Cataracts - op to be done for close work or distance - advice please.
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I need my cataracts done and I'm very scared! I'm extremely nervous about the op itself and also about the outcome and making a wrong decision: For various health reasons and being in a lot of pain I'm not out and about very much and when I'm at home I use my iPhone and iPad a lot when I'm sitting down. if I have my eyes done for distance which is what the majority of people have, I would have to use glasses every time I want to send and receive a text message, look on Facebook, use the iPad, look something up etc. - and because of this I've been advised to have them done one close and one close--and-a-bit. I'm also concerned that if they are done for distance I won't be able to see properly to do my make-up, particularly eye-make-up, which is important to me. I will be quite happy to wear glasses for driving, TV, cinema and theatre, which is what I do now. If any ladies have had their eyes done for close vision rather than distance, can you tell me can you see ok to use your iPhone and do your eye make-up? Equally, any ladies who have had their eyes done for distance vision, how do you find it for using iPhone, seeing texts, and doing eye make-up? Apparently make-up glasses are a huge nuisance and not terribly successful. Any advice from either a patient or a professional would be most welcome. Thank you very much.
0 likes, 34 replies
primeland marion22818
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primeland marion22818
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primeland
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getwellsoon marion22818
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jean76494 marion22818
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I am writings novel and I was feeling the same as you I opted for the dual lens - like variafocal lens. Suffering at the mo with flickering and light flashes along the side of my eye. Hoping this will pass it know it is a problem just from this site. I think if I had gone for the single lens I would be doing the same. I'm still struggling a bit but much better (its easy to alter text size for text and email on iPhone. I'd check with dr to see how strong lens you would need too. Good luck with the op. Jean
marion22818
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etc., or whether any ladies hsve found that having standard lenses ie for distance, can you see really close up to do your eye make up and if not how well can you see close-up with a magnifying mirror? Or is it a huge nuisance? And do any ladies use make- up glasses? Thanks for reading this and I look forward to your replies.
primeland marion22818
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As for getting two distance single focus lenses, I have been near sighted all my life. I am used to seeing things up close and need glasses for distance. I tried putting in two distance single focus contact lenses to simulate what it would be like to have two single focus distance lenses put in when my cateracts were removed. I have to tell you it is very uncomfortable for me not to be able to see up close without glasses. I wake up in the morning and go to the bathroom and I cannot see my phone or who called me because everything up close is a big blur. And I have to find my glasses to be able to see up close. When driving I cannot see anything in my car that is up close without glasses. Just a big blur. I went to take my medications and realized I had no idea which pill bottle was which because they were all just a big blur. So two distance lenses are out for me. I am now trying one distance and one intermediate and that works pretty well but I am told that I won't like monovision if I never had it before and that my contact lens simulation is not as good a test as I think. But at least I can see intermediate and distance and at least I can see my phone and read my text messages.
So I am either going to get two intermediate or one distance and one intermediate. Getting two close seems a little restrictive and one intermediate and one close, if you are going to get monovision, might as welll have one of them for distance.
Or I can just wait and see if technology brings somethign better in next couple of years. It will, just who knows when. I hope this little analysis helps you. I have put tons of research into this.
marion22818
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anyway, Primeland, if you could just tell me if you could have seen close enough and wanted to put eye make up on really close up, would you have been able to with the distance/intermediate trial lenses - and with or without using a magnifying mirror. That was my other query, with the new vision, whatever it is, would one be able to see clearly close up in a magnifying mirror or would it be blurred as your new vision is fixed.
By the way I was told that having one distance and one close if you haven't previously worn contact lenses is likely to be very problematical as the brain can't adjust to the new vision. I had a trial of contact lenses like this at the opticians and felt completely disorientated. (I did try contact lenses to see what the post op result might be like - and tried and tried to get on with them and found them extremely difficult. I just about managed to get them in but had great difficulty in removing them, so much so that I managed to burst a blood vessel in one eye because I had unknowingly pressed too hard trying to get the wretched things out! So I gave up on that idea!). Anyway I look forward to hearing from you, and many many thanks. And if anyone else can answer the make-up query Please let me know.
primeland marion22818
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Seems like u r a female version of me so I think I can answer your questions.
1. As for contacts, I am exactly the same as you. Cannot stand anything touching my eye. Cannot even put in eye drops because I cannot keep my eye open to put them in. I have to put them in the corner of my eye when it is closed and then try to blink the liquid in. Putting in contacts is hard enough but I am getting better at it. Doctor charged me $21 for a "lesson". After they wanted to charge me another $21 when I couldn't get them out, my local eye glass doctor helped me and YouTube was a much better teacher. There is even someone on their who figured out a way to get them out by blinking without even touching your eye at all. Did it once in one eye but haven't been able to duplicate it since. It seems like everytime I try to get them out, they get lost somewhere. Not on my shirt, not on the table, not on the chair, not on the floor. They just vanish, hopefully not somewhere in my eye. I can slide them off my pupil but have difficulty grabbing them to get them off my eye entirely. What a difficult procedure. OMG!!
2. I am naturally near sighted in both eyes so if I put one distance contact in my left eye (the one with the more dense cataract) and do nothing with the right eye, I am simulated monovision with one distance and one near. I never have worn contacts before except when I was a teenager. I kind of liked it. It was great to drive with no glasses and I could see close up clearly too. No headaches. No disorientation. However, I only tried it for a few hours since I did not want to go past 7PM, the time when my local eye glass doctor closed so that if I could not get the contact out, I knew I could always drive to his store and he would help me. Didn't want to go to the emergency room to get a contact out. Yes, if I were a woman and wanted to put on make up, I would have no problem with one distance and one close up according to my simulation. Magnifying mirror was not necessary but it would be better to use a magnifying mirror. I use magnifying mirror to take my contacts in and out and can see perfectly (aside from the cataract which of course makes it not perfect)
3. Next I put one distance in my left eye and one intermediate in my right eye. Again, I liked it. Could see my phone, pill bottles, caller id, and computer. Computer not so well, but maybe because of cataract and maybe because contact was generic free samplel off the shelf and not tallor made for me. Nothing is crystal sharp because I have cataracts in both eyes, more dense in the left. Could I put on make up like this? Yeah I don't think that would be a problem.
4. Then I tried both eyes with distance contacts. OMG! Not being able to tell what time it is on my watch and not being able to see the caller id on my phone or to look at the digital phone directory on my land line phone as I scroll thru it, is kind of like being blind. You just cannot see anything. Make up? Not a chance. With magnifying mirror, maybe, but safe to tell you, not a chance. Anytime I wanted to see anything at all close or intermediate I had to put on a pair of $20 reading glasses I picked up at Target for this purpose. It was cool to see distance but when I went driving and wanted to see even my GPS it was difficult. Supermarket, forget about it. Cannot read any product boxes unless I put my Target glasses on. I didn't like it at all. But of course I have cataracts so you have to take that into consideration.
5. So would I do monovision? Well my cataract doctor, who has done over 70,000 cataract procedures told me I wouldn't like it and that my contact lens experiment was not such a good indicator. Plus I have not lost both my contacts and am waiting now a week to 10 days to get replacements in the mail. My surgery was scheduled for Monday but I cancelled it because I am undecided on what to do and want to longer trial with the monovision.
6. You can try accomodating lenses. The only one approved by FDA is crystal lens by Bausch and Lamb. I read that it works off the muscles that control your capsular bag of your eye (whatever that it is) and that, as we eye, it gets hard and less pliable and you lose the "accomodating" features of that kind of lens and it goes back to monofocal. I also read of a new accomodating lens that allows you to see all distances without the problems of multi focal called the Sapphire AutoFocal IOL, the next generation of accomodating lense which does not have anything to do with your eye muscles or the capsular bag. It actually works off software and how your pupil changes when you look far, near or intermediate. You can google it but it is probably a few years away from being available. Article was from 2013 and said it was 2 years away from starting FDA clinical trials.
My cataracts are annoying but not critical. One doctor told me if they were not interfering with my life style I should wait until they do and he told me to come back next year. I have met my insurance deductible this year out of pocket so surgery is free for me this year and not free at all after dec 31st when my deductible starts all over again. But for me, it is my eyes and I don't want to let money dictate my decision. You use your eyes every second of your life except when you are sleeping. AT this point, it looks like I may just put the whole thing off until next year or even year after. I just cannot decide and maybe need longer contact lens experience. I think in about 5 years from now they will have lenses that will see all distances with none of the problems of today but don't know if I can wait that long.
Hope my lengthy comment helps you. For me, I would love to hear from someone out there who has been near sighted all their lives and see what kind of IOL choices they made and if they are happy with their selection.
primeland
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marion22818
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All the best, and I hope you make the right decision and that all goes well.
softwaredev marion22818
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I would suggest that a contact lens test is worth trying if possible, even if it is only for a day or so to get some idea, or even just for a few minutes in the office. The issue is mainly whether cataracts have degraded your vision too much for contact lenses to give a good sense of what your vision would be like, which is likely the real problem. The contact lenses can set your eyes to about the same distance they would be after surgery, but the quality of vision won't be as good due to the cataracts. You also wouldn't get a good idea of how much nearer vision you'd have from that distance, depending on how much presbyopia you have now.
You mention Moorfields, which might mean you are getting the surgery done via NHS. If so then as far as I'm aware the only choice is monofocal lenses and not the accommodating lenses posted about above (I'm in the US but as far as I know the UK is like the US where government plans, and insurance, only cover the basic monofocal lens). If however you are getting private treatment at Moorfields (they have a private clinic as well as NHS) then in addition to the accommodating lenses they also have multifocal lenses which give you a broader range of vision, like the Zeiss AT Lisa trifocal. Most people have great experiences with the lenses, but there is a greater risk of visual side effects with multifocal lenses, such as seeing halos at night from headlights and othr lights, but only a small fraction of patients find that to be a problem. There is also a new lens called the Symfony which gives a wider range of good vision than the monofocal with risks of halos comparable to a monofocal, so overall if you are willing to spent he extra money it is a good bet since it improves the range of vision without much risk of any added problems.
In my case I went to Europe to have cataract surgery and get the Symfony lenses (since they aren't yet approved in the US, but are over there) and I have almost 20/15 distance vision, and 20/25 near vision (so I'm guessing 20/20 at intermediate). I can read the small print on my eyedrop bottles, and use my smartphone without trouble, though everyone's results differ. If you chose to have the lenses set for intermediate vision rather than distance you'd likely have very good near vision. I'm a typical male who has no idea about what sort of vision would be required for makeup unfortunately, I'd guess a cheap magnifying mirror might be required. Any of the types of premium lenses (accommodating, multifocal, or "extended depth of focus" like the Symfony) give you a wider range of vision than the monfocals, meaning even if you set them for intermediate you'll have better near than you would with a monofocal (or you could set them for a bit further out intermediate).
primeland softwaredev
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thanks
softwaredev primeland
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After I got the Symfony, the US approved some low add bifocals earlier this eyar which seem like a fairly decent option for those who need surgery soon in the US. They will still split the light which reduces contrast sensitivity. I don't know if you'd tried multifocal contact lenses since those have the same issue. I never found it to be a problem with multifocal contacts when I wore them, but with the Symfony I have noticeably better low light vision than I had with the multifocal contacts (a restaurant I have a weekly meeting in has lower light and I'm so familiar with it that I immediately noticed the difference looking at the menu, and the room and people). If the low add bifocals were available in the US at the time I might have considered going for those rather than traveling, but the Symfony still seems a better bet.
Someone I know about the same age here had the Crystalens implants, and oddly even though those are a single focus lens, he notices a drop off in near vision with lower light. I met him after a lecture in a well lit auditorum and he had a near reading chart, and even holding a folder over the chart to cast a shadow was enough for his near vision to be reduced, but it didn't make a difference for mine. I don't know for sure how much is optics of the IOL vs. personal variation in our eyes.
The optics of a multifocal contact lens aren't exactly the same as multifocal IOLs (likely not as good as an IOL meant to last decades and not move as much), but they are still a good test case I think to get some idea. The fact that I preferred multifocal contacts to monovision contacts was one reason I was interested from the start in a premium IOL. For instance even though I'd not noticed a reduction in stereopsis, 3D vision, when wearing contacts in monovision a few years, when I switched to multifocals I was suddenly aware of what I'd been missing, near objects did seem more 3D.
The Symfony has recently been approved in Canada, which isn't as far to go (although it may be comparable to US prices). I don't know if the trifocals are available in Canada, but I know the AT Lisa tri is available in Mexico in clinics that seem to be likely US quality treatment that are located just over the border from San Diego (at least one mentions they will transport people from hotels on the US side of the border to the clinic) to take advantage of the differing approval policies. I hadn't evaluated clinics in either country since they didn't have the Symfony a year ago.
I had decided to go to Europe to get a better lens, and then discovered the UK was somewhat expensive and that there is a medical toursim industry elsewhere in Europe to take advantage of that, with the Czech Republic a common destination for high quality treatment at lower prices. I figured that as long as I was traveling, if I could get high quality treatment I may as well go for a lower priced country. I was only 52 when I had the surgery so I figured it was worth some hassle to get a better lens since I may be living with it a few decades, and since I'd been highly myopic all my life I liked the idea of not needing correction anymore.
Most doctors here didn't have any trouble with the idea of doing followup visits (though ask around, a minority seem to dislike following up other people's patients), there is nothing medically different about the Symfony compared to other IOLs, the optics are just different. It is the same overall physical shape and material as the widely used Tecnis lenses in the US. Also, after I had my surgery there have been Symfony trials in the US so some US surgeons do already have experience with it. I think the trials are over since they have submitted data to the FDA (if there are any trials ongoing for the Symfony in the US, it may not be a good option since at least the initial one I heard of was randomized, a 50-50 chance you'd get a monofocal).
Since I spent a great deal of time on the computer (as my username was meant to indicate re: my visual needs), intermediate distance is important and when I had my surgery done a year ago the only bifocals available in the US were high adds that weren't as good for intermediate vision, and in a small fraction of patients the Crystalens doesn't provide anything more than a monofocal (and has some risk of complications other lenses don't have, like z-syndrome, though the newest version seems to be better). I'd had good luck with multifocal contacts so I wasn't worried about going for a multifocal, so initially I'd expected to go outside the US for a trifocal lens to get better intermediate. Then the Symfony came out, which has better intermediate vision than the trifocals, but not as good really near. I figured that was an ok tradeoff to make since it also has contrast sensitivity comparable to a good monofocal and lower risk of problematic halos, comparable to a monofocal (some folks see halos even with a monofocal).
I turned out to be in the minority of patients who do see halos with the Symfony, but they are translucent, I see through/past them, so I don't find them to be a problem. Overall as far as I can tell my night vision is better than it was before I had a problem cataract, less glare from headlghts for instance, which makes up for halos from headlights. I'm not sure if being atypically young to get lens replacement made seeing halos more likely with any lens.
Intermediate vision was important to me since aside from computer distance, it includes most social distance and household tasks, TV, etc. I also realized after the fact that since I hike&run on trails around here that its useful to have crisp intermediate vision since that is what you are using to pick out your footing amidst rocks and avoid icy patches during the winter (even just for normal walking around outside during the winter its good to be able to spot ice of course, unless you live in a warmer area). I think the trifocals would still have been good enough for that, even if their intermediate isn't quite as good, I can't picture how much difference it would have made.
primeland softwaredev
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softwaredev primeland
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I may do micro-monovision eventually via lasik. Unfortunately I wound up with one eye plano, but the other perhaps +0.5D hyperopic which reduces its near vision, so I may bring that in to -0.5D someday to give me a bit more near (I haven't noticed a great need for it, but it just seems a waste to have the eye hyperopic). So actually the near vision to read my smartphone is mostly coming from one eye due to the other eye being a bit hyperopic. Unfortunately there isn't an exact formula to determine the lens power, it is based on statistics of past operations, and usually for most people its accurate but for high myopes for various reasons it can be off a bit and it was in my case for that eye.
Distance vision is comparable to a good monofocal, mine was almost 20/15 a week after surgery and is probably at least that now since subjectively it seems like it improved a bit during the first few months as I adapted to it. I'd always been highly myopic, but even with contact lenses I can't recall my distance vision ever being corrected as crisply as it is now with the Symfony. I don't know whether some of that might be because of the extended depth of focus which means more things are in focus at once, whereas before surgery the eye would be accomodating to change focus to see objects at different distances. Even a year later when out hiking I'm still constantly appreciating how good my distance vision is (and intermediate, rocks on the trail being in crisp 3D).
Yup, the way it transitions from intermediate to near is more natural than a multifocal since there aren't 2 or 3 different peaks of visual acuity. Just like with presbyopia, the further out you hold something the crisper the focus is but the smaller it is. There is no hunting for a "sweet spot" the way there might be in theory with 2 different focal points. That said, with multifocal contacts I don't recall ever consciously thinking about the hunt for the "sweet spot". To me the Symfony feels like vision just when presbyopia started to become noticeable but where I didn't really need glasses aside from things like threading a needle, perhaps vision like in my early to mid 40s. I don't notice that I need to hold objects out further to see them or anything, I hold my smartphone at a natural distance. It is only say reading the fine print on an eyedrop bottle for instance where I had to hunt for a good distance to be able to read it. I think I made the right choice of lens for my case. I do sometimes wonder what the added near of a trifocal would be like, but I think the crisp intermediate vision and better low light vision, etc, is worth the tradeoff. I'd guess my intermediate is 20/20 or 20/15, I hadn't measured it but its in between distance and near in quality.
You'll see comments from many US surgeons who are optimistic about the Symfony, one recent video I saw interviewing a US surgeon who is an expert at a conference on treatments for presbyopia asked what he would do if he had to get cataract surgery this week, and he said he'd likely go have one of his European colleagues implant the Symfony.
There is another "extended depth of focus"/possibly-accomodating lens that is approved in Europe, the WIOL-CF, but there isn't much data out there on it yet so I'm not sure its an improvement over the Symfony, it seems perhaps comparable. It sounds like the manufacturer is doing some more trials and refinement before trying to widely commercialize it, which suggests some caution. One reason for that I suspect is that it doesn't have haptics like most lenses (the arms that stick out to hold the lens in place) and instead relies on filling the capsular bag to stay in place. One surgeon commented via email that he is concerned that the lens wouldn't be as stable for that reason, and there is one article talking about a couple of cases of disolated WIOL-CF lenses, though I don't know what the statistics are to know if it is really an issue.
There are some next generation accommodating lenses in early clinical trials around the world, but it'll be a while before they are even approved in Europe and due to the issue of them needing to move (and to continue to do so for decades) it may be a technology to be cautious about when it first comes out. The Symfony is the same material and shape as the rest of the widely used Tecnis family of lenses. The only new technology in the Symfony is the design of the optics and that isn't something that requires movement so there is no issue of how well it survives wear like there is with an accommodating lens. Optics are something they could easily study on optical benches outside the eye, and model on computers, to be sure they got it right.
primeland softwaredev
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It seems like the symfony is the one for me and, if I understood you correctly, if you had it to do all over again you would have gotten the same symfony lenses put in as what you had and that you have no regrets and are happy with your decision. The press i read on it says that it transitions better for all focal lengths, not just from intermediate to near, but from distance to intermediate too, and even from distance to near and back again. Of course I am not expecting it to be like when I was 20 but I started wearing glasses for near signtedness when I was around 15 so I've always worn glasses for as long as I can remember. My reasons for wanting the symfony are many. 1. better transitioning, 2 better low light 3 better contrast 4 doesn't move like accomodating so no wear and tear issues 5 can see all ranges of vision without glasses and 20 /25 for near is certainly acceptable for me. 6. Don't have to wait years for approval since it seems approval for U.S. is around a year away before it is commercially available here. 7. the nice guy from softwaredev from the cataract forum got them and is very happy with his decision.
And how about halos and sensitivity to glare? You mentioned you see them but it is a very minor inconvenience when compared to the severe halos and glare you can get from the standard multifocal IOL's our there today. Also I heard that with the premium lenses you run a higher risk of secondary cataracts. Have you had any issues with that? And I assume of course that the haptics are a non issue to you, that you don't feel them and wouldn't even know they were even there unless you were told about it, right? So the only thing that a tri focal would give me is maybe some better near vision and not wroth the trade off of all the other known issues with today's multifocals. So I was thinking both eyes at distance, which is what you got, right? When you are talking about minr or micro monovision, what exactly are you suggesting? If you got both eyes with symfony for distance and wound up seeing now as you do, I would be very happy with that. Would not want to sacrifice distance (and hence have to wear glasses to drive) just for a slightly better near. thanks.
softwaredev primeland
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Hyperopic means far sighted, the opposite of nearsighted. That means that it takes 0.5D of the "depth of focus" merely to see distance, which means I have 0.5D less of near vision in that eye. That eye doesn't have any astigmatism. Both my eyes were targeted for distance, so ideally that should have been 0D. In retrospect I should perhaps have gone for some tiny amount of monovision. Since that eye is farsighted, which isn't of any use, I might consider a laser tweak to make it slightly nearsighted instead for micro minovision.
Plano means 0D, no spherical refractive error. I should add that eye has perhaps -0.5D of astigmatism which means it isn't perfectly corrected, but that isn't enough to notice, it might give a minuscule boost to near (since that is the "spherical equivalent" of -0.25D, but the fact that astigmatism adds blur may cancel that out).
Yup, I think the Symfony was the right choice for me, and still would be. If I'd stayed in the US, perhaps the +2.75D Tecnis bifocal would have been my choice. Yup, as I said it won't give you the same degree of acccommodation, near vision, as you had when you were 20, perhaps more like early to mid forties. Your distance vision may be comparable or better though than when you were 20 due to the correction for chromatic abberation beyond what a natural lens has.
There are lots of articles and videos on the net about the lens now where you can see surgeon's comments, all of which tend to be positive. The only study I've seen that was a bit negative regarding its level of near vision was one where it showed the patients wound up even more farsighted than my one eye is, so it isn't surprising they lack near vision.
Unfortunately things like halos vary with the person, and some people have problematic halos even with a monofocal lens, so you are merely playing the odds, and the odds are this is comparable to a monofocal. Back even before cataracts I still always was bothered by glare from headlights, and I seem to notice less glare from them with the Symfony, which may be part of why I don't find the halos to be a problem. The risk of "secondary cataract", PCO, has diminished over the years so its fairly low with any lens these days, and it has to do with the material&overall shape of the lens and its edges, and not its optics (the curve for the optics isn't the issue). The surgeon who did my last followup here said he would bet that the way I was healing I'd never have an issue with PCO.
The haptics are a non-issue in terms of the patient perception, you don't feel them, they are merely what holds the lens in place. The Symfony has regular haptics, again it is the same shape as the other Tecnis IOLs like their monofocal and multifocals. It is the WIOL-CF that doesn't have haptics, instead relying on the lens being physically larger and almost filling the capsular bag to hold it into place as the bag heals around it. Some surgeons suggest that is a good approach, I've just heard from one who is skeptical of the idea (but has never implanted the lens) and saw a paper talking about cases of dislocated WIOL-CF IOLs. However I haven't seen any statistics, those cases may have been rare, and even lenses with regular haptics can be dislocated. I admit I'm curious about the WIOL-CF and how it would compare to the Symfony, they are fairly different designs. In retrospect it might have been better in my case since I have a rare side effect of light flickering that has nothing to do with the lens choice (at least among lenses other than the WIOL-CF). Rare as in one out of tens of thousands perhaps or more, I never got any surgeon to give a guess.
Highly myopic people usually have larger eye structures than average, including a larger natural lens. The IOL is physically the same size no matter what power it is, so for a minority of highly myopic people when the natural lens is replaced by a smaller artificial lens, the iris can lose support and jiggle when the eye moves (not in any way that others notice, but I caught mine doing it on video from my phone). Usually that is harmless and never noticed, but in rare cases it seems to be responsible for a flickering side effect that I have. My iris is light colored, blue, but has darker striations, so when the iris moves the stray light coming in through it changes, which causes flickering when my eyes move a lot in order to read. It is headache inducing when trying to read for a long time, but my brain has been slowly learning to tune it out. In retrospect I wonder if the larger WIOL-CF lens would have supported the iris better, but its too rare an issue for others to consider when choosing a lens. That side effect is part of why I keep checking eye related forums and opthalmology news, in case any way to deal with it appears that the surgeons I've talked to hadn't come up with (they suggest that any possible treatments risk more harm than good and its best to see if my brain will eventually tune it out completely).
primeland softwaredev
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So you would have preferred a bit larger lens so as not to have any flicker or jiggle, but that is not available at this time. Is it something I should bring up with my doctor whether I have a large, normal or small iris in comparison to the lens he would be inserting? But other than this new WIOL-CF lens you mentioned, all of the IOL's are the same size, right, whether you got monofocal, multifocal, accomodating or symfony extended range, right?
Anyway if you had it to do all over again wouldl you get the exact same distance symfony in both eyes or would you get one distance symfony and the second eye at a near or intermediate symfony too?
For me, I don't see any emergency of having to do this immediately so if I have to wait a year for the symfony to be commercially available in the U.S it seems like it would be worth the wait. I shied away from the multi focal since my doctor told me about all the side effects and didn't think I would be a good candidate since he considered me a "picky" person and I said to him that if I would be a little "picky" and dissatisfied with a not so perfect multi focal IOL, how unhappy do you think I would be not being able to see what time it is on my watch if I got two monofocal for distance? To me, this is a decision I will likely live with for the rest of my life so if a better lens most of the benefits of a multi focal without the side effects is coming out in a year, why not wait and try to be able to achieve great vision without glasses.
Do you wear glasses now or do you keep a pair handy for reading very close or other such tasks or are you completely glasses free. Would a pair of glasses be able to tweak what you have now without glasses to make you see even better or are you pretty much max'd out with what you have now?
softwaredev primeland
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Micro or Mini monovision merely refer to the size of the difference between the eyes compared to regular monovision where the difference is fairly large. In all cases one eye is set for distance, the issue is how far in the other eye is set. Micro is the least difference between the eyes, one eye set just a little bit in, e.g. perhaps -0.5D, mini a little more, say -1.25D, regular say -1.75D (though those numbers are just illustrating the issue, there is no strict definition for the dividing lines).
The WIOL-CF wasn't intentionally trying to get rid of haptics due to a problem with haptics, its intention is to be a larger lens that mimics the natural lens more closely. The side effect of making it larger is that they think it doesn't need haptics to stay in place, and that there isn't room for them. I can't recall if there is a toric version of the lens, since that would present more of a challenge since toric lenses need to avoid rotation since they aren't symmetrical.
The WIOL-CF is approved in Europe, but it is not being actively marketed or commercialized last I read since the company is instead focused on refining it and testing it more, which suggests caution before considering it. At the time I got my surgery there wasn't much information out about it so it didn't seem worth the risk, and I had no clue I'd wind up with a rare side effect that in hindsight might perhaps have been alleviated by using that lens, but even that possibility is pure speculation. I haven't seen enough data from the WIOL-CF to get a good sense for how it compares to the Symfony in terms of visual quality, so far I'd consider the Symfony a safer bet. It is just an option to keep an eye on if someone is waiting another several months.
Other than the WIOL-CF, other IOLs tend to be approximately the same size, with perhaps only slight differences between brands/models that aren't as big a deal as the difference with the WIOL-CF.
Out of the options available, if I were doing the surgery today, the Symfony would have been my choice still (given that I wouldn't have known about my rare issue that appeared after surgery and shouldn't be a factor for others). Based on my experience, I'd have targeted one eye for distnace, but targeted the other for -0.5D, especially knowing that in highly myopic people the lens power can wind up being off slightly (I don't know if you are highly myopic to the degree that is an issue). The Symfony results suggest that the average patient still has a bit better than 20/20 distance vision even with -0.5D of micro-monovision. The Symfony manufacturer's give the results of one study on their site showing the results for different levels of micro-monovision. I guess I was playing it safe initiallly targeting both eyes for distance though, its perhaps simply because I see the results I got that I'm thinking after the fact that micro-monovision might work well, though I'll try it in contact lenses. Some surgeons offer a package deal where when you get a premium lens, if the power is off then after surgery they include the cost of doing a laser enhancement to adjust your eyes to hit the target.
Wearing reading glasses can improve near vision with the Symfony, or monofocals, or an accommodating lens. It will also improve near vision with a multifocal, though of course it moves all the focal points in so it may be trickier to find the "sweet spot".
For visual acuity purposes, the only time I've felt a need to wear glasses so far is for threading a needle. I never have any with me when I leave the house, I don't need them for phone, watch, shopping, etc. I mentioned the rare side effect of light flickering which is problematic when reading (due to the constant rapid eye movements leading to jiggling), and so even though I don't need glasses to see the computer clearly, wearing them seems to cut down on the flickering side effect so if I am on the computer for more than a few moments I tend to wear glasses to cut down the flickering. If I didn't have that rare side effect, I wouldn't use glasses for the computer or reading. It is still slowly improving so I'm hoping the flickering will eventually go away and I won't bother wearing glasses at al.
However results do vary by person, studies just show average results, so there is a chance you'd need reading glasses with both eye's set for distance. Using a slight bit of monovision would make it less likely you'd ever need glasses for any reading, but would reduce distance vision a bit, so it depends on your priorities and which visual range you'd risk giving up a little on.
The side effect I have is so rare and unpredictable there isn't really anything to ask the doctor about since they wouldn't have a clue beforehand, and most surgeons never encounter it. Iridodonesis, iris jiggling, is a rare risk for those who are highly myopic, but even those who have the issue are never aware of it since its innocuous. Among those rare few who do have issues from it, it seems mostly those with light colored eyes, and many see it go away quickly. Mine is an unsual case. Often those on forums like this are atypical patients and have encountered things the vast majority never need to worry about.
primeland softwaredev
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One of the reasons I am postponing my surgery, the main reason being I want the symfony, based upon everything I have read (and based in large part to your helpful comments from a patient who is actually wearing them) is because every doctor I speak with tells me something different. Nobody takes the time it seems to really care if they get it right I am the one who will be wearing these things likely for the rest of my life! With so much uncertainly, better of to wait for the symfony. But what is confusing to me now is, whether my distance would be like wearing a -2.0 contact lens or a -2.5 contact lens, if I just got my left eye a micro monovision of -2.0 or even a -1.5, if intermediate is all the way to a -.75, how is having an IOL set to -2.0, or even -1.5, going to do anything at all to help my near vision? And if it does nothing to enchance my near vision, which you tell me you have uncorrected 20/20 with both eyes set for distance, why would I give up any distance accuity and perhaps even a slight depth of field (the problem with monovisoin, at least for with monovision, is you lose your depth of field perception I have been told, not only just some sharpness) ? Thanks.
primeland softwaredev
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softwaredev primeland
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I am guessing your dry eye won't disqualify you, but I don't know for sure. I didn't have any issues with dry eyes before surgery so I perhaps didn't pay attention, but I don't recall seeing much concern over dry eyes for patients considering multifocals, it tended to be mostly concern over more serious eye health issues or things like corneas that are too irregular from prior refractive surgery.
I have read sugeons comments suggesting that they are likely to consider the Symfony even for patients who have some eye issues that make them not a candidate for multifocals, and that most patients are likely candidates for it. Even though it isn't a multifocal though, it does use a diffractive lens, and that complicated optics might potentially be an issue for some minority of patients, but I don't know what the limitations are. I suspect some doctors will be cautious at first until more study is done.
The sign of the numbers being used can be a bit confusing when talking about this. If someone uses a -5D lens usually for distance and they want to instead be focused in a bit near, say 1 diopter more myopic, targeting a focal point of -1D (which puts the best focus at 1 meter) that would mean they'd use a -4D lens.
In terms of monovision, the issue is how much the near eye is undercorrected for distance compared to what a perfect precription would be. It isn't clear which of those numbers you give is your usual perfect distance prescription, so I'll use an example. Lets say person A usually wears contacts with -6D for the left dominant eye and -5D for the right eye , both corrected for full distance. If they were going to have micro monovision of 0.5D they would undercorrect the right eye so it was left a little nearsighted, so they would use a lower power lens. They would use -6D for the left eye and -4.5D for the right. For monovision of 1D they would use -6D for the left and -4D for the right. Of course if the person wanted monovision targeted at intermediate for the "distance" eye then both numbers would be altered, e.g. bring them both in by 1D to make it -5D for the left and -3D for the right to give 1D of monovision with one eye targete
You don't mention what your usual distance prescription would be in contacts to guess at why they are giving different numbers. It may be that one doctor is suggesting not to use full distance correction for the distance eye, but to undercorrect it a bit to give you more intermediate and to lessen the difference between that and the nearer eye. People who are undercorrected for distance a little bit can still have 20/20 or 20/30 vision at distance and see well enough to drive.
One problem with trying to simulate monovision prior to cataract surgery is that monovision with contacts is different from monovision with monofocal IOLs if you are young enough to still have accommodation (e.g. being 52 when I had surgery I had presbyopia, but still some accommodation left), For instance a 20 year old wearing a contact lens for distance will still have great near vision in that eye, but if they were given a monofocal IOL for distance they would of course not have much near vision. To give a 20 year old the feel for what a monofocal IOL set for distance would be like, they would need to give them a contact lens that made them so farsighted that all of their accommodation would be used up just to be able to see well at distance, and they wouldn't be able to see well at near anymore. So for someone around 50 to give them a good sense of what a distance monofocal might be like, they might make them slightly farsighted in their far eye to reduce some of their remaining accommodation, say if there usual prescription were -5D for that eye they might give them say -6D or -7D to leave them a bit farsighted, which reduces their near.
Actually my uncorrected near is around 20/25, which might be a bit better than average, but since that is tested at my "best near" I'm not sure. The average uncorrected near with the Symfony set for distance in both eyes is closer to 20/30 according to the data on the Symfony site, with the average distance acuity a bit better than 20/16. With 1D of monovision the average near is almost 20/20 and the average distance is still almost 20/20.
primeland softwaredev
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So you are suggesting that if I get -2.5 in my left eye in a symfony lens, that I should consider a -2 in my right eye OR if I get a -2.0 in my left to consider a -1.5 in my right to have mini monovision and that that will somehow make my near vision better, even though the correction doesn't even come close to the -.75 I am told I need to even achieve optimal intermediate in a monofocal? Of course I will pose the same questions to my doctor but I am asking you because the are already wearing the symfony lenses, both set for distance.
softwaredev primeland
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The difference for monovision is the difference between each eye's best focal point (not the prescription). If one eye is focused for distance, 0D (whether it takes a -5 or -10 lens or whatever to do it), then for micro-monovision of 0.5D (a focus at 2 meters) your other eye would be corrected 0.5D less than the power to correct it for distance (e.g. if it takes -6 to focus that eye for full distance, it would instead be corrected -5.5D to have it focused best at 2 meters).
The further in your best focus is for an eye, the more near vision you get. If your eye is focused best at 2 meters, it can see a bit closer in than that (due to "depth of focus" which lets you see some number of diopters closer in than your best focus), and you'd have more near than if it were focused at infiinite distance. If your eye is focused best at 1 meter then you'd have more near than if it were focused best at 2 meters. The amount of near vision you get depends on the depth of focus of the lens, but the closer in you move its best focus the more near you get. Picture it like holding a rule in front of you pointing ahead where ruler is the depth of focus, you move the farthest point of the ruler in or out, and the near point of the ruler moves in or out. The Symfony has a larger "depth of focus", like a larger ruler, so it already provides some decent near even when targeted at distance, so moving its best focus in a little bit helps your near.
Unfortunately the ruler isn't an exact analogy, since a 0.5 diopter difference is a different meter difference depending on whehter you are going from 0 to -0.5D or from -2D to -02.5D
Also I should note that these are using the sort of diopter measurements you'd use in contact lenses to achieve monovision. The actual IOL power would be a bit different (since it is replacing your natural lens, rather than adding a contact lens on top of it), though you don't really need to know those numbers . Even though you are myopic it would be a positive power, e.g. for example it might be say +18D for distance and then for monovision it might be say +19D to correct your eye a bit closer in.
primeland softwaredev
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I will let me doctor explain to me more thoroughly what my options would be for micro or mini monovision. Thanks.
softwaredev primeland
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In terms of halos I didn't say you "wouldn't experience any at all", I said the odds are low that you will (and if you do, low that you will consider them a problem). Even monofocals leave a minority of people with problematic halos, so there are no guarantees. The risk of halos is merely comparable to a good monofocal like the Tecnis (I get the impression some monofocals may even have higher risk of halos).
My low light vision like in a dimly lit restaurant is better than it was with multifocal contacts, and I don't notice a problem with it. It can't recall well enough what it was like with regular single focus contacts several years ago so I don't know if its as good as that, but it isn't a problem. Comparing low light vision to someone here about the same age who has the Crystalens, he seems to have a noticeable drop off with even slightly dimmed lighting (despite it being a single focus lens), which I don't have.
The last test I had for distance I saw almost 20/15, I suspect it is 20/15 since subjectively it has improved, and at near I saw 20/25. Intermediate I didn't explictly test but is somewhere in between, likely 20/20 to 20/15 depending on the distance.
In terms of the results of others wearing the lens, obviously they have some in the studies if you learn the jargon to read the results. The ASCRS and ESCRS conferences have searchable abstracts that give several study results, in addition to what shows up in articles on the net and on the manufacturer's site.
primeland softwaredev
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softwaredev primeland
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If you do micro-monovision or mini-monovision that lowers the odds you'll need reading glasses. You could also opt to wear glasses for distance and have both eye's set in a little bit, e.g. -0.5D for one to focus best at 2 meters and -1D for the other to focus best at 1 meter for a bit of micro monovision and make it even less likely you'd need reading glases. That would give you great intermediate vision for social interaction and household tasks, and lower risk of glasses for near. Or you could bump those in even further, -1D and -1.5D, though it seems likely having one eye at 2 meters would be useful to cover social settings, like someone on the other side of a larger dinner table, and other intermdiate tasks beyond computer distance.
As I said some people get problematic halos even with a good monofocal lens. There is currently no lens in existence that can guarantee you won't have problematic halos, its merely a matter of risk. Even with good multifocals only a small minority have problematic halos. The risk with the Symfony is reportedly comparable to the risk with a good monofocal, and likely better than some monofocals.
Again, trifocals might give you more very near than the Symfony, at some slight reduction in intermediate. I finally saw more info on the new Panoptix trifocal which sugggests it might be a little better for intermediate than the currently widespread trifocals. Links send messages to moderators and I don't know how long that takes, but if you do a search there is an article on the new Panoptix trifocal in Ophthalmology Times from December 1, 2015.
primeland softwaredev
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softwaredev primeland
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I am just one example and since results vary I may be atypical. If their impression about the statistics were right then I might merely be one of the lucky 10%. However other studies I've seen on ESCRS and ASCRS sites suggest that most people don't need reading glasses, if I recall correctly the worst case figure I'd seen is perhaps 20% may need readers. You might try checking with places in Europe that have been using the Symfony longer to see what they say in terms of their statistics.
I've seen the London Eye Hospital reference to a quadfocal but I haven't seen any indication of what model lens it is. It may actually be the Panoptix trifocal which I've seen refered to in one place as being actually a "modified quadfocal" design, but which most places refer to as a trifocal. I haven't seen any other reference to a quadfocal IOL so thats why I suspect they may be stretching the definition a bit when even the manufacturer seems to be marketing it as a trifocal rather than quadfocal. Yup, it will likely have lower contrast sensitivity than the Symfony, though the design is supposed to minimize that and I haven't seen a direct comparision. The studies seem to show less loss of contrast sensitivity than I would expect, in some cases better than the average for age 50-75 (but that includes up through like age 75 which presumably includes people with natural lenses still that are clouded even if not enough to have led to cataract surgery). I get the impression the loss of contrast sensitivity than multifocal contacts, which I had no trouble with and that many are happy with.
re: "assuming I will not have these issues with the Symfony"
Again, there is no guarantee with any lens, including monofocals, that you won't have problematic halos. The odds again are comparable to a good monofocal. Studies show contrast sensitivity also comparable to or better than a good monofocal, and better than the AT Lisa trifocal (the only head to head comparision I've seen between the Symfony and a trifocal).
primeland softwaredev
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softwaredev primeland
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it isn't "too good to be true" in the sense that of course you don't have the same level of accommodation someone in their 20s does, for some closeup tasks glasses may be needed, even if rarely. Occasionally there will be a need to thread a needle or whatever other infrequent small near task. Some people prefer to risk the potential negative side effects of a multifocal to get a bit more near. I haven't seen enough studies to be sure about the Pantoptix trifocal, but since it has a bit better intermediate than the Finevision, along with good near, it might be worth considering for some
There are many surgeons who do think the Symfony is a major advance and will have a big impact on the premium lens market because it does seem it improves on a monofocal with no (or statistically insignificant) added risk.
Even if vision is great at intermediate and decent at near, if your best focal point is at distance then glasses can always be used to improve things for other distances. Its just that usually they aren't needed, and the difference may not be apparent.
I assume progressive glasses should be able to be used with the Symfony if desired as well, perhaps focused on intermediate&near, even if hopefully they aren't needed. For the most part vision with the Symfony is similar to early presbyopia, and since it is a single focus lens (even if the focus is "extended") I can't think of any reason why progressive glasses wouldn't work, even if I hadn't read of people using them with the Symfony. Progressive glasses might also be usable with a multifocal IOL, I hadn't read about it, though its possible the multiple focal points would confuse someone as to which point in the progressive lens is best to look through. The Symfony is a single focus so that shouldn't be an issue. I don't know if multifocal contacts would interact well with the Symfony's optics or if for those who like them that would be an option as well to get more near. (I don't know enough about the exact details of the optics to be sure, or whether the multifocal contact would interefere with the method to extend depth of focus).
If you are putting off surgery, I would suggest keeping an eye on the Panoptix to see if they do any direct comparisons with the Symfony and if more comes out about the risk of halos&glare. I've only seen one article with any data on the lens, not enough to be sure what to think. It may be that its new design is better than existing multifocals in terms of side effects. and that it will give more near than the Symfony.
There is another new IOL that seems to be getting less attention and study, the "Mini Well". There hasn't been enough info available to evaluate it well, but if you are waiting on surgery I thought i'd mention it is another to keep an eye out for if more information appears. I don't know how it compares in terms of contrast sensitivity and risk of side effects since it is sometimes described as "extended depth of focus" but also sometimes as a "progressive multifocal" (but that may be because people are used to the word "multifocal"). The fact that its getting less attention may be because it is less promising, but its possible that is because it doesn't have an existing big player in the IOL market behind it. One study suggests it is perhaps slightly better than the Symfony at certain pupil sizes, but that wasn't based on patient data but merely based on an optical bench study and and it didn't give statistics on the other factors like halos&glare and other factors to get a sense of how it compares. I suspect its less likely to be approved in the US anytime soon since I haven't heard of any clinical trials, and because it doesn't have an existing US company in the IOL biz behind it.