CATARACTS and IOLS
DETAILS and COMMENTS

     
 

 
RADICAL ACCEPTANCE

  
 
  • The lenses we're born with eventually lose clarity

  • Cataracts occur at all ages for many reasons including traumatic injuries

  • Once a cataract begins, it's progress can slow but doesn't reverse

  • Glasses and contact lenses sit outside the eye. An IOL sits inside the eye
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    After my FOV and unfortunate retinal tear mentioned on the previous pages I expected to have clear, floater-free vision for another decade. But the bubble used to heal the tear had other plans. This is because the presence of a gas bubble can cause a cataract to form very quickly, sometimes in weeks. And as I expected shortly after the bubble disappeared I noticed an increase in fog across my vision. A trip to my Opto confirmed it was due to a PSC (Posterior Subcapsular Cataract) forming. This meant that in the space of a few months I had gone from a PVD floater -> FOV Club -> Cataract Club.

    I expected a cataract eventually but I hadn't expected it to appear so quickly. But rather than obsess about my predicament I made an appointment to meet with an IOL surgeon. Beforehand it made sense to do my own research to be well-informed in IOL and cataract-speak. Living with an unintended side-effect afterwards was one thing. Equally upsetting would be living with the constant feeling that I had been talked into the wrong lens, or out of one I wanted. This is why selecting a good surgeon who is well-versed and experienced in this field is so important. Also important was to not be duped by IOL marketing, AI chat-bots on forums, or other outside opinions.

    So I studied the TYPES of IOLs and their details. Then I decided which of their OUTCOMES fit me and my lifestyle. There are several overlapping concepts which made it challenging.

    MY PHILOSOPHY
    Matched, 3D, binocular vision has been the standard provided by glasses for over a century. So I decided not fixate on what what I'm losing but what I'm gaining with IOLs: the ability to drive glasses-free day and night — Traveling, hiking and outdoor activities with no worry that if I lose my glasses that I'm stranded — Watching live music events and cinema with few anomalies or halos — and getting up in the morning and going straight to the kitchen with no glasses. Yes I knew I would have to wear readers up close. Yet many of the people I know over the age of 45 need readers, even without IOLs. So having to wear them for near was a mild price to pay in my opinion. This meant a goal of excellent intermediate and distance vision and using glasses to fine-tune for different tasks. Glasses adapt easily—IOLs don’t.

    PERSONAL REMINDERS

    HUMAN VISION IS IMPERFECT: Eyes naturally have a broad range of diffraction effects including astigmatism. In other words, fuzzy details, smearing, and flaring lights are common. A person wearing glasses or contacts for years might think they have enjoyed perfect vision. In reality they had poor vision 24/7 and it's only with correction that life became tolerable.

    MYOPIA IS NOT FULL-RANGE: Without glasses a moderate -3.00 becomes blurry at 13"(33cm). That's only one foot of acuity. The same person with Presyopia may have a sweet-spot only a few inches deep. Being trapped in a small myopic bubble where everything outside a range is blurry is not very enjoyable.

    AN IOL SWAPS THIS WORLDVIEW: Set to distance, the focus-range becomes roughly 24"(50cm) to infinity. Being able to suddenly function with everything beyond two feet without glasses is pretty exciting IMO. Faulting IOLs for not providing complete, full-range vision is valid but unrealistic. Contact lenses and RLE (Refractive Lens Exhange) used by younger people without cataracts have the same near-focus limitation but don't receive the same criticism.

    KEY CONCEPTS

    Myopia (nearsighted) is when details past a certain range are out of focus. Prescriptions are written as -0.00

    Hyperopia (farsighted) is when details past a certain range are clearer. Prescriptions are written as +0.00.

    Presbyopia is when the eye loses flexibilty with age and has trouble focusing up close.

    Emmetropia is the medical term for perfect vision or 20/20 sight.

    Plano means 0.00 diopters of sphere in a prescription. Achieving perfect distance (plano 0.00) is possible in IOL surgery. Some surgeons prefer to hit slightly on the myopic side (.10-.25).

    Monovision dates to the 1960s when clinicians noticed that some people did well with one contact lens for distance and one for reading. In the 1970s it gained popularity when monovision-with-contacts became a popular method to avoid bifocal glasses. In the 1980s the monovision concept was borrowed and used to mix IOLs for the same reason. Monovision is not for everyone though. People who rely heavily on precise depth perception and 3D clarity for spatial judgment are said to be poor candidates. Their brains are used to extracting high-quality, matched images from both eyes—and don’t like giving that up. As a result, many surgeons will trial a patient with contact lenses to test monovision before IOL surgery.

    Mini-monovision: Different than standard monovision in that the range between eyes is narrower (-.75 to -1.50). This is said to have better depth perception and fewer side effects.

    Insurance only covers basic monofocals for "useful" vision. Useful means to drive legally, read signs, watch TV, and navigate daily life. This "low bar" of basic vision may be acceptable for some, but the highly-visual pace of life in the 21st century requires better results IMO. Unfortunately, more expensive enhancements such as laser incision (FLAC), Torics, multifocals, or incisions for astigmatism are not covered by insurance. While a profit motive can exist for any product or service this doesn't mean that these enhancements have no value however. If I can get a better outcome I will gladly pay extra. Why accept mediocre vision for the rest of my life?

     

    LENS TYPES

    -- Monofocal, EDOF, Multifocal/Trifocal, Toric, LAL --

     
  • Monofocals are fixed-distance just like a standard contact lens. Said to comprise 80% of replacements chosen wordwide their popularity provides many case studies for the Opto world and IOL manufacturers. Aspheric versions are known for providing sharper images, better contrast, and improved night vision with less glare and halos than Spherical. EDOF (Extended depth of Field) versions can provide a wider focus range for near and intermediate.

  • Multifocal and LAL are designed to provide a wider range of focus to get rid of glasses. They have several caveats that should be discussed with a surgeon beforehand.

  • Toric corrects for astigmatism and need to be inserted precisely.
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    LENS OUTCOMES

    -- Preference-based on lifestyle, priorities, and tolerance for trade-offs --

     
  • Monofocal - Both IOLs are set to the same fixed distance. Readers are used.
  • Monovision - A combination of distance/near monofocals to reduce the need for glasses.
  • Multifocal/EDOF/LAL - Enhanced-range IOLs to reduce the need for glasses
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    After much research and discussion with my surgeon I decided on the J&J Eyhance Toric II.
    My surgery is in early April 2026 and will be detailed here.

     
         






    		 





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