Lara and Lisa, edof and trifocal mix and match iol - or not?

Eye care
1

I started to write in another thread, but I guess it is better to start my own separate thread....

So, 5 weeks ago I had the Zeiss Lara edof in my dominant eye, surgery went well, I am very satisfied, although near vision lacks a bit compared to what I would have liked. Today this eye was tested, at this point the iol have shot over the target by 0.5, which also explains why the near is lacking a little bit, even that real reading vision is not to be expected with this lens in any case.

And right after checking the Lara eye, surgery was up for the second eye, and I needed to decide if I wanted another Lara, or a trifocal. Talk about dilemma, a Lara that hits the target or slightly under, would off course give better near vision than one that have hit over the target. And two eyes is better than one, so maybe this would be great, it probably would. But then maybe I would still feel I could have got more near with the trifocal, and I have sufficient far and midrange vision now with the Lara, so why only add more of the same.

It did not make the choice easier knowing, that the first Lara had shot a bit over the target, and the surgeon really could not tell me anything I did not know already, that made it easier to make a choice. By the way, this time is was another surgeon, quite a bit younger, I would guess somewhere in his forties, where the other surgeon was in his sixties. But he seemed very confident, so it did not matter to me really.

But - I went with the Lisa trifocal. Pros and cons go both ways, I guess only the result will tell me if it was the right decision.

It is a few hours since I had the Lisa implanted, I am sitting at home drinking coffee, and just counting the minutes waiting for the pupil to retract, so can see the result, and waiting is killing me... :-) Right now the pupil is almost bigger than the eye itself, they gave it some extra hardcore stuff because the surgeon was not satisfied with the pupil dialation to start with, so they gave it an extra punch. So I guess pupil will not retract before tomorrow, surgeon said it could make than 24 hours, I would have loved to tell the world how great the Lisa is right now, but I have no clue if it is good or bad, right now its all kind of blurry. I can read the screen, and see the keyboard, but it is blurry, almost making me a little bit dizzy if I only look with that eye.

What I do notice, is that the text on the screen gets quite a lot thicker and almost seems bigger with both eyes, compared to only the Lara eye, so even that the Lisa image is blurry, it does add a lot to the picture in my head, funny how the brain works. But positive that the brain is already accepting it, and are combining the two images.

I don´t have a feeling that there are more than one picture in the Lisa eye, but off course it is hard really to tell right now. Trifocals are known for long adaptation time, so I guess my result is pretty normal at this stage.

2

Wow! Our resident guinea pig Mr Viking :slight_smile: You are such a womanizer, Lara and Lisa lol
What was the reason for using a different surgeon?

Any reason why they shot .5 over the target? Just how it settled in your capsule?

Btw Did Dr Zeiss’s info push you towards Lisa, away from the arms of Lara? Wishing you all the best in this journey :slight_smile:

3

At first I was scheduled to have both eyes done at the same time, but I needed time to think about the trifocal.
So when the second surgery was booked with another surgeon, I just went with it, I am sure this clinic does not have a surgeon that is not skilled at what he do.

They never hit the target 100%, and statistically about 1/5 gives the surgeon a refractive surprise.
If it was the trifocal that had this result it would compromise the vision, but with the Lara it means you have lost a bit on the lower end, it is still within the range where it works, although not the result you would hope for.
I am crossing my fingers that the trificocal hits the target better, otherwise it would need correction, and I would not like that.

I would say dr. Zeiss contributed to the feeling I already had, that trifocals have something the edofs don´t have. Dr. ziess is not the first surgeon that have this opinion about edofs.
In the end the main argument that was in my head, was that the first impression the older surgeon had, was I would get the best vision with the mix.
And I believe that out first impression is often right, so I went with it - but I am still excited and a bit nervous how it turns out, but why not go for the gold :slight_smile:

4

Wow I am as anxious maybe as you to fond out the results - but yes you ate right on adaptation time for trifocals and it may be a longer wait. But I am guessing you should have preliminary feelings about it by tomorrow.

Overshot target by .50. Do you know if plano was targeted? Most surgeons if going for plano will target -25 as the IOL settling can make a difference of .25 either way. When was that first surgery? If less than 6 weeks you could still see further change.

Hoping for best possible result! I didn’t have a viable option for trifocal 2 years ago in NB so opted for another Symfony.

Keep us up to date!!!

5

Yes I think with EDOF lenses surgeons were overselling glasses free and managing expectations afterwards was difficult. Better to say more independent of glasses and contacts and keep expectations realistic. Better to under promise and over deliver!

6

I’m also looking forward to hearing your results and comments once your eyes stabilize. One item of interest to me would be if you perceive colors differently between the two eyes.

I have a multifocal in one now coupling with a multifocal contact. They work very well together but eye #2 will need surgery eventually. I am thinking of either an EDOF or trifocal (if the PanOptix or an alternative finally gets approved in the US). I’m pretty sure I’ll be able to adapt to the focus differences but I know that people describe colors differently with different IOL’s so I’m curious about what you end up seeing.

Best of luck with your recovery.

7

rest the eye. my blur cleared 11 hours after surgery. u r the first to mix match lisa/lara on here so would love to know your observations. when possible please see if +0.5 glasses keep your distance clear in the lara eye. that would confirm the overshot and that eye may still change for plano. good luck with the healing!

8

Now 8 hours after surgery, the blurry stuff are much less but still there, the pupil is crazy big, I am sure bigger than it will ever get by itself.
So I have a lot of light effects with rings and different patterns of light, when light hits the eye from different angles.
I guess what I am seeing now, is what people experience, when pupil dialates beyond the edge of the iol. Wow, this is not for the fainthearted, I think (hope) it will be gone tomorrow, but I can see this would be a big problem, if it is like this always in dark conditions, that would be hard to deal with.

Light, colors and contrast are very bright in the Lisa, in fact so bright that it makes Lara look a bit yellowish and fainted - lenses are same material, should be same color, so we will see if this stays with me - or maybe it could be a sign of early pco in the Lara eye, to be honest I have noticed the Lara have turned down the colors and brightness a little bit the last couple of weeks, but maybe just brain adjusting, we will see.

Eyes are already working fine together, none of them have right now real reading vision in normal artificial indoor light at a distance of 16", but together reading vision at this distance works quite well. I am very pleased with this sign, that the eyes works together so early, even they have different images.
And I expect more from the Lisa at this range, but time will tell.

I don´t know if they planned the Lara at -0.25 but I think it would be normal, they are always more scared of shooting to low with edof.
It is 5 weeks since surgery, we will se what happens, I don´t think I would risk a ReLEX smile laser surgery only for the 0.5, I will probably rather live with it.
I had a very strong suspicion that the Lara was a little bit over target, because when I put on +1 readers, far vision is almost the same, so I assumed the Lara had to be over target, otherwise far vision should be worse with +1.

9

I’m sure it will work out well for you Danish_Viking!

For sure, tri-focals take a little longer to adapt. I know I was told it can take one week to 3 months to fully adapt.But I still found it unusual in the early days that I could see distance very well, but intermediate and near were very fuzzy. Took a couple of weeks for near to adjust.

There seem to be lots of articles about mixing and matching AT LARA with AT LISA (probably because Zeiss is the only one of the four largest that has both an EDOF and a tri-focal). Seems to be lots of positive results. Latest from May 2019 that comes up in search: “ATLara vs ATLisa mix Dr. Nabil”

10

thanks for the update. i am a big proponent of going myopic than plano for all lenses. the iol diopters are in steps of -0.35. so if someone is plano at -0.15 they should go to (-0.15-0.35=) -0.5D. person can wear light glasses with astigmatism correction. File size is too bigwith +0.5 glasses my distance gets quite a bit blurry.

11

12

Super great to read this, your descriptions and knowledge are so thorough. You have a lovely optimistic and curious attitude that we all can emulate. Thank you for sharing your experiences…will keep following for sure!

13

And, most important of all: CONGRATULATIONS!!!

14

Thanks :slight_smile:

15

Just came back from check, 19 hours after Lisa implant, the pupil is still dialated from the hardcore eye drops they gave me yesterday.

The Lisa eye have never really been useful before, I have not been able to read or see anything detailed with that eye. I could use it so I did not walk straight into furniture, but that is about it.
Trifocals have a reputation for long adaptation time, so I did not expect too much the first couple of weeks.
Now, 19 hours after surgery, far vision is 70%, near vision at 16" is 80%.
Intermediate vision was not measured, but it is very close to Lara when I compare the two.
Pretty amazing! :slight_smile:

Maybe the eye did have a little surprise behind the 45 year old cataracts, vertical lines are slightly tilted (perfect straight but tilted) to the left in the top, horizontal lines are perfect.
So my smartphone have the shape of a rhombus, kind of weird looking with only that eye.
I guess it must have been that way always, and the vision have been to bad for the brain to correct it.
They said today the lens is perfectly centered and everything looks good. If it is not caused by the surgery, I believe the brain will sort it out as time goes by. In any case the eyes works fine together, everything gets better when I use both eyes.
The measurements on the Lisa eye today showed -0.25 diopter and +0.25 astigmatism, so this is pretty perfect, I am crossing my fingers it stays the same, but time will tell :slight_smile:

16

Viking soldier battling on and forward :slight_smile:

17

Fingers crossed for you Viking - with eye still dilated it’s tough to really know what the end result will be. It could also account for curved lines and weird light streaks. Don’t strain too much - relax rest and let the healing begin. Banking on big strides over next few days. Hang in there. I have done a few half marathons and last mile is always the hardest! Long how long you waited for the IOLs to improve and the miracle that had already taken place with the Lara eye. This one will come through - you’ll have that amazing vision!

18

Looks like you’re going to get excellent results! I’m sure you will be amazed at how good your vision gets as you neuro adapt.

19

my pupil extends beyond the iol on nasal upper corner. surprisingly i didnt see the artifacts immediately after the surgery. i see them in their entirety after dilation now. otherwise it is arcs which are bothersome.

20

Looks like Danish has fallen asleep lol Danish don’t forget your live CNN updates, we are waiting excitedly :stuck_out_tongue_winking_eye:

On a serious note, Danish are you seeing any wavyness?