Intraocular lens suggestions

Posted , 11 users are following.

I am 40 years old, and I found out last year that my worsening vision is due to cataracts. Everything is completely blurred with my left eye, but my right eye is still pretty good. I know soon enough I will have to have surgery. I have never needed glasses and would prefer to not need reading glasses if that option was available, even at an added expense. What types and/or brands of lenses do you recommend? Also, does anybody have any recommendations for eye surgeons in the Baltimore, Maryland area? Thanks!

0 likes, 31 replies

31 Replies

Next
  • Posted

    I am scheduled to have Cataract surgery on my right eye on August 13 and my left eye on August 30. My doctor has given me two options. If I want to be able to see at all distances without glasses, he will use a Symfony Multifocal lens in my right eye and a Symfony Multifocal Toric Lens in my left eye to address the astigmatism. These are both premium lens and cost $3300.00 per eye. Second option is to correct distance only with a regular monofical lens in my right eye that is Covered by my insurance, and a regular Toric monofocal lens for my left eye. The cost for the regular Toric lens is $2200.00. I would have to wear glasses for reading and possibly intermediate distance with the second option. I have a week to decide. I have read a lot about both options and am leaning in the direction of the Symfony Lenses.
  • Posted

    So sorry to learn you have cataracts at 40.  Must be a difficult decision especially since you likely don’t need reading glasses now.  Do you wear glasses or contact lenses currently?  If you’d care to share your current prescription there are a number of people here that will offer suggestions.

    Is your worsening eye still able to correct to 20/20 or 20/30 with glasses or contacts?  I am from Canada and when my best corrected vision even with glasses was worse than 20/40 our healthcare system paid for the surgery.  

    I had both eyes done last summer due to cataracts at 53. Once you have cataract surgery your eye(s) lose  all accommodation so if you don’t need cataract surgery yet I personally would wait and read all you can as most of us have not found our surgeons very good at providing much information.  You’ll find this especially true in the USA where a lot of them will push for premium lenses at quite an expense.  There is no guarantee you’ll be glasses free with them but likely you’ll be more glasses independent.  They do come with a trade off/compromise of your night vision.  There are more halos  around light sources to contend with.  Some prefer the regular monofocal lenses where one eye is targeted for distance (usually your dominant eye) and the other for intermediate and monofocal  lenses tend to have less night vision issues. 

    As you have one eye that doesn’t need surgery you may want to consider having a monofocal lens in the eye that needs surgery targeted for best corrected distance.  Your good eye will be able to read and you’d likely not need glasses (if you don’t wear them now) or wear a contact lens in that eye.

    I had to have both eyes done and did chose Symfony EDOF (extended depth of focus) lenses and don’t wear glasses but do see concentric circles around light sources at night  (traffic lights, car brakes, LED porch lights).  If I did a lot of driving at night these would not be lenses i’d choose.

    There are pros and cons to each lens (no perfect ones yet on the market) so it’s good you are looking into your options prior to surgery.

    Wish you all the best.

  • Posted

    I was exactly in your situation last year. 40 years old, cataract in the left eye and no cataract in the right eye. The only difference was that I have worn glasses for distance since 14 years old. Based on my doctor’s advice (sales pitch), I got Symfony toric. A decision I regret every day since the day of the surgery till today. 

    My advice - postpone getting the surgery as long as possible. Even with Symfony your near vision would not nearly be as good as it must be now, even with cataract. Symfony works best when done in both eyes- at least that’s what I have been told, but that’s not what you’d be doing. With one good eye and one Symfony you’d always be comparing left to right and feel frustrated. Symfony comes with glares and halos that make night vision miserable. 

    Monofocal lens will lead you to needing glasses also. But that is the best bet given how clear the vision can be without side effects. I would advice getting a monofocal set to near a little bit so you end up at needing about -1.00 to -1.25 and wear glasses for distance. Given your without glasses perfect right eye, you will mostly just do fine at all distances with that. 

     

  • Posted

    Johns Hopkins would be a good place to go in Maryland. 

    I am somewhat insane situation as you. Diagnosed a year ago. I am 42. Left eye is completely blurred far and near.

  • Posted

    My left eye is short-sighted at -2.0 and right eye is currently implanted with Symphony EDOF IOL set to -0.5 (good for intermediate distance but not good for near distance shorter than 40cm to 50cm, depending on contract and lighting condition), which was the result of discussion of me and my doctor on August, 2017, almost one year now.  

    Now, I don't need glasses for daytime since my left eye takes care of near objects and right eye takes care of intermediate objects (from 50cm upwards).  Yes, in the beginning there seems to be a slight coordination problem between left eye and right eye. But now, I don't seem to feel it. 

    As  Sue.An said "...here are more halos  around light sources to contend with" in Symphony EDOF lens, especially at night, which is ABSOLUTELY correct and I am getting used to it now.  I drive often, mostly on daytime, so I wear glasses or contact lenses to correct my short-sighted left eye, no correction for my IOL right eye.  

    As  sunny68454 said: "...With one good eye and one Symfony you’d always be comparing left to right and feel frustrated. Symfony comes with glares and halos that make night vision miserable....", which is somewhat I had gone through but I didn't feel too troublesome after a few weeks. 

    Because my right eye was completely blurred near and far before cataract, I did a research by reading a couple of cataract clinics papers and talked to my doctor about what I desired and we had reached an agreement on what kind of surgery and what kind of IOL to use. Yes, the IOL will never be as good as natural eyes but with cataract I had no choice but to choose what I thought was the best for me. I am satisified with my decision and am grateful for the help of my doctor. 

    I concur sunny68454's suggestion that Monofocal lens might be the potential best choice for you.  Please, find a good doctor who is willing to talk to you about the pros and cons of the surgery and IOLs. No IOLs will be as good as natural eyes so a good doctor is very important to help you getting the best surgery/IOL option available. Good luck and wish everything goes well with you. 

    • Posted

      Do you by any chance know what your axial length is of your right eye. 

      I am asking because even after leaving you -0.5 refraction it still is only 40 to 50 cm and not closer. 

      I am going to follow similar strategy and wonder if better near vision is a function of axial length. 

    • Posted

      Sorry, I don't know my axial length of my right eye. My doctor did a complete check on my right eye and then asked what distance of clear vision I desired.

      Yes, you are right and that is what I said in my post that my -0.5 refraction right eye only allows me to see objects no closer than 40 to 50cm with good lighting and contrast,  which is usually fine during the daytime. My doctor first suggested me to accept -2.0 refraction for my right eye just as my -2.0 left eye so that (1) there will be less coordination problem between left eye and right eye, and (2) I can see close objects (less than 50cm) clearly. But in that case, I will need spectacles for both eyes for intermediate to far objects.   

      I don't know much about axial length but I know that (1) IOL loses the auto focal point adjustment ability of natural eyes, and (2) IOL is about Presbyopia 3.0. So, by adjusting the refraction of IOL will allow you to target how near object to be seen clearly. 

       

      Hope this helps and wish everything goes well with you. 

    • Posted

      Sam.My having a hard time understanding why your Symfony EDOF lens doesn’t provide better near vision than 40cm (targeted for -0.5).  Would you know if it is a regular Symfony Lens or a toric lens to correct astigmatism?

      I have 2 Symfony regular lenses targeted for plano and can see from 11 inches to distance.   The usual is to see well from 16 to 18 inches but that should provide good reading distance anyways.  With targeting Symfony for -0.5 I would expect you to be able to read well with that lens.  What is your exact current prescription with that eye?

    • Posted

      Now that I think about it 40 cm is seems a good result for -0.5 refraction.  The doctors project 60 cm to be the distance for plano.  Which is a 2D length.  So improvement of 25% to 2D is a 25% improvement to 60 which is 45 cm.

      I think people with smaller axial lengths get better results than the standard.

    • Posted

      Hi Sue.An, You can see from 11 inches to distance, does it mean that anything nearer than 11" is blur? My husband read out to me from a book placed right under his nose, at arms length and anywhere in between with no difficulty at all. His has amazing intermediate and distant vision to boot.

      I once saw a pie chart detailing a good success rate of Symfony EDOF, with about <30% patients having issues with night vision. However, I can't seem to find it now.

    • Posted

      Yes starting at 11 inches things start to blur - I can make words out at 6 or 7 inches but it is not comfortable and as things come closer to my face things become blurrier.  So your husband can see to read things very close?

      Soks was wondering if the ability to see closer with Symfony had anything to do with the axial length of a person’s eyes.

    • Posted

      Hi Soks I think I replied to Jantje that it was those with longer axial lengths that people have better closer.  Thanks for clarifying as it appears to be reverse.
    • Posted

      "ability to see closer with Symfony" as in people with high degree myopia? Yes, hubby is very short sighted with astigmatism, but was implanted with normal Symfony EDOF lenses.  Sorry for bothering you all with silly questions but I've stopped bugging that poor guy at home, and decide to find out myself why he came out unscathed.  

      @soks, If this will put your mind at ease, new technology has eliminated axial length measurement error in 95% of cases, and thereby minimizing IOL power errors. It never occurred to me to find out my axial length.  All I remembered was, during the pre-cataract surgery consultation, I had to go to two different rooms to look at 2 different machines.  My husband had to go to 3 different rooms, presumably 3 different machines.  In fact, we had little interfacing with the eye-surgeon other than the basic pertinent Q&A and assurance of the pending surgery(ies).  We left all the IOL measurements and more complex details with the genius. smile  These people have very high IQ, you do not want to rub them up the wrong way prior a surgery just sayin'.

    • Posted

      I am really not sure why some people are able to see closer with regular Symfony lenses vs others.   Thinking there are several factors involved including skill of a surgeon.  The literature regarding Symfony targeted for plano is that one should expect to read at about 16 to 18 inches.  And of course reading becomes easier when both eyes are implanted with Symfony lenses.  

      My pre-op tests were conducted 2 separate times.  I had one done at the hospital where I sat in front of 3 different machines.  Once those results were sent to opthamologist I had a separate exam and consult with him.  My eyes were dialated and examined and during consult I asked about IOL options.   At home I searched online and came across these forums and thatbjust made my decision more confusing so I contact the opthamologist for a second consult which delayed my surgery another month.  At that consult I was leaning towards Symfony sonhe had me go with an assistant from his office for another test in front of a machine in his office.  I was told I could change my mind up till 2 days ahead of surgery and if I wanted Symfony I had to call the hospital to arrange payment minimum48 hours ahead of surgery which is what I did.

      I don’t look back on the decision as I do enjoy the freedom from glasses which I never really had.  Would be nice not to have nightbtime vision issues but one can’t have it all.  Last night Saturn was visible in the night sky.  For me I saw a little hali around it.  My daughter and husband didn’t see that - Saturn was just a bright orange light for them both. So yes Symfony does have it’s drawbacks.  I guess if one didn’t see well during the day or needed glasses anyways that trade-off would be harder to accept. 

    • Posted

      I am just speculating. I do not know for sure. For example a natural eye lens would have to flex lens for smaller distance within the eye than for larger distance. Hence my logic. 
    • Posted

      My axial length is 26.8.  The Barrett method corrects for all axial lengths. 
    • Posted

      Some may find that 'halo effect' cool, there is one from this site. cheesygrin  It's a pity I cannot post a diagram here. From "crystoday com", night vision symptoms or photopsias are closely related to the near vision these premium lenses provide: 1) Glare and starbursts generally result from PCO, refractive error (eg, astigmatism), optical aberrations, and/or problems with the tear film or ocular surface. 2) Halos typically are related to multifocal IOLs.  (fig. 1)

      3) In a plano, perfectly focused eye, all the rays from a point source are on axis. (fig 2)

      The figure I gave earlier about <30% patients having issues with night vision is excessive. Try to googling and pull out these "bar charts" ~ very interesting.

      ZXR00 ~ Tecnis Symfony EDOF IOLs, Degree of Difficulty with Visual Symptoms (bar chart)

      ZKB00 ~ Tecnis Symfony Multifocal IOLs, Degree of Difficulty with Night Vision (bar chart)

       

    • Posted

      Sam.My, how is your distance vision without glasses in the Symfony eye?
    • Posted

      Hi Sue.An, I asked hubby if he saw a hali around the Saturn, and he said that it is the only planet that has a ring. The only explanation why both your husband and daughter only saw a bright orange light but not the hali, is your "bionic eyes" (aka premium lenses). smile

    • Posted

      I think it is because if the refractive index of the orange color against the premium lens. My pre surgery eyes distort green color lights even during the day time when there are no other light issues. 
    • Posted

      That could very well be.  Even with concentric circles - they appear around red orange or amber lights - but not around overhead street lights and I have often wondered why not white lights.
    • Posted

      Do you see them around street lights like the famous internet photo?  What about green stop lights?  And the head lights of oncoming cars?

      Wonder why Saturn just had one ring and not multiple since it is dark outside the pupil will be max dilated to lit up all rings.

    • Posted

      In the case of Saturn - it’s the distance.  And the ring I saw around it wasn’t well defined like one of the concentric circles.  

      Do not see the concentric circles around oncoming car headlights- depending on type of headlight that’s more of a glare vs a halo.  Especially the new blue-white ones everyone says are annoying (even without cataracts or artificial lenses).  Overhead streetlights - have less glare than headlights and no concentric circles no matter what distance they are from me.  Same with red brake lights on a car - no circles until the brake is applied - then I see the circles.   I don’t see them around green traffic lights either.  I wonder if the colors have to be very vivid for me to see the circles.

      I do know the concentric circles when they appear are visible when I am a certain distance from light source and as I get closer to the light as in the case of red traffic lights they disappear altogether and I see a bit of a glare around the light.

    • Posted

      Are you sure its Saturn and not the planet Mars?

      Mars is very bright right now since its at its closest to earth at this time and is orange color in the sky.

    • Posted

      Mars looks blood red and huge. I see Saturn like any other star of fluorescent light. 

      There is another planet in the west that is huge right around sunset. Probably Venus. 

    • Posted

      Hi soks, perhaps it is the desired telephoto effect. I own a basic DSLR, although I hardly use it now I still go online to browse at others' galleries. Some of them had cataracts removed and all chose premium lenses, and now have razor sharp vision. My dentist is postponing his cataract surgery(ies) to next year. Those at the prime of their career sure are nervous even if the risk is less than say 1 percent.

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.