Hi, I was short sighted since young, but underwent lasik some 15 years ago. So now I have vision for all 3 regions. I can read newspapers and computer without any problems. But nowadays I could not read the very very very very tiny fonts on food packaging, meaning mild presbyopic. . I don’t want mono-vision. Reason : un-natural . I don’t want multi-focal or tri-focal. Reason : concentric circles causes 8-10% loss of light transmission resulting in loss of contrast . I don’t want Supracor. Reason : Supracor might align light transmission nicely for this moment but if my natural lens becomes cloudy a few years later and I need to do cateract, the alignment will be messed up, and I need to do some rectifications after cateract surgery, meaning the money I spent on Supracor goes down the drain. - Question 1) If I implant aspheric mono-focal lens AND set it for near vision, does it mean that I will lose my intermediate and far vision? Presently I can see all 3 clearly. - Question 2) If I implant aspheric mono-focal lens AND set it for near vision, does it mean that my mild presbyopic will be eliminated and I can read the very tiny fonts without glasses? - Question 3) If I implant aspheric mono-focal lens AND set it for near vision, AND if I indeed lose my intermediate and far vision, is it possible to do a Lasik to recover back these losses so that I can have perfect vision for all 3 regions again? - I am having so many constraints mentioned above but I am trying to find a way out that addresses each constraint adequately and leaving no constraints neglected. Sorry for posing such a difficult scenario. Hope you can find a way out for me. Thanks!
Everyone’s results will vary as there are so many factors.
I would suggest you look at the defocus curve for the monofocal you plan to get. In general a monofocal will give you great vision if set to Plano. But you should get good vision down to 3 feet or so. Again everyone results will vary.
It is unusual to want close vision over distance, but you can shift that defocus curve to get an idea of Vision Acuity. So if instead of shooting for Plano you could shoot for -2 D and see what your close vision acuity would be. I personally would not recommend this as the more myopic you go the greater risk of unwanted side effects. There is a tradeoff to all IOL choices.
Also the doctor might not hit the target, so you might think about an LAL, especially being you are talking about changing your power later to get more distance; hyperopic .
My suggestion is look at a lens like Vivity or if you really don’t want to lose any Contrast then Enyhance and at least consider micro monovision to gain more intermediate and close vision. The Vivity alone will probably add a line and with micro monovision .5 D to .75 D you will gain another line or more.
It sounds like your only vision issue is not being able to read very small print. I would suggest the best solution is simply reading glasses. Or you may want to get progressive prescription glasses instead as they can fix overall vision issues and any astigmatism as well. I frankly would avoid an IOL solution until you develop a cataract and it becomes necessary.
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The basic issue with implanting a monofocal IOL is that you lose any accommodation that you have. You do not mention your age, but that part of our vision is what we lose when we get older. Your eye loses the ability to change the shape of the natural lens so you can focus close. It sounds like you are starting to lose that ability. However, when you implant a plastic IOL, you lose it all. There is no ability for the eye to change the shape of that lens. There are some IOLs that have attempted to use accommodation but they have largely been unsuccessful. Perhaps in the future sometime.
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One thing to keep in mind is that Lasik surgery complicates any IOL surgery. When IOL surgery is done one of the most important things that the surgeon has to do is measure the shape of your cornea to determine what power and potential astigmatism correction you need. Your overall vision measured by an optometrist is irrelevant as the natural lens is being removed. If they get the power wrong, you end up with bad vision, and it is not all that easy to exchange IOLs. The other issue is that if a lens that correct for all distances is used those with previous Lasik are more likely to have side effects such as halos, flare, and spiderwebs especially at night. Some will not use certain multifocal lenses if there is previous Lasik. Looking down the road to when you may need an IOL due to a cataract, I would avoid any further Lasik.
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Back to your questions. When a monofocal lens is implanted it will give you the best vision for the distance it was selected for. Most choose a distance vision. I have that option. I can see better than 20/20 at distance and very good down to about 18 inches. Under that reading becomes difficult especially in dimmer light. Essentially it is the vision of an older person that needs reading glasses. If you select a lens power for closer up, then you will not see clearly at distance and will need glasses for distance. And unless you get into monovision it is basically that simple. Have you actually tried monovision by using contacts? If you have good distance vision in both eyes the way to test it is to get a contact with a +1.25 to +1.50 power and use it in your non dominant eye. This may give you the reading ability you need without interfering with your distance vision.
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Hope that helps some. I think the best advice I can give you is to not get into IOL lenses until you actually need them because of a cataract. And, also avoid any further Lasik as it will further complicate any needed cataract surgery down the road.
The answer to question 3 is no. LASIK is not a treatment for presbyopia. If you ask about it they will offer you monovision via LASIK or a refractive lens exchange (i.e. implant multifocal IOLs into someone that does not have cataracts). But you can just do either of those with IOLs.
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The best anyone can offer you with a monofocal is one distance of your choosing. Your mileage may vary but that’s the best anyone can promise. As rwbil said you may want to look into Vivity. There is a warning about contrast loss and night driving but so far surgeons mostly seems to be reporting very happy patients. Of course if you search the internet you will find some unhappy patients but there’s likely a strong online bias towards that (i.e. people with a good outcome are not posting about it online… they’re just out living their life)
Ron makes an excellent point. You don’t actually mention having cataracts. If you do not have cataracts I would absolutely not even consider surgery of any kind. Just get some readers.
Thanks so much for your reply. Your info is very technical and I need some time to digest. Sorry I am a non-optometrist layman struggling with all these jargons.
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Could I ask you very critical questions on your first paragraph?
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If I understand correctly, set to Plano (set to zero) means no correction at all. Base on all the literature available for standard monofocal lens, they always mention about setting it for distance vision and then using glasses for near and interm. They did not mention about setting to zero like what you described.
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Critical questions :
1)Is it technically possible to set to Plano on standard monofocal lens?
2)If set to Plano, whatever focus that I have before lens exchange remains exactly the same after lens exchange. The difference is I have a more transparent synthetic lens resulting in enhanced contrast. Is this correct?
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If your answers to these 2 questions is yes, it would be wonderful and life will be very much simpler for me.
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That means I can do like what you said (standard lens exchange set to plano), and then go for Supraco after that. That means I am spectacle free but traded off nothing by losing no focus, losing no contrast, and also much reduced halo/glare. But I will burn a hole in pocket due to Supraco.
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If the above is possible, I won’t need all these Eyhance, vivity or symphonie. All these premium lenses involves trade offs
Sorry, I admit I am being very picky and difficult by being unwilling to accept any trade-offs. I was very myopic since age 7 and when I did Lasik 15 years ago, my world suddenly becomes so beautiful and no words can describe the happiness I experienced back then. I cherished this gift of sight so much that I am going to do everything possible to maintain and secure this gift. I would want my world to continue to be this beautiful and won’t want to compromise a single bit of contrast loss. Now I am depressed over my loss of ability to read tiny fonts and trying to addrss it. Hope you understand my feelings
OMG!!!
I just assumed you had cataracts until I read Ron’s reply.
***** Forget everything I said *****
ABSOLUTELY DO NOT GET CLEAR LENS REFRACTIVE SURGERY. ANY OPTHAMALOGIST THAT DOES THAT SHOULD BE DIS-BARRED IMHO!!!
Sorry, but I will provide NO Advice to anyone getting Clear Lens Exchange as I think it is the biggest mistake possible. BTW I have MF after cataract surgery, so I have a clue about what I am talking about including getting floaters after surgery. Again Do Not Do It!!!
No man made lens will compare to the natural lens and they all come with tradeoffs and risk of surgery.
Learn to live with Reading Glasses!!!
Thanks so much Ron for your kind reply.
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I agree my problem can be easily solved by reading glasses or progressive. But I am trying to find a better way out. Nothing beats having perfect vision. I don’t know how to describe to you how blessed I feel when I attained perfect vision with Lasik.
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It is for this reason that I am contemplating lens exchange even though my vision is still very clear. I can live without cateract operation. But I got excited when I learnt about aspherical lens. If I understood it correctly, aspherical monofocal lens can add more contrast to what I am having now as it can correct distortion caused by curvature of natural cornea resulting in more light transmission to retina, thereby enhancing contrast further.
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Question : Will this loss of accommodation cause visual problems if I set the monofocal lens to plano?
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You could have misunderstood the sequence of the action plan I described. I contemplate Lasik only AFTER IOL insertion to correct any loss of focus as a result of monofocal lens.
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They keep talking about using reading glasses after monofocal lens insertion. I could not understand why is it technically not possible to do Lasik after cateract in order to attain vision for all 3 without compromising on contrast.
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I dislike the idea of monovision as I feel that it is imperfect solution. Each eye cannot survive without the other. If we are unfortunate to lose sight of one eye when we become very old, eg. 100 years old, the other eye will give imperfect vision.
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When you attained perfect vision, the happiness that comes with it will make you not want to lose a single bit of it. Hope you understand. Cheers!
Hi David,
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Yeah Lasik is not for presbyopia. They used to have something called PresbyLasik but it seems outdated. Now the latest technology is Supracor.
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Monovision via Lasik is a horrible idea to me.
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Vivity is so new and I only knew when RWBIL mention it.
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Base on what I know, all of these multifocals involve loss of light transmission due to the concentric circles. 8% loss for Symphony and 12% loss for Panoptix. Not sure if vivity has such loss.
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Correct me if I am wrong. Multifocals, trifocals, bifocals will not beat Monofocals in terms of contrast because of the circles.
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Those people who do not complain about loss of contrast, I suspect they might have severe clouding of their natural lens and might have already lost perhaps 20% of light transmission before lens exchange. So if they implant say Panoptix with inherent 12% loss, the net result is that they gain 8%. This could probably explain why they are happy patients. But at the end of the day, they still lose 12% due to Panoptix as compared to what they have when they are in their teenage years. Again, please correct me if I am wrong.
Do you have cataracts or the beginnings of presbyopia? Personally I do not think you will get much support for clear lens exchange (basically cataract surgery) here on the forums. You stated you are particular - that has it’s own concerns when it cones to lens selection and all lenses have a trade-off. If reading fine print your only concern glasses would be your best option. Perhaps there will be a perfect lens when you need this surgery for cataracts.
Don’t mean to put you off but read through a few of the threads and you’ll see there are worse outcomes than having to wear glasses.
You asked about plano in another reply above. We’re talking about targetting plano as the end result of the surgery not implanting a lens that keeps your prescription the same. So the goal is to use an IOL that give you uncorrected distance vision (20/20 aka plano).
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Supracor sounds crazy. I looked into it and it looks like they are basically burning a Vivity style profile right into the cornea?! Wow. Personally I think I would not do any kind of LASIK. It’s ok when you’re young for distance correction but when you get cataracts (and you will… everyone does eventually) it will make it more difficult to get a good result.
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Also if you do not have cataracts I would strongly recommend you do not do elective surgery to remove your otherwise fine (but presbyopic) lenses you were born with. Get some readers. Growing older sucks but what can you do. Doing unnecessary surgery seems ill-advised to me. Plus in 5-10 years we may very likely have an implant that perfectly mimics the human eye and has no compromises. I’d wait for that personally.
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Yes any IOL that doesn’t just focus all of the incoming light to a single point of focus will have contrast loss. It just makes sense. Silly analogy but imagine you have a 9" birthday cake and you want to make it go further. You cannot add any more cake. Your entire “budget” is just this one cake (the “cake” is the amount of light entering your eye). Your choices are to cut it into thinner slices (like a multifocal) or squash it flat to spread it out thinner (like an EDOF / Symphony / Vivity). Either way, no one focus point is getting the entire “cake” (and eating it too, LOL).
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Vivity actually has more peak contrast loss than today’s best multifocals.
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p.s. The other thing we may have in a few years is simple eye drops for presbyopia. The technology is not great today for fixing presbyopia but it’s progressing very rapidly. I would WAIT. Just deal with readers until better technology is commercialized.
An aspherical lens is a good idea for some people, but not any kind of miracle. In a younger person the aspheric error in the cornea is offset by the opposite error in the natural lens. When the natural lens is replaced with a spherical lens when you are older there is a residual aspheric error. An aspheric lens corrects this. Some do it more, and some do it less. This improves the sharpness of the vision at one distance only because the artificial lens has no accommodation. The spherical lens on the other hand provides focus over a wider range. The image is not as sharp but for example you may be able to read closer with it.
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But in short it is not a solution for what you are trying to do.
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Question : Will this loss of accommodation cause visual problems if I set the monofocal lens to plano?
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It doesn’t matter what distance you set it to, you will have NO accommodation with a IOL even if it is aspherical. If anything a spherical lens will have more apparent accommodation, but it is not much. That ability is lost when the natural lens is removed. That is why it is a mistake to replace a natural lens with an artificial one unless you really have to.
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I would not dismiss monovision until you actually try it. The brain is quite smart at deciding which image to use based on the quality of it. I have an IOL for distance in one eye and a contact in the other eye to give me monovision. I can type this on my computer and see it very well and look up across the room at the TV and see that very well. I am obviously switching from seeing with one eye to the other, but the brain looks after that without thinking about it. I have progressives and reading glasses but 99% of the time I am eyeglass free with my simulated monovision. The advantage of trying monovision with contacts is that it is so easy to change the power of the contacts to find what you like. Changing IOL lenses is very difficult and needs to be avoided if at all possible.
thanks very much Sue for your reply. Except for the loss of ability to read tiny prints, I don’t experience any blurred vision, so i guess i don’t have cateract, or very mild at worst.
Reading glasses and progressives… very depressing. I had thought the synthetic materials are way superior to natural ones, so it makes sense for an exchange, didn’t expect so much objections and also didn’t know that there is such thing as “accomodation”. Let me sort out my thoughts. I am inundated with too much info. Cheers!
Thanks Ron for your kind enlightenment. The info you provided is quite disturbing.
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If I have to keep the natural lens, I still have the option of correction at cornea either through PresbyLasik, Supracor or common Lasik monovision. It solves the problem very perfectly for time being with everything properly aligned, but once my lens becomes cloudy, I am sure the alignments will be messed up with the lens exchange, and I will end up with unpredictable imperfections. I am 40+ and I am not sure how long more my lens will stay clean.
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There is also such a thing called inlays which is very uncommon and there is a question of whether the inlay can last forever just like the IOLs.
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Cheers!
Yes, supracor is correction at corneal level. It burns to reshape cornea just like lasik.
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That is the main trouble with Supracor. When the time comes for cateract lens exchange, the perfect alignment will go haywire, and I will end up with unpredictable imperfections.
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5-10 years we may very likely have an implant that perfectly mimics the human eye and has no compromises. But if my lens are still clean, I don’t benefit because I am not allowed to implant…….
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Yeah I read about the eye drops. It’s for presbyopia. They didn’t mention whether it is temporary or permanent correction. But I believe it is temporary. Does not seem possible for an eye drop to produce a magical permanent correction.
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ohhhh… life is so difficult… I am so disheartened… I hope one day they can do some gene therapy so that we never grow old and never have cateract…
Thanks rwbil for your thoughtfulness. I am disheartened. Life sucks. Cheers and have a nice day!
Keep in mind that these light level differences in lenses are not something you see until you get into dimmer light and your pupil is wide open. Like a camera in auto exposure mode your eye compensates for reduced light by opening wider.
I would really encourage you to read up and research before going ahead with clear lens exchange. Very expensive and chances are you will end up with glasses for at least one distance anyways. No surgeon (a good one) will promise glasses free. The lenses that provide more range of vision (often called premium lenses - trifocals or EDOF - extended depth of focus come with a compromise of less contrast and night vision issues like halos glare and concentric circles . Not saying they do not serve a purpose - I myself have Symfony lenses EDOF. but i do have some glare and see huge concentric circles around lights at nifht (ie red traffic street lights). But my cataracts were bad enough at 53 that I could no longer get a good enough correction with glasses (ie could not read license plate on car in front of me at a stop light. I had to have the surgery or lose my driver’s lic. Most people of cataract age cannot recall good vision so these IOLs provide something list long ago. Younger you are there are more compromises to make. Make no mistake this is a very profitable business and often these IOLs are over sold and people aren’t told much about the trade-offs. Many countries pay for this surgery for cataracts. I live in Canada so my surgery was covered. I paid for the difference between standard monofocal and Symfony ($900 a lens) If I did this for any other reason the expense would gave been easily $5,000.
Take your time before deciding to do this. It cannot be undone.
Yeah I am reading up and researching. Hopefully something can be invented in near future without any trade-off.
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If you could not read license plates, that means your cateract would have caused you to lose quite a significant amount of light transmission such that you experience a net gain of light transmission after installing Sympony.
By the way, can you read the very tiny fonts on drinks cans or biscuits packaging? How about reading newspapers? Or mobile phones> It is known fact that Sympony gives not so good near vision.