I was also a bit surprised in the astigmatism measurements from my surgeon. I have only seen one surgeon but he used two different methods to measure it. Based on my eyeglass prescriptions I was expecting in the range of 1-1.5. With one method of measurement my astigmatism came out to 0.0 and the other 0.4. My understanding is that toric lenses are only used down to 0.7, and some are even reluctant to use them at that level due to a cost benefit trade-off. I guess one of the issues with astigmatism is that it is the sum of cylindrical error in both the cornea and lens. When you remove the lens it can get better, or in some cases actually get worse. The other issue is that the incision for the lens is likely to induce some residual astigmatism as well. Complex thing to manage, and it appears complex to measure.
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I agree with your thoughts that how can they correct for astigmatism if they can't reliably measure it. In my case either number is not enough to correct for, so the decision is simple. My doctor suggested that I should wait to see what I actually get with a standard aspheric lens and if not satisfied then consider Lasik or the like to make the final astigmatism correction. I think if vision is not as good as I want, I will simply use eyeglasses. Pretty sure I will end up with progressives in any case.
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One of the things I have found is a pdf document called surgeon_brochure at the myalcon professional site. It is somewhat informative. Here is the graph they show for fitting range. The SN6AT3 IOL is said to be suitable for a corneal plane cylinder correction of 0.75 D to 1.54 D. That is a fairly wide range, so perhaps the precise measurement of astigmatism is not that necessary, as the ranges of correction available is not that fine. I suspect the angle it is implanted at still is critical, although probably less so for a low level correction compared to one up in the 3.0 to 4.0 D range.
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One last thing, I believe there is some consideration of whether or not it is with the rule or against the rule. I've forgotten which is worse. The problem I have in my second eye which probably does have enough astigmatism to correct with a toric lens is that the surgeon says I have irregular astigmatism in that it is not symmetrical. He says that is hard to correct for with a toric IOL. It may be more suitable for a surgical or Lasik correction. That is a ways off for me, as I still see very well with that eye.
Aloha Hubert. I did have both eyes set for distance. The vision is identical in each eye, although the power is .5 different between them. I did consider mini-monovision as well, but decided that I would rather have to deal with reading glasses than a potential reduction in depth perception. You are correct in that the enVista has less market share than Acrysof or Tecnis, but it's worth noting that enVista is based on the same optic platform as the Crystalens/Trualign/Akreos IOLs which have a long track record. I really did not consider "Axial Compression and Corresponding Dioptric Shift" as it really didn't come up in my research. I understand the nervousness and apprehension. I certainly suffered from that as well. My advice is to talk with your surgeon about your concerns. Trust them to help you sort out all the information and marketing surrounding the different IOL choices. Personally, I was getting overwhelmed with it all and had to just pull back from it for a minute and refocus on what was really important to me visually. Namely the best quality of vision possible at distance. In the end, my experience matches up well with the enVista literature & marketing. Hope this helps, and feel free to ask more questions.
Thank you very much, Charles and RonAKA! Did you choose femto-laser for your surgery? or ORA Intraoperative aberrometry ?
At this moment, I think I am in full panic and retreat mode toward my upcoming surgery for both of my eyes. Sorry to hijack your post, Charles.
To give you some background, I am in my early 40's with lifelong myopia (-8 in both eyes so long eyeball) and started having cataract developed in my RE two years ago. Now my LE cataract is also catching up. Overall my eyes are healthy with no history of LASIK or any other surgery. There are some retine lattice degeneration and small scars.
Most of surgeons I talked to recently all recommend Panoptix because of my age and active lifestyle. Since I waited two years and Panoptix just got into US market last year, why not? But then after hearing my concern on trifocal lens, they all proposed alternative like mini-monovision or set both of my eyes to near since I have been myopia for so long.
With a couple of excellent and world-renowned surgeons in my area, I am having a such tough time to decide which one to go with after almost two years research into this matter. I think my fear is coming from the fact that at the end of day, the cataract surgery is not perfect. No matter what lens I choose(Tecnis/Acrysof/enVista), what setup I choose (mini-monovision/both distance or near/multi-mono-mix), what doctor I pick, there are issues I have to deal with for the rest of my life, not to mention potential risk of retina detachment. Such thoughts just freak me out since I still have some pretty active years to live for and my precious little one I need to take care.
At some worst points, I am not sure if I can hang on anymore. More research I do, more fearful I become. I tried so hard to sway my head towards positive side about what will happen after surgery. But there are so many uncertainties.....
These are tough decisions. On the upside we normally only have to make them once. On the down side we have to live with the outcomes if we make the wrong choice. Ouch! . Here are a couple of articles which I found helpful on Monovision if you have not already seen them: . Monovision Strategies: Our Experience and Approach on Pseudophakic Monovision Misae Ito CO* and Kimiya Shimizu . Basically it says they choose pure mild monovision for people with smaller pupil sizes (older people), and for those with larger pupils (likely younger) they choose hybid monovision - monofocal in the distance eye, and multi focal like the PanOptix in the close eye. The hope would be that you get the best of both lenses, and not the worst of both! . Then there is this article on monovision which goes into a bit more detail on the pros and cons of more or less anisometropia. This one has convinced me (age 70 and probably 71 before I get my COVID delayed first lens) to go with pure monovision and probably 1.25 anisometropia. I will try to test it with contact lenses using varying degrees from 1.0 to 1.5 D in the second eye after the first one is done . Optimal Amount of Anisometropia for Pseudophakic Monovision Ken Hayashi, MD . I think one needs an overall strategy to doing IOLs. My basic strategy is to do the bad eye first, see what I get, do some contact lens testing, and then decide one way or another on the second eye. The standard approach to this seems to be to correct the dominant eye first for distance, see what you get, then make a decision on monovision or not, ideally using contacts.
The decisions are not easy, involve making compromises, and you do not get to test drive the IOLs.
I chose to go with the femto-laser option on the recommendation of my eye doctor. His rationale was that the traditional Phacoemulisification surgery was like taking a pneumatic drill to the eyeball and could result in retinal detachment, although not a common outcome. In addition, the femto makes more accurate incision points, produces perfect capusalorhexis (often recommended when premium lenses are being installed), and faster recovery time.
After 11 months with the Panoptix I have concluded that it was the best choice for me. Being glasses free was the #1 priority, and dealing with small halos is 5% or less of my viewing time. I might have liked or been happy with mini-monovision but there was no guarantee of being free of glasses.
You should not worry or be concerned about the surgery itself, it is quite painless, and the recovery time is quite short.
Sorry I have to post this reply twice since my last one has some encoding issues with some paragraphs.
Thank you, Ron and Chris. I agree with both of you. The challenge and fear I am facing is that you can not test drive IOL and no one can tell you what your vision will be after surgery. With my current eye condition (myopia with long eyeball and some minor retina lattice degeneration), it will be unwise for me to try something adventurous then take them out later if I am not happy (one surgeon actually tried to ease my mind by saying that he can take them out based on his experience).
A lot of little things I can do ok now will be deeply impacted afterwards no matter what choice I will make.
e.g. I am a foodie and I love to cook/bake for friends and family, lately mostly for my little one. The mere thought that I will not see clearly the food in front of me while I am tasting it without reading glasses is just depressing.
My work is also around the computer and I read a lot, not only myself but also to my little one. This whole cataract situation just put me in a deep depressed mode for past two years and if anything goes wrong, I think it is only getting worse.
I am deeply sorry to spread this kind of negative energy here. I know a lot of people like me are looking for more upbeat info here. That is why I appreciate such positive story posted by Charles. But I just do not know what to do. On the one end I just want to Panoptix on both of my eyes and hope for the best.
One second later I will be so afraid of halo/glare, let us just do monofocal for distance like everything else do.
what makes this uncertainties even worse is that all the surgeons I visited all offered me different approach, not only on the lens options but also on laser/astigamatism correction.
Interestingly enough one of surgeons I visited is actually pioneer in femto laser but he insisted that for my case I do not need it with full awareness of my retina and astigamatism situation, while rest just appraise the effectiveness of laser and suggest me to use it.
Hubert, you have not suggested how much of your time will be spent in conditions where experiencing halos could be an issue. If you are a taxi driver or trucker and spend hours driving at night then this is not recommended. Otherwise it may not be an issue. My eyesight was very myopic, but could read without my glasses prior to surgery. Having spent my life being able to see up close without any aids was a comfortable life style that I did not want to give up. Also I did not want to put on glasses to examine my face in the mirror, and did not want to put on glasses to read a menu and then take them off to see people at the table. Thus the Panoptic was my choice. There is nothing that I could do before surgery that I cannot do now, and there are things that I can do now that I could not do after my cataracts had developed. There is disagreement about the benefits of the femto and many feel it is a cash grab. There are some benefits and it is a very expensive piece of equipment. My general recommendation would be to select the surgeon that you feel most comfortable with, discuss your priorities and concerns (indicating a preference for the Panoptix), and go with whatever they recommend.
Thank you,. Chris. I guess my concern about halo/glare is mostly from my own cataract experiences. For my past two years, the night time driving became more and more difficult and at some points, I simple gave it up due to safety concern. So if 3 out of 100 people like me (with bad myopia) will have severe halo/glare after Panoptix, and this is one of my biggest complaints with cataract I am too afraid of trying any trifocal IOL.
I do not drive a lot at night. And all of my work happens around computers. However I travel often. So driving in a low light situation in a unfamiliar area of mine could be a potential issue but again without trying trifocal IOL myself, I do not know how bad it will be.
Do you mind I ask you how bad is your myopic? Mine is around -8 for both eyes and based on my understanding, I am not a perfect candidate for trifocal. Again different surgeons have different recommendation.
And how is your vision in a low light condition with Panoptix? As for your statement "I did not want to put on glasses to examine my face in the mirror, and did not want to put on glasses to read a menu and then take them off to see people at the table. ", I totally agree.
I do not want to look for my reading glasses whenever I want to read a book to my kid. I do not want to look for my reading glasses whenever I need to check on my bakery or work long hours in front of my computer. I still have 20+ years of active and busy life to live for. This cataract just totally ruins it.
Hubert, I do not have the prescription from when I wore glasses but think they were in the -12 or -15 range, so pretty bad. The power label on the Panoptix lens is 13.0D & 11.0D, but this measurement is not the same as the glasses. My surgeon had no reservation in recommending the Panoptix.
I can read a newspaper in low light conditions, and driving at night with no street lights and oncoming traffic is fine. My laptop and I spend at least a few hours together each day on emails, reading news, spreadsheets, etc. No fatigue.
Although being ~30 years older than you, I expect to have another 20+ years of active life, so your estimate may be low.
Hubert112 - just reading through this thread tonight. i had my surgeries 3 years ago with EDOF lens Symfony. Your concerns mimic mine at the time when I was going back and forth trying to decide between these and monofocals. I work mostly on a computer and wanted to be able to see near and concerned about halos with other lenses. Although some experience that with monofocals too.
In all your consultations did any suggest a mix and match of IOLs? You could consider a monofocal targeted for distance in your dominant eye first and for the other eye go with an EDOF or trifocal lens. This would minimize the halo/glare effects of the premium lens.
Wish you all the best in your decision.
Thank you very much, Sue. I think I am getting very close to blow off my surgery.
For all three surgeons I talked to, only one mentioned the possibility of mixing trifocal with monofocal aim for distance. Even he later on retreated back to traditional mini-monovision set up after hearing my fear about glare/halo. So at this point, all three of them agree that mini-monovision setup by using monofocal IOL will be good solution for me giving my anxiety.
However I am fully aware mini-monovision is a compromise as well. From time to time, I wish I will have courage and guts to just give trifocal a try. If everything works well, I will be truly spectacle free and happy. But then glare/halo story on this forum and internet will put me in full panic mode in a second.
My feeling is that cataract patients have a love or hate relationship with trifocal IOL.
How is your Symphony doing so far? I hope it works out well for you.
Hubert: for clarity, Symfony is an Extended Depth of Focus (EDOF), more like a bifocal, and Panoptix is a trifocal. The statistics show lower incidence/degree of halos with Panoptix than the Symfony.
I fall into the love category.
thank you, Chris. yes, you are correct about symphony lens as edof. and thank you for the encouraging news.
so you have both of your eyes implanted with Panoptix?
Yes, both Panoptix trifocals, not the toric version.
Hi Hubert - agree if your surgery isn't absolutely necessary now hold off to research more to perhaps take the pressure off and reduce your anxiety. I changed my mind about lens selection and wanted another appt with my surgeon which delayed my surgery an additional 3 months but no regrets to having that extra time to decide.
Personally very happy with Symfony. Day vision is great. So rarely use glasses. Near vision was better than expected - read from 11 inches no problem. Dim lighting (upscale restaurants) I will use flashlight mode on iphone to help with menus.
Night vision which was a concern of mine as well was better than what I had with cataracts for contrast and and glare was much less. There are huge concentric circles around certain lights. These got more faint with time or perhaps brain tunes them out. In the early months planned my routes where there was overhead lighting but now i don't think twice about driving at night. I do find those blue-white new headlights blinding but so does my husband and he doesn't have cataracts or IOLs.
As you say each choice including monovision with monofocals has it's pros and cons and only you can decide what the compromise will be. I was 53 when diagnosed so it felt like a blindside and I was quite anxious and worried about my decision.
One thing - likely due to my own situation now - I developed this year EM (epiretinal membrane) and my left eye doesn't see very well. Things are distorted all distances. Waiting to we a retina specialist now. Thankfully right eye takes over and I see well read just fine. Makes me wonder though if I had chose monovision with monoficals if I woukd be struggling with distance or near vision with just one good eye.
Hope you to get to a place of comfort with your decision. Remember most going through this don't post anything - bulk of surgeries turn out fine. Lots of good people here to support you.
All the Best
SueAn
Good to hear you ate happy with your lenses. Trifocal in Canada was not available when I had to make a decision. Results with Symfony though are not like bifocals. My vision is seamless - no dip in between like a bifocal. For whatever reason my near vision is excellent. See well from 11 inches. Can thread a needle or repair sunglasses (tiny screw) all without glasses. Expectation was near vision would be at 18 inches. But some get good intermediate even from monofocals - might be uniqueness of some eyes vs another person's eyes. There is slight loss of contrast in dim lighting. Like restaurants with low lighting - need to turn on my iphone's flashlight to read.
Nice to read of another's success story. Most seem to come from people who do their research and find the forums prior to surgery. Stands to reason if one doesn't look into it a d has a great result why would they post? nice though for others to see the surgery can give you back something cataracts destroyed.
I did not have femto or ORA as Kaiser does not offer these options. Addressing a few of your other comments/concerns:
"all recommend Panoptix because of my age and active lifestyle." - I'm 56 and a competitive triathlete. I was very concerned that I wouldn't be able to read my running/swimming watch or my cycling computer, but it really isn't a problem. I can see them fine.
"The mere thought that I will not see clearly the food in front of me while I am tasting it without reading glasses is just depressing." - I see my food just fine. I cook a lot and can see just fine to use measuring cups/spoons etc. The only time I wear readers in the kitchen is if I'm using a recipe I'm not familiar with and have to read a lot on my tablet or a cook book.
Just to be clear, I'm not advocating for this approach. Just giving you the benefit of my experience. If you have a good surgeon and they are comfortable with the IOL and visual strategy I'm sure you will have an acceptable result. All choices involve some degree of compromise. That is why I think it's important to make a list of your visual priorities in order of importance, and let that guide you as you make your decision.
I do not want to look for my reading glasses whenever I want to read a book to my kid. I do not want to look for my reading glasses whenever I need to check on my bakery or work long hours in front of my computer. I still have 20+ years of active and busy life to live for. This cataract just totally ruins it.
There is an option of having both eyes corrected for near vision. This means of course that you need glasses for distance, but not for near vision. It is an option that some near sighted people choose as they have lived their life with the ability to take glasses off for near vision and can miss it if corrected for distance and become totally dependent on glasses for reading. It is one I have thought about, but probably will not go with it. I know I will miss not having excellent close up vision without glasses.
Being corrected for near vision would be exactly like my over 50 Presbyopia situation, maybe even slightly better. At that time I was wearing progressive glasses all the time, but could remove them for reading. My strong preference after cataract surgery, maybe irrational, was to be able to examine my face closely, cut my nails, etc. without needing glasses and to have good depth perception. Enter the world of compromises.
Chris, not irrational at all. I had both eyes done 10 months ago, with near-distance monofocal lenses (Acrysof IQ - no glistenings to report as yet!). I have worn glasses since I was 7, was very nearsighted (~-8) in both eyes and emphatically did not want to lose my closeup vision. I spend most of my day, both for work and pleasure, reading (actual printed books) or on the computer. I chose to have -2 lenses implanted (after much discussion with my ophthalmologist, who agreed that in my situation my "brain would be happier"), with the understanding that they might not end up that way. My left eye has remained at -2, while my right eye is -2.5, so I've effectively got mini-monovision. I am beyond delighted. I spend most of my day without glasses, only putting them on to watch TV or when I go outside (which isn't that often these days!) I was wearing progressive glasses before my surgery, and that's what I have now, so I can see perfectly at all distances when I need to. But just walking around my house and going about my daily tasks I can see just fine without them. I know that I'm in the minority here, but just wanted to give you another opinion. Good luck with whatever you choose!