Cataract surgery, how to chose focal distance
 

I'm having cataract surgery in a few weeks, and am having trouble choosing a focal distance for the new lenses. I think I want monofocal lenses, because I have read that they have fewer complications.

Factors affecting my decision:
I've worn glasses since I was 7 years old. I don't mind wearing them; they are part of my identity.
I bicycle a lot. I'd like to be able to get not-too-expensive biking eyewear for protection against sun and wind.
I'm a text-based life form. I read a lot. I prefer paper, but I read on my desk-top, my phone, and my Kindle as well.
I knit and sew, and when I make mistakes, (which is often) I have to do very close work.
I travel, including bike touring for several months a year, and would like to keep the fuss and weight of extra glasses to a minimum. However, I need to read maps, including paper maps.

I'd love to hear what others decided, and particularly would like to hear from people who have regrets about what lenses they chose. I'd also like to hear how you manage juggling glasses during recovery and after.

I've read the discussion on focal distance from a few years ago, but I imagine there are new thoughts and experiences since then.

Thank you!

I haven't had it done yet but definitely is on the radar. When I visited the DMV recently for a drivers license renewal the lady who handled the paperwork suggested I return to the DMV and update the restrictions on my drivers license once the surgery was done. I would then be able to drive without using glasses if I got the version that corrects for distance. It sure would be nice to go back to single-vision glasses for reading and be able to ditch the glasses for driving. She also told me I could be cited for not using glasses if I had the correction and didn't notify DMV of the change.

Thank you!
 

Thank you! I hadn't thought of that.

What does your DMV say about contact lenses? That’s what I wear for “corrective lenses.” How would they know you’re not wearing contacts?

Long story shortened but a vitrectomy in my left eye hastened the development of a cataract by years... the right eye is several years off. I've decided that I want distance vision and can wear readers for everything else. Currently I do need some correction for slight nearsightedness in my right eye and even less in my left. So I do have two pairs of progressive lenses, one clear one sunglasses. They're mainly for use in the car so I can clearly see things on the dash... and on my bike so I can see the bike app on my android. That and I have readers scattered all over the house. Having said that, my decision that monovision wasn't for me is a personal one and may not work for you. Also part of my decision revolved around if I ended up not liking monovision there wasn't much I could do about it post surgery but distance only vision could be easily corrected with readers or progressive lenses.

Also may I suggest that you consider or at least research Laser cataract surgery or sometimes called Refractive laser assisted cataract surgery. Conventional surgery uses a handheld "cutter". The skill of the surgeon, at least for making the cut, is taken out of the equation. The laser also breaks up the old lens. I went that route with the big downside being insurance doesn't usually cover it. With the vitrectomy in that left eye they told me if I ended up with 20/30 or 20/35 corrected vision I'd be lucky. Well I'm either very lucky or perhaps the laser decision helped but my corrected vision in that eye is 20/20. If you decide laser is for you they may tell you that you're not eligible... that's what they told me because I don't have astigmatism or something like that and so it wasn't FDA approved for me. Anyway, I insisted so there are ways around the restriction.

My surgeon gave me a wallet card that states 'Interocular Lens'.
I went with distant focus and my wife went with reading.

Why not multifocal? Function similar to the eyeglasses and cover all focal lengths.

I had multifocal lenses inserted about 7 years ago. Have always considered that one of my better life decisions.

At that time Medicare would only pay for fixed focal length lenses. So I had to pay the difference. Not an easy thing. But it was the right choice. Financially not having to buy glasses has paid for the multifocal implants.

Moved from 50+ to Pills and Ills.

I went through the same process a year and a half ago! I went mono and I still wear glasses with a progressive lense. But it is basically clear with only magnification at the bottom for reading. I bought cycling sunglasses with readers in the lense. As we do a lot of touring this works great for map reading!

I went with distance vision, need glasses for reading, for the following reasons.
My doc favored it, though he offered all other choices. It seems to be the most commonly chosen. So it is likely to be the best understood and supported. You can get reading glasses at the drug store, not distance glasses.

I still wear prescription progressives, though in theory I could drive w/o them and get cheaters to read. But that is a bother, it's easier to just wear glasses all the time.

I didn't need glasses to read previously. One eye was distant, the other near. So it was a bother at first. But a friend choose that bi-optical option and has had problems, some blurring. I occasionally wish I had chosen close vision, but that would just flip the problem to the other side.

One thing I noticed after the surgery, which was over the winter: I'm a birder and commented to my wife in the spring how much brighter some of the plumage seemed on the warblers that year. She reminded me that the cateracts had dimmed my vision and I was noticing the difference.

By the way, check your insurance, they will probably cover a new pair of glasses after the surgery.

My experience transitioning from myopia with -11diopter glasses pre cataract and good vision from 1" to ~6" from
the eye surface was a bad week between one surgery and the next as one eye was now 20/20 from ~3'and the other blurred
from 6" out. After the 2d eye was done both were corrected to 20/20 from 3' out and only 2.75 diopter reading glasses
needed. Over the next 2 yrs the vision drifted to 20/20 at 6' then ~10' out with adequate vision closer in but reading
glasses at 2.75 diopters and computer use 1.75 diopters. I can read my bike computer with uncorrected vision but
generally I wear a set of Rx progressives nominally 0 at top 1.75 in mid and 2.75 at bottom about 90% of the time now.
When looking at TV/movies/concerts/driving/conversation with small group I really don't need glasses and frequently
take them off. I have reading glasses all over the house. Rx glasses pre-cataract were ~$400-600, now they are ~$100.

After the surgery, the Left eye is 20/15 at 20 feet to infinity.
The Right eye is almost 20/20 at infinity and beyond.
So I have bifocals setup with the top section for 2 to 8 feet and the lower section at 17 inches.
In both sections, the Right eye is +1/2 diopter stronger than the left.

I had high myopia both eyes(-12 diopter) and decided to get both eyes corrected for distance. From 50 years on however, I wore contact lenses with mono vision. Meaning, right eye could see far and left eye could be used for reading. I was a big fan of mono vision. So, after the cataract surgery I ask my eye doctor if I could get a contact lens for reading for my left eye and not have to get progressive glasses. He loaned me one for my left eye and the immediate problem is that you cannot change focus. So, I had a fixed reading distance and it was quite limiting. Meaning I was used to being able to see a computer screen and read a book with no problems. With the contact I could read a book, but I could not focus on a computer screen because I sat further back. Lots of things you do close up, require some kind of change in focus. So, I ended up with progressive glasses that allow me focus on things that are within arms reach. Since I had high myopia I was also more prone to retinal detachment, my doctor felt far vision in both eyes left me with the ability to see far if an eye had retinal problems in the future. In terms of the lense replacement type, I also had lenses with blue light blocking. Not sure if it helps, but my doctor felt I needed it.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496098/

I have settled in to using reading glasses for the computer(+1.5). The progressive glasses are not the best for scanning a large computer screen, I play computer games. For close work, I purchased these:

https://www.amazon.com/Donegan-OptiVISOR-Headband-Magnifier-Magnification/dp/B0015IS6K2/ref=sr_1_1?keywords=donegan+optivisor+glass+lense&qid=1567650080&s=gateway&sr=8-1

I have a DA-5 and a DA-7. The DA-5 I use for cutting finger nails, and such. The DA-7 I use for antique clock repair. The DA-7 was based on what I could focus on before cataract surgery. As a high myopia I could see down to an inch in front of my eyes. I could take out splinters no sweat. Make sure you get the glass lens version, they are very good optically.

For riding a bicycle, I use sunglasses with a +1.5 bifocal, that I purchased at Walmart(under ten dollars). It lets me see the handle bars clearly and that is all I need riding. I got a clear pair also for riding at night with my bicycle light. I thought I would like not wearing glasses, but found that the progressive lenses let me do everything I used to be able to do. When driving I want to be able to see the dashboard and what is happening on the road. My wife on the other hand has had perfect eyes all her life and now that she needs reading glasses will not go with progressives. My older neighbors are like this also, they are always looking for their reading glasses when they need to do close work.

Finally, at 3 years out I had to have YAG surgery as I got 'second cataracts'. I was not aware of this condition until after the cataract surgery, when my optometrist brought up the procedure. I hemmed and hawed on getting this done, but in the end it was totally worth it.

Longtime high myopic athlete my whole life, beginning with glasses in the third grade. Had to deal with multiple pairs of glasses, then hard to gas perm to soft contacts beginning fifty years ago in senior year of high school. High altitude mountaineer, big wall rock climber, cyclist... you get the drift. VERY active.

My long time Opthamologist here in Denver also happens to be a highly recognized lens implant surgeon and we've been watching my cataracts slowly 'ripen' over the past five years and this past May, we did my left eye and waited five months to make sure there was no retinal issues. Six weeks ago, we did the right eye, both procedures went very well.

The results are like pure NIRVANA! I opted for distance and am happy and fortunate to say, my eyes are 20/20 with an incredible 60% acuity at the 20/15 line. Of course, I need close in glasses when reading and I used +1.50 readers before, the last few years as my cataracts increased. Now, I'm using +2.00 readers and getting a special pair for the piano, to take into effect some astigmatism.

Bottom line... I need to pay attention to my right eye's further recovery but you can only imagine how ecstatic I am to have said goodbye to contacts and eyeglasses! Plus... my vision is now so clear and crisp... I am glad that I opted for distance correction The readers... I can deal with.

To anyone else needing lens replacement surgery, I wish you the best of success with the best surgeon you can find!

My vision is very near sighted and I’ve worn gas perm contacts forever. In my twenties. I tried soft lenses but couldn’t get the clarity due to astigmatisms.
I was pulled by a city patrolman in my younger days at night for “weaving”........fortunately no alcohol.....just poor driving!?!? He noticed the vision restriction on my license and really quizzed me about not having on glasses.......after doing the alcohol protocol. Probably due to the weaving??? I explained I was wearing contacts and he didn’t believe me. He shined his super bright flashlight in my eye and after a while convinced himself that I was telling the truth. After he left I had to sit for a bit to let my eyes refocus from his flashlight!!!!

My eye doctor has been monitoring my cataracts for a while. I’m probably 2-5 years away from surgery. I’ve been monovision with great success using gas perm contacts. I have both good distance and reading vision with the gas perm lenses. My right eye is used for reading and left eye for distance vision. I haven’t had any depth perception issues on the golf course. But I’m really looking forward to the day I can ditch the contact lenses. When doing overnight bike tours it’s a pain to put in contacts, in your tent, in the dark, with cold hands. While I don’t shoot rifles and shotguns that often anymore, I’d love to have distance vision in my right eye. It would be wonderful to watch television, sit on the beach, ride bikes or go swimming without needing corrective lens. It’s also an issue if you get a very small spec in your eye while riding, playing golf etc. it’s particularly an issue riding in a ground on wet roads with spray coming up into your face. You need glasses to keep the spray from affecting your contacts but you can’t see due to the water on the glasses....

While I’d really like to have distance vision in both eyes I’m just not sure what I will do when it’s time for surgery. I hadn’t thought about getting both eyes corrected for distance and using a contact for reading though. With my success in monovision that might just be the ticket for me though.

Question, for those that have good distance vision in both eyes but need readers, are you able to read the screen on your bike computer without corrective lens while riding? I use Garmins (mostly a 1000) with the slightly larger screen if that makes sense. I was hoping that wouldn’t be an issue if I had corrective distance vision for both eyes.

Not necessarily a recommendation, but here's what I had done about three years ago: I had both eyes done with some sort of multi-focus lenses. Not having to wear glasses all the time (which I had been for decades) is wonderful! I can see distance pretty well, and close pretty well. I can read the car's dashboard, my bike computer, and my phone. Not having to peer through wet glasses on the rare occasions I get caught on the bike in the rain is super. Sometimes, usually in the evening, if my eyes are tired, I have a bit of trouble reading books or computer, so I sometimes rely on reading glasses to help, but this is a fairly low percentage of time. The one "shocking" thing about my lenses (maybe all) is the thousands of little radial lines you see at night from any bright light (headlights, street lights, traffic lights, tail & brake lights, etc.); the brighter, the worse it is. In addition to the radial lines, there are lotsa circular ones too. Eventually your brain is supposed to tune these out; mine is still a work in progress, but better than originally. This has not eliminated night driving for me, but has made it a bit more difficult and tiring. YMMV.

Would I do it again? Certainly.

I have good enough uncorrected vision in both eyes, using my birth lenses, that I can drive without glasses, though I can't see the numbers on the dash nor can I read my Garmin or a cue sheet. For riding, I used relatively inexpensive biking glasses with built-in readers. At 70, I switched to progressive lenses with correction which is of course even clearer. If I hadn't needed correction, I would have continued with the inexpensive bike glasses (Dual Eyewear). If you go with distance, you'll need readers for the Garmin, not "corrective", just readers. OTOH, you might want progressives so you'll have clear focus all the way. That's what I think I'll get when the time comes. Although I might stick with the Dual Eyewear on the bike, custom bike eyewear being so pricey. I'll just have to see.

Just had replacement lenses fitted over the past 3 years, followed by YAG laser secondary cataract removal. I was a minus 23 before, and at the limit of my opticians capability and patience!. He sent me early for lems replacement.
Due to preceived glaucoma, I have a restricted driving license, but in reallity I've never had better vision.
My driving has improved by 20mph,
I have 3 pairs of prescription glasses tp correct for distance, mid range (computer/piano) and readers. All brilliant. Night driving was a problem with glare etc, but has steadily improved over the last 12 months.
I'm very happy with the results. Some eye complaints are beyond the skill of the medics at the moment. But overall, wonderful!

I'd take distance vision because you'll almost always be wearing readers. If you can tolerate mono vision then do it, but be sure to try it first with glasses to see if it makes you crazy or not, I can't work with it, so prefer a surgical correction on distance to 2020 or 2015 and the after healing to get whatever readers are necessary. That way you can drive and bike with K-mart sunglasses or clear biker eyewear at night.

Report back
 

I was > -6 in both eyes. At the recommendation of my eye surgeon, I went with lenses optimized for computer distance, about 3 feet. I am legal to drive without glasses for the first time in my life, though I'd much rather not, and, with some effort, can read larger type at arms length. I still wear progressives pretty much all the time; I have astigmatism, but more important, I feel too vulnerable without my eyes protected. I've been wearing glasses since I was seven, and I just don't understand how people can walk around with nothing between their delicate eyes and the world! I keep 1-diopter-stronger-than-my prescription drugstore glasses around for very close work or very small type, and keep drugstore readers for reading in bed, and am okay with my choice. It's nice to see some stars without my glasses, but I more often find myself wishing for better close-up vision than distance vision.

One thing I hadn't expected: I've been wearing photo-grey lenses for a while, and my new glasses don't get as dark as my old glasses did. They are only border-line okay for riding in bright sun for a few hours, where I rode all day for summer-long tours in the other glasses. I don't know enough about the process to know whether it's because they didn't dip the lenses long enough or because these glasses are so much thinner than my old glasses.

I, too, wore glasses from age 7 until 45 when i had Lasik. I got tired of not being able to read the digital alarm clock two feet from my face -- my uncorrected vision was -5.75 and -6.00. So I put aside some funds into a HSA and had the Lasik. Since I was soooo far out of whack, they opted to err on the side of caution and NOT try to get the correction in just one surgery, lest they go 'too far'. I had one eye done in December, and the other in January (different HSA years ;) ) One eye corrected, and the other wore a contact until it got corrected! Post surgery, 20/40 in one, and 20/30 in the other. After three months, I had the 'fine-tuning' correction that got them to 20/15 and 20/20. Yeah, both done for distance.

A couple of years later, I started to develop the need for reading glasses for close vision - so off to Walmart for a pair of $5 'readers'...

So now at age 60+, I go back to the optometrist, and I'm still 20/20 in one, and 20/25 in the other.

Was it worth it? YOU BET! It also made getting sunglasses much easier!

Cataract Surgery
 

My eyes were done about 8 and 10 years ago; I guess the lenses are better now but my ophthalmologist/ surgeon talked me into paying extra and getting short in one eye and long in the other. I started with long in the left I and was very dissatisfied with my vision; I went to another ophthalmologist who felt the regular Medicare paid for lenses were just as good. I went with the medicare lens in my right eye and the Doc cleaned up my left eye with a laser. My eyes currently correct to 20x15 and 20x20 with reading lenses in my trifocals. If I were to do it again I would not have gotten different focal length lenses as the medicare paid for lenses seem to be just as good. At least when my eyes were done the focal length bit was a scam to line the Doctors pockets. I basically see as well as I did at 16 without glasses except for reading.

I’m coming up on the surgery next week. I’m going for multifocal.

EDIT: Just found out my first eye is moved up a day to Monday. Also, I've changed my selection back to Vivity, an Extended Range type. It does not have any issues with glare or halos. I'll probably need reading glasses or perhaps a binocular loupe for cycle work. My surgeon has me on dilation drops since Friday

Interesting discussion. The information will be helpful when it’s my turn. My cataracts aren’t bad enough but are getting there. I’ve been mono vision using contact lens for a long, long time. But I’d love to have distance vision in both eyes. But mainly I’d love to be able to ditch contact lens altogether.

I had cataract surgery a little over 3 years ago. At the time I anticipated having to do an eye test for the DMV and was concerned I would fail, plus my night vision was getting worse.

As it turned out, I got an automatic renewal, and the cataracts have worked out well, but I would have waited for more advancements otherwise.

I got a modified mono vision. I generally use readers, but I can read clearly at around 18” in my right eye. My vision is less clear at an intermediate distance, but clear at longer distances. My left eye kicks in at 3-4 feet and stays clear at distance. Overall this lets me function at most tasks without glasses.

The only real inconvenience is close up work. Since I’ve been nearsighted since I was 8 years old, I always was able to see small details up close, readers help, but not the same.

John