Hi, everybody. I apologize in advance for the Great Wall of Text. I know it can be seen from outer space, cataracts or no, but I really need your help and hope you will forgive me. I am 48 and have been in glasses since age 20. I have significant astigmatism in the right eye and have been wearing prescription reading glasses for the last 10 years. 3 years ago my prescription was updated, but I couldn't see well. A month later I had my eyes checked again, and the prescription was very different. Investigation showed fast-progressing posterior cataract. Today I have 20/200 vision in the cataract eye and pretty good vision in left eye with glasses. The cataract eye is rife with light disturbances at night. I can see 5 or more of each light-related image (such as road reflectors and reflective signs), and all lights are J-shaped "halos" with glare everywhere. The left eye is fine, but the doctor says he sees a "blister" which he deems the beginning of another cataract and says I will need to have it replaced in 3 years. For now, he offered me 3 choices: 1. AcrySof IQ IOL (basic monofocal lens) 2. AcrySof IQ Toric IOL (monofocal astigmatism-correcting lens) 3. AcrySof IQ ReSTOR Toric IOL +3.0 D or +2.5 D with Activefocus Optical Design (multifocal astigmatism-correcting lens) I don't know much about these options, and they didn't tell me. He said there are no bad choices, but he did highlight the "premium" lenses. The difference presented was: 1. Basic monofocal: Wear glasses all of the time (and "end up with the eye of a 70 year old" after he removes my lens--what does that even mean?) 2. Toric monofocal: Only wear reading glasses 3. Toric multifocal: Never wear glasses again NOTHING was mentioned about light phenomena at night or pros and cons/tradeoffs. Just that it would "be a shame" to put 48-year-old eyes in the basic monofocal IOL, and if I have the funds I should consider a premium IOL. The scheduler said that whatever I put in my right eye I will need to put in my left later. They wanted to schedule me right then and there. I said no and went home to research. It took me 3 days to even find a forum where real people talk about their real experiences, blood, guts, halos, and all. I've read articles galore and still feel I am no closer to understanding or making such a HUGE choice. I sure would appreciate your help. A little more about my personality: * I don't mind wearing glasses--it's kind of my style. * Although I dislike it, I would rather have 2 pairs of glasses and switch back and forth, than have progressive spectacles, because the bother and risk of not neuro-adapting scares me (however, my brain has done a pretty good job of adapting to the 20/200 cataract eye...but still, I would not want to be this way for life). * One of the things I dislike the most about having a cataract is the light disturbances. * I do a lot of reading, writing, and crafting (knitting, sewing, stained glass cutting, etc.) * I also like target shooting but had to quit, because I site with my cataract eye. * One thing I do dislike about wearing glasses is that it makes me lose depth perception (and the frames do appear in my peripheral, which gets in the way of the sense of my visual field being "the whole wide world"). * I try to be thorough and am type A. Some Questions * Are nighttime, light-related visual disturbances (NLVD) eliminated with basic monofocals? * If you have basic monofocals, do you achieve crystal clear day and night vision with glasses? * Is there a period of neuroadapting with basic monovision? * In comparison, do toric monofocals have the same or worse risk of NLVD? * Do toric monofocals have the same risk of NLVD as toric multifocals? * When doctors say "basic monofocal" are they both set for distance? * What is the consequence for setting both for distance rather than one for distance and one for near (a scary prospect for me since it results in "mismatched" vision, which I'm mot enjoying now). * If you no longer need glasses because of multifocal implants, does it restore the depth perception lost by wearing glasses? * What is the "diamond-eye" effect of multifocals that I read about, which makes others uncomfortable when they interact with people implanted with them? What is this, and does anyone here experience it? * Are there other questions I should be asking or considerations I should be pondering? Many, MANY thanks! ❤
I personally would go see another doctor. The notion that multifocals are better or guarantee "glasses free" vision just doesn't sit right with me. These doctors frequently try to push premium lenses because they can make more $$ off them. If i were you I would be highly considering a monofocal lense since you are okay with wearing glasses and don't particularly enjoy light disturbances. It's not to say light disturbances are 100% impossible with monofocals but its much less likely than a multifocal. Multifocals literally have to split the incoming light rays in order to produce vision at multiple focus points (so it makes sense why light problems are more likely). I have a multifocal lense and considering exchanging it to a monofocal but its a risky surgery. I would also look into the B&L Softport AO 3 piece silicone monofocal IOL if you're really worried about light problems (this lense is known to "do no harm" and my specialist doctor is recommending it for me since I have so many issues with my current multifocal).
I am 6 weeks out from my second cataract surgery with the first completed 11 weeks ago. I had to meet with a retinal specialist prior to surgery because of my high myopia and he advised me not to go with a multifocal lens. In addition, I had read a lot on these forums and wasn't willing to risk the side effects that can go along with them. I chose a toric monofocal because my surgeon said someone "with my personality type" would not be happy if my astigmatism was not corrected. My right eye (non dominant) was purposely undercorrected at -1 to give me better mid-range distance and my left, dominant eye was targeted for better distance vision. A week after my second surgery, I was seeing 20/20 with my left eye and with both eyes together and 20/30 with my right eye. Five weeks later, I am not sure where they have settled but I do not need glasses for driving or for any of the activities that require mid-range vision. I do need glasses for reading and any close work (I am also a sewer/crafter so this was a concern of mine) but 2.0 over-the-counter readers work very well. I had read about the "diamond eye" effect and, even though it is only cosmetic, I knew it would make me self-conscious so I wanted to avoid it, if possible. During my research, this effect seemed to be attributed to the AcroSof brand. I asked my surgeon if we could go with a different brand so he used the Tecnis Toric. Overall, I am happy with my results although I sometimes experience this sense of blur with my left eye. Part of this I attribute to my floaters, which I had prior to surgery, and I think eye dryness may also contribute. Good luck with whatever you decide! It's a big decision knowing that you will live with the results for many years.
Thank you for your reply. What about your "personality type" made him say that?
Is this "diamond eye?"
hi there! I have been very nearsighted my entire life. had cataract surgery on my right eye in February. i chose a monofical toric . i ended up slightly undercorrected and still need a contact lens for distance in that eye. no surgeon should guarantee no glasses after surgery. that being said if you have astigmatism I'd recommend getting the toric lens. you will not be happy if you leave your astigmatism uncorrected. a bigger issue for you...and me...is with only one eye done, you cannot wear glasses after surgery because the difference in refraction between the 2 eyes will give you double vision. so, i still wear contacts in my surgery eye and my non surgery eye. one eye is -4.50 and other eye is -.50. i have no halos at night, but i did have some ghosting initially until my eyes started working together.
another option you have is set your surgical eye IOL to a prescription close to your left eye. in other words,if left eye is -3.0 leave right eye -3.0 too. then you can wear glasses after surgery with no issues. if you set your right eye to plano glasses are likely out. sorry this was so long. but there are lots of scenarios to cover here. do NOT be rushed into surgery until you get every question answered and you are comfortable. my doctor did not e
Hi AshMac - I would absolutely seek out a second opinion. I do not like the fact that this doctor made a statement about it being a shame that you might end up with the eyes of a 70-year-old. After cataract surgery many 70 year olds see perfectly fine! In my case, I saw three ophthalmologists and each one offered different opinion (aack!). In the end I went with the doctor who practiced at a leading eye care center (rated #7 in the country), had listened to my concerns and answered my questions with patience and confidence, and didn't hesitate in offering her opinion on what lens she and I both thought would work best for my life circumstances. I've learned that the varying opinions from doctors are really only because no one can predict 100% the outcome of any patient's surgery. Everyone has a slightly different outcome. There can be no promises of perfect vision. No this going into your own surgery.
I went with the basic AcrySofIQ near vision lens. I have been nearsighted all my life and I'm used to wearing contact lenses and glasses. Most people go with distance lens in order to give up wearing glasses. I was so excited about that possibility! How great it would be to not need glasses!! But... other factors led me to chose the near distance lens. For example, I did not like the idea of losing my close up vision. I'd read that people who are nearsighted almost always need reading glasses, even with the multi-focal lenses (someone on this forum can confirm). I read one woman's account about not being able to put on eye makeup, pull out splinters, thread a needle, shave her legs... like she was once able to. Most importantly if I'd gone with the distance lens I would have needed either laser or early cataract surgery on my "good" eye in order to bring the IOL into sync (can't be more than 2.0 difference between the eyes or you end up seeing double). I do not need cataract surgery on the "good" eye likely until I'm in my 80's. I certainly didn't want any surgery on my "good" eye. A lot of people complain about halos and light glare with the multi-focus lens (Symphony). I've always had this problem, so it's nothing new for me. I certainly didn't want to make it worse.
Anyway, the cataract surgery I had has been a success. I think my only complaint is that sometimes I feel like I can see the edge of the lens to the right of my vision depending on lighting. It's weird... but the difference I see in colors and clarity is amazing.
You are right to ask all these questions you've posted. Please do not go forward with the surgery until you get at least on more recommendation. No doubt the doctor you saw is a good surgeon, but it doesn't hurt to seek other professional advice.
Keep us posted!!
Hi Ash. I had both eyes done in August and September of 2018. I got the regular lense that had no extra charges. I wore contacts for 40 years and always had to use dollar store reading glasses. My vision now is better than it was with the contacts of course due to the cataract removal and I still use the same reading glasses I used before. Nothing changed except I don't have to wear contacts. My eyes were 20-50 and 20-30 with my contacts in and now they are 20-25 and 20-25. I got a second opinion due to the first place telling me I needed the expensive lenses. At the second place I was tole the astigmatism was included and that would dramatically change my sight to normal. And it did. I used Barnet, Dulaney and Perkins. they include the astigmatism and the other place wanted $1,500.00 per eye to remove it. Please consider all choices and do a lot of google search to find pros and cons which I did months before. I would have been broke if it wasn't for the second opinion. Dr. Perkins told me himself they were trying to hard sell me. When a surgeon admits that to you I think he means it. I hope this helps and please google all options and visit many sites. Thank you and have a wonderful day. Ruby
Hi AshMak welcome to the cataract forums. a year and a half ago i was in very similar shoes at 53 diagnosed with fast progressing cataracts both eyes.
As a few others have said if your current doctor is promising glasses free with Restor and wanting you to make a quick decision I would back off and research like you are doing. You'll want a second and maybe a third opinion and someone that will work with you through questions you have.
There are trade offs to every lens so reading up on those is important to understand the compromises you are making. There is a high rate of success but things can go sideways and target is not an exact science. It is true no matter which IOL you select glasses or contacts could be necessary to see well. During the healing process (6 weeks in general) the IOL which is much thinner than your natural lens shifts back and forth until it adheres to tissue. That process alone can account for .25 diopter difference from target either near or far. most doctors won't target plano as that could make one far sighted and in my opinion being slightly more near sighted is always better.
The doc may have mentioned Type A personality as those tend to be very picky and demand perfection. With premium lenses coating a lot more money the expectations of the patient rise.
I think you if I were in your shoes I would want the astigmatism corrected and would opt for a toric lens.
I know a lot of people do not want to compromise night vision and if you drive a lot at night or ate a pilot definitely stick with a monofocal lens. There is no guarantee there will be no halos and glare to deal with but the % is less than a multifocal.At 48 your pupils will dilate more than a person of usual cataract ago and IOLs are mostly 6mm in diameter. A few on the forums have the issue where their pupils dilate beyond the IOL and they have additional night vision issues - that is the case whether you choose a monofocal or multifocal lens.
I don't disagree with other posters about monifocal lenses but for myself I went with Symfony in both eyes. I am very happy all went well and I don't need glasses (I was nearsighted since 12 years of age). I have a prescription for +1.25 for extended periods of reading or for tiny print on pill bottles. I work full time with computer and spreadsheets and really didn't like thought of progressives or changing glasses. I do have night vision issues that bothered me more in the early months than now. Very little glare issues now - certainly better than what I experienced with cataracts. Still see multiple concentric rings of light around certain lights like red street lights. Odd looking as they are these are light and I kind of ignore them and see through them.
I do live in canada where cataract surgery is covered regardless of IOL selection so my put of pocket coverage was far less than what is charged in other countries.
Please take your time with this decision and seek out good, reputable doctors as that can make a big difference in how it turns out. Ask around or here on forum for references. I would say it is even worth traveling if need be.
Good luck to you and if you have questions there ate lots of good people here ready to provide input. We aren't experts but have been where you are.
Hi:) Definitely get a 2nd/3rd opinion and take your time to decide. Doctors often form financial relationships with certain vendors and end up recommending their products, partly because they don't have experience with other options. There is absolutely no reason you should have "70-yr-old eyes"! That's very outdated thinking. And no reason you "have to put the same type lens in the other eye years later". Make the choice which gives you the best options for now & the future.
I suggest reading all the threads on this forum about mini-monovision, Symfony lenses, and using monofocal lens in one eye and Symfony in the other eye. Symfony is an EDOF (extended depth of field) lens with about 9 focal points, not a typical "multifocal" lens with only 3 focal points.
It's also important to know and consider which of your eyes is dominant, as this effects any decision about mini-monovision. It's very possible to get amazing results with little or no need for glasses, but you need the necessary info to make the right choice for your situation, regardless of what one particular doctor may say. I chose mini-monovision with monofocal in dominant LE set for best distance and Symfony Toric in RE set for slight myopia. I am extremely happy with the result, with near perfect vision at all distances. Best wishes!
I agree about doctors. How long have you had your multifocal lens? And which one do you have? I don't know how to get the Softport. I think the dr. I saw only implants AcrySof. And his practice is the only one in town with ORA. Weird thing: my regular (non-surgeon) eye doc advised the basic, non-premium, nonxtoric lens but recommended I absolutely pay the extra $400 for ORA. The eye surgeon said they only use ORA for premium lenses (toric or multifocals). Does that sound right? How has the Softport lense gained its "do no harm" reputation? Is there data I can look at?
Hi. Thanks so much for your reply. I have been farsighted since 20; nearsightedness happened in the last decade. so I have never had good distance without spectacles. I have severe astigmatism. Did your doctor use ORA for your operation? RE: glasses...this outfit told me that after the implant in the right eye, no matter what lens I choose, I will have to wear glasses until the left eye is done years down the road. they said I will just need a clear lens for the IOL eye. That actually sounds a little crazy to me now from what actual patients are saying. But maybe they are referring to your second option. IDK. The place I go to is definitely an eye mill, but the only one with ORA. What does "plano" mean?
Thanks for your reply. Wise words. I will not go forward without seeking another opinion. I will have to appeal to my insurance to go out of the area though, and I have no idea if they will allow that. One thing I am hesitant to do is lose my glasses. I like them. Don't love having 2 pairs of them and constantly switching between them though. I would rather wear glasses most of the time. I like the way they make me look. I'm crazy, I know.
Thanks, Ruby. What brand/name is lens did you end up having. When you say they included the astigmatism do you mean you have a toric lens?
my symfony lenses have concentric circles but are not visible to me or others. Doctors can see them in an exam.
Thanks for this, and for your experience with multifocals. I definitely need to research more and get more professional opinions if possible. Thanks for the info about pupil dilation and edge issues. I am seeing such severe disturbances at night right now that even concentric circles seem like a step up. However, I want night images looking as crisp as possible. I want to get as close to natural vision as I can. My expectations are actually pretty low right now, and I'm scared. Maybe that will ultimately work to my benefit. I dunno. I have 20/200 vision now. I have to do something at some point.
Y'all, I think I told you wrong: I needed glasses for distance since my 20's. In the last decade I have needed prescription reading glasses. SO that means I have been nearsighted for most of my life, not farsighted, correct? Ugh, as you can see, I barely understand any of this. I' m a hot mess!
ACRY Sof IQ by ALCON. And if you google LRI (limbal relaxing incisions it will explain how it corrects the astigmatism. Hope this helps. Some doctors will include the LRI and some will charge depending on how severe the astigmatism is. Thanks, Ruby
I think because I researched and asked lots of questions, he considered me to be a perfectionist.
Perfectly understandable to be anxious and afraid. I remember the feelings. I waffled with the IOL decision for months before going ahead with a decision.