Cataract monofocal IOL far or near?

I am 67 yrs old, I have cataracts both eyes, left eye cataract level 3.5, right eye 2.5, the doctor asked me can you read with out glasses I said yes then he picked nearsighted at -2.50 for monofocal IOL. He says I will be able to read at 16" not more or less without glasses.

He discuss about arm's length he thinks to add from -2.50 to 2.75 so I can read alittle bit closer to 13" without glasses.

Sadly, I know I will not be able to see close up as I can see upclose to 6" without glasses, both eyes are different, left eye at 5" and right eye at 6". I believe it is because with cataract it can cause to have second sight. so maybe I am not really nearsighted??

I am not sure which is best near or far for momofocal IOL.

Right now I can not read without glasses at arm's length and I can take off my glasses read upclose at 6" not farther I need my glasses to read or cook or read computer.

I read some here on this site and find some people prefer far distance rather than near.

I am confused which is best? I don't mind wearing glasses after surgery.

Help me understand what is IOL power, is that RX?

If you choose far distance is it required to add eyeglasses RX on IOL? can you have without eyeglasses rx in IOL? Is the IOL power is same as rx eyeglasses?

I don't understand how it works the IOL power for far distance?

Is it possible to have iol inplanted wthout rx correction and then wear correction glasses?

Thank you, I am just learning and just want to make the right choice.

oh here is my RX

OD Sph -2.75 Cyl -2.00 Axis 070 add +2.50

OS Sph -3.00 Cyl -2.00 Axis 093 add +2.50

Am I myopia? thank you,

Most people want to be able to drive without glasses, but don't mind using reading glasses for reading. Others like you may want to be able to read without glasses, but won't mind using glasses for driving. There is no right or wrong answer here. Thus, based on your life style, if it makes sense for you to be able to read without glasses after you have the cataract surgery, the choice of aiming for -2.50 for monofocal IOL (as suggested by your doctor) will be the right choice for you.

Personally, rather than going from -2.50 to -2.75, my personal preference will be to even consider going from -2.50 to -2.25, if you want to be able to look at a computer screen without glasses (this usually requires being able to read well at about 18 inches compared with reading well at 16 inches for books). Any way, the choice is still yours to make.

Hpwever, please be aware that your eyes have quite a bit of astigmatism, which may require use of toric lenses. Also, the IOL prescription calculation can be easily off by about +0.5 to -0.5 from the desired prescription. The doctors do their best to do it right, but it is hard to get it completely right.

If you don't mind wearing glasses, and by your age must be used to the need for progressives/varifocals or bifocals, then there is no wrong answer since the same options are available after surgery.  You are myopic now, nearsighted. 

As another poster mentioned, to be able to provide you with good vision without correction at any distance  they'd need to correct the astigmatism (though it sounds like you manage some reading vision now even without glasses, even if its not as sharp as it could be). Usually at your level of astigmatism (assuming you've had it all along, that it isn't just due to the cataract) they'd do that with a toric lens, which in most cases is considered a "premium" lens and you need to pay extra out of pocket for it (beyond whatever an insurer or government pays). Alternatively some surgeons will correct even that level of astigmatism with an incision, which doesn't cost much but is also extra. 

If you don't correct astigmatism, then even if you had monofocal IOls with a power set for distance, you'd likely still need to wear correction in order to drive. If you manage some reading even now, then you might manage to do some with an IOL set for near even without the astigmatism corrected.

Many people like the idea of not needing correction to have sharp vision for at least some distance, so they'd opt to have the astigmatism corrected.  As to what distance you should have the eyes set for in that case, it depends on when you'd prefer to not need glasses. Some people prefer to not need glassses for driving, others prefer to not need them for normal household tasks and social interaction, others prefer to not need them for reading physical books. 

Usually when people are talking about where to leave the eyes, they are talking about what RX the person would be left at, e.g. leaving the eye focused at -2D would mean they'd be myopic, nearsighted, and see best at 50centimeters=19.7 inches and need glasses for -2D to see far. Usually people aren't discussing the actual lens power of the IOL itself, but merely where they want the eye to focus best after surgery. 

You would figure out the distance you wish to focus best at, in feet/inches and they'd convert that to cenitmeters. The prescription that corresponds to is diopters= - (100 / distance_in_cm). So  to focus best for social distance and walking around at 2 meters (6.5 feet) = 200 centimeters that would be -(100 / 200) = -0.5D. To focus for reading at 40cm would be -(100 / 40) = -2.5D centimeters.

Some people have their eyes set for different distances, monovision. For instance they might get one eye set for -0.25D (=4 meters) which gives some far distance vision and further out intermediate for walking around, and the other eye set for -1D (= 1 meter) for social interaction and some household tasks at arms length.

Usually though people can only tolerate a certain amount of difference between the eyes, since the brain has trouble merging the images if they are very different, so usually the difference between the eyes prescriptions with  monovision is less than 2D or so, and even lower is better. Having the eyes set differently, with one for distance and one for nearer in, means you are mostly using only 1 eye for certain distance ranges, which can reduce depth perception. A small difference doesn't have much impact.  Some prefer to have both their eyes focused at the same distance to make that distance clearer. 

 

sir, i will just explain what i did in hopes it will  help you.  i'm 63 have been near sighted for close to 50 years.   because of cataracts driving had become difficult, almost impossible at night....   i got both my eyes implanted with a monofocal lense for distance.  my gosh, the result was miraculous.  i cannot ever remember seeing like this.    now, the down side for distance only lenses,  anything closer than three feet i see somewhat blurry.  i can cook, look at car dash board,  eat my dinner, all things that i need to do.   except read a book, or work on the computer. for those two things my near vision is not sharp enough, i use cheap reading glasses.  if i were to take up my crafting again, i would need glasses for that also. 

what do you do most of the day...do you use your near vision the most, or are you outdoors where you need to see far.   please, just keep in mind that if you correct as you stated for just near, you will not be able to watch tv, grocery sho

p, anything from 3 to 5 feet out without glasses or contacts.   and your astigmastim is high it needs to be attened to or you vision will likely be blurry at all distances.  have another talk with your surgeon until you do understand.

meant to add yes i do miss my near vision, but in just two months, i got used to it. what i gained is far, far better for me...if i were an younger women perhaps i'd think differently. wishing you all the best

Hi at201,

Thank you for your info,

Most people I talked to chose far distance for monofocal IOL and are happy with it and one person I talked to chose near and she was ok with it but not able to see far far like her husband (no cataract) can see far infinity but reads readers glasses, and other person told me she was told by several people who have chosen near have regret it wish to have chosen far, so I don't know.

If I chose near I will be able to see at 16" to 18" with -2.25 without glasses, if so I would need reading glasses or progressive lens for upclose at less than 16" and below and plus rx glasses for far distance?

Will I loose 5" upclose if I chose near? I would still need reader's glasses or progresive lense for that.

I do cooking, gardening, watch tv read closed captioned most of the time.

I also drive and will be traveling I may want to see clear, too.

My current glasses I am able to read computer, cooking with my right eye, I read newspaper with my glasses with progressive lens only at 10" inward but can take off glasses read at 6". I am not sure if reading lens is correct since last time eye exam 3 years ago is reading at 10" normal?

My concern is that my RX precriptions is 3 years old and I am pretty sure it has changed, unable to do eye exam because cataract got worse, how do they know my correct RX as of today?

If Dr put my old rx right eye as -2.75 and left eye -3.00 in the IOL for far distance that will be wrong rx, how do they firgure out to make it right? I don't understand that.

I am sure my astigmatism is not accurate now, 4 yrs ago it was -2.50 then down to -2.00 3 yrs ago, what if it has changed?

My husband recently went to see dr and he has early cataract and said He would chose far distance for him. He will wait.

I am confused. near or far.

If I chose far I would not be able to see intermediate distance, like cooking, computer, etc? I would need progressive lens for both intermediate and reading, tri-focal?? bi-focal?? and will not be able to see upclose.

I am just learning.

thank you

Hi softwaredev,

Oh boy, I'll try to understand, is that what dr will use to put on IOL? I have seen my friends IOL cards from 19 to 21 D. Is that how it is measured? not using eye glasses prescription? like -2.75 for my left eye, use -2D for IOL?

I cannot read at 16" without glasses but can read at about 6"-7".

I want to be able to read at computer distance, do gardening, cooking, play card table games, watch tv read closed captioned.

I like to read but have readers glasses if I can get used to it? or wear progressive lens for intermediate and reading.

If I want to be able to see far far infinity then I will loose near upclose at 5"

If I chose near then I will loose far far infinity not as sharp clear as I would like is that true? and will I be able to see upclose at 5" if I chose near? choices I have to make.

I replied to at201 with my concerns about my RX being not update, IOL power will be using my old rx, that is not accurate.

I am not sure what I want, afraid of wrong choice and will not be happy with it. I'm just learning.

Dr will be using Tecnis 3-piece IOL is that good compare to 1 piece IOL? why 3 piece?

Thank you

Hi sue13546,

Thanks for sharing your info, glad to hear that you are happy with the results, what was your nbr D on your IOL card that the dr gave you for you to carry it with you?

RE: now, the down side for distance only lenses, anything closer than three feet i see somewhat blurry. i can cook, look at car dash board, eat my dinner, all things that i need to do. except read a book, or work on the computer. for those two things my near vision is not sharp enough, i use cheap reading glasses

Ok, eat dinner or cook or look at dash board thats 18" from you? so thats somewhat blurry for you? (closer than 3 feet)

Can you ask for glasses for intermediate distance like 18" to 30"? to see clear if you want to? but you said you can cook seeing ok? 18" look at dashboard, eat your dinner but it is somewhat blurry.

I am short 5' tall and for me if I cook it'll be 16-18" eat dinner is 10" I also like to do gardening thats about 24-30"? can you see ok somewhat blurry at that range?

does it not bother you somewhat blurry? do you think vison get better as muscles change to help you see better without glasses? How up close can you see without glasses? How can you see your face in the mirror? with reading glasses?

Were you able to see upclose at 5"-6" before surgery? did you wear progressive lens before surgery?

I do not understand how IOL vision or rx works did the dr put your rx from your eye glasses in your IOL, what did he put down on?

sorry for many questions, just trying to understand.

Haven't read anyone posted with their near IOL choice if they were happy with it or not.

I wish this forum allow to have private message, I don't see where it is.

thanks much for your help,

I think that even though you are used to being able to read at 5 to 6 inches away, practically everyone typically reads books at about 16 inches away and computer screen at 17-18 inches away. Thus, if you choose to get the monofocal lenses set for reading at 16 to 18 inches away, you should be able to read practically all material one encounters on daily basis (this assumes that you don't have astigmatism after cataract surgery). For example, my left eye is set for about 17 - 18 inches distance and I can read practially everything (I have used a reading glass or a magnifying lens only once in the last 3 months to read the very fine print on a tiny eye-drops bottle).

With the eyes set up for 16-18 inches focus distance, you will definitely need glasses to see well anything which is more than about 2 feet away, unless you opt for monovision with one eye set for reading and the other one set for distance (I have this, but it requires some getting used to. So, you may not want to go that way).

As you have found out, most people prefer to be able to see well at distance without any glasses and then use reading glasses when they need to. You can't go wrong with that choice either. But, it is your choice to make.

If you do choose to get the eyes set up for distance, you won't have the best vision at less than about 6 feet, but you will find that most of the daily activities like cooking or watching TV don't require you to have the best vision. If you want to be able to see well down to about 3 or 4 feet as well as at distance, you can set one eye for best focus at about 6 feet.

Your doctor should be able to help you make the choice which will fit your life style the best.

As a side note, in answer to your other question, the IOL power is completely different from your prescription glasses, because the IOL is going to replace the power of the natural lens as well as the prescription glasses. The doctors can figure it out by taking measurements of your cornea, distance to the retina etc.

first off, you do not need to worry about your old eye glass prescription being inaccurate.  the surgeon does not use that to calculate the power of your iol. you will have several tests at the docs office which will help him to calculate the power that he will use.    twhen i use the word blurry , it seems too strong. think not totally sharp. as if up close i see in 144 instead of hd. yes with progressive glasses can see as close of you want to.  .ok.  i rarely have glasses on, unless i'm reading or am at the computer.  i cannot see super close without a magnifying glass.  whatever you can see at before surgery, you need to forget about. if you get a monofocal iol it will focuse at one distance only.  your eyes will not be able to accommodate like when we're young.   yes it's a trade off but before my surgery my best corrected vision with glasses was just 20/60 i could no longer drive at night because of glare from the headlights.. if you choose monofocals for distance, very clear near vision will be lost.  if you don't mind wearing glasses, than you can get progressives to have accuate near vision.  you cannot use my results to calculate wha

oops,   your results will be different.  it depends on your eyes and alot of other variables.  sorry i can't be of more help  sue

yes i can see my face in the mirror from about a foot away. it's just somewhat out of focus.  with glasses on i see fine. sunnyjan, it's just a in lifestyle.  i too loved my close vision.  i could read a book at about 12 inches and do my nails without glasses..... but now i just put on my readers and i can still do those things.  i never thought that i would be eyeglass free and i'm not. but what i gained is so much more than what i lost.  the colors outside are beautiful again..  i know that you will make the right decision for you. let us know how things turned out.  praying for you

The number of pieces of a lens doesn't have anything to do with the optical quality. Usually they use 1 piece lenses inside the capsular bag (the bag where your natural lens was that they try to put the replacement lens in), or a 3 piece outside the capsular bag (if the bag tears when removing the natural lens for instance).

The Tecnis lenses tend to be high quality, though typically they'd use a 1 piece IOL for placement inside the capsular bag. I don't know why they are using a 3 piece in your case, if they think there is some problem with the capsular bag which means it might be placed outside the bag perhaps.

They measure the power of a lens, how strong it is, in units of diopters, which is the "D" that is in the IOL power or is used for glasses or contacts.

Your natural eye acts like a lens, but it actually has 2 major parts you might think of as seperate lenses. Lets call  lens   "A"  the actual natural lens in your eye which has a cataract, and lens   "B"  the rest of the eye. If someone is nearsighted like they are, it means those lenses aren't the right power, and someone gets a prescription for glasses or contacts for a third lens, "C".  Since you have a cataract, they need to replace lens "A" with an IOL.

If you had perfect vision now and didn't need glasses, that would have meant lenses  A and B were the right power (that you didn't need the third lens, C). So if they are going to replace A, with a new lens, they would want the IOL to have the same power as A. The typical power of a natural lens is about 22D (D=diopters), but each person varies.  You can't determine the power of A from the power of your glasses C. If someone has good vision without glasses, their prescription C is 0, but their lens power A is still something like 22D or so. 

 If you wear glasses now, then as long as they are replacing lens A, rather than giving you the same power as A, they can   change its power to give you good vision without glasses. Its sort of like combing the power of A and C into the power of the IOL. The problem is determing what your actual natural lens power is, determining how much of the eye's focusing power is in A and how much is in B. They can't do that with a regular eye test. The way they do that is by taking different measurements of the size of the inside of your eye. They compare it to the measurements of people who had surgery before, and the lens power that worked for them.Your eye measurements won't be exactly the same as anyone elses, but  using statistics they can take a good guess about what power replacement lens would work for you.

So they don't use your current glasses prescription for anything.  The week of surgery they will give you a pre-operative exam some day before the operation and will take measurements of the inside of your eye to try to calculate the right lens power. The question for you is what distance you want the lens to focus at. When people are talking about getting a lens set for say "-1D", they  mean to focus where a slightly nearsighted person would see, which is 1 meter. The actual IOL power is not -1D (it might be perhaps 21D), its merely an indication of how nearsighted you want that eye to be. 

If you don't mind wearing glasses, then there is no wrong choice since you can always wear them afterwards. In general terms there are three general distance ranges: distance, intermediate and near, and the IOL is only good for one of them, and maybe a little bit in another. If you get an IOL set for distance, then intermediate will be a bit blurry and you likely won't be able to see much of anything up close. If you have it set for intermediate, then distance will be blurry but you may see some, and near will be blurry. If you get it set for near, then you may have some blurry intermediate, but likely not see much at distance.  When I say "blurry", how much depends on the person, and the exact distance. You can always wear glasses for the other distances. 

You can set both eyes to focus at different distances, but they can't be *too* different or your brain has trouble combining the two. 

Unfortunately the closer in you set an eye, the smaller the range of good vision. e.g. someone set to have good distance vision might see well from 6 feet to infinitiy, but someone who gets an IOL set to focus well at say 10" might only get 1.5" of good vision. That is a result of the math (which I know many people don't like to deal with).  The point of best focus is distance_in_centimeters = - (100/ lens_power_in_diopters)

So getting set to focus at -0.5D would be -(100 / -0.5) = 200 cm, or getting to focus at -2D would be -(100/ -2) = 50cm.  The reverse calculation to find the diopters for a particular distance is then lens_power = - (100 / distance_in_cm). 

You might have a range of good vision of perhaps 0.5D from the best focal distance (however it depends on the IOL and the person, it might be more like 0.75D for some) . So a lens focused at -2D would give some good vision at -2.5D (or -1.5D going the other way, though there is usually less of a range of vision going outwards than going inwards). 

Hi at201,

Thank you for your info, it helps.

I still have not decide which near or distance. still thinking back and forth near or distance, pro and cons.

Two choices: monofocal IOL for near at -2.25 to -2.50 for both eyes close to intermediate for cooking,read computer, gardening and hope I won't need progressive lens for reading. If I do loose close up vision then get progressive lens for near and glasses for distance from 2 feet to 20 feet? right?

Hopefully I will have 20/20 vision if i choose near. Read somewhere if you want closer / nearer vision you loose good vision distance.

I have a friend who chose near with -2.56 one eye and -3.08 other eye her IOL 18.5D and 19 D and she said eye test, she cant see well at distance out of 5 lines she can see clear 2 top lines bottom 3 lines not clear. That concerns me to choose Near.

re: For example, my left eye is set for about 17 - 18 inches distance and I can read practially everything (I have used a reading glass or a magnifying lens only once in the last 3 months to read the very fine print on a tiny eye-drops bottle).

with that set to 17"-18" do you wear glasses for distance is it good as 20/20?? How good is your distance vision? 20/30? D?

what IOL you use? monofocal?

OR

Go for distance and wear glasses for near and intermediate, and I will miss out close up vision.

Most people chosse far distance so maybe I should go for that and be over with it. I dont know. I drive and would like a good distance vision.

RE: If you do choose to get the eyes set up for distance, you won't have the best vision at less than about 6 feet, but you will find that most of the daily activities like cooking or watching TV don't require you to have the best vision. If you want to be able to see well down to about 3 or 4 feet as well as at distance, you can set one eye for best focus at about 6 feet.

Ok pick one eye set at about 6 feet and what other eye set to be at? and no glasses for distance but still wear glasses for near  and maybe intermediate?

My surgery date is March 9th. I will call the dr to change when I make my decision. It's hard to decide.

Thank you for your info and help.

Thank you, it helps, getting better understanding it, I learn alot, math is hard part, i'm getting there.

I had eye exam they measured few weeks ago, they used Keratometry, Pachymetry and axial length.

Surgery K's 43 and 44 both eyes axial length: od 24.06 mm os 23.93 mm

He did the external exam, (pupil bright 3mm) (last year was 5mm bright, dim 6mm) Slit lamp exam and Fundus exam.

That is what is on my report paper include eye pressure, visual acuity

that was all, hopefully that is what they need to measure my eyes.

Still haven't decide which to go for near or distance, will ask dr to change to -2.25--2.50 for near from -2.50 to -2.75 for computer distance.

OR

go for distance set at ?? for some intermediate vison, and wear glasses for reading, maybe some intermediate? and have a good distance vision, no glasses.

I did not get the # D for IOL from the dr yet.

Thank you for your help.

Thanks for your prayers i need that. still haven't decide yet but almost there I think.

It is always tough to make a decision on something with which one has to live with the rest of our lives. But in this case, at least you know that with good surgery and choice of lens, you may need the help of glasses at certain distances but will be able to see well overall.

Before I answer your other questions, my suggestion will be to pick one of these choices:

a. Get one monofocal lens set for best focus at about 16-18 inches and the second one at about 26 inches. This will require a slight monovision adjustment for your brain, but this much difference is easier to deal with compared with if the second one is set at distance (with the first one set for 16-18 inches). With this combination. you will be able to read, work on the computer, and see quite well to about 3 feet. You will probably be able to see the 20/50 line or the 20/40 line for distance, but will need glasses for distance (all this assumes that your astigmatism is corrected).

b. Get one monofocal lens set for best focus for distance and the second one at about 40 inches. This also will require a slight monovision adjustment for your brain, similar to choice "a". With this combination. you will be able to see well at distance and at intermediate distances down to about 26 inches. However, you will need glasses to read and work on the computer.  ( this also assumes that your astigmatism is corrected).

Your selection out of  the above 2 choices depends on your life style and your desire about when you will prefer to wear glasses.

In answer to your questions about my experience, I had a cataract surgery in my left eye about 18 years back, had the monovision lens adjusted to about 17-18 inches for reading (was used to this with contact lens before the surgery). In the mean time, I had my right eye set to distance with contact lens. (My adjustment to monovision took probably less than 5 minutes, although some people need longer to adjust to it. ) As I grew older, my intermediate vision became worse because of the progressive loss of the natural adjustment in my right eye. But, the only time it bothered me was in very specific situations such as reading  picture description on a museum wall from 2-3 feet away.

I did have a cataract surgery in my right eye also about 3 months back, set for distance using the Symfony lens. It has provided me a better intermediate vision than what I was getting lately with my contact lens. Thus, I am happy with my day vision. However, I have a night vision issue because of seeing multiple concentric circles around lights, as many other people also seem to have. There is a different discussion on that under "Has Any One Else Noticed this Unusual Vision Issue with Symfony Lens." Thus, if you don't mind using glasses for some activities, my suggestion will be to go with monofocal lenses for both eyes.

The diopter power of the IOL itself won't tell us much of use. The issue is how myopic its targeted to leave you.

The average axial length for eyes is about 23mm, with higher axial lengths on average for those who are nearsighted.The axial length is usually what they consider in terms of the potential accuracy of IOl power choice.  Although its possible for lens power calculations to be off for anyone, for low myopes its less of a concern. They tend to have more of a concern for the accuracy of lens power calculation for those who are 25mm or higher, though moreso when it gets up around 27mm or so. One of my eyes  was 25.69 mm and the power was on target, the other was 26.9mm and it was off target +0.5D.

The K's by themselves aren't of much use, the more important issue is the level of corneal  astigmatism in terms of whether or how much correction you need. (you presumably need it, since most astigmatism is corneal, but some is on the natural lens which goes away when the natural lens is removed). I deally they got that  through measuring total corneal astigmatism including  posterior astigmatism in addition to the usual anterior astigmatism. Usually they used to just measure astigmatism from the scan of the front of the cornea, assuming other astigmatism was always too little to worry about. They discovered that sometimes they were left with more astigmatism postop than they expected, and that the issue was they needed to measure posterior astigmatism. Not all surgeons do this yet since not all equipment is up to date to provide accurate measues of that. 

oops, typo.not that it matters but the eye on target was 25.96, not 25.69.

what is it called when they measure corneal astigmatism did I have it done?

maybe I can look for it in my report.