Is a multifocal IOL not truly multifocal?

I can certainly understand (and agree) with doctors being conservative.  Much better to under promise and over deliver than the other way around.

Unfortunately starting to see IOLs being aggressively sold to non cataract patients promising them they’ll see great at all distances and not have to worry about cataracts down the road.

I predict we will see a lot more unhappy patients in that catagory.

No I did mean monovision as that is  what I’ve had in my contacts for the last 20 years.

Interesting - most people cannot tolerate full mono vision.  After my research I was too concerned about the drawbacks including (1) lost depth perception, (2) increased chances of slip and falls in my senior years  (3) my eyes not working together thus increased chances of needing glasses at all ranges.  I've heard some people really like it and if you have been living with it for 20 years then perhaps it might be right for you.  Best thing is to do as much research as you can and talk to your doctor.

When I asked the surgeon / opthamologist about depth perception being affected with monovision,  he thought it would be most noticeable in people who play sports. 

I believe full monovision May affect more than those who play sports.   For some it can affect balance - not everyone ‘s brain adjusts well.  With my history of migraines my surgeon said this could bring them on more frequently than I already experience.  Mini monovision on the other hand is something most people could tolerate very well.   

In any case my surgeon would not do full monovision on someone who had not tried this out with contact lenses.  My cataracts at the time didn’t allow me to experiment with contacts.

Given you have had that setup for 20 years it would appear to be most logical for you to go with monofocals and do monovision.  It would eliminate glasses for you for most everyday tasks and you would not have to deal with any of the night issues that would be associated with Symfony lenses.

susan44499,

Having used monovision for the last 30 years, firstly with contact lens and the last 2 years with a monofocal lens set for reading and a Symfony lens for distance, and based on your having used monovision with contact lens,  this is my personal opinion:

1. You will probably not have any issue due to monovision with monofocal lenses, such as getting used to them or having balance problems.

2. However, you may find that because your natural lens has been replaced by an IOL, you have lost even the small remaining focus adjustment in the natural eyes. Practically speaking, with one eye set for distance and the other eye set for reading at 16-18 inches distance, your vision will not be good from about 30 inches to 80 inches. You can adjust to that, but just be aware of that.

If you want a little bit better intermediate distance vision, you can probably aim one eye for -0.25 D and the other one at about -1.5D (or best focus at about 26 inches). With that, you won't see a significant drop in your vision until you are looking at something closer than about 20 inches. You will probably have to use glasses for reading fine print or a book comfortably.

If you do a lot of work on the computer, may be you should have the second eye set for about 20 inches.

If you will rather have good near and intermediate vision, you can have one eye set for about 18 inches and the other one for about 40 inches. You will probably see 20/30 instead of 20/20 for distance, which should be good enough for most activities. You will then use glasses only for driving or anything where seeing well in the distance.is important.

Thus, the choice depends mainly on your life style. There will be a compromise in whatever choice you make and you have to figure out the compromise which will me most acceptable to you.

I wish I'd done a contact trial with multifocals before I had cataracts, though it's not exactly te same as IOLs.

 

Why a Symfony lens for distance and not a monofocal?

I got the Symfony lens on December 1, 2016 for distance in my right eye because at that time no one (doctors, the Symfony manufacturer Abbottt, people on this forum) seems to have mentioned or talked about the night vision issue of multiple circles around lights at night and thus, the extended focus capability of Symfony lens seemed to be available without any vision compromise. That is why just a few days after my surgery and being acutely aware of this unexpected night vision issue,  I started the post "Has Any One Else Noticed this Unusual Vision Issue with Symfony Lens " in the hope that others will become more aware of this problem when they make the decision for themselves.

It has been a good post - lots of discussion and raised awareness.

Out of curiosity to your knowledge has anyone tried a setup you recommended if targeting Symfony for intermediate with a monofocal targeted for distance in dominant eye and experienced less of the halos?

I did this this and it turns out that it's probably a better "trial" for a Symfony lens but without the night artifacts (at least in my case). The reason I say this is because your eyes probably still have some accommodation left and it doesn't take very much to extend the focus range of those two focal points. I went with a low-add muiti-focal contact to simulate a low-add multi-focal IOL. With the contact, I have a continuous, clear vision range of maybe 20" to infinity (and I still wear this in one eye). This is close to what Synfony should give you. With the multifocal IOL, instead I have two distinct focus zones with less clear vision in between (because now there is zero accommodation left in the eyes).  

I think that Night-Hawk was considering trying that combination a few months back. I am not sure if he posted his experience with that.

He has had one eye done - toric monofocal for best distance and it has turned out well - pretty much target he and his surgeon was aiming for.  He has not yet had 2nd eye done- but I think Symfony is something he is considering to have better intermediate / near vision.   Jury’s our for the moment.   Makes me envious a bit of those who have time between surgeries - lol.

There is a new EDOF lens by Zeiss in clinical trials - I would expect it to be available soon in UK ( at LARA).  Claims to provide a better extended focus than Symfony and less halos (jury would be out on that too until a number of actual patients weigh in).

Yes I am considering that combination but probably not for several years in the future.

I had my cataract surgery so far only on my right eye which had the cataract that was bad enough to warrant it since it had gotten worse than 20/50 vision corrected.  I now have a Tecnis toric monofocal in the right eye set for distance vision, ended up right at PLANO power with some residual astigmatism (probably 0.50D or so cylinder). My vision still varies at times in that eye probably due to dry eye since it improves after using some lube eye drops.  Usually in the mornings and in good outdoor light I can get close to 20/20 distance vision in that eye, in the afternoon and evening it may drop to 20/25 or 20/30, especially noticeable driving at night.

But my left eye only has a very early stage cataract that hasn't effected that eye's vision yet and corrects with eyeglasses or contacts to 20/15 or so and is quite stable even driving at night.

I may consider a Symfony toric IOL for that eye when the time comes probably in a few years, either that or another toric monofocal but set slightly nearsighted like -0.50D to -1.00D at most, that works for computer monitor viewing for me. Though with a Symfony I could get good distance and probably down to -1.50D for excellent intermediate vision and good enough near for smartphone reading. But I have to decide if I'd be willing to accept the Symfony night vision artifacts.

A new EDOF lens choice would be excellent for the future, I hope more such choices are available in a few years since my left eye probably won't need surgery for several years.

The dry eyes can definitely affect your vision during the day.

There are many reasons for having dry eyes, which is why different people prefer different types of eye drops.

For the eyes, which become dry due to the reduced lipids in the eye tears (causing the tear drops to evaporate too fast), taking a fish capsule as a supplement seems to help. I started taking those after reading an article in the Science Section of the New York Times 2-3 months back and it made such a huge difference that I hardly use eye drops any more. May be a worth a try for you also.

I wish I could recall where I read something similar- except I take a flaxseed capsule supplement daily.  I too rarely use eye drops.   Glad too as those eye drops aren’t cheap.  And because they are non prescription ai cannot claim on insurance.

Also since Susan 4499 mentioned AMD been doing some reading to see if there anything one can do to keep the macula healthy.  Is there anything to substantiate adding these supplements to your daily routine?  

Lutein, 6-10 mg

Vitamin C, 500 mg

Vitamin E, 200 – 400 IU

Vitamin D3, 1000 – 2000 IU

Zeaxanthin, 2 mg

Zinc, 20 – 80 mg

One study I read said these can slow down progression if you have AMD but didn’t conclusively day if they would help prevent.  Also there are side affects to taking higher dosage of supplements that one should weigh beforehand just like any medication.

Yes hoping there will be other options for you Night Hawk.  

Could be I am just more aware (or sensitive to it) but seeing more and more ads for clear lens exchange - can’t imagine wanting to do this unless one has cataracts.  But that whole industry will push for better and better lenses.  Hard to contemplate my own parents will benefit from that and I couldn’t.  Cataracts weren’t even on my radar till I was blindsided.   But diesntvprevent me from wishing others better IOL options.  

Had a few work colleagues interested in this technology (clear lens exchange) as the lasik procedure they’ve had 20 years ago was fine up till now and they are starting to need reading glasses.   I tell them not to do it but they are envious of my not needing glasses.  Hard to convey to them they might regret the night vision issues and there is no guarantee they’ll be glasses free.

Have a great day!

There is a good article on the potential benefits of Fish Oil Capsule for Dry Eyes in a Mayo Clinic Q and A, Nov 2017 article

You should be able to find it by searching with the key words:

Fish Oil Capsule Dry Eyes  Mayo Clinic 2017

Thanks - just read through that Q&A on fish oil capsules for dry eye.   I have a shellfish allergy and allergic to some fish like cod - although I can eat salmon without issue.

Always been concerned about fish oil capsules as I don’t know what type of fish oil is in them.   I have been taking flaxseed oil as an alternative.  Will need to research more to see if I can find a brand which indicates type of fish used.

Seems like dry eyes are pretty common (more common?)  after cataract surgery.

I eat a very low carb, high fat diet (Paleo/Ketogenic) and I find that I don't get dry eyes.  Maybe I'm just lucky, or maybe it's actually my diet. I also take fish oil capsules every now and then (I often forget!).

Yes, dry eyes is listed as a common symptom after any eye surgery that involves cutting the cornea, including cataract surgery as well as LASIK, etc.