Eyhance help/choice of iol ?? cataract newbie

wow rwbill thank you for being out there and answering. Is Synergy a multifocal? How is your vision current without cataract and what made you decide a multifocal

“How is your vision current without cataract”

I wish. I have the Tecnis low-add MF in my left eye and my right eye cataract is so bad I cannot even see 20/200. I got the MF about 5 years ago, shortly after it was approved and available in the US. Based on my research it was the best defractive IOL available at that time. IMHO the IOL material was better than Restor and it did not have as much dim light issues.

Fast Forward, I am now looking at implanting the Tecnis Synergy IOL in my right eye, which is a combination of EDOF and MF, which “supposedly” give the best Vision throughout the defocus curve. It is also supposed to do well for a light splitting IOL in dim light. Synergy is the latest and greatest defractive IOL from Tecnis. Well I guess there is also the Symfony plus, but good luck in getting information on that one.

“what made you decide a multifocal”

A variety of reasons. When I started to get presbyopia, I hated having to carry readers with me everywhere. No matter how many pairs I had I still never had one when I needed it. And I am a bit of health nut that reads the labels on canned goods.

With the MF I got functional close vision which is what I was shooting for, which means I can find the sweet spot and read a label or a menu at a restaurant. But to do serious reading like read a book I need readers and good light.

Of course with all defractive IOL, comes more dysphotopsias than a monofocal. And that is the scary part as everyone is different and you just don’t know how bad or not bad it will be until after you get the IOL. I KNOW, DAMN SAD!!!! But that is the way it is.

My dysphotopsias are not horrible and I am fine with them for the close vision tradeoff. What bothers me more is just how dark things are in low light. I am hoping the Synergy allows more light through. That reminds me of something I recently hear a doctor mention on that subject. He was talking about how even minor PCO can be worse for someone with PanOptics, due to the light splitting. I guess he is saying minor PCO can affect light getting through and if that light is already reduced ……

Bottom line there is no Perfect IOL. All come with tradeoffs. It is your job to understand these tradeoffs as best as you can and decide what is most important to your lifestyle.

Gosh, one last bit of advice, if you can still correct your vision to be “Decent” enough, my advice is procrastinate as long as possible. There are some new revolutionary IOL in the making like the adaptive Juvene IOL.

thank you rwbill. i can sympathize with how dark things are in low light. funny i thought my whole life everyone vision is like that. Props for self responsibility in understanding trade off. This forum clarifies choices and procedures. Wow I was thinking of holding off right eye due to new future iol. I fully onboard with self responsibility but Dr is not really communicating much. I think astigatism diopeter is 1 and was told i have alot and should use femtosecond. but real life stories on this forum say 1 diopeter is average its not affecting me

rwbill what does refractive iol mean with edof to vision or the way we see thing

Diffractive Optics uses diffraction of the light waves to distribute light. For example, in case of Multifocal it creates 2 focal points and in case of trifocal it splits the light 3 ways allocating 50% to distance, 25% to intermediate and 25% to close.

I think the confusion comes in with these new generation “Enhanced” IOLs that do not use diffraction, but instead use Optic Trickery (stolen from Ron) to create a minimum EDOF effect. In the case of Vivity, from what I read at the cost of Contrast Sensitivity.

In general there is no free lunch and EDOF, even slight, comes at a cost. What makes the Tecnis Eyhance interesting is it calls itself an Enhanced Monofocal and "Supposedly" provides a little bit of EDOF without sacrifice. Only time will tell as more data is collected.

Ron gave a link to an article that reviews this new IOL category.

I guess if I had to pick one of these New IOLs I would probably go with Vivity and do -.75 d of monovision in my non-dominate eye giving me a total of -1.25 d.But I have not really researched the 3 FDA approved IOLs that fall into this category so that is just based on mild reading about these IOLs.

I would add if you have any eye condition, other than cataracts and maybe minor astigmatism, I would avoid a Diffractive IOL, especially one like Synergy.

Though I am probably the only one to say this, dysphotopsias can sometimes be cool. I was driving home tonight in the dark and there was a cop car with its red and blue lights blazing and at such an angle that I saw this large circular halo that looked like a multiple color force shield covering the entire front of the police car. I thought that is cool! P.S. if that sounds horrible to you, again don't get a diffractive IOL.

i get that cool effect. i think now that im aware of dysphotopsias due to this forum as a life long myopic i have had them forever and i thought everyone else saw that too. With your help I understand Eyhance now. I cant choose which distance like traditional monofocal? and is that why its inbetween mono and multi? By reading this forum I think i understand what is really important now . RW is -1 diopeter enough for leaving myopia after surgery? And i love contacts im myopic and see perfect with them i want to continue wearing after surgery will i be able to wear as pre surgery?

“RW is -1 diopeter enough for leaving myopia after surgery”

I am assuming (yes I know; ass out of you …) that you are referring to monovision. I am not a big monovision fan or expert. Ron is more the expert in that area. My experience with monovision was not Positive. But I did it with contacts a long time ago and at a time that I was clueless. I don’t even know how much monovision the doctor set the contacts to. At that time I realized I need good distance vision in both eyes.

I can just tell you the bigger the image difference the 2 IOLs project onto the brain the more problems people have. Like anything some people will do better than others. If I did monovision, it would be micro monovision and for Goodness sakes IMHO avoid full monovision.

Now for my suggestions:

1. Get familiar with the defocus curve for the IOL you choose. Try and find one that also shows the standard deviation on it. This is important; 20/20 is just the gold standard. You don’t have to have 20/20 to have good vision. These are all the things you must factor in when making a decision. Maybe 20/40 (this might be the border line distance vision for driver’s license) distance or close is acceptable to you. Then you can look at the defocus curve with this information and see what your visual acuity will be with different refractive setting for monovision. So one can set dominate eye at Plano or slight myopic -0.25 (hopefully getting 20/20) and then decide on the non-dominate eye setting.

2)If you are leaning towards a monofocal and planning on monovision, consider the light adjustable Lens. The LAL is a revolutionary lens that allows you to adjust the power after surgery. So you could actually try out different monovision setting and see which one you like or if you hate them all just set it for Plano for both eyes.

There is a great video on the LAL on you … tube from Summit Eye Care. Check it out.

My experience with monovision is using a monofocal IOL set to distance (0.0 D spherical, 20/20) in one eye, and then under correcting the second eye with contacts. I found that a 2.0 D under correction is too much. 1.5 D is ok, but I prefer 1.25 D. When it comes to having my second eye done, I will go with a monofocal again and ask to be under corrected by 1.25 to 1.5 D. IOL's are in 0.5 D steps so you can't be as precise as you can with contacts.

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My thoughts are that to do monovision the best way is to have the dominant eye done first with a monofocal targeted to leave you at -0.25 D, but never positive. Then the optimum for the non dominant closer vision eye is dependent on the choice of lens. I would suggest the following:

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Monofocal -1.25 D

Eyhance -1.0 D

Vivity - 0.75 D

i ask Dr to set both same leaving some myopia cause i used seeing nearsighted. no monovision cause balance possibility issues. Dr said he would set 1.0 Am i just wrong or clueless about iol or surgery or the whole experience? Lifelong myopia approx 5 both eyes i see perfect with contacts near far etc. In my mind i thinking i just get monofocal set for distance a little myopia and i can just wear contacts like i do now and i can see perfect. Now this question is probably most basic but most important rwbill am i wrong

since my eyes myopic and vision bad is already i dont think trialing monovision is possible. Ronaka is monovision comparable to like a different prescription for contact lens in right eye and left eye but both eyes see same together

". Dr said he would set 1.0 Am i just wrong or clueless about iol or surgery or the whole experience? Lifelong myopia approx 5 both eyes i see perfect with contacts near far etc"

Are you saying you want to get 2 monofocals and set both at -1.0 D. Remember your natural lens adopts which is why you can see both near and far now. That will not happen when your natural lens is removed.

As far as I am aware if you set for -1D and then use contacts all day to get corrected 20/20 distance that makes no sense to me as you just lost the close vision you were trying to get with the -1.0 D setting.

You would need to wear progressives or something like that I would think or just contacts when you needed great distance vision.

Here is what I can tell you from just a quick glance at the defocus curve and remember everyone's results will vary. If you go with -1.0 D setting and assuming the doctor actual nails that refractive mark perfectly you will have approximately 20/32 at distance and out another -1.0 D or so. So basically 20/32 vision from distance to maybe 21 "- 24" . Is that your goal. If Yes, then you might have a plan, if no then rethink.

rwbill what do i do? I thought i could just get both mono set for approx. -1D then wear contacts weaker prescription then i do now and see the same. Would Eyhance be a better choice than both Mono with - 1D ? I dont want glasses been wearing contacts 45 yrs and i get perfect vision. i really thought i could see the same i do now with contacts which is perfect for me after the surgery with contacts making up for any correction i need. I'm so damn clueless and Doctors explain nothing You are a major help and source of knowledge for me and countless other who come to this board looking for direction. Shout outs to Ron and Lucy and all the other wonderful amazing people who took time out to share. First Dr I saw mentioned setting me distance and plano now before this board i didnt know what plano was. After he said that I came to this board and realized i could have ruined eyesight the rest of my life based on his decision. Your answers are a gift to all of us and if you saved me you saved countless others from bad choices. Your calculations of 20/32 after surgery at distance are unimaginable to me in a good way my distance blurry my whole life. So that is a good thing? 20/32?when you say my natural lens adapts and that is why i see near far now i get what monofocals really mean. If i go with -1D both mono how do you think intermediate and near vision might be? would mini monovision result in better vision than both eyes -1?

The only obstacle to trialing monovision would be if your cataracts are so bad that you can't see well even with contacts. If your contacts are doing a reasonable job then a trial is possible.

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First determine which eye is your dominant eye. Just point at something and close one eye. if you are still pointing at it, then you closed your non dominant eye. If you are no longer pointing at the object then you closed the dominant eye.

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Then say for example you are wearing -5.0 D contacts in both eyes to fully correct your vision. You would continue to wear a -5.0 contact in the dominant eye, but instead of this power in the opposite eye, you wear a -3.75 D contact. In other words you under correct the non dominant eye by 1.25 D. Then you go that way for a while to see how you react to it. Ideally you will see distance well with the dominant eye fully corrected with the -5.0 lens, and you will be able to read reasonably well with the non dominant eye. Other options to try would be to under correct by 1.0 D, so instead of the -5.0 lens use a -4.0 lens in the non dominant eye. And also try more under correction with a -3.50 D lens. The purpose is to see what you like and whether or not you can tolerate it.

Mary, based on what you've said I'm a little concerned you may not understand the concept of accommodation. Accommodation is the ability of your natural lens to adjust focus from near to far by changing shape. An IOL is just a solid piece of plastic. It cannot change shape to adjust focus. So setting your IOL to be near sighted (as you are now) and using contacts (as you do now) WILL NOT give you good vision from near to far. After surgery you will only have optimum focus at ONE point. Near OR far (your choice). Not both. Not without using a multifocal IOL (which has quality of vision compromises because it's splitting the incoming light up to achieve greater range of focus) or Vivity (which has fewer quality compromises but still not quite the same image quality of a monofocal) or simply going with monofocals and using glasses with progressive lenses or readers when needed (assuming the monofocals are set for distance). Yes Eyhance is another option but you should not expect any range of focus miracles from it. It will let your see your car dashboard well but that's about it. It's only slightly better (range of focus wise) than a standard monofocal. The nice thing about it is that unlike multifocals or vivity there is virtually no trade off in terms of vision quality compared to a monofocal. Only VERY very slight loss of image quality compared to monofocal.

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Yes monovision (setting each eye for a different distance) is another option but it has trade offs as well. Basically there is no perfect solution right now. You have too choose which trade off you're most willing to accept.

I was having the same concern, and you have clarified it well. The only minor point would be that even the term monofocal is sometimes misunderstood. If you get a monofocal set for distance it is only set for one perfect or optimum distance which is infinity. But it still does allow you to see very well down to 2-3 feet and sometimes less in brighter light. I think sometimes people new to IOLs get the impression that a monofocal is one single distance and vision drops off the cliff if you depart from that distance. And yes if you were to set the optimum focus at 1 foot, then you are not going to see much at distance without glasses. Very few do that though.

First I am not good at reader's digest post, so forgive the lengthiness. Second anyone know how to insert carriage returns to separate paragraphs.

“First Dr I saw mentioned setting me distance and plano now before this board i didnt know what plano was. After he said that I came to this board and realized i could have ruined eyesight the rest of my life based on his decision”

This is what the vast majority of doctors do. They implant a monofocal IOL and set the power to achieve Plano or just slight myopic and you wear readers for close vision. Most people get this without even knowing there are premium IOLs out there. I know this as I have talked to those people and asked why they did not choose a premium IOL and they tell me I did not know about them and I did what my doctor said to do.

Now my thoughts & suggestions:

1)I would suggest you become an expert in the IOL options and the defocus curve for each IOL option and all the tradeoffs and then find a doctor who is knowledgeable about the options and will take the time to discuss them with you. At least now you know what to ask. And sadly this is harder than it sounds. For example, in my entire area, there are only 2 doctors that even have implanted the Synergy IOL (the IOL I plan to get). Another suggestion is many eye Surgeons are super busy and will not spend much time with you, therefore you might look for an Optometrist that will take more time and go over the options, but keep in mind most people just get a monofocal, as that is what insurance pays for, and might not be familiar with premium lens options and their tradeoff, so you have to find one that is.

At this point, I must include, with my modifications, one of Ron’s Quotes. Premium refers to the price and not necessarily the quality of vision, so know the tradeoffs!

2)The basics - I went on you … tube trying to find a video that explains how the natural eye lens works and cataracts. This one is the best I found just doing a quick look. Watch it first before proceeding. Not animated, but he shows how the natural lens changes to provide both close and distance vision and discusses options at least a little bit. Now as you age, your natural lens loses that adaptability and you get presbyopia and the natural lens will no longer be able to see objects that are near and you will need to wear readers. Some folks will do a clear eye exchange due to this (Remove the natural lens and replace with a diffractive IOL). I never recommend a clear eye exchange.

“Enhance reading AND distance vision with Cataract Surgery” by Hunter Vision on You …. Tube.

Another You …. Tube video below does a great job of explaining the functioning parts of the eye and how it focuses. It does not talk about cataracts but first, it is important to understand exactly how your existing lens works including the muscles that make it change shape and this video does a good job of that.

**“Eye Works 1: Focusing: Cornea, Iris and Lens” by Craig Blackwell. **

3)Now with cataract surgery, your amazing natural lens will be removed and replaced with a piece of plastic. Now, this part is hard to accept; physics will only take you so far and there is only so much a piece of plastic can do and NOTHING will be as great as your natural youthful lens.

4)All replacement Intraocular lens come with tradeoffs. You have to learn what each IOL can and cannot do and decide what tradeoff you are willing to live with and everyone is different. There was one person that came on here just wanting close vision as that was most important to them.

5. One option to get close vision is a diffractive multifocal or trifocal or EDOF IOL, but these lenses come with tradeoffs, like contrast sensitivity, dysphotopsias and being dark in dim light as the light entering the eye is divided. With these IOLs you would NOT do monovision.

6. Monovison is another method to obtain more intermediate and close vision when implanting a monofocal or the New “Enhanced” Monofocals. I do not know the proper name is for this new class of IOLs is. But the FDA-approved ones are Eyhance, Vivity and Rayone EMS. Maybe they are called refractive EDOF, but Eyhance does not technically qualify as an EDOF.

These enhanced Monofcocals are new and like many new IOL the initial promises do not live up to their claims with the passing of time. We are already finding out the Vivity comes at the loss of contrast sensitivity. Eyhance is “Supposed” to have all the benefits of a monofocal and yet provide just a little bit of EDOF. For example, you might go from 20/25 vision to 20/20 -2 characters. It is possible if the Tecnis Eyhance IOL lives up to its claim and cost comes down, it could become the new improved monofocal. Again only time will tell.

Ron is more knowledgeable about monovison and talked about it so refer to his post regarding monovision .

7)Another option is to mix and matching the IOLs, this is NOT monovision and a lot of doctors will not do this. I will be getting doing this option. In this option, you get an IOL in one eye and then determine the weakness and get a 2nd IOL to address the weakness. So you might get an Eyhance in one eye to get the sharpest distance vision and a Synergy in the other eye to gain close vision. Hoping the 2 work together and the brain picks the best image to provide you with the overall best vision possible.

8)

8)As far as 20/32 being blurry (I don’t think blurry is the right word); it comes down to what your starting point is. If you had 20/32 vision before you would not think 20/32 vision is bad, but if you had great 20/20 vision before surgery then you might not like your vision. It is like if you went from 20/15 vision down to 20/20. That’s why I think the hardest candidates to please are those who have super good vision and just the slightest cataracts and then get cataract surgery. By the time I had cataract surgery on my first eye, my vision was so bad pretty much anything was an improvement and 20/32 vision would have looked great! My point is 20/32 vision is not bad it is just worse than 20/20 vision. Again every IOL comes with tradeoffs, so it is important to understand this concept to pick the best IOL for you.

9)Hmm, at this point I probably got you more confused than ever.

10)Defocus Curve is Your Friend - Pull out a defocus curve and learn it inside and out. I cannot stress this enough! The defocus curve will answer many of your questions. Do not proceed until you pull out a defocus curve for at least the IOLs you are thinking about and understand those defocus curves. You can go online and do a Logmar to Sneller chart conversion and diopter to inches conversion (I actually made an excel table to do it).The defocus curve will show the average results patients got with that particular IOL from distance to close and everything in between. Remember this is average results and everyone’s results will vary. The defocus curve will also make you stop and think about what is close and intermittent vision to you. Do you need to see 20/20 at 13”? What distance is comfortable reading for you? These are the things you need to think about and make a decision on. Heck, take the defocus curve and mark on it where you think intermittent and close vision is for what activities you do. This will help you identify what option is best for you.

11. At this point, you are probably thinking I will be better off just mindless doing whatever the doctor says, as many people just do that. I prefer to take the time and do the research. In many cases, I know more about the IOL than the doctor. By the way, I did not even go into IOL material and issue like glistening, as that would probably be overload. But once you learn the basics you should look into that also.

12. I had posted the different FDA-approved IOls in the past so I am copying and pasting it here, but it is probably out of date a bit. Again and I cannot stress and repeat this enough, no IOL will be as good as a youthful natural lens and they all come with tradeoffs. You have to decide which tradeoff is right for you.

P.S. I wrote this before I read David98963 post. He probably explained it more concisely and better than I did.

Non Premium Monofocals:

These are the most common IOLs implanted. They will have the best contrast and the least issues of any lens (unless you consider close vision an issue). They have been around and tested for a long time. A Monofocal lens should provide great distance. In general close vision is reading your cell phone or a book, maybe 33cm-40cm. Intermediate is about 2 feet or so. A perfect example might be the dashboard on your car.

One comment on distance vision. Some people I think are confused by that term. If you look at the defocus curve on a monofocal you should get pretty good vision down to about 2' -3' or so (again it depends on many factors). As you get in closer; vision quality drops off rapidly. This is important, everyone’s Visual Acuity will vary as there are so many factors, such as short eyes, astigmatism, previous Lasik surgery, mascular degeneration and on and on.

I also suggest just getting 1 eye done at a time and evaluating the results before getting the other eye done. Mix and Match is always a possibility to obtain the best vision possible.

Premium Monofocals:

LAL – If considering a monofocal I would recommend giving this IOL serious consideration. I have had Top Ophthalmologist highly recommend this lens. Having said that it has been around for a while now, but not as long as the standard monofocal so there is the test of time issue.

What makes this lens great is no matter what equipment Ophthalmologist use they don’t always hit the refractive mark and in a few cases can be way off by more than 1D. And let’s say you decide to do monovision. You want to hit those marks.

But it even gets cooler than that. From what I understand you can adjust the LAL more than once. So you decide on monovision, but not 100% sure how much monovison. So set 1 eye to plano and then try various settings with the 2nd eye to see which one works best for you. I would only consider micro-monovision like -0.75D, but if I had the option to adjust it you could try a different setting and see if you end up with a lack of stereopsis or other problems.

Crystalens Lens – You hardly hear about this lens anymore. This is the only FDA approved accommodating IOL. Many people did not get accommodation or much accommodation, so you were paying premium price for a monofocal lens that did not give the range of vision expected.

But from what I have read Crystalens at distance provides the same level of contrast as a standard monofocal and you are likely to get some accommodation. This lens could be a great mix and max with a PanOptic Trifocal IOL.

IQ Vivity and Tecnis Enhance - The newest hottest IOLs on the block. A refractive IOL that provides some EDOF. I think IQ Vivity is around .5D and Eyhance a little less. So not a lot but combined with micro-monovision you should get decent intermediate and some close up vision.

Now here is the part that is trick. I have read that Vivity gets EDOF by manipulating SA. So that means contrast sensitivity will not be as good as a standard monofocal. Could the average person notice the difference, I don’t know. But I suggest you get an Ophthalmologist who is an expert with these lenses so you can discuss that exact issue. And of course there is the test of time issue.

I tried mono-vision with contacts and I know it is not the same, but I hated it. I need good distance vision. That is why I say if doing mono-vison go with micro-monovision (<-0.75D). If you do that with Vivity you will be getting -1.25D of mono-vision, preferable in the non-dominate eye.

Enyhance is a little less clear to me as from what I read there is no CS lost, but you don't gain much EDOF. I am not even sure it is much better than some monofocals. But IMHO you have to be giving up something to get even that little bit of EDOF. So this one needs further research.

Vision accuity is more complex than it sounds. There are just so many environment factors and so many ranges to go with those conditions. Will you be able to see well indoor at a concert or basketball game vs seeing up close in dim light vs moderate light vs bright light.

Diffractive IOLs

These IOL, which include MF, Trifocal and EDOF IOLs, give you improved intermediate and close vision but they all come with tradeoffs (dysphotopsias & Contrast Sensitivity loss). This category is a paper in itself, so I will not go into details unless you are interested in a diffractive IOL. I personally have a diffractive lens. In the US the main diffractive lens currently would be Panoptics and Symfony IOL. I actual have the Tecnis MF low add, which is a bit of older tech now. The latest option just approved is the new Tecnis Synergy IOL that combines EDOF with MF to provide the best overall defocus curve I have seen.

(Summed up at bottom of post if too long)

I may be an example of that (what you just said Ron). Had my first (non-dominant) eye done on Aug 30th. Surgeon made me more myopic than I intended to be. He went ahead and gave me eyeglasses script only a week out, on Sept 7th, for -2.50D in that eye, and made next appt for Jan2022. Since then, I read on my online chart that manifest refraction in that eye was actually -2.75D, and I suspect it is really -3.00D bc old glasses worked so well just after surgery. He knew I asked for -2.25D, and No more, preferring to go closer to -2.00D than the other way, since it isn't exact science (as he put it). Right now, I cannot be refracted again, because vision in operated eye has steadily declined. I've now been diagnosed with Irvine-Gass syndrome (Cystoid Macular Edema), back on eyedrops for infinity, with vision Still getting worse by the day. I now have next to no vision in that eye, just darkness and blur.

What I want to stress, is that when you set your eye up that close to get good near vision, it is very true that you are compromising your "walk-around-the-room" intermediate vision. I asked my surgeon about this particular thing before surgery, and he said that no, there is not a wall of blur, that you'll still have "some" accommodation left. Well, not in my case. During that first week, when I could actually See out of operated eye, I could read the very smallest writing on the eyedrops bottles. But looking out a couple feet away, and covering my unoperated eye, it Was a blur. Even from those early days, I was having major difficulties walking around inside the grocery stores, as I only ever wore my glasses to get sharper vision while driving. Now I have to constantly be putting them on and taking them off.

I wasn't going to comment on anything until my IOL eye clears up, but I do know some things now that I didn't know before surgery. Like a lot of other people on here who are living with one eye done and one not done, I now have an understanding of this accommodation thing. I have a tecnis monofocal IOL, DCB00 +19.5D, supposedly set for -2.25 but I'm sure much more myopic than that. Things look very very small in that eye compared to non-operated eye, which is -2.00D. Now that IOL eye is blurry and next to non-functional, my good eye is blending in that errant data into it's better (but still cataract double vision, and macular scar) data, and it's hard to navigate around the house, much less out in public with the noise and bright lights. While I do have other issues affecting my ability to function while out and about, I'm trying to comment only on the visual aspects.

I tested my focus in both eyes, during that first week while I could still see. IOL eye was focusing at 14" out, with blurriness even a little further out. 30 inches out, could not read brand labels on containers. I measured this with a measuring tape, so I'm not guessing about this. I couldn't make out the time on the wall clock across the room when using only the IOL eye, best I could do was see that yeah, that was probably a wall clock there, cause round shape, but couldn't tell where the hands were if my life depended on it, bc couldn't see them. It seemed like part of the issue was the small size of everything in operated eye. Printed material, objects, Everything in other non-operated eye is a Lot larger (it is naturally -2D).

Conversely, when I tested my focus in non-operated eye, I still have a Lot of accommodation in that eye, when I was expecting none (according to what I'd read on this forum). When sitting on the front steps looking out at the trees 30-50 feet away, I can focus in on individual branches and leaves, and when looking at my hands, I can see details, just a slight ghosting from the cataract that's still there. While it does have a scar on the macula (about 7 o'clock position) from an auto accident in the 70s, and I've not been able to see a straight line with it since then, it is now my "good"eye. Up until the macular edema set in, I was still seeing better binocularly than with just unoperated eye, even though that one is now more myopic. But now that has changed as unoperated eye is bringing in more blur, and I can see better just walking around with IOL eye just closed.

To sum up (sorry this is so long):

Test your eyes individually before surgery, to see how much accommodation you do have left, and where your point of focus is.

When you set your eye for near vision with an IOL, you may not get much intermediate vision. Maybe everyone's different here, but I didn't.

I'm getting well enough near vision with my -2.00D unoperated eye. I don't think I needed any more myopia than that. I can tell now, that I can actually focus on the small writing with -2D eye just fine, it's the ghosting from the cortical cataract that is causing the problem, not that it needs to be any more myopic. The print looks larger, so is actually easier to read than with the now more myopic IOL eye. I wish I'd tried this experiment before surgery.

Reading Ron's post, another thought popped into my head. If your cataracts are minor and your vision is still good have your Optometrist prescribe contacts with power level that give you 20/32 distance vision. You natural lens will adopt providing close vision, but lets ignore that for now. The goal is to see what 20/32 distance vision is like.

Honestly, I wish I knew this before I let my cataracts get to bad.

In fact try several setting 20/25, 20/32 and 20/40. This will give you some ideas what you can live with for distance.

And of course do the monofocal contact lens test Ron suggested also.

rwbil Ron and David so much information so must knowledge started to read casually through all responses to savor in detail after I got to rwill paragraph 10 and Im so laughing Thank you all so much for making sense of this and weighing decisions and options with all your help. Thank you rwbil the 13 paragraphs and all after you posted above should be The Handbook to iol choices Asking questions back and learning from your real experience so helpful. I think I want Eyhance and as all of you identified with we all have better vision then before. I have no idea why Dr seemed cold when I mentioned Eyhance preferring zcboo But to me damn contacts gave me perfect vision for years its like having real eyes with great vision. I think I can get

Monofocal iol then use contacts to give me same vision Now going over all posts again and looking to really understand and make choice based on the experience and advice all have so generously taken time out to post for all of here on forum

rwbill i think im going to use the advice you have given and use my two yearly visual eye union benefit to question optician about some choices and issues forum brought up. I feel so underground and elusive for my own eyes asking my own Dr or trying to message him.

my vision is good only with contacts in really myopic average -5 to -5.5 now with cataract both eyes

thank you Jettesun in advance im reading at where you started where you are example of what i said and no no posts never too long we need to all share our experience I feel like I am on undercover ops here to get best solution and information from medical community all sharing all can learn from

Is there a solution for your operated eye to see better? Is it your eyesight or the iol that is creating hardship? I thought i could just set monofocal for distance leaving a small nearsighted and use contacts like i do now. Seems so dumb after reading this forum. Jettesun not to press but can you explain what experiment you wish you tried and how I would do it? thanks for your time

sorry the graphics on that last post did not end well. jettesun is there any solution or fix to your operated eye? What does your Dr propose to give you better vision? Is it the iol or the eyesight? Please share details of how i can do experiment before surgery

LAL sounds best of all why isnt there more chatter on it

yes Ron i kind of thought that set for distance my vision would drop off cliff well said. and i would lose intermediate and definitely near. i just thought mono set for distance with like -1 diopeter would be ok leaving the drop off less so. thank you that post was a little encouraging.

"LAL sounds best of all why isnt there more chatter on it"

It is relatively new and it takes special equipment so only a few doctors have the equipment. In addition insurance will only cover a traditional monofocal and what P**s me off is they will not even pay for the monofocal cost and allow one to pay the difference.

So a lot of folks willing to pay the cost want something that will give them close vision.

The retinal swelling (Cystoid Macular Edema) can be treated, and hopefully will go away... treated with eye drops, eye injections (hopefully won't come to that), and Time. The more-myopic-than-intended cannot be treated, and I'll just have to learn to live a new way, develop different habits, also will take time. Will have to work on training my eyes to work together better. I'm not used to having to wear my glasses around the house, and I don't like it at all.

The experiment I was wishing I did, was to analyze my eyes separately, before the IOL was placed. I only took note of how I was seeing overall, binocularly, which was poorly due to the worsening cataract (both cortical and nuclear), I didn't take note of where each eye was focusing by itself. I've since measured with a ruler (in the house) where the unoperated eye (-2.00D eyeglasses prescription) is focusing, and noticed outside how far out I can see, and where it begins to drop off. Cannot go back and do that with the operated eye now of course, but would love to know where that one was focusing before surgery, with the natural lens having an eyeglasses prescription of -2.25D.

My whole experience with the tecnis monofocal lens probably won't apply to you if you decide on multifocal or EDOF lens, because you won't be stuck with just one focus point. That's why people who choose monofocal lenses sometimes try monovision, because it gives them more range of functional vision without glasses.

rwbil " At this point, you are probably thinking I will be better off just mindless doing whatever the doctor says, as many people just do that" lmaoooooo

so i took your practical advice and made appt with local optician i go to for contact yearly prescription to get astigmatism status etc. i did call and really nice tech actually gave me some info over phone and said i have barely any astigmatism and said for contact script its like -25 or something or -50 he also said which i had no idea which might help others on forum even though i have choice of either contact or glass exam that when i get contact exam dr also records glasses script dr never told me that

Keep in mind that the astigmatism or cylinder that needs to be corrected by an IOL will almost always be different than that which is corrected by a contact or eyeglass lens. That is because the eyeglass/contact prescription has to correct for the sum of the astigmatism in the natural lens plus the cornea. When you remove the lens as is done with a cataract surgery the astigmatism in the lens is gone. Astigmatism, can go up or it can go down when the natural lens is removed. The surgeon that does the detailed eye topography and measurements will be the one which has the real astigmatism number.

is that what the forum means by irregular and regular (i think ) astigmatism meaning the shape of the cornea?

No, irregular astigmatism is another kettle of fish. It is when the astigmatism is not symmetrical in the eye. Astigmatism is kind of hour glass shaped if you see it on the doctor's computer topographical screen. Irregular astigmatism is not symmetrical and not hour glass shaped. Because the toric lens has a regular symmetrical hour glass shape correction it does not work well on irregular astigmatism.

david if i can see dashboard well then i guess that is good. thank you making me see connectn between accomodating and plastic piece. there are so many unique variables to optimum vision from iol. guilty thinking that iol set for distance all i see distance but then iol does give range of vision ? at least a little?

Isn't it best to test mini-monovision with contacts first to be safe?