I have no idea which lens to choose!! Please help!

lucy24197 Jennifer_Guess · 2021-11-15T12:13+00:00

One thing that can be very, very helpful is to become familiar with defocus curves. People get VERY different results, even with the same lens. A defocus curve is made when a group of people with the same lenses are tested for visual acuity. It shows you what the average visual acuity for that group of people is at different diopters, which can be converted to distance. Be very, very careful about thinking your results will be exactly the same as what another person has experienced. For example, I have monofocal lenses set up for monovision. My far eye is at -0.5D, and my near eye is at -1.75D. There is NO WAY I could use a cell phone just using my far eye. I can just sort of make out text when the phone is held at arm's length--and that's with guessing at a lot of the characters. No way could I hold the phone and dial/text at the same time. Looking at where things are in focus, if my far eye result for the lens was the same as Ron's, I'd need the phone held more than 50" away to be able to use it.The same goes for reading distance. If I finagle together some glasses to get my eye to about -1.25D, if I hold a letter from the bank at full arm's length it's in comfortable focus for reading. Coming in as little as an inch or 2 and it starts getting blurry.

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One thing to really consider is where do you spend most of your "vision" time, and what activities are most important to you. For me, I absolutely hate taking on/off glasses all the time to see something. If I'm going to settle down for a while, like for driving or reading a book, the glasses don't bother me. Plus I'm always driving in the car, or reading in a particular spot in the house, so my glasses can just live in a particular location. So I gave up a little distance vision in order to not have to always be looking for a pair of glasses, and having always been a little nearsighted, I'm used to this. Other people really want the best distance, and don't mind having readers lying all over the place (they hide from me in my house.) There are no perfect lenses; there will be some issue with every choice and you need to really thing about what's important to you. Then it's a matter of deciding what compromise you can best live with.

kevin1951 Jennifer_Guess · 2021-11-16T09:38+00:00

Jennifer,

Wishing you luck. I am a 70-year old male had both eyes done this fall with Vivity. My second eye was done recently, Nov 4. I was far-sighted. I would rate my experience and results, not perfect, but very, very good.

Driving is a tad more difficult at night as it seems darker, but doable. We just got a car with brighter headlights, so that helps. I sensed a was a bit of glare and a peripheral flicker, but that lasted only a few days. No halos, no more glare from oncoming headlights than with my natural lenses.

I am typing on my Macbook now without glasses. I am fine on the computer. I can read the car dash without glasses. To read text on a paper page I have been wearing the least powerful readers, 1.25. I do sense a bit of eye fatigue using the readers. I may have a bit of residual astigmatism. I was told to wait a bit before testing to see if prescription readers might help.

Someone in the thread noted some clinics offer only do Alcon or Johnson and Johnson. The doctors I go to only do Alcon. I also liked the idea of the J and J Eyhance. The Eyhance would have meant glasses for intermediate as well, but would have been largely covered by my insurance. My out-of-pocket for 2 eyes in Pennsylvania was near $5000. I've seen here that others have paid more for these same lenses.

If your cataracts are not now noticeably and negatively affecting your vision, well, you might feel disappointed in the change after lens implantation. I felt that way a bit. It is hard to really remember what one's former vision was like. But when I visited my trusted optometrist, she told me my vision was, in fact, far better than before. The surgeon did not go for any sort of mono-vision correction. Both eyes are set to plano, so distance and intemediate are fine Things get fuzzy closer than 24 inches. The doc told me my intermediate vision is now 20/25 without glasses, which of course, is imperfect, but improved.

Again, wishing you success. I hope you end up as happy as I am with my new lenses.

Sue.An2 Jennifer_Guess · 2023-11-25T23:02+00:00

Hi Jennifer - not a fun diagnosis is it. I was 5 years older than you when I got the terrible news. my cataracts were bad and progressed rapidly - may have been years of steriod creams for atopic ezcema that was cause.

I am not going to talk up any one type of IOL. There are pros and cons to each. No perfect lens. I will say do your research on surgeons as that plays a significant role in outcome and the more the target is achieved better the outcome.

For myself I chose an EDOF lens Symfony. Like you I spend my work day on iPhone and laptop - working with spreadsheets so I really did not want progressives or to whip on and off glasses. i had both surgeries summer of 2017. Have not had pco in either eye and rarely wear glasses. I do have readers +1.25 to read fine print - like stock wuotes in paper, pill bottles - labels on soup cans etc and occasionally when I read novels extended period of time.

Compromise is night vision - although to be honest I do drive at night with little thought to the halos. The glare is minimal - far less than when I was driving with cataracts. This is where minimal refraction error is important from my understanding. I do see huge concentric circles around certain lights ie red traffic lights that get smaller as I approach them. Outer rings are so faint at this point years after surgery I have to concentrate to see them. Inner rings are more vivid and they are still noticeable.

I did develop epiretinal membrane in one eye in which straight lines appear curvy and vision is blurred. Both eyes open I do not notice this. surgery not recommended at this time (deemed risky and since my vision with both eyes open is good no need). Epiretinal membrane can be caused by cataract surgery itself and that is the most likely cause of mine.

My thoughts - given my current situation if I had chose any sort of monovision my overall vision would be more compromised than it is and I would likely be wearing glasses to correct. I like to play golf and snorkel - it is wonderful not yo have to wear glasses everyday. Everyone is different - but I have no regrets for going with EFOF. If there was refraction errors and i had to wear glasses to correct as well as live with the night time issues my answer would be different.

I think younger patients have a much more difficult time deciding. Older patients already experienced decline in vision so they gain something from cataract surgery. Whereas a younger patient has to make a compromise and give up something.

Wishing you well on this journey.

Guest Jennifer_Guess · 2021-11-16T12:51+00:00

Given your criteria and the options available to you I think the choice is very clear… go with Vivity. If you drive a lot at night I wouldn't risk the Panoptix. And yes you may not even be able to check a notification on you Phone with a Monofocal without progressives or readers let alone actual reading. Vivity should give you "good enough" near vision for quick glances like checking your phone but you'd still likely need low add readers of plano progressives for actual reading (like reading a book)

Beth-R Jennifer_Guess · 2021-12-14T00:39+00:00

I recently went through all the choices for IOL's... it can become overwhelming! I, too, was new to these forums and didn't understand some of what people were talking about because they use acronyms, but I learned most of them.

I have an astigmatism and wear tri-focals, I have four sets of glasses for varying tasks (reading, driving, watching TV in bed and a set of tri-focals for everything) it can get expensive each time my vision changes! I found out I have a cataract and it grew quickly in 6 months. Since I have the astigmatism, it was suggested I get a Toric lens if I go for a multi-focal lens. My doctor gave me the choice of Eyhance (I would still need glasses) or the PanOptix and he said I might need glasses for very fine print. I had read about the haloes and other issues some people have had with the PanOptix. To be honest, all the choices seem have some trade-offs, whether it is that you will still need reading glasses, halo effects, etc. I read many different sources about the PanOptix and felt comfortable having it put in.

My surgery was yesterday, (11/18/21) in the morning. Today I went for my follow-up and I'm seeing 20/20 in that eye! Where I used to need my computer/reading glasses to type this on my computer, I am not wearing my glasses at all, even for my other eye, which the doctor said might happen. I am very happy with the lens and it is nice to know I don't need glasses. I know I need to wait 6-8 weeks for my eyes to fully adjust to the change. Since I haven't been outside at night, I went out on my 2nd story balcony and looked directly at a spotlight on the ground. I looked at it with my non-operated eye and saw a hazy area around it. Then looked at it with the new lens and I saw radiated light from it, but it was more like a radiant star and the lines were straight instead of hazy. It didn't seem abnormal, just a different look. I doubt I will have problems driving, as there has always been some sort of haze around headlights, street lights and traffic signals for me.

Everyone has to figure out what is best for their situation and budget. Maybe you have different options if you don't have an astigmatism. I know the PanOptix is expensive, but I figure after I have the 2nd eye done next year, I'll save a lot of money not having to buy new lenses all the time (I rarely would change my frames and it saved me lots of money).

On another note, I was very apprehensive about the cataract surgery, as I have never had eye surgery and it is one of the things I have always feared. I talked to many people and they kept telling me it is so easy. I think I read too much about the surgery and the post-operative issues and that made my fears worsen. I didn't see any instruments and only saw a light during the procedure. No pain at all, not even any pressure. Also. my doctor doesn't offer the laser-assisted procedure. Some doctors do... it costs more and it depends on the doctor's cutting abilities. The doctor still needs to manually suction out the bits of the cataract the laser breaks up, and insert the lens manually. So the laser basically only measures and cuts, then breaks up the cataract.

Lastly, my post-op was a little scary. Last night I had a large black floater I was seeing and today I found out it was the medicine he puts in the eye so I don't have to add the expensive post-op eye drops. Also, when I looked at bright lights, like my vanity lights, I saw flashes of light. This morning I called the office when I saw them and they checked my eyes and found the retina was not detached. This is actually a normal side-effect to the surgery (PVD) and will subside as the eye heals from the surgery. I also go to a retinologist and he always told me that if I ever saw flashes of light to call him immediately because it could mean the retina is trying to detach. My cataract surgeon explained that the eye has had a lot done to it to take out the cataract and install the lens, so this is the adjustment the eye goes through. My retinologist also explained to me that the vitreous fluid changes as we get older and can cause some of the changes we see in our eyes. I've learned quite a bit over the past few years about my aging eyes... and I'm only 66!

I wish you luck in your decision and surgery. Take it from someone who was so apprehensive... it really is an easy procedure. It is also the most common surgical procedure.

I have no idea which lens to choose!! Please help!

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