Hey folks, It has been super helpful reading many of your discussions, I only wish I had read some prior to my second cataract removal. For anyone willing to listen my story and offer any feedback at all, THANK YOU and please buckle in for a novel: I’m in my very early 30’s, just one of the lucky ones with congenital cataracts. First, non-dominant eye operated on 13 months ago. Second, dominant eye operated on 3 1/2 months ago. Going into both surgeries, I had no idea what accommodation was, or even the concept of presbyopia. My surgeon told me he was going to “leave me near sighted” because for my age, that would be what I was used to, and I was already accustomed to wearing my -1.25 myopic glasses prescription for driving/distance. First surgery, fantastic, I now see textures and color that I didn’t even know I was missing. I wanted the same result for my second eye, which wasn’t nearly as advanced a cataract as my first, and was really livable, but insurance covered it, so I did it. The day after my second surgery I was CRUSHED. I had lost my remaining accommodation that I didn’t understand I still had, and I became fully presbyopic in an instant. I cannot believe that I had no idea this would be the result, I was so ignorant, and so so regretful. Fast forward almost 4 months to today, and I’m making peace with it. The way I see it, my cataract was progressive, I maybe had a couple years at best, and I’m making the hard adjustment now to losing my near vision, and in 10 or 15 years when my peers are griping and moaning about it, it’ll be old news to me. Because I had no idea what accommodation was, I also had no idea why my surgeons office was having me watch a PanOptix promo video and check the box stating I was offered it, I was thinking “y’all want SIX THOUSAND DOLLARS so I don’t have to wear my distance glasses! HA!!”. But of course I now know there’s much more to it than that. If you’re still reading, thank you. So I now have my fixed monofocal vision with what I feel is a fairly constrained sweet spot of 18”-20”. Around the house, I’m fine without glasses, still a -1.25 prescription for distance. I tried progressive glasses, couldn’t do it. Tried several brands of multifocal contacts, they’re all pretty terrible. I’ve settled on lined bifocals for now just so I can read my phone without taking of my glasses. As a craftsman and an artist, not being able to see closer than 18” was a huge(and frankly, really emotional) loss for me, but I accept it as my uncorrected near vision now. The most normal I have felt to date is recently when I started wearing a distance contact in my dominant eye, and seeing with monovision. The pseudo-accommodation it gives me was such a joy at first, but the glee was short-lived when I started noticing the huge gap in intermediate vision. But I’m contemplating a solution, and I want to get it right, because I have an opportunity. My surgeon is willing to discuss exchanging the IOL in my dominant eye, as it’s still relatively new, and he knows how disheartened I am with my outcome. A week ago I was super excited about exchanging for Vivity EDOF for my dominant eye. My thought was, if all went well, I’d still have binocular near vision at around 18”, with the huge perk of full time monovision WITH the intermediate I’m sorely missing(car dash, GPS/media display, grocery shopping without leaning in to read, etc), and I’d simply get glasses to correct my near eye if I wanted binocular distance clarity for night driving, or going to the movies. Sadly, my “Vivity is perfect for me” bubble burst when I discovered the nighttime contrast loss. God willing, I have decades of night time driving ahead of me, and I dont want to be guessing at what’s a deer and what’s a shadow. So unless someone can tell me otherwise, Vivity is out for me. I’d rather deal with halos, because I see them as a nuisance, not a safety issue like nighttime contrast on a dark highway. Sidenote: I’m fortunate that I have no driving halos currently, but I did for a couple days post-op, so I understand the concept. Which brings me to Symfony Plus. I have yet to find any actually patient reviews who had a newer Plus lens put in, but if it’s even a little better than the original Symfony, I’m hopeful it would reach back to 18” for me and let me keep my binocular “near” vision, while giving me intermediate and distance for my monovision. I don’t want to consider PanOptix for the same reason as Vivity, I don’t want to lose any more contrast than I have to. I wish Synergy were in the US to consider, but who knows when that’ll be. Lastly, I’m considering the conservative “safe bet” to avoid halos, with is Tecnis Eyehance to give me distance and some intermediate, to pair with my 18” non-dominant eye. The downside, I lose my binocular near vision, I’m simply trading it for monovision. However, I gain the intermediate vision I’m currently missing, and probably 90% spectacle independence, so that’s something. All of this is to say that the IOL exchange goes perfectly. I understand there’s a risk, but I’m pre-YAG(in both eyes), so I’m hoping it’ll be a smooth operation. At the end of the day, I just don’t think I’m prepared to live out the rest of my years with my current, unaccomidating vision, I want more. I know I can’t have it all, but I just want more. I have an appointment for pre-op measurements in a couple weeks, and I want to be prepared to make a lens choice. If you’re still reading, thanks for commiserating with me, and please drop a comment is you have any thoughts, Justin
What is a brand of your curent IOL?
Tecnis
Tecnis Monofocal ZCB00? Do you have perfect vision (no night visual disturbances - dysphotopsia)?
Yes I believe that would be the model. I have no real halos while driving, it would have to be a tiny single point of light on a pitch black road for me to get a small halo currently.
No starburst or glare?
Nope, but I’m also wearing glasses when I drive at night, so perhaps the anti-reflective coating on them is helping me out there.
It has nothing to do with that.
If that’s the case, I’d never ever consider an IOL exchange. You’re very lucky to be dysphotopsia-free.
I have the very same lens and am suffering a lot. I’m also around 30.
If you really can’t stand mulifocal glasses, I think you should consider add-on lenses (piggyback), such as Rayner Sulcoflex.
Did you have surgery in both eyes? I’m sorry to hear you’re having issues, I know many people choose monofocals to be “safe” from those, so I’m sure thats dissapointing. I do a lot of woodwork/carpentry and when I noticed progressive glasses caused me to see straight lines as curved, I immediately gave up on them. I havent researched or considered a piggyback IOL, but I will look into the one you mentioned. I can say though I dont like the idea of adding “more parts” to my eye, a single IOL seems like a more stable longterm solution, but I’ll definitely research it. Thanks for your input!
I can relate somewhat to your situation. I have had an AcrySof IQ monofocal in one eye (non dominant) set for distance plano. My eyeglass prescription for it is now 0.0 D spherical and -0.75 cylinder. I can quite easily see 20/20 with it and about half the next line. Where I don’t relate so much is that with this IOL eye I can quite easily see my car dash instruments, and even read text on my computer screen at arms length, but not well when I get closer. I am a little puzzled that you cannot see something similar when your correct one eye for distance with a contact??
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My other eye has a cataract but not bad enough to operate yet. It also has some more significant astigmatism. But, at least approximately I correct it to leave me about -1.25 D myopic like you say you are with your IOL. With this eye I can easily read my computer screen unless looking at a PDF with really small print, and most paper documents. Very small print on OTC medication ingredients etc are an issue though. With this combination of distance plano and -1.25 in the other eye, I am eyeglass free 99% of the time. I have progressives, and they certainly give me crisper vision, but I prefer the monovision with no glasses. I also have some reading glasses I use very occasionally but never bother to take them with me. I drive day and night without glasses. I recently did a woodworking project where I needed to measure and cut to the 1/32", and this was not possible. I had to resort to the reading glasses, or progressives for that.
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The other part that does not seem to relate is you report a hole in your vision at an intermediate distance. What distance would that be? I can’t say I have any hole with my simulated monovision arrangement.
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I think one option with your priority on night driving would be to go to distance plano with your distance eye using a monofocal. However, that would seem to leave you short on reading, and what you describe as an intermediate hole.
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On using progressives, I have used them for years. There are differences in the quality of them. Some is just getting used to them and not looking down at your feet when going down stairs. The other is that some have much wider close and intermediate vision view. I have had good success with the Costco Freedom Accolade HD ones. Still I prefer my eyeglass free monovision.
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On considering EDOF and MF options for an IOL be aware that they all have some issues that some can tolerate and others cannot. You need to be wary of jumping from the frying pan into the fire…
Hi Justin. I had a good outcome with Symfony 3 years ago. I have seen they’ve a newer one now.
My first thought as I was reading your review was it is too bad the surgeon did not go with best corrected distance in one eye. Then I’d suggest under correcting the exchanged eye with Symfony plus (under correction of -.5 D). That set uo someone on the forums had (regular symfony prior to new one). The monofocal corrected for best distance will take over so you’d not see the halos/concentric circles. Ideally you’d wznt the dominant eye to have the monofocal corrected to best distance and I understand it is the dominant eye you ate considering Symfony for.
I am probably going contrary to what many would advise. Likely if you did the exchange and Symfony would take i er distance and mid vision you’d most likely see some are and concentric circles at night. I do not drive for a living so if you do that might not be something you’d want. I do drive at night and living in New Brunswick Canada we get deer and moose - able yo see them fine. If one darts in front - hard to avoid good or bad vision lol.
I do wish you the best and if you are unhappy with your current result and feel it affects your bring able to function this is the time to do the exchange.
Word of caution - dies your surgeon do many exchanges? These require a more skilled surgeon and I would let s regular cataract surgeon do the exchange. You’ll want one who does these regularly.
RONAKA / perhaps I misunderstood but think Jason’s surgeon had both monofocsls set to be nearsighted and to correct that he is wearing a contact lens in one eye to see distance. That may be too much monovision? It would definitely leave a gap mid.
Hey RonAKA,
Thanks so much for your reply. I speculate that maybe my “intermediate gap” is exaggerated because my distance contact is overcorrected. My prescription is -1.25, but my contact is bumped up to a -1.50 to offset my -0.50 cylinder astigmatism. I think it does a good job at clearing up the astigmatism, but maybe its making my monovision transition greater than it needs to be. That is a big part of why the idea of Tecnis Eyhance appeals to me. Because I would hopefully end up with good distance, and have some intermediate, and then from that intermediate point my brain’s transition from the intermediate to my near eye should be more seamless. As I mentioned though, I’d be a bit disappointed to lose my binocular near vision. I hate to say it, but I’m young enough to have caught the tail end of the Instagram generation, and I also use my iPhone all day for work, so I’d miss having my phone in binocular focus at 18".
As far as the intermediate gap, I can read my navigation display in my truck when seated, its just out of focus, and I wish it weren’t. It’s silly, but I had the chance to drive a really nice Porsche last week, and what should have been a really fun experience was kinda disappointing, because I couldn’t appreciate the details of the interior or instrumentation, and it was just another reminder of the accommodation that I’ve now lost.
I just need to keep reminding myself that I can’t have it all, and make the choice that will make me 80% happy. I think having fulltime, IOL monovision has a value in the sense that I would always have functional vision at all ranges, at all times. Not perfect vision, but at the drop of a hat a can run out the door and have vision without needing glasses or a contact, and as a man hoping to raise children soon, that idea appeals to me. Anyhow, I’m rambling again, thanks again for the thoughtful reply!
Sue.An, I was thinking about the situation when BuilderJ was using a contact to correct distance vision in the dominant eye. If I was understanding it properly the dominant eye should be plano with the non dominant eye under corrected to be -1.25 D myopic. That is essentially what I have. Anisometropia of 1.25 D is moderate and usually called mini-monovision. I tried a contact that gave me 1.5 D anisometropia and I found that it did leave me a bit of a gap that extended into my computer screen range. Each person is going to be a little different though.
Hi Sue!
I’ve read many of your comments about your Symfony experience so I’m excited to have a reply from you. I totally agree with you, it would have been ideal to have a monofocal for the dominant eye, and then the EDOF in the non-dominant. As I mentioned, I was SO clueless when I had the surgeries done, and truly did not understand accommodation. Initially I was angry, wondering how my surgeon, who knew I had not experienced Presbyopia, did not better prepare me for this experience, but with time I have accepted that I should have done my own research about cataract surgery. I still say though to any younger person, you cant fully understand accommodation until you lose it. I don’t know that I will be able to have my older IOL replaced, #1 i have very faint beginnings of PCO in that eye, and #2 I dont know that I can afford a second premium IOL, so I want to get the most function I can with my dominant eye, and then correct the other occasionally with glasses.
Thats part of the appeal of Eyhance, strong (basically monofocal quality) distance vision and some of the intermediate I’m currently missing. Symfony Plus however, though it will come with some halos, would also hopefully let me keep my binocular near.
How close can you read sharply with your dominant Symfony eye?
Thanks so much!
Also Sue, regarding the my surgeon’s experience, I definitely have that question written down for my pre-op appointment. He is a really nice guy, and clearly performed two successful procedures on me, but he also is only in his early to mid-30’s, so perhaps he hasn’t done many explantations. I’m gonna gauge his confidence level when we have another conversation.
One thing you may want to try is a distance contact of -1.25, or perhaps even -1.0 without compensation for the 0.5 astigmatism. I get my contacts at Costco and they are very liberal with free contacts to do a trial with to see what works. It probably would not compromise your distance vision at all, and it may even be just as good or better. It is somewhat surprising but I did a bit of research into getting my residual astigmatism of -0.75 corrected with a limbal relaxing incision (LRI). What I found was a mixed review of doing it. One surgeon commented that about half of his patients are happy with the results, but the other half are unhappy because they lose reading ability. I think what happens is that the astigmatism is kind of doing what lenses like the Eyhance are doing in another way - stretching out the point of focus or extending the depth of focus. If you think about your eye as like a circle or pie, part of the pie is seeing with an additional -0.5 myopia in your case. This helps nearly as much as the Eyhance does. My astigmatism in the IOL eye is -0.75 and uncorrected I can see down to about 18". The residual astigmatism may be what is helping me do it. This may be a little hard to accept as we tend to think that for the best vision we need to correct all error down to zero.
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What is your eyeglass prescription for the other eye? Is there any residual astigmatism in it? I have lots of it, and that also may be helping me read. I can read my iPhone down to about 6" with my simulated -1.25 anisometropia and have no trouble reading any of the text except sometimes reading the white text on green or red in the Stocks app. But with a little concentration I can read it, especially the white on green. White on red (loss) I don’t care for reading so much!!! Mostly green today…
getting my ruler out and I can read newspaper print sharply (well) at 11 inches - after that it blurs but can read it blurry till 8 inches in good lighting. That has been the case since early on after my surgery and not changed. No sign of PCO after 3 years now. That was astounding to me as I was expecting that distance to be 18 inches. As said I so rarely need glasses. On a computer for work - no glasses need for that and I don’t wear glasses for driving. My only drawback are the concentric circles and a bit of glare (fuzziness) around lights at night. It took a while to get accustomed to those but glare did subside after 6 months I would say and the circles although huge not as bothersome either. I was aware of them prior to surgery. I guess one had to make a decision and the trade-offs. Perhaps having good vision otherwise helps. If I could not see well I would be looking to exchange too.
I wore glasses/contacts since childhood for distance so to be able to snorkel etc and see for first time was a gift.
Are you in the USA? Julielyn who is commenting now on the forums (she had her exchanges at a place in Florida (after having an exchange already) would strongly suggest you select a surgeon with a lot of experience.
Wishing you all the best. Do lots of research - plan - hope gor the best. All we can do.
Yes ideal if dominant eye set for best corrected distance and non dominant eye a bit nearer. Some experts say that dominance doesn’t matter as your eyes will/can adapt if other way around. My surgeon said that to me. Haven 't looked into it much
The arrangement I ended up with is not the dominant eye for distance. I ended up getting the non dominant eye done first for distance. My surgeon said that it is usually not a problem. I am adapting but sometimes I think that at moderate distance like 30-40 feet my eyes battle over which image should be used. Since I do some shooting right handed, I was not against making my right (non dominant) eye the distance one. This is called crossed monovision.