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Help…confused and anxious about upcoming lens choice

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Larksparrow
Larksparrow

First, thank you for your grace and patience in answering my questions. I am 1 month out from surgery and researching daily on IOLs. Maybe a bit too much because often you only see dissatisfied people posting online about their experiences.

I'm in my eary 50s, I have never worn glasses and just dealt with my minor vision limitations, until now with the cataract (I honestly don't even know my prescription). Since I am only implanting one eye (my dominant right) and my left is mostly clear with a minor prescription that I’ve never addressed.

Where do monofocal lenses set for distance start losing focus? My left eye can focus without strain at about 12” and my right (cataract) focuses at about 18-20”. So using devices has never been an issue for me. Distance wise both eyes struggle to read street signs (depending on text size) clearly until I’m about 40 yards away but can still see the road, mountains, and buildings (not perfectly, but easily distinguished and relatively sharp at infinity). The surgeon says im a great candidate for a multi like vivity or panoptix. I’m honestly looking much less at halos as a concern now and hyper focused on contrast sensitivity loss with them. I work in a bright environment and use hand held devices a lot but generally arm's length. I’m also a hobby photographer and outdoors enthusiast who is worried about losing contrast in the low light I find myself in during early and late hikes. Since my left still has good near, I’m leaning more towards a mono for distance IOL to keep colors crisp and allowing my left to do the work on near until it needs correction.

Am I completely overthinking? I’m just terrified I’ll choose wrong and spend a bunch of money and be unhappy. The alure of Multi and the hopes of remaining glasses free is tempting.

0 likes, 5 replies

5 Replies

  • RonAKA
    RonAKA Larksparrow

    Edited

    First off, choosing what type of lens and vision you want is a stressful decision as there is no perfect answer. It really depends on what you value most and what you are willing to trade off. It is not as simple as "you get what you pay for". With IOLs you can pay more to get a different lens (EDOF or MF) but it is not necessarily going to give better vision. They have compromises beyond just making your pocketbook a little lighter.

    .

    On the question as to how close you can see with a monofocal IOL set for optimum distance, my personal experience is 18". However, that seems to be better than the typical average of 24". I can easily see the dashboard in the car, but the text on the steering wheel is starting to get a little fuzzy, but I can still read it.

    .

    Both the Vivity and PanOptix will sacrifice some contrast sensitivity, and the PanOptix is more likely to have halos and flare as an issue at night. The Vivity is not a multifocal (MF) lens and gets the closer vision through an extended depth of field technology (EDOF). The PanOptix is a MF lens and as a result is likely to have more optical issues, but a closer depth of focus. Some users still find it comes up short for easy reading though, and they need reading glasses.

    .

    You do have an option of having a full range of eyeglass free vision without glasses though. It would be to get a monofocal set for optimum distance in your right eye, and a second monofocal in the left eye that leaves you mildly myopic at -1.5 D. With a blend of vision from both eyes you should be able to see from 10" or so out to full distance. From what you describe with being able to see down to 12" in your left eye now, you may have something very close to this situation already. It is called mini-monovision when you do it intentionally.

    .

    One option you have would be to get a monofocal IOL set for distance in your right eye. From what you describe that should give you a similar range of vision in that eye to what you have now (18-24" and further out). With only one eye done you may still manage a full range of vision with your left eye which sounds mildly myopic already. A method to further evaluate this as an option would be to use a contact in the left eye that leaves you at -1.5 D (if you are not already at that amount), and then determine how well you like the monovision. If you like it then you could get the second eye done with the left eye at -1.5 D using a monofocal IOL.

    .

    With respect to contrast sensitivity a monofocal lens has the maximum amount at the optimum vision point. In the right eye set for distance you would have maximum contrast sensitivity at distance. In the left eye maximum contrast sensitivity would be for near vision, and peaking at 24" or so. Across the whole range of distances from close to far the contrast sensitivity of the blended vision should be very good.

    .

    With respect to photography if you are doing digital darkroom work, then you may be interested in getting a lens with a blue light filter. The natural young eye has a blue light filter built in, so an Alcon lens like the Clareon monofocal (Also Vivity and PanOptix) simulates the young natural eye for colour balance. The colour balance you see with a blue light filter IOL should be very close to what a young person sees, so you can be confident in doing the colour adjusting that what you see is what others see (unless they have cataracts!). Cataract vision is most often yellowish compared to normal vision. You likely will see a big change in colour balance when you get an IOL.

    .

    Keep in mind that you really only have to make a decision on the first eye, and have other options after that eye is done. You could have a monofocal in the right eye and still get a Vivity or PanOptix in the second eye. It is a decision that can be made later. If you are happy with the simulated monovision with a contact, I would be inclined to go with another monofocal in the close eye. It will give you the overall good balance of contrast sensitivity near and far.

    • Larksparrow
      Larksparrow RonAKA

      Posted

      First, thank you for this very detailed and thorough response. I have literally gone back and forth a hundred times. Right now I am leaning towards a mono in my right thinking my natural near focus in the left will balance it the way it does now. I was concerned the Mono lens set at distance would impede my vision more dramatically at about 30-36" and that would be problematic, but if I can get 20" I'd likely be happy TBH. I am looking at Clareon technology regardless of type. I desperately want colors and contrast to be crisp as possible. Would my left eye balance contrast loss in the right from Panoptix or Vivity in the same manner it can with focal distance?

    • RonAKA
      RonAKA Larksparrow

      Edited

      Yes, your left natural eye, as long as it retains good vision should help offset some of the contrast sensitivity loss in the eye with the Vivity or PanOptix. But that offset will end when the left eye needs an IOL and you use another Vivity or PanOptix. Once you have cataract free vision in your right eye, you may find that the left eye is not nearly as good as you currently think it may be. I thought my other eye was very good until I had the IOL eye to compare it to. The second eye colour was then obviously very yellowish in colour balance. The Vivity and PanOptix technology causes most of the contrast sensitivity loss at distance, but they are a bit better than a monofocal at closer distances.

  • indygeo
    indygeo Larksparrow

    Edited

    Hi Larksparr,

    I think going with a monofocal for distance in the dominant eye isn't a bad idea. I did a mini-monovision strategy and have a monofocal in one eye set for distance and my "near" eye has the RayOne EMV offset 0.75 D "in" from the monofocal. I love it. You may find that you've got good vision from about 1 metre (maybe even less) with the monofocal especially if you aim for - 0.25D. Your good near eye may provide you with adequate monovision overall. Best to discuss with your doctor of course.

    Regards,

    Indy G

  • soks
    soks Larksparrow

    Edited

    if i was starting over as a myope i would get eyhance in my dominant eye set for between -0.5 to -0.75. once that eye has healed i would get sample reading (+ power) contacts from optometrist. i will wear them on the eyhance eye to see how much near i get with more myopia. depending on that i would set the other eye with eyhance at -1 to -1.5. if i hate the near vision with eyhance during the contact trial i would consider a clareon panoptix in the other eye. the Eyhance should somewhat negate the effects of panoptix and your brain will try to make the best of both worlds.

    vivity has optical issues with more near than eyhance. but if you are signing up for optical issues then get better near vision for it.

    good luck.

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