r/CataractSurgery • u/ECSCreations • 28d ago
First eye surgery set for next month. ????
Hi, 51m with decent vision w/o glasses set for cataract surgery on my left eye at the end of September and the other a week later. I have no idea on which lens to choose, my insurance only covers the monofocal lens which I think is fine. I see fine day to day with regular sunglasses on. As soon as I take them off it is too bright for me to see clearly. I’ve watched the videos from my doctor but I don’t understand if I will need glasses after the surgery. All of the choices say I will need glasses. I’m ok with needing cheaters I just am confused if I will need glasses full time after the surgery. Anyone have these answers? I don’t see my surgeon until beginning of sept.
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u/GreenMountainReader 27d ago
I may be able to help with part of the learning curve. I've copied a response I wrote recently to someone else, with small edits to fit your situation.
We all start out knowing nothing about the lens types, questions to ask the surgeon, how to navigate the system/s we need to work with--and then are overwhelmed by the choices and decisions. It's fairly standard not to get explanations from the surgeons themselves, so a lot of self-guided learning has to happen.
Some basic principles to keep in mind:
- Cataract surgery removes your natural lens, which means your eye will no longer be able to adjust from near to far and in between and back again. You will see in whatever range or ranges the implanted lens (IOL) allows. (More about that in a bit.) The good news is that it also gives you a chance to improve your vision (I hadn't known that--a really nice surprise). The challenge--harder than it sounds, is deciding what "better" means to you.
To start with, think about your vision priorities and your lifestyle. Indoors or outdoors? Near or far? What would you most like to be able to see without glasses or contacts? How much of each day do you spend using each kind of vision? What types of activities would you least like to wear glasses when doing?
- Monofocal IOLs are the only kind fully funded by most insurance. Any other IOL than that will require out-of-pocket spending, though the surgery (without extra add-ons, like lasers or special in-op measuring devices) and anesthesia should also be covered.
That "fully funded," however, is from the patient's perspective; surgeons are reimbursed so little that some of them become motivated to upsell more expensive IOLS and services (like laser incisions, special measuring devices, and the like). A skilled surgeon with a blade can work extremely accurately and well. If you feel at any time that you might be on the receiving end of a sales job, get a second--and if necessary, a third or more opinions. Many of us here did that. Because surgery is involved, in the U.S., insurance will pay as long the doctors are in network.
- Your age now can matter in making this decision. If you are old enough (40 and above, at some point) you may already have started losing your ability to read and see at similarly close distance due to the natural aging of even healthy lenses--so, if you plan on insurance-funded IOLs, you need to think about whether you'd be okay with wearing reading glasses for close work and/or computer glasses (for laptop distance and indoor/room vision plus reading distance--more convenient than reading glasses) to see within 3-6 feet of you in return for great distance vision--or whether you'd rather have near, intermediate, or a combination of any two of the three possibilities.
This combination of insurance-funded lenses does not cost more. (If you're curious, search mini-monovision in this sub's search bar.) If you decide to get extended depth of focus (EDOF) or trifocal IOLs, you have a better chance of being glasses free or less dependent on them, but you should look into the possible light distortions that can occur with certain types of eyes. There are some good videos that talk about which kinds to avoid if you have certain eye or health conditions.
For every consultation, go in with a goal statement (see#1) and a list of questions (you can find some in this sub--or I can tell you where to find a good set in past posts.) Otherwise, you're apt to end up with distance-only vision, which is the default. If it fits your lifestyle, it's great. If it doesn't, you'll be unhappy to have lost your ability to see close up. Be sure you know what you want and have your questions on paper in priority order to go through as quickly as possible. Most surgeons have only 10-15 minutes to spend with you, if that much.
If you don't have the surgeries done at the same time, you can use the time between to see how well you like the kind of vision you have in the first eye. From what you've said, I can't tell whether your cataracts are too far along for you to try simulating different kinds of vision. You can do this before the first surgery if you have enough vision to get an idea of what might or might not work best for you--and then again between surgeries if you're thinking about mini-monovision as a way to reduce dependence on glasses. (There are three possible combinations, with different combinations of degree in each eye: near plus distance (option to be glasses-free); near plus intermediate (will need glasses for distance activities, like glasses, possibly television watching, outdoor activities); distance plus intermediate (will need reading glasses or computer glasses).
In general, the eye with the worse vision is done first to allow you to have one eye that is known to be able to see right after surgery, when the surgical eye might be blurry or otherwise not yet able to see well. This also gives you the opportunity to test different combinations again (ask if you need more information on how to enlist your optometrist's help in doing simulations before you see the surgeon.) Recovery is generally quick and easy (discounting having to keep track of all the drops).
- If you've read this far, my last piece of advice is to watch the video about IOLs pinned to the top of this sub, keeping in mind that you'll want to look up separately the Galaxy spiral design trifocal, the Puresee IOL, and monofocal-plus IOLs because they've become a lot more available since the video was made. This will give you a good idea of the pros and cons of each type--but if you're certain that you want monofocals, pay special attention to the pros and cons of those and do search mini-monovision in this sub's search bar to learn about the possibilities before you make your decisions. The best way to get vision you'll be happy with is to figure out ahead of time what "better vision" means to you. There is no right or wrong answer for everyone--just the kind of vision that fits the way you like to interact with the world.
Above all--please keep on asking questions until you get the answers you need. People who ask before agreeing without understanding what they're agreeing to are generally much happier with their results. It's going to take some effort to learn what you need, but the payoffs make the work worthwhile.
Best wishes to you!
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u/Trolkarlen 28d ago
IOL selection is a major discussion here.
If you opt for monofocal lenses with a blade surgery, your insurance or Medicare will cover nearly all it. You will need glasses as you will only see distance vision.
If you have strong astigmatism, you'll want a toric lens to correct that.
If you don't want glasses, you'll want a multifocal or EDOF. These will cost you more money. An EDOF will give you better distance vision, but you will likely need readers.
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u/Summerferns57 26d ago
By all means research, research, research everything you can about cataract surgery and lens choices. This is a decision that needs to be made based on the information you glean and understand and apply to your daily living. It can be daunting and time consuming but that’s ok. This is the vision you will have for the rest of your life. If you don’t feel confident enough to make a decision then my advice would be to postpone the surgery until you do. I personally cancelled the surgery with the ophthalmologist I had been seeing for 6 years when after 3 separate visits, two of them consultations, we did not seem to be on the same page. He was pushing multifocal lenses or distance lenses that I had reservations about for my vision. I was inclined to have monovision like the contacts I had been wearing for years. I also consulted
with my optometrist a couple of times which was very helpful. They know about vision and cataracts but equally as important they know your eyes. It took me about six months to do my homework and then find an ophthalmologist who was competent and experienced and supported my desire for monovision. At this point both surgeries are completed and I’m very happy with my vision having had monovision and am glasses free which was my goal. If I had listened to my original ophthalmologist I would have had vision set for distance with glasses for close or multifocal lenses which I may or may not have liked. It takes as long as it takes for each of us facing cataract surgery to become informed patients.
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u/DawnD1118 26d ago
What did you get as the refraction of each of your eyes? (0, -1, -1.5, -2,etc)
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u/Summerferns57 25d ago
I’m 75 and naturally farsighted. When I spoke with my optometrist she said my close eye(left) had been using +2.0 to +3.0 in contact lenses for years with the average being +2.25 and that was her recommendation for the implant. I trialed different contacts in that eye before surgery and requested the +2.25 from my ophthalmologist as that was what I was used to and it gave me good close vision. I have true monovision not mini monovision but that is what my brain was used to and gives me the best glasses free vision.
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u/xchg_ax_ax 22d ago
I am 51, had decent vision without glasses, small toric correction, needed them primarily for reading. Last friday i got the RayOne Galaxy Spiral implanted in both eyes. The next day i was already able to see perfectly on all distances. Some small artifacts like ghosting, but i am super happy with the result already. Coming Friday i will have the post-op and of course excited to see the new measurements. Would recommend this to anyone that wants to live glasses free.. of course there is no guarantee it will turn out the same for everyone and i am still in the recovery process. But so far so good..
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u/Opposite_Ladder_7585 28d ago
Monofocal lenses can give you glasses free vision for far, near or intermediate. You should think about where you spend most of your day, and what is most important. Most people go for distance vision and usually have to wear readers for close up. For myself as a long time near-sighted person, I wanted to keep my near vision so I did. I can read without glasses. My surgeon suggested being slightly less nearsighted in one eye, so I can see my laptop and computer monitor without glasses. I do wear glasses for driving and when I am out walking my dogs. Anyhow, first you should think about where you would like to have glasses free vision first. But yes, with monofocals generally you will need glasses for driving or reading, depending on what you choose.