Cataracts and choices

[Jeff Bartley]

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

[Maurice Mcmurry]

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.

[Alan Rutherford]

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.

[Jim Allen]

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.

[glenn bradley]

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.

[Alan Rutherford]

... 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?

...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.)

[glenn bradley]

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?

A coworker was talked into this by his lasik guy and has been unhappy ever since. It is not unusual to see him with his hand over one eye or the other depending on what he is looking at. If you are lucky you can have your lasik tweaked after a decade or so. Not so much with implants.

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.)

Lens degeneration certainly contributes to our declining eyesight. An implant removes this decline. If only that were the only thing that started to show the effects of father time . If you are unfortunate enough to have blood sugar issues retinopathy can be problematic. Macular degeneration, muscle atrophy, macular edema, and pressure (glaucoma) are some common issues for the rest of us as time goes on. Your inter-ocular implant does nothing for these.

My point is that an aggressively corrective implant can become problematic as we age. Trying to correct the previously mentioned issues if they come along is bad enough. Trying to prescribe glasses that you have to wear over what are essentially permanent glasses just makes things more tricky.

I'm not trying to convince anyone to do or not to do anything. I just have a knee-jerk reaction to some things growing up the son of an eye doc. Your reliable medical professional is still your best option for answers to these questions. The sales clerk at Ernie's 1-hour LASIK . .. not so much.

[Chris Parks]

A coworker was talked into this by his lasik guy and has been unhappy ever since. It is not unusual to see him with his hand over one eye or the other depending on what he is looking at. If you are lucky you can have your lasik tweaked after a decade or so. Not so much with implants.

I reckon I was nearly legally blind before I had the first cataract done and before the operation the doctor mentioned he would like to correct my vison in the eye for long distance and give me a corrective contact lens for the other eye for reading. At that time mono vision was a fairly new thing but I thought about it for about one second and said yes as nothing was irreversible. I took to it like a flock of ducks to swimming and have never regretted it at all and my second cataract was set up for reading, twenty years down the track and I have never regretted it but I can put a corrective lens in my reading eye and wear reading glasses if needed as mono vision destroys depth of field to some extent and fine jobs like soldering can be a bit tricky. It is a good option but only after testing which could be done using lenses.

[Barry McFadden]

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....

[Jeff Bartley]

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?

[Jim Allen]

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.

[Jeff Bartley]

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.

[Alan Rutherford]

.. 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.

[Jeff Bartley]

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!

[Alan Rutherford]

... 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.