Vision, especially at night

[dhays]

At night peripheral vision is better to locate unlighted marks than looking straight ahead.

Yes and no...

When our eyes are fully dark adapted, we have incredibly sensitive night vision from the rods. On a dark clear night after being out camping or hiking with no bright lights around, you can notice that if you look directly at a faint start in the sky that you sometimes can't see if if you look directly at it. However, if you look just to the side, then you can see it. The center of vision is nothing but cones, they don't function in low light. Just away from the center of the vision we have rods that will function in low light.

However, look at any reasonably bright light, be it an instrument display, a smartphone, or a lit match, then your rods are instantly and completely bleached out and take a while to recover.

 

[dhays]

Wish you were closer...I would give you my old eyes some business....

Lots of good folks you can see, even in New Jersey.

 

[psneeld]

Like so many who have had bad experiences with any profession, including the medical, it is hard to pick and trust out of the blue.

I had some great flight surgeons through the years, they were friends as well as Drs.

Now that has been stripped from many military retirees.

 

[dhays]

I did not mean to imply that an ophthalmologist was the place to start. We go to an optometrist, for a couple of reasons. One, you note, is that they will refer you to the right specialist. The second is that we've found they are much better at prescriptions for lenses on the whole.

OK, I understand you now. Obviously I agree with you. However, any general practice optometrist or ophthalmologist is a fine place to start.

It only gets sticky when the patient needs surgery. Most general eye surgeons simply are not as good at the surgical procedures as the specialists are. Most of those that specialize have little interest in general eyecare, particularly refractive care.

There is some cross-over. Good LASIK outcomes are largely based on the systemic procedures as opposed to surgical skill. Being very technology intensive it is more about how well trained the team is and how diligently the clinic is at maintaining their equipment. There are a number of great cataract surgeons who good LASIK surgeons. The same is true with corneal surgeons, they can do LASIK in their sleep.

The areas where there isn't normally crossover is with eyelid/plastics, retinal, and glaucoma surgery. Those are pretty highly specialized.

 

[rwidman]

She looks just fine. Her website is off-putting to me as it is full of hype and a bit short on specifics, but that is not too unusual in this day and age. She most certainly will be able to address your concerns about the halos and glare.

I never looked at her website until today for this discussion. She was highly recommended by friends and after going to "eyeglass stores", her thorough exams were welcome. She has never tried to upsell me with anything like Lasik although if it would improve my vision it would be hard to turn down. We have been going to her for eight years or more.

FDR was President when I was born so my eyes have been around a while. I've had the halo and night vision issues for years but I will ask her specifically about them next time I see her.

 

[rwidman]

............... However, look at any reasonably bright light, be it an instrument display, a smartphone, or a lit match, then your rods are instantly and completely bleached out and take a while to recover.

And this is the problem when driving (a car) at night. You can't avoid oncoming headlights and now that folks can go down to the auto parts store and buy incredibly bright aftermarket lights it only gets worse.

 

[BruceK]

Dave, Thanks for your professional input.


I don't know offhand what sort of eye doctor mine is but she is not just one that gives exams in the mall eyeglass store.

This won`t help you, but might save others from following your erroneous and unnecessarily critical views.
My referral to an ophthalmic surgeon regarding cataract,and again when I was the 1 in 4 who form "pseudo cataract" a couple of years post implant surgery, came from optometrist/opticians, at different locations. In each case they advised that updating specs, available at the premises, was not worth doing.
The competence of a trained professional optometrist/optician does not depend on their geographical location.

 

[rwidman]

This won`t help you, but might save others from following your erroneous and unnecessarily critical views. ............

Huh?

 

[JimTid]

My stress level goes way up at night because of reduced vision. I have a great sense of responsible while in control of my boat. I avoid boating at night. If I am going to be out I try to have some young eyes on board. I use a hand help spot light to put light where I need it.

 

[koliver]

I hoped a professional would come in on this, you`ll have to make do with my anecdotal experience and observations.
Cataract formation is routinely checked by opticians and ophthalmic examiners, I think it is easy to diagnose for a professional. Typical signs are poor vision in low light, little improvement from changing lens prescription,less need for sunglasses in bright light, loss of color intensity,and just plain lousy vision. Doubtless there are others. Maybe sun exposure is a contributing cause, especially reflected sun off water, boaters get lots of that.
The point is, you may not realize what you are missing, due to deterioration being so gradual, or how dangerous your loss of vision is. I had no idea how bad my vision had become, and no idea how much better it could be. The unrecoverable cost was substantial, even with Medicare for Dr. fees(ophthalmic guys here charge way over the Govt idea of fees), but my private hospital cover worked very well. Obviously cover varies, different places different schemes.
The procedure is not a problem, I was in and out in 3 hours each time, the eye cover comes off the same day. The procedure is done under a form of anesthesia. It is not normal to do both eyes at the same time, due to the risk of sympathetic opthalmia.The implanted lens is set for distance or reading, it can`t be both, you`ll need glasses for the one you didn`t choose, I chose distance vision achieving better than 6/6, so I use reading glasses.

Bruce:

I have had the lens replacement and the laser "fine tuning " to return my vision to pre-cataract acuity. I highly recommend it. But no, it will never get you absolutely perfect vision, and there will always be the difficulty reading in low light, especially if you are unable to move the item you wish to bring into focus into the zone where your new focal length brings it to perfection.
The more pricey lenses that I chose give me dual focal lengths, so in one eye, I focus perfectly at about 12" and again at about 20', so I have good vision for reading books and for most outside pursuits. The other eye focuses perfectly at about 20" and again at something like infinity, so I have good vision for using my computer and again for outside pursuits.

I no longer need any glasses, I no longer have any astigmatism. I have worn gasses since getting my driver's license at age 16. I absolutely cherish the freedom from glasses.

My wife has also had the surgery and for her, with eyes that were quite a bit worse than mine her whole life, the difference is even more dramatic. She does, however, experience chronic dry eyes since the surgery, a fairly common result.

As for boating safety, I would never have considered joining the RCMSAR group on Saltspring before the surgery, as my vision at night was simply terrible, even with glasses. Even with the skill set that I bring to the job, my vision at night was a sufficient handicap that I could not overcome. After the surgery I can spot the targets as well as any of the other crew, many of whom are quite a bit younger.

 

[BruceK]

Keith, good to hear of good results. I didn`t know there were "multifocal" implant lenses, they sound great. I once had contact lenses with multifocal areas, your brain works out how to use them, amazing. It`s wonderful sight can be restored like this. I suppose one time people just effectively went blind
Between lens implant 1 and 2, I did my driver license renewal eye test, without glasses. How`s that! And I can share your confidence operating at night.
The late Aussie ophthalmic surgeon, Fred Hollows, established a network in disadvantaged countries to do cataract lens replacements in disadvantaged countries, using local people trained to do the procedure, but certainly not doctors. His wife carries on the Foundation, they say a donation of $30 cures one person (well short of around $3K per eye I paid).
Let`s hope reporting our experiences encourages others with concerns to explore treatment.

 

[dhays]

Keith,

You are doing great with your multifocal implants. However, any MF implant is a compromise. ie, you could have seen better in the distance (anything around 20' or more) if you had opted for a monovision implant. However, you would not have been seeing much at all at near without putting on reading glasses. With reading glasses, you would have seen better at near without a compromise.

So I don't argue your decision, but your characterization of seeing "perfectly" at any given distance is false. Simply put, it ain't possible unless the laws of physics are different in Canada.

Having said that... compromise isn't a bad thing provided it is informed. Just like the discussion of SD vs FD. A FD hull is a compromise but one that makes sense for most of us. A multifocal implant at the time of cataract surgery MAY be an appropriate compromise for some. If it was my and I had to make a decision now, I would probably go with a singlevision implant to get the best distance vision I could. Part of that is that is it is what I am used to.

 

[rwidman]

I wear bifocals. If I could have surgery to get good distance vision, I would seriously consider that and wearing glasses for reading and other close work.


Wearing bifocals, I now understand why many older people walk the way they do. I have to bow my head to walk down stairs because without bowing, I can't see the stairs clearly.

 

[BandB]

I wear bifocals. If I could have surgery to get good distance vision, I would seriously consider that and wearing glasses for reading and other close work.


Wearing bifocals, I now understand why many older people walk the way they do. I have to bow my head to walk down stairs because without bowing, I can't see the stairs clearly.

Something I'd love to hear DHays address, but my experience says that one problem, and one you may be encountering is that the sections on lens, even progressive, not the best for the individual. I've been fortunate to work with an optician who does a great job of making the lenses the way they work best for me. In my case that's a small near section, as small as possible intermediate and a large distance area. I don't ever really use the mid range. Also, and it may well be the optician, I could not get glasses with systems like Hoya that worked for me with their "advanced" lens making techniques. It was too advanced and controlled too much by the system vs. the optician it seemed. When fitting bifocals, lined or progressive, it seems to me the importance of the optician's role is greatly increased.

 

[dhays]

I wear bifocals. If I could have surgery to get good distance vision, I would seriously consider that and wearing glasses for reading and other close work.


Wearing bifocals, I now understand why many older people walk the way they do. I have to bow my head to walk down stairs because without bowing, I can't see the stairs clearly.

That is one of the many nice things about what Keith had done. Multifocal implants are improving all the time for cataract surgery.

 

[dhays]

Something I'd love to hear DHays address, but my experience says that one problem, and one you may be encountering is that the sections on lens, even progressive, not the best for the individual. I've been fortunate to work with an optician who does a great job of making the lenses the way they work best for me. In my case that's a small near section, as small as possible intermediate and a large distance area. I don't ever really use the mid range. Also, and it may well be the optician, I could not get glasses with systems like Hoya that worked for me with their "advanced" lens making techniques. It was too advanced and controlled too much by the system vs. the optician it seemed. When fitting bifocals, lined or progressive, it seems to me the importance of the optician's role is greatly increased.

Yeah, this is a problem. I saw a patient yesterday with this same issue. He had been wearing a great progressive lens made by Essilor but wanted a wider area in the intermediate and near zones. We changed him into a different great progressive made by Hoya. This dramatically increased his intermediate and near usable are, but decreased the distance usable area. What he wanted what a lens that would do both. Unfortunately, not possible. Again, back to compromises based on design.

Often we find we have to use different lens designs for different applications. Most common is a different lens for an office environment vs general wear. As you point out, it is a matter of working with someone who can explain the different options and how each can best meet your needs.

Most patients understandable want one pair of glasses to do everything. That means that the lenses we wear most of the time aren't ideal for any particular task, but are the best compromise for all the tasks that we ask them to perform. It is a lot like the FD, SD, or PH design discussions. Each has advantages and disadvantages and it is a matter of picking the design that will best meet the needs of the user. The problem for me is explaining to a patient that nothing we give them is going to make their vision like it was when they were 20 years old.

 

[cappy208]

B and B hit the nail on the head. The retinal scan and pressure test in addition to your regular Drs visit annually. My vision is slightly lower than when younger. HBP, Typell Diabetes and weight all play into the equation. Doing nothing about all the aforementioned things is not going to help the situation.

 

[BruceK]

I just exchanged another boat dollar for a 30 second laser clean up of my right (post cataract) implant lens. Based on the left, takes about a week to attain optimum improvement, and I hope the ophthalmologist is right that the foggy deposit never recurs.

 

[BandB]

I just exchanged another boat dollar for a 30 second laser clean up of my right (post cataract) implant lens. Based on the left, takes about a week to attain optimum improvement, and I hope the ophthalmologist is right that the foggy deposit never recurs.

Everything I've heard says it is one time and one time only to be cleaned up.

 

[BandB]

B and B hit the nail on the head. The retinal scan and pressure test in addition to your regular Drs visit annually. My vision is slightly lower than when younger. HBP, Typell Diabetes and weight all play into the equation. Doing nothing about all the aforementioned things is not going to help the situation.

When I was about 17, I changed doctors. That's when I realized I'd never really had a decent examination. There was lot's of inquiry into my history, a good many labs and tests and full discussion of everything going on.

Same with eye doctors. You'll know the difference when one does check your eyes completely and tells you what they're doing and discusses them with you, even any expectations for the future.

Some doctors, some optometrists and opthalmologists will make you feel like it was "Slam Bam, Thank you Ma'am." It can happen with the most reputable eye surgeon in town who is dismissive because you don't need his primary and best paying services, or the optometrist set up in the discount eye wear store who is just about getting you a prescription.

Much of what you'll face with your eyes will be normal for your age at the time, but a good doctor discusses that with you, then discusses anything that isn't part of that normal aging process. They'll advise you also on how to take care of your eyes.

 

[dhays]

I just exchanged another boat dollar for a 30 second laser clean up of my right (post cataract) implant lens. Based on the left, takes about a week to attain optimum improvement, and I hope the ophthalmologist is right that the foggy deposit never recurs.

As B said, one and done.

Needless explanation:
It isn't really a deposit, but the capsule itself that initially held your own lens in place, and now holds the implanted lens in place, simply gets cloudy. In other words material isn't being added to the capsule but the nature of the capsule changes and goes from clear to translucent.

The laser doesn't clean it up, the YAG laser simply blows enough holes in the back surface that it opens up. Much like if you had cellophane stretched over a bowl and you poked a bunch of holes in the center in a "+' pattern. For this reason, it can never recur.

Some floaters are normal for a few days after the procedure. Generally, I will do a dilated retinal exam a week afterwards to ensure there are not any retinal tears induced by the shock waves produced by the laser.

 

[Shrew]

Consider the well laid out marking systems in the US. You can navigate from lit marker to lit marker. There will never be an unlit marker in your path between two lit markers. You will pass by them, but unless you're way off course, you won't hit it or be on the wrong side of it.

There will not be an unlit marker on a turn on 'intersection'.

Boats should have Nav lights and the colors indicate direction.

Trust your electronics and radar.

Maintain enough speed to ensure GPS is holding a true course.

 

[cappy208]

Although the thread was more about failing eye sight (and age related deterioration) it does not seem that some of us can see as well as we could a few years ago. And how to deal with the change in vision. It's not about just following the waypoints. It's about seeing the minutia: buoys, lobster pots, lights, number of flashes, the details ON the radar/plotter, the temp gauge. Etc etc etc.

Consider the well laid out marking systems in the US. You can navigate from lit marker to lit marker. There will never be an unlit marker in your path between two lit markers. You will pass by them, but unless you're way off course, you won't hit it or be on the wrong side of it.

There will not be an unlit marker on a turn on 'intersection'.

Boats should have Nav lights and the colors indicate direction.

Trust your electronics and radar.

Maintain enough speed to ensure GPS is holding a true course.

Unfortunately not true. There are multiple locations I am aware of ( and transit regularly) that do not meet this portrayal.

And if you are depending upon this technique for accurate navigation at night then you depend WAY too much on the charted buoys being ON location, with accurate swing circles, with no buoyage error.

Iirc the 'allowable' swing circle diameter for a buoy is 6 times the depth. So if the channel is 10' deep the buoy can be up to 60' off station and still be considered 'on station'. Think about that next time you are in a 150' wide channel on a windy day!

 

[Dougcole]

I'm 52 and my eyes are still pretty good. Just in the last year or so I sometimes wear magnafiers for reading, (especially in the morning) but most of the time I don't really need them unless the print is super small like the serial number on the back of a cell phone.

My distance vision is still really good. I get it checked once a year and the docs always comment on how surprised they are that my vision is so good for my age.

I was a flats fishing guide for many years, a profession that requires good vision. I cherished my good vision and always wore the best sunglasses I could find. I've always had great vision, I don't know why, just lucky I guess.

I still see pretty well at night as well. I run (not the boat, jogging) at night quite a bit with no street lights and do fine.

 

[rwidman]

Consider the well laid out marking systems in the US. You can navigate from lit marker to lit marker. There will never be an unlit marker in your path between two lit markers. You will pass by them, but unless you're way off course, you won't hit it or be on the wrong side of it.

There will not be an unlit marker on a turn on 'intersection'.

Boats should have Nav lights and the colors indicate direction.

Trust your electronics and radar.

Maintain enough speed to ensure GPS is holding a true course.

I think there is some bad advice here. We need to be able to see more than markers and navigation lights. We need to see anything that could be a hazard and that includes crab pot markers, fish trap markers and debris in the water.

"Maintaining speed" at night is really bad advice. You shouldn't be going any faster than you can stop in the distance you can see and react. Yes, that may be 4 knots but it's better than hitting a log or tangling your prop in a trap line.

 

[psneeld]

Consider the well laid out marking systems in the US. You can navigate from lit marker to lit marker. There will never be an unlit marker in your path between two lit markers. You will pass by them, but unless you're way off course, you won't hit it or be on the wrong side of it.

There will not be an unlit marker on a turn on 'intersection'.

Boats should have Nav lights and the colors indicate direction.

Trust your electronics and radar.

Maintain enough speed to ensure GPS is holding a true course.

Not all turns have lit markers even if they should.

Going pretty fast and gps will not react quickly enough to keep you out of shallows in some narrow ICW spots and radar won't either. In this situation, only visual clues will....so you better have a lighted aid or hit the unlit one with a spotlight if you want to keep from going aground. You are correct that going too slow and gps may jump around too much.

It is impossible to see most debris at night unless you are running with a light or night vision aid or flir...so slow or fast is what means you have to see them, not an absolute speed.

Usually feeling comfortable with speed at night is a matter of what aid you are using, visibility from the helm, situational awareness as in local knowledge and experience doing it.

 

[Spottsville]

I`m told one in 5 cataract surgery patients gets a misty "growth" on the back of the implanted lens, mimicking cataract. Unfortunately I`m in the "one" group. Lasering it off takes 30 secs, costs $970. One done one to go. Assured it does not recur.

So if you zap them they are gone?.....someone told me they often congeal and stop floating and obstructing?

Thanks
Norm

 

[FlyWright]

Consider the well laid out marking systems in the US. You can navigate from lit marker to lit marker. There will never be an unlit marker in your path between two lit markers. You will pass by them, but unless you're way off course, you won't hit it or be on the wrong side of it.

There will not be an unlit marker on a turn on 'intersection'.

Boats should have Nav lights and the colors indicate direction.

Trust your electronics and radar.

Maintain enough speed to ensure GPS is holding a true course.

Not sure about your parts, but not so on the rivers of the West. Many channels follow a curved path from green to green (or red to red). But my only experience is out here so I can't speak to other waters.

 

[BruceK]

So if you zap them they are gone?.....someone told me they often congeal and stop floating and obstructing?

Thanks
Norm

Norm, dhays explanation above is more help than the explanation I repeated, which really didn`t explain the procedure correctly.
As he says, and B&B said, and as I was told, it does not recur. I would still have had the implants done, but I would expect a surgeon to tell me there was a 1 in 4 or greater chance of a second procedure.
As to floaters, I had none with the first eye but some with the second. No flashes(unlike the dreaded F&F, ie.flashes and floaters, which I understand can in some cases indicate impending retinal detachment). I understand the floaters are the lasered material which should subside in 2 weeks.
The main issue I set out to raise was gradual loss of vision, which in, ahem, older people, can, like fading gloss on car paint,
go unnoticed. I had no idea until my vision, esp at night, had reached a parlous situation. There is a risk that until then we can and probably do unknowingly put ourselves and other at risk. My advice is regular eye examinations, and if you find other can see things much better than you, esp at night, get yourself checked, the world can be a lot brighter.