I am planning for a cataract surgery on both eyes soon. May I hear users’ valuable first-hand experience with (i) **EDoF** & (ii) **monofocal** (**Eyhence** in particular) lenses regarding night vision effects (starbursts, halos, glares...) for an understanding of the extent of the issues that I’ll have to face? Thank you folks.
I had a Symfony multifocal implanted in November. Many halos a concentric circles at night. I had an exchange done 4 days ago with a monofocal. Much better!
which monofocal and how much near did you lose after the exchange?
It was a Tecnis Toric, don't remember the model. With the Symfony I had excellent intermediate but not as good near, so if I read for more than a minute or two I would still be using readers. Now I can barely read a text message on my phone, but not that good, so I prefer readers. I've used glasses all my life so that is fine.
Hi Henry - the responses you'll get will be varied. No 2 eyes are the same and add in people's personalities and tolerance levels into that mix. What some find tolerable others will not with same lens.
I have 2 EDoF Symfony lenses - implanted July and August 2017. I rarely wear glasses. If in dim lighting or extended period of reading I have +1.25 readers.
Day vision is good. At night there is mild glare and concentric circles around certain lights. Circles are big - inner ones more vibrant than outer. I drive at night and although I wish these weren't there I do drive and aren't overly bothered by them. Personally I like not wearing glasses so haven't considered an exchange.
I have recently developed ERM (left eye). Optometrist said this is not related to my cataract surgery or IOL choice. Waiting to see a retina specialist. This condition makes everything a little distorted (central vision). Thankfully with both eyes open I don't really notice it but sure would be nice if this could be repaired.
how is your intermediate now?
If Eyhance it is as good as J&J marketing materials say it is -- a mono-focal that gives good distance and intermediate. vision, with low incidence of artifacts like a mono-focal, then it should become the sales leader in the mono-focal category. It has only recently been approved in Europe, so you won't find too many people who have actual experience with it.
Not sure why you are comparing specifically to EDOF. Wouldn't the better comparision be "premium" presbyopia-correcting IOLs vs mono-focal (with Eyhance potentially being the best mono-focal)? As patients, we are looking for outcomes, not choosing lenses. I was also thinking about EDOF based on articles about problems with "multi-focals" (which are really talking about bi-focals). My clinic (one of the top private clinics in Toronto) used to use EDOFs (because it was the best approved IOL in Canada in the premium category) but switched from EDOFs to tri-focals in the premium category three years ago. The manufacturers keep improving the IOL design and both EDOF and tri-focal designs keep getting better. but tri-focals are generally the latest and greatest in the premium IOL category at this time. I saw you asked similar question in another thread, and specifically asked Danish-Viking who has EDOF in one eye and tri-focal in the other eye, and he likes the tri-focal better.
As far as artifacts, unfortunately, everyone is different, but I believe the most common comments I see from people with PanOptix (tri-focal) is: halo is generally very mild (most see two faint and small rings), there are starbursts which for most are not an issue. and I don't recall anyone complaining much about glare. Of course outcomes will be different for each person, so even if the vast majority have no issues, if night driving is very important to you, you need to decide if you are willing to risk that you are in the minority who have greater issues with artifacts. I have a long post ("cataract surgery just completed -- sharing my experience -- PanOptix Tri-focal) where I share images of the starburst effect -- very moderate for me. For EDOF, artifacts seems a little more, with people here describe artifacts like several rings and spider-web like effect.
No halos at all with monofocal? You mentioned "a" monofocal. What abt the other eye? Natural eye?
Thank you Janus.
So, it looks like there are artifacts as well with monofocal? What are they? Presumably much less than multifocal? I thought only multifocal has them.
I read price charts on computer (example attached). I am therefore looking for lens that provides sharpness & causes minimal artifacts. Based on the scanty info I’ve gathered so far I am zeroing in on monofocals & EDoF both of which I thought give less artifacts than multifocals, be they bi-focal or tri-focal.
I wld very much prefer binocular vision to monocular to always share the load between the eyes. Between monofocal & EDoF I thought the latter gives better viewing range so I can do away with glasses. But if EDoF gives more serious artifacts than monofocal (yes, it is a subjective matter so some pictures wld serve as excellent illustrations for an objective comparison & judgment) I’d then have to go for monofocal, maybe Eyhance for enhanced intermediate vision as J&J claimed.
I’d then have two choices, (i) distance + intermediate or (ii) intermediate + near.
Views are most welcome.
So i received PanOptix Tri-focal) in my right eye Feb 5th and my left dominate eye Feb 26th. i can read the smallest print its amazing i also can see intermedite distances like my tv very well. when im indoors i absoluttley live these lenses for me. when i go outside day or night my vision seems to be distorted a little. i have halos during the day that i can handle but those night time ones are so big they take over the cars. so on that note im torn on what to do! i am active and own a salona nd need to drive at night. i heard that i have to give it time so i am. however, i have seen no change in either eye as of yet. My doctor did say he might first try ordering me glasses for driving. we will see!
That's what I fear & don't want to have. My understanding is that the artifacts you are experiencing won't change or go away. Instead, you (or your brain to be precise) wld probably get adapted & used to them with time. I don't think glasses will get rid of the artifacts. That's why I ruled out multifocals. Just my understandings.
I believe it is less commonly done but you could get both eyes done with monofocal but set for near distance. You would then of course need glasses for distance, and if you don't want to keep taking them off, then progressive prescriptions.
An added advantage of glasses for distance when outdoor is have them tinted to filter out UV light. :-)
Well, hopefully time will fix the large halos
I believe most IOLs filter out UV light, so that should not be a worry. Where they differ is in that some also filter out some blue light in addition to the UV. They have a yellow tint. While on first blush that may seem to be fooling with mother nature and giving the eye an unnatural view of the world. The facts are that the natural lens even without a cataract already does blue light filtering. The blue light filtering lenses are actually closer to a natural lens than a clear IOL is. Most of the AcrySof lenses and the PanOptic filter blue light, and I believe some of the newer Tecnis lenses also do. Here is an illustration of how the light transmission of a clear lens compares to blue light filtering lenses and the natural eye lens.
I think the big advantage of using glasses with IOLs is that any uncorrected refractive and astigmatism error can be corrected. It also give you the opportunity to get progressive lenses that let you see up close as well as in the distance. And if you really want the best computer vison you can get prescription computer glasses as well.
There is an important point you mention - residual astigmatism. I got residual astigmatism of -0.5 and I like to wear glasses to increase sharpness.
If residual astigmatism is a norm, then I would get eyhance and set it for -1 in both eyes. That should give me good intermediate and decent near. Then wear glasses. At -1 I would probably not require glasses indoors.
henry,
i have symfony edof and they give al the artifacts you talk about and my near vision is terrible from 24 inch in.
also distance+intermediate is safer than intermediate+near as more diopters are required for near so the range of near you get is small.
That part on IOLs filtering out UV as well as blue light is new info to me. Will bear it in mind. Thanks.
Thank you for sharing.
I am in a similar position to you. One eye is more urgent, and the second will come later. I have come to the conclusion that this is not a single decision. It is actually a process. I have discounted all the multifocal/EDOF type lenses because like you, I am afraid of the night vision issues. But, that is only part of the decision making. Right now I am about 50-50 on going for both eyes with distance monovision or a monofocal solution. Here is my process plan:
- First eye will be distance monofocal - AcrySof IQ Aspherical. I have discounted the "glistenings" issue as a minor concern. I like the idea of having blue light filtering, and I believe the AcrySof material is more resistant to PCO.
- Will find out how accurate the correction was in the first eye. It cannot be assumed that what is targeted for correction is actually achieved. The power steps, unlike glasses are in 0.5 D steps, not 0.25 D. And they have to base correction on the topography of the cornea, not on vision tests. The usual target is -0.5 to 0.0 D, but that may not be what you get.
- If the target is achieved and distance vision is really good, then I will then consider monovision using the second eye for near vision. However, I will test that first by using a few different under correction contact lenses in my second eye to see what I like or if I like the idea.
- If the target in the first eye is not achieved, then I will most likely go for distance again in the second eye, and resolve to use prescriptions glasses to correct the residual error.
- And either way, I strongly suspect I will end up with progressive prescription glasses that I can use for the best vision up close and for distance at night.
My suggestion is to consider it as a plan, rather than a single decision on this lens or that lens.