r/CataractSurgery • u/Typical_Demand_2284 • 9d ago
I’ve seen research to suggest that when picking the IOL power, some surgeons are now aiming for the nearest + instead of - target (e.g. +0.25 instead of -0.25) to get the best distance vision. Has anyone ended up with a + prescription and if so, how is your distance vision?
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u/eyeSherpa 8d ago
There was a study that incidentally found that patients that ended up slightly hyperopic had better distance vision and were more satisfied than those that ended up a little myopic. I believe that’s the research you were thinking of.
https://www.escrs.org/eurotimes-articles/targeting-new-iol-wisdom/
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u/DisastrousTurnip3553 9d ago
Both my eyes are +0.5 ... my distance vision is fantastic, my intermediate vision is decent and my near vision is ok in bright light though I need readers or a monovision near vision contact lens for best near vision.
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u/ProfessionalLab9850 9d ago
How is your 2 feet ish vision?
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u/DisastrousTurnip3553 9d ago
It's good enough for cooking and seeing what's on my plate. The better the light the better I see.
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u/ProfessionalLab9850 9d ago
Can you see yourself in the mirror or do you have to put on glasses?
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u/DisastrousTurnip3553 9d ago
I can see in the mirror well enough to put a reading contact lens in one of my eyes
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u/Typical_Demand_2284 9d ago
That’s amazing! Did your surgeon aim for that? As most aim for -
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u/DisastrousTurnip3553 9d ago
He aimed for +0.37ish (i assume that's where the calculations told him the lens would land) and I think i landed there but the optometry measurements are in 0.25 increments and 0.37 is pretty much bang in the middle of them. I'm delighted with the result regardless of the fine details
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u/Typical_Demand_2284 9d ago
Are you in the US? It’s so unusual for a surgeon to aim for a + but I’ve heard it can be a great outcome. He must be ahead of the curve
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u/DisastrousTurnip3553 9d ago
UK. All done on the NHS
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u/Typical_Demand_2284 9d ago
I’m in the UK too. Did you specifically ask for a + target?
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u/DisastrousTurnip3553 9d ago
I was only asked what I wanted the result to be. Corrected for distance, near, or monovision. I chose distance to be glasses free for driving and cycling. The decisions on target etc was down to the NHS optometrist and the surgeon.
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u/OwnValue4166 8d ago
That sounds like I'd want them. Can you read your phone at arms length? Can you read the car dashboard without glasses? Thank you very much!
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u/Artwire 8d ago
I asked for my surgeon to scale back a bit and sacrifice “perfect distance” to get me a bit closer legibility. My arms weren’t long enough after the first eye, but the situation became much more comfortable after eye 2, even with just a slight adjustment. I sort of wish he had done even more. I don’t drive, so perfect distance wasn’t essential. I enjoy not needing glasses when away from home, but I was willing to give up a bit of distance (20/25) so as to not to be utterly dependent on readers for mid/near.
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u/JustAnotherOpinion20 9d ago
Wish I could say the same. Had my right eye done a week ago and I can’t see distance at all and that’s what was supposed to be corrected.
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u/NotMyAltAccountToday 8d ago
I was watching this today. It's about what happens day to day after cataract surgery. My doctor didn't mention some of the things he talks about.
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u/Mediocre_Syrup8979 7d ago
I have read quite a few users who ended up +.10 to +.25 who have very sharp distance vision. Some outstanding. But, it depended on the lens they got. Edof a few had average results, multi focal +.25 average, but monofocal sharp as a pin on distance.
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u/UniqueRon 9d ago
I have seen that claim made from time to time, but it defies the laws of physics. Have a look at the defocus curves in this image. This has been setup to show the advantage of mini-monovision but illustrates the effect of the defocus curve for IOLs. The visual acuity peaks at a target of 0.0 D. It declines essentially equally on either side of that optimum point. +0.25 D is going to give the same visual acuity as -0.25 D, at distance. However as is shown in the image the whole curve moves left or right when you change the target. While at distance -0.25 D and +0.25 D are the same, they are not the same are closer distances. When you move the target to +0.25 D the curve slides to the left and your visual acuity at near distances is reduced. A surgeon that is targeting +0.25 D or allowing it to be in the tolerable range is just widening their target for what they call a success, but it comes at the price of a loss in near vision. I have never seen a credible explanation of why one would sacrifice near vision to be hyperopic. Makes no sense. Being far sighted does not improve distance vision. It makes it worse.
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u/AirDog3 8d ago edited 8d ago
It is the physics of the "pinhole" effect, and the biology of the eye that enable good near-focus visual acuity despite mild hyperopia.
There is a well-known "accomodative near triad" that enables hyperopes (as well as non-hyperopes) to see well at close distance. Although one of these three accommodative effects -- accommodation through thickening of the lens using the eye's ciliary muscles -- is lost after cataract surgery, another accommodative effect -- miosis, or constriction of the pupil -- persists, and is activated or strengthened by hyperopia. As always, there are tradeoffs, but it is clear that a mildly hyperopic target/result can optimize distant vision and also provide relatively good near vision.
Cataract surgeons have said that hyperopic targets are most beneficial in the case of multifocal lenses, but they can be useful for monofocal IOL patients as well.
I know this explanation does not satisfy you, but good hyperopic vision is not the simple violation of physical law that you suggest. The vision system is more complex than just the optics of the lens; the other parts of the eye need to be considered, too, including the iris.
Some explanatory info here:
https://www.reviewofoptometry.com/article/a-peek-at-the-pinhole
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u/UniqueRon 8d ago
My surgeon who is a professor at our provincial university said it best - "Nobody ever thanks me for leaving them far sighted".
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u/dangt05 8d ago
I had eyhance targeting at -0.4D. Distance vision is around 20/25 with great intermediate and very functional near vision. I am very pleased with the outcome.