AcrySof Toric Monofocal Experience
Posted , 9 users are following.
Hi. This is for anyone who might be weighing IOL choices prior to surgery and wants to know more about the toric monofocal specifically. Some really lovely people (for whom I am so grateful) have really helped me on this site, and I would like to pay it forward.
To start, I am 48 and have a genetic predisposition for early-onset cataracts. I have had no eye injuries and no eye disease. I do have astigmatism. I only had a cataract in my right eye, which gave me 20/400 vision uncorrected, and 20/200 vision corrected, so I was legally blind in that eye, and surgery needed to be done. The doctor said he saw the beginning of a cataract in my left eye and anticipates lens replacement in approximately 3 years.
I am a SAH, home schooling mom. My favorite activities are reading, writing, and crafting, so I do a lot of close work. Even so, I chose a monofocal lens set for distance. I didn't choose a multifocal for 3 reasons (in order of importance):
- higher risk of light aberrations at night (halos, spiderwebs, glare, etc.)
- drops in field of vision
- the possibility of still needing glasses after the possible night vision compromise and added expense
I am odd in that I did not really want to stop wearing glasses, because, frankly, I look better in glasses. I could have chosen the non-toric monofocal but, ultimately, I felt that (for me) vanity was a poor reason to sacrifice the convenience of not wearing glasses full time and the chance to see God's natural world again without frames in my peripheral vision and with proper depth restoration. (They have filmed several movies in my area due to the rare and beautiful environment, and I really want to gaze upon it again with unimpeded vision.) I could have gone with the non-toric monofocal that insurance covers and then worn contact lenses, but I have never worn a contact, and I did not want to go through the trouble of IOL implantation and then place another synthetic lens on the external surface of my eye. For me, "enough is enough," so I killed 2 birds with one stone and opted for toric. I will still require reading glasses, so I joke that I will look better half the time. I realize that requiring reading glasses qualifies as a pretty big "drop" in my field of vision (see number 2 above), however, it does not come with a statistically high risk of night vision disturbances, so it's a compromise. I also realize that the same risk of needing to wear glasses anyway (number 3 above) applies, but I won't resent it as much as I would have if I had paid for it with my night vision and $6,000 for both eyes, eventually, in multifocals. I did what, for me, felt like a good balance. I did not "go for it" with a multifocal, and I did not "settle" for uncorrected astigmatism. I took what was, for me, a moderate approach that fits with my situation and certain aspects my personality.
A couple things to note:
Having astigmatism means that my reading glasses are also prescription. If I lose them or leave them at a restaurant or friend's house, I can't read until I get them back from wherever I left them or have a new pair made. Having a toric implant means I will likely get to wear non-prescription readers which are cheap, widely available, and don't pose any risk to my night vision. I should add that, for all my concern about night vision, I don't drive at night or have a night-related career. I do drive at night occasionally, and I do walk at night, and there are streetlights which I did not want to look at and see halos or webs, etc. I mainly wanted to reduce the risk of permanent visual disturbances period.
Regarding the surgery, I had dropless (no post-surgery eye drops) and ORA, because my regular optometrist (not my eye surgeon) strongly recommended it and because:
"For the first time in medical history, cataract surgeons have the on-demand ability to measure outcomes, correct astigmatism and verify lens implant calculations in real time during cataract surgery with the introduction of Optiwave Refractive Analysis (ORA). This technology is one of the most dramatic breakthroughs in intraoperative cataract care in the past two decades."
For a week I need to wear an eye shield when I sleep, but that's it..
I just had the surgery yesterday morning. It took 30 minutes and was a fun and interesting experience.. Fun because, let's face it, legitimate narcotics are relaxing, and it was interesting, because I could see what I assume to be the broken pieces of my lens swirling around in the light in my eye. I made a remark during surgery and was told not to talk, so make note of that-- no conversations during eye surgery when they are trying to keep your head as still as possible. That should have been obvious, but, yanno...drugs.
Post surgery my eye hurt. I was told it would be mild pain. No. It was downright painful. It felt like my eyeball had a bad sunburn and like I had something in the middle of my actual, internal eyeball. I can't describe it other than to say it felt like an acrylic lens was implanted in my eye. I still have the sensation of that "fullness" in my eye. It's novel, but not too creepy or bothersome. Instead of taking an ibuprofen I went out for lunch with my husband and then took an all-day nap. 19 hours later my eye is slightly sealed from the excretion response to the trauma of surgery and sleeping so long. I am not forcing it open, because it feels better shut, and I am not anxious to see out of the eye, because I know my post-op vision is jacked up and it's way too soon to tell. I am not in as much pain.
Current emotional impressions:
I saw some light aberrations while traveling to the restaurant. Bright sun glinting off cars, headlights, and that sort of thing produced starbursts and halos. The restaurant was dark and had recessed lighting and white Christmas lights too. There were halos around points of light, and the recessed lighting looked like big white "snowballs" with halos around them. Because of this site, I knew to expect all this and that it will most likely go away in time. Thus it did not bother or frighten me one bit. But after seeing these aberrations I am kind of second-guessing myself thinking I could have dealt with spiderwebs/halos, etc. and probably been OK with a multifocal. Still, my husband saw about 5 friends he knew while waiting for me to come out of surgery. One of them, said he got the multifocal implant 9 years ago but now needs glasses again. So then I also started second-guessing myself about even getting the toric monofocal, thinking maybe I shouldn't have spent any money if I'm just going to need to again wear glasses for everything in the future. So I'm kind of all over the place right now. Hopefully at some point I will settle in and be confident about the choice I made. It's hard to really know, since there are so many variables, and we can't try each option out before we decide. At any rate, I am grateful that ANY options exist to help with cataracts. I have lots of experience with health conditions that have no available treatment, so the fact that anything can be done for a cataract is a wonderful gift.
4 likes, 44 replies
britkennels AshMac
Edited
AshMac,
Thanks for such a wonderful description of your own experience. I honestly believe that the better informed we are, the better we are to face the surgery. While I didn't take this advice, I was lucky. lol
Anyway, please don't second guess yourself because you'll go batsh*** crazy. It truly sounds like you made a very informed decision based on your own circumstances. In the end, it all comes down to you, your health, your doc's skill, what's available, yada, yada, yada. Sometimes I think that maybe if I waited just a bit, then something "new and improved" would have come along and then... but the truth is that we already have some truly incredible eye care options open to us that even our parents could only dream about. Every time I find myself thinking "what if...," I simply look out the window and marvel at the fact that I can see individual leaves on trees in the distance. This was something I couldn't do even with my super-strong contacts.
OK, enough sounding like some bad TV evangelist. I wish you nothing but swift, trouble-free healing.
Cheri (the talkative one)
AshMac britkennels
Edited
Thanks for your support, Cheri. I am definitely struggling with second guessing. While I'm now very happy and sure that getting toric was the right thing, I kind of wish I had just taken the risk and gotten multifocals. I think I may have been overly concerned about the night vision issues people have with multifocals. I say that because from time to time I experience seeing the edge of the IOL and having it jiggle around thus jiggling the image. In my research I had read about these and, conceptually, they were far more alarming to me than they are (again, to me) in real life. I actually find it kind of neat and interesting. So I think I probably could have dealt with halos and other night vision issues. Would it have gotten old? Maybe, but because my distance is so fantastic now, my intermediate is seriously meh, and my near distance is completely jacked up without glasses, I am kicking myself. If I had it to do again, I would probably go for the multifocal, because it is just so wonderful being able to see distance clearly without glasses again, and it would have been amazing to see near and intermediate as clearly too without glasses. I didn't think that was important to me before, because I have spent the majority of my life in glasses. I just didn't realize how awesome it is. It's probably well worth some spiderwebs and glare. (Kudos to those who took the plunge.) That said, my night vision now is completely unaffected. It is crisp and clear like it was when I was a teenager. So I got exactly what I bargained for. My only problem is NOW I WANT MORE! LOL! I will never really know if I would have loved or hated multifocals, but I think I was overly concerned about the accompanying issues. I submit this for others in the process of choosing a lens.
soks AshMac
Posted
edge glare is the worst symptom for me. especially the arcs. complete circles of edge glade are still bearable.
spiderwebs and halos are nothing compared to the edge glare.
AshMac soks
Posted
Do you have multifocals?
soks AshMac
Edited
Congrats on the surgery and fixing the problem! You are young at 48. I am 43 and also have family history so I understand the pain.
How is your near or intermediate vision?
Good luck on your recovery.
AshMac soks
Edited
Thank you. My near distance is pretty much zero. Can't see my phone. Can't see my tablet held 16" away. I can't see my tablet even 23" away (arm's length) so I'm pretty much relegated to wearing reading glasses on a chain around my neck. My near vision is definitely worse than it was before the cataract made me blind. I didn't need readers on the fly. To read lots of text comfortably, yes. But I could see my phone and tablet if I HAD to. Now I can't. My non-IOL helps enough for me to get by right now, but in the distant future the doctor wants to set the lens in that eye to distance also. That kind of scares me, because I'm not really getting any intermediate or near with this IOL. I feel like I will be legit blind except for distance. I'm a little surprised that my intermediate distance is so bad. I was not really expecting that. My toric monofocal experience is more extreme than just "needing to wear glasses to read." I mean, I thought that's where I was at before cataract surgery. But this is nothing like my vision before the cataract. With two eyes set like this I'm sunk. Really wishing I had gotten the multifocal like the doctor advised. Hang night vision! This is the pits!
soks AshMac
Posted
with SYMFONY my near vision is terrible. intermediate is decent.
i understand this is nothing like vision before cataract and i too worry about vision after getting the second eye done.
the age is not on our side on this.
Deb03 AshMac
Posted
I'm very sorry you are disappointed Ash. I recommend you play around with a contact in your non-cataract eye to see if mini-mono or monovision would work for you. I know it's your dominant eye but I read a study where IOLs were placed in 33 non-dominant eyes only and 7 patients had a change in ocular dominance. You can google ocular dominance after cataract surgery and find it.
Or perhaps you could get a multifocal in that eye when the time comes.
I'd also suggest trying glasses with progressive lenses if you haven't before.
AshMac soks
Posted
Thanks, Soks. I guess it just goes to show there are no guarantees. That talks a little sense into me, and I appreciate it. ❤️
AshMac Deb03
Posted
Thanks for these suggestions. I am definitely going to play around with the left eye to see if I can find something I can live with. Thankfully, the doctor said it will be about 3 years before I need Leftie replaced, so I have time to really do some experimenting. I will look for the study. I don't think I will do a multifocal in the left eye. I think it would be emotionally difficult to find that I love it and should have gotten it in both eyes or hate it and shouldn't have second guessed myself. I know that sounds crazy, but if the lens fits...
I'm hoping I can find a good field of vision fit with a contact and sort of end up with all fields of vision without having risked my night vision, since I'm already in a monofocal. Is that unrealistic?
Oddly, I can wear my old glasses, and they work pretty well even with the old lenses in them. So I'm wearing them for reading for now. I have heard I should wait 6 weeks to see if I end up needing any correction in the "new" eye. Part of me wonders if I should be wearing my old glasses over the "new" eye while it is healing. Could it cause a permanent problem? Is that a silly question?
Deb03 AshMac
Posted
I don't know the answer to the question about wearing the reading glasses. I'd call your doctor and ask. I think the only way to end up with all fields of vision would be to go near in your other eye. In all likelihood you would then need glasses for night driving. But if you can adapt to monovision, I don't think that wearing glasses for night driving would be a big deal.
AshMac Deb03
Posted
Thanks for this. Do you think mini-mono would work?
Deb03 AshMac
Posted
I think it would get you a little closer but you'd still need readers. I'd ask your doctor/optometrist for samples of a couple of different powers of toric contacts. Then you can see first hand how it would work. My personal opinion (for what it's worth) is that monovision is a very good option for people who can adapt to it and who want glasses independence. I think a lot of people are scared to try it, but many adapt to it just fine. Another thought just occurred to me. If you are getting new reading glasses when you get an updated readers prescription, have them pop the lens out of the IOL eye in your current readers. If my thinking is correct, that should simulate monovision.
AshMac Deb03
Posted
Great advice! Thank you so much!
Night-Hawk AshMac
Posted
If you can pop the right lens out of the eyeglasses that would be better, thats what I did for a few months after surgery until the eye stabilized to get a new eyeglasses Rx. I also only needed cataract surgery for my right eye and had almost 3D cylinder astigmatism, so I got a toric monofocal IOL for that eye since Symfony toric IOL isn't available in a high enough cylinder for me.
My left eye probably won't need cataract surgery for many years and it has astigmatism but not as high as the right eye was so I could get a Symfony toric IOL for that eye when the time comes or another toric monofocal. I got my right eye toric monofocal set for distance focus, but I need glasses to correct the left eye for now at any distance but I can do a lot around the house now without glasses using the right eye primarily for 4feet and beyond like watching TV. But at the computer or reading smartphone I put on the glasses, I can use an old progressive eyeglasses pair that I just put in essentially a clear lens in the right eye, the left eye lens correcting for both distance and near is good enough for reading and driving and TV, etc. Only at the computer do I use a different pair of eyeglasses, with about +1D correction in each eye plus my regular Rx for an intermediate focus.
Its difficult to get perfect vision with IOL at all distances, so best to aim for just two of the three focus ranges (far, intermediate, and near) - whichever you use the most. I'd be satisfied with far and intermediate glasses free and use glasses for only close fine print reading. So years from now I plan for the left eye to go with either a Symfony toric IOL to get distance+intermediate focus in that eye, or a toric monofocal set for intermediate for computer distance focus about 2feet probably -1D or so, that would be mini-monovision which I did years ago successfully with contacts. I could do that now with a contact only in my left eye but I now have some dry eye effects so contacts aren't recommended at my age (64).
AshMac Night-Hawk
Posted
Thanks for your reply. I am kind of in the same boat. I am going to aim for mini monovision for sure.