Choose EDOF or monovision with monofocal?

Eye care
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Hello, I had a monofocal IOL (Tecnis) implanted in my right eye due to cataract in 2015. I was only 40 then. The doctor said my cataract may be caused by high myopia (-7D) or previous PRK operation. At that time, doctor chose to set my right eye to intermediate vision as I work in front of computer most of the time. I can see clearly from 50 to 70cm by right eye now and don't need a glasses for most of the activities. Need reading glasses for prolonged reading. My left eye is getting worse. It sees spiderweb like image to bright light sources (traffic light, street light, break light, etc) day and night.

image

With left eye alone, I can't tell the outline of a car 10 meters away from dusk. All I see are light patterns crossing each other. But with right eye's assist, I can see the cars and the original position of light sources, so I have no problem driving at night. ( I have driven 60km one way on 401/QEW and locals every work day for two winters in Toronto) I'm seeing doctors to have my left eye implanted, as it barely sees anything. But three doctors all said my only choice is another Tecnis monofocal with monovision, because both eyes have to use the same type of lens. But on internet, many surgeon are practising mixed IOL implantation. Are doctors in Toronto too conservative? Based on studies I did recently, I think EDOF may be a good candidate for my left eye targeting to distance vision. Then there will be no blurry area between distance and intermediate by using monovision. It can also tolerate the calculation error considering the difficulty with post-PRK eye. I understand EDOF may have higher chance of visual effects. However, my left eye now has much worse effects by cataract and I'm living with it. I think I should be able to EDOF. Should I insist using Symfony in my left eye? Or should I wait longer for newer lens available in Canada like Tecnis Eyhance monofocal?
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Also appreciate inputs if anyone has experience with monovision.

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The visual effect on my right eye is mainly thin streaks from light sources.

In very dark environment, there would be a big concentric ring in addition to streaks. The brightness of the ring could be 1/4-1/3 of the light source. I only see this symptom in the dark room or after dilation.

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There are a lot of posts on this topic in this forum. I had both eyes done for Monofocal last year. One was set to intermediate and one eye set for distance. It may take a while for your eyes to fully adjust but for the most part it works well. My eyes get tired if I drive a lot but that could happen to anyone. If I wasn’t so vain and didn’t mind wearing readers I’d have just gone with two distance lens since my distance eye can almost see everything except my phone and reading material up close.

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Thank you Jeff.

How about your depth of perception? Can you judge the distance accurately? Right now, with one eye having clear image, I have a hard time reaching to the exact position, e.g. thread a needle.

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Hi Chen
Off course the doctors are the experts, but to me they do sound quite conservative.
I have mix of lenses, although it is a mix with edof and trifocal. I know results can vary, but in my case I had perfect blended vision day after surgery of the second eye, in my case the brain had no problem at all using mixed lenses.

Only problem I could think of, is if you have had a spherical monofocal implanted.
Symfony is an aspherical lens, and I think most surgeons would agree, that you should not mix spherical and asherical lenses.
But if your monofocal is an aspherical lens, I believe that Symfony could be a good choice in your situation.
You probably got a small card after surgery, that shows exactly the lens you have in your eye, maybe this can tell, what type of monofocal lens you have.

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Thank you Danish_Viking.
I do have an aspherical monofocal in my right eye. It’s Tecnis ZCB00 and JnJ website says “anterior aspheric surface”.

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Hi Chen

I believe your first picture is how you see a light source in your cataract eye. correct? I see it the same way. Almost like a snowflake. It’s amazing that it creates a circle.

Since you are only in your 40s you probably have pupil dilating beyond the lens in dark, which shows you the ring which is the lens edge. I see similar to the second picture and a ring around it but a lot many spokes from the light source then in your diagram. i do have the Symfony though.

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Hi Soks,
Yes, the first is what I see from left eye with cataract.
I only see outer ring through right eye in occasional cases, so I am fine with it. Do you see that ring always with Symfony?
Have you done with your the other eye? Which lens did you choose?

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i see that ring at night regularly. it is bothersome. i see the upper half of the ring at night when outdoors. inside in pitch dark i will see the complete ring.

i have not done my other eye. i am inclined towards tecnis synergy but it comes in yellow tint so thats the hold up for me.

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Well, then I don´t understand those doctors at all, many people have monofocal and Symfony, and are happy with it.
Off course you need to accept the visual side effects from the Symfony, but I can like you, see many advantages from the Symfony over another monofocal.

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I have no problem with depth perception.

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Jeff, may i know the diopter difference between two eyes?

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I think I need to discuss with the doctor further about the options

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will the image from your natural eye help suppress the rings?

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Soks, how dense/bight the spokes and rings are compared to the light source? Will they block the objects behind them during night?

Synergy looks great, however, there should be some compromises JnJ didn’t tell us. You will need to wait for users’ experience becoming available.

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I tried use the glasses to correct my right eye to distance vision. Then I can see monitor clearly from 1 meter or further. It will be blurry within 1 meter. Right eye without glasses sees clearly from 70-40cm.

Does it means that if I end up with using monovision with two monofocals, chances are there would be a blurry range between 1m and 70cm? Would binocular help make up this range?

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You said the ring you see is caused by lens edge. Do you see the concentric rings @Sue.An2 mentioned?

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image from my natural eye does not suppress the concentric rings or the lens edge ring. it suppresses the overall glare though and suppresses the halos around light due to Symfony.

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the spokes and the lens edge ring is if the same brightness as the light source. the concentric rings are a little lighter. the spokes will block objects behind them. when the lens edge appears the spokes will extend to the edge ring edge. otherwise they are much shorter.

i think if i go with synergy i am operating on the assumption that i will not drive at night. but at at least i will have good vision at all three distances. please note that i am speaking for myself here based on my own Symfony experience. JnJ is also coming out with Symfony Plus. but both Synergy and Symfony are with yellow tint which makes a color mismatch with Symfony.