Anyone transition from multifocal contacts before cataracts to multifocal IOL?

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Hello:

I am 50 and having cataract surgery in February. I've read what I could on this issue (and this forum) and based on advice in this forum, I decided that I'd trial multifocal contact lenses before cataract surgery. I am fortunate in that the cataract in my left eye does not yet affect my vision (only in the right eye) so I figured it was worth taking this step to 1) determine if my brain could possibly adapt to simultaneously having multiple focal points and 2) see if I could potentially go with a monofocal IOL (for distance) coupled with a multifocal contact (distance plus intermediate) or if I should stick with my original plan to go with a low-add multifocal IOL

I started a lens trial on Monday and I adjusted to the multifocal contacts within a day or so and the results are quite good. I chose an intermediate ADD to approximate what I’d end up with in terms of a multifocal IOL. My distance isn’t fantastic but I think that might be a fit issue. It’s not bad but not nearly as sharp as with my prior contacts. However, my intermediate distance is fantastic. If I could get a little sharper distance, I’d be very satisfied with this setup. I’m curious about others who did use mutifocal contacts before surgery and then went with multifocal IOL’s. I’d be using the Restor 2.5D for what it’s worth and here are my questions:

1)    Was the loss in contrast/low-light detail comparable between the two? I’m fine with the slight loss I have experienced with these lenses but not sure if the loss with the IOL would be more.

2)    I think I understand the differences in the types of halos endemic to multi-focal IOL’s (vs other types) due to the 2 distinct focus points and that a distance point light source should produce a specific type of halo that would be central spot of light with a gap and then a ring of light around this. I could not come up with a situation that would induce this artifact. Perhaps that was due to the specific lens design. I did notice added glare and more of a “blob” look to light sources, with LED headlights and street lights being the worst. However, the size of these “blobs” were small enough that I didn’t feel it impacted my overall vision too much and I’d easily make this trade to get back useable intermediate vision. I drove in a dense urban setting, away from the city and during rain and I was always able to identify people and other objects sufficiently in all cases. I did rotate back and forth between lenses and glass and this effect was definitely due to the contacts. Is there a specific type of multifocal contact (brand/model) which would be more likely to create similar halos to the multifocal IOL’s.

3)    Were you able to achieve excellent distance vision with the IOL and was this better than what you could achieve with the contacts?

4)    I noticed no discernable dropoff in vision between maybe 24 inches and 10 ft. I’m assuming that this is due to some accommodation left in my natural lens and that I will notice a dip with the IOL (assuming my near point is targeting 24” for best focus). Does this seem accurate?

5)    Any other thoughts or things I should test? I’m using Acuvue 1-Day Moist Multifocal lenses now and these are center near, so maybe not as close of an effect to what I could get to the IOL? My optometrist is happy to let me trial as many lenses as I wish over the next few months.

Overall I’m pretty optimistic as I know that a monofocal IOL coupled with a multifocal contact should give me a good result. I kind of like the option of being able to remove the contact, for example before an extended drive, if needed. Thanks.

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  • Posted

    As I am just a few weeks from going MF contact lenses to monofocal I cannot answer some of your questions but can add some comments on the MF contact lenses in case that helps.

    Acuvue is one of many I've used and my current contact lens (I have 10+ powers/adds in stock as I experimented with that for months). Your Acuvue 1-Day intermediate add is an up to 1.75D whereas one of your IOL options is an up to 2.5D add.  Acuvue's high add is up to 2.5D add (where most MF contacts top out) so perhaps a better comparison, however if you try that add you'll get a marked drop in distance clarity, which is why Acuvue and some other MF contact manufacturers suggest a mix of medium and high add as their top tier.   The problem is also comparing a daily lens quality with a probably 250x dearer IOL. 

    The loss of distance clarity is normal, my wife recently transitioned to MF contacts (Acuvue 1-day medium add)  and immediately complained of loss of distance. However a few weeks later and she no longer notices unless comparing with glasses as she has just got used to it.  

    For night time effects, no matter what make or type of MF contact I've tried I have only ever experienced increased glare around light sources and perhaps a fraction more starburst than with my glasses (I always have some).  No rings or other issues and never enough to be a major issue other than just not quite as good as glasses.

    Each MF contact lens has a different distance/intermediate/close balance. For what its worth the Acuvue are better intermediate than most at the cost of close (their +1.75D is not as other manufacturers with the same add) and then distance.

    For me the weakest area of MF contacts and probably MF lenses in general is close and intermediate focus in dim light (not dark) situations. This is understandable as pupil dilation reduces the use of the near part of the lens.  The reverse isn't of an issue as bright light and small a small pupil 'aperture' gives good depth of field.  Due to this a few years ago I tried the CooperVision lenses with an option on centre near/distance in all variations and it didn't give a better compromise so went back to the usual centre near.

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  • Posted

    You can get mono vision IOL . Where one iol is set for distance and one iol is set for near & intermediate 

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    • Posted

      Thanks, but I've ruled out monovision for the IOLs. I tried that before with contacts but could not tolerate it. Just like now with a cataract in one eye, I alternate opening and closing my eyes 100+ times per day to compare the focus, so no way could I deal with that for the rest of my life.

      If I go with multifocal IOLs I may opt for slightly different add powers, but for distance I want both eyes be identical.

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  • Posted

    My eyes couldn’t cope with mono vision as I had a muscle convergence in my eyes . Monofocal has been good for me and I have had no issue with the double vision I had before my operation due to the muscle convergence 
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