decision on type of cataract lense.

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I have severe astigmatism both eyes.   69 yrs/old.  my eye surgeon in Dallas has given me 3 lense options:

1. basic lens implant-- AcrySoft IQ IOL Monofocal Lens- free with medicare, my golfing buddy has this, says it is great

2.  Toric Monofocal-- im not a candidate, will correct distance only

3.  SymFony Toric/ Multifocal Toric--- they seem to press for this one but

      a.  i read a lot- im a lawyer by profession

      b.  i see several postings complaining about glare/ night driving problems/halo

       c.  i have been wearing glasses 24/7 for 30 years, doesnt bother me, and i do not lose them like i might lose readers if i dont need glasses for everyday..



1 like, 10 replies


10 Replies

  • Posted

    Why were you told you were not a candidate for monofocal toric?  I would think you would be a candidate for that .  Especially if they are pushing g for Symfony toric.  

    Get as much info as you can in these 3 options.

    Are you still working as a lawyer at 69 or retired?

  • Posted

    Well, once again I have absolutely no clue. And, once again, I continue to be absolutely amazed by the info you people have! Remarkable! 

    I know you'll get great feedback from this group. Learned more from them than I did from my doc!👀👀

  • Posted

    Hi, all I can attest to is my personal experience. Had #3 on your list performed in February of this year. From day one have been having terrible night vision.

    Surgeon who performed cataract surgeries was first in denial. Then in May he performed YAG on one eye. Vision did not improve at all. When I pushed for answers/solution he finally said, only solution was to replace lenses.

    I then decided to move on until I could find a doctor who could solve my issue. Consulted a cornea specialist who will perform the lens exchange. He adviced me not to perform YAG on left eye as that makes replacing more complicated. He also prescribed bifocals for me to wear. It's helped with my vision but not night vision problems.

    Seeing him next week so hoping for the best.

    Saying that, I believe I am in the small percentile of failure or something gone wrong. My astigmatism which was supposed to have been cleared with the toric lenses have worsened by 75%.

    PROS. The world seems a more colorful place than it was before.

    Unfortunately though like even right now and wearing the glasses, my vision tends to get blurry at times.

    So, although I paid for the best lenses it just made things way way worse than pre cataract surgery.

    Eventually it's your decision. Weighing the higher percentile of success against the lesser failures.

    Good luck

    • Posted

      Thanks veepee.  Your night vision problem is exactly what i am concerned about with the SymFony lens.  I wonder whether night vision problems are likely with the standard cataract replacement lense.

        I expect to work several more years as a lawyer with lots of close reading, and am used to trifocal glasses 24/7.   Does anyone know where one can get statistics on the problems with the various lenses?


    • Posted

      I have a Symfony lens in one eye - waiting for 2nd surgery later this month.

      With one eye done see from near 16 inches to distance well.  If you need to read closer likely readers would be necessary.  Waiting  on 2nd eye to be done to see if I will want readers.   I have to hold iPhone out further than I was used to.  Perhaps that will become new normal or I will get readers.

      Night time - I do have some glare.  Also see conentric circles around certain type of lights.  I have been able to drive though at night.  Decided I was ok with this compromise as my day vision is really good and seamless from near to far.

    • Posted

      If I was in your position I would research the best eye surgeons in town. Am not too far from Dallas and the cornea specialist I will be consulting is in Dallas.

      I really don't know how things work out well for some and not for others.

      In my case there was no discussion with my opthalmogist/surgeon. He decided, I accepted. Really, get someone who'll really talk to you. Not a doctor who thinks he's God. That, in my humble (having only been a HS grad) opinion is the crux of the matter.

    • Posted

      if your current opthamologist is pushing for a particular lens you may want to seek out a consult with another surgeon.   If you live in USA a number of them are motivated by $$$ than what's best for patient.  

      Agree with a201 you'll want to have the astigmatism corrected- visual outcomes will be poor without that corrected.

  • Posted

    I am 71. Have severe astigmatism both eyes. Was very near-sighted. Had cataract surgery done on both eyes two years ago. Had AcrySoft monofocal lenses implanted, under Medicare. I'd always worn glasses with progressive lenses and before surgery the opthomologist said I would still need glasses, due to astigmatism. Surgery on first eye went fine and settled down within a few days but second one took over a month to settle down, which is not unusual. Then, I went and got my new Rx and glasses. Took about another month for my eyes to adjust and "normalize" but my vision has never been better. Crisp and clear, and no night halos. I am VERY GLAD I got the monofocal lenses during cataract surgery, even though I still wear progressive lens glasses all the time.

    I did go and get fitted for contact lenses a few months ago, which I had never worn before. With the astigmatism, I had to get "monovision" ones, which basically provides distance vision in one eye and close-up vision in the other. Replaces the need for glasses but nowhere near as crisp and clear as progressive lens glasses. What I learned from this is that it would have been a horrible mistake if I had chosen anything other than the standard AcrySoft MONOFOCAL cataract lenses (fully paid for by Medicare) during cataract surgery two years ago. I now rarely wear the contact lenses (solely for vanity) and am more than happy to wear my glasses all the time because of the great vision they provide.

    • Posted

      Happy you have gotten results and outcome that provide you with vision needed.

      Some like myself who are 20 years younger, still working g and raising g children may decide on another type of lens to give us vision to help us function.

      This is a very individual choice.  I am pleased with my outcome with a Symfony lens.  My additional cost was $900 - I spend more than that in a year in entertainment and vacations.  the seamless vision I will have is invaluable to me with my job which is spent in front of a computer 80% of my day.  

      My other eye will e done later this month.  I wish I didn't have to have this surgery at this age, however I am thankful that there are better choices today for this surgery than my grandmother had. if I were retired and older I likely would have gone with standard monofocal lenses.  Although my uncle in England in his late 60's chose a multifocal and when is chatted with him prior to surgery said he was happy with his choice and he had to spend a lot more as he had to go private.  NHS would not cover surgery unless he went with a monofocal lens.

      Each person should do their homework and seek out a good surgeon who will dialogue with them about pros and cons.  There is no one lens that is best.  My surgeon was very honest about the compromise I would have to make with each lens type.

  • Posted

    Since you have severe astigmatism, you really need a toric lens. The basic monofocal lens is not a good option unless you are willing to wear glasses for all activitiies or are open to corrective surgery for astigmatism at the time of the surgery.

    I will also stay from Multifocal lenses. Those have even more night vision issues than Symfony lenses (which have more night vision issues than monofocal lenses).Also, the associated vision tends not to be as clear as with monofocal or Symfony lenses.

    Since you don't seem to mind wearing glasses, my suggestion will be to get monofocal toric lenses. The simplest choice will be to get them for the best focus at far distance (ending up with -0.25D to 0D). You should have very good vision for distance, but will need glasses for intermediate and reading distances.

    Next choice, if you do not want to need glasses for the intermediate distance also, will be to get one of the eyes (preferably the non-dominant one) set for the best focus at about 40 inches (corresponding to a spherical prescription of about -1.0D). You will be essentially using mini-monovision, which is not that hard to get used to. This will provide you good vision from 26 inches and beyond. You will still need glasses for reading at 16-17 inches. If you decide to go this way, please have the first eye done for far distance. Only after you are sure that you have met that target, you should make the decision for the second eye.

    If you prefer not to wear the glasses even for reading, for the second eye (non-dominant), you can consider using a Symfony toric lens (instead of monofocal toric) set for the best focus at 40 inches. There is no problem in mixing the types of lenses in the 2 eyes. This combination should result in less night vision issues than those associated with my combination of Symhony toric lens for distance and the monofocal lens for reading. If you will like to, please read my experience with the Symfony-associated night vision issue in my post (Has Anyone Else...) .



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