Anyone decided NOT to have Cataract surgery?

[Travelassie]

Originally Posted by McGowdog

It's been my understanding that "back" or cataract lens does in fact harden up, muscles stop moving lens in and out with age, and we're left with the need for longer arms or readers for reading and up close. But with cataract surgery, they can replace the lens to bring you back or whatever.

Why not consider some kind of monovision at that point? One or dominant eye for close and the other for far?

All of course only after you require the cataract surgery.

I could be wrong though, just my current understanding of it.

Sounds about right to me.

As I understand it, the natural lenses and eye muscles work together to adjust a person's vision for up close, far away or in between as needed. But as a person ages, the lenses tend to harden, become thickened and impede the vision, making things blurry, contributing to serious glare in response to light, and as both my husband and I have experienced with our cataracts, distorting color vision as well. I've been told this occurs to some extent in most people as they age, though the amount of change varies and some people never get to the stage where they need their lenses replaced ( cataract surgery). In general it takes years to get to the point where vision is affected enough to need surgery.

In cataract surgery, the thickened, ( often discolored) lens is removed, and replaced with an artificial intraocular lens. These lenses vary, may be monocular allowing the person to see well either for distance vision, or close vision. There are also lenses that enable the person to see both distance and close vision, but these don't "adjust" automatically like natural lenses to achieve this effect. Instead they work like bifocal or trifocal lenses in glasses, in that the corrective sections of the lenses are located in different areas of the lens and these areas are, if you will, accessed by the patient depending on where he/she looks.

Which types of lenses are chosen depends on the patient's wishes, life styles, other eye issues, and the patient is interviewed,
measurements are taken prior to the surgery to customize the lenses to each patient. Many people ( including myself and my husband) have chosen the distance vision monocular lenses, resulting in excellent ( 20/20 for me and hubby both) distance vision, and the use of magnifying glasses ( we use Dollar Store cheapies) for close up vision, has worked out well. There are also monocular lenses for close up vision, and the person with those likely needs glasses for distance vision. The reason for needing glasses in these instances is that the IOLs implanted by the cataract surgeon cannot adjust themselves like natural lenses to accomodate the person's close, distance or in between vision. Ideally the lenses that accommodate both close and far vision would mean the person who gets those doesn't need glasses at all, but I think individual results vary. I've heard both not so great, and glowing reports on this type of lens, and I'd think over the years there have been improvements on these types of lenses and people like them better.

I think many people still choose the monocular lenses for cataract replacement as the cost of these is covered by Medicare ( considering most patients needing cataract surgery are old enough to be on Medicare), but it doesn't cover the variable distance lenses, so the out of pocket costs of the latter is significant. And it seems most of these folks ( myself included) don't mind using glasses when they need them for close up or distance vision. I have heard of people who've chosen the options of a monocular close lens for one eye, and a distance monocular lens for the other eye, counting on both eyes to coordinate the vision so the person sees well for both far and close distances. I'd think those results would vary with the person.

Though cataract surgery is elective, a person whose natural lenses continue to thicken, cloud up and discolor over time (becoming cataracts, if you will) can go blind. I recall two great-aunts I had who were virtually blind from cataracts. This would have been in the 1950's when cataract surgery involved a long hospital stay with the head held immobile, and the results could be iffy- if such cataract surgery was even available, probably not in the rural or small towns where my aunts lived.

My husband, always one to drag his feet regarding any elective medical decision anyway, waited about two years after he was informed his cataracts needed to come out, and even though it was painfully obvious his vision was seriously affected by the cataracts. But he finally had the surgery, and the surgeon commented on how thick, stiff and discolored his cataracts were. His description put me in mind of stale gummy bears! But the differences between his before and after vision was amazing, he's now got 20/20 distance vision and can tell colors again.

[terracore]

Originally Posted by McGowdog

Why not consider some kind of monovision at that point? One or dominant eye for close and the other for far?

All of course only after you require the cataract surgery.

I could be wrong though, just my current understanding of it.

Monovision was, and still is, used in IOLs for cataract lens replacement. Until the multi-focal IOLs were developed they were the only way to provide some patients with good vision at distance and up close. But monovision has it's limitations. The first being that some people can never adjust to it. For somebody to be considered a candidate for what is more or less a permanent surgery, they need to establish that they can accept monovision with corrective lenses first. The second limitation with monovision is that it has a narrow range where it's effective. When I started having problems seeing up close they gave me monovision Rx and it delayed my need for reading glasses for about 5 years. But eventually the presbyopia naturally progressed where the monovision no longer worked. I could neither see distance nor up close very well, and the eye docs told me I had outgrown the monovision. I switched to multi-focal contact lenses, which were not brand new at the time but most eye docs didn't have a lot of experience with them and didn't normally recommend them (I had to ask). And HOLY CRAP was it different! One of the first casualties of monovision is seeing in full 3D. I didn't realize how much depth perception I was missing out of until it was fully restored by the multi-focal contact lenses. And since both eyes were seeing distance and up close together, instead of working against each other and letting the brain work out the differences, I was seeing things with so much more detail and clarity. Add that to the restoration of full 3D vision and those new contact lenses felt like a minor miracle. I wish I would have tried them years earlier. The eye doc told me most people have an adjustment period before these types of lenses work for them, and some people can never adjust to them. But immediately after the doc put them in my eyes they worked like magic. No adjustment period.

My honeymoon with the multi-focal contact lenses lasted about 9 months and then my vision started to deteriorate quickly, and the culprit was the turbo cataracts I had developed. So when they offered multi-focal IOLs as an option it was a no-brainer for me.

[Williepaws]

I may not have cataract surgery, I'll see as time goes on. Ive met too many artists who had the surgery and then it took almost a yr for them to be able to draw again. Some said if they had known they probably wouldnt have had it done. Drs may be all knowing about the lens in your eye but they like to ignore how your brain imterprets what it see. So for now no thanks to the surgery.