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Thread: Cataracts and choices

  1. #1
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    Cataracts and choices

    Apparently we all get cataracts. Some get them later in life, others earlier. I guess I’m in the earlier camp as mine were diagnosed about 5-6 years ago. At first I didn’t notice a deference in vision but over the last two years I have given more consideration to having the surgery.

    But with the surgery comes choices: which lens and what surgery? The surgical choice is a blade or a laser. The lens choice is much broader. There are single focal lenses which correct for either distance clarity or close up clarity and there are the multi focal lenses that correct for both but come with some side effects, like halos around lights at night.

    I am hoping others here can share their experience with cataracts, especially anyone who has had multi focal lenses. I have no first hand accounts of that experience. I will admit that I’m terrified to have my eyes operated on but I’m actually more terrified of choosing the wrong lens. I’ve been told that it’s a bad idea to do cataract surgery twice.

    Please don’t be shy about sharing your cataract stories and if anyone has one but doesn’t want to share it to the world feel free to DM me. I have about a month to make the final choices for my surgery, I’m scheduled for early Dec for the first eye.

    Thanks! Jeff

  2. #2
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    Mine was a laser operation. I did not go for corrective lenses. The world went from yellow and hazy to clear and bright. Sort like the difference between a Van Gogh and an Ansel Adams. I am a year out and still having a lot of sensitivity to dust and brightness. I also have a little tremor that is triggered by fatigue, dust and brightness. I am back to needing reading glasses.
    Problems with glare and halos in the car at night are solved. The young man that did mine does up to 30 a day twice a week. They move patients through like cattle. The operating room and equipment are awe inspiring.

    Best wishes on your procedures.
    Last edited by Maurice Mcmurry; 10-08-2022 at 11:21 AM.
    Best Regards, Maurice

  3. #3
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    I had the Vivity extended-focus (or whatever they call it), higher-priced lens put in my right eye a year ago and I'm not happy. Cataracts were stage 3 in both eyes but not a big problem for me, except for target shooting. I was somewhat nearsighted and used cheap reading glasses but could get by without them. Indoors, outdoors and driving I was OK except at large distances. Now that eye has excellent vision at infinity but is worse everywhere else. I can't read without reading glasses. The cataract is gone and colors are now more accurate in that eye but frankly I like the slightly warmer colors I see with my left eye. I feel worse off than before the surgery.

    I'm right-eye dominant, right-handed and shoot a pistol with iron sights. I had some astigmatism in my right eye and as cataracts got worse I found I could shoot better with my left eye several years ago. The astigmatism is now gone - that's a plus - but I'm still shooting with my left eye because otherwise I would need corrective lenses to focus on the sights.

    I don't know how much better the range of focus of this lens is compared to the cheap ones - if any. The lens doesn't actually change focus. I believe the muscles you use to change the shape of the lens in your eye for focus are no longer functional after the surgery. I couldn't get a clear description of what the lens actually does. I wish I had tried harder.

    IMO for those of us who spend most of our life indoors, or at least not looking at the horizon, good focus between about 3 feet and 20-30 feet gets you through the day with the least hassle and you can still read street signs and use cheap reading glasses when you need them. I can't tell you how to get there from where you or I are. I'm not sure what I'm going to do with my other eye.

    PS: If you really want some opinions, head out to the gun range. Lots of old guys who have a lot to say about eyes. Also prostates, but that's for another day.
    Last edited by Alan Rutherford; 10-08-2022 at 1:00 PM.

  4. #4
    The mistake I and the Dr. made was to correct my vision, wasn't given a choice. I was near sighted, had worn glasses for 50 years, and loved the fact that if I wanted to see up close I'd just take my glasses off. That all changed, I still wear glasses almost all the time (because I like to see everything), and if I want to see up close I reach for my +4 reading glasses or a magnifying glass.
    Assumption is the mother of all screw ups
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  5. #5
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    I am not a doctor. I am simply regurgitating what I have learned from my father who has been involved in cataract surgery since it was an in-hospital procedure. Large grain of salt rule applies . First, do not take any advice from someone who is not an ophthalmologist with a history of thousands of cataract operations under their belt. No offense if we have any members who are OD's but most optometrists are poor at pathology and should not be your recommending agent either. Your OD can certainly refer you to someone for that assessment.

    Like plastic surgery and dental implants, lasik and other eye work yields big bucks for some shysters. Inter-ocular lenses are not contacts. They are not glasses. They are replacements for your natural lenses. It has become common to do a very slight distance correction today. Using the IOL's in place of glasses or contacts is not the norm. Higher degrees of correction in IOL's would be in rare and specific situations where the downside would be outweighed by the benefit.

    I was also ahead of the curve for cataract surgery by about 10 years due to specific circumstances. The rapidity of vision change varies with us all but, generally our vision declines more rapidly as we age. You can see how putting a highly corrective inter-ocular lens in someone 65 years old would make things more and more difficult to correct at 70, 75, and 80. It would be like getting lasik at 30 . . . you now get to correct around the surgical correction for the rest of your life.

    Get multiple opinions. Do not shop for bargains. The current state of technology does not allow second chances for eyeball mistakes. Don't shop the clearance rack for brain surgery, eye care, or parachutes.
    Last edited by glenn bradley; 10-08-2022 at 12:32 PM.
    "A hen is only an egg's way of making another egg".


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  6. #6
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    Quote Originally Posted by glenn bradley View Post
    ... Using the IOL's in place of glasses or contacts is not the norm. Higher degrees of correction in IOL's would be in rare and specific situations where the downside would be outweighed by the benefit...generally our vision declines more rapidly as we age. You can see how putting a highly corrective inter-ocular lens in someone 65 years old would make things more and more difficult to correct at 70, 75, and 80.....
    Several people have told me about the option to have one eye focus closer than the other to give a better range of vision without glasses. I would think the simple lenses could be selected to focus at any distance desired - whether that's a good idea or not. Are you saying that's not done?

    Quote Originally Posted by glenn bradley View Post
    ...generally our vision declines more rapidly as we age. You can see how putting a highly corrective inter-ocular lens in someone 65 years old would make things more and more difficult to correct at 70, 75, and 80.....
    I'm not a doctor either but I thought the decline in vision was from a loss of elasticity in the lens with age making it more difficult to focus up close. Also cataracts of course, but with implants they're permanently gone. If that's correct about the reason for decline in vision I don't see why the correction of a lens implant at 65 would be a mistake by 80. (I crossed that bridge years ago, but I still want to understand what's going on.)
    Last edited by Alan Rutherford; 10-08-2022 at 3:03 PM.

  7. #7
    I had cateract surgery about 10 years ago...the knife type not laser. I was at the point when a car was coming towards me at night I would see about 10 headlights instead of 2. I went for upgraded lenses which had better night vision. The scary part for me was being fully awake when the surgery was preformed! I was much more comfortable with the second eye since I knew how it was going to go. I could see halo's around lights for about a week or so and as the surgeon said....it is the eye seing the edge of the lens that causes this.In a week or so your brain decides this edge of the lens it sees is now normal and ignores it and no more halo's....

  8. #8
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    Quote Originally Posted by Jim Allen View Post
    The mistake I and the Dr. made was to correct my vision, wasn't given a choice. I was near sighted, had worn glasses for 50 years, and loved the fact that if I wanted to see up close I'd just take my glasses off. That all changed, I still wear glasses almost all the time (because I like to see everything), and if I want to see up close I reach for my +4 reading glasses or a magnifying glass.
    Jim, it’s not an option to correct or not correct your vision with a IOL, the choice is what focal range, either for distance or close up. The other option is the multi focal lenses that cost much more.

    It sounds like yours correct for distance?

  9. #9
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    Thanks for the responses guys! Keep them coming! Allen, was the lens you got multi focal? I’m sorry you feel worse off, that’s literally what terrifies me about having the surgery.

  10. #10
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    Also, a couple points to clarify for those that haven’t had to think about this. The surgery itself is done with either a blade or a laser. In both cases they completely remove your natural lens through a small incision. The incision is made with either a laser or a blade. Whichever is used the IOL (interocular lens) is then inserted through the same incision.

    Then your choice of lens determines if you’ll need glasses post surgery. Lenses are either simple with one focal range (close up or for distance), multi focal (which work sort of like bi or trifocals), or the third option is called monovision where one eye is corrected for distance and the other is corrected for close up. They say only 20% of the population can make that work. I tried it with contacts and didn’t like it, especially when riding mountain bikes at high speeds through the rocks. The depth perception was just not the same.

    And I think what Glen is pointing out is that eye surgery is easier with younger eyes. I’ve seen two ophthalmologist and both encouraged me to get mine fixed sooner than later and mine are 2’s.

    Also, Maurice, it sounds like yours were corrected for distance as well.

    Again, thanks for the discussion and kind words!

  11. #11
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    Quote Originally Posted by Jeff Bartley View Post
    .. Allen, was the lens you got multi focal?...
    When I asked that question after the surgery the answer was "no" but that's not the impression you get. The doctor's handout says "Correction for residual astigmatism and distance, intermediate and near vision." The manufacturer's website says "The Clareon® Vivity® IOL helps your patients take advantage of enhanced vision where they need it most. By harnessing the power of non-diffractive X-WAVE™ Technology, the Clareon® Vivity® IOL delivers monofocal-quality distance with excellent intermediate and functional near vision." An FDA document describes it as "Extended Depth of Focus Intraocular Lens".

    I believe no lens can be truly multifocal without moving parts and/or the use of those muscles in your eye but different parts of the lens can focus at different distances and they say you adapt.

    I'm arguably better off now, happy or not. The cataract and astigmatism are gone and distance vision and color are excellent in that eye. But I'm peeved, really peeved, that I can't see what I'm writing here clearly without glasses and I could before. My eyes were fine for driving before and other than driving if I really want to see something sharply at a distance - that's what binoculars are for.

    If you can afford the higher-priced lenses I'd think you have little to lose compared to the cheaper ones even if they don't live up to the hype, but ask lots of questions.
    Last edited by Alan Rutherford; 10-08-2022 at 3:51 PM.

  12. #12
    Quote Originally Posted by Jeff Bartley View Post
    Jim, it’s not an option to correct or not correct your vision with a IOL, the choice is what focal range, either for distance or close up. The other option is the multi focal lenses that cost much more.

    It sounds like yours correct for distance?
    You're right Jeff I was left with 20-20 vision, my surgeries were over 20 years ago, I don't think multi focus lenses were available then. I wasn't given the option of focal range. At the time I was still working and did a lot of closeup work and I missed being nearsighted.

    I was in my sixties and my eye sight hasn't changed much since then.
    Assumption is the mother of all screw ups
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  13. #13
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    Quote Originally Posted by Jeff Bartley View Post
    ... riding mountain bikes at high speeds through the rocks....
    I think that's an excellent example of a situation where you want your best vision to be at an intermediate distance.

  14. #14
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    I had them a couple years ago, and get the best implants you can afford, and if given the choice, purchase an upgrade.

    You will also have a choice on the focal length of the implanted lens. I elected for long distance and still wear glasses for reading.
    Regards,

    Tom

  15. #15
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    Agree with the recommendation to only take advice from an expert but anecdotal evidence can help you know what questions to ask. I had cataract surgery 12 years ago (I'm 73 now) and went for the more expensive multifocal lenses and have no regrets other than wish I could have done it decades ago. I was very shortsighted and wore glasses from grade 7. My prescription glasses were getting to be around a thousand bucks every few years. Not sure about other lenses mine have concentric focus rings and somehow the brain learns which ring to look thru for different distances. At the time my prescription was at the limit for the lenses I selected. When it comes to reading fine print I do miss my myopic days when I could take off my glasses and focus an inch away and read anything and my mid range, like reading things on the dash when driving or using a computer isn't perfect but I get by. I have computer/reading glasses but rarely need them. I do see halos around lights at night and avoid night driving as much as I can but when I need to, I can see well enough to drive safely. That said, a friend recently had a bad experience with halos and after a few weeks had the multifocal lense removed and went the mono focus route with one for distance and one for close up. He said he saw halos 6 ft in diameter. When I was still wearing glasses I also wore contacts for sports like skiing, I recall trying the one lense for distance and one for close up system without success, don't recall why.
    My surgeon was one of the pioneers in the field and per his website has done over 70,000 procedures.
    Last edited by Doug Garson; 10-08-2022 at 7:26 PM. Reason: spelling

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