Cataract - School me on IOL ?

(If you don't get what I'm saying, good for you !)

I'm 49 and I have had a congenital cataract for more than 10 years. I'm now to the point where I badly need bilateral surgery. I just can't see shit.
I'm also shortsighted since childhood and I'm starting to get presbyopia because 49.

I've discussed my options with my surgeon and I've come to this :

The new monofocal implants, like this one, provide great long distance performance while allowing me to read a computer screen or a book without glasses. They have an extended depth of focus compared to the "traditional ones" and perform well down to a distance of 20 inches. They offer the best lowlight perfomance and mostly no side effects (glare etc). So, I would not need glasses most of the time.

The multifocal IOLs correct both myopia and presbyopia, so I may never need glasses again. But, some people (up to 20%) have trouble to adapt to them. They 're more sensitive to low light conditions, contrast is weaker and one may experiment glare and other refractions when driving at night, for instance. But it is supposed to get better with time for most patients. Many patients swear by them, but more than a few juste hate them and can't get used to them.

Monovision or not ? My surgeon's take on monovison procedure is "not for everyone". Some people have trouble to adapt to it and, since my eyes are even in their poor state, I may need some time to get used to balance both eye and get a good distance perception.
A 100% spectacles-free life is not guaranteed either. I may need glasses at night, for instance, or get tired after a long reading session.

I lean strongly toward getting monofocal implants (I don't care if I need glasses to read some small prints as long as I'm glasses free 90% of thge time) and to rule out a monovision procedure (as, basicaly, a poor substitute for multifocal IOLs). Basicaly, I want the best visual acuteness, since that's the whole point of the surgery, and I don't mind to put on some glasses to read a book in the evening.
Cost is not really an issue, here, in socialist France.

Edit : I've heard of some new accomodating lenses, that would rock, but they're fairly new, and I don't like new, in a surgery...

Is there anybody here old enough to have some imput ?

I can't answer your question directly but maybe my experience has some merit. I had pretty bad double vision. It was corrected by prisms in my glasses ( I have been myopic since age 5 and more recently presbyopic as well). However it kept getting worse so that even with the prism lenses there was just enough double vision to blur things at any distance and to interfere with depth perception. Hiking on rough ground was a particular problem, and without glasses I was hopeless. I finally had eye muscle surgery to correct the double vision. When I went home that day I went out into the garden and the world jumped out at me. I hadn't realized how much I missed by not having good binocular vision. Because my vision has actually improved as I've aged I can now drive, use a computer, ski (that's the big one) and read most print without glasses. For finer print I do wear them. This is the opposite of when i was young--when I had to wear glasses except to read.
The point of this long, boring story--for someone active in the outdoors like yourself, I would think monovision surgery would not be a good idea. I think you would lose some of your depth perception. (You should check this out with your doctor; I'm making an uneducated guess based on my experience.) I would say go for an option that gives you good distance vision. It's better to wear glasses to read and maybe use the computer (I don't for the computer) than to use glasses outdoors and driving (and especially skiing with goggles.) Being glasses-free 95%+ of the time has been one of the few good things about getting older for me. The new monofocals sound appealing to me, but as I said, no personal experience with them,

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Originally Posted by old goat

I can't answer your question directly but maybe my experience has some merit. I had pretty bad double vision. It was corrected by prisms in my glasses ( I have been myopic since age 5 and more recently presbyopic as well). However it kept getting worse so that even with the prism lenses there was just enough double vision to blur things at any distance and to interfere with depth perception. Hiking on rough ground was a particular problem, and without glasses I was hopeless. I finally had eye muscle surgery to correct the double vision. When I went home that day I went out into the garden and the world jumped out at me. I hadn't realized how much I missed by not having good binocular vision. Because my vision has actually improved as I've aged I can now drive, use a computer, ski (that's the big one) and read most print without glasses. For finer print I do wear them. This is the opposite of when i was young--when I had to wear glasses except to read.
The point of this long, boring story--for someone active in the outdoors like yourself, I would think monovision surgery would not be a good idea. I think you would lose some of your depth perception. (You should check this out with your doctor; I'm making an uneducated guess based on my experience.) I would say go for an option that gives you good distance vision. It's better to wear glasses to read and maybe use the computer (I don't for the computer) than to use glasses outdoors and driving (and especially skiing with goggles.) Being glasses-free 95%+ of the time has been one of the few good things about getting older for me. The new monofocals sound appealing to me, but as I said, no personal experience with them,

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Thank you for your answer.
Yes, that's my take too. Monofocal IOLs, the same on both eyes. I want contrast and depth perception.
It should be awesome to see where I'm skiing. Flat light days have been a nightmare those last seasons.

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Originally Posted by philippeR

Thank you for your answer.
Yes, that's my take too. Monofocal IOLs, the same on both eyes. I want contrast and depth perception.
It should be awesome to see where I'm skiing. Flat light days have been a nightmare those last seasons.

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Sorry, but they still will be.

I had the IOL surgery 2 years ago at the age of 52 even though I didn't have cataracts.

At our age, we need these implants to just work... a long time. At this time, there is no opportunity for a do over. So, I recommend simplicity and reliability. Don't try to solve focus problems with the lens. Get the best distance vision possible.

I had both eyes done; one was standard and one was toric. The standard eye can see very well. The toric eye is a bit off... the lens position is not perfect. I can see well enough to do everything I want outside without any additional correction.

I work with computers all day, so I do wear glasses that fixes the vision in the toric eye and sets my focus to be optimal for computer work.

As for skiing, my vision, eye comfort and eye health could not be better. I have goggles for bright days and a different set for the more challenging days.

Select the most reliable mono focal lens recommend by your doctor. They are going to last you for the next 30+ years. Good luck and enjoy!

It's on. The surgery is scheduled next week. Left eye on monday, right eye on tuesday.
I'm going bionic.

Absolutely amazing. Abso-fucking-lutely awesome.
As old goat said, the world jumped at me. Had one eye done on Monday and the other one yesterday. Back to work today. Saw my surgeon this evening. Procedure went well (pretty impressive and very psychedelic visual impressions...And a pretty stressful experience ), everything's fine. I'm supposed to be at 2/3 of what my visual acuity will be, a final assessment will be performed in 2 weeks. But it's still mind blowing.
I can see really good from a feet to the horizon. I spent the day reading papers and screens, and working on a computer without the need for my glasses. And everything is so much brighter and clearer, it's like seeing a photoshop with the sharp setting dialed to 11. It's almost too much. To get rid, overnight, of my cataract and my shortsightedness and half my presbyopia at once is life changing,to say the least.
I'm absolutely stoked. Thanks for the advices.

Local anesthetic, eh? You're a braver man than I am. Hernias, OK, but not for the eyes for me.
Biggest problem for me after wearing glasses for 60 years, all day every day, is that now I keep losing them when I put them down.

Very cool.

Bumping this because I’m about to have this done next month. My left eye was about 2+ out of 4 in whatever units they use to measure the cloudiness. I hope I got that right.. Anyway, it had become so difficult to see, even after correction. So, I can get my astigmatism fixed, as well, at the same time, for about $5K per eye and insurance doesn’t cover that. Fuck yes I’ll do it! I’m so sick of glasses. It will so good to be able see without wearing glasses, and in particular, be able to wear ski goggles without glasses!

As long as I don’t get blinded in the operation, that is.

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Originally Posted by billyk

Bumping this because I’m about to have this done next month. My left eye was about 2+ out of 4 in whatever units they use to measure the cloudiness. I hope I got that right.. Anyway, it had become so difficult to see, even after correction. So, I can get my astigmatism fixed, as well, at the same time, for about $5K per eye and insurance doesn’t cover that. Fuck yes I’ll do it! I’m so sick of glasses. It will so good to be able see without wearing glasses, and in particular, be able to wear ski goggles without glasses!

As long as I don’t get blinded in the operation, that is.

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Good luck with your surgery. (How much extra would it be to get the lenses that let you see through women's clothes like they used to advertise in the back of comic books?)

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Originally Posted by old goat

Good luck with your surgery. (How much extra would it be to get the lenses that let you see through women's clothes like they used to advertise in the back of comic books?)

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I’m tortured enough by the fair sex 👀

One revelation to me from this process is how damaging dry eyes are. The doc says my eyes are like raisins and they need to be grapes. Wish the optometrists that checked my eyes over the years had mentioned that.

Had surgery on Friday on my right eye, so this is my third day post-op. Left eye will be done in a couple weeks. They usually like to do them separated by a week, but I fell into some scheduling hole. I took a lens out of my glasses to get by in the meantime.

I’ll give some details in case anyone is considering this, and you can feel free to mock my choices :-). I elected to do toric Symfony lenses, which give improved midrange focus. It was an extra cost option over single focus toric lenses, but what the heck. Don’t fully understand how they work, except that they use a diffraction grating to extend the focal range. I’m seeing 20/20 from infinity down to about 15 inches or so. Closer than that is still blurry. Working on the computer is fine, and if I hold my phone a little farther away than I’m used to doing, that works, too.

Doc says he’s going to pull the focus of my left eye closer, so I guess that’s what’s called monovision? Well, I hear the arguments about depth of field loss, but that’s where I’m headed. I’ll let you know if I have any regrets.

Surgery went very smoothly. They have it set up like an assembly line, cranking the old folks through like clock work. Was awake for the whole thing, which took maybe 10 minutes. He had me watch a particular light, to keep my eye steady. There was no pain, since they gave a bunch of numbing drops. They also gave me a pill to help me relax, and sleep afterwards. Not much pain afterwards, either, a little but not much. Kind of a dull ache at times.

One of the last things they did was give me a drop that caused my pupil to constrict. That’s supposed to help center the lens, and restrict the light going into the eye initially. Indeed, vision in my right eye is much darker, and yellow/brown colored compared to my left eye. In my next day follow up visit, the doc explained that was normal and should clear up in a few days. That was a couple days ago, and it’s improved a little, but still a ways to go.

All in all, though, happy so far. Came dangerously close to buying a $500 pair of sunglasses at the mall.

About two weeks post-op on my second eye now. The “constricted pupil” problem that I talked about in my previous post went away right at 5 days, which my doc tells me is the way they like it. I’m still amazed that an eye drop can affect your eyes for so long, but I guess they know what they are doing.

Distance vision was good right from the start, 20/20 for my right eye and 20/25 (or is it 25/20?) in my left eye from infinity down to about 18 inches or so. He shifted the prescription for the left eye a little closer to give me better near vision with that eye. So far, I’m not really seeing that yet, at least at close range. I can read my desktop computer screen fine, but struggle reading my phone or laptop. Sometimes it is pretty clear, but gets blurry after a short while. Doc says it can take up to 3 months for my vision to settle. Then, I guess we will see if I need prescription reading glasses. In the meantime, I’m using some cheap readers from Walmart as needed, but those are blurry crap. Really enjoying the clear distance vision, though.

I passed on the $500 Tom Ford sunglasses I was eyeing, and opted for Maui Jim’s. Liked the technology behind them. Of course, my wife pointed out the $3 sunglasses at Home Depot, and wondered why I couldn’t have bought those.

$5000 for the astigmatism? that's an outlyer?!

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Originally Posted by CTR

$5000 for the astigmatism? that's an outlyer?!

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Not just astigmatism. Toric lenses fix astigmatism. The multi focal lenses ( in my case Symfony Toric) is what costs extra. And I didn’t do a lot of price shopping. It’s possible you could get it for less. I went with a doc that was pretty highly rated, so it probably did cost more.

You can get fixed focus IOL lenses for less, but then you definitely will need glasses.

Had my 1 month post surgery checkup today. My vision has actually gotten a little worse. Doc said it is due to scar tissue that is forming, and that is normal. After 3 months, they will zap off the scar tissue using a laser and make any necessary fine tuning that needs to be done at no extra charge.

I mentioned “multifocal lens” in a previous comment. Actually, there are three general types of IOL lenses that provide more that just single focus. These are multifocal, adaptive, and “extended depth of field”. The Symfony lenses that I got are in this latter category, and so far the only example of this new type. It uses a diffraction grating to correct chromatic aberrations which somehow translates to being able to focus at both distance and intermediate distances at the same time. I still don’t fully understand the physics behind it, but it is pretty cool.

Except that it does have its limits. Reading at close distances may require reading glasses, no matter what.

Well, I’ll update in a few months after everything settles out, and the final adjustments are made.

Another update on this, and maybe the final one. When they remove the original lens and replace it, there’s a membrane at the back of the lens that is left in place to help hold things together. Well that essentially dies, since it is no longer being supplied by the lens that got removed. So it gradually accumulates scar tissue and turns cloudy.

So, at about 3 months, if everything has stabilized, they remove that membrane by zapping it with a laser. I had that done about a month ago. It did help clear things up quite a bit.

I have to say I can see most things pretty clearly. I can see 20/20 at distance, and I can see well enough to read my phone (which was not the case before they zapped the membrane).

On the other hand, it is not what I would call crystal clear perfect vision. My sight keeps shifting from being clear to being blurry. Kinda how I remember wearing contacts was, if you can relate to that. The doctor says it is due to dry eye. However, the drops he has me on doesn’t seem to make much difference as far as I can tell.

Not a huge deal. I’m still glad to be free of glasses. But something to consider if you are thinking about doing this. Or, maybe you’d have a different experience.

Anyway, that about wraps up this from me.

Back to this. I have a family member in their mid 50s about to get cataract surgery in a few days. Terrible vision their whole life so the lens replacement should be amazing for them, to say the least. Knock on wood.

They are going for the light adjusting lenses - LALs. Essentially the lenses get implanted and then have 3-4 zapping sessions of UV light over a few weeks. The zapping sessions allow the lenses to be perfectly dialed in. Only kicker is that you can't expose your eyes to UV light till they are finalized and set. 4-5 weeks.

They have ski trips planned during that 5 weeks. They give you UV light blocking glasses but they are huge and won't fit under any OTG goggles I have found on amazon. So, anybody dealt with this? Any ideas? Anybody dealt with this before?

- the glasses manufacturer, cocoons, makes googles that are supposed to be UV blocking. Not medical device rated though I don't think. Any info or experience?
- anybody know of any huge over the glasses goggles that would work with wrap around glasses?
- anybody done this surgery or know anything about it and can give advice on a ski trip being a good or bad idea?

Thanks. They are super nervous - for understandable reasons, obviously. The cataract eye docs are not that familiar with a 50 year old that is so aggressively outdoor active, even in Boulder, so it's hard to get good advice. SO I figured I'd come to the dentists here.

Why don’t they just ski in the wraparound glasses? This seems like a non issue if they’re set on skiing.


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Originally Posted by MagnificentUnicorn

Why don’t they just ski in the wraparound glasses? This seems like a non issue if they’re set on skiing.

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Utah/Colo in Jan/Feb can be pretty tough in glasses - cold, wind snow, etc. And regardless of what the literature says, it's too easy to get blasts of sunlight past wrap around glasses on a full sun day at 12,000 feet I'd think.

The literature says you are even supposed to wear the UV blocking glasses (a clear version they also give you) inside and only take them off for sleep and showers.

Also, big glasses, small face and nose - I'm betting they won't stay on well skiing.

If it’s that critical why don’t they wait until the doctor gives them clearance?


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Can't have their cake and eat it too, I would suppose. Either postpone the surgery or the trip. There's not really a good way around it other than making sure they have an adequate UV protection lens in whatever goggle they have, wear it until inside the lodge, put on glasses when goggles aren't on.

It’s only their vision, no big deal


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