Conflicting surgeons opinions on suitability of multifocal IOLs

Infact i have been perfectly happy with my monovision. It is only because of the onset of cataracts in recent years that I'm having to get something done.

I was trying to understand why one surgeon would flatly refuse to offer a multi focal option while another would say I'm a perfect candidate for it and it's a straight forward case.

"This condition is extremely unlikely with monofocals, but not unheard of.". You're completely wrong. Many people, including me, expirence huge dysphotopsia. "Unlikely" is just super misleading. I think you should work for an IOL manufacturer, great propaganda.

Sorry Ad12345 but Chris is right based off statistics. I am deeply sorry you have had a bad experience with monofocals and glare etc. Likely this would have been much worse with premium lenses. There also could have been a miscalculation of power or your pupils dilate beyond the IOL. Statistically monofocals provide better contrast sensitivity and less glare and starbursts than premium lenses but doesn't mean it can't happen.

Have you sought out other opinions? Perhaps there is a reason why you are experiencing these visual disturbances that can be fixed.

Thank you for the resource - all information is helpful at this stage. I suppose I'm wondering, since my cataracts need to be removed and new lens inserted, a) if multifocals might give me a better overall outcome, since that's what he suggested first, before i mentioned monovision and b) since it is being offered as an option now, i should consider it. I have a little astigmatism in both eyes, and he said this could be corrected. I would prioritize unaided close vision( for craft, phone, cookery, and pen-&-paper-writing) and intermediate (for laptop). I'm prepared to wear glasses for distance and night time driving, but would like to be as glasses-free as possible (obviously!) If there's a better outcome to be had, albeit at a higher cost, i think I'd prefer to take it.

My opinion is that multifocals are different, but not necessarily better. I would look at them as an option to be considered, but like monofocal lenses they have their issues too. Have you had your eye measured by a surgeon? The error in our eyes that needs to be corrected with eyeglasses is a sum of the error in the lens and the error in the cornea. The errors can combine to make the total worse, or they can offset each other. Currently your Lasik surgery has changed your cornea error so that it offsets the error in the lens. When the lens is removed in cataract surgery the new lens no longer has to correct for the lens error, just the cornea error. Once the lens is removed you may or may not have sufficient astigmatism to correct for. They can only tell you that when they measure the topography of your eye. My thoughts are that if you have enough astigmatism to correct with an IOL ( 0.7 D or more) and it is symmetrical, then a toric lens is a good choice. The other option is more Lasik to correct any residual astigmatism if it is small.

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Whether or not go to go multifocal is a more difficult choice. I would suggest it is almost certain you will have optical side effects from them. The question is whether or not you can adapt to them. Night driving with a multifocal probably is the worst situation with halos and flare from headlights and street lights. But if you never night drive, then it is not an issue. Or, if you can adapt to driving and ignoring the optical effects it is not an issue either. The next issue is likely to be close vision in low light. Same thing there. If you always have bright light and don't do really fine work, then that may not be an issue either. And there is always the option of using reading glasses. This is where the type A or B personality thing comes in. A type A perfectionist may not adapt well to having less than perfect vision. From a surgeon's point of view I have seen it stated many times is that the key step for them is to screen their patients, and ensure they fully understand they are not getting a perfect solution, and what the compromises will be. Their worst nightmare is having the patient come back and want to have the lenses exchanged because they can't stand them. Responsible surgeons will do their best to screen those people out rather than push them to get the premium lens.

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As far as being glasses free most of the time, if you can adapt well to monovision, then it may be a toss up between monovision and multifocal. The advantage that a trifocal may have is better intermediate vision. To a tennis player "watching the ball onto their racquet" that could be an advantage. The advantage to monovision is that you are more likely to avoid the optical issues like flare and halos.

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Hope that helps some,

i have come to a conclusion that unaided great quality close vision would only be possible with a trifocal. of course i talk about this only for myself. setting symfony at -2.5 would give me great close up but literally no intermediate and far. monofocal would be worse than symfony for this approach. the trifocals will come with the nighttime glare possibility.

setting monofocal or symfony for -1.5 would give me workable near vision bu5 not great near vision. when i saw great i mean hd video on an iphone.

again this is for myself only based on my one symfony exoerience.

what do you mean by type A or type B?

In today's political scene, Trump would be a Type A for sure. Hard to find Type B's at that level, but Biden would be closer to a type B. If you have seen the movie Caddy Shack (my favourite movie) there are some good examples. Ty (Chevy Chase) and Carl the greens keeper (Bill Murray) are obvious type B's. Al (Rodney Dangerfield) and the Judge (Ted Knight) are clearly type A's.

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"personalities that are more competitive, highly organized, ambitious, impatient, highly aware of time management and/or aggressive are labeled Type A, while more relaxed, less 'neurotic', 'frantic', 'explainable' personalities are labeled Type B." from Wiki

It is so true about personality traits and how they influence how a person perceives the outcome of the surgery. When I was deciding on lens options I read somewhere that a surgeon's worse patient is a type A who is an engineer by trade that wants to see a gnat on the back wall of a theatre, has astronomy as a hobby and a Jewish Lawyer for a brother-in-law.

I'll chime in here as someone who took the old-fashioned monofocal route and who also wanted near vision prioritized. I've been quite nearsighted my whole life (-8 in both eyes before surgery), and didn't want to lose the close vision that I've always been used to.

I had -2 Alcon Acrysof IQ lenses implanted in both eyes just over a year ago, with the final result (as of February - no doctor visits since then) being -2 in my dominant right eye and -2.5 in my left, i.e. mini-monovision. I deliberately didn't want to aim for mini-monovision, since I knew from reading (especially this forum!) that there are no guaranteed outcomes, and didn't want to wind up with too great a discrepancy between my eyes.

Long story short...I am delighted. I spend most of my day reading or on the computer, and only put glasses on to watch TV or when I drive. I don't mind wearing glasses (I have progressive lenses) at all, but find that I just don't need them most of the time.

At night I see slight haloes around car headlights, but they are as nothing compared to when I had cataracts, and don't interfere with driving. I haven't had any dysphotopsias. Oh, and I'm a Type B perfectionist. 😃

That would be me, except I do target shooting instead of astronomy, and don't have a Jewish Lawyer (Yet...).

lol