Need advice on IOL for cataract surgery

[Mike OTDP]

I'm facing cataract surgery in the near future. Left eye first, right eye most likely in a year's time. The problem being picking a lens.

Both eyes have refractive errors. Left eye has a small amount of astigmatism, right eye a significant amount...enough that if I read without glasses, my eye hurts after an hour or two.

Right now, I'm looking at two options. One is a toric lens, which will correct for the astigmatism but leaves me unable to focus (need glasses for close-up work). The other is an adaptive lens (NOT a multifocal), which adjusts to focus for distance but doesn't correct for the astigmatism. My surgeon says the right eye (sighting eye) is marginal for an adaptive, but within limits. He also recommends going with the same type of lens in both eyes.

Tricky part: I'm a very serious competitor in the precision pistol disciplines (black powder, up to the International level). Iron sights only. So I need the maximum possible precision.

Suggestions welcome. Thanks.

 

[dirtman]

Gonna have to watch this thread as i am getting both mine done in the next month or so.... I have been leaning towards distance lens and using 1 power reading glasses on right eye for sighting...

 

[scaatylobo]

I'm facing cataract surgery in the near future. Left eye first, right eye most likely in a year's time. The problem being picking a lens.

Both eyes have refractive errors. Left eye has a small amount of astigmatism, right eye a significant amount...enough that if I read without glasses, my eye hurts after an hour or two.

Right now, I'm looking at two options. One is a toric lens, which will correct for the astigmatism but leaves me unable to focus (need glasses for close-up work). The other is an adaptive lens (NOT a multifocal), which adjusts to focus for distance but doesn't correct for the astigmatism. My surgeon says the right eye (sighting eye) is marginal for an adaptive, but within limits. He also recommends going with the same type of lens in both eyes.

Tricky part: I'm a very serious competitor in the precision pistol disciplines (black powder, up to the International level). Iron sights only. So I need the maximum possible precision.

Suggestions welcome. Thanks.

Sorry but I do not recall the name of the lenses that I had done,about 4 years ago.

Had both eyes done and the left is for close up,the right for distance.

I can state without a doubt,that I see better now than I did 40 years ago..

Still suffer badly from eye watering and have tried so many different drops that I lost track,on Restasis now for a while and not much better.

BUT, now I can shoot AND read without any scripted glasses.

I had other eye issues that compounded my issues,Keritikonis in the left eye.

And surgery implant to fix that before the eye work.

LOVE the results,I drive at night,ride a Harley,shoot and hint with no scripted glasses.

Best wishes to you.

My Dr. is Fichte ,Elmer & Endle in Niagara Falls .N.Y.

If that helps.

Wife is getting her's done this month !!

 

[Jim Watson]

The usual approach is distance implants, reading/shooting/computer/tv glasses.
I know one shooter with sight focus implant in the right eye, distance left, but that is not very common. Although I do know a lady with reading left, distance right, which makes it hard for her to shoot.
I don't know anybody with accommodating implants, although I listened to a sales pitch by an ophthalmologist who offers them.

In my youth, I was myopic; clear reading, distance Rx. I have toyed with the idea of near implants and distance glasses, but I bet the ophthalmologist would try to talk me out of it. Ought to be a while before I have to decide, I was just showing pre-cataract lens changes this Spring.

 

[edwardware]

I think you need to shop around and find a good optometrist to talk to, someone willing to think through the physics of focal depth and astigmatism with you (better: a competitive shooter!).

I just started wearing contacts, and it's nearly ruined my ability to focus on the front sight with reasonable target definition. I'm trying the third optometrist in January, hoping to find someone who will problem solve with me instead of just plugging in the standard solution.

 

[bgw45]

Since I couldn't get any convincing surity that lenses would work with my eyes ( glaucoma ), I opted for the toric solution. I reconciled with the "shooter/readers". I'm not a gambler. I'm not 27 any more. Works for me. Just my experience.

Blessings on your decision

 

[shootist2121]

Had similar issues..The surgery left me going from left eye dominance to right.. I can see at moderate distances well, but was left using glasses for night driving and reading glasses for close up.. With out glasses I can really see my sights.. Target is blurry as it should for target work.. Hope yours goes better.

 

[Mike OTDP]

As it happens, I just got back from the doc who will be doing the surgery. He told me that while I have astigmatism in the right eye, it's not enough to make a toric worthwhile. He can fix the nearsightedness, but best performance will require glasses. OTOH, I've worn those for 45 years. My current thinking is to go accomodative (Crystalens), set up for distance. Then correct with glasses for astigmatism, and reading glasses for close-up work (the accomodative lens isn't as good as young eyes).

 

[entropy]

As it happens, I just got back from the doc who will be doing the surgery. He told me that while I have astigmatism in the right eye, it's not enough to make a toric worthwhile. He can fix the nearsightedness, but best performance will require glasses. OTOH, I've worn those for 45 years. My current thinking is to go accomodative (Crystalens), set up for distance. Then correct with glasses for astigmatism, and reading glasses for close-up work (the accomodative lens isn't as good as young eyes).

That's exactly the solution I was going to suggest.

 

[joed]

I'm scheduled for surgery shortly so I'll be watching this thread closely.

 

[Jim NE]

I had the Toric lenses put in both eyes for cataract surgery about four years ago. I can not - and will not - speak to their effectiveness for competitive shooting, as that wasn't on the list of my concerns regarding my eyesight, and I'd hate to mislead you in that respect. Having said that, they are the closest thing to a medical miracle that I've ever experienced in my life (so far.)

I was in my mid fifties when I got the surgery, and had been wearing glasses for 40+ years. From junior high on, my eyesight kept getting worse and worse due to astigmatisms, but my ever changing (and thickening) lens prescriptions more or less kept up with my changes. When my cataracts developed, I couldn't pass the unrestricted driver's license eye exam, so my license was slightly downgraded (Mirrors required on both sides of the car - no big deal.) So you're talking about a person that had about 20/200 or more uncorrected vision in his worst eye, and hardly better in his best eye - legally blind by some definitions. I can't remember what my corrected vision was with cataracts, but I'm thinking about 20/50, as they won't give you a license if you're worse than that.

My eyesight NOW, uncorrected, is 20/25 in one eye and 20/30 in another eye, so yes, I need glasses to be at 20/20, but I can drive without glasses pretty easily during the day, and even at night, though my night vision is greatly improved with glasses. The mild prescription I now have in my glasses gives me the best vision I've ever had in my life: 20/20...hence, the miracle. For people with a history of terrible eyesight due to astigmatism, Toric is amazing.

Drawbacks: You need reading glasses; your eyes will no longer adjust to close up work, but my eyes are about 28" away from the computer screen right now, and I'm not needing readers. Also, I had issues with the steroids they give you in recovery, but that's rare in most cases. If you don't need sunglasses outside now, you may after the surgery, but that's the cataracts...they darken your natural vision. Consider that for outdoor competitions. Hopefully your eye surgeon told you that cataract surgery leaves you at a higher risk for detached retina - a potentially dangerous condition. Could be an issue with some high power rifles with heavy recoil. Also, one of my eyes sees a little better at close distances than the other, and the other sees a little better at medium distances. That may be by design...I can't remember, but I think - with the close up vision issues - they sometimes try to give each eye a range of vision slightly different than the other to compensate.

My grade for the Toric: A+++++, but I don't know what to say to a person who has a very specific set of vision needs, like a competitor. However, four years on, and I'm still blessed by the surgery. Still working great.

 

[Hoppes Love Potion]

Ask your doc about the CrystaLens. This and the Toric lens are both "accommodating IOLs". One may serve you better than the other.

 

[Mike OTDP]

We discussed it. Turned out that we miscommunicated the first time, I'm not a candidate for a toric IOL. There's not enough astigmatism. I will need glasses to take that out for maximum acuity. I've worn those since I was eight - not a problem, especially when shooting a muzzle-loading pistol (my specialty). When I get the right eye done, I'll still need glasses for close-up work. Again, score that as break-even.

 

[ms6852]

I am almost in the same boat as you and my ophtamalogist recommended that since I like to shoot and use iron sights to use reading glasses for close up stuff and take care of my astygmatism for long distance and iron sights. I have not decided yet. But the glasses he gave me prescriptions for are for long distance and it helps, and also driving at night. Something to consider.

 

[Jim Watson]

Very interesting.
If I could get enough depth of field to see from sights to target, I would not mind reading glasses.

 

[Tinman357]

Just had my right eye done on 3/13. Last Tuesday. went from 20/200 with cataract to clear vision, no glasses at all. Now that eye is 20/15. Full vision. Crystal clear and sharp from 10 inches to as far as I can see. Irons clear, pistol and rifle, red dot clear. Crystalense implant, multifocal. Slight ring around lights at night. Not an issue.

It's hard to articulate the difference. I'd compare it to an old cassette Walkman to the New York Philharmonic, live. it really is that much better.

The lense alone was $2200.00. Worth every penny. Getting the left done next week. Hoping for the same result.

OP.... pm me for contact info on the Doctor.

 

[Jim Watson]

Thanks. I was talking to a guy last week who was very pleased with his multifocals. Seemed to be in the minority.

 

[Mike OTDP]

Update...had the left eye done two weeks ago. Wound up having to change doctors. Second doc recommended a monofocal IOL - he said the accommodative lens currently on the market has a reputation for not settling to a consistent level. "The gift that keeps on giving" was his exact phrase. OTOH, he took care of the astigmatism. In theory.

Right now, the eye is 20/30 at distance, with some astigmatism. But it takes months for everything to stabilize, I'm told. Possible tune-up LASIK. Compared to what I had, it's fantastic. But I'm going to hold off on the right eye until after the shooting season, then take stock. The right eye is correctable to 20/20 at diatance, though everything has a yellowish tinge to it. OTOH, close up I can see individual pixels on anything short of an Apple Retina display.

Optically, going for distance is the best bet. Past 20 feet or so, focus at infinity will give acceptable performance. Close up, you'll wind up 20/20 at one distance, then need glasses for everything else.

 

[RETG]

Everyone is different. I had a friend who paid up to 4K for lenses and it helped, but he still needs glasses. I opted for the standard (free) set of lenses and I came out of the surgery with 20/20 vision in both eyes (closeup to distance) and reading glasses are no longer needed except for very small print. However, I did opt for a very weak set of prescription glasses just to ease eye strain while reading. And the bad part is you never know what your eye sight will be until after the surgery.
My eyes are like I was 20 again. I just wish there was some type of operation that could make the rest of the body feel like it was 20 again.

 

[Jim Watson]

I just wish there was some type of operation that could make the rest of the body feel like it was 20 again.

I know what you mean. Maybe I should stop reading science fiction with accounts of rejuvenation too far in the future to help me.

 

[entropy]

I know what you mean. Maybe I should stop reading science fiction with accounts of rejuvenation too far in the future to help me.

Like John Ringo's stuff?

Second doc recommended a monofocal IOL - he said the accommodative lens currently on the market has a reputation for not settling to a consistent level. "The gift that keeps on giving" was his exact phrase.

Acoomodative IOL's are still in their infancy; they are getting better all the time, but it might be a few years before all the bugs are worked out. I hope they have then worked out by the time I need them (I'm 54 now, eyes are still clear in the slit lamp.)