Cataracts - op to be done for close work or distance - advice please.

I need my cataracts done and I'm very scared! I'm extremely nervous about the op itself and also about the outcome and making a wrong decision: For various health reasons and being in a lot of pain I'm not out and about very much and when I'm at home I use my iPhone and iPad a lot when I'm sitting down. if I have my eyes done for distance which is what the majority of people have, I would have to use glasses every time I want to send and receive a text message, look on Facebook, use the iPad, look something up etc. - and because of this I've been advised to have them done one close and one close--and-a-bit. I'm also concerned that if they are done for distance I won't be able to see properly to do my make-up, particularly eye-make-up, which is important to me. I will be quite happy to wear glasses for driving, TV, cinema and theatre, which is what I do now. If any ladies have had their eyes done for close vision rather than distance, can you tell me can you see ok to use your iPhone and do your eye make-up? Equally, any ladies who have had their eyes done for distance vision, how do you find it for using iPhone, seeing texts, and doing eye make-up? Apparently make-up glasses are a huge nuisance and not terribly successful.  Any advice from either a patient or a professional would be most welcome. Thank you very much.

 

Have same dilemma. Try accomidating lens

Im in exact same position as you. I've been told accomodating lenses world give me distance and intermediate but that they dint always work as described. Thought of one sustenance and one neat or intermediate, but dint want to lose depth perception. What have got decided?

Sorry for all the typos but u think you can understand me

I was just 34 (earlier this year) when I got the surgery done... I was hit by a racquetball 7 years ago ... the surgery is painless and you'll be just fine... because my other eye is good I don't need glasses for near-distance reading... one precaution - before the surgery you'll have a pre-op when they do measurements. Because I had a very dense cataract they couldn't get the measurement done using the regular machine so they switched to an ultrasound and got some readings that weren't powerful enough... so now I have to wear contact lens for the surgery-eye too... the surgeon offered me an option to add an 2nd lens anytime in the future when I want to... otherwise the surgery will bring a big relief... I have switched to cricket and can play my best game.. all the best!! AND DO NOT WORRY, just get the pre-op done correctly... 

Hi Marion

I am writings novel and I was feeling the same as you I opted for the dual lens - like variafocal lens. Suffering at the mo with flickering and light flashes along the side of my eye. Hoping this will pass it know it is a problem just from this site. I think if I had gone for the single lens I would be doing the same. I'm still struggling a bit but much better (its easy to alter text size for text and email on iPhone. I'd check with dr to see how strong lens you would need too. Good luck with the op. Jean

Thanks everyone for your replies but I'm not sure that any of them precisely answer my query. I'm not going to have accommodating lenses (I'm not entirely sure what they are actually - are they like varifocals in glasses?) just one close and one close-and-bit, so I would still have glasses for TV, cinema, theatre and driving which is exactly what I have at present. I am not out and about very much as I'm slightly disabled so I don't need to see  for sport or any of the other requirements that people who have replied have mentioned..  I'm indoors quite a lot but I do drive to friends and I'm quite happy to wear glasses for driving post-op. The question I would really like answered please is if any ladies have had close and close-and-bit and whether this is ok for doing make up and how that is just generally walking about the house, preparing food

etc., or whether any ladies hsve found that having standard lenses ie for distance,  can you see really close up to do your eye make up and if not how well can you see close-up with a magnifying mirror? Or is it a huge nuisance? And do any ladies use make- up glasses? Thanks for reading this and I look forward to your replies.

Well, I am not a lady but I can answer your question.  Accomodating lenses are supposed to change focal distance by using your own eye muscles. So, theoretically, they work like a telescope and can allow you to see distance, midrange and near.  But in practice, I am told they don't exactly work like that. Sometimes they work great, sometimes not so great and sometimes not at all.  Also I am told there is a 1 in 1000 chace you get Z syndrome which means the hinges get twisted giving you big astigmatism.  My doctor told me that accomodating do everything single focus does except it has a chance of seeing more than just one focal distance so it is better than nothing and, if you don't mind the cost, why not try it?  No downside other than money.  But I am researching it and I am told that they stop accomodating after a few years as your eye muscles get weaker with age and that there are newer accomodating lenses around the corner which might solve those problems.  Who knows though when they will come to market?

As for getting two distance single focus lenses, I have been near sighted all my life.  I am used to seeing things up close and need glasses for distance. I tried putting in two distance single focus contact lenses to simulate what it would be like to have two single focus distance lenses put in when my cateracts were removed.  I have to tell you it is very uncomfortable for me not to be able to see up close without glasses.  I wake up in the morning and go to the bathroom and I cannot see my phone or who called me because everything up close is a big blur.  And I have to find my glasses to be able to see up close.  When driving I cannot see anything in my car that is up close without glasses. Just a big blur.  I went to take my medications and realized I had no idea which pill bottle was which because they were all just a big blur.   So two distance lenses are out for me.  I am now trying one distance and one intermediate and that works pretty well but I am told that I won't like monovision if I never had it before and that my contact lens simulation is not as good a test as I think.  But at least I can see intermediate and distance and at least I can see my phone and read my text messages. 

So I am either going to get two intermediate or one distance and one intermediate.  Getting two close seems a little restrictive and one intermediate and one close, if you are going to get monovision, might as welll have one of them for distance.

Or I can just wait and see if technology brings somethign better in next couple of years. It will, just who knows when.  I hope this little analysis helps you. I have put tons of research into this.

Dear Primeland, thanks so much for your reply. You've answered my query regarding seeing up close eg your phone and pill bottles.   But about doing my makeup! As you say, you're not a lady! but when you had the trial intermediate/distance (if I understand correctly) and you could see your phone and your pill instructions, would you say that you would be able to see your eyes clearly if for example you got something in your eye and needed to see close up to clear whatever it was in your eye? I'im trying to find out if you could see to put eye make up on if you were a woman. I wish I could get a reply from another woman! Surely there are some ladies who have had this query and who have had their cataracts done who could answer this question??! Does anyone else reading this forum know of any ladies who have had their cataracts done and who wear eye make up? What strength lenses did they have? I cannot be the only one!!!

anyway, Primeland, if you could just tell me if you could have seen close enough and wanted to put eye make up on really close up, would you have been able to with the distance/intermediate trial lenses - and with or without using a magnifying mirror. That was my other query, with the new vision, whatever it is, would one be able to see clearly close up in a magnifying mirror or would it be blurred as your new vision is fixed. 

 By the way I was told that having one distance and one close if you haven't previously worn contact lenses is likely to be very problematical as the brain can't adjust to the new vision.  I had a trial of contact lenses like this at the opticians and felt completely disorientated. (I did try contact lenses to see what the post op result might be like - and tried and tried to get on with them and found them extremely difficult. I just about managed to get them in but had great difficulty in removing them, so much so that I managed to burst a blood vessel in one eye because I had unknowingly pressed too hard trying to get the wretched things out! So I gave up on that idea!).   Anyway I look forward to hearing from you, and many many thanks. And if anyone else can answer the make-up query Please let me know.

Marion,

Seems like u r a female version of me so I think I can answer your questions.  

1.  As for contacts, I am exactly the same as you.  Cannot stand anything touching my eye.  Cannot even put in eye drops because I cannot keep my eye open to put them in.  I have to put them in the corner of my eye when it is closed and then try to blink the liquid in.  Putting in contacts is hard enough but I am getting better at it.  Doctor charged me $21 for a "lesson".  After they wanted to charge me another $21 when I couldn't get them out, my local eye glass doctor helped me and YouTube was a much better teacher.  There is even someone on their who figured out a way to get them out by blinking without even touching your eye at all.  Did it once in one eye but haven't been able to duplicate it since.  It seems like everytime I try to get them out, they get lost somewhere.  Not on my shirt, not on the table, not on the chair, not on the floor.  They just vanish, hopefully not somewhere in my eye.  I can slide them off my pupil but have difficulty grabbing them to get them off my eye entirely.  What a difficult procedure. OMG!!  

2.  I am naturally near sighted in both eyes so if I put one distance contact in my left eye (the one with the more dense cataract) and do nothing with the right eye, I am simulated monovision with one distance and one near.  I never have worn contacts before except when I was a teenager.  I kind of liked it.  It was great to drive with no glasses and I could see close up clearly too.  No headaches. No disorientation.  However, I only tried it for a few hours since I did not want to go past 7PM, the time when my local eye glass doctor closed so that if I could not get the contact out, I knew I could always drive to his store and he would help me.  Didn't want to go to the emergency room to get a contact out.  Yes, if I were a woman and wanted to put on make up, I would have no problem with one distance and one close up according to my simulation.  Magnifying mirror was not necessary but it would be better to use a magnifying mirror. I use magnifying mirror to take my contacts in and out and can see perfectly (aside from the cataract which of course makes it not perfect)

3.  Next I put one distance in my left eye and one intermediate in my right eye.   Again, I liked it.  Could see my phone, pill bottles, caller id, and computer.  Computer not so well, but maybe because of cataract and maybe because contact was generic free samplel off the shelf and not tallor made for me. Nothing is crystal sharp because I have cataracts in both eyes, more dense in the left.  Could I put on make up like this?  Yeah I don't think that would be a problem.  

4.  Then I tried both eyes with distance contacts.  OMG!  Not being able to tell what time it is on my watch and not being able to see the caller id on my phone or to look at the digital phone directory on my land line phone as I scroll thru it, is kind of like being blind.  You just cannot see anything.  Make up?  Not a chance.  With magnifying mirror, maybe, but safe to tell you, not a chance.  Anytime I wanted to see anything at all close or intermediate I had to put on a pair of $20 reading glasses I picked up at Target for this purpose.  It was cool to see distance but when I went driving and wanted to see even my GPS it was difficult. Supermarket, forget about it.  Cannot read any product boxes unless I put my Target glasses  on.  I didn't like it at all.  But of course I have cataracts so you have to take that into consideration.

5.  So would I do monovision? Well my cataract doctor, who has done over 70,000 cataract procedures told me I wouldn't like it and that my contact lens experiment was not such a good indicator. Plus I have not lost both my contacts and am waiting now a week to 10 days to get replacements in the mail.  My surgery was scheduled for Monday but I cancelled it because I am undecided on what to do and want to longer trial with the monovision.  

6.  You can try accomodating lenses. The only one approved by FDA is crystal lens by Bausch and Lamb.  I read that it works off the muscles that control your capsular bag of your eye (whatever that it is) and that, as we eye, it gets hard and less pliable and you lose the "accomodating" features of that kind of lens and it goes back to monofocal.  I also read of a new accomodating lens that allows you to see all distances without the problems of multi focal called the Sapphire AutoFocal IOL, the next generation of accomodating lense which does not have anything to do with your eye muscles or the capsular bag.  It actually works off software and how your pupil changes when you look far, near or intermediate.  You can google it but it is probably a few years away from being available.  Article was from 2013 and said it was 2 years away from starting FDA clinical trials.   

My cataracts are annoying but not critical.  One doctor told me if they were not interfering with my life style I should wait until they do and he told me to come back next year.  I have met my insurance deductible this year out of pocket so surgery is free for me this year and not free at all after dec 31st when my deductible starts all over again.  But for me, it is my eyes and I don't want to let money dictate my decision.  You use your eyes every second of your life except when you are sleeping.   AT this point, it looks like I may just put the whole thing off until next year or even year after.  I just cannot decide and maybe need longer contact lens experience.  I think in about 5 years from now they will have lenses that will see all distances with none of the problems of today but don't know if I can wait that long.

Hope my lengthy comment helps you.  For me, I would love to hear from someone out there who has been near sighted all their lives and see what kind of IOL choices they made and if they are happy with their selection.

 

In re reading what I sent u, I made a few typos.  I wrote t h e i r, when I should have written t h e r e.  And some other types too. I'm  a pretty educated person.  Those were just typos.  I hope u make the right choice for yourself and i hope it works out for you.

Dear Primeland, thanks so much for your very detailed reply. I am very grateful to you for going into such detail - it has been very helpful. Regarding contact lenses I'm not afraid of touching my eye, putting drops in etc., that's all fine, but I just found it terribly difficult to manage to get the contact lenses in and out. Like you I would only practise when I knew that my own optician was available if I needed help getting them out! In fact I found it so difficult he actually gave me his private mobile no.! He also said that trialling contact lenses would give me an approximate idea but that no-one can say exactly how things will be after the ops. so I just finished up getting very confused.  Whereabouts do you live? You are obviously in the US. I'm in London and my surgeon is a Moorfields man, Moorfields being the world renowned eye hospital in central London so I know I shall be in good hands.

All the best, and I hope you make the right decision and that all goes well.

Hi I have put questions and answers in before but just saw in your message some query that I too was concerned about. I have one eye that had deteriorated through premature cataracts caused by large doses of steriods for sarcoidosis earlier in my life. the worst eye distance prescription was 10. so I couldnt see very well at all at a distance. However, close up was clear but obscured by blind spots that formed a sort of semi circle just around the area used to read up close. So pretty difficult. Fortunately my other eye was not so bad.

The concern I had when having a replacement lens fitted was that the sacroidosis could flare us and also was the blind areas be repaired (as my consultant was not sure but thought that they could be caused by the light refracted by the cataract. 

Anyway, its all too easy to forget these sites when things do go wrong, as after all that when you are anxious and want advice etc.

I joined the blog when after chosing to go from a bifocal lens so I had a chance of seeing better at a distance but also the possibility to be able to read? (my dr said I would still need glasses for driving and maybe for reading ?) - I joined in the conversation when after the op I was having really annoying flashing lights at the side of my eye. along with sensitivity to light. I could not of sat here by the light writing this blog without shielding the side of my eye.

Good news is that has subsided. So much so its not really noticable at all. Its not 3-4 weeks after my op and I am looking forward to having an eye test to get the one lens in my glasses changed to use to drive. Although to be honest I am coping well enough to manage but need to check that with the optician.  With regard to reading, I can see a lot of things to read up close. I may need to move my phone away to say a foot from me but now I just have some cheapo magnifiers in my bag and I can see then super easy. Regarding makeup etc everything is fine without any glasses.I am really thrilled with the results so far. I know I wasnt going to bother with the blog now Im alright but I felt its important to write in as its positive news and so no to necessarily panic and as my dr said the bright lights are common and in a lot of cases with subside.

I must thank you all for telling your stories and my heart gopes out to those who are still suffering. I hope that you all find someone who can help very soon. Kind wishes to you all

One comment I'd make based on your posts above is that  unless you have other eye health issues, after cataract surgery your vision should be able to be corrected to see well at whatever distance you choose. That means that if you don't have enough near vision without glasses, that a magnifying mirror should work, the question is merely how much magnification you need. 

I would suggest that a contact lens test is worth trying if possible, even if it is only for a day or so to get some idea, or even just for a few minutes in the office.  The issue is mainly whether cataracts have degraded your vision too much for contact lenses to give a good sense of what your vision would be like, which is likely the real problem. The contact lenses can set your eyes to about the same distance they would be after surgery, but the quality of vision won't be as good due to the cataracts. You also wouldn't get a good idea of how much nearer vision you'd have from that distance, depending on how much presbyopia you have now. 

You mention Moorfields, which might mean you    are getting the surgery done via NHS.  If so then as far as I'm aware  the only choice is monofocal lenses and not the accommodating lenses posted about above (I'm in the US but as far as I know the UK is like the US where government plans, and insurance, only cover the basic monofocal lens).  If however you are getting private treatment at Moorfields (they have a private clinic as well as NHS) then in addition to the accommodating lenses they also have multifocal lenses which give you a broader range of vision, like the Zeiss AT Lisa trifocal. Most people have great experiences with the lenses, but there is a greater risk of visual side effects with multifocal lenses, such as seeing halos at night from headlights and othr lights, but only a small fraction of patients find that to be a problem. There is also a  new lens called the Symfony which gives a wider range of good vision than the monofocal with risks of halos comparable to a monofocal, so overall if you are willing to spent he extra money it is a good bet since it improves the range of vision without much risk of any added problems.

In my case I went to Europe to have cataract surgery and get the Symfony lenses (since they aren't yet approved in the US, but are over there) and I have almost 20/15 distance vision,  and 20/25 near vision (so I'm guessing 20/20 at intermediate). I can read the small print on my eyedrop bottles, and use my smartphone  without trouble, though everyone's results differ.  If you chose to have the lenses set for intermediate  vision rather than distance you'd likely have very good near vision.  I'm a typical male who has no idea about what sort of vision would be required for makeup  unfortunately, I'd guess a cheap magnifying mirror might be required. Any of the types of premium lenses (accommodating, multifocal, or "extended depth of focus" like the Symfony) give you a wider range of vision than the monfocals, meaning even if you set them for intermediate you'll have better near than you would with a monofocal (or you could set them for a bit further out intermediate). 

wow, finally someone who got one of the newer options out there.  Where did you go to have the Symfony put in for you?  Do you know when it will be avaialable in U.S.?  Who do you go to if you have a problem since your doctor is overseas?  I heard multi focal had problems with halos, contrast, low lighting since it splits the light, and contrast. The symfony is suppposed to solve all that.  What is your experience?  trying to decide if i want to get distance / intermediate monovision or wait a bit and see if the next generaltion multi focals get approved in U,.S. like the symfony, 

thanks

The US is unfortunately a few years at least behind the EU and elsewhere, and in fact some companies don't seem to even bother applying for approval in the US for new lenses. I haven't heard anything for instance about the major EU trifocals, the AT Lisa Tri and the Finevision, even attempting to get US approval. Fortunately the Symfony is made by an American company AMO and the Tecnis family of IOLs is widely used in the US and so I've read they recently submitted data to the FDA for approval. The Symfony is consired to be in a new class of IOLs, "extended depth of focus" so I'd read they have been coming up with guidelines for how to evaluate such lenses for approval. So unfortunately how long approval will take is hard to guess, it takes a long time for even product categories they already have setup, so  I don't know if it'll be 6 or 12 or 18 months, I've seen different guesses.  I know Alcon has had a trifocal recently approved in the EU, the Panoptix, and since they are also a major US supplier of IOLs perhaps they will be seeking approval for that as well, though I've no idea the timeline. I've also seen absolutely no data or studies on the Panoptix, which is odd, though its likely similar to the existing trifocals.

 

After I got the Symfony, the US approved some low add bifocals earlier this eyar  which seem like a fairly decent option for those who need surgery soon in the US.  They will still split the light which reduces contrast sensitivity. I don't know if you'd tried multifocal contact lenses since those have the same issue. I never found it to be a problem with multifocal contacts when I wore them,  but with the Symfony I have noticeably better low light vision than I had with the multifocal contacts (a restaurant I have a weekly meeting in has lower light and I'm so familiar with it that I immediately noticed  the difference looking at the menu, and the room and people).  If the low add bifocals were available in the US at the time I might have considered going for those rather than traveling, but the Symfony still seems a better bet. 

Someone I know about the same age here had the Crystalens implants, and oddly even though those are a single focus lens, he notices a drop off in near vision with lower light. I met him after a lecture in a well lit auditorum and he had a near reading chart, and even holding a folder over the chart to cast a shadow was enough for his near vision to be reduced, but it didn't make a difference for mine. I don't know for sure how much is optics of the IOL vs. personal variation in our eyes. 

The optics of a multifocal contact lens aren't exactly the same as multifocal  IOLs (likely not as good as an IOL meant to last decades and not move as much), but they are still a good test case I think to get some idea. The fact that I preferred multifocal contacts to monovision contacts was one reason I was interested from the start in a premium IOL.  For instance even though I'd not noticed a reduction in stereopsis, 3D vision, when wearing contacts in monovision a few years, when I switched to multifocals I was suddenly aware of what I'd been missing, near objects did seem more 3D.

The Symfony has recently been approved in Canada, which isn't as far to go (although it may be comparable to US prices). I don't know if the trifocals are available in Canada, but I know the AT Lisa tri is available in Mexico in clinics that seem to be likely US quality treatment that are located just over the border from San Diego (at least one mentions they will transport people from hotels on the US side of the border to the clinic) to take advantage of the differing approval policies.  I hadn't evaluated clinics in either country since they didn't have the Symfony a year ago.

 I had decided to go to Europe to get a better lens, and then discovered the UK was somewhat expensive and that there is a medical toursim industry elsewhere in Europe to take advantage of that, with the Czech Republic a common destination for high quality treatment at lower prices. I figured that as long as I was traveling, if I could get high quality treatment I may as well go for a lower priced country. I was only 52 when I had the surgery so I figured it was worth some hassle to get a better lens since I may be living with it a few decades, and since I'd been highly myopic all my life I liked the idea of not needing correction anymore. 

Most doctors here didn't have any trouble with the idea of doing followup visits (though ask around, a minority seem to dislike following up other people's patients), there is nothing medically different about the Symfony compared to other IOLs, the optics are just different. It is the same overall physical shape and material as the widely used Tecnis lenses in the US.  Also, after I had my surgery there have been Symfony trials in the US so some US surgeons do already have experience with it. I think the trials are over since they have submitted data to the FDA (if there are   any trials ongoing for the Symfony in the US,  it may not be a good option since at least the initial one I heard of was  randomized, a 50-50 chance you'd get a monofocal).

 Since I spent a great deal of time on the computer (as my username was meant to indicate re: my visual needs), intermediate distance is important and when I had my surgery done a year ago the only bifocals available in the US were high adds that weren't as good for intermediate vision, and in a small fraction of  patients the Crystalens doesn't provide anything more than a monofocal (and has some risk of complications other lenses don't have, like z-syndrome, though the newest version seems to be better). I'd had good luck with multifocal contacts so I wasn't worried about going for a multifocal, so initially I'd expected to go outside the US for a trifocal lens to get better intermediate. Then the Symfony came out, which has better intermediate vision than the trifocals, but not as good really near. I figured that was an ok tradeoff to make since it also has contrast sensitivity comparable to a good monofocal and lower risk of problematic halos, comparable to a monofocal (some folks see halos even with a monofocal).

 I turned out to be in the minority of patients who do see halos with the Symfony, but they are translucent, I see through/past them, so I don't find them to be a problem. Overall  as far as I can tell my night vision is better than it was before I had a problem cataract, less glare from headlghts for instance, which makes up for halos from headlights. I'm not sure if being atypically young to get lens replacement made seeing halos more likely with any lens. 

Intermediate vision was important to me since aside from computer distance, it includes most social distance and household tasks, TV, etc. I also realized after the fact that since I hike&run on trails around here that its useful to have crisp intermediate vision since that is what you are using to pick out your footing amidst rocks and avoid icy patches during the winter (even just for normal walking around outside during the winter its good to be able to spot ice of course, unless you live in a warmer area).  I think  the trifocals would still have been good enough for that, even if their intermediate isn't quite as good,  I can't picture how much difference it would have made.

Wow, thank you so much for that detailed explanation.  So you had your procedure done in Czech Republic?  Yes Canada would be closest for me since I live in U.S. (Florida).  I was going to get my procedure done this year since I had met my insurance deductible this year, but I thought that should not be the main reason to get it done.  I've been told I had cataracts for about 5 years now, and, while it gets a little worse each year, still not so bad that it interferes really with my lifestyle.  But I know I have to get it done eventually.  I was quite excited when I read your post.  My doctor recommended a monofocal because he did not think I would be a good candidate for multi focal since he thought I would not be happy with the side effects and also that it doesn't work all that well, considering that it splits the light and has low light issues and the halos and loss of contrast.  I wanted the best possible vision with glasses and you cannot correct for loss of contrast.  Then I read your post and I though wow, symfony iol's .  That sound like it would be perfect for me.  Seems like all the advantages of the multifocal without any of the disadvantages.  I was mostly concerned with loss of contrast and halos so bad that i might have to go thru the ordeal of changing lenses.  I am extremely sensitive to things touching my eye. I put in drops by closing my eye and blinking them in.  But they told me I would be almost out during surgery lightly out, and so I am ok with that.  So, as I understand it, the symfony gives you all the ranges, although maybe might need glasses for pefect near.  But I should be able to see near enough to read a letter or text on my phone?  But I will have really good distance and intermediate?  To me, that means I will not have to wear glasses anymore?  AND much less chance of halos, and even if i get halos they will be much less severe than with today's multi focal.  Also, based on your post, I have been reading up on it.  They expect approval in U.S. by end of 2016 or beginning of 2017.  The way it transitions from distance to intermediate to near is different too.  Much more natural than with a multi focal.  Seamless they say.  So you have them so it seems you would be a good person to ask.  I can live with not so perfect near as a trade off for no low light problems and no contrast problems and less severe halos, if any.   Are you happy with your choice?  Can you read near, even if not perfectly, but well enough that if you had to read a note or something for a few seconds you wouldn't have to search around for your glasses to read it?  Is you distance and intermediate (computer) nice and sharp?  Any other issues?  Based upon your post I have decided to forego my surgery this year and either go to Canada or wait until 2017 to get symfony put in in the U.S.  Seems to me like the best of all worlds.  Do you agree?  I just hate the idea of a monofocal where I only see at one focal length.  If I get intermediate, then cannot see near or distance and I tried two distance contacts to experiment the simulation and it was like being blind up close.  could not read the caller id on my phone.  And monovision with one eye distance and one intermediate is a little strange. Seems like symfony is the way to go for me.  Even better than tri focals because it does not split the light like trifocals or even bifocals and you don't have the same halo problem or loss of contrast and it transitions between the distances more naturally.  So you are wearing them. Are they as good as I am envisioning them to be??  thank.

Yup, I went to the Czech Republic from Boulder, Colorado for my surgery.  I can read the text on my smartphone with no trouble (4.7" screen), in the web browser with a newspaper with 2 columns I'll usually zoom in on one column to read it more comfortably, but can make it out without zoooming.   I've no trouble at all with maps or email on the phone. If you aim for micro or mini monovision you can get a bit more near without a noticeable loss of stereopsis. I think the stat is that perhaps 20% need reading glasses with the Symfony set for distance, I suspect few do if they do micro or mini monovision. 

I may do micro-monovision eventually via lasik. Unfortunately I wound up with one eye plano, but the other perhaps +0.5D hyperopic which reduces its near vision, so I may bring that in to -0.5D someday to give me a bit more near (I haven't noticed a great need for it, but it just seems a waste to have the eye hyperopic). So actually the near vision to read my  smartphone is mostly coming from one eye due to the other eye being a bit hyperopic. Unfortunately there isn't an exact formula to determine the lens power, it is based on statistics of past operations, and usually for most people its accurate but for high myopes for various reasons it can be off a bit and it was in my case for that eye.

Distance vision is comparable to a good monofocal, mine was almost 20/15  a week after surgery and is probably at least that now since subjectively it seems like  it  improved a bit during the first few months as I adapted to it. I'd always been highly myopic, but even with contact lenses I can't recall my distance vision ever being corrected as  crisply as it is now with the Symfony. I don't know whether some of that might be because of the extended depth of focus which means more things are in focus at once, whereas before surgery the eye would be accomodating to change focus to see objects at different distances.  Even a year later when out hiking  I'm still constantly appreciating how good my distance vision is (and intermediate, rocks on the trail   being in crisp 3D). 

Yup, the way it transitions from intermediate to near is more natural than a multifocal since there aren't 2 or 3 different peaks of visual acuity. Just  like with presbyopia,  the further out you hold something the crisper the focus  is but the smaller it is. There is no hunting for a "sweet spot" the way there might be in theory  with 2 different focal points.  That said, with multifocal contacts I don't recall ever consciously thinking about  the hunt for the "sweet spot". To me the Symfony feels like vision just when presbyopia started to become noticeable but where I didn't really need glasses aside from things like threading a needle, perhaps vision like in my early to mid 40s. I don't notice that I need to hold objects out further to see them or anything, I hold my smartphone at a natural distance. It is only say reading the fine print on an eyedrop bottle for instance where I had to hunt for a good distance to be able to read it.  I think I made the right choice of lens for my case. I do sometimes wonder what the added near of  a trifocal would be like, but I think the crisp intermediate vision and better low light vision, etc, is worth the tradeoff.  I'd guess my intermediate is  20/20 or 20/15, I hadn't measured it but its in between distance and near in quality.

You'll see comments from many US surgeons who are optimistic about the Symfony, one recent video I saw interviewing a US surgeon who is an expert at a conference on treatments for presbyopia asked what he would do if he had to get cataract surgery this week, and he said he'd likely go  have one of his European colleagues implant the Symfony.  

There is another "extended depth of focus"/possibly-accomodating lens that is approved in Europe, the WIOL-CF, but there isn't much data out there on it yet so I'm not sure its an improvement over the Symfony, it seems perhaps comparable. It sounds like the manufacturer is doing some more trials and refinement before trying to widely commercialize it, which suggests some caution. One reason for that I suspect is that it doesn't have haptics like most lenses (the arms that stick out to hold the lens in place) and instead relies on filling the capsular bag to stay in place. One surgeon commented via email that he is concerned that the lens wouldn't be as stable for that reason, and there is one article talking about a couple of cases of disolated WIOL-CF lenses, though I don't know what the statistics are to know if it is really an issue.

There are some next generation accommodating lenses in early clinical trials around the world, but  it'll be a while before they are even approved in Europe and due to the issue of them needing to move (and to continue to do so for decades) it may be a technology to be cautious about when it first comes out. The Symfony is the same material and shape as the rest of the widely used Tecnis family of lenses. The only new technology in the Symfony is the design of the  optics and that isn't something that requires movement so there is no issue of how well it survives wear like there is with an accommodating lens. Optics are  something they could easily study on optical benches outside the eye, and model on computers,  to be sure they got it right. 

I know what monovision is but I don't know what micro, or mini, monovision is.  Are you saying to get the symfony set one eye for intermedate and the other for near?  I want to get one, or both, set for distance because I would like to not have to wear glasses anymore.  If I understood you correctly, you can see 20 /15 distance, 20/20 intermediate and 20/25 near.  I would be very satisfied if I achieved the same..  You are looking back and wondering if you could have done something else to give you a bit better near but if you can read the back of a pill  bottle without glasses, how much better does it have to be than that?  You said you wound up with one eye "plano".  What does "plano" mean?  Don't know what hyperoptic means either.  Wow, didn't realize there was so much I didn't know. 

It seems like the symfony is the one for me and, if I understood you correctly, if you had it to do all over again you would have gotten the same symfony lenses put in as what you had and that you have no regrets and are happy with your decision.  The press i read on it says that it transitions better for all focal lengths, not just from intermediate to near, but from distance to intermediate too, and even from distance to near and  back again.  Of course I am not expecting it to be like when I was 20 but I started wearing glasses for near signtedness when I was around 15 so I've always worn glasses for as long as I can remember.  My reasons for wanting the symfony are many.  1.  better transitioning, 2  better low light  3  better contrast  4  doesn't move like accomodating so no wear and tear issues  5 can see all ranges of vision without glasses and 20 /25 for near is certainly acceptable for me.  6.  Don't have to wait years for approval since it seems approval for U.S. is around a year away before it is commercially available here.  7. the nice guy from softwaredev from the cataract forum got them and is very happy with his decision.

And how about halos and sensitivity to glare?  You mentioned you see them but it is a very minor inconvenience when compared to the severe halos and glare you can get from the standard multifocal IOL's our there today.  Also I heard that with the premium lenses you run a higher risk of secondary cataracts.  Have you had any issues with that?  And I assume of course that the haptics are a non issue to you, that you don't feel them and wouldn't even know they were even there unless you were told about it, right?  So the only thing that a tri focal would give me is maybe some better near vision and not wroth the trade off of all the other known issues with today's multifocals.   So I was thinking both eyes at distance, which is what you got, right?  When you are talking about minr or micro monovision, what exactly are you suggesting?  If you got both eyes with symfony for distance and wound up seeing now as you do, I would be very happy with that.  Would not want to sacrifice distance (and hence have to wear glasses to drive) just for a slightly better near.  thanks.

Mini and micro monovision are just small amounts of monovision, I don't know that there is a precise definition for how small each prefix is used for. The manufacturer's site for the Symfony (easy to find, this site sends posts with links to the moderator so I won't give the link) gives information on studies of the Symfony with a tiny amount of monovision. A tiny amount of difference is something people adapt to without thinking about it and which doesn't noticeably impact steropsis or contrast sensitivity. It also only has a minor impact on distance vision with both eyes. 

Hyperopic means far sighted, the opposite of nearsighted. That means that it takes 0.5D of the "depth of focus" merely to see distance, which means I have 0.5D less of near vision in that eye. That eye doesn't have any astigmatism.  Both my eyes were targeted for distance, so ideally that should have been 0D. In retrospect I should perhaps have gone for some tiny amount of monovision. Since that eye is farsighted, which isn't of any use, I might consider a laser tweak to make it slightly nearsighted instead for micro minovision. 

Plano means 0D, no spherical refractive error. I should add that eye has perhaps -0.5D of astigmatism which means it isn't perfectly corrected, but that isn't enough to notice, it might give a minuscule boost to near (since that is the "spherical equivalent" of -0.25D, but the fact that astigmatism adds blur may cancel that out).  

Yup, I think the Symfony was the right choice for me, and still would be. If I'd stayed in the US, perhaps the +2.75D Tecnis bifocal would have been my choice. Yup, as I said it won't give you the same degree of acccommodation, near vision, as you had when you were 20, perhaps more like early to mid forties. Your distance vision may be comparable or better though than when you were 20 due to the correction for chromatic abberation beyond what a natural lens has.

There are lots of articles and videos on the net about the lens now where you can see surgeon's comments, all of which tend to be positive. The only study I've seen that was a bit negative regarding its level of near vision was one where it showed the patients wound up even more farsighted than my one eye is, so it isn't surprising they lack near vision. 

Unfortunately things like halos vary with the person, and some people have problematic halos even with a monofocal lens, so you are merely playing the odds, and the odds are this is comparable to a monofocal. Back even before cataracts I still always was bothered by glare from headlights, and I seem to notice less glare from them with the Symfony, which may be part of why I don't find the halos to be a problem. The risk of "secondary cataract", PCO, has diminished over the years so its fairly low with any lens these days, and it has to do with the material&overall shape of the lens and its edges, and not its optics (the curve for the optics isn't the issue). The surgeon who did my last followup here said he would bet that the way I was healing I'd never have an issue with PCO. 

The haptics are a non-issue in terms of the patient perception, you don't feel them, they are merely what holds the lens in place. The Symfony has regular haptics, again it is the same shape as the other Tecnis IOLs like their monofocal and multifocals. It is the WIOL-CF that doesn't have haptics, instead relying on the lens being physically larger and almost filling the capsular bag to hold it into place as the bag heals around it. Some surgeons suggest that is a good approach, I've just heard from one who is skeptical of the idea (but has never implanted the lens) and saw a paper talking about cases of dislocated WIOL-CF IOLs. However I haven't seen any statistics, those cases may have been rare, and even lenses with regular haptics can be dislocated. I admit I'm curious about the WIOL-CF and how it would compare to the Symfony, they are fairly different designs. In retrospect it might have been better in my case since I have a rare side effect  of light flickering that has nothing to do with the lens choice (at least among lenses other than the WIOL-CF). Rare as in one out of tens of thousands perhaps or more, I never got any surgeon to give a guess. 

Highly myopic people usually have larger eye structures than average, including a larger natural lens. The IOL is physically the same size no matter what power it is, so for a minority of   highly myopic people when the natural lens is replaced by a smaller artificial lens, the iris can lose support and jiggle when the eye moves (not in any way that others notice, but I caught mine doing it on video from my phone). Usually that is harmless and never noticed, but in rare cases it seems to be responsible for a flickering side effect that I have. My iris is light colored, blue, but has darker striations, so when the iris moves the stray light coming in through it changes, which causes flickering when my eyes move a lot in order to read. It is headache inducing when trying to read for a long time, but my brain has been slowly learning to tune it out. In retrospect I wonder if the larger WIOL-CF lens would have supported the iris better, but its too rare an issue for others to consider when choosing a lens. That side effect is part of why I keep checking eye related forums and opthalmology news, in case any way to deal with it appears that the surgeons I've talked to hadn't come up with (they suggest that any possible treatments risk more harm than good and its best to see if my brain  will eventually tune it out completely).