Interested in your feedback on questions for opthamologist

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I have an appointment Wednesday. Cataract surgery scheduled early July. Live in Canada so surgery and monofocal lens covered by our healthcare system. Am ok with additional expense for Symfony lens (which I am considering)

What key issues/questions should I cover with opthamologist aside from possible halo/glare should I opt with Symfony.

If I don't go with premium lens thinking I would prefer monofocals set for near vision given my line of work with computers. I currently wear glasses for distance - just starting needing a bit of help for intermediate distance. Optomestrist 2 years ago thought I should get used to wearing progressives although I take my glasses off for reading.

Thinking it would be easier for me to adapt to what I have now and wear glasses for distance.

Would appreciate for those who've already had cataract surgery to weigh in with your thoughts .

Thanks - I am grateful for your feedback. Reading these forums has really helped me come to grips with realistic expectations and outcomes. Knowing there isn't an ideal lens out there - trying to decide what I would value more.

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  • Posted

    I had a cataract done on my left eye, but because of macular pucker it will never be good vision. I had the same idea about near vision mono and so I went to the dollar store and bought the strength they recommended and tried it out for a few days. Took the lens out of the left side of the glasses and was really happy. Will need glasses for distance, but like you, prefer not to use them for up-close and mid range.
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    • Posted

      Thanks Victoria. There so many things I do close range that I am thinking I would prefer to keep that. I guess if I choose for distance I gain something I haven't had since a child but I'd lose what I have had - my near vision. Might be best to go with what I know.

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  • Posted

    If you are used to wearing glasses for distance as needed, it is ok to choose your IOL's for reading. However, you will probably have to use the progressive glasses to see well at anything beyond 20 inches.

    I adjusted to monovision in less than 5 minutes, but everyone does not do that well. However, most people adjust to blended vision (or micromonovision) very well. You may want to try the blended vision with contact lenses (or at least with glasses) right away to see if you are comfortable using it.

    If you are comfortable using blended vision, then:

    1. If you want to use monofocal lenses only, then you should have one eye focus distance set at about 17 inches (or at -2.25 D) and the other eye at about 26 inches (-1.5D). With this combination, you should not need to use glasses for near or intermediate distances: will need them only for distance.

    2. If you are willing to use a combination of a monofocal with a Symfony lens (a combination which I have), I will suggest using a Symfony lens in the non-dominant eye set for the best focus at about 32 inches or -1.25 D (which should give you a good vision at 16 to 48 inches range) in combination with a monofocal lens in the dominant eye set for the best focus at distance (-0.25 to 0.0 D). You should not have to wear glasses with this combination.

    3. A more common (but still overall not common) combination of a Symfony lens and a monofocal lens, which uses a monofocal lens in the non-dominant eye set for the best focus at about 17 inches or about -2.25 D  in combination with a Symfony lens in the dominant eye set for the best focus at distance (-0.25 to 0.0 D). This combination should give you a good day vision at all distances. This is the combination which I have and with which I am very happy with my day vision, but I don't like the associated multiple circles or the halos.

    If I had a chance of going back in time, I would have chosen the Symfony lens and monofocal lens combination as in no 2 above (instead of as in no 3 above), because I think it would have provided me equally good day vision with better night vision.

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    • Posted

      You are a wealth of information and I wish I'd have been so well informed prior to my surgery! I have a question for you.

      August of 2016: cataracts removed and the basic lens ( only lens covered by insurance) was implanted.

      Insurance only covered the traditional surgery--scalpel, no laser. I have basically no near vision any more, and have floaters as big as horseflies. Also have something I can only describe as a curtain that remains over my eyes after blinking. Sometimes it will go away after a couple of blinks. Other times it lingers for 5-10 minutes.

      The eye doc tells me that he "slightly" reduced my near vision so as to facilitate better vision distance. So far, I've washed my hair with dog shampoo (after our dog had his bath, I left the bottle by the people shampoo and my near vision is so bad that I couldn't tell what I was grabbing). I also used baby butt cream as toothpaste!

      I can't figure out how any tweaking was accomplished without some kind of laser. Is it possible to do it with a scalpel?

      Any ideas? Thank you so much.

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    • Posted

      1. They used to use a "scalpel" to correct vision, but most of the opthamologists began to use laser for the vision correction about 30 years back. The best way to know what he did is to ask him that question again and make sure that he gives you a direct answer.

      2. Sorry to learn that you have been having quite a few vision issues. Again, the best thing to do is to address them one by one. Starting with the floaters and the curtain effect in the eye, check with your surgeon or another opthamologist: for an explanation. Hopefully, the problems will get better soon on their own, but it is nice to know the reason for the problems and to know if anything needs to be done at this time. He should do your eye examination, as needed, to confirm his diagnosis.

      3. Regarding the poor near vision, I assume that you are wearing glasses most of the time. What is the prescription for those glasses: for distance and for reading? How well can you see with those glasses at distance (20/20?) and at reading distance. If you can share that information, I may be able to give you a more specific suggestion.

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    • Posted

      I just saw your reply. Sorry about that. I haven't been able to get a pair of prescription glasses because my eyes have't reached the end goal. The surgeon had told me that he would be able to fix my near vision and when I repeated that the cost of lasik was not in my budget then and still wasn't, he said "It can be worked out".

      That's what I thought I thought all the contact trials were working towards. Rather than $3600, he was allowing me $200 off per eye.

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    • Posted

      It is surprising that the doctor has not given you a prescription for the glasses which you need to see well. if you had the cataract surgery in August, it has been almost a year since you have needed some glasses.

      Even if you to have to spend about $100 to get an inexpensive pair of prescription glasses to see well, which may become obsolete in couple of months ( if you have LASIK for eye correction), they are worth the cost. Also, you will know how well you can hope to see after LASIK or if you have some other vision issues. Also, that will remove the urgency of your having to make a decision about LASIK.

      Just for reference, after my cataract surgery in early December 2016, I had the prescription for my glasses to get the best distance vision about 2 weeks after the surgery, even though I was scheduled to have LASIK enhancement to correct the astigmatism in another 4 weeks. I used the glasses to see well at night for only 3 weeks, but the $80 spent by me were  still worth to me.

       

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    • Posted

      I never even thought about buying an inexpensive pair of glasses! Absolutely it would be worth it! The only talk about glasses was that I'd be waiting until vision was more stabilized. Thank you SO MUCH!

      I was reading a bit about my surgeon today, only to find out he is one of the Rising Stars in his field in Minnesota! He invented a gadget that aids in a part of the laser procedure. Of course, he is beyond reproach!!

      I think the cloudiness (curtains) is worsening. Although the retinologist advised to proceed with the refraction work prior to cleaning up the back of my eye, I'm not really able to make.an informed decision about setting the vision because of the increased haze I'm looking through. Jeez Louise!! Always something!

      Thanks again!!

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    • Posted

      201 - thinking more about these options. Do you know if I have to choose this scenario (no 2) in advance? Or if I go ahead as is with Symfony lenses and after first eye I can change my mi d about 2nd. If Symfony works well in first eye would just keep with Sufi y in 2!nd. But if night vision an issue switch and for monofocal for distance.

      I have never tried multifocal contacts or any sort of monovision (too late to try that due to cataracts).

      Thanks for your help. Surgery for 1st eye is July 10

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    • Posted

      I think that besides making the Symfony versus monofocal lens choice, the first decison which you need to make is whether you are willing to use a small amount of monovision in order to not have to wear any glasses even for reading. If you don't use even a small amount of monovision, then you will be needing glasses for reading. Nothing wrong with making that choice, but you just need to be aware of that.

      Whether you have the Symfony lens installed first or second will probably not make much difference. Having 2 Symfony lenses instead of having the combination of a Symfony lens and a monofocal lens does not really offer significant advantage regarding the day vision, but has the potential of increasing night vision issues.

      My suggestion will be to stay with no 2 option. It provides you with a good chance of not having any night vision issue as well as not needing any glasses. Most people adjust fine to a small amount of monovision. If by any chance, you find that you just can't adjust to it, you will still have the choice of using LASIK fo change the best focus of the Symfony lens from 32 inches to the far distance.

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    • Posted

      I should add that the basic message which I am trying to convey is:

      1. One can get most of the day-vision benefits of using two Symfony lenses by using a combination of a Symfony lens and a monofocal lens, with the combination potentially resulting in less night vision issues if done right.

      2. One has the best choice of avoiding the night vision issues by using the monofocal lens in the dominant eye and setting it for the best focus at far distance (equivalent distance prescription of zero).

      3. It is better to have the Symfony lens in the non-dominant eye. Setting it for the best focus at far distance will result in the maximum chance of requiring glasses for reading. Setting the Symfony lens for best focus at about 32 inches (corresponding to -1.25D prescription) will probably mean not requiring any reading glasses. However, one can choose to aim for the effective prescription of any value between -1.25D and 0D: the more negative this value corresponds to less chance of requiring reading glasses, but a larger (even though still small) difficulty in adjusting to the difference in the prescriptions for the 2 eyes.

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    • Posted

      Thanks for your input - first eye I am being operated on is my right eye which I think is my non dominant eye. Still thinking I will stick with Symfony lens. Although I don't mind glasses thinking that this will give me best range of vision. If I need readers for fine print and extended reading that won't bother me. Really hoping I can adjust to halos over time. Do you know if the Symfony lenses are pupil dependent? From my reading seems the MF lenses that are pupil dependent cause more halos. My optometrist cautioned me about MF lenses as my pupils are large. So thinking they play a role in this. My understanding is younger people's eyes do dialate more anyways and as we age they construct more so perhaps another reason for visual night time issues.

      I also read on this his forum some are experiencing halos with inside lights. Haven't read that anywhere in studies so wondering if those are separate issues to the lenses themselves.

      If all goes well will likely do both eyes with Symfony as my surgeon said they work

      Better together. However if I am not comfortable with that after first eye will see about left eye - consider monofocal.

      Appreciate your feedback.

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    • Posted

      If your right eye is non-dominant and you are going to get Symfony lens in that for distance, that is fine.

      However, even if the halos in that case are acceptable, my suggestion will be to leave well enough alone and have the monofocal lens in the dominant eye (left eye). All you will be doing at that stage by choosing Symfony lens in the left eye will be paying a lot more money for minimal additional benefits and taking unnecessary risk of having halos.

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    • Posted

      Are halos really bothersome? Worries me a bit. There are times I want to chicken out and get monofocals both eyes. Is the whole neuroadapt thing rhetoric from the medical community.
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    • Posted

      Sue.An

      I'm guessing that you mean nighttime halos, right? Maybe there are other kinds I don't know about. I've learned more about cataracts from people on this site than I was ever told by my doc.

      Anyhoo..my biggest trouble with driving at night is headlights that are no longer defined, they are starbursts. Best of luck to you!

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    • Posted

      The halos are not the same for the various types of lenses even though they tend to be lumped together. For example, the multiple circles (about 10 of them ) which people like me see around lights at distance with Symfony lenses are unique because Symfony lenses are the only ones with 10 diffractive circles in the lens, which is their key design feature.

      As I have said ealier, the best solution is to not limit yourself to either Symfony lenses or the monofocal lenses. Combining a Symfony lens in the non-dominant eye with a monofocal lens in the dominant eye gives one the best chance of achieving a better good vision range (compared with 2 monofocal) while providing a better chance of avoiding the potential night vision issues with using 2 Symfony lenses.

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    • Posted

      With that combination do you end up with monovision? Do you wear a contact lens then in one eye (obviously glasses wouldn't work) for eye with monofocal.

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    • Posted

      If both the lenses (one monofocal and one Symfony) are set for the best focus at far distance, there is no monovision.

      The decision about whether to have monovision (and how much of that) is independent of that (one can achieve that with 2 Symfony lenses, with 2 monofocal lenses, or with a combination with 1 of each).

       

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    • Posted

      Been having a lot of anxiety over this. Realize it's partly just my personality of wanting to know the outcome. Strong

      Pull right now to call

      My surgeon's office this week to say I have changed my mind and going with mi officials. Feel that's the safer route - but that's because wearing glasses is all I have known. Whatever isn't corrected with a monofocal I can get glasses for. 85% of multifocal lenses are happy - but if I wind up the unhappy statistic I will be sorry I did t choose a monofocal.

      I know you're helping a lot of us on these forums with these decisions and outcomes. Have you encountered many happy patients?

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    • Posted

      you should have been given a card to carry in your wallet. Your lenses should be indicated on that.
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