Multifocal vs Monofocal Near vs Far Laser vs Conventional

Eye care
1

I am told I need to get cataract surgery on both my eyes,.  My left has a fairly dense nuclear cataract and my right  eye not as bad.  I have the following decisions to make and I would love to hear from anyone who has gone thru what i am about to go thru who can help me with my decision and lessen my anxiety.

1.  I am told I could wait if it is not interfering with my quality of life, but that if I wait too long, the longer I wait the harder the cataract will become and if it becomes too hard and/or brittle, it could make the procedure more difficult and hence more risky.

2.  I am near sighted., I wear progressive glasses.  Nothing is sharp anymore because of my cataracts, even with glasses but I can see my computer and my smartphone without glasses.  If I go with monofocal, which one?  Distance, intermediate or near?  Anyone who had this surgery and chose one or the other, would love to hear how you are dealing with being able to see only one out of those 3 choices and whether you are happy with your decision..

3.  Multi focal vs Mono focal:  I am told multi focal has not been perfected yet and there is a loss of contrast you don't have with mono focal.  Also there is a problem with glare and/or halos.  Some people are so unhappy with multi focal that they have another operatnion to switch to monofocal.  Would love to be able to see at all distances but want to know what people think who have gotten the multi focal. Also there is a new multi focal for the past few years called TRI focal instead of BI focal.  Supposed to let you see at intermediate which the bi focals did not do. 

4.  Most people say laser is better but I have a doctor from bascom palmer who is telling me that she is more comfortable with conventional and that she gets better results with conventional.  Yeah but what about scarring, healing, no stitches, less energy required to break up the cataract and less stress on the eye that I heard about benefits of laser.

5.,  Anestheisa:  I am VERY squeamish about anything touching my eye. I cannot imagine a blade or even a laser, cutting into my eye. One doctor wants to put my eye totally to sleep so I won't be able to see for hours after my operation. wow, that's scary. want to ask about what the procedure is like, what you see and what you feel.

Thanks guys..  Any help would be greatly appreciated. 

2

Hi Again

I'm sorry that I'm not able to make any comment on a lot of your questions but I am able to tell you of my experience of the op. I noticed that something was not right with my left eye probably more than a year ago. I asked my GP who confirmed that I had a ctaract. I was reffered to hospital where my appointment took some months to come thorugh. When I eventually went I was seen by a specialist who told me that they would remove it. I was shocked when he told me that he would prefer to do this under General anasthetic. I asked why and the reason I was given was that I was a younger patient (and quite nervous I admit) that it was better to be out for the op because if I moved during the operation it could have negative consequenses. I have to admit that I didn't like the idea of someone cutting my eye either, so I went along with his recommendation. Eventually the time came for my op. I was also nervous about that (I'm not a very good hospital person) However all I can say is that the staff and everyone was fantastic, I was reassured and really cared for and to be honest the whole thing was not almost as bad as I had been worying about. For me at least the general was the best thing that could have been done. I just hope that this might reassure you when the time comes. I happen to live in Malta by the way and I have to say I am very grateful for the wonderful care of everyone.

3

thanks for your help Keith.  I live in Miami Florida.  I am also a terrible eye surgery patient.  I cannot even tolerate someone putting dropsin my eye I am so squeamish about anything touching my eye.  My doctor told me she could not even get a pressure reading because she was unable to touch my eye with the pressure reading machine.   She told me that she wanted to totally anethesize my eye so that, I will be awake, but my eye will be "blinded" for about 3 hours. OMG!!  That kind of freaks me out a little bit as I am waiting (hoping) for that anesthesia to wear off so I can see again.  I wonder if general anesthesia would be better than injecting anesthesia that temporarily blinds me.  

4

Hi Again

Well at least I have met another soul like myself. When the Dr first mentioned the general I was very surprised but in truth it was by far the best option for me. Not being ever in a hospital since I was 13 I was really worried and uncomfortable with the thought. However the staff were just great and as mentioned it wasn't such an ordeal at all. The afterwards stuff was fine. Since I've learned from various sources that the offset vision and dizziness that I mentioned are normal I feel good about that. I would say that if you have that option go for it. I did and would certianly do it again if I needed to.

Good luck

5

actually I wasn't given the option of general.  what is offset vision?  how long did the dizziness last? thanks

6

Well as mentioned, it was the specialist who suggested that he do general because of my younger age (being 58) and the need to remain very still during the procedure. I don't know if my use of the term offset vision is actually what I'm experiencing. It just seems when I go outdoors I get the sensation that you might expect as if you had just had a bang on the head. Not quite double vision but not that far from it. Kind of makes you feel a little dizzy as well. It's really quite hard to describe this. However I have read that it's a normal reaction and as my op was only just 9 days ago, it's really still early days. I have read that it will go with time. I'm not unduly worried now having read what I did. Hope this helps

7

I went onto the Internet and watched the operation before I had it done. Very interesting.

8

Hello primeland

I was very interested to read your posting as it is the first time I have heard multifocal/trifocal lenses being mentioned. I had Zeiss Trifocal lenses implanted 18 months ago, and will tell you of my experience with them.

But firstly I would assure you that the procedure itself is absolutely nothing to be alarmed or apprehensive about. Everyone I have met who has gone through it is amazed and delighted at how quick and pain-free it was - in fact almost sensation-free too. So please don't worry in the slightest. I myself was offered a mild sedative once in the operating theatre, and was barely aware of anything happening. Afterwards I felt completely OK. The eye that has been done will have a hard plastic cover taped over it, and this remains on until the next day, when you can remove it and 'see' with your new lens - everything will look whiter, brighter and cleaner!

Back now to the Trifocal lenses. My surgeon was very encouraging that these would suit me and so I agreed (and paid a large amount of money too!) 

Since the procedure I have been through quite a lot of mixed emotions, and at first was very upset and regretful as I did not achieve as good results as I feel I had been led to believe. I find that on a bright sunny day I can see everything near and far incredibly well, even better if I wear polarised sunglasses. I can even read 8pt text (one of my hopes was to be be able to read packets in the supermarket and I now can). However in artificial light my sight becomes very weird and strange, with much glare and haziness, especially in fluorescent lighting. As you mention, at night I see haloes and starbursts round headlights and streetlamps (this depends on the type of light). I was told this would lessen over time but it hasn't.

All I can say now, eighteen months later, is that I have got used to it, and am glad not to need glasses (though my eyes feel more comfortable with an old pair of glasses when working on the computer as they increase the contrast). On some days my focus is not as good as on others - i don't know why this is - but I can manage everyday activities and tasks OK.

I can now accept that perfection has not been achieved for me, but what I now have is good enough and will, I hope, remain the same for the rest of my life.

I hope this helps

9

wow, thanks for yoru comment.  So many choices.  So confusing.  So I asked my doctor today about tri focals and he and his staff looked at me like I had 2 heads.  Apparently they don't do tri focals here yet.  And I live in Miami Florida.  You would think they would have the latest of everything. I explained that, according to what I researched, tri focals are a distinct improvement over bi focal multi focal IOL's in that they correct for near, distance AND intermediate.  Anyway I met this doctor for the first time today.  My 3rd opinion I guess u could say.  So, as I understand it, multi focals are not perfect in that, as you mentioned the halos and starbursts around bright lights.  But that doesn't worry me so much.  What I am more concerned about is the loss of contrast and the problem with low light conditions.  From what I have researched, multi focal lenses, by their very nature, split the light coming into the eye into different segments so, whatever focal length you are looking at, you don't get 100% of the light that people with normal eyes see.  You get anywhere from 75% to 85%.  I think enough to be noticeable.  So I was concerned that everything would seem slightly dimmer to me, if I had multi focal, than it would to everyone else.   Of course under bright light conditions, it wouldn't matter because plenty of light to go around, but in dim light conditions??? Have you noticed a loss of contract and/or focus in dim light conditions, whether at night outside or inside in a dimly lit room?   The trade off is of course being able to see tiny letters very close up.  That is very cool.  

So now they are telling me I should try accomodating lenses.  Theoretically they are supposed to move with the muscles of your eyes to allow you to see distance and intermediate by changing the focus of your eyes naturally,  I am told in practice it may not work as well as on paper but this doctor said, still better than just monofocal which you know you are going to get distance only.  

I thought that, with glasses, I wanted the best vision possible and that if I got multifocus, I would never have that since you cannot correct for contrast, even with glasses.  Anyway the big question is are you happy with your choice?  I know you expected perfection and didn't get it, but considering the alternatives, monovision (one eye near and one eye far), mono focal (one focal length of your choice only and the other two you will need glasses) or accomodating (distance and maybe intermediate - or maybe not- and glasses for close up BUT you get 100% of the light all the time so excellent contrast in all lighting conditions and only a very small chance of seeing halos or starbursts), are you happy with the ones you have or do you sometimes wonder if it would have been better with one of the other althernatives?  In other words, if you could start all over and do it all again, what would you have chosen?

Last question. Did you get laser or conventional knife and did you need to correct for any astigmatism.  

thanks.

10

Hello again Primeland

Nice to hear back from you so soon. In answer to your last question first, I had my first eye done with a scalpel (which was absolutely fine), and the second eye with a laser. I had to pay extra for this bu it is supposed to mean a faster healing time, and more accuracy. weLl, perhaps it was all this, but I did not notice any difference either way. I think it depends mainly on the skill of the surgeon.

Re loss of contrast - yes, I think there is some but it is now quite hard to remember what my original vision was like. Yes I do need strong light to read in the evenings, but perhaps I did with my original vision too.

Would I do it again? pErhaps I should mention that I had these lenses implanted in order not to have to wear glasses - I did not really have cataracts bad enough to necessitate IOLs. I know - sheer vanity, some might say! But now I don't have to take glasses around with me which is great. I do use an old pair just for screen work or late at night when my eyes feel tired.

When I have my eyes tested I am told I have very good vision, but in such a situation I am merely seeing high contrast black letters on a bright white background. There is more to vision than this, and my main problem is strange vision in artificial light. 

If I were able to do it again, I think I would first try contact lenses again and see if I get a better outcome than previously.

Yes, I did have som astigmatism, but it seems to have been corrected somewhat, and was not that bad.

I don't know if any of this is much help to you - all I can say is that I am now used to my new vision (it's good enough even though not all the time)and no longer beat myself up for having had the procedure.

I do sympathise with your trying to decide which lenses would be best though. A very hard decision to make, with so much choice.

Let me know how you get on.

Good luck! 

11

re: "And I live in Miami Florida.  You would think they would have the latest of everything."

Unfortuantely the problem is that the FDA is overly cautious about approving new technology and keeps us a number of years behind what is available in the rest of the world in some areas such as IOLs (even ones that are made by American companies which are often the innovators, but sometimes don't even try for US approval).

None of the trifocals have been approved yet by the FDA. Trifocals have been available for a few years in Europe (there are  3 main models out  now, the AT Lisa Tri, the Finevision and the recently approved Alcon Panoptix, and I think another minor brand or two like the RevIOL might still be in the trial stage, or recently approved).  The trifocals tend to provide lower risk of halos&glare than the older high add bifocals, but I'm not sure how they compare to the new low add bifocals that were approved this year by the FDA which also tend to have lower risk of night vision issues. (the lowest add Tecnis bifocal has a study suggesting there are fewer night driving issues with that lens than with a monofocal).

I was diagnosed with a problem cataract in one eye at the atypically young age of 49 and figured since I'd be living with the lens for hopefully another few decades that I wished to get the best choice possible, and was frustrated to discover the situation. Since one eye remained good, I postponed surgery for 2.5 years   in hopes something better would be approved, but finally gave up and travelled to Europe last December for my cataract surgery to get the latest lens. I was more concerned with intermediate distance than with near vision since as a software developer (/entrepreneur) I spend lots of time on a computer.

Although I almost went with a trifocal, I instead went with the new Symfony lens (also not yet approved by the FDA, but it is in trials here now so it might be in a year or two) which provides better intermediate vision than the trifocals (one study from a few months ago says it has the best visual acuity from 46 cms outwards of the IOLs they tested) but not quite as good very near vision, but with also a lower risk of halos&glare issues (comparable to a monofocal) and less lost of contrast sensitivity (again comparable to a monofocal).   

The right lens to go with depends on your visual needs, and whether you wish to risk things like halos&glare.  The vast majority of people have good results with multifocal lenses, and even the minority that see halos usually don't consider them a problem. It is a minuscule fraction that ever get a lens exchange due to issues with multifocals, but unfortunately of course on the net its often those with problems that post to the net so you can get a skewed perspective of how many people have problems. Unfortuantely of course anyone can wind up being the "statistic" that has a problem so it is something to factor in.

The newer low add bifocals as I mentioned tend to have lower risk of halo&glare issues than the older high add bifocals, especially the Tecnis lenses which seem to have some advantages over the Alcon lenses (which seem to merely be marketed better so many doctors use them). 

There are some doctors that mix&match different add multifocals for each eye to try to give them good computer distance vision in one eye and better near vision in the other for reading. 

The Crystalens is the only accommodating lens available in the US, and has a good chance of giving better intermediate vision than a high add bifocal, but I'm not sure how it compares to the recently released low add multifocals. The reason I didn't consider it is because in some fraction of patients the lens doesn't seem to accommodate at all and is merely the same as a monofocal  (the guesses vary, I think I'd seen one surgeon recently talk about 10% or 15% perhaps). Older versions of the lens also seemed to have more of a risk of complications like z-syndrome, which the newest lens may be less prone to but I hadn't seen good statistics on that. Even among those where it does accommodate, how much near you get varies, I think I'd seen figures suggesting that perhaps half of the people need reading glasses. (though that can be made up for by using some degree of monovision).  I decided the trifocals, and the Symfony, were a better bet for decend near in addition to decent intermediate. (I have 20/25 near vision at my best distance, and have no trouble reading my smartphone or even the fine print on eye drop bottles). 

If I had to do the surgery in the US today, I'd likely have gone for the low add Tecnis bifocal out of the limited choices available here.  However the other option with the Crystalens is that if it doesn't provide enough near vision, there are now corneal inlays that may be able to provide more near. They are intended for people with presbyopia to give them better near vision, but they have been tested for people with monofocal IOLs as well, though I haven't seen a study of them being used with the Crystalens to see how well they do. The Kamra inlay was approved by the FDA this year, though I think the Raindrop (approved elsewhere, but in trials here so it may be approved) may be a better bet since it seems to reduce contrast sensitivity less. I don't know if the inlays could be combined with a multifocal lens (or the Symfony), it just seems likely they'd be an option with the Crystalens since it is a single focus lens like a monofocal, and merely is able to perhaps accommodate a bit to change focus. 

I don't know if your vision is too degraded by cataracts to do a contact lens trial, otherwise you might try multifocal contacts and perhaps monovision with single focus contacts. The optical quality won't be as high as a multifocal IOL (e.g. I suspect they reduce contrast sensitivity, low light vision, more) and the optics aren't quite the same, so even if you don't like them you might still like a multifocal IOL, but if you do like them that might give you a clue. I liked the multifocal contacts I  had (which I fortunately was wearing even before my cataract) so I wasn't concerned about risking a multifocal, or the Symfony. I have noticeably better low light vision with the Symfony than I did with multifocal contacts.

12

re: "Did you get laser or conventional knife and did you need to correct for any astigmatism. "

Unfortunately the issue of whether laser cataract surgery offers any real advantage is still a research topic. Studies so far  show for the most part the results are comparable visually, and the risk of complications is comparable but merely with different complications. Some surgeons like to get a feel for the fragility of the capsule when they cut into it to give them some clue how cautioius to be so they prefer manual surgery, but as I said the overall statisttics show them as being comparable.  They are always improving the technology though so its possible at some point it will have a proven advantage.

My surgeon could have performed laser cataract surgery, but he didn't see any advantage to doing so in my case.  His impression was that the laser was better than an inexperienced surgeon, but he had done 40,000+ manual surgeries so that wasn't an issue so I decided to trust his experience. (studies do show that practice makes a difference, on average more experienced surgeons have better results, but of course there is some variation in skill as well).  I'll note that even experienced surgeons have a learning curve with a laser, so if you go that route it is best to be sure they have done at least 100-150 or so with the laser. 

There  are some individual cases where some factor leads there to be a demonstrated advantage with laser cataract surgery, like a very ripe/mature cataract (which is rare unless you have a very rapidly developing cataract, since most people get surgery well before their cataract is that mature). If you research the topic you'll see mostly optimism about the future of laser cataract surgery, but disagreement among surgeons because the evidence doesn't yet show a benefit.

In terms of astigmatism, it depends on how much you have whether its best corrected with an incision or with a toric lens, and surgeons do disagree over where the dividing line is to switch to a lens. Since the astigmatism is due to the shape of the cornea, to me it makes sense to correct it on the cornea if possibel with an incision. However the incisions can be less predictable so there is a tradeoff.  Then again some surgeons like using laser incisions even for a fairly high degrees of astigmatism since they are having luck with that (though no studies on the issue that I have seen indicate which way is best). In my case I only had a minor bit of astigmatism so I didn't bother with a toric lens. 

In terms of your concern earlier on this page about anesthesia, they very rarely go with general anesthesia for a surgery like this. They just gave me a mild sedative and a local anesthetic. I felt no pain at all, just a minor annoyance when they rinsed the eye occasionally which wasn't painful. It was far less of an ordeal than even a minor dental filling in my experience. They are used to whatever normal movements someone might accidentally make so that isn't an issue. I admit that in my case since I traveled beforehand I was also out of it from being jet lagged and sleep deprived so perhaps I was able to zone out easier and relax. 

 

13

re: " that if I wait too long, the longer I wait the harder the cataract will become and if it becomes too hard and/or brittle, it could make the procedure more difficult and hence more risky"

The guidelines vary, but I think I'd commonly seen concerns start to be raised if the visual acuity is worse than a best corrected 20/100 in the eye since then they start having trouble seeing in to check out the rest of the eye before surgery. The odds are your vision isn't yet that bad.  It has to get even worse than that however for it to be hard enough to impact the surgery itself, though I don't think I've seen what visual acuity might go along with that.  As I mentioned in another post, if the cataract is very mature and hard, then there are apparently advantages to laser surgery, I know someone who had a very rapidly developing cataract that became hard within a few months (very rare) who decided on the laser surgery for that reason. 

 

14

You "beat yourself up" orioginally because you had "strange" vision in arftificial light?  Do you have a better description of what you mean by "strange"?  If you didn't need cateracts removed, why didn't you just do LASIK? But I guess u had reasons for making your choice.  

I am glad you are happy with your vision now. I would love to get multifocus but I heard that you see significant halos and starbursts. I don't think that would bother me all that much.  What concerns me is that I read that distance is fairly good but not great, intermediate is not very good at all and near is excellent.  More important I understand that multifocals split the light coming into your eye so you only getr 75% of the ligtht that everyone else sees.  I would love to know if you notice this.  It seems to me that everything would always seem a little dim compared to what everyone else is seeing.  That's why the night vision is not so great, from what I hear on multi focals.  Still good enough not to wear glasses which is great.

I don't really mind wearing glasses and want the best vision possible at all distances, even if that is with glasses.  I wont get that with multifocals because you cannot correct for contrast.  

So I am considering accomodating lenses.  One doctor wants to totally paralyze my eye because she is afraid i might move during surgery since I am so squeamish about anything touching my eye.  She say I won't be able see for a few hours.  That's not what everyone else gets and that really freaks me out.  Considering using a different doctor for that reason alone.  

As for laser vs scalpel. actually I was told that the scapel makes a smoother incision, but the laser is more precise.  Maybe you heal faster.  Did you?  Or no difference at all? Was there any pain during surgery, after surgery?  Did you see anything during surgery?  

The amount of choices is dizzying.   I would put the whole thing off but they tell me that the longer you wait, the harder and more brittle it might become which could cause problems during surgery.  One doctor told me to wait and 3 others told me to do it now. every doctore has a different opinion.   unbelivable.  thanks for you help.  I really appreciate it. 

15

yeah I heard that the laser surgery softens it.  I think I am around 20/60 in my left eye (my dominant eye) I think the right eye is 20/40.  I was told i need cateract surgery if it is worse than 20 50.  youare telling me 20 100?  wow.  where did you hear that?   I had one doctor tell me I didn't need it yet and 3 other doctors told me I did.  I had one doctor who wants to do the surgery on my right eye first (the better eye) for the onyl reason being that it is the non dominant eye. The other two doctors say to operate on the worst eye first.  Every doctor has a different opinion.  unbelievable.    thanks

16

When you need cataract surgery is up to you, when it impacts your vision enough for you to decide it is worth the risk/hassle/time/money. Some people may prefer to get it when their best corrected vision is down to 20/30, though at that level it likely isn't covered by insurance. Usually in the US at least it is covered if best corrected vision is 20/40 or worse. I wasn't saying that you need to wait until it is 20/100, I was saying that  I'd read it is best to get the surgery before it is much worse than 20/100, that when its worse than that they have a hard time seeing the rest of your eye to make sure it is ok before surgery. (since if the lens is clouded that effects them seeing in, just like it effects you seeing out). It'd need to be worse than 20/100 before the cataract is actually hard enough to benefit from using a laser, though I don't know what a typical value would be. Few people in modern countries wait until their cataract is that bad, unless it developed incredibly rapidly as it did for someone I heard from where it only took a matter of weeks before it was mature.

In my case I only had a problem cataract in one eye,  my good eye remained 20/20 correctible up until surgery on the bad one. Since I could see well enough it wasn't a concern to rush. I actually didn't the problem eye done until it was about 20/100, but that wasn't enough to cause any issues with the surgery and there was no benefit to using the laser.

17

Also, in terms of the laser, as I just posted on another page here, there is a good ebook that gives an overview of cataract surgery, including issues like whether to get laser cataract surgery.  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

The surgeon author of that  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. I don't think anything has really changed since that ebook came out based on what I'd read. As I mentioned above, I didn't choose to get laser cataract surgery.

 

18

re: "She say I won't be able see for a few hours.  That's not what everyone else gets and that really freaks me out. "

That shouldn't be a problem since you can see with your other eye. As far as I know, standard practice these days is to put an eye patch over the eye after the operation and remove it the next day, which is what they did with my surgery. You will be sedated from the surgery so you shouldn't be driving yourself after the surgery so seeing through only one eye shouldn't be a big deal for the rest of the day. I have heard of some people who didn't need to keep an eye patch on overnight, but I don't think that is typical. 

I haven't heard of a surgeon paralyzing an eye during the surgery  because the patient is squeamish, but it makes sense. If they do it, it  shouldn't be a big deal since as I said most people don't use that eye the rest of the day anyway.

As I mentioned above, this year the FDA approved  new low add bifocals from Tecnis and Restor which give better intermediate vision than the high add bifocals of the past, with the tradefoff being near vision isn't quite as good as with a high add bifocal.  Some doctors chose to mix and match different adds in each eye to try to give you a mix of intermediate and near vision, depending on your needs. 

I had multifocal contact lenses and although they split the light also (likely less efficiently as an IOL) and reduce low light vision, I never found that to be a problem.  Each person's reaction will vary however, which is why doctors really should have people try multifocal contacts, and monovision contacts, before they get a problematic cataract which makes such testing more difficult.

re: "If you didn't need cateracts removed, why didn't you just do LASIK? "

Since I'm responding to something else in your post, I'll note that standard some  people who are presbyopic these days (moreso outside the US) choose to get clear lens replacement surgery (i.e. the same surgery as for a cataract, without the cataract) in hopes of getting better near&intermediate vision with a premium IOL. 

Standard LASIK only corrects the distance focal point, it doesn't correct for presbyopia. There are some methods to use LASIK to create a multifocal pattern on the cornea, but many people think replacing the lens is a better option. It is easier to exchange a lens if it doesn't work well than it is to deal with a multifocal pattern lasered onto your cornea if you decide you don't like it. There are   also corneal inlays as I mentioned above that some consider a better option to correct for presbyopia, rather than replacing the natural lens. The advantages of replacing the natural lens is that you'll never need to get cataract surgery, and  that even in people without cataracts, the natural lens of someone in past their 40s has still usually deteriorated with age and isn't as transparent as a young natural lens, or an IOL. 

19

You know I would LOVE to get multi focal, but I have heard so many bad things.  The main things being that it splits the light (does that mean that to a person with multi focal lenses, you are seeing the environment that a person with normal vision slightly dimmer?  Probably wouldn't notice it because you cannot put yourself into that "other" person to see what they are seeing to compare but that thought woudl bother me.  Also bad contrast and night vision.  What I want is the best vision possible at all distances WITH glasses, and I am told that, with multi focals, you will never see as good WITH glasses, as you would with the monofocals WITH glasses since you cannot correct for lack of contrast.  If I get multi focals and see OK at all distances I would rather wear glasses and see perfect at all distances.  Have you heard anything about the accomodating IOL's which are supposed to give you both distance and intermediate?  I have been near sighted all my life and cannot imagine not being able to see anything close like my cell phone.  I would get mono focal for near or intermediate except that no one does that as I understand and everyone gets distance.,  I wonder why. 

What I meant by not being able to see is that the thought of having my eye open and not being able to see is a little scary. It's like I hope the anestheia wears off.  Well it always does when u see the dentist.  

20

I did not/could not have laser surgery as it is apparently noit appropriate when you are over 50 (I am in my 60s). I had a few years ago gone for a consultation but was told that they would only be able to 'take my eyes back about 5 years' and that my eyes would continue to age as most people's eyes normally do.

Regarding receiving less light, my eyes are very light-sensitive and I have to wear sunglasses more frequently than most people - even when driving on a winter's day. So I am not aware at all of less light getting in, or being split up by the lens.

I have just looked out of my window and can see the tiles on a fairly distant neighbouring roof, the leaves on the trees, and individual bricks of the house across the road. Not too bad, I think.

It is now about 18 months since my eyes were done. In the months afterwards I made notes on how things felt/looked with my new lenses, which were on the whole not at all what I had hoped for - blurry, inconsistent vision, poor low-light vision, starbursts and haloes - I summarised it by saying that my vision felt as though I had someone else's glasses on and things just didn't look 'right.'

It's been interesting going back over this diary as  I now realise how much better things are now. I guess I have got used to it, or things really have improved albeit very slowly, but I am now OK with it all. The only thing that disturbs me are the haloes and starbursts at night, and when driving I choose the route that would have the least traffic. 

You are at a very difficult point in your life, having to choose between so many types of len, and so many doctors' recommendations - all very alarming and distressing. 

With regard to the actual procedure - the worst part was the time leading up to the event, but when it happened it was entirely painless and easy. And no, you don't see a knofe coming towards you - you are barely aware of anything coming towards you - only the surgeons head! Of course your eye will be anaesthetised - you wouldn't want to feel anything, would you? But it will be covered over till the next day with padding and an eye shield, by which time it will have recovered. There was really hardly anything to it when it was actually happening, and many many people say the same thing.

I do wish you well with your decision, and look forward to hearing about it.