Eye Surgery

As old as some of us seem to be from post of what happened back when, I am pretty sure some here have had Cataract Surgery. 
If you have, did you have a procedure for Astigmatism, at the same time and did it help with your Astigmatism?

I will be having a consultation (told 3 hours) with surgeon Tuesday. One of the options I will be given is to have a Laser Astigmatism treatment done at the same time.

Just curious if this has made a real difference for a red dot shooter?

Had regular mono vision
Never asked about astigmatism

I had cataract surgery when I was 51.  I had a clear cataract in my shooting eye that was causing double vision. They did both eyes about two weeks apart. The surgeon did some cuts to deal with the astigmatism in both eyes. For a while, I had 20/15 in my shooting eye. Twenty years later, the astigmatism is back, very slightly. My shooting eye is now 20/25. I wear trifocals since your eyes get old, no matter what,, but can shoot rifle without them.  For iron sight pistol, I have a pair of glasses with the trifocal lens in the top position so I can focus on the front sight.

REConley,

I had cataract surgery on both eyes about 6 weeks ago.  I was extremely nearsighted (-6.5 diopters) with some astigmatism and had worn glasses all day every day since 5th grade.  I am now 20/20, have no detectable astigmatism, and use glasses only for reading and close work.

My procedure involved use of a laser to break up the cataract prior to removal, and a second laser to make a final eye measurement during surgery to confirm selection of the lens to be inserted.  The astigmatism correction is built into the interoptic lens itself, and this is a more expensive lens than the "plain vanilla" variety.  The laser is also used to confirm the axis of the astigmatism so that the lens can be positioned properly "on axis".  The entire surgery took only about 30 minutes.

There is also a more expensive multi-focal lens available which supposedly maintains sharp distance vision while also eliminating the need for reading glasses.  That one seemed a bit too close to the state of the art for me, and I chose not to go that route.

What your surgeon recommends will depend in part on the physiology of your own eyes, what procedures he is most confident in performing, and even what equipment may or may not be available to him.  I am very pleased with my results.

Don, what you describe are the three choices I will have available to me per the brochure that has been provided. I am, prior to discussion with the surgeon, inclined to opt for the middle option which is what you had. Opting for that method, I have a choice of excellent distance or excellent near vision. I would be going with the optimized distant vision and some sort of reading glasses as needed. In my case I have had glasses since college years. The 350 person lecture halls with a need to read the green board and your own notes disclosed my astigmatism. 

Everyone thanks for the comments.

At the Aravind Eye Hospitals in India, they first completely test your eye.  Based on the distance the computer has found in your eye, the computer can suggest what power you need to give you good vision.  If you don't have astigmatism, they usually provide a mono-focal IOL (Intra Ocular Lens) that will give you the best vision at a pre-selected distance.  I specifically asked for a power to give me clear vision from two meters to infinity in sunlight.  Artists sometimes ask for the clearest vision to be at the distance to their easel.

If you have astigmatism, they can provide an IOL that both corrects your vision, and also corrects for the astigmatism.  As noted above, the doctor puts this IOL in at the perfect angle to correct your astigmatism.

They also have premium multi-focal IOL's available to give you good vision at two different distances, and now at three different distances.  All the images show up on your retina simultaneously, and your brain learns to "see" the appropriate one for whatever distance you're trying to see.

The people who make the IOL's advised me to ONLY go for the mono-focal IOL.  That provides the sharpest view of whatever you are looking at, at the distance the IOL was designed for.  For other distances you wear glasses.

Laser assisted cataract surgery is the equivalent of what a good eye surgeon can do, but my choice was to let the doctor do the surgery, no laser. 

Something not mentioned on the internet is that depending on the power of the IOL, the "size" of what you are looking at changes.  Most of the time this isn't noticeable, but if you get surgery in one eye to provide distance vision, and surgery in the other eye to provide close-up vision, the apparent difference in size might be very annoying.  For me, the apparent "size" of something is smaller when I view it with my left eye, than when I view it with my right eye.  This has never bothered me, but I know it's there.  I was told that if I got a distance IOL in one eye, and a close-up IOL in the other eye, I would most likely find it annoying.

There are ways in which a standard IOL is preferable to the "premium" multi-focal IOL's, in that the people I've spoken to about their multi-focal IOL's have to deal with reflections, halo's, and other things, especially so when driving a car at night.  The people providing the "premium" IOL's don't talk much about this, but if you search long enough on the internet, you'll discover the issues.

In one sentence, the choice is between CONVENIENCE and QUALITY.  While you don't need to wear eyeglasses as much with a multi-focal IOL, your vision is not as good as with a mono-focal IOL with a single prescription.


For me, all of this was a no-brainer.  I wanted to see the sharpest possible vision of what I was looking at, and wearing glasses didn't bother me.
I want what I see in my camera to be as sharp as possible.
I want the target to be as sharp as possible.


Something else to ask your doctor about.  If you know what "depth of field" means in photography, the same thing applies to cataract surgery (although none of my doctors in India understood this).

Let's say you are looking at a target at 100 yards.  You want that target to appear as sharp as possible.

• The obvious solution is to get a distance prescription for your IOL, so your target at 100 yards is perfectly in focus.  Depth of field means that things at some distance before and after that distance will appear equally sharp to you.
  
•      (There can be nothing "after" infinity, so that ability is wasteful.)
  
• What I feel to be a better solution, is to get an IOL designed to give you sharp vision at something closer, but not too close.  If the doctor understands how IOL strength is determined, they can give you an IOL that gives you sharp vision closer, and still gives you sharp vision at infinity.
  
• For me, knowing that, the people did the math, and gave me an IOL of the correct strength, so anything from two meters to infinity appears sharp.
  

There are lots of variables.  The calculated strength of the IOL "should" give you the right vision.  But IOL's have a tolerance, and the IOL may be a little stronger or weaker than the power listed on the packaging.  Also, this is based on the IOL being at a perfect distance inside the eye, but the actual distance may be slightly closer or further away.  Your final result may not be precisely what you want, but it should be close.


There are videos posted on the internet that show and explain cataract surgery.  It's a good idea to watch some of them ahead of time, so you understand the choices, can tell the doctor what YOU expect from the surgery, and ask his advice.  (My experience is that the doctors understand ALL of the above, with the exception of "depth of field".  You can do a search for "depth of field", so you can at least try to explain to the doctor what you want.  

Or, you can just tell the doctor that you want an IOL to give you good vision over a range of two meters to infinity.  
I think the doctor would understand it that way better.)

Mike, yes I understand DoF. There are two D5's sitting in my big camera bag behind me. The Doctors/Manufactures are taking advantage of the Circle of Confusion principles with the provided literature. Since one's man made lens can not refocus, there is only a single plane of actual focus. I will be going for some form of far distance bias in the replacement lens I choose.  Their literature also describes an astigmatic correcting lens on top of Laser surgery IF my eye is very bad off with the astigmatism. All to be discussed and cussed Tuesday afternoon. 

If we can get ride of the cataract, tame most of the astigmatism and result in no more than mildly corrected distant vision with glasses being needed. I will be happy. Reading glasses will not be a big deal. And the Nikon +1 to -2 diopter adjustment should let me shoot my cameras eye glass free.

The difference between looking into a camera with verses without glasses is very big,in my experience.  Seeing all of those control setting and sensor reading while framing is very good. If you are a manual focus guy, bad eyesight outside the built in diopter adjustment just makes for some frustrating work.  

Thanks for the comments.

Sounds good - depth of field when explained to eye doctors in India might just as well have been "voodoo".  Nobody understood, but for that matter, none of them knew what "focal length" was - they all deal in power, which is the inverse.

Two D5's !!!    Wow!!!!

Curious - why do you want laser surgery at all?  If you get the astigmatism corrected in the IOL, laser surgery, as in cutting into the cornea, if that's what you're referring to, shouldn't be needed?


I understand what you mean about using the diopter adjustments for the Nikon viewfinder, if that's what you mean, but then the LCD on the rear of the camera will still be blurry.  I asked the doctors in India to make me a special pair of progressive lenses, with the top part being "distance prescription", and the bottom part being extreme close-up to see the LCD screen. Problem solved.....

.....but you're right, it is. SO much better to look through the viewfinder without wearing glasses.

I recently got a new Nikon Df body, and have put all my other Nikon stuff away.  I had no idea how much I would enjoy the Df.  It is now by far my favorite Nikon - but back when I was doing r/c race car photography for magazines, I had a D2, then a D3.  I love the D4, D5, and I think now the D6, but they're all so big and heavy.  ....or I'm so weak.  

Life will get SO much nicer for you after the cataract surgery!  
(Send me a PM sometime, about what kind of photography you do.)

Dr.Don wrote:REConley,

I had cataract surgery on both eyes about 6 weeks ago.  I was extremely nearsighted (-6.5 diopters) with some astigmatism and had worn glasses all day every day since 5th grade.  I am now 20/20, have no detectable astigmatism, and use glasses only for reading and close work.

My procedure involved use of a laser to break up the cataract prior to removal, and a second laser to make a final eye measurement during surgery to confirm selection of the lens to be inserted.  The astigmatism correction is built into the interoptic lens itself, and this is a more expensive lens than the "plain vanilla" variety.  The laser is also used to confirm the axis of the astigmatism so that the lens can be positioned properly "on axis".  The entire surgery took only about 30 minutes.

There is also a more expensive multi-focal lens available which supposedly maintains sharp distance vision while also eliminating the need for reading glasses.  That one seemed a bit too close to the state of the art for me, and I chose not to go that route.

What your surgeon recommends will depend in part on the physiology of your own eyes, what procedures he is most confident in performing, and even what equipment may or may not be available to him.  I am very pleased with my results.

Had mine done last of Jan and first of Feb, your experience mirrors mine. -7 or so myopic with some astigmatism. Went with the toric lens correcting astigmatism and distance vision. My eye doc and the surgeon recommended the laser because of the "long" eyeballs. I guess there is less chance of complications using the laser. Sure was more expensive....
The outcome has been great. Still working on the best solution for shooting open sight pistol, using some cheap +1 safety glasses now. I got another set in +.5 for the little bit of action pistol I still do. The lens quality leaves much to be desired but as soon as I settle on power I'll have some good ones made.

mikemyers wrote:

Curious - why do you want laser surgery at all?  If you get the astigmatism corrected in the IOL, laser surgery, as in cutting into the cornea, if that's what you're referring to, shouldn't be needed?

I do not necessarily want the Laser surgery, however if the astigmatism is severe they will use it to shorten the eyeball. Testing Tuesday will find that out. 

I'm just in a wait and see mode right now and thinking about all of the possible options.

Blindshooter, got to like that name being 72 this April and entering eye trouble years.  I am thinking the toric lens is what I will be doing. The middle choice on cost, although the brochure does not list amounts. They have a separate little payment financing person I am also scheduled to see. Maybe, just maybe this pandemic thing will save me some money. Last week when I had my annual eye exam the clerk that handles payment or co-pay said that I had no co-pay due to the pandemic recovery plan that impacted insurance companies. If I do not, there might be a new pistol in my future. 

I went through this over the last two years...both eyes.  Right now, there are three options with IOLs.  

Monofocal is set up for one focal length.  It's tempting to get it set up for close in if you do a lot of reading or computer work, but the difference between what's needed for one foot and two feet is significant.  Six feet to infinity is nothing.  So I recommend getting set up for distance.  

Multifocal actually produces two images.  Think of it as two lenses, one set up for close in, the other for distance.  The idea is that the brain picks out the image that is clearest.  For a shooter, or anyone doing high-precision work, this is effectively throwing away half the performance of the eye...which is UNSAT.

The third is Accomodative.  These actually change the focal length.  My eye doc recommended against this, due to issues with getting the things to stabilize.  His description of them was "the gift that keeps on giving."  If you can hold out, there are a second generation of accomodative IOLs in the pipeline that are very promising...I suspect that a decade from now, those will be the standard option.  But it's not really ready for prime time today.

They'll do a base prescription for the IOL that will take care of nearsightedness or farsightedness.  They can also tweak the cornea...and since you're there anyway, you may as well get that taken care of.  This will give the best performance and compensate for astigmatism.  Pay the money, it's worth it.

Be warned that this surgery isn't 100% accurate...they had to go back in on the left eye and drop in a piggyback lens, the first one was over 1.25 diopters farsighted.  Everything is 20/20 or better at distance now.

Well I had the right eye lens replaced and astigmatism done this morning. The astigmatism and surgical cuts took about 30 seconds. Then off to get the old lens sucked out and new installed. The last part was about 15 minutes. So many eye drops, of various types that I lost count. Walking out to the car my vision in the left eye was noticeably improved. I have the halo they spoke about. If you remember the movies where someone meets god and there is this white halo around everything. That is what I have. Once the drops are gone that disappears. An interesting part was when the referenced marks were placed on the eye ball. That was strange.

Now  4 weeks of eye drops of various types and it all starts all over again in one week with the right eye. 

Red dots, right now with all this stuff from surgery still in the eye, the Ultra dot and an Aimpoint Micro only have a few very small fuzzy lines around the dot. The dots are round, no distracting tails at all. Doctor says vision will be much better next morning after all the drops are gone.

Welcome to to the club!  I had my right eye done four years ago and my left eye two weeks ago.  I'm starting to taper off on the eye drop routine, down to one at bedtime.  They used the Toric lens to correct my astigmatism.  

I hope everything goes as well for you as it did for me.

Unless things in the USA have changed, no showering, no washing your face near the eye, and so on.  The drops minimize the chance of infection, but you need to do your part.  In India, it is two weeks of avoiding things.

Sleep on the other side of your head.  No touching, or rubbing your eye.  In India, they give patients a printed list of when they can again start doing things again.

Congrats!

Showering is fine, but no direct water or soap anywhere near the eye. I spent an hour the other day putting the eye drop schedule per eye in the phone's calendar. I am getting beeped a lot. Antibiotics for 5 days and another drop for two weeks and the third for 4 weeks. At bed or nap time I have a hard eye patch with holes in it that is taped over the eye for five days of sleeping. They gave the list of don'ts twice. 

Halo is gone and maybe 75% of the white cloud is also gone. Just tested where clear vision begins (most like to early) and about 6-8 inches past my barrel on a six inch appears to be where it starts. Expected that. 

I just went out to my dry fire practice target and without any glasses (right has yet to be done) I can clearly see the X and 9/10 scoring lines. 

Everything is looking up here.

Thanks for the comments guys.

Can not wait for Wednesday to get here I am scheduled to do the right eye at 6 am. The day after surgery post op examination all was well, more healing to come over a week or so. The  vision should get better as well for the next few days I was told, however the eye examine had me already at 20/20.  All halo is gone and astigmatism issues with red dot is also gone. 

I should have done this sooner.

When do they test you for reading glasses?  You might enjoy progressive lenses, that work at all distances.  The progressive lenses I prefer are Essilor X-Series.  

For shooting glasses, a year or two ago I was looking into these:
https://www.safevision.net/action-eyewear/shooting-hunting/quantum.html#/lens_type-frame_only_no_lenses/bifocal_type-none/tint_type-please_select/tint_color-please_select/anti_reflective_coating-none/mirror_coating-none/case_type-none
There may be better choices now.
I'm still using the glasses I had made for me in India.

Most shooters abhor the progressive lenses...

I didn't mean for shooting - I dislike mine for shooting as well.  But everywhere I go other than the range, I wear progressives.   

(They're also too expensive to risk getting them scratched at the range.)

September 9th I am going in for normal eye exam and glasses prescription. I have a set of trifocals that are the old prescription. I most likely will get a pair of reading/computer glasses. I will talk to them about another pair for 6" past my trigger finger and see what is recommended.   I have two pair of clip on lenses, one 1.0 and the other 1.25 that I bought to see if they would improve the iron sights with my old glasses. The +1.25 alone brings focus on my eye in from 6 feet to front sight distance. A pair of clear and and a pair of polarized shooting glasses at +1.25 maybe all I need. Need to get to the range and test that out.

great topic! i am scheduled to have glaucoma surgery in my right eye in october, very nervous! i don't have much of a choice in this as i am at the top of the eye drop program now ( three drops a day three times a day!) but also was told that this procedure could most likely bring on cataracts. i was told that if i did nothing soon i would lose vision in that eye within ten years. so, i could let it run out since i am 73 years old now. may die by then, or go for it . dot sights all look fuzzy to me, and i have 4 different ones. unfortunately this is my dominant shooting eye! but thanks for all the interesting discussion. i will review it with my doctors, sort of hoping the operation brings on cataracts so i can get rit of my astigmatism. LOL! thanks guys.

The astigmatism is treated with the Laser machine. It can be performed separately if one wanted, I believe. The thing about Cataracts, from my experience, is that the timing is up to the patient to complain about them before they move on surgery. I have had noticeable cataracts for 4 or 5 years and the doctor would always mention them and tell me the surgery was in my future. The first time I said that my left eye seemed to be a little worse off, during an annual eye exam, I was given an appointment with the surgeon for a 3 hour long evaluation and walked out of that the exam room into to the surgery scheduler's office.

Your final prescription will probably be about 4 weeks after the second eye is done.  Mine test 20/20 with no correction so I can drive, etc. with no lenses.  My final prescription was -0.5 for distance, with +2.5 added for reading.  I had progressives made so I can go from reading to computer to distance with one set of glasses.  For shooting I am using clear shooting glasses with about a 1.0 clip on lens for iron sights.

You will probably wear the glasses more often that you think.  They are a pain to carry around and its impossible to read anything (phone, watch, etc.) without them.