Some Past Experiences with Cataracts/Surgery

First topic message reminder :

The topic of cataracts never drew this much attention 10 years ago on our Bullseye site, so I guess there are more and more older shooters now.  First, I'm an Optometrist and not an Ophthalmologist.  I don't do surgery.   That means I see the progression of my patients' cataracts before surgery and their results after surgery.  I see some good results and some not so good.  I don't tell them they have 20/20 vision when they don't.

Shooters and everyone else should consider cataract surgery when their quality of life have been affected by subnormal vision and not "gut it out."  When one waits until the nuclear sclerosis of their lens becomes very opaque, the surgeon will have a more difficult time removing the cataract and complications may arise.  Undoubtedly, such a patient would be lucky to be under anesthesia and not hear the surgeon curse during surgery.  Just kidding!

One must make their own decision as to which Intraocular implant would be best.  Members of this forum have posted good results with the different choices, monofocal, multifocal, and accommodative.  I do agree that the monofocal IOL will consistently provide better and stable vision, important for shooters. 

A couple of patients come to mind who opted for the multifocal IOL. One, from a local club didn't recalled which type of IOL he received.  With my best efforts, his responses kept changing as I showed him various lenses for his eyeglass prescription for both far and near, super sharp one second and blurred a minute later.  He had the multifocal IOL.  He was never quite happy with any prescription.  Another patient paid extra for the multifocal IOL and expected no need for eyeglasses afterwards, but was extremely bitter when she needed a distant and near prescription and was not correctable to 20/20 vision.  Of course, there were many others who were very happy with their mutifocal IOL's.

For those who have monofocal IOL's, we can "always" come to a final endpoint for their best prescription, and if their eyes were healthy, they had 20/20.

Surgeons are human and computers are very important but not infallible.  Results cannot be guaranteed.  Measurements for the axial length of the eye from the front of the cornea to the fovea are critical for a good result.  If the measurement is off by 1/3 of a mm, the patient will need a 1.00 dioptor lens to correct the vision.  One member of the forum wrote to me that his post-op prescription was +1.50 D in one eye.  Visual acuity wise, that would translate to about 20/80 to 20/100 uncorrected vision.

The IOL's come in 0.50 D power increments but recall that our eyeglass prescriptions come in 0.25 D steps.  Although small, there a chance that the post-op vision could be slightly off.  As to the terms "stronger" or "weaker" IOL powers, there may be some slight confusion.  A stronger IOL than what the computer recommends means that the new focal point would be in front of the fovea (of the retina) and thereby result in a myopic situation.  This is not a bad result.  The opposite, when the new focal point is behind the fovea, we then have far-sighted situation, not desirable.

When one is slightly myopic after surgery, one can still see relatively well far and fairly well at near, depending on the exact numbers.  Since most of our daily tasks require near vision to some degree, one can do well most of the time without the need for eyeglasses.  Your eyecare professional can simulate these various scenarios simply by demonstrating with trial lenses during the pre-op exam.

On a different topic best discussed later, there are fine differences when I fine-tune a shooters prescription for their best vision.

Hello folks,
Thought I would ask a question regarding eyesight post-Cataract surgery. When I was 55 I developed fast-forming cataracts in both eyes due to using prescription drugs containing Hydrocortisone. After changing eyeglass Rx three times in two months, and finally getting frustrated and consulting an Ophthalmologist instead of waiting on my Optometrist to notice the problem, I was diagnosed and elected to have laser-assisted cataract surgery on both eyes to replace the cloudy lenses and see if the laser could correct my astigmatism. Pre-cataract I had 20:500 vision or worse. I think the doc called it Hyper-Myopia. I could work on a watch mechanism without glasses, but I could not distinguish individual leaves in an Elm tree without my Coke-bottle lenses. After surgery, I was delighted to have 20:15 distance vision in both eyes. I elected distance vision at surgery, and use +2 reading glasses for computer use and book reading, otherwise I get by without glasses after 50 years of wearing those old Coke bottles.
My question regarding post-Cataract surgery results is in regard to iron sight clarity. In bright sunlight,my Pardini's sights appear crisp when aiming at the metallic silhouettes at my 50 yard range. They are painted white and the irons are of course factory black. If I wear yellow tinted safety glasses instead of clear non-Rx safety lenses, I seem to have less of an ability to obtain a clear sight picture. If the sky is cloudy or dark, I find it difficult to obtain a perfect sight picture and am unable to maintain the correct space between the front sight post at the rear sight blade. This problem is with my uncorrected 20:15 distance vision. What would you recommend to improve my pistol iron sight clarity? I currently use bifocals which are Plano on top 3/4 of the lenses, and +2 Diopter for reading on the bottom 1/4. They allow me to have clear lenses protecting my eyes during shooting, while allowing me to use the bifocal +2 at the bottom of the glasses to read the adjustment marks on my various handguns so that I always turn the windage clicks the correct way. Some turn left to move bullet impact left, some turn right to accomplish the same thing. Just one of those things that standardization could have fixed many moons ago, but did not  
Thanks for the educational info in the thread!
Amanda

The consensus is to add .75 diopter to your DISTANCE correction.  So get a pair of quality shooting glasses (Randolph, Serengeti, Ray Ban?) and get them +.75 where your Plano is now and +2 bifocals.

The laser used in cataract surgery does not correct astigmatism, it just makes the same cuts that a skilled surgeon would make.  To correct astigmatism, the IOL that they insert in your eye was most likely a "topic", meaning it corrects the astigmatism, inside your eye, and your glasses don't need to do so.

My own advice is to get an exact prescription for your eyes, to the front sight.   I made the gizmo shown below, that puts a business card at the same distance as the front sight, so I could see the small lettering.  That seemed to satisfy the people doing the refraction.  If your refraction is done for that exact distance, that is the sharpest your front sight will look.  (If you do this for one hand shooting, it won't work that well for two handed, and vice versa.)  As for my gizmo, I added "sights", so now that I've got my glasses, I can use it for "holding drills" while I'm away from home.  The phone case is now fully filled up with Rupees, to approach the weight of my 1911.

Your eyes after cataract surgery no longer focus - the focusing is done by the eye, (IOL and cornea), and your glasses.  In dim lighting, with your pupils opening up, you won't have as much "depth of field" as in bright sunlight, so if the prescription is slightly off, the dim lighting will make things appear worse.

I now nothing about how tinting is supposed to improve vision.  It never has worked for me.  I see the best with clear lenses, unless it is too bright outside and darker lenses make it more comfortable - but for shooting, I prefer clear lenses.  

An inexpensive way to get what you want, is to have your shooting eye lens made for the exact prescription, and the prescription for your non-shooting eye set at the distance to your workbench, for adjusting sights, and so on.  There is then no extra charge for bi-focals.  I got three pair of glasses like that, one for 1911 one handed, another for 1911 two-handed, and a third set for red-dot sights.

Mike,
My surgeon used the laser to make limbal relaxing incisions (LRI) and correct my mild astigmatism. I did not need a Toric lense in either eye for that purpose. After the surgery, I can see license plate numbers at a much greater distance than I could when wearing glasses, but as you say, I cannot focus as before. My eyes are like a rifle scope focused to infinity. As long as the object I want to see clearly is beyond the length of my arm, I am in luck and have defined and clear 20:15 vision. If I wish to read the combination on my gun safe, or on the combination locks on the gates holding my Dobermans inside the fence, it better be a bright sunny day or I must have the lights on in the garage to get the safe open. Otherwise, I need the reading glasses. Compared to the previous 50 years of Coke bottles, I am extremely satisfied with the trade-off from being hyper-Myopic and having less than 20:20 corrected vision. Plus, I don't worry about fogged up or broken glasses anymore, and I can see underwater in the swimming pool
I will try out the lense suggestions for the handgun iron sights and see what happens. It appears to be a minor inconvenience, since I have no issues when using my UltraDot  equipped handguns at 25 and 50 yards for Bullseye, and defensive use to 25 yards with a concealed pistol is not an issue. I would like to be able to make more accurate shots at small rimfire silhouettes at 50 yards when using Iron Sights offhand, so hopefully the suggestions provided will accomplish that.
Thanks!
Amanda

Wobbley wrote:The consensus is to add .75 diopter to your DISTANCE correction.  So get a pair of quality shooting glasses (Randolph, Serengeti, Ray Ban?) and get them +.75 where your Plano is now and +2 bifocals.

I'm not sure abut this, as I now have three pair of shooting glasses, one for red-dot (distance), one for one-handed shooting, and one for two-handed shooting.  The gun is at a different distance based on how I'm holding it.  The front sight might be reasonably sharp with my hand(s) in one position or the other, but not both.  

My old shooting glasses worked fine with a S&W Model 41 with the long barrel, but the front sight was noticeably less sharp with a 1911.  Both were for two-handed, but the longer barrel moved the front sight further away.

I have all my paperwork, and am still at the eye hospital.  Maybe I can document all three values, and see how the .75 diopter difference compares with either of the steel front sight values.

Wobbley wrote:The consensus is to add .75 diopter to your DISTANCE correction.  So get a pair of quality shooting glasses (Randolph, Serengeti, Ray Ban?) and get them +.75 where your Plano is now and +2 bifocals.

The following is for my new shooting glasses:

Distance prescription for "infinity", red dot sight:          +0.5 diopters
Prescription for one hand shooting, 30" to front sight    +1.5 diopters
Prescription for two hand shooting 24" to front sight     +1.75 diopters

If my arms were shorter/longer, or my gun had a longer distance to front sight, these numbers might change.