choosing the correct lens for cataract surgery

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I have been trying to find what people think is the best route to go with my second cataract surgery. My first was done almost 3 years ago. I chose to have it done because I also had a macular pucker and I wanted it cleared up so that only the pucker was the problem. I had surgery on that in January and my vision is quite a bit better but will not be any where near normal.Everything is still blurry but best at vision for about 10 feet away. I asked the Dr about getting the right eye for close up work. He really didn't want to do that and is suggesting intermediate. Before presbyopia set in I was normally bi-focal with one eye near and the other far sighted. I want to be able to do computer work, reading and handiwork without glasses. I don't mind wearing them for distance. I was given the choice of Crystelens (?)+ $1900, Symfonic + $3800 or standard + $0. We are retired and I could manage any but it would be somewhat a pinch with the Symfonic. I'm worried that if I go with the intermediate, I'll need glasses all the time. Any advice is greatly appreciated.

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  • Posted

    That is a tough decision.  I would difinately get more than one opinion.  I still think Holland Eye is above every other in the State of Michigan.  Pull up YouTube and look for: Fox17 News:  Laser Assisted Cataract Surgery With Multifocal Lens implant at Holland Eye.    I caught it on the evening news one night and it was a done deal.  I made my appointment and had it done.  We are very happy with the follow through that Doctor Snyder is doing with me.  If anything... do get a second opinion with Holland Eye Surgeons if you live in Michigan.
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  • Posted

    I think that you should pick the best focus distance for the lens for the second eye based on what your desires are.

    If you will like to read and do computer work without glasses (and use glasses for distance), you may pick the monofocal (standard lens) for best focus at 16 to 18 inches. However, I will have 2 potential associated concerns. Firstly, your eyes will need more of an adjustment to monovision (It was very easy for me, but other people have a problem). Secondly, the distance glasses prescription difference in the 2 eyes will probably be more than 1D, which tends to cause difficulty in getting used to wearing those. If you don't want to deal with these concerns, getting the monofocal lens for distance (as the surgeon has suggested) will probably be a better choice.

    In your particular case, the Symfony lens may offer advantages. With this, if you set the best focus to about 32 - 40 inches range, you should be able to see well at reading as well as the intermediate distances. The amount of monovision is much smaller, which will make it much easier to adjust to. Similarly, the difference in the distance prescription will be low and the brain should be able to deal with it much easier. Thus, with the Symfony lens, my suggestion will be go for the best focus range of 32 - 40 inches.

    However, the price of $3800 for the Symfony lens seems to be too high. I paid $2200 extra for the Symfony Toric lens in the Seattle area. The price included LASIK enhancement, if needed, after the cataract surgery. (I ended up needing LASIK enhancement)

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  • Posted

    I went to the dollar store and purchased a pair of readers at +150. I popped out the lens on the left as that eye already has a new lens. I am going to try wearing these full time for a couple of days to see how I do. I have the on right now. I have a slight head ache. Distance isn't great. I can seee my big wall clock and tell the time, but it's a bit blurry.The computer is great. Haven't done much reading yet. Hoping this will work. I will check to see if I can find the symfony any less.

     

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    • Posted

      The test you are doing is actually combining the 2 concerns which I had in one package: the monovision and the double vision due to the different size images due to the different  prescriptions for the 2 eyes inglasses. Thus, this is a more difficult combination.for the brain to deal with than what you will have with the monofocal set used for reading and the prescription glasses used for distance. Obviously, if this works, that will be great. If it does not and you want to give a more fair test for monovision, you may have to try wearing a soft contact lens of +1.5 in the right eye (unlike glasses, contact lenses don't cause the discrepancy in the  image size).

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    • Posted

       I posted this on the other page (perhaps keep responses on this one for those following your situation). For those who missed it: I will note that if the cataract is noticeably degrading vision then of course it isn't a prefect test. Also the range of vision you have in from there may be different with a monofocal IOL than it is now, depending on how much remaining accommodation you have in that eye. A monofocal IOL may be less than near than you are getting in this test. A test with a contact lens might be a bit closer to what the result would be like than trying it with glasses, but it'd still not be fully accurate due to the cataract and any remaining acommodation.

      What the other poster was referring to is the issue that if you have different lens powers in glasses (in this case 0 power in one and +1.5 in the other),  that each eye is seeing a difference size image. Glasses  change the size of an image, even if most people don't notice it when both powers are the same.How much they change image size depends on the power of the lens. If the image sizes are almost the same, then your brain merges the images and you don't consciously realize there is a difference. If the image size is tooo different then your brain may struggle with it. However now your experiment has  a lens power difference of only 1.5 diopters, which is within the range most people adapt to. For those curious to google it, the  issue is anisometropia (two different lens powers) leading to aniseikonia (two different image sizes leading to problems merging the images). Except it isn't an issue in your case it sounds like.

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    • Posted

      Thank you. No, it does not seem to be an issue. But, during this test, I do wish I could put on my distance glasses at times. smile Do you think the least expensive lens will work for me or should I try to get the Symfony? Again, thanks
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    • Posted

      oops, re-reading that I seem to have more typos than usual, sorry, posting quickly to get on to other tasks. 

      I posted a bit more below before I saw your response here. What distance do you do this "handiwork" at? Unfortunately it tends to be hard to get much of a range of near vision in addition to distance since a small change in distance at near is a larger change of lens power. The diopters to focus at a specific distance is diopters= -(100/distance_in_cm). So to focus at infinity you are at 0D of myopia, to focus best at 2 meters you are at -0.5D of myopia, 1 meter is -1D, 50 cm is -2D, 25cm is -4D, 10cm is -10D. The range of vision you get with a particular IOL will be a fixed number of diopters, so in terms of inches/meters, a 2.5diopter range of vision gets you more of a range at distance than it does at near. If it were focused best ad distance it might give good vision  from 0D=inifinity to -2.5D=40cm, wheres if it were focused best at 1 meter it would go from -1D=1 meter to -3.5D = 28.6cm. (sorry for using metric, but the formulas are based on that, there are conversion calculators on the net, or the chrome browser will do conversions in the address bar without needing to leave the page).

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  • Posted

    Unfortunately since it sounds like vision in your first eye is subpar, its unlikely you'll get everything from distance through handiwork without glasses. A Symfony set for distance has decent odds of getting up through reading, but if you are talking about even closer "handiwork" (an ambiguous phrase) its not clear what the odds are. I have 20/25 at near with it,  but for say threading a needle I'd use readers.  As long as your vision in this second eye isn't degraded by other eye health problems, if cataract is the only issue,   a  Symfony set a bit nearer in, like say a best focal point of -0.5D  (a +0.5D reading add) which is 2 meteters, would likely still provide decent distance vision and have a bit more near, though how much varies with the person and it isn't clear if it'll be good enough for "handiwork". A Symfony set at -1.5D  (the +1.5D add you are testing) would provide a greater range of vision than a monofocal would to provide more of a chance of doing handiwork without correctoin, though you'd likely want distance glasses. 

    The reports I'd seen from surgeons are that the Crystalens doesn't provide quite as good near as the Symfony. Also since the Crystalens requires the eye to accommodate a bit while the Symfony is a static lens that doesn't need the eye to accommodate. That   means that even if an eye with the Symfony and an eye with the Crystalens   test the same on a near vision chart, you may get eye strain with the Crystalens that you wouldn't with the Symfony for doing more extended reading. The results seem a bit less predictable with the Crystalens, some seeming to only have the range of vision they'd get with a monofocal. There are also a higher risk of some uncommon complications due to the movement of the Crystalens, e.g z-syndrome (which is reportedly lower risk in the newest model Crystalens, but not gone, though I hadn't seen good data). I know someone   the same age with the Crystalens who also seems to have more trouble in dim light (which may be a statistical fluke since light needs vary by person, increasing with age). We talked in a well lighted auditorium after a lecture, and he had a near vision chart with him to compare results. If he held a file folder over top of the chart to cast a shadow on it, that was enough to reduce his near vision by some lines, though it didn't impact mine (but again 1 anecdote may be a statistical fluke, and I hadn't seen data, but the Symfony's correction of chromatic aberration may be helping it due better in dim light).  

     That said, I don't know how much of a risk you are at for macular issues in that eye given you had issues in the other. I've never had reason to look into them since I haven't had macular issues, I don't know if that may impact the IOL choice. I know some surgeons are wary of multifocals with those at risk of macular issues. They don't seem as concerned with the Symfony since its optics are different from a multifocal,  but I figured I'd mention that some surgeons may not be up to date on the issue since there isn't much data yet on the topic. One site reports (google to find it) on using it with challenging eyes with other eye problems aside from cataract that  weren't candidates for multifocals but went for the Symfony:

    "This 1-year review also found 82% of patients that presented with contraindications for multifocal IOLs, including 19 patients with retinal pathology, 29 with high-order aberrations, five with amblyopia, four with high hyperopia, 13 with high myopia, four with severe dry eyes and one with ptosis. In addition, 24% of patients had significant conditions such as epiretinal membrane, lamellar macular hole, dry age-related macular degeneration, cystoid macular edema and even one patient who had suffered a stroke, resulting in a large visual field defect in both eyes. I would never consider these patients as candidates for multifocal IOLs, but the Symfony IOL afforded them 20/25 uncorrected distance and intermediate vision, and 20/40 uncorrected near vision?—?visual results that are identical to those in patients with normal eyes."Though that likely should have said "almost identical", normal eyes have better results on average, but the point was that despite other issues the results were about as good as could be hoped for when there are other eye issues.

    As I posted on another page (for those not reading that), its odd to see the Symfony listed at twice the price of the Crystalens, is there any chance someone there gave the price for 2 eyes instead of one? Usually premium IOLs are priced about the same. I also suggested checking around for prices, including checking elsewhere in the country if you are able to travel (this poster said they can't) since the price difference may be worth it even including travel expenses. I traveled out of the country (which most people won't, I did it before the IOL was approved in the US) and got it   cheaper in the Czech Republic even including travel.

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    • Posted

      Thank you. The retina specialist says I have no signs of macular degeneration though I suppose further down the road I could as my grandma had it and I do have drusens. Not sure if the burst blood vessel on my facial nerve has anything to do with my other eye issues, left eye, or not but highly suspect they do
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