Hi Linny,

I've done quite a bit of research on this topic for myself and for others. I developed cataracts in both eyes in my late 40s and had both eyes done. My brother also had both eyes done in his 40s (bad eyes seem to run in my family since both of us also developed retinal detachments in our mid-50s). And I spent MANY hours discussing this topic on the phone with our former listserv pal, the late Liz Day, before she had both of her eyes done. Liz was particularly concerned about the effects of certain lenses on contrast sensitivity and color perception.

You basically have five options for intraocular lens replacement:

1. Monofocal. This is the simplest type of lens that focuses at only one distance. You can choose to have the lens focus at any focal length you want - near vision, distance vision, or even intermediate distance.

2. Toric lenses. This is a type of monofocal lens that also corrects for astigmatism. If you have an astigmatism, these work really well, but they have to be positioned very precisely within the eye. Make sure your surgeon is certified to implant these and has lots of experience with them.

3. "Monovision". I think this is a poor term because it sounds so much like monofocal. This is what others have described where you put a distance lens in one eye and a close up lens in the other. As others have said, this can be difficult to adjust to and may not result in good vision at ANY distance. I'm not sure why some doctors push this option since I've never heard anything good about it.

4. Multifocal lenses. This sounds like what you were talking about. These lenses literally split the light coming into your eye into multiple beams with different focal lengths. I'm aware of two such lenses using slightly different technology. The AcrySof Restor depends on differing lighting conditions to change the focal length. For example, in bright light, the pupil constricts and the light is directed through the center of the lens onto the fovea for better close-up vision. In low light, the pupil dilates, allowing more light to hit the edges of the lens, which focuses it for distance vision (this is great for driving at night but what if you happen to be driving in bright light?). The other option, the Tecnis Multifocal, uses somewhat different technology that supposedly doesn't depend on differences in lighting conditions. Multifocal lenses are very popular because they free people from having to wear glasses, but I don't think either of these is a good option for an artist. Because the beam of light is literally split into different focal lengths, less light hits the retina at any given spot. According to the research I read, this results in reduced visual acuity and reduced contrast sensitivity (i.e, reduced ability to tell the difference between subtle shades of gray or colors).

5. Accommodative lenses. When we are young, the lens in our eye is small and flexible. There are ciliary muscles in the eye that can stretch and relax the lens to change the focal length, allowing us to easily change focus from near to far. This process is called accommodation. The Crystalens and Trulign Toric (both from Bausch & Lomb) flex with changes in the ciliary muscle, similar to the eye's natural focusing mechanism (these two lenses are identical, but the Trulign Toric also corrects astigmatism). There's just one problem. According to my doctor, by the time most people need cataract surgery, they have already lost much of the ability to accommodate. This is because the lens continues to get thicker (and more stiff) as we age, and eventually the ciliary muscles just stop working. This is why so many people develop presbyopia later in life and need glasses for both near and far vision. Even in my 40s my doctor didn't recommend this option for me. I also read some research that, similar to multifocal lenses, accommodative lenses give poorer contrast sensitivity than plain old monofocal lenses. Again, not a great thing for an artist.

After doing lots of research and discussing this at length with two eye doctors, I decided to go with monofocal lenses with the same focal length in both eyes. I did have an astigmatism in my right eye, so I had a toric lens put in that eye. It completely fixed the astigmatism.

When choosing a monofocal lens, most people choose either distance (for driving) or close-up vision (for reading). Since I do all of my artwork on the computer, I told my doctor to give me lenses with a focal length of about 30 inches - the distance from my face to the computer screen. I wanted to be able to work all day without glasses, even if it meant wearing glasses for distance and reading. As it turns out, this was a pretty good compromise because my close-up vision is good enough to read anything except the tiny instructions on medicine bottles and my distance vision is good enough to drive without glasses.

Jim



James A. Perkins, MFA, CMI, FAMI
Board Certified Medical Illustrator
Fellow, Association of Medical Illustrators

Professor and Graduate Director
Medical Illustration
Rochester Institute of Technology
CBET 75-2129
153 Lomb Memorial Drive
Rochester, NY 14623

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On Aug 10, 2016, at 10:26 PM, Linda Heagy wrote:

Re: [SCIART] Discussion: Cataract surgery for artists
Hi Linda,

I will have both eyes done, but not at the same time. ... I thought they could put in a lens that had both far away AND up-close vision in each eye?

Good point, Linda. I may be confused about the procedure and lenses. I was thinking that there was one lens that had the ability of both focal powers of far away and up close. I was not thinking of having one focal for distance in one eye and one for close-up in the other eye. No, that does not sound like a promising solution to me at all !

My last year visit with doctor alluded to coming new advances in lenses and cataract surgery. Just how soon, I do not know and what those advances are. So I was hoping I could hold out till those new advances were available.... If they are even beneficial to me.
 
Have you had cataract surgery and were you satisfied with the results?

Best,
Linny

___________________________
Linny Heagy
DBA: Linny/Designer, Illustrator
Arlington, TX

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