How do you find contact lenses after IOL?
Posted , 5 users are following.
I've currently have one IOL and chose a monofocal lens (other eye being done soon). The reason for not having a multifocal IOL or EDOF IOL is because they all have some additional compromises and my preference was to have the sharpest vision to put glasses and contacts over as multifocal contacts don't work well over similar IOLs.
I was aiming for mini mono vision with my IOLs, but this is looking near impossible to achieve due to targeting errors so augmenting them with contacts appears my best option. Many multifocal contacts come in low/medium/high adds and include 0 and +/-0.25D values so like glasses can be used to fine tune vision which isn't possible with standard contact lenses which have 0.25D increments but start at + or - 0.5D).
I've been testing contacts lenses on my operated eye and comparing results with the other eye before it has its IOL. The reason for the post is I wondered how my experience compares to others and wanted to share some my thoughts as using contacts and especially multifocal after cataract isn't discussed much.
In general I've found that monofocal contacts work well over my monofocal IOL, but for me leave an additional ring (light/slight blur) around parts of the edge of my vision in certain lights which wasn't the case before surgery. I am not sure if this is because I already have dysphotopsia issues (and starbursts) with that IOL or if its always an issue with IOLs. Does anyone else experience this?
Multifocal contacts also work well over monofocal IOLs and interestingly have almost none of the ring issue as above. I presume this is because the zones of differing power break up the effect.
As with multifocal/EDOF IOLs, multifocal contact lenses cannot fully cover the full range of vision and currently my preference once both eyes are done for my close work/hobby lifestyle is:
Dominant eye: A medium add under adjusted to -1.00D as this will give an effective -1.00D to -2.25D range).
Non dominant eye: A low add under corrected to -0.50D to give an effective -0.50D to -1.50D.
That would leave me borderline for driving but I would use glasses over if needed for that or just use a different set of lenses with less under correction for those days. Contact lens manufacturers boast higher reading adds than I've listed above but in my experience they are far too optimistic.
Has anyone here worn multifocal contacts long term after IOL?
0 likes, 9 replies
robert20416 pg128
Posted
Follow.
If I'm not mistaken, you have changed your preference to -1.00/-0.50 target, much less myopic than before. If so, why the change?
pg128 robert20416
Posted
I haven't changed my monofocal IOL target preference which would still be -1.25D and .1.75D as my other posts.
The above is pretty much what I have always planned adjusting whatever I ended up with for times when the IOL result didn't cut it. As these are multifocal contacts which have a reading add built in they not the same as a -1D/-0.5D monofocal IOL target and will cover the same -1.75D/1.25D focal points albeit with a loss of quality.
My IOL choice was aimed at trying to leave myself with excellent vision for just the range of 50cm to 80cm (my work and main hobbies). For everything else I had expected to use multifocal contacts where their impact on contrast/sharpness wouldn't be an issue.
With the first eye already ending up between -0.75D and -1D it looks like I'll be wearing glasses to get the sharpest vision for work (I use 3 large screens with tiny text) and the contacts above the rest of the time.
robert20416 pg128
Posted
Sorry, I'm misunderstood your preference. You can tell I have no idea about multifocal contact lens prescription.
Just in case you're curious, five weeks after my second eye surgery(ten weeks after my first), I ended up -1.25/-1.50, a result that would have made you very pleased. The targets before the surgery were -1.00/-1.75. The two eyes deviated from the targets the same amount but in different direction. I like my results for having "walk around" vision. I can do almost everything without glasses, although distance and reading while passable are a little less than ideal. Overall, I'm pleased.
Sue.An robert20416
Posted
So now for distance and reading do you have bifocals or prefer 2 sets of glasses - one for distance and another for reading?
robert20416 Sue.An
Posted
I have two sets of glasses for distance and reading, respectively.
However, I'm trying to adapt not to wear them. For distance, I have driven car, played tennis, ran half marathon, all with plain sunglasses and did okay. My distance vision is borderline 20/40, or a 50/50 chance of passing the driver vision test. I would not drive in a unfamiliar city without glasses, whereas locally no problem. What bothering me most now is watching sports on TV, couldn't quite make out the small ticker tapes from 10ft out.
As for reading, I'm mostly okay. Reading newspapers in good lighting is fine, though wearing a reader makes it better.
Overall, I would give the following vision scores without glasses: distance(70), intermediate(100), reading (90).
Sue.An robert20416
Posted
Those results sound good for everyday functioning.
Something I want to ask at my next optometrist visit is whether vision will fluctuate as it did prior to having cataracts. I am guessing perhaps it will as time goes on but not sure or maybe depends on other vision issues if they arise. I know PCO does. So far so good on that front. Seems for a number of people that procedure doesn’t help or brings on a different set of vision issues.
pg128 robert20416
Posted
It's great you've got a result you're happy with, even if not quite your original plan. I appreciate the advantage of good 'walk around' as that's what I've had for years and its easy to live with despite the need for close or distance glasses/lenses at times. The lack of mono-vision also means readers can be cheap off the shelf ones.
Unless you don't like contacts lenses then multifocal are certainly worth a try. They're the biggest growth area in contacts and from one or two options a decade ago there are now 20+ and many daily lenses so good to use less frequently. The low and medium adds give a really good boost to focal range with negligible downside.
My right eye not only missed the target by a bit over 0.5D, the astigmatism also went from -0.5D pre surgery to 0D just after and now almost -0.75D and still rising three months after surgery. A little astigmatism (-0.25D to -0.5D) is good as it increases close vision and without that I would be worse off. However its now borderline making multifocal contacts an issue as multifocal contacts are not available with toric correction other than one special order non daily that I don't like.
For me the error factor is the key issue as I was hoping for +/- 0.25D which several surgeons said was 75% likely given my low myopia. I think I will shortly be flipping a coin to decide on -1.64D or -1.99D target for my other eye as even with all my extensive testing and research this error factor has defeated my logical mind :-)
derek40125 pg128
Posted
Does your doctor believe that your astigmatism will stabilize over the next few months? It would seem like you could them do a procedure to correct the astigmatism and then continue to wear your multi-focal contacts.
I just did a multifocal IOL in my right eye. The left eye has a cataract but it's not yet affecting vision. The surgeon wanted to operate on that eye 3 weeks later (since they like the multifocal IOL's to be implanted in both eyes). However, I ended up trying multi-focal contacts over the 2 months before the surgery and after several complete failures, I found a lens that was perfect, so good in fact that I'm postponing the left eye indefinitely.
I'm really interested in hearing how this works out for you and what you end up deciding. Please update if you can and ultimately let me know how you'd rate the quality of the multifocal contact + IOL over both your distance and ADD target points. I'm still considering a monofocal IOL at plano with a multifocal contact once the left eye does need the surgery.
pg128 derek40125
Posted
My surgery was vitrectomy for very severe floaters affecting my work, and combined with IOL and posterior capsule cutting. Hence the surgeon is a vitreo-retinal specialist and he seems less interested in discussing the finer points of IOLs and lens outcome which is understandable (I spent a year choosing a surgeon and vitrectomy experience was key).
The only thing the surgeon has suggested is a piggy back lens which isn't surprising given that is something he does regularly and he is thinking of it to help the dysphotopsia I suffer from as well as fine tuning the correction. Once I get the other eye done then I can always see someone else for another opinion on astigmatism and focal point. It was a tough choice to do this all in one surgery but I still think not a bad choice, there was no good choice given my situation and what floaters have done to my life/work in recent years.
As you've found with multifocal contacts there are significant differences between makes (material and approach), the various adds, where the focal zones are and impact on contrast. I have tried nearly every multifocal contact lens around and at least half don't work well for me (material not comfortable/poor vision/too little intermediate etc) and of the rest are okay to great.
It was my experience with multifocal contacts that made me question IOLs with the same approach even though they're higher quality. Ultimately there's only so much light coming into an eye to split into various focal points and I prefer the compromise to be a removable one. Vision with my monofocal IOL once corrected for the required distance is very sharp and has excellent contrast so that part of things worked out.