I am 62 years with a more dense cataract in my right eye than the left. I am managing all activities with glasses. No blurriness with prescription glasses. I have had mono vision all my life with very small numbers in both eyes. Since 3 years I have started seeing starbursts while driving at night without glasses and my vision got blurry gradually. My right eye is near sighted and left eye seems to be the dominant eye. I work on computer for 5-6 hours a day. I can read the screen but I am more comfortable with glasses.
I saw many eye doctors and they suggested mono focal or Symfony lens. Recently I found a very good eye surgeon in my area that says he can give me whatever type of lenses I want. He offers mono vision or mini-mono vision as well as all types of multi focal options. He said I have very little astigmatism and do not need correction at this time.
I have blocked a date with him 3 weeks later for mono focal IOLs in both eyes. He will use a technology to measure my power during surgery and can give precise number. However he said with mini mono vision my right eye will read cell phone screen but I will need readers for very small print.
First he is doing my right eye for near vision with mono focal. I am thinking of asking him to do a mix and match for me. Do a perfect near vision for my right eye first. My left eye has distance vision with less dense cataract. Not enough to watch TV or drive without prescription glasses. I may use glasses until my right eye surgery is done. I am wondering if I should stick to mini mono vision with a mono focal in both eyes or get a Symfony lens for my left eye (or right eye?) and mono focal for the other eye. My objective is to get all three zones by combining the abilities of two types of lenses. I believe Symfony lens does not provide very good near vision. Therefore, considering mono focal in one eye. Which eye should I do first?
I read this forum posts and have educated myself on all terminologies but I am not able to communicate that to my doctor or here very well. I am afraid he will think I am trying to tell him how to do his work. Any advice? Thoughts?
My advice is that any highly regarded surgeon should be experienced & knowledgeable enough to tell you what is best for your optimal outcome. Saying that you should do the weakest eye & then after you see the results consider doing or not doing the stronger eye. I just had a Symfony IOL in a very dense cataract eye & will be waiting to do the other with a slight cataract as needed in the far future.
Thanks Dennis. I just read your recent post about your Symfony experience. Also thanks for sharing the Symfony results will everyone. You are right about saying that the doctor should know the best. My thought is similar to yours. I want to remove the more dense cataract from my right eye and have an IOL which will provide good near vision. Having mono vision all along I am used to this. Since I can wait to do the left eye in the future when I will have a chance to go with either Symfony or another one available at that time which may add to my near vision. I am wondering if I should go with mono focal for near vision for my right eye or go with something that gives me two zones. Like near and a little distance vision as well. Thank you again for your response.
Mind my asking where u had the surgery please .
My experience has been somewhat similar to yours. Had a monofocal lens in my left eye set for best vision at about 17 - 20 inches in 1999. That together with a contact lens in the right (dominant) eye worked well for about 17 years. Then had a cataract surgery in my right eye and had the Symfony lens for that eye. Am very happy with my day vision, but don't like seeing the multiple circles around lights at night.
Having said all that, my suggestion will be to go with your surgeon's recommendation and get a monofocal lens for the right set for the best vision at 20 - 26 inches range, the exact value depending on your prescription for the left eye (it will be good to have only about 1.0D to 1.25D difference between the two: a higher difference may cause vision issues with glasses)
When in a few years, you need to have a cataract surgery done in your left dominant eye, you will still have all the options for your left eye. At that time, you can decide between the monofocal lens, a Symfony lens or something better than Symfony (in terms of reduced night vision issues) such as ZEISS AT LARA to pick the best choice at that time.
is it usual to see circles of light at night following surgery?
Hi anu1942
Comments from others are all great so won’t be able to add much else. I will say that like you the cataract was worse in my right eye than left and thought my left eye was dominant. After both surgeries turns out it is my right eye that is dominant. Often the eye that sees best at certain distances takes over and becomes the dominant eye. All to say that given you see distance better with your left and cataract isn’t as bad in that eye it may be taking over as your dominant eye right now.
I wish you all the best for your surgery. I had both eyes done just over a year ago with Symfony lenses.
I have always seen the annoying multiple circles around lights at night since the day of my surgery almost 2 years back with no change in their intensity. These are due to the diffraction circles (to provide the extended depth) on the lens itself, which can be seen by the surgeon when looking into your eye.
Since everyone does not complain about it, I assume that different people's eyes may not dilate as much as other's eyes at night or have a lower contrast perception which can make a difference about one's ability to see the circles. For me, it is an annoyance and I can live with it, but really wish that I did not see these multiple circles.
Your example of a monofocal IOL for near in one eye and a Symfony IOL in the other eye for distance+intermediate focus, is a decent option. However you would have monovision for all focus distances, though you could wear glasses to correct the near focus eye in some circumstances like for driving to get good distance stereovision when needed. Indoors that combo might work well glasses free.
That assumes both your eyes end up close to the target, but its possible you might end up with some residual astigmatism or the power a little off due to variabiliities involved that can't be predicted. Ending up glasses free is never guaranteed with cataract surgery unfortunately.
I myself had a cataract in my right eye that got bad enough that could not correct my distance vision to better than 20/50 or so, though my left eye has only an early stage cataract that does not affect its vision yet. So I did cataract surgery 10 months ago only for my right eye and went with a toric monofocal since that eye had significant astigmatism (too high for even the Symfony toric version) and it was targeted for distance focus. The result was very close for the power (near plano) but I have residual astigmatism of about 1D probably just due to how the incision healed which is unpredictable. I get about 20/25-20/30 uncorrected in that eye which is pretty good but not as good as can be if I correct with glasses. My plan for my left eye when it needs surgery in a few years, is either a Symfony toric IOL to get good distance and intermediate - I don't mind reading glasses for fine print since the Symfony should be good enough to read a computer screen and smartphone which is most of my reading. An alternative would be another toric monofocal IOL for the left eye for a mini-monovision to get intermedate focus in that eye, but Symfony would offer a better alternative.
Of course, the Symfony IOLs have issues with night vision artifacts - so its best if you don't do very much night driving. Though mixing a Symfony in one eye with a monofocal in the other eye may reduce the night artifacts (circles around some lights, etc) somewhat. I do very little night driving nowadays, so I would accept that tradeoff personally for a wider focus range daytime and indoors. But that choice would vary individually.
Dr Tal Raviv at Mount Sinai NYC.
Thanks. I asked my surgeon to do 'min mono vision' and he said I would need readers for fine prints. So I told him that it is fine but I want to be able to read my cell phone comfortably. He said some people hold their cell phone close and some people like to hold it far and read. I told him that far is better. I am not sure if I should measure at home and tell him in inches rather than far and near. You mentioned to set the best vision at 20 - 26 inches range. So does that cover cell phone and computer both? These are the two things I look at all day long.
Smartphone reading 20" is doable if your arm is long enough. I've tested with my monofocal eye set for distance focus and I need at least +1.25D reading glasses for smartphone reading at that distance. A Symfony IOL should be able to get you that if the power ends up near plano, if you target slightly nearsighted like -0.25D or -0.50D you could get better near vision with still good distance.
Different people feel most comfortable using cell one and computer at slightly different distances. I use both of those at about 18 - 20 inches. You can probably check what distance you typically use those at. Of course, one always makes slight adjustment to that distance, if needed, depending on one's vision.
As I indicated before, the prescription in your left eye should influence your choice for the right eye. For example, assuming that you have negligible cylindrical correction (for astigmatism), if the spherical prescription in your left eye is -0.75D, then my suggestion will be to aim for -2.0D for the right eye (corresponding to the best focus at 20 inches). Similarly, if the left eye is at -1.0D, aim for -2.25D (18 inches) and if the left eye is at -0.5 D, aim for -1.75D (23 inches) for the right eye.
If you can share your current left eye prescription, then I may be able to make you a more specific suggestion.
Yes a Symfony Lens would provide computer and iPhone distance. I haven’t needed glasses since surgeries. I don’t have to extend my arm st all to read text messages - arm comfortably bent. My preference is to have both eyes read. I wouldn’t want to put that all on one eye but that’s just my personal preference. Others may find the monovision to their liking.
I find one eye for reading the smartphone works fine for me, thats how I'm doing it with glasses - my left eye has a progressive lens for distance and near focus and my right eye has a nearly clear lens since the IOL is set for distance focus
I do have a pair of eyeglasses now with progressive lens for both eyes, but I find the one with only the left lens progressive works best most of the time since progressive lens reduces the clear focus width. With one eye non-progressive that gives me a clearer wide focus view overall and for reading its not usually 3D so one eye is ususually enough though with two eyes you can focus on smaller print easier.
So with my eyeglasses pair with left eye a progressive lens and the right eye almost a clear lens, I'm hoping to approximate what I might get with a Symfony IOL in the left eye in the future to to with my monofocal toric in my right eye. Not precisely since the Symfony gives about a 1.5D focus range, and my progressive lens gives 2.25D range, but good enough for smartphone and computer reading anyway.
I find most days are spent in that near or intermediate range (at least for my work - perhaps that will change in retirement). Hopefully by the time you need that 2nd surgery there will be a better EDOF lens that provides a greater range of focus than Symfony.
Hello Anu1943,
i had cataract surgery on my right eye on August 13, and my left eye (yesterday) September 13. My right eye has a Symfony Lens and my left eye a Symfony Toric Lens. I can tell you that I have not put on a pair of glasses since the morning of August 13. I could see at all three distances without glasses after my right eye was done. I am super happy with the Symfony Lens. I can read the newspaper, my phone, my computer and see the beautiful mountains and read the road signs. I am typing this message just a few hours after the patch was removed from my left eye. I do not do a lot of night time driving. Maybe only a couple of nights a week. Before my first surgery, I saw blurry circles around the oncoming headlights. Now I see well defined lines going away from the lights (similar to a simple drawing of the sun). They have not bothered me. I am very thankful for what I now consider crystal clear vision at all distances without glasses.
Thanks for your response to my question. Yesterday, I went to my optometrist to get my prescription. Here are the details: OD: Sphere: -2.50 Cylinder: -0.75 Axis: 172 Add: +2.75 and OS: Sphere: -1.0 Cylinder: -0.75 Axis: 017 Add: +2.75. Now both eye seem to have the same number for reading. My optometrist said once I get a mono focal lens I am stuck with that number. He said if it was him he would get a distance in the right eye which has cataract that is more dense. However, he also said I can continue to use prescription glasses for up to two more years. I am not able to decide what I should do. I have 3 more weeks to work on this and decide what is the best option for me.
I think that there is no single choice, which is best for everyone. A lot depends on what one's needs and desires and what one is used to.
From what I understand regarding your situation, it is important for you will like to be able to work comfortably on the computer for long time without needing glasses and you don't mind wearing glasses for distance.
Your current eye prescription actually makes it easy to achieve your goal without a significant need to adapt to a new way of day-to-day living.
You should not have any problem, if you get a monofocal lens for your right eye, which set for the best reading at about 18 to 20 inches (-2.0 D to -2.25 D). Your astigmatism is small enough that you should be able to work comfortably on the computer or see the cell phone clearly without any glasses. You may not need any glasses for reading, except for reading fine print. Your two eyes will be working a little closer than they are working right now. You will still need glasses to see well at distance, but you are used to that. You will have some glare at night due to a small cataract in your left eye, but the glare from the right eye will be a lot less.
Thus, you should see improvements in many areas, without taking a chance of introducing new issues.
As I said before, following this plan, when in a few years, you need to have a cataract surgery done in your left dominant eye, you will still have all the options for your left eye. At that time, you can decide between the monofocal lens, a Symfony lens or something better than Symfony (in terms of reduced night vision issues) such as ZEISS AT LARA to pick the best choice at that time.