Hello, when i knew i had to have my cataracts removed, i went to the same surgeon who did my Lasik in 2003, because i was 100% happy with those results. He did mini monovision giving me perfect distance vision in right eye and excellent close vision in left eye. Discussing IOLs with him, he specifically told me i was not a candidate for multifocal lenses. For various reasons, i did not get my surgery done with him. Today (8 months later) i had an appointment with another highly recommended surgeon who said i was an excellent candidate for multifocals. Based on the first opinion, i had gone prepared with questions about monofocal IOLs and mini monovision, but he threw me off-track completely and i left wondering what could be the reason/reasons for such opposing opinions. Where i went today is a multi-surgeon "state-of-the-art" type set-up, whereas the first one was a long-established single owner surgery. Could it be that different and more sophisticated instruments/measurements give different results? Or what other reason could there be? I'm 63 and feel there's been a slight deterioration in my vision in the last 8 months.
Both surgeons and opthamologists seems to have strong opinions and be divided right down the line on this topic. You will find some who say they would not put these in there own eyes so would not recommend it for their patients. The most significant potential downside from multifocals is the possibility of glare or halos. It is minor in many/most cases but can be bad with a small percentage of patients. This condition is extremely unlikely with monofocals, but not unheard of. I think monovision is safest with people who either have this naturally or have adjusted from contact lens or Lasik. You did not say how mini monovision is working for you, and what your expectations are for monofocals. There are many trade-off so you need to clearly understand your goals and where you are prepared compromise.
Let me say that this is a complicated subject and decision making process. It is one I have agonized over and have come to my personal decision. However, it is a personal decision and different people are going to have different expectations and as a result have different degrees of satisfaction with the various choices. . I will give you a reference to read if you want to take a deeper dive into the issues around the various choices. This article is written by an optometrist, not a surgeon, and the intended audience is other optometrists. It does not really cover the pros and cons of various options from a surgical perspective, but more from an outcome perspective. Still it is quite technical and requires some effort to read and understand for us laypeople. If you google the following you should find it. We are not allowed to post actual links here: . Review of Optometry Picking a Premium IOL for Every Patient Victoria Roan, OD . In your particular case I would focus on a few points: . 1. You say you essentially have monovision now with Lasik surgery. You say you are 100% happy with it. If you are, why would you consider a multifocal or EDOF lens? What aspect of your vision are you trying to improve on? Generally the issue with monovision is that the patient does not adapt to it, but you seem to have adapted... You have a great advantage on most by knowing from real experience what monovision can do for you. But one caution. With the natural lens you can still focus to some degree close up even at age 63. With a monofocal IOL you will lose that ability. But, you still have a pretty good idea what monovision is like, and you could experiment more now using contacts providing you can still see well enough to evaluate different degrees of monovision. 2. I would ask about any complications that may present considering that you have had Lasik surgery. For example do you have astigmatism? Is the astigmatism symmetrical or irregular. Irregular astigmatism may not be corrected well with a toric lens, and there may be issues with halos and glare especially with the premium lenses. 3. Do you have any hobbies or work activities that require special vision at a particular distance. Does it have to be perfect, or just OK? 4. Are you a type A or type B personality? It may be the biggest factor in what type of lens you will be happy with. . As I said in the beginning it is not an easy decision, and based on my research there is no silver bullet slam dunk answer. It depends on you and your priorities. My suggestion would be to read and reread that article until you understand what issues are, so you can make an informed decision. I'm sure it will prompt other questions which you will want to investigate further. I hope that helps some.
Thank you for the resource - all information is helpful at this stage. I suppose I'm wondering, since my cataracts need to be removed and new lens inserted, a) if multifocals might give me a better overall outcome, since that's what he suggested first, before i mentioned monovision and b) since it is being offered as an option now, i should consider it. I have a little astigmatism in both eyes, and he said this could be corrected. I would prioritize unaided close vision( for craft, phone, cookery, and pen-&-paper-writing) and intermediate (for laptop). I'm prepared to wear glasses for distance and night time driving, but would like to be as glasses-free as possible (obviously!) If there's a better outcome to be had, albeit at a higher cost, i think I'd prefer to take it.
My opinion is that multifocals are different, but not necessarily better. I would look at them as an option to be considered, but like monofocal lenses they have their issues too. Have you had your eye measured by a surgeon? The error in our eyes that needs to be corrected with eyeglasses is a sum of the error in the lens and the error in the cornea. The errors can combine to make the total worse, or they can offset each other. Currently your Lasik surgery has changed your cornea error so that it offsets the error in the lens. When the lens is removed in cataract surgery the new lens no longer has to correct for the lens error, just the cornea error. Once the lens is removed you may or may not have sufficient astigmatism to correct for. They can only tell you that when they measure the topography of your eye. My thoughts are that if you have enough astigmatism to correct with an IOL ( 0.7 D or more) and it is symmetrical, then a toric lens is a good choice. The other option is more Lasik to correct any residual astigmatism if it is small. . Whether or not go to go multifocal is a more difficult choice. I would suggest it is almost certain you will have optical side effects from them. The question is whether or not you can adapt to them. Night driving with a multifocal probably is the worst situation with halos and flare from headlights and street lights. But if you never night drive, then it is not an issue. Or, if you can adapt to driving and ignoring the optical effects it is not an issue either. The next issue is likely to be close vision in low light. Same thing there. If you always have bright light and don't do really fine work, then that may not be an issue either. And there is always the option of using reading glasses. This is where the type A or B personality thing comes in. A type A perfectionist may not adapt well to having less than perfect vision. From a surgeon's point of view I have seen it stated many times is that the key step for them is to screen their patients, and ensure they fully understand they are not getting a perfect solution, and what the compromises will be. Their worst nightmare is having the patient come back and want to have the lenses exchanged because they can't stand them. Responsible surgeons will do their best to screen those people out rather than push them to get the premium lens. . As far as being glasses free most of the time, if you can adapt well to monovision, then it may be a toss up between monovision and multifocal. The advantage that a trifocal may have is better intermediate vision. To a tennis player "watching the ball onto their racquet" that could be an advantage. The advantage to monovision is that you are more likely to avoid the optical issues like flare and halos. . Hope that helps some,
Infact i have been perfectly happy with my monovision. It is only because of the onset of cataracts in recent years that I'm having to get something done. I was trying to understand why one surgeon would flatly refuse to offer a multi focal option while another would say I'm a perfect candidate for it and it's a straight forward case.
i have come to a conclusion that unaided great quality close vision would only be possible with a trifocal. of course i talk about this only for myself. setting symfony at -2.5 would give me great close up but literally no intermediate and far. monofocal would be worse than symfony for this approach. the trifocals will come with the nighttime glare possibility.
setting monofocal or symfony for -1.5 would give me workable near vision bu5 not great near vision. when i saw great i mean hd video on an iphone.
again this is for myself only based on my one symfony exoerience.
You should take a hard look at the RxSight light adjustable lens. Search youtube. I don't think people realize what a game changer it is. Alcon, J&J, and especially Lensar want to keep it that way. You get to dial it in exactly how you want it.
"This condition is extremely unlikely with monofocals, but not unheard of.". You're completely wrong. Many people, including me, expirence huge dysphotopsia. "Unlikely" is just super misleading. I think you should work for an IOL manufacturer, great propaganda.
Here are my thoughts on conflicting opinions. But, let me warn you up front they are based on very limited data; that is my personal experience with one surgeon, and a friends experience with another surgeon. We are both in Alberta, Canada, and the issues may be different in the US, assuming that is where you are? . My friend got into the cataract decision about 2 years ago. She agonized over the choices but decided on a multifocal PanOptix (tri focal) lens in both eyes. The surgery was done in a private office kind of like you describe -- state of the art. While she was initially happy with the results and expected the side effects would improve with time, they actually did not. She now thinks she made a mistake in going multi focal. Here main issues are halos around lights at night to the point she will not drive at night, and reading especially in lower light. Even with brighter light she uses +1.75 readers for reading. While one could conclude that perhaps they "missed" on the correction, it would seem odd that they missed with both eyes. This said, if you search here you will find many posters who have had PanOptix and are very happy with them. This is just a sample of one. . I was next and we live in a different city and I was referred to a different surgeon. In Canada we really do not have much ability to "shop around" for a surgeon. I recall I waited 10 months just to see the surgeon for a initial assessment appointment. He is a university professor in ophthalmology and does all of his work out of a hospital that has a large eye specialist department. A number of different independent ophthalmologists use the same facility and equipment. I was referred to this guy by my optometrist who said that he would offer premium lenses if they were suitable. When we discussed the options after he reviewed the detailed measurements, he said multifocal options were available but he had a hard time recommending them to patients because he would not put them in his own eyes. I was somewhat prepared for this and had investigated multifocals and concluded I did not have the right personality for them -- a bit of a perfectionist I am! We moved on to toric lenses and he said that I did not have enough astigmatism to use them. He suggested that non toric lenses were best and if they did not achieve the vision I wanted then he could do some correction with Lasik to correct any residual error. From there we moved on to the issue of glistenings that the Alcon AcrySof lenses are said to be susceptible to. He said that in his practice he had seen them but they had never been significant enough to be a optical concern. He also claimed Alcon had made QA improvements that had significantly reduced the incidence of them. He has been a paid consultant for Alcon in the past. But, he said if I was concerned he was quite prepared to use the Tecnis lenses which are claimed to be free of glistenings. In the discussion he said that the glistenings issue in his opinion had been overstated by some in the industry. He went on to "talk out of school" about some of his peers in the city that operate out of their own offices with their "own" equipment. He basically suggested in so many words that their full office equipment had been supplied free of charge from Tecnis and that they were a a little bias in what they recommend for lenses, and were liberal in their criticism of AcrySof. . My point in telling the story is that there are things going on behind the scenes having to do with the economics of a practice that may have some influence on the recommendations the surgeons provide to the patient. To be frank, there is more money in prescribing premium lenses than standard ones. I think an ethical surgeon would provide all alternatives with their associated pros and cons and let the patient decide which way to go, with eyes wide open! I suspect some do, and some may not. It is kind of a buyer beware issue. . My thoughts in your case if it is feasible would be to get a third opinion from another surgeon that perhaps would not be so polarized in choices. In your case, I think monovison would be a safe choice, and the questions is whether or not multifocal would offer a benefit to offset the potential risks of it. It is not an easy choice.
what do you mean by type A or type B?
your friend's scenario is what i worry about. i have also seen in here someone with synergy say that they need enlarging mirror for make up.
i wonder if this is a case where your friend would need a much larger reading correction with a monofocal than required by general population.
with symfony i definitely need 1.25 readers for computer and 2.5 readers for closer HD quality. also my side effects never got better if at all anything they got worse in 2 years.
In today's political scene, Trump would be a Type A for sure. Hard to find Type B's at that level, but Biden would be closer to a type B. If you have seen the movie Caddy Shack (my favourite movie) there are some good examples. Ty (Chevy Chase) and Carl the greens keeper (Bill Murray) are obvious type B's. Al (Rodney Dangerfield) and the Judge (Ted Knight) are clearly type A's. . "personalities that are more competitive, highly organized, ambitious, impatient, highly aware of time management and/or aggressive are labeled Type A, while more relaxed, less 'neurotic', 'frantic', 'explainable' personalities are labeled Type B." from Wiki
I really can't explain it. My friend is not an extreme type A personality, but is certainly a perfectionist. I think her expectations for the lens may have been too high, and she is having trouble adjusting to the reality. That said, personality types really do not explain why one would need +1.75 readers to read in daylight with the PanOptix. I just don't understand it. I know she has prism issues and has always had issues with getting good eyeglass prescriptions, but, I just don't know. I know I share her perfectionist issues and have concluded this is not the road for me.
Sorry Ad12345 but Chris is right based off statistics. I am deeply sorry you have had a bad experience with monofocals and glare etc. Likely this would have been much worse with premium lenses. There also could have been a miscalculation of power or your pupils dilate beyond the IOL. Statistically monofocals provide better contrast sensitivity and less glare and starbursts than premium lenses but doesn't mean it can't happen.
Have you sought out other opinions? Perhaps there is a reason why you are experiencing these visual disturbances that can be fixed.
It is so true about personality traits and how they influence how a person perceives the outcome of the surgery. When I was deciding on lens options I read somewhere that a surgeon's worse patient is a type A who is an engineer by trade that wants to see a gnat on the back wall of a theatre, has astronomy as a hobby and a Jewish Lawyer for a brother-in-law.
Ron: I am "going out on a limb" here, please excuse me. I have the ultimate respect for you and all the contributions you have made to this forum from your extensive research. However, your ongoing reference to your friends situation seems like judging the viability of a product based on a single patient. I am not in denial of her issues, but the more information you post on her seems to indicate that she was either not a good candidate for a multifocal lens or more likely failures by the surgeon. Failures in pre-op assessment and measurement, and failures in post-op remedial actions. Yes, there is a small percentage of patients with poor outcomes, with any lens, but that should not deter someone from making an informed choice for that lens. Feel free to use me as a reference as a second point in your statistics. Type B personality but also a perfectionist. 20/20 vision with my trifocals and can thread a needle without glasses. Completely glasses free even with residual .25 & .75 astigmatism. Mild halos with LED car lights, day or night, but quite acceptable. I have no reservations in recommending this lens along with my surgeon to anyone. Maybe some other lens would have been just as good or even better but there is no trial option, so I will never know. All the best to you and your upcoming procedure!
I'll chime in here as someone who took the old-fashioned monofocal route and who also wanted near vision prioritized. I've been quite nearsighted my whole life (-8 in both eyes before surgery), and didn't want to lose the close vision that I've always been used to. I had -2 Alcon Acrysof IQ lenses implanted in both eyes just over a year ago, with the final result (as of February - no doctor visits since then) being -2 in my dominant right eye and -2.5 in my left, i.e. mini-monovision. I deliberately didn't want to aim for mini-monovision, since I knew from reading (especially this forum!) that there are no guaranteed outcomes, and didn't want to wind up with too great a discrepancy between my eyes. Long story short...I am delighted. I spend most of my day reading or on the computer, and only put glasses on to watch TV or when I drive. I don't mind wearing glasses (I have progressive lenses) at all, but find that I just don't need them most of the time. At night I see slight haloes around car headlights, but they are as nothing compared to when I had cataracts, and don't interfere with driving. I haven't had any dysphotopsias. Oh, and I'm a Type B perfectionist. :-)
Agree with you Chris. One cannot assess a lens or anything on anecdotal examples. Had this same argument with a family member over vaccinations.
That being said it is not a comfort to the 5% who end up in the small statistics of those with poor outcomes. My Symfony ho e me good near vision although when reading in low light or extended periods of time (small print) I do have readers +1.25.
My friends would consider me with perfectionist tendencies too. Not sure I am classic Type A though or as one gets older you tend to have to live with many imperfections.
I still do see huge concentric circles around some lights but they are light and now it's been 3 years since surgery my brain tubes them out. Glare is minimal. I drive at night regularly - have to from Oct to Feb with less daylight hours
Shel53548 You will find most surgeons have a bias or their go to lenses. I would not push one to go with a lens not in their wheelhouse. There are pros and cons / trade offs to every IOL. Best you decide what compromises you want to live with. If you have cataracts that require surgery you'll find your vision vastly improved after successful surgery no matter the lens. Forums tend to be more on negative side as people do a search if not all is well. People with successful surgeries rarely post unless they were on the forums searching prior to surgeries and even in that you'll find both success and unsuccessful experiences.
Do your homework on IOL selection, seek out several consults and then trust that surgeon.
I had my surgeries 3 years ago now. There are always better lenses coming onto the market. I live in Canada and at that time symfony EDOF lenses were new on the market and no trifocal was available. I went with these and all worked put well.
Now is the time to read up and then decide what trade-offs you can live with. My own surgeon (as I was younger at 53 for cataracts) said older patients gain something but the younger you are the more compromises you need to make.
Wishing you the best.