre-op" clearance required.
First doctor: I left the office utterly confused.
Second doctor: I left the office utterly informed (or so I think).
First doctor: each eye will cost you $2500 out of pocket
Second doctor: each eye will cost you $3500 out of pocket.
Sigh.
BUT STILL!
Next: I think I'm going to make an appointment with a third doctor!
posted by DMelanogaster at 5:56 PM on February 25, 2023 [3 favorites]
First doctor: You have quite bad astigmatism -- you need toric lenses.
Second doctor:Your astigmatism is WELL below threshold for toric lenses, and (as said by someone above) your astigmatism is going to be corrected by the laser surgery ITSELF.
First doctor: You have to choose between "far" distance or "near" distance -- nothing in the middle.
Second doctor: You can absolutely have "computer" ("intermediate") as your single focal point!
First doctor: You can have one far and one near if you want to (monovision)
Second doctor: You can get the "Mini" monovision (or maybe some other word besides "mini") with one far and one computer distance
First doctor: We don't recommend monovision because people only usually like it if they've been doing that via contact lenses for a long time
Second doctor: The Mini Monovision is great because we will put in Extended depth-of-focus (EDOF) lenses, which limits the distance between the "near" (in my case, intermediate) distance lens and the "far" distance lens because, in addition to the fact that the distance between them is literally smaller, the EDOF lenses will extend the depth of focus for BOTH lenses.
First doctor: We sort of put you out under "twilight" anesthesia, so here are the pre-surgical clearance forms for you to take to your primary care physician, including EKG, blood work, etc.
Second doctor: We do this under local anesthesia, no "pre-op" clearance required.
First doctor: I left the office utterly confused.
Second doctor: I left the office utterly informed (or so I think).
First doctor: each eye will cost you $2500 out of pocket
Second doctor: each eye will cost you $3500 out of pocket.
Sigh.
BUT STILL!
Next: I think I'm going to make an appointment with a third doctor!
posted by DMelanogaster at 5:56 PM on February 25, 2023 [3 favorites]
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So, in your position I think it's very sensible to pick the distance you use the most, and then make sure you have options for other distances you might need. In my case that would also be laptop distance, and I would want to be sure I had solutions for very close up (magnifying glass in a pinch?), across the room for TV (glasses?) and distance for driving and spotting sheep on the hill that have gotten into trouble (different glasses?) In my last round with my opthamologist (who is very good) there was definitely a bit of working through his default assumptions about what distance most people prioritise versus what I actually need most in my day to day, so I think it's good to really talk that through with yours before making your decision.
posted by Rhedyn at 6:27 AM on February 24, 2023 [3 favorites]