Cataract Lens choices

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Hi, I'm about to undergo cataract surgery in about a month and pondering what lens to use.Would appreciate any suggestion for my situation.

I'm 61 and has been nearsighted since youth. My eye prescription is as follows: 

-6.0, -0.75, +2.5

-6.5,  DS,   +2.5

So I'm quite nearsighted on both eyes, slightly astigmatism on my right eye, and moderate presbyopia on both eyes. I've been wearing progress glassed for the last ~10 yrs. The cataract doctor was pretty sure that Sympony lens is most suitable for me. The main reason he mentioned is Symfony lens has the best chance of allowing me not needing glasses after surgery.

The thing is I don't really mind wearing glasses. My main goal after surgery is to be able to see well in all distances even if I have to wear glasses. The research I have on Symphony is it may give me good distance vision without glasses but monitor and reading may be borderline acceptable. Here are my questions:

1. Would it be a good idea that the Symphony lens is set to optimize intermediate and near visions? The distance visions then become borderline acceptable, meaning I can still function without glasses but if I want to sharpen up I wear glasses. So the end result is I will wear glasses to correct mild nearsightedness most of the time but remove glasses when reading monitor and books.

2. Can the above scenario be achieved with standard monofocal lens? Sympony lens is expensive.

Thanks in advance, Robert   

 

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  • Posted

    Others who have gotten the Symfony IOL have reported night vision issues like halos, circles, etc. - so if you do a lot of night driving that may be an issue with it.  It gives about a 1.5D focus range, so if set for good distance vision you get good intermediate (2feet+) as well, but may need weak reading glasses (+1D or so) for near small font and/or low light reading.

    I'd suggest deciding based on your unique focus range priorities - you can most likely get two of the three focus ranges (distance, intermediate, near) without eyeglasses if the refraction result is close to the target.  So decide which 2 of the 3 focus ranges are most important to you and then the targets for each eye would be designed for that.

    If you wish to avoid the possible night vision issues, consider a monofocal IOL in each eye, perhaps with small mini-monovision to cover two of the three focus ranges.  Thats what I am considering for my own surgery.

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    • Posted

      If I could only cover two of the three focus ranges with IOL, then it seems easiest to me to wear glasses for distance as I have done that all my life. What I hope is the distance vision, while not optimized, is not bad enough to prevent me from functioning, like short distance driving in case I forgot my glasses.

       

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    • Posted

      In that case, it might be good to target the intermediate vision eye so its distance visual accuity is not worse than 20/40 (the typical driving exam limit) which may be possible with about -1.0D target in that eye.  But the result is not guaranteed unfortunately.
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  • Posted

    In answer to your questions:

    1. If you are willing to use glasses when needed, my suggestion will be to use monofocal lenses for both eyes.

    If you get Symfony lenses for near and intermediate vision in the 2 eyes, you will not have the concentric circles or glare issue at those distances (which will probably be inside). However, as soon as you put on glasses to see well at distance for driving (say), you may have those night time issues just as if you have Symfony lense set for distance.

    2. You can achieve a better result with monofocal lenses by having one eye set for best focus at near distance (-2.25D) and the other one set for the best focus at intermediate distance (-1.5D). Most people don't have any problem with such a small prescription difference between the 2 eyes. You will be seeing well at both near and intermediate distances well. Also, when you put on prescription glasses to see at a distance, you will not see any concentric circles and the glare will be less than with the Symfony lenses.

    Obviously, you will also be saving lot of money by using monofocal lenses instead of the Symfony lenses.

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  • Posted

    In your suggested desire to set for mild nearsightness for glasses free intermediate and near (reading) focus range and use glasses for when best distance vision is needed like driving, one solution might be with mini-monovision using monofocal IOLs.  One eye could be target for -2.0D to -2.5D and the other eye target for -1.0D to -1.5D.  Symfony would work too with a target of about -1.0D in each eye, but would cost a lot more and might produce night vision artifacts, so its a tradeoff.
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    • Posted

      Both you and at201 mention mini-monovision. I certainly will look into that. One negative of mono vision is depth perception. I play a lot of tennis and is also a biker. So I strongly against it. The mini-version of mono vision is new to me.
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    • Posted

      The depth perception by using monovision has never been an issue for me (have used it for the last 30 years). I don't play tennis, but do participate in lot of outdoor activities such as hiking in the mountains. The depth perception will be an even less of an issue with mini-monovision.

      Please note that with monovision, one is still seeing with both eyes at all distances. One of the eyes has clearer vision than the other, but that does not seem to affect the depth perception. The brain just uses the information from the eye with the clearer vision.

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    • Posted

      Mini-monovision (only about -1D difference between the eyes) should not affect depth perception, compared to full monovision.  However if you plan on using glasses for distance vision which would probably be the case for tennis and biking (also for eye protection) the glasses should correct both eyes for distance so you wouldn't have any monovision while wearing them.

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  • Posted

    Hi Robert - I had Symfony lenses implanted July 10 and Aug 21 respectively.  Surgeon aimed for plano both eyes for distance but I seemed to have wind up with slight mini monovision.  I see well at all distances.  Just had 6 week post op and see 20/20 out of right and 20/30 out of left eye.  Can read tiny print at J1 from 14 inches.  I can read closer too - from 10 inches out.  Have t worn glasses since 2nd surgery.

    However I do see concentric circles at dusk and night.  If you drive a lot at night perhaps you would find that bothersome.

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    • Posted

      Sue.An, thanks for sharing your experiences with Symfony. Do you think your having slight "mini-monovision" is a contributing factor for your being able to see well in all three focus ranges?

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    • Posted

      You are lucky that you ended up with a small amount of mini -monovision even though your surgeon and you had not planned on it. As you have probably found out that it is not hard to get used to and it does offer some advantages.

      By the way, did you also receive a prescription for the 2 eyes? Did you end up with -0.75D or -1.0D in the left eye? Am just curious.

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    • Posted

      I think it may have helped.  Surgeon was targeting 0D for both eyes.  First eye operated on my right eye is OD and I had a 6 week wait for 2nd surgery.  I could see at about 15 inches out to read with just that one eye.  Wore glasses with right lens poked out for this weeks.

      However my surgeon said that for Symfony lenses he only tests for reading once both surgeries are done as they work better together.  When he initially discussed Symfony lenses with me he did say I would be able read well without glasses and only need them for tiny print on pill bottles.

      I am not on regular meds but have grabbed a few from drug store and still think for certain print depending on background I would need +1.0 for that.  But I can read the newspaper or phone book or stock quotes without glasses now.  Haven’t bout a pair of cheaters yet.  The slight mini monovision I have doesn’t seem to bother me (I suffer from migraines which was my original reason for not wanting mini or full monovision).  Been having a bad fall with migraines with this up and down weather - sue hoping weather settles soon.

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    • Posted

      I tested 20/20 with first eye (right) and 20/30 out of left.  Surgeon said with both eyes open I see and test 20/20 so he saw no need for me to get prescription.  I didn’t know I had mini monovision.  He had me read at 14 inches away and I could read the smallest print J1.   He did mention that if I wanted to get readers to get +.75 or +1.0 for tiny print or read long periods of time or in low light.  It has been 6 1/2 weeks and I haven’t experienced a situation where I could not read something.  Nighthawk and Mark wondered if I could read better through one eye or the other and I could slightly read better / closer through left eye that distance wise is slightly weaker.  My surgeon never did test one eye then the other for reading (just distance).  Even prior to surgery he stressed that Symfony for reading works better when implanted both eyes.

      my surgeon doesn’t prescribe glasses - he just said I could get readers at drugstore or see optometrist.  I asked about follow-up and he said I could go back to my optometrist for 1 year check up.  She would refer me again if anything came up.  I asked about PCO and in his email experience about 25% get it in 1 to 5 years with younger patients experiencing it sooner.  He said if vision becomes hazy that I should ask for a referral to see him.

      But I definitely now agree mini monovision not really hard to get used to.  Vision seems seemless.  And there are advantages to it.  Really must be difficult for surgeons to get power spot on.  Unless that was my surgeon’s plan all along my knowing it would provide better range for me?  I sometimes wonder as he sure was a lot chattier after surgeries.  Even mentioned he was my age and if it were him and the choices out there he would have gone with Symfony for his own surgery.  Something he never said prior.  And he was honest to me about the night time visuals.  I have to say my vision is as he originally described it would be.

      Question - do you also think this has contributed to my seeing less strong glare/flare at night?  Do still see the spider webs but those aren’t as difficult to drive with.

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    • Posted

      I was told I would see at all 3 focal ranges anyways with Symfony but the near vision with them would not be as good as a Multifocal lens but they have a dip in intermediate distance (with plano  as target).  Whereas Symfony is an interesting extended focus - quite seamless - no getting used to it.  I really thought I would need a bit of help with small print and i would have to hold things at 14 inches.  But I can pull things to about 10 or 11 inches - no blur.  It is really better than I was expecting and yes do think mini monovision is the contributor to that.
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    • Posted

      Symfony is a premium in a class by itself.  Many lump it in as a multifocal but it is not.  It is an extended depth of focus iol providing a seamless ranGE of vision.
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    • Posted

      Symfony is an "extended focus lens"

      Multifocal lenses usually have only two focal points, distance and  near, so they lack an intermediate (computer, smartphone) distance.

      Symfony covers distance, intermediate and a little near, as a continuous focal range.

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