Your Post Lasik Cataract Surgery Results (Trifocals, EDOFs, Multifolcals and Halos—oh my!)

Eye care
1

I posted this on the 7th of August but it has been in moderation and it is now the 10th so I am posting it again. If it gets posted twice, I will attempt to remove the duplicate...

My name is Jorge. I am in the US. I had Lasik in 2004 and vision was great until about 3-4 years ago. I initially saw an opthalmologist who told me that I had a cataract forming in my left eye and another just starting in my right.

I was also told that they were not "ripe" and that I should wait about a year before looking into surgery. It has been about 3 yrs now and the vision in my left eye is really annoying me. I have been trying to drink water and carrot juice and all sorts of other things but the vision continues to worsen. I have done a lot of research on IOLs and it seems clear that in the US our IOL options are very limited compared to what is available in Mexico, Germany, Turkey, Greece and Belgium (probably many other places too).

I was seriously considering traveling to another country to have the surgery done because of the options (trifocals such as the Reviol Tri-ED or the LIght Adjustable Lens. The LAL was developed here in the California yet is still not yet approved by the FDA but I believe it has been available elsewhere since 2009. I hear they are "close" to approving it here).

I am now thinking that I should maybe NOT go elsewhere because if there are any complications or adjustments that need to be done, they would not have any experience with those lenses here and because I had chosen to go around them, may be all too pleased to tell me that I would have to fly back there for them to deal with me.

I would like to ask people who have had Trifocals, multifocals and EDOFs what results they have had. I have been told that none are perfect and that I will have to compromise on one of the following:

• near vision

• intermediate vision

• long distance vision

• night or driving vision (halos and glare)

• low light vision (the ability to see properly in low light situations)

I was told that almost all lenses other than monofocals will produce halos/glare but that after about 3-6 months my brain would adjust and I would not notice them.

I have been dealing with the cataract getting worse and worse for 3 years now, I am wondering if the halows I would see after the surgery could possibly be any worse than how I am seeing now. Maybe it would be a marked improvement!

One doctor told me that that I should try the "small aperture" IOL because by using a small aperture it extends the depth of field. That made sense so I then followed up with a question about low light sensitivity (since just like a camera, you can get almost infinite DOF if you stop the lens down but you then you can almost not see anything unless it is bright daylight), he never responded.

There was another lens, the Reviol Tri-ED. I contacted the author of an article: "The Lens: Reviol Tri-ED” (/). The article made the lens sound great because it had great light distribution. He sent me a research article: 

RESEARCH ARTICLE Open Access

Clinical outcomes of a new diffractive

trifocal intraocular lens with Enhanced

Depth of Focus (EDOF)

Banu Torun Acar1*, Erkan Duman2 and Saban Simsek1

Everything sounds great until I ask him:

Besides the Reviol, are there any other IOLs that you recommend to eliminate halos as well as providing continuous focus from close to far?

His response: In Reviol and Zeiss, there are complaints about halo glare. Alcon Panoptics gives us better results.

Keep in mind that this was the doctor who penned the research article that stated: 

"All our patients achieved spectacle independence without an incidence of photic phenomena, such as halos and glare at 6 month-follow up."

I cannot ask any of the local doctors what their opinion is on these other lenses because they will only recommend what THEY can do and claim that the FDA only approves the latest and greatest and if they have not approved it, then they are "obviously not having good results overseas".

So at this point, I am completely confused.

1) I can get the surgery done here in the US knowing that there are more advanced and probably better lenses with possibly fewer post surgery abberations and side effects.

2) Go to another country where I will have to stay 1-3 weeks and then hope that when I come home nothing needs anymore work

3) I can go to Mexico and get the LAL but I do not really know how competent they are there. The LAL is adjusted post-op and after your eye has healed (about 2 weeks). Up until your eyes heal, you must wear a pair of UV blocking sunglasses for those 2 weeks so as not to inadvertently expose and thus alter the lenses. After 2 weeks you go back, to the office, they measure your eyes as they are now healed and then adjust the lenses and then once it is dialed in, lock the lens in with another Laser that then prevents any further changes to the lens. The thing about the LAL is that they change shape and can get bigger than when first implanted and if they need to be removed (I don't know under what circumstances you would need them removed) it can be a chalenge since they will be bigger than when they went in.

4) Go to Canada and see what options they have there

5) Go to Greece to visit a doctor who practices both in NY and Greece. If I had to make any changes I would only have to go to New York but that might also be a PITA if I had to do it more than once.

6) Go to New Zealand. There is a doctor there who is one of the few in the world who has worked with the Harmoni lens and I do plan on moving to NZ within 2-3 yrs but that is a much bigger hassle if I have to go there because of the long flight times and their expense.

So, in closing, I would like to hear from people who have had Lasik. I would like to know what type of lens you opted opted for (multifocals or mono) and why. I would like to know if you are happy with them and if you would recommend them.

Thanks in advance and sorry for the long post but I wanted to give as much background as possible.

Sincerely,

Jorge

 

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2

I saw some information about LAL before my cataract surgery 1 1/2 years ago. I called and emailed a few professional in Canada and USA. It wasn't approved in Ontario that time. And I checked some forums and it is new. I don't want to take it. I made the diciition to go with mono. if I chose distance mono. I am fine with distance and middle. And I have only one eye is working now.  Depth is a problem for me to decent ( may be only one eye is working)I am using reading glass for reading and waiting for the cataract surgery for the other eye. I prefer less trams for my eyes. And I am reasonably happy with the left eye which has mono focal implanted for distance and I see middle ground also. 

3

Hi Rose,

I grew up  with glasses and would hate having to use glasses for both near AND far. I think that I can tolerate having to use glasses for one of the extremes, either very, very close, tiny text or for very long distance. So I am willing to give up some visual acuity for long distance but would rather not have to wear glasses most of the time.

Since you have monofocals, I am gussing that you at least are not experiencing any halos, correct?

Jorge

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I would also appreciate hearing from anyone who opted for accomodating lenses!

5

Hi

Thought I would weigh in on my experience.   You didn't mention your age but I am guessing you are young for cataracts.  It is definitely not something I wanted at 53.  However with 20/70 in one eye and 29/60 the other I couldn't hold out for better lenses.  I have had a Symfony EDOF implanted in right eye just over 4 weeks ago.  The other eye will be done in a couple of weeks.

I use a computer 80% of my day at work, have a child in high school and lead an active life.  I did not have prior lasik surgery - have worn glasses since I was a teen.  I am near nearsighted (-2,25 in one eye and -2.75 the other.  Still didn't need glasses for near so thought of monofocals set for distance didn't appeal.  I know some people get them set with a mini monovision however never tried this set up.

My surgeon prepared me with pros and cons saying at my age and given good near vision I would need to compromise.  I live in Canada and Symfony was approved just over a year ago.  

My vision is good - tested 20/20 day after my surgery and I see well from 16 inches away which is a little further out but acceptable.  For pill bottles and ingredients on soup cans will need readers.

The compromise is night vision.  Although with cataracts (and with one eye operated on I still compare) halos and glare and contrast is worse. Streetlights do not bother me.  Nor neon store signs or porch lights.  Mostly red taillights I see concentric circles around these when brakes applied or on dark highways where there is. I overhead streetlights.  Glare from traffic coming towards me has lots of glare especially new LED headlights.  

I figure I wanted good daytime vision without glasses (and in reality it would be bifocal glasses for near and intermediate or 2 pairs) with monofocals.

If you don't need the surgery right away wait.  Likely better are in the wY to being approved.

I did learn in my research that a number of surgeons are comfortable with implanting Symfony vs multifocal lenses in those who have had prior lasik.

Good luck.  Sounds like you are researching everything you can and have the means to explore options.

6

I have a ripe cataract in my right eye, but the left eye won't mature probably for several years.

In considering the available IOLs and what I have read from others experiences with them, I consider what distance viewing ranges are most important to me to help decide which IOL types would help meet that.

Its a tradeoff, so if you want good distance vision as a top priority, near vision will have to suffer or vice-versa.

It is possible with some of the premium IOLs to get distance and intermediate (computer, 2-3feet) vision without glasses like with the accommodating crystalens.

Another approach to get distance and intermediate is to use monofocal IOLs with one eye set for distance and the other set for intermediate (about -1.0D or so).  You could alternatively set one eye for close near vision, but that can be difficult for some to get used to if the difference between the eyes is too great.

The Symfony IOL can achieve distance+intermediate a little better than the accomodating IOLs (or could be set for intermediate+near) but that IOL along with multifocals have the greatest risk for night vision artifacts (halos, starbursts, circles around bright lights, etc) compared to the other types of IOLs.  So that too depends on your priorities - if you rarely drive at night but desire a good range of daytime/indoor vision that might be a good choice.

I think for the best overall chance of distance and intermediate vision as top priority, leaving only the need for near reading glasses, plus good night vision the choices are limited to monofocal IOLs or accomodating IOLs. And that is what I've been considering for myself.

7

I'm having a monofocal IOL set for distance next week. I had Lasik around 15 years ago. My brother also had Lasik and then had cataract surgery with a monofocal IOL set for distance and he can see at all ranges including up close except for the tiniest print. Good luck!

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Oh and he's a software consultant for a Fortune 500 technology company, so he has to be sure his vision is excellent.

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Actually it's one of the 5 top software companies in the world (not saying which though!).

10

Would they know at scanning that this is what distance correction you need for lens and this is what you will need for reading glasses.?

11

This is a great post given the issues reported with symfony for night time especially with driving. 

What's next after symfony? LAL?

Symfony sounds tempting with near and dish vision but night issues could be bothersome. 

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 Ina if your brother got that test from monofocal lenses I would say he got lucky - that is not what any surgeon would advise you would get with monofocals.  

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Just to clarify - only a small percentage of people will consider the night vision issues bothersome.  You can read the studies on those.  Personal it would be great if there were none however don't consider them to limit my life.  I have been driving around the city with no difficulty.  The worst is when I face bright headlights from newer cars that have LED headlights but my husband who doesn't have cataracts find them bothersome too.

It really comes down to what compromise you want to make (and there is that no

matter which lens you choose).  Monofocals also can cause night issues (I am actually wondering if that comes down to pupil size).  Also funding as premium lenses are out of pocket expenses.  How I

Wish there were ma Hines that would mimic the view you'd get prior to implanting lenses but currently there are not.

14

Hi Sue.An,

I'm just recently 59.

When I got Lasik, my surgeon convinced me to try monovision and I HATED it. So, I am not interested in one eye set to close and the other set to intermediate/distance.

I believe that I prefer to have close, medium and good night vision with a compromise on long distance. I use intermediate and close far more than long distance so that would mean the least use of corrective lenses.

I've not heard good things about Symphony. I read that about 9 months ago there was a recall of the Technis Symphony lens but I don't believe it had to do with the lens itself.

15

Yes, I read that the multifocals are most likely to produce nighttime artifacts.

I read that accomodating lenses only achieve what is expected of them about half the time and in another article, I read that people fear that as you get older and your mucles do too, that there will be even less accomodation and thus it will become more and more like a monofocal.

I think my highest priorities are good close and intermediate indoor vision as well as good nighttime vision but another thing that I saw mentioned was contrast and that cannot be corrected for with glasses so that is yet another factor to be considered.

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I would love to be able to see at all three distances with a monofocal because from what I hear, they are the only lens that does not produce halos. I just don't understand how, if they are not accomodating lenses, one is able to see well at all three distances. Your brother is very fortunate.

17

I believe I spoke to someone who said that the LAL finished its last FDA trials at the end of 2015 and that they now had to submit their 12 month follow up results so it seems as though the LAL will be approved here sometime soon.

18

Is anyone familiar with the Haromi lens? Since I cannot post links on posts, I willl paste what I found from one site:

The Lens: Harmoni Modular

Robert Edward Ang, MD

 

 

 

 

 

Despite multiple advances in IOLs and the tools we use to implant them, the basic design of IOLs has remained essentially unchanged for 50 years: an optic with two or more haptics affixed. Enter the Harmoni Modular IOL (ClarVista Medical). With this two-component design, the haptics—the base of the lens—can serve as a stable platform in the capsular bag, and the optic component can be exchanged or adjusted to accommodate each patient’s changing visual needs.

AT A GLANCE

• The two-component Harmoni Modular IOL allows surgeons to address the changing needs of patients over time.

• With the base simulating a capsular tension ring and holding the capsular bag securely, the optic can be safely decoupled and removed, and a new optic can be inserted....

...CONCLUSION

The standard IOL design is no longer capable of meeting the demands of many of today’s active seniors, who may well have decades of life ahead of them when they undergo cataract surgery in their 60s. The modular design of the Harmoni IOL allows us to address the changing needs of our patients over time. 

With this lens, surgeons can have peace of mind that they have given their patients multiple options for the future. [author]

This lens is available in New Zealand and only a handful of doctors have worked with it so I am concerned about any possible follow ups, if I were to get it.

In addition, they say that the premium IOL choices are limited for post-lasik patients since the lasik further compicates the calculations needed to come up with the right power lens.

Of course, no one can be sure what lens they are going to recommend until after they test you and I would be displeased to fly to NZ only to be told that they suggest using a lens that I could have gotten at home.

19

I had Symfony Toric lenses implanted in both eyes about 6 months ago - ZXT375 in the right eye and ZXT450 in the left eye. These operations were carried out in the UK (where I live) and about four weeks apart. Having started with glasses and a prescription of -12.50 (right) and -11.00 (left) for myopia and -6 (right) and -4 (left) for astigmatism, I am now glasses free except when trying to read newsprint in low light. There are some (for me) minor drawbacks - such as halos around bright lights and some spiderweb effect. However, these may be the consequence of slight capsular opacification (PCO) which will need treating eventually. Currently my vision is excellent.

20

Hi banterer,

no  helos yet.