Cataracts lens exchange mix and match

Hi Christian - first I wish you the very best of luck and pray all goes extremely well for your surgeries.

The likely reason why you've not seen much on the Zeiss lenses is because they are not available in Canada or USA and many posters are from there. Europe offers many more IOL choices. we do have someone who had atLISA implanted in both eyes in Mexico and she is very pleased with result. I have Symfony in both my eyes and am pleased with result. I have better than expected near vision and rarely need glasses and I have read that atLARA should provide a little more range than Symfony. The one downside ate the multiple concentric circles at night around certain light sources. I assume atLARA would be similar. But day vision is really good.

Let us know how your surgeries turn out.

Hello Christian,

I wish you the best of luck with your surgeries. I live in the U.S, and as Sue shared, we do not have as many options in lens choices as those of you living in Europe. I also had the Symphony lens implanted during my surgeries last August and September. I have a Symphony Toric lens in my left eye to address the astigmatism and a regular Symphony lens in my right eye. I am extremely pleased with my results. I do not need glasses at any distance and my vision is excellent. My vision prior to my surgeries was extremely poor. I do see some starbursts at night, but they have not been a problem.

Please let us know how you are doing after your surgeries.

Regards,

Phyllis

Hi Sue and Phyllis

Thanks, nice to hear you both are happy with your results, it makes me even more impatient 😃

The Symfony lens is widely used here in Europe too, often with micro-monovision, and the lens have a very good reputation for being a "stable work horse", people are very happy with them here as well.

And yes off course, I did not think of it, but I have heard that people from U.S. come to Europe too, for the Zeiss lenses, because they are not FDA approved.

I must admit it would feel like a more safe choice, if I went with AT Lara in both eyes, that would be quite similar to yours Symfony lenses, and maybe it would also give me enough close vision to do without glasses in a daily basis.

But the surgeon have made more than 25.000 lens exchanges during the last 25 years, and when he suggested the trifocal in the fellow eye, to give me a bit more reading power and he thinks it will work fine, I rely on his experience 😃

Off course I would like the added reading power from the trifocal if it works, but time will tell if it was the right decision - it is hard to imagine how things can be, when I have had poor vision all my life.

I know the mix and match strategy are sometimes used with the Symfony lens as well, with Symfony in the dominant eye and a multifocal lens in the fellow eye, to add reading vision, and people seems to be happy with it.

So I think the mix and match strategy are invented in the U.S. with the Symfony and are now being adopted in Europe by some surgeons especially after the AT Lara have hit the marked.

It is kind of interesting, i read that the Lisa Tri are trifocal in the center and bifocal in the periphery, so in good lightning where pupils are small they work as trifocal, and when the light is low the pupil gets bigger then the lens works more like a bifocal, to reduce the contrast loss in dim lightning, and to reduce the trifocal side effects. It is crazy what they are able to make 😃

Christian, I'm excited for you too. If you have had severe cataracts your whole life, I think you will have dramatically improved vision after the surgery.

As to mixing IOLs, I would trust your doctor to make the best recommendation based on your measurements. Many patients will get the same IOL in both eyes, but there are also many who mix and match based on their situation.

If you search "The Opthalmologist" and "Mix, Match, and Micromonovision" you will find a three year old article from a doctor who does a lot of mixing and matching, including specifically using a the Symfony EDOF (AT LARA is a newer EDOF lens) in one eye.

Sticking with the same manufacturer for the two eye (so AT LARA and AT LISA) is preferred but not an absolute requirement.

Best of luck. I'm sure you will be happy with your new vision.

That's awesome for you to be getting new vision, Cristian!

Yes, I chose the mix and match micro-monovision. (We've been calling it mini-monvision, but "micro" is more exact, as the difference between eyes is only a half diopter, 0.5D, in my case.) I had to insist on my choice, after reading about good results on this forum) and ultimately chose a 2nd surgeon for my 2nd eye. You are fortunate to have a very up-to-date surgeon with no financial incentive to choose anything but the best option for you!

I have a monofocal standard lens in my dominant eye set for distance, and a Symfony Toric in my right eye set for 0.5D less distance. I've been extremely happy with the result, with perfect vision at all ranges. (I've developed some PCO in both eyes about a year after surgery, so will be having a YAG procedure in 3 weeks. I've read this happens in about 30% of patients.)

My only caution about your plan is about which lens you place in the dominant eye vs. night time driving artifacts (halos, starbursts, etc.) I don't know if the Zeiss IOL's have similar artifacts as the Symfony, or which of the 2 IOL's you're choosing would have more artifacts, if any.

I found that having the monofocal lens in my dominant eye set for distance made it easy for the brain to adapt and "Tune out" the starbursts in the nondominant eye set for intermediate/near. (The starbursts are most visible at distance, hence the monofocal dominant eye set for distance without artifacts.) I can see them if I look, but most of the time my brain ignores them now, as they have diminished with time.

Congrats on your decision to do a lens exchange. Sounds like anything will be better than what you have currently. Indeed, I expect you will be absolutely blown away by the improvement in your vision. Please let us know how you get along after the surgery. I'm excited for you and excited to hear about the change in the quality of life you are about to experience.

Regards,

IG

Christian, this is so exciting, thank you for sharing your journey. And since I read on another thread that you've done your first eye now, CONGRATULATIONS!! I am curious to hear how it's going for you.

Thank you, too, to the others who recommended some articles. It's truly so helpful.

I have a Tecnis ZKB00 multifocal in my non-dominant eye (it was worse so done first) set for 20/20 at distance, and now have lots of halos and ghosting (even with the moon and stars) so the original plan to put a multifocal in my dominant eye was stopped. I have good vision near with that nondominant eye, and stellar vision far, with a bit of difficulty at intermediate, say, in dim museums. Also when I'm tired it wanes a bit.

I now have to decide what to do in the dominant eye which has a steadily worsening cataract. My instinct says to go monofocal in the dominant, and maybe change the multifocal out for a simple monovision approach.

So I began correcting my dominant eye partially with a contact lens to simulate what a distance monofocal would be like, and that made the halos much much better on the roads. On a computer, however, it made the ghosting worse because now that multifocal eye is the only near eye, and reading small print on labels requires me to close my dominant eye to isolate the multifocal eye.

My other concern is for which distance I should set the monofocal. I believe my ophthalmologist will recommend having it a little nearsighted to complement the multifocal and help with reading. But if I end up wanting to switch out the multifocal entirely and go for mini monovision, then I would want that dominant eye to be plano. I must say, after 30 years nearsighted and 5 years with a cataract, the infinite visual acuity is delicious.

So it feels like I have to make the decision about changing out the multifocal before I can truly compare.

Would love to hear people's thoughts, if any; I hope this isn't a hijacking of Christian's thread (if so, please advise and I'll create a new post). @seeherenow49806 it sounds like you are very close to what I might end up with. How close in does your dominant monofocal eye see? Do you ever use reading glasses to balance out the input? How long did it take your halos to fade (or did you only have starbursts)?

With much gratitude,

tamarinda