I had an epiretinal membrane peel, which led eventually to a cataract, as they warned. I had the cataract removed and got a long distance vision lense. I had the operation two days ago. I can see incredibly sharply long distance without glasses now and am SO pleased. But I notice when reading, everything seems to jump rapidly, sort of out of the side of my vision. I realize my eyes are settling down and still adjusting, but is this normal? I talk to my dr in a week but am a little worried.
So you got the monofocal IOL's in both eyes for distance? How is your intermediate vision? I heard that everything close up will be a total blur. Is that true? Are you able to see your computer (intermediate ) without glasses? Are you able to see your cell phone? Did you get laser or conventional? How did the surgery go. Was it painless and easy or was there anything unpleasant about it? I heard it takes several weeks for your eyes to adjust but certainly I would ask my doctor if what you are experiencing now is normal.
Well, hmmmm, I cannot find the stupid card they gave me with the name of the lens and the prescription of it. But it is just a regular lense (for seeing long distance) on the left eye (right eye hasn't been done yet, not bad enough of a cataract yet). It allows me to see distance perfectly sharply, and yes I can read my computer (intermediate) but I cannot read a small print paper up close with that eye. It was just a normal cataract surgery, no laser, conventional. It was totally easy, no pain, kind of interesting to watch the changing shapes and lights actually. It only took like 10 or 15 minutes and surprised me at how easy and painless it was. In fact, I sort of thought they were just putting in eye drops and prepping me and all of a sudden she says (the doctor) "You are all done." I was shocked. My right eye is still fine so it compensates for up close vision to a degree. I'll be fitted for glasses in 4 weeks but for now don't even need them except for reading.
Wow, glad to hear it turned out so well for you. I head that people who got both eyes for monofocal distance could not see intermediate (computer) without glasses and that everything close up was a frustrating blur. LIke could not text or email on your cell phone without glasses or even read a caller ID when your phone rings. Maybe it is because your other eye was not done yet or maybe you will be lucky and see both long and intermediate even after both eyes are done for distance. I heard that laser heals faster than conventional. One doctor I spoke with at Bascom Palmer tells me that conventional is actually better and faster than laser and two other doctors tell me that laser heals faster but that the cut is actually smoother with conventional. Wonder how much of the laser is just advertising hype and how much really is better. One of my doctors wants to put my eye totally to sleep so that I won't see anything for hours afterwards and the other two I spoke with told me it would be what you had probably with a mild IV and numbing gel. She says she is concerned with how squeamish I am with anything touchinng my eye and tells me that she is afraid I might otherwise move. I have to tell u I am really not happy about the idea of not being able to see when my eye is open for hours after surgery. Anyway really glad to hear it is such an easy and painless procedure. I watched a video on the procedure and....well that probably wasn't the best idea. All surgeries look scary. I guess what you have now until the other eye is done is monovision, where one eye is set for distance and the other for intermediate. But they tell me with monovision you lose depth perception. So your new lens you see distance perfect but if you closed that eye and looked out of only the other eye, distance not as good and maybe intermediate better? How about if you closed the eye that is still unchanged and looked at intermediate only with the new eye, how is your intermediate? Also just as good? You do what most people do. You just followed your doctor's advice and got it done. I want to make sure I am making hte right decision since it is not like changing your shirt if you don;t like the one you put on and it is for the rest of your life. Anyway thanks for sharing your experience. I am glad it turned out so well for you.
There is a very good free ebook online by a cataract surgeon that addresses issues before and after surgery, which says something that might match what you are experiencing:
"It's okay to read, but your vision may seem "jiggly". Because the lens capsule has not yet contracted around the IOL, there may be a slight jiggle of the lens with each eye movement. This is most noticeable when reading and will improve over the next few weeks."
Unfortunately on this site they send the message to a moderator if you include a link, so to avoid delay I'll say that the PDF file of the book should be the first link, or close to it, if you Google for this line:
"David Richardson, MD" "what you need to know about cataract surgery" pdf
I'll also note that book addresses the issue of laser surgery that primeland mentions above, and he comes down on the side that for most people laser surgery isn't worth the cost yet, though it depends on each person since some people may have complicating factors that makes a laser better in their case. Also lasers for surgery are improving all the time so eventually it may get there, the benefit just hasn't yet been proven in the view of many surgeons.
re: " head that people who got both eyes for monofocal distance could not see intermediate (computer) without glasses and that everything close up was a frustrating blur."
The vision people get with a monofocal lens set for distance depends on the eye's natural depth of focus. A tiny minority, a few percent, of lucky people can do some reading, but it isn't good to expect that sort of lucky outcome. A more typical result I hear is 6 feet inwards being blurry. That is part of why the results for something like the Crystalens vary as well, since some people have more natural depth of focus and would have seen well even with a monofocal.
wow, interesting information. Finally someone gave me a distance I can understand. OK, so 6 ft or less could be a bit of a problem and over 6 ft I would be good. Unless i am one of those rare lucky people. I was told that the crystalens doesn't work so well but my doctor told me it was "better than nothing" and that at least with the crystal accomodating lens I have a "chance" of seeing intermediate and near but with monofocal I would have no chance. But what you are telling me is that I would, even with monofocal depending upon my natural depth of focus. So what is the point of the crystalens? it doesn't really do anything like it is supposed to in theory and it inserts a complicated device with moving parts in your eye. Z sydrome possibility and no long term studies to see how long those movable hingese will last. do you have any thoughts on that or do you know anything about the crystalens accomodating IOL? before your surgery were you near sighted or far sighted? I am wondering if near sighted people are more or less likely to be happy wiht two monofocal distance IOL's than far sighted people would be. I think it would bother me not to be able to see my cell phone when someone sends me a text or email and to first have to find my glasses to read it. But nobody gets monofocal at intermediate or near. I wonder why that is.
re: "But nobody gets monofocal at intermediate or near."
Some people do, it just isn't that common. On the Medhelp site there is a page or two of people discussing that option. I think the issue is that with monofocals set for distance (or monovision) you can presumably wear progressive glasses to try to cover intermediate&near. If you get monofocals set for intermediate, you might need a pair of glasses/contacts for distance, and perhaps for near. If someone goes for monofocals, to me though the idea of monofocals for intermediate sounds interesting though since with a bit of monovision (different levels of intermediate) you could perhaps cover most social distance, computer distance, and most household tasks without needing glasses. If you only get a slight bit of monovision (micro-monovision or mini-monovision) there is less risk of depth preception being reduced.
I was highly myopic, before cataracts changed the prescription it was something like -6D and -9.5D, so I needed to wear correction all the time, mostly contacts, so I liked the idea of potentially not needing to wear correction again (or if I did, only sometimes for reading). I suspect part of the issue of what people go for depends on what they are familiar with. The average cataract patient in their mid 70s lost their near vision long ago and is used to that and probably doesn't mind the idea of monofocal lenses. In my case my cataract became a problem at age 49 while I still had some accommodation left and didn't like the idea of losing all of it. Also what you go for likley depends on what correction you've used before. I had used multifocal contact lenses and liked them, and preferred that to monovision contacts due to better depth perception.
The point of the crystalens is that in most people it does seemingly accommodate at least a little bit (though there is debate over whether it is actually moving) to give some better near. I've seen different guesses as to how many need reading glasses, one noted surgeon I recall seeing mentioned perhaps half. As I mentioned on the other page here you started (perhaps you missed that, reread the page) there are some fraction of people for who it doesn't accommodate (I've seen varied comments, I seem to recall some guessed perhaps 10-15%, but I'm not positive) and its no different than a monofocal. The newest model crystalens reportedly has less of a risk of z syndrome, but I hadn't seen figures.
In my case since I was willing to travel outside the US to get a better option, I decided the Crystalens wasn't worth the risk when the trifocals (which are better than the US based bifocals, less contrast sensitivity reduction and lower risk of side effects) and then the Symfony which I wound up with seemed a better bet for my needs. As I noted on the other page, there are now corneal inlays to give people better near vision, and they have been tested with monofocal IOLs so I suspect they'd also work with the Crystalens, as an option to try later if you don't have enough near vision. (though it is an added surgery and expense of course).
btw, the Symfony is now available in Canada so you needn't travel to Europe or Asia or Australia or New Zealand (which were the options I explored before going to Europe), and the AT Lisa trifocal is available in Mexico (I don't know about Canada) and there are at least a couple of clinics just over the border from San Diego, walking distance from the US, that seem to cater to US patients so they might be US quality treatment but using non-FDA approved more modern technology.
The distance of 6 feet was only a vague general guideline that I commonly hear repeated, not an exact figure. If you want to understand the likely performance of IOLs, you'll need to look at study results, sometimes located on the manufactuers web pages or via searches, which usually given the average visual acuity of the lenses at various distances (though again those are averages, some folks get better, some worse). Those distances are sometimes given in diopters rather than inches or centimeters, e.g. the visual acuity may be 20/40 for -2Diopters. You can convert those to distance_in_centimeters = (100 / -diopters), e.g. if they give the visual acuity for -1D that is for 100 centimeters ( 1 meter), for -2D that is for 50 centimeters, etc. For instance if you look up the Tecnis Symfony lens, the manufacturer page on the clinical tab has a defocus curve that shows the visual acuit of that lens (which isn't FDA approved yet) but it also includes the Tecnis monofocal as well which is a high quality monofocal you can use as an example.
It is hard to picture of course what a particular visual acuity means. If you google "visual acuity print size" the first hit should be a page giving an idea of what near visual acuity you need to read various size print. Visual acuity can be given sometimes in 20/20 type format, other times in things like logMar or decimal, if you search you'll see on wikipedia and elsewhere charts to convert between the different measurements.
It is a monofocal lense for seeing distance. My eyes of course are still adjusting but when I block the regular eye, here is the result. Using a yard stick (I'm in the USA) and I can see enough to read at about 25 inches or in other words 2 feet away (no closer and no further). This was a Harry Potter book normal print size. You are right that my "good" unoperated eye compensates for now so I don't even need glasses for reading unless the print is real tiny. At the gym, I set the book about 2 feet away as I ride the bike and I'm golden. For me, the other issue is I have a floating sort of backwards capital E in my left vision (where the new lense is) and have had that since my epiretinal membrane peel back in April. That gets in the way a little but I can still read around it. I do notice for long distance I now have depth perception since both eyes now work together. I chose long distance because I wanted to be glasses free for driving. I did do some research on various new multifocal lenses, talked to some friends who actually had it done. Trouble was every single one of them ended up having to get reading glasses and most were most troubled with halos at night. I also watched the cataract surgery but I kind of enjoy watching surgeries so it wasn't a big deal to me. I don't care that much about the computer because if I need to, I just increase the size of things using those three bars on the upper right corner of Google Chrome, or decrease as preferred. I will put off doing my right eye as long as possible since I am delighted with how things are for now.
Thank you softwaredev for Dr. Richardson's info. That makes sense about the jiggling and I am reading it now.
Thank you Softwaredev this helped explain it to me and it wasn't just my Multifocal IOL that was just implanted. I would like to respond to my experience with the multifocal tecnis lens , I am 3 days post op and my intermediate vision and distance vision is amazing, my near vision is so much better than it has been the last few years and the doctor said it will get even better and more defined after my second eye is done. Besides the jumpy vision I am happy and they said the jumpy vision will go away, along with it it is like something is in the perfical vision and again was told that would diminish and go away. Thanks for the pdf info that helps a lot and no I didn't need laser vision because I didn't have any astigmatisum that needed corrected.
Hey there Ladymccoy, which multifocals did you exactly get implanted?
I got the tecnis multifocal 2.75 my vision is not jumping now, maybe in a store under bright florescent light. I am still waiting for the beveled edge effect to go away at times I don't notice it so I hope it goes away. But no glasses makes me happy
I just had the Symfony lens implanted in both eyes. The right was done 10days ago, the left three days ago. At the one day check, I was seeing 20/20 for distance, intermediate (computer distance) and for reading. That has stayed true for the right eye at the one week checkup. I am amazed at the transformation. My eyesight was really bad with -14 and -13.5 plus astigmatism. This is so incredible! The only caveat is that I am seeing large halos at night when driving. I was used to halos, but these are immense. I hope they get better. I have not talked to my opthamaligist about it as I had not experienced it until after the second surgery and I started driving again. Also, my eyes get tired and I can't see as well. I will need reading glasses for tiny print and very close up work. Hope this helps others.
cherylswede,
Thank you for sharing your epxiernece. Did you get the Symfony torics or nontorics for your astigmatism or perhaps you got it corrected with an incision? Reading about your vision it seems like you got both set for distance with no micromonovision. How much near can you see? You mention reading glasses for tiny print, do you have to hold things a bit further from you to see it? You don't mention the importance of near vision for you and whether you were myopic or farsighted prior to surgery. I'm myopic so near vision is a must so was wondering. I hope your halos do get better, not entirely sure if it is because it's during the healing process but it would be a disappointment if the Symfony lead to larger halos.
Jason.
I'm thinking about getting symfony which is now available in the US for $5,000 per eye. Are you still happy and is this about what your paid in Europe? I have been wearing mono vision contacts but need better distance and don't want reading glasses. I want 20 year old eyes so thinking symfony is my best bet. I'm wondering if I should wait as technology just keeps getting better and better but symfony seems to be new as only one, out of two Doctor's I met with even mentioned symfony as an option so was glad I decided to get two opinions. Is symfony laser only? Been reading laser may not be better than conventional. As I'm sure you can tell from this email I'm at the early stage of investigation.
In the Czech Republic the cost is more like $1200-$1800/eye with a premium lens (I got it for a bit less than that since I got a discount others won't get since i was the first person to get the Symfony there, but since its implanted just like other Tecnis lenses that are the exact same size&shape it wasn't a concern to me to be the first there).
Laser cataract surery would have been just a few $hundred more but I didn't bother going for it since my reading on the topic indicated that it hadn't proven its benefits for uncomplicated cases, with merely a different set of rare complications. The surgeon offered the laser, but agreed it wouldn't really provide any benefit for my case. I'm used to the reality that in the tech world sometimes new technology is immediately better than prior options, but other times it can take a while to be polished before its better than prior technology (even if many people jump on the bandwagon early). I decided the Symfony was worth the bet, and the travel, but that the laser wasn't worth going for.
Unfortunately there is no lens yet which will give you the sort of visual range you had when you were 20. Your distance vision might be comparable to what you had at that age with the Symfony (or with a good monofocal with a low abbe material like the Tecnis). The natural lens does degrade with age (dysfunctional lens syndrome) even without a cataract so an IOL can improve things in certain ways. My distance (and intermediate) vision seem better than I can remember them being before I had my cataract and I wore contacts or glasses. My distance vision is almost 20/15 (actually the last times they just confirmed it was at least 20/20, it could be it is 20/15 or better now).
In my case I'd describe it as being like early presbyopia where you just start noticing you can't always see near. e.g. I can read the small print on an eye drop bottle, but I do need to find the right distance to hold it (unlike larger print where I don't need to). I have 20/25 vision at my best near, and have no trouble using my smartphone with the usual fonts, but for instance to thread a needle I needed readers.
The Symfony was just approved in the US this summer, and it wasn't until the last month or so that they got distribution setup for US doctors to start using it, so US surgeons are often going to be less familiar with it. Its been approved in Europe and elsewhere for a couple of years.
Unfortunately there is no lens that provides perfect vision at all visual ranges yet, so its a matter of deciding what your visual needs are and finding the option that best matches your needs. It partly depends on how much risk you wish to take, since .e.g. most people don't have problems with halo&glare issues with any lenses, but the odds of a problem are higher with multifocals than the Symfony. Outside the US there are trifocals that attempt to provide good vision at distance, intermediate and near. I was originally going to go for one of those until the Symfony came out. The tradeoff is that studies tend to show slightly better intermediate vision with the Symfony (one study indicated the Symfony had the best visual acuity results out of all premium lenses from 46 centimeters and outwards), with the trifocal providing better near vision. In my case intermediate vision was more important to me than really near vision, since I figured worst case I could use readers for that at home/office (or they make foldable readers to carry in a pocket). The Symfony also has a lower risk of halos and glare issues than multifocals. Although the risk of night vision issues like halos is lower in trifocals and the new low add bifocals than it used to be, I preferred a lower risk of night vision issues to having a bit better near. The Symfony also has reportedly better contrast sensitivity (e.g. low light vision) than multifocals, even though again the trifocals and low add bifocals aren't too bad.
In my case I was happy with multifocal contacts before my problem cataract arose. I didn't mind having reduced vision in low light, but I definitely have better low light vision with the Symfony than I had with the multifocal contacts. (though granted the optics of a multifocal IOL may be better than a multifocal soft contact lens and have less light loss). I notice the difference in a restaurant I have a weekly meeting at which is somewhat dimply lit.
Sometimes I wonder if I should have bet on a trifocal to have a bit more near, but I think the crisp intermediate and distance were a good choice. I know also that as we age we need more light, so eventually when I'm in my 60s and 70s the difference in low light vision may be more of a big deal.
The Crystalens tends to also provide decent distance and intermediate , but with a slightly higher risk of night vision issues than the Symfony, and I'd seen estimates that around half of those with the Crystalens need readers despite the near visual acuity results on paper seeming to be comparable to the Symfony, if perhaps even a little better. Most with the Symfony don't need readers. The thing that worried me about the Crystalens was that I'd seen reports (no hard figures) that perhaps 15% of people didn't get any better results than they would have with a monofocal, that it didn't seem to accommodate. I preferred not to risk that. There was also a higher risk of complications like z-syndrome (which is lower in the latest generation, but I never found good figures for it) and other issues. I know someone here with the Crystalens, and he seems to have more of an issue with low light vision. (e.g. we met after a talk in a well lighted auditorium and he had a near vision chart. Holding a file folder above the chart to cast a shadow was enough to reduce his vision by some lines, whereas it didn't make a difference to me).
If you wait longer, there is a chance something better wil be approved. I waited 2.5 years for surgery (since I retained good vision in one eye) in hopes of a better lens. I haven't heard of any new lenses working on getting US approval, I don't think any of the trifocals is trying for approval here. Its possible that might change since the Panoptix trifocal is from Alcon which is a major IOL supplier in the US so perhaps they'll try for approval, but I hadn't seen anythig about them even starting the clinical trial process.
Outside the US there are other lenses that haven't been well tested yet, seeming to be still being tweaked before they are marketed widely, that might provide a slight edge over the Symfony (e.g. the Mini Well) but I hadn't seen good comparison data to know for sure (merely optical bench comparisons testing the lens outside the eye, not comparisons with the lens in humans to test for things like halo issues, etc) and the difference might be slight.
Where in Czech did you get yours done?
I'm interested in either accomodating IOL eg Symfony. maybe toric IOL or corneal relaxation incisions
What was the total surgical cost?
The Symfony is an extended depth of focus lens, not an accommodating IOL like the Crystalens. It depends on the level of astigmatism whether a toric IOL is appropriate or an incision. Surgeons tend to use incisions for lower amounts and toric IOls for higher,but where the line is drawn varies with the surgeon. One prominent surgeon wrote in a trade publication about preferring an incision via laser for even a few diopters of astigmatism.
The Symfony is now available in the US, and I suspect any country where you can get a premium IOL. If don't know which country you are in, if the issue is cost, I know some in the UK use the Czech Republic for medical tourism. In my case at the time only one surgeon there had gotten access to the Symfony before I had to decide which country to go for surgery, but its available widely now. Where I went wasn't as convenient since it was a small city where the surgeon spoke english, but not all the staff since they weren't really setup for medical tourism, so I hesitate to talk about it to any who aren't truly in for the ordeal. Now the Symfony is available in places like Prague where there are more English speakers than a small city (where even the cab drivers didn't speak english) and places that are setup to deal with medical tourists, even providing english language websites. Last I checked surgery there varies in the range of $1200 - $2000 or so depending on IOL choice and whether to use a laser and other factors (I got a special discount being the first to get the IOL there so it was a bit less). I've been in touch with someone who recently got the Symfony toric in Prague from an experienced surgeon, the price list shows about 1325 euros. (I hadn't checked the website guidelines to see if they mind mentioning specific doctors/clinics, some sites frown on public posting of that info and remove such posts, I don't remember if this is one, so I won't mention that in this post. I also hadn't researched the best current options, this was just one).
PS, oh, and the price range I was giving was per eye. I'm in the US so I used dollars based on memory of the conversions I saw, though most sites quote in euros and the Czech currency.