Best IOL?
Posted , 4 users are following.
Hello everybody.
Goal: I am planning to have having cataract surgery soon. My optimal goal is to have better distance vision without increasing halos/glare at night and without compromising too much of my current reading vision.
Current Vision: My left side is -2.75 Sphere and -1.0 Cyl.
My right side is -6.0 Sphere and -1.75 Cyl.
Heath Issues: Both LASIK and PRK were out of the picture because my right eye has a very thin cornea. My left eye however, can do PRK. Currently, I have dry eye and night time driving is very difficult due to the glare which is sometimes reduced with my glasses.
Questions: I am not sure as to which IOL lenses is the best for my case. I understand that there are three combinations possible(both monofocal lenses, one monofocal lense and one multifocal lense, and both multifocal lenses). One solution my surgeon presented me with is having both monofocal lenses implanted, however I am worried about the loss of depth perception: which is very limited at the time being. Both multifocal lenses to my understanding, would not allow for fully clear vision at all distances(near, intermediate, and far) in addition, halos and glare seem to be a major issue with multifocal lenses. This leads me to be quite unsure about one monofocal and one multifocal which seems to be the best for my case.
Brands: For a monofocal lense, I was leaning towards with a Tecnis Symfony lense or a Softec HD lense. For multifocal lense, I was leaning towards TECNIS® Multifocal or AcrySof® IQ ReSTOR.
Conclusion: If you could please include your age range, what type of lense you chose (monofocal or multifocal and brand), you current depth perception, the severity of night time halos/glares and any opinions you have in hindsight about your procedure would be greatly helpful to me. Thank you to everyone who has commented or read about my situation.
0 likes, 14 replies
Sue.An tracy91956
Posted
First off no IOL is perfect. You will need to decide what is more important for you and then accept the compromises that will inevitably come with the decision you make.
I am 53 and had cataracts develop early and quickly at 52. Vision deteriorated in a year to the point my best corrected vision was 20/60 in right eye and 20/50 in left. I didn’t require reading glasses at the time so losing that worried me. I work full time and value near and intermediate vision.
I chose Symfony lenses for both my eyes. By the way these are not considered monofocals. A monofocal iol will allow you to see well at your targeted distance and have to wear glasses or contact lens for the rest. Symfony are extended depth of focus lenses that give you a range of vision from 16 inches to distance if targeted for plano. I achieved great distance vision (20/20 left and 20/15 in right). For some reason I am able to see from 11 inches - closer than that and it gradually gets blurry.
The compromise I made was night vision. I knew about this from my surgeon. He carefully explained that I would see halos around light sources at night. The glare and starbursts were bad at first. Around 6 week mark these lessened but I see multiple concentric circles around light sources starting at dusk. The circles will never go away as it is part of the lens design. For example when driving I don’t see the circles around brake lights but they do appear when driver applies brakes. Also see them around red traffic lights certain porch lights. They appear more at a certain distance.
If you do a lot of driving these lenses may not be a good choice.
What I do enjoy about Symfony lenses is the great daytime vision they provide. I have not worn glasses since my surgery. Something you may want to consider is a bit of mini monovision. Most eyes tolerate that and don’t lose much in the way of depth perception. A monofocal set for best distance in your dominant eye (wait a few weeks between surgeries for eye to heal and settle) that way you can have non dominant eye set to complement it. If set for .50 diopter neater you should see well at most distances and need glasses just for close-up. That would provide you with less night time visual issues.
It is hard to base your decision on other people’s experiences as each eye (even with same person) is different. My best piece of advice is to research the surgeon/opthamologist as much as the IOL you select. This can be the difference in your outcome.
Wishing you all the best.
tracy91956 Sue.An
Posted
Thank you so much for your valuable insight. I just had some questions for you one being, how bad were the glare, starbursts, and halos before the procedure(if you had any)? Second one being, what was your Rx Sphere and Cyl. before and after the procedure? Finally, knowing what you know now would you change anything about your procedure?
-Tracy
Sue.An tracy91956
Posted
Prior to my surgeries I was having glare issues driving at night. I started noticing summer 2016 that I couldn’t read road signs during the day and at night driving was harder due to increased glare (at the time didn’t know I had cataracts). I waited till Jan 2017 which was beginning of new benefits year for work to get my eyes checked. To my utter shock optometrist couldn’t correct my vision and told me I had cataracts. Waited 4 months to see an opthamologist (nothing mov s fast in Canada). I wasn’t given a prescription but from 2 years prior I know SPH was right eye -3.0 and left -2.25 (didn’t need readers). Not sure for CYL. At opthamologist appointment he said my astigmatism was negligible so didn’t need to consider a toric lens.
I was tested at my optometrist 4 weeks ago as I did want to know my current prescription post surgery so here it is:
SPH for both eyes is plano CYL is .25 right eye and .50 left. Axis is 105 for right and 65 left.
Although my reading tested at J1 at 14 inches she gave me a prescription for readers saying that I may want them for lower light conditions or extended periods of reading. For now reading is fine - iPhone is 11 inches - exactly where I used to hold it prior to my surgeries. Good distance for me.
The glare and starbursts were worse (than driving with cataracts prior to surgery) for at least 5 or 6 weeks. So much so they hid the concentric circles. I even thought I was one of the ones that wouldn’t see those. However the glare/starbursts have greatly subsided and aren’t an issue. That is now far less than what I had experienced with cataracts. Big improvement for me with that. I used to plan my routes to work or driving at night around roads with overhead lighting as that helped. Dark unlit roads were the worst. Now I don’t hesitate to drive anywhere at night. Maybe in fog? But I have yet to experience foggy conditions. But without the glare/starbursts to hide the concentric circles I do now see them. They are lighter and look like a spider web. Depending on how far you are from the light source they are huge - 3 times size of a car when someone applies brakes (oddly they aren’t there around brake lights until that person brakes.) Also notice them on red traffic lights and certain bright LED porch lights. Inside lights are normal/fine. I think one has to be a certain distance to see the circles (my guess 25 or 30 yards). One thing I was concerned prior to cataract surgery were sport field floodlights as my daughter plays soccer. Thankfully these aren’t any more bothersome than before surgeries and I enjoy thhe game - even now see player jersey numbers. With cataracts I was miserable as game and players were blurry. Hard time even following the ball.
Would I change anything about my procedure? Really hard to answer that as it is one of those things you cannot test out. Maybe I would have been equally satisfied with another lens. I did consider monofocals to avoid the night time halos. But I was worried about losing my near vision. I work with a computer and spreadsheets most of my day. I think I was scared of the unknown. Had I already experienced losing near vision and wearing glasses for that it wouldn’t have bothered me so much. I also suffer migraines and need medication for seasickness when on cruises as those are perception issues do I didn’t want to try mini monovision in IOLs. My cataracts prevented me from trying this out with contacts.
I did research my opthamologist and spoke to several of his patients. One had Symfony lenses rest had monofocals. All were satisfied with their results.
I am completely satisfied with my outcome. Yes would love not to see concentric circles at night. But thankfully I was fully aware of these prior to surgery and they were the compromise I was willing to make. If I could see well at all distances - my answer would be different and I would have regretted getting these lenses. For me finding the right surgeon is key. Thankfully in Canada our surgeons are not paid any more if you choose premium lenses. My cataract surgery was covered under our Medicare system and I paid the hospital the difference between a monofocal and premium lens ($900).
Find a good surgeon - one that will dialogue with you about what your visual preferences are. As said there is no perfect lens. So know what your preferences are and what you could compromise on. That will not be the same for everyone. Best of luck to you.
at201 tracy91956
Posted
All the lenses have advantages and disadvantages. Irrespective of the lens selection, you may gain in a good vision in some areas, but may not be able to meet all your desires.
So, you need to be very clear in your mind about the vision characteristics which you are willing to accept. For example, if you want to minimize your chances of having night vision effects such as halos around lights (multiple concentric circles with Symfony lens), starbursts, glare etc, you should concentrate on figuring out the best set of monofocal lenses for you (incidentally, the Symfony lens is not a monofocal lens: it is an Extended Focus lens).
With the monofocal lens, you can have mini-monovision to get either good far and intermediate distances vision (and needing glasses for reading) or get good intermediate and near vision (needing glasses for good distance vision.
I will not advise anyone to get multifocal lenses at this stage. The Symfony lens seems to be definitely better than any multifocal lens in terms of day vision, while being slightly better for night vision issues (although Symfony still has more night vision issues than monofocal lenses).
I have a Symfony lens (set for distance) in my right eye and a monofocal lens (set for reading) in my left eye. I have good vision at all distances beyond 16 inches (don't have to use glasses for any activity). However, I do wish that I did not have the night vision issues (specially multiple circles around lights at night) due to the Symfony lens. Also, I have been used to monovision for the last 30 years with contact lenses so that that was a clear option for me: it may not be an option for everyone.
tracy91956 at201
Posted
at201 tracy91956
Posted
tracy91956 at201
Posted
If you don't mind sharing, I was wondering what your Rx Sphere and Cyl. was in both eyes before and after your procedure.
at201 tracy91956
Posted
Now, after the cataract surgeries and LASIK enhancement, my right eye is plano and the left eye is -2.25D (set for reading) with minimal astigmatism.
Susie91820 tracy91956
Posted
I have the TECNIS Multifocal and I have severe night time halos and glare so bad that when I went to a Christmas outside light display last month I felt dizzy..also issues with depth perception, day and night, that has added an interesting new challenge to my tennis game(I play 3-5 times a week). In hindsight I would go with mono focal lens and wear reading glasses...I still need the reading glasses which is ridiculous because that's why I paid all of the money...not happy. I am 68 and very active.
Susie91820 tracy91956
Posted
tracy91956
Posted
My doctor has recommended monovision, and after the surgery my corrected vision will be my right eye(near) with -2.50 Sphere and the left eye(far) will be 0 Sphere. I have been reading about troubles with focusing when sphere's have a difference of more than 1.5. If you could give me any additional insight along with my prior questions, I would greatly appreciate it.
As a reminder, of my current vision:
My left side is -2.75 Sphere and -1.0 Cyl.
My right side is -6.0 Sphere and -1.75 Cyl.
at201 tracy91956
Posted
2. However, you will be using a monovision, which some people have a harder time adjusting to. Most people will adjust to the difference of about 1.0D in the 2 eyes.
2. I have a Symfony lens in my right eye set for distance and a monofocal lens set for reading in my left eye with good day time vision at all distances (the night vision issues due to the Symfony lens design is a different issue).
3. Assuming that you are thinking of using monofocal lenses, you will find that you have good distance vision and good close-up vision, but not a good vision at the intermediate distances, which you will have to learn to deal with.
4. You will find that aiming for a combination of far and intermediate distances or a combination of close and intermediate distances will work out better. Then, you will just use glasses either for reading only or for looking well at distance.
Guest tracy91956
Posted
Hi Tracy,
I just had one eye implanted 5 months ago with a monofocal intermediate/near IOL (-1.25D) and am very happy with it. (Other eye is -1.5D with small cataract). You mentioned that your optimal goal is to get "better distance vision." I can tell you that going from -2.0D to -1.25D offered much better overall "walking around" vision, without sacrificing too much reading. Though I do miss being able to hold very tiny print close up to read, I really never need readers for most print. Computer and other intermediate vision is excellent. I only wear glasses for driving, TV (sometimes), movies, outdoor activities, & meetings. I have a couple of years to decide about the 2nd eye, but will definitely select another monofocal, as the risks for artifact with multifocal/EDOF are just not worth it. Targeting your first eye at -2.5D is definitely a "safer" choice for good reading, but you may want to consider something closer to intermediate (-1 to -1.5D) for the first eye, then depending on how it goes, you can get the 2nd eye a little more on the near end if you need better reading. Keep in mind that the more near-sighted you are, the more often you'll be wearing correction for distance, therefore requiring more frequent removal of your glasses to read (or adding a bifocal/progressive). Every IOL choice requires some compromise. So far I've found an intermediate IOL to be a good one for me.`(Age 58; Previously -2.0D sph with minimal astigmatism; lens is Alcon AcrySof IQ). Good luck!
Guest
Posted
Follow-up here -- sorry, I didn't see in your other post that you were planning to get 0D sph in the other eye. I would still consider intermediate for one eye (with the other for distance or reading) so the discrepancy is not quite so great, unless you've had experience with full monovision. I know some people do well with it, but best to try it first. I agree with at201 that intermediate/far or intermediate/near would be easier to adjust to, though would require some correction at one end or the other. I would much prefer to use correction for far or near, rather than lose mid-range vision and have to adapt to that much asymmetry.