Cataracts lens exchange mix and match
Posted , 8 users are following.
Hi there
First of all - sorry for my English, I live in Denmark 😃
I have read some of the threads in this forum - and thank you all for sharing your experience, so others like me have some help making this big decision 😃
I live in Denmark, here we can get almost any lens from the worldwide marked, I think Ziess and Tecnis are the most common used lenses.
I am 45, and I was born with cataracts in both eyes, my eyesight is quite bad actually, but until now no one have been able to measure my eyes, or take a picture of the retina, because my cataracts are too dense to look through, so no one have been able to tell me, what I could benefit from a lens exchange, so I have not been too keen to jump on the boat.
But two days ago I did find an eye clinic, that had some new expensive very fancy equipment from Zeiss in Germany, that was able to measure my eyes and take pictures of the retinas. And the surgeon finds that retinas looks fine, and he predict I can get a solid result with a lens exchange.
He has been very honest about risks, possible side effects and so on.
I have booked lens exchange in two weeks from now, and I honestly almost can not sleep, I am way too excited, this is something I have hoped for all of my life 😃
The lenses I am going to have is based on the mix-and-match strategy, and off course I am very excited to see the result, but really, almost anything is better than what I have had all of my life, so I am easy to please.
I will have the Zeiss AT Lara in my dominant eye, the known advantage of this lens is relative few side effects, and low contrast lost, you could say a relative safe bet for the dominant eye.
And in the fellow eye I will be getting the Zeiss AT Lisa Tri, that if the eye turns out to be good and accept the lens well, I can get some better reading sight on this eye, and off course the rest of the way it should support the dominant eye.
I have not seen this combination mentioned on this forum, but I have read many cases on other forums, often people have very good results.
Somehow it is like people "only" have the side effects from the lens with the fewest side effects, but often have the best side of both lenses, because they compliment each other and the brain chooses the best of both worlds - a bit strange, but if it works, i will take it 😃
Off course both eyes needs to be good, for this to work , I am not naiv, I know everything have two sides, but we will see in two weeks - I really wish it was tomorrow....
If anyone have any experience with the type of mix and match, off course I am eager to hear about it.
Cheers
Christian
0 likes, 18 replies
Sue.An2 Guest
Posted
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.
phyllis31515 Guest
Posted
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
Guest
Posted
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 😃
Sue.An2 Guest
Posted
Will you have a wait between 2 surgeries? I had 6 weeks and was pleased I did. Often an adjustment can be made for 2nd surgery as the lens can shift till it settles and you end up .25 a diopter either way. During that time discovered I could read just fine without glasses with symfony - you may find atLARA does the job too.
Guest Sue.An2
Posted
Hi Sue
Both eyes will have lens exchange at the same time, but I like your idea, it would be a good way to find out how my eyes react.
Anyway, I have booked the surgery on 17/7, and the lenses are ordered, i need toric lenses as well, so now I just cross my fingers and hope for the best 😃
My surgeon makes more than 1000 lens exchanges each year, an have done that for 25 years, I assume he have made this lens selection according to what he predicts will have the best outcome, based on his experience.
Actually most people gets the trifocals in his clinic, and almost all are very happy with them, so by choosing the Lara for my dominant eye, the surgeon is already taking a bit more conservative approach with me.
Others experince that they "only" get the side effects from the dominant eye, so I guess I should expect the same side effects that you are having - but I know it depends a lot.
Thanks, I will get back after the surgery - if I still can see the computer screnn 😃
Guest
Posted
Hi Sue
I have decided to take your advice, I have right now changed the plans with my surgeon, and in one week I will have the Lara in my dominant eye only, and I will wait for at least one month, before I decide if I will go for the Lara or the Trifocal in the other eye.
Thanks for your good advice.
Cheers
Christian
janus381 Guest
Posted
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.
seeherenow49806 Guest
Posted
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.
Sue.An2 seeherenow49806
Posted
Interesting enough I read an article not that long ago suggesting pco occurrence higher than 30% - should we live long enough! Will have to find that article.
Guest seeherenow49806
Posted
Thank you for sharing your experince.
I will be getiing the Lara in the dominant eye, and yes, I will no doubt have some the negative side effects from this lens, but I think (hope) they will minor, compared to the vision I have had all my life 😃
The trifocal lens I will be getting in the fellow eye have even more negative side effects, but for some reason, people with this combination often "only" have the side effects from the dominant eye.
Anyway - surgery is booked to 17/7, so time will soon tell, if it was the right decision 😃
Cheers
indygeo Guest
Posted
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
Guest indygeo
Posted
Thanks, I amvery excited too, I will have the lens implants on the 17/7, so I cross my fingers and hopes that I am one of those in the positive part of the statistics 😃
tamarinda Guest
Posted
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
seeherenow49806 tamarinda
Posted
Hi Tamarinda:)
Yes, your plan sounds very similar to mine except your non-dominant eye's IOL is multifocal and mine is EDOF. The EDOF has more ranges in the lens (7 or 9, not sure) and the multifocal usually has 3 ranges. I don't have any dip in the mid-range/intermediate, all equally awesome.:)
First - your situation allows you to take your time with these decisions! I waited 4 months between eyes. SueAn said in Canada they recommend at least 6 weeks in between. Don't know how recent your first surgery was.
I wouldn't rush to replace your first IOL That's a more complex surgery, more trauma for the eye in general, and may not be necessary at all if you get the monofocal in your dominant eye. I had no starbursts/spiderwebs at all with the monofocal IOL. With the Symfony EDOF, I did have them with night driving but they subsided quickly as the dominant eye took over for distance.
I still have minor halos in both eyes but WAY less than the cataracts caused! I use a yellow night visor extended from the car visor to help with the glare from LED headlights and light blue sunglasses for driving in general. If it's especially sunny, I use the darker polaroid sunglasses provided by my surgeons..
My dominant eye with monofocal IOL sees extremely well at all distances. I can read my phone, computer, see hillsides in distance. My sister had a similar result, so it may have to do with the shape of our eyes - very long, very nearsighted. Also, I didn't correct the astigmatism in that eye, which my 2nd surgeon said might also contribute to having such exceptional near vision with the monofocal set for not quite plano. We set it for -0.5D and it settled at -0.25D, so - effectively perfect vision except for night time driving in rain or unfamiliar areas. So you may have a similar result if you've been extremely nearsighted, but really can't predict.
If you are seeing well at near & far with your multifocal IOL in non-dominant eye, then your plan to set the dominant eye IOL to perfect or near perfect distance sounds good. You would probably pick up some more intermediate vision with that eye and your brain would sort out the two to give you the best of both. If you still ended up having to close oe eye to read bottle labels, that would probably be well worth the trade.
Wishing you the best!:)
Deb03 tamarinda
Posted
Which monofocal would surgeon use? I would suggest one that is less prone to positive dysphotopsia. Do you know if you have a high refractive index? Evidently those are more prone to the positive dysphotopsia. Mine is 21. Seems like that is a little on the high side but I'm not sure.
Deb03
Posted
Correction. 21 is my IOL power, not refractive index. Sorry for the confusion.
tamarinda Deb03
Posted
I asked for my medical records but it didn't come with all the measurements...just the standard surgical report and clinic notes. I'll call on Monday.
What do you know about which monofocals are less prone to positive dysphotopsia? (and if that's in your previous post about silicone vs acrylic, etc, just refer me back there... I'll dig it up. I check these from my phone and it can be a bit of a maze but I can get on a laptop.)
Sue.An2 seeherenow49806
Posted
Hi seeherenow - yes I knew some people see at pretty much all distances and recall asking my doctor about it. Reply was not to count on that. Wish they could tell who gets that result prior to surgery - would be helpful. Like you I suspect it is shape of eyes and likely pupil size.