Hi l am 48 and told l need cataract surgery within a year and deciding what IOL to go with, l still have good vision both reading and disatance but l will soon lose this as my cataracts progress, l dont want to lose all my near / intermediate vision with monfocal distance so l am thinking of either EDOF or mulitfocal. IS the diffence that mulifocal gives you vision at near / imtermediate and disatance but EDOF only gives you intermediate and distance, so you need reading glasses but the overall constrast and vision quality is better and theres less side effects like night glare? is that correct? If thats the case then l prefer EDOF to multifocal, what the best brand of EDOF
Well it is more complicated than just that as there is diffractive and refractive IOLs and now premium refractive IOLs that fall into the EDOF category.
First, let’s discuss diffractive IOLs.
One of my IOLs is a Tecnis MF. It has 2 distinct foci. So it splits the light for distance and close. Different MFs set different close foci points. And, in general, the closer the foci point the larger the halos. So your best vision would be at those foci points with vision getting worse as you move away from those points. So when deciding you need to think about what close vision distance is most important to you.
Later came trifocals that split the light into 3 distinct foci; distance, intermittent, and close. Again different Trifocals can use different foci points.
The best know EDOF in the US is the Tecnis Symphony. It has one elongated focal areas giving an extended depth of focus. It gives about 1.5 D of EDOF. So the goal was to get distance and better intermittent and close vision than a monofocal and simultaneously do this with less dysphotopsias than a traditional diffractive IOL. As far as the latter goes I am not sure it succeeded as there are many complaints of dysphotopsias associated with diffractive EDOF IOLs.
Then there is the Synergy, I have it implanted in my 2nd eye, and it combines EDOF with MF. It has the ability to provide one with great overall vision acuity from distance to close, but also IMHO the highest risk of all the IOLs. Even missing the refractive mark by too much can cause problems.
Now there are these NEW refractive EDOF IOLS (sometimes called Enhanced Monofocals) such as Tecnis Eyhance (does not even meet EDOF requirements), Alcon Vivity, and RayOne EMV. The goal of these IOLs was to give monofocal like vision quality and yet provide just a little bit of EDOF. I am talking just a little bit; like gaining a line of vision. But I argue everything comes at a cost and it has been shown that at least the Vivity comes at the cost of Contrast Sensitivity.
So my first advice is to find a top Ophthalmologist. If located in the US, look at US News Report for top Ophthalmologist. Maybe you will luck out and one of the ones listed will be near you.
Also start researching the different IOLs and learn there tradeoffs. All current, IOLs come with tradeoffs and you have to decide which tradeoff you can best live with.
Another idea is you can look and see if you can get into the clinical trials of the Juvene IOL. It is a revolutionary adaptive IOL. Have to have the guts to be such an early adapter.
Also there is the option of monovision, but Ron is the expert there so I will let him comment on that one.
And I should not leave out the Light Adjustable IOL. Another IOL to research.
By the way if you scroll through all the threads, all of these IOLs have been discussed at one point or another.
Thanks , l dont really mind glasses for reading close up, what l want is intermediate and distance without glasses and the highest quality possible, For example l dont mind wearing glasses to read the recipe book but l dont want to need glasses to make the meal. The most important to me would be excellent distance vision outdoors and driving and watching TV . l’m worried if l go with trifocal or EDOF the contrast and vision quality wont be very good and theres more risk of side effects or problems if the surgeon does’nt get it totally right, l guess what l want is the monofocal vision quality and sharpness with some intermediate to perhaps read my mobile phone if l stretch it out to arms lenght without glasses. The Tecnis Eyhance monofocal looks interesting. l am in Australia , l dont know all the lens options we have here
vivity is better than eyhance in terms of vision quality and range of vision. but vivity iol material could be prone to glistening which can get worse with time.
Hi @john20510,
You can read my recent posts about the Sympfony/Synergy combination. I am very happy with the outcome with these. I see well at all distances (20/15 far and 20/20 up close). Intermediate (not measured) seems best just from my own perception.
Good luck to you 
Hi John - good you have time to look into your options before needing cataract surgery. At 53 I was diagnosed with cataracts and needed surgery - no time yo look into it much. vision was poor - couldn’t even read big E on eye chart. I did have a few months due to Canada’s wait list for surgery and thankfully stumbled on these forums which were a tremendous help and support.
Younger you are the more compromise you must make. As my surgeon put it - in your 70s or 80s one gains something lost but when you are younger still working etc you have to decide what to give up. Personality plays a factor - more type A or perfectionist you are the less tolerant one may be of trade-offs with premium IOLs.
Myself given I work with a laptop most of my day - work with excel a lot - I wanted to be able to see that well. Was concerned about progressive lenses as I was just starting to need them and was having a hard time adjusting when cataracts hit. It was suspected my long term use of steriod creams were a contributing factor to my having this type of early cataracts.
I chose the EDOF Symfony lenses both eyes. I was surprised by how much near vision I got with these. I rarely need glasses - just for small print like pill bottles. There is a slight reduction in contrast sensitivity so good lighting needed for reading. In a dimly lit restaurant I use my flashlight feature on my iphone - although since pandemic hardly eat in those anymore - lol. Seriously though I can count number of times in last 3 years I wore glasses on one hand.
Trade-off and there is one is night vision. I see huge concentric circles around certain light sources night. IE red traffic lights - as I get nearer to them the circles get smaller and smaller till they disappear. I do not have that issue at night in my home with lights. I did have a lot of glare too till that settled down after a few months. I think that could be worse if the refraction target was missed. If I drove for a living or were a pilot this would not be a lens I’d choose.
each eye is different too and I think some people get better near vision based on their pupil size etc. Younger people have pupils that expand more and could potentially cause additional issues with them dilating beyond IOL (most if not all are a standard 6mm).
Wishing you well and it is really great you have this time to weigh your options.
I think the simple answer to your question is that an EDOF stretches the distance that a reasonably clear image can be seen. Instead of a sharp focus like a monofocal, image quality is compromised for an extended stretched out distance. And a MF lens splits the light and provides better vision at two or three distances. Since there is less than all the light used at each distance this compromises vision quality too. In my opinion both of these methods compromise image quality and contrast sensitivity. In simple terms instead of seeing a sharp single image you are seeing multiple images or ghost images around the main image. Your brain tries to ignore that, but since it is not a single sharp image there is a loss of contrast.
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Google the fairly recent article listed below. In particular pay attention to the graph that shows the vision quality at various distances (Defocus Curve). The bottom scale is in diopters but can be converted to distance by dividing 1 meter by the diopter number. Diopter of -1 is 1 meter away. A diopter of -3 is 1/3 meter or about a foot away. On the vertical scale you can see the vision quality. The 0.2 logMAR is considered to be good vision (20/32), and when you drop below that vision is being noticeably compromised. A pure monofocal hits this limit at 1 meter, while the Synergy hits it at about 30 cm or a little under a foot.
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There is one issue with this graph. I don’t believe the Vivity curve. It seems to be more optimistic than what Alcon reports in their technical documents. I would suggest that a more realistic intersection point of 0.2 LogMAR for the Vivity is at -1.75 D, or 57 cm, or 22". The Eyhance is not shown on this graph but it hits the 0.2 LogMar at about 1.3 D. What is worthwhile noting from these curves is that a monofocal set for distance, does not drop off a cliff as you go closer. The monofocal hits the 0.2 limit at a diopter of -1 which is one meter or 3 feet. So when you say you want distance and intermediate, if you define intermediate as 3 feet then a basic monofocal will do it. And the other important thing is that these curves are an average of what real eyes get. Some will do better and some will do worse. I have a monofocal and I don’t know what LogMAR it is, but I can read text on my computer screen at about 18-20" or so. It is not super crisp, but I can read it.
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Optometry Times A guide to the latest presbyopia-correcting IOLs October 27, 2021 Tracy Schroeder Swartz, OD, MS, FAAO
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On the monovision, since you still have good vision, I think you would be doing yourself a disservice by not trying simulated monovision with contacts. It is easy to do and try different amounts with contacts to see what you like or if you like it at all. As a simple example if you have a correction refraction for eyeglasses of -4.0 D in both eyes, you would determine which eye is dominant, and use a -4.0 D contact in that eye to correct fully for distance. Then in your dominant eye you would under correct it by 1.25 to 1.5 D. Which in the example would mean trying contacts of -2.75 D and -2.5 D. The idea is that you don’t need sharp vision in both eyes to see a sharp image when you have both eyes open. Your brain will pick the best one. As you get closer and closer to an object your brain will switch from using the dominant eye, to both eyes, and to the non dominant eye. I am half way down that path now with one eye having an IOL for distance, and a contact in the other eye to give me -1.25 myopia or under correction. I like it a lot. With contacts it is easy and cheap to simulate.
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Hope that helps some,
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Edit: To your original question if you look at the Defocus Curves in that article. You will notice that the EDOF lenses drop off smoothly as the distance gets closer. The MF lenses have bumps where the add powers kick in to boost vision at that distance. And keep in mind that the PanOptix and Synergy may use a bit of both, but still have MF bumps.
Glistening hasn’t been an issue with Acrysof in years. They’ve improved that to the point where it’s no longer a clinically relevant issue. And the image quality of Eyhance should actually be better than Vivity according to bench data (dramatically better contrast). But Vivity will have better range for sure than Eyhance. You just might need extra light in low light situations or need a night light to navigate the house in the dark if you get up in the middle of the night… etc. Which are probably totally acceptable compromises for most people for being more glasses independant.
Thanks yes l am thinking of going with sympathy lens, l dont drive and hardly go out at night so thats not an issue, my only concern with sympathy is the contrast and vision quality , if for example you are outdoors in a national park and looking at a scenic view does it seem just as good and sharp as it was before you had cataracts , is there no noticable differnce ? also watching Tv and movies does it pity much seem just as good and sharp as before
Thanks l spoke to two optomerists for advice, one said l should go with monofocal set for distance , the other one said l should go with Trifocal lens. You mentioned consider mono vision, l guess if l had both eyes set for distance l could wear a contract lens in one eye to give me close vision in that eye and its not permanet as l could just slip it out if l dont like it. One optomerist said if l go both set for distance l should be able to see well everyting past arm lenght well without glasses. Is that correct. Monofocal distance seems like the safest option as l am guaranteed clear sharp distance vision , only downside is glasses for close up, but withiut glasses would l have daily problems such as tripping over things not being able to see well enough to make meals on the table or read the car dashboard when driving. IF l go with Trifocal l risk poorer vision quality and contrast, theres no point being able to see near intermediate and distance if all three are poor quality vision . l find it hard to decide
not sure how much glistening issue is resolved. alcon iols are prone to scratching at implantation (see wong panoptix video) and we have a recent post from sorryeyes whois experiencing glistening with his panoptix. clareon will resolve some of these issues with acrysof it seems.
especially important as glistening is time induced so important consideration in very young.
thanks you said the monofocal distance The monofocal hits the 0.2 limit at a diopter of -1 which is one meter or 3 feet. Does that mean everything from 3 feet will be clear and not need glasses, if for example to were to stretch my arm out and hold my mobile phone at arms lenght l may be able to see a number without glasses , l were to look down at my feet or an object on the ground without glasses would it be clear
“You mentioned consider mono vision, l guess if l had both eyes set for distance l could wear a contract lens in one eye to give me close vision in that eye and its not permanet as l could just slip it out if l dont like it.”
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Yes, you could do that. However if both eyes are set for distance you will have to live with that essentially for life, and to be glasses free you would have to wear a contact in one eye for life. Exchanging IOLs is not a simple risk free procedure. It makes much more sense to trial mini-monovision now by using contacts in both eyes. Then you can try different power easily to see what you like. The advantage of doing mini-monovision with the IOL lenses is that you can be essentially glasses free except for the occasional need for mild reading glasses. And keep in mind that most will still get progressive glasses which will correct both eyes for distance and close. With monovision you may hardly ever wear them, except for difficult situations like driving at night.
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On both eyes set for distance your optometrist has it right. You should see well from about arms length and further. Some may see closer. As I said with my distance IOL eye I can see down to 18-20" which is a little closer than arms length. For me the dash instruments are perfectly clear in my vehicles with my IOL eye. Making meals with both eyes set for distance is a bit iffy. It may be difficult to read recipes, or read the measuring cup, etc.
Yes. A monofocal should put everything in good focus from 3 feet out to infinity. As I mentioned I can see closer than that, but that will vary from person to person, and is hard to predict ahead of time.
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I can kind of read my iPhone 8+ at arms length, but that is far from convenient, and it depends on the size of the text on the screen. I would suggest on a practical basis if you get monofocal lenses set for distance it is not going to be practical to use you smart phone easily without glasses.
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If you golf I would suggest that monofocal lenses set for distance is no limitation. You will not be able to read the name of the ball at less than arm’s length. However you should see it as perfectly as anyone when the ball is on the tee. If you swing and miss the ball you can’t blame it on the IOL lenses!
I agree that for all practical purposes Alcon has solved the glistenings issue with the AcrySof lens line. I think that Eyhance as well as all EDOF and MF lenses suffer from a loss of contrast sensitivity. The closer they focus, the more they will suffer. While Vivity suffers, I am sure it does not suffer as much loss as the Symfony. Because Vivity put a warning out about the loss they seem to get all the attention.
l am now thinking the best lens for me would be the TECNIS Eyhance . It does’nt have the contrast loss and side effects of the EDOF and mulitfocal but will give me better intermediate vision then standard monofocal with the same level of excellent distance, l dont mind glasses for reading now and then. Do you think thats correct
From the information I have seen, the Eyhance may take you from about 3 feet close vision with a monofocal to 28 inches. So about 8" closer with the Eyhance. Is that going to be enough to use a computer monitor? Not sure. Not likely suitable for text on paper or reading a smart phone… I believe there is a thread here that users posted about it and can give you first hand experience with the lens. I think the Eyhance would only give good reading vision for text on paper, or a smart phone if it is under corrected in monovision style in the non dominant eye. Probably needs to be under corrected by -1.0 D or so. And if you do that there is probably no need to use an Eyhance in the dominant eye - just a monofocal.
Bit eyhance set for distance in both eyes would still give me a bit better intermediate vision then a standard monofocal , but if l were to go with an EDOF lens to get better intermediate what EDOF has the best contrast and vision quality and keast side effects
I’ve never looked into the Symfony and I don’t know what the bench data looks like (MTF). But on the bench data (MTF) of the Eyhance is actually better at some pupil sizes than some monofocal IOLs.
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The Vivity warning (as you may know) was due to it failing FDA contrast minimums in bench testing. But those bench tests are done monocularly and in binocular clinical testing (i.e. real people looking at a chart with both eyes not a model eye on a laboratory bench) the lens passed the FDA minimums. So they approved the lens with the patient information warning.
Yes, having the Eyhance in both eyes provides a touch more binocular vision in the 28 to 36" range. The difference will not be huge and likely would not add a line of vision on the eye chart. I am not sure that this distance range vision is all that useful. The Eyhance to me without some significant myopia in the non dominant eye would fall short of my expectations for reading. I spend a lot of time on my computer with the TV on (yes bad habits!). I switch between reading text on my computer to looking at the TV (10 feet away) hundreds of times per day. I would not want to put on and take off readers hundreds of times per day. With my simulated monovision it has probably been a week or more since I put readers on. To me that is occasional use.
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I have a simplistic view of contrast and the probability of optical side effects like flare and halos at night. The basic aspheric monofocal lens has the lowest risk and as the range of closer vision increases the risk of loss of contrast and risk of flare and halos goes up. Of the more common Alcon and J&J IOLs on the market in North America I would rate them from lowest risk to highest as follows:
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Monfocal Aspheric (Tecnis 1, AcrySof IQ, Clareon)
Tecnis Eyhance
Alcon Vivity
Tecnis Symfony
Tecnis Symfony Plus (if it is available yet)
Alcon PanOptix
Tecnis Synergy
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If I was determine to have an EDOF and I was prepared for the night time halos and flare, I would likely go with the Symfony. I am not prepared for that however, and will go with either a Clareon or Vivity in my closer vision eye in monofocal under correction.
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These are tough decisions and everyone has different priorities and tolerance for optical side effects. I think the most important thing is to be fully prepared for what you are going to get, and not end up with buyers remorse.