LI61AO Sofport IOL

thanks for sharing deb. anxious for your results. good luck.

Wish you all the best.

Glad you were able to see him! You know he has a Youtube channel where he posts all of his surgical videos (if this interests you). Please keep us posted on how things go! Best of luck

hi deb

what do you mean by bad floaters? vitrectomy will reduce the small risk of retina detachment too. i see a lot of flow in the light halos. i wonder if that will go with vitrectomy.

Bad was a poor choice of wording. Significant floaters would have been a better term. I had post vitreous detachment in both eyes last year which which resulted in large floaters that hang around the center of my vision.

Thank you. I have seen his videos. Maybe I'll make his youtube channel and my eye will be famous lol!

ha ha. he seems pretty cool about exchanging lens in open capsule.

ha ha. he seems pretty cool about exchanging lens in open capsule.

By open capsule you mean YAGed capsule, right?

Dr Zeiss thinks it is no big deal either! It is amazing the confidence level between various surgeons.

Any updates on your eye? Did you do the exchange with Safran?

I did have the surgery last Thursday. I haven't posted because unfortunately I don't have much to share on whether it was successful regarding the PD. I have a fold in the capsule which is causing the Maddox rod effect. This occurred after my first surgery but went away after about 4-5 days. So far, it hasn't subsided at all. If it doesn't go away on it's own, I will need the YAG laser and then won't really know if the PD was caused by PCO. I have not had my one week post-op yet, but I can tell my visual acuity is much better. He also did a vitrectomy for floater removal and that was successful.

I had my one week post-op today with my local optometrist. RE vision is -.25 -.25 x 130. I asked the Dr. to target slightly myopic which he did. Astigmatism started at -.5 so it's a slight improvement from where it was. Not sure if it will change some - hopefully for the better if it does, but I'm not complaining about .25! Maddox rod effect has not subsided at all. Optometrist saw the fold(s) in the capsule. My plan is to go to NJ for a YAG procedure in a few weeks.

Because of the Maddox rod effect, I can't say that the exchange did anything for the PD. Regardless, I am happy I did the surgery though because I have a concern with the high refractive index and the potential for glistenings with the Alcon lens. My vision is also better (I was .5 farsighted with first op) and my floaters are gone. I mentioned this earlier, but I don't think my pupil dilates beyond the edge of the IOL. I noticed the PD day and night.

what are ur pd symptoms? a coworker of mine got maddox rod at 3 months. YaG fixed it. after i sort this out i will go to wills eye for yag.

RE - prior to lens exchange - halos, starbursts, monocular diplopia. It's hard to say what my symptoms are now because Maddox rod is so prominent.

LE - same symptoms, but I have glare also. I think the glare is definitely caused by PCO. Thanks for the info about your coworker!

Maybe there are issues with my pupil dilating beyond the edge on an IOL. I'll explain my observations and let me know what y'all think please . LE - Alcon Acrylic +.25S. RE - B&L Silicone -.25S -.25C (one week post op). LE sees perfect distance during the day. RE has a little astigmatism so beyond about 6 feet or so LE sees best. 6 feet in RE sees best. I was traveling and stayed in 2 different hotels. At night in the first hotel, there was an LED clock across the room. Looking out of my left eye, the time was blurry. Right eye, time was clear. Unfortunately I didn't think to test my vision with the lights on. Move to hotel number 2. Now there is an LCD clock across the room. Maybe 13 feet. In the dark again I noticed LE blurry, RE clear. This time I thought to turn the lights on. LE is clear with the lights on. RE can still read time but not as well as LE. I did the test multiple times. Thoughts?

does LE have PCO? did u also see the lens edge glare along with the blurry time?

my initial thoughts are PCO. LED is now blurry in my operated eye in the dark. so are the traffic lights. especially the green one. both are clear in light.

yes. as of 2 months ago, PCO 2+ LE, 1+ RE. Did not notice edge glare. As you know, this has been my dilemma with the lens exchange. Its hard to know if its PCO or the acrylic/high refractive index.

i have the same dilemma but my glare started 6 days post op so the pco must be less contributing factor.

Deb I am experiencing same thing and amazed both eyes open nothing is blurry. I am thinking my is pco developing in LE or astigmatism is worse in that eye. I will need a doctor to confirm.

Deb was your LE always like that? At one time mine was clear vision either eye.

Looking back at the last 4 months since my LE surgery, I really feel like the symptoms are classic PCO, and I had it from the start. Post surgery, I saw halos around lights. At 7 weeks post op, PCO grade was 2+. I can't say when, but at some point I started to be bothered by glare in my LE, and it has become fairly significant. I definitely have noticed loss of visual acuity from the glare.

I tend to think that my RE PCO (noted as trace at one month and 1+ at 7 weeks) is not the cause of my RE visual disturbances. However, I've read that wrinkles/folds in the capsule can be a form of PCO, and my RE has folds. I am getting YAG on my RE this week and will update everyone on the results.

Thanks your your input. Wish you well. Would be interested in knowing if it clears everything for you

I really feel like the symptoms are classic PCO, and I had it from the start.

I believe that.

It backs what 2-3 surgeons told us. They had said during early consultation that the cataract was dense and they could not look behind the lens properly. They said that cells could already be causing opacity on the capsular bag (even before the actual cataract surgery). I am still not fully clear on the science but...anyway.

However, I've read that wrinkles/folds in the capsule can be a form of PCO, and my RE has folds.

Can also be caused by tension on the capsular bag by the haptics of the IOL. I think it happens maybe more on people with small capsular bag.

Either way YAG will take care of it. Deb, good luck 😃 I am sure all will be good.

"Can also be caused by tension on the capsular bag by the haptics of the IOL. I think it happens maybe more on people with small capsular bag." -- isn't the tension actually a good thing for the capsule?

Sue -- how do you see the headlights of a car or street lights. forget the halos and rings how do you see the actual light? i read danish viking saying edof does some weird stuff around the lights and i see some weird stuff around the car hard lights and street lights in the dark from day one. almost like a twinkling ring. so if day 1 pco is a theory then that explains it.

deb -- i will be standing next you (literally) for moral support during the YAG. ha ha.

on day 5 or 6 i first noticed positive dysphotopsia and the arcs. at 5 weeks i was told i had peripheral pco. at 7 weeks i was told i had mild pco. i think the concentric circles got smudged at around 3 weeks. at around 4 weeks the dysphotopsia ring got some king of a rainbow effect. around 4 weeks the clear halo around the lights and the clear star bursts have some kind of flow / floaters in them. i can move them away by rapid eye movement. the rainbow effect seems to have reduced now. at 8 months i had PCO at 2. at 11 months night time stop lights have become multiple and bit distorted. i think my near vision has become worse than since the surgery.

Deb - what are your symptoms? is it possible that the PCO cause the pupil to dilate more because less light is passing into the eye?

isn't the tension actually a good thing for the capsule?

Probably strong tension and not gentle good tension.

I meant... strong tension that causes too much distortion vs gentle good tension that holds IOL in place.

I don't think so. LE halos and glare. RE I've got the Maddox rod effect from the fold(s) and some ghosting/double vision. The ghosting/double vision gets more pronounced the further away the light source is. I don't notice it all if I am fairly close to it.

Deb how are you doing now? did you get the YAG? was your IOL exchange with Safran worth it you think? still considering my exchange with him soon

grant

Well the jury is still out. I keep having issues so I can't say for sure. I was diagnosed with a swollen retina today and have started steroid and anti-inflammatory drops. I do still have night time artifacts. I am happy that my daytime vision is better (I am -.25S and -.25C). He also did the vitrectomy which resolved my floaters. So from a surgical standpoint, I believe he is an excellent surgeon. He is also very accessible and great with followup. He truly cares about his patients. I did get IOL pitting from my YAG which I'm not happy about. I am not planning to get my LE exchanged. The night time artifacts in that eye are not as severe, and I think may be from PCO.

@Deb03 How are you doing? I find your story quite confusing, so, to sum it up:

1. You had Acrysof monofocal in both eyes and you were bothered by glare, halos and starburst.
2. You had your IOL exchanged with the LI61AO Sofport by Safran.
3. Your sympthoms of glare, starburst and halos did not resolve and you also got other complications with retin as a result of secondary procedure.
4. You think it was not woth a try as you still have the same night-time issues with that eye.

Is that correct?

I find my story confusing too. 😃

1. Yes.
2. Yes. He is an excellent surgeon.
3. Disclaimer - I have swelling and macular edema so it could be having an effect on my vision. But currently, from pre-exchange to post yag, I'd say my night time artifacts are worse. Whether it's IOL pitting or light reflecting off the edge of the capsulotomy or something else, YAG seemed to make it worse. I also had and still have vertical monocular diplopia (with lights at distance) in both eyes.
4. Same disclaimer. I'd really like to answer this after my eye clears up and after I have YAG and vitrectomy in LE; then I can better compare the two eyes. Worth a try is hard to answer. In my case, I ended up with better visual acuity (-.25S -.25C) - I'm typing this on my laptop with no glasses. Was +.5S -.5C. I also needed/wanted a vitrectomy which I did at the same time. I also won't worry about the possibility of glistenings and complications down the road with the Acrysof lens.

@Deb03 Believe me or not, but my next step is based on your story to some extent. Cause the worst outcome I could imagine, except total loss of vision or its acuity, would be to get the very same night-time troubles or even more, like swelling and macular edema that you got due to secondary procudre.

I mean, Positive Dysphotopsia will be the only reason for me to open the eye again. My vision acuity is very good.

I am not able to carry on with it that way, but am extremly scared of stories like yours where the issues acutually did not resolve.

Have you had YAG and does constricting your pupils resolve it? Tamarinda who is on this site has a premium lens in one eye and got the li61ao in the other eye. I think she is happy with it. It might be helpful to message her to get her feedback.

Howdy!

I have a multifocal ZKB00 in non-dominant eye, has halos and ghosting I dont like and starbursts that dont bother me as much. Settled in at +0.25.

Very psychologically traumatized by the unexpected outcome!

Four months later got B&L lens, monofocal for distance. Settled in at -0.5 unfortunately. Also small capsular wrinkle creates some small Rod Maddox effect. With that eye alone I have some haze around certain very bright traffic or tail lights but not nearly as bad as the multifocal. And no ghosting which is a huge relief.

I've heard from others with monofocals that they get starbursts from headlights and reflected sunlight. I think it's common. Not as bothersome to me because I just look away. Doesn't impede driving.

With both eyes I still get some ghosting and halos but much better than before. I really notice the improved intermediate vision with slightly nearsighted monofocal: museum plaques were blurry with multifocal alone but clear with monofocal.

When I put a contact lens in monofocal eye, it practically eliminates the halos at distance. And the immediate gets a bit worse of course.

I can do everything without glasses but reading in bed is for some reason not as good as uptight, haha.

Places I notice decreased near vision: fixing things, trimming hang nails, sometimes when eating. I'm clear at about 17 inches and there is some contrast loss.

i have mild PCO in first eye already but will wait to YAG until I see exchange specialist because I think I would like to do a monofocal in original eye too. Still evaluating, still doing drops in second eye.

Hope my story helps clarify your decision. It's an aggravating process for sure.

Note that I do think the positive dysphotopsias are very very gradually improving. Not so much that I don't see them, but that they don't bother me as much consciously. That said, it feels a little like white noise... you think you're fine, but when you turn it off you realize how subtly stressed you were by it.

The second eye with a monofocal was so EASY. Knowing I can just use a contact lens for refraction error and that improves the haze some too... it's such a relief. Nighttime is enjoyable again.

Pilocarpine 0,5% resolves my issues down to zero for about 1.5 h but it's painfull and imagine hiding yourself wherever you can just to apply the next dose to keep your pupil constricted.

No, I do not have PCO at all.

I have theoretically a better setting as my second eye is natural without any issues, however, Tecnis 1-piece is soo problematic that it doesn't matter when it comes to binocular vision, my sympthoms get reduced by maybe 1%. Neuroadaptation is a fake, it's impossible not to see huge artifacts. It is simply not possible not to think of it when see them everywhere at night.

adam, it sounds like you should strongly consider a lens exchange. I would look into the long term effects of using pilocarpine daily. I'm not sure it's a good thing in the long run.

Neuroadaptation does occur but it is super slow...years. It also requires not being anxious about it, and in a sensitive person that can be really hard. I think many of us on this forum are highly sensitive. Also, it's a jolt to have a sudden change, and even more so when we are young and feel that life is cheating us.

During my process, I kept having people with way worse health issues show up..one woman was 50 and had like 15 operations for glaucoma. saw only a little sliver of the world. Used to ride a bike but no longer. She said, "Im grateful that I can see at all!" Boy, that reminded me to start being grateful for what I do have. That made me begin to relax so I could make more rational decisions about the eye. And that made me feel less helpless and frustrated.

What are your plans for exchange? It has been quite some time since your implant, yes?

It's been 16 months. I do know Pilocarpine is not the best solution, but I've been using it for the last 15 months and there's no long term inpact on my eye. It is believed that low % of Pilo is not unsafe. It is much more risky in case of people who apply 2% four times a day or so.

Being honest, according to surgeons I met it is much safer to carry on with it than do an exchange.

Besides, there are stories here like Deb03's where IOL exchange caused additional troubles without PD improvement.

If you do opt for an exchange you just need to find a very good surgeon. This requires far more skill and experience that a regular cataract surgeon would have. Check out Julielyn's story - her initial implants were completely done wrong and she found a very good surgeon to do the exchanges and life is better after the exchange. I agree it should not be a decision to enter into lightly and only you know if life is bearable the way it is or not.

I afraid one may find the best suegeon in the World, but it's still a lottery.

What I find strange is that surgeons here in my region, in Europe, say you just be insane if you even consider exchange. It is regarded as highly risky procedure But I noticed that in the USA it's more like "ok, let's go, let's do this, not a big deal".

I've got a question to tamarinda and Deb03 about your Sofport LI61AO.

When you had your follow-up, did you notice glare/ starburst/ halo?

I mean when you had your pupil pharmalogically dilated.

Yes more common in USA and there are dome good surgeons. Yes riskier but that is where one outweighs risk vs reward. If symptoms bad enough might be worth the risk.

Hi adamadam,

My ophtho doesn't dilate during the follow-up visits.

I can say that with the multifocal eye, when I was living in a darker place (I've moved back to the city to be nearer to the doctors while I take care of this), I could see a very large round hazy effect around street lights if I looked up at them from below. I figure that was a function of dilation. I don't know if that's what you are having.

My B&L Sofport does have a funky liquid-like halo around very bright red stoplights, a kiytle like a lava lamp. And a haze of dots around tail lights.. I sort of feel I can see the sifference beyween the acrylic Tecnis and the silicone B&L. The silicone is softer, a tiny bit less crisp but that feels more natural anyhow. (Note: that might be refraction, as the acrylic is at +0.25) Anywho, the diameter is much smaller than the multifocal halos.

At some point, I have to accept that even natural eyes have aberrations...and certainly mine with cataracts had a lot!

sorry for the typos....phone isnt cooperating.

I will be dilated in a few weeks and post back. I had a strong night time dilation earlier this month and the best description I can give is lights looked like ferris wheels with the actual light in the center. I saw this with each eye and saw more "spokes" in the B&L eye. My husband was driving luckily because I saw dozens of ferris wheels everywhere I looked from lights. I hope you don't see anything like that on a regular basis. My best recollection of day time artifacts is seeing flares off of lights in the B&L eye. When I am dilated, I wonder if the IOL pitting could play a role.

ferris wheel is the best description of the positive dysphotopsia that i experience. just that it is not a full circle. some sections of the circle and i dont need dilation.

and the worst part is that my right unoperated pupil is 0.5mm larger than the left one.

Yeah you're reminding me: when my multifocal eye got dilated once I had such crazy effects it was beyond the pale and I just laughed. I knew they would go back to the standard lousy I had before the dilation so I treated it like psychedelia. But living with it that bad all the time would be horrific.

Oh wow. I am so sorry. The ring is quite bright. It's not like the usual glare/halos that I see around lights (and natural eyes do to some extent also).

exchange before yag they are OK with. they dont want to do it with open capsule.

yes my circle or circle quadrants are that big. direct light ring or arc is bright. indirect light ring or arc is dull.

I'd be afraid that wouldn't go away with a lens exchange. They don't make IOLs with round edges anymore do they? Also, which drops don't permanently constrict your pupils? I think I'd like to try them to see if they make a difference on occasions when I have to do a lot of night driving.

i thought the softport lenses had rounded edges. also i was thinking the spokes of the ferris wheel were because of symfony. with monofocal it would be just the ring. alphagan / lumify (brimonidine tartrate) probably will constrict only temporarily. pilocarpine constricts permanently. there are 2 iols greater that 6mm. both are monofocals.

Thanks. They may have been rounded at one point but they advertise square edges. Sending you a link in message. Supposedly some square edge designs are better than others as they are rounded/frosted at the corners. I couldn't tell you about the different designs and whether B&L does something to smooth the edges.

I think the spokes I see are in my RE post yag. I don't recall seeing them (or at least not as significant) in my Alcon non-yagged LE.

Do still see things like this?

Actually it was my mistake as I insisted to take the Tecnis 1-piece instead of Alcon. My surgeon has been using Alcon Acrysof since he started, we took Tecnis and I am the very first case of Positive Dysphotopsia in his career. So I think that index of refraction, glistening --> all these terms are bullsh*t. What matters is the IOL diameter and it's proper power.

The truth is that we should be given compensation from the manufacturer as it's their fault, faulty design without clear warning that their product is associated with issues by definition.

Deb03 how would you describe differences between your Alcon and Sofport eye? Which one is better in terms of quality and intermediate vision? What about blue-light blocker? Is your Alcon eye vision more yellowish?

Which one? I heard of the STAAR cq2010a that is 6.3 mm I believe and XL-Optic ASPIRA-aXA, but the latter is not that easy as its diamter depends on its power.

The greater the power, the lower the IOL's diameter, 5.5-7.0 mm.

sulcoflex, alcon cz79bd. i need 16D.

Just to let you know My surgery went well for Phimosis of lens capsule in my left eye. I had a capsulectomy and vitrectomy last Friday. Beryl

is this drawing from your left eye. from left eye i do see the arc in the same place as your drawing which is nasal upward direction. the spokes extend until the arc and there are no spokes where the arc is not present. and then add glare glow to the ferris wheel.

i think 7mm iol will solve a lot of problem. why is that asking too much.

Only when dilated do I see the ring and it's much thicker and brighter than the picture. I see slightly more yellow but it doesn't bother me. With both eyes open, I see I am hoping to get my capsulotomy and vitrectomy in my Alcon LE in January. Then both eyes will be on a similar playing field. Right now, I really can't compare quality of vision because of PCO and floaters in LE. I have more intermediate vision in my B&L RE because I'm slightly myopic. Aren't the Alcon and Tecnis the same diameter? Don't beat yourself up. I would have chosen the Tecnis myself.

Actually the Tecnis has a reduced functional area. My surgeon said it doesn't matter, but it turned out that he didn't know what he was talking about.

What is you corrected and uncorrected acuity in your B&L eye?

To sum it up, night-time side effects are still visable with the Sofport and it's more pronounced when your pupil is dillated, right?

It's quite important to me as my pupils are big as I'm much younger and I'm afraid that IOL exchange in my case would change nothing as long as you can still see dysphotopsia with the LI61AO.

Do you know how big your dillated pupil might be?

I tend to think your case and Soks case are different than mine. I don't think my eyes dilate beyond the edge of the IOL. I don't know my pupil size. I am 57 so I imagine smaller than yours. I have my doubts about exchange for you since I see bright rings when I'm given dilation drops.

"To sum it up, night-time side effects are still visable with the Sofport and it's more pronounced when your pupil is dillated, right?" Yes. I also see effects during the day, just not as pronounced.

Regarding visual acuity, I am -.25S, -25C. I can read 20/20 (not well though) without glasses. I will say that I question the prescription a little bit. Maybe hoping it's off is more accurate. I see ghosting that gets worse the farther away an image is and also the closer an image is (distant vision and near vision - intermediate is fine). This is new after my second yag.

Well, acutally I can see my pupil shrinking and dillating, e.g. when I look outside at night I can see terrible starburst but when I unlock my smartphone in front of me, PD gradually dissappears. There is no magic here, my pupil is simply too big. However I am surprised that you are struggling also during daytime. I do not have any issues then. Anyway, some says, including your surgeon, that Sofport is increadible and dysphotopsia-free. It seems that's not true.

Adam, what is your pupil size?

I'd say around 5 or 5-6 daytime, 6-8 at night

I'd say around 5 or 5-6 daytime, 6-8 at night

I don't mean guess I mean from the actual measurement 😃

My wife's left pupil is exactly 6.26mm, right is 5.94mm, when full dilated.

.

Was it not measured when it was full dilated? They measure it when they do the measurements for the IOL. If you have copy of your paperwork you will see it in there.

Adam if your pupil is really 8mm then you must be related to colossal squid 😃 I doubt any of the 6mm or even 7mm IOLs will help you 😦

I don't get why you're surprised. I'm 27. It's quite common to have such pupils at this age. It was my guess as my pupils were estimated at around 6,8 at night, but it's not 100% true as it wasn't taken in complate darkness, but with some amount of light. So, I do estimate that it may be up to 8 mm.

My girlfriend who is 24 and has blue eyes dillates up to the boundry of her iris at night, so her pupils probably reach about 1 cm. But I heard that it's common among young women with blue eyes.

I know it is common as 4mm to 8mm is average pupil size. I was just curious as to what the exact measurement was to cause so many issues. Technically anything over 6mm can cause issues, actually even 5.xx mm could cause issues if the IOL is not well centered.

.

My wife is not having any issue though. Only sees edge of the IOL in darkness but no side effects to bother her though.

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My wife's pupil dilates all the way to the extreme edge of the iris too. When her eyes are dilated I almost feel as if I am cheating on her as her natural eyes that I am used to looking at are green/blue/with a touch of light brown 😃

.

What IOL does she have?

Actually I had issues right from the beginning, however, it got much worse after about 1.5 months post-op. So it's not as simple as the pupil diameter.

What IOL does she have?

Zeiss Asphina 509M, plate haptic

Actually I had issues right from the beginning, however, it got much worse after about 1.5 months post-op. So it's not as simple as the pupil diameter.

Yes it is multifactorial but your pupil size is not helping matters.

Maybe you should open a new thread just for yourself too, if you haven't already. More people in similar situation as you can connect via Google search plus it acts as a diary to refer back to.

I'm also thinking of IOL exchange using Zeiss Asphina, but 404 as it's aberration-neutral.

Are you in Europe?

Yes

This is my thread, but I lost access to my previous email and this is my new account.

did your second yag induce astigmatism to cause ghosting?

do you think the plate haptic is helping with not seeing the edge?

i think they would if the haptics are places along the longer diameter of the pupil. i don't know if that is possible though.

I measured the same as I did post-surgery with the phoropter, but at the time of measurement they also diagnosed the mildly swollen retina. Once my issues clear, I will get measurements again. I hope it is something that can be fixed or at least improved with glasses. While I notice it during the day, it's not that bad; it primarily affects my night vision. It goes away with a pinhole occluder, but I'm not sure if that confirms refraction error.

Guys. I can reassure you that there's no way that glasses may alleviate your sympthoms. I've done many experiments and it is just not related to your refraction error, it is casued by IOL itself regardless of your error. For example, I am 20/20 in my left eye with the Tecnis uncorrected, my right nautral eye is sph -1D/ cyl- 0,75D, so I use only one contact lens in my right eye. Because I have full accommodion in my right eye, I don't need any reading glasses. I can see closeup like I used to before surgery. But it I do not put any contact lens in the right eye, there is NO dysphotopsia. Even if my natural eye is dilated up to 1 cm, NO dysphotopsia, just blurry.

Adam we should connect. I'm also in a similar situation to you (29 years old with multifocal IOL in left eye only; considering options to correct positive dysphotopsias). One thing I may not have mentioned before is that I also have a cataract growing in my right eye & it's starting to become more problematic. I might actually go for regular cataract surgery on my RE first to see if it improves the overall vision (since my LE multifocal disturbances used to be more tolerable but now they're getting worse; possibly due to my dominant RE becoming dimmer from cataract development).

gmag21 - what you describe is exactly what i am experiencing except i turned 44 last week. LE done with Symfony but i can see the lens edge outdoors at night - arcs and circles depending on the darkness. my right eye is becoming problematic with the cataract entering the visual axis. my LE also has PCO so that is also affecting the corrected vision.

but i can see the lens edge outdoors at night - arcs and circles depending on the darkness.

When my wife sees it, she does not find it problematic at all. Does that on it's own bother you or is the combination with other stuff that bothers you?

I've never seen the edge of my lens before but I do have problems with off-axis (peripheral) light rays during the day & night. Particularly indoor lights above my head tend to create a horrible glare in front of my vision. At times it can be nearly disabling but luckily I work in an environment where the ceiling lights are mostly diffused (which reduces the issue).

on its own. the circles are huge and on all light sources when they happen. it is weird though coz some days they do not happen at the same light intensity.

Hi gmag, that was my situation, except for age: I just turned 51. I had multifocal in nondominant R eye, really bad halos and ghosting. After tortured decision process (mostly hoping it would get better or that if I did both eyes it would somehow magically resolve)...I went for Sofport monofocal in the dominant L eye, set for plano, 5 months after first eye.

Now 6 weeks out from L eye, I have developed an astigmatism but my optho thinks that's some irregularity of capsule causing some bending of light rays, not necessarily the cornea. (Autorefractor machines get variable readings.) Thinks YAG would improve that, but of course can't do that until a few months from now.

At any rate, one exchange surgeon I saw last week was very clear about all the potential complications of an exchange operation (he said 10-15% complication rate). Even though he said it was reasonable to consider an exchange, I was a bit spooked, quite disappointed... but then shrugged and felt maybe life is telling me I should back away from that option. Once I changed my mindset (i.e., stopped torturing myself about the pending decision), I found my brain really relaxing and settling in, accepting what is instead of yearning for some magical fix...and my vision is quite acceptable, truly. Not perfect, but very workable, and I am noticing how almost everyone one I know wears glasses or contacts anyways. I think opthos oversell the idea that one won't need glasses. Or, we hear what we want to hear.

With the astigmatism in my L eye, if I don't put a contact lens in there, it makes me a little nearsighted in that eye and extends the blur circle, which fills in the intermediate gap that the bifocal Tecnis ZKB00 has. That improves my vision at supermarkets and museums, and also on my computer screen, that I had noticed was a bit lacking. The ghosting at distance and near gets MUCH better. The halos are maybe a little better...but honestly, once I relaxed, I stopped caring and they don't annoy me as much because I can see everything so clearly everywhere else. And the binocular summation is indeed delicious. It just lends a quality of vividness, I guess I'd describe it. Makes it all feel more vibrant.

If I isolate my L monofocal eye, the Sofport has some dysphotopsias too (hazy punctate region around red stoplights), but they seem to be able to vascillate, occasionally disappearing...so maybe it's me seeing my vitreous humor more...who knows? Maybe our brains can in fact suppress the unwanted stuff eventually.

If I correct the L eye astigmatism, the distance becomes much clearer but the intermediate and near then rely exclusively on my multifocal eye, and that augments the ghosting on my computer and phone and dashboard.

In other words, while I still have one more appointment with an exchange surgeon (the best in this area), I have already begun to contemplate just leaving the R eye alone: cut my losses rather than push for hoped excellence and face potential worsening. I'd probably only use contacts for distance nighttime vision where interpretation of lights is important, say, on boats. Perhaps on highway driving. But even driving around the city, I can make do without the contact lens.

One thing that came up with the first exchange surgeon I just saw last week is that neuroadaptation is basically not really going to happen when you have one eye multifocal and one eye monofocal, because the brain will always be able to compare eyes. Still, I can feel that the changing around all the time is part of what makes the dysphotopsias worse. Once I settle on a configuration, my brain will make do with whatever I choose.

While I want to second-guess the whole thing at times, I could also say that this really is the best possible outcome ever, because I have far and intermediate with vibrant bilateral summation, and good enough near to read most food labels without glasses. So I don't have to carry reading glasses around with me. I don't use them with my phone or laptop. Basically, I don't use them at all, and might just use a contact lens for nighttime at sea, during which times I'd sacrifice a bit of intermediate and near but still can get by without readers.

Wow very interesting! Do you know what your prescription is for the R eye multifocal when correcting for distance? My multifocal eye Rx is about -1.75 (with a slight cylinder) which puts my clearest uncorrected focus point at about 22" away. I can also see clearly at 8" away in the multifocal eye but this distance isn't really practical. If you exchanged your multifocal IOL which lens would you go for? Another Sofport potentially?

I also find that the halos get worse as the light source gets further away. When I wear glasses to correct for distance the halos get smaller. One very annoying problem with my multifocal is during the day & night I get terrible fog/shadows around text (see photo example below). Does your multifocal do anything like this?

My multifocal eye settled at +0.25. My near point of maximum clarity is at 17". And so distance is amazingly clear. That's a blessing and a curse because it seems I have to overcorrect my other eye in order to totally suppress the ghosting.

That answers your second reply: yes, I have ghost images on lots of things, including actual 3D objects, like my silver necklace or a tree limb with a bright background or a person speaking in front of a projected screen. The ghost images are what I may always see forever if I keep this lens, because they occur at all distances. They also are the most distressing part, because I can't tell if they are real or not. At least I know the halos are artifact. But ghosting could be a font with shadow or a marquee sign with backlighting: I simply can't distinguish the difference.

If I end up keeping this lens, I may use an overcorrected contact lens when I sail at night, and if I need to graphic design something (posters or flyers for meetings: nothing professional), I might wear readers to make my dominant eye good for near. Whenever the dominant (monofocal) eye can take over, the dysphotopsias disappear.​My halos also get worse at distance, like yours do. I think that is standard when the halos are caused by the eye seeing the concentric rings.

Interesting perhaps to your case is that I did try a contact lens with +1 add once, to see if we could simulate monovision by making the multifocal eye more nearsighted. It made the halos much worse. ​Yes, I'd do a Sofport set for nearish, for a monovision setup. That means I have to try and figure out if my left eye is good enough to be the main distance eye. If I exchange, I may be dependent on contacts. As is, they are optional, just to reduce dysphotopsias.

Even though I am still technically deciding what to do, it is a huge relief to have one eye done with such a simple straightforward lens that I know I would never reconsider it. And the quality of the vision in that eye is excellent. That sense of relief does open my mind and heart to a sense of gratitude that I wasnt able to find before the second eye was done. That gratitude has me remember that sheesh, I was literally going blind and now I can see almost everything! The more gratitude, the clearer my vision, for sure. This is a very mental/emotional experience.

The multifocal feels a bit like high definition TV: startlingly clear and a little fake. The Sofport is just deliciously naturally clear. Like the way it used to feel when I got a new eyeglasses prescription.

One other thing I am noticing now is how it takes a second for my brain to switch from eye to eye. That doesn't bother me, since I know what it is: I'm more curious about it. I heard one monovision patient say she sometimes gets impatient with it, but not a lot.

Back in June or July I posted scribble drawings of what I see, in case that interests you.

Hi gmag21

What type of premium lens do you have?

I have edof in one eye, that one makes white highlighting around white letters on black background, but no ghosting.

The other eye have a trifocal, which is almost having none of these side effects, there are few small side effects in the dark, but a lot less than the edof and never when it is daylight, neither with white letters on black background or anything like that.

My trifocal eye is taking more and more over, so I don´t see the side effects from the edof much any more, only if I close my trifocal eye it is still there, but even the edof side effects have fainted a lot, and I would assume it will continue to get better, it is 4-5 month since surgery.

my symfony does that 'Example' effect from day 1. it became worse with PCO.

gmag21 - why did they set you up for near/intermediate with a multifocal? they could have set you up with edof set for near instead giving you a bit more distance.

I have a ReZoom multifocal that was implanted back in 2007 (I was 17 at the time). Originally my surgeon targeted "plano" and for the first 3-4 years I was 20/20 at distance uncorrected . I noticed halos & dysphotopsias from day 1 but they were very tolerable and not so bad. Fast forward to 2013 and I've become more myopic (wearing glasses about -1.25 Sph with a slight cylinder). Also in 2013 I started noticing shadows around text (an effect I never really had before). I described it to my doctor as sort of a double vision problem and he recommended doing a YAG since my capsule was also a bit cloudy and he thought the symptoms might be cured by the laser. Immediately after doing the YAG I honestly couldn't see much & was in a state of extreme panic (I was literally having an anxiety attack because I thought my eye was ruined). My BCVA had dropped from 20/20 to 20/60. Apparently the laser caused a bunch of residual lens material (RLM) to break off my lens and float around in my vitreous. The doc reported that I now had a 3+ white haze/cloudy mass that would move whenever I turned my eye (as a result of the YAG procedure). I was then sent to a retinal expert (the same day) and he recommended a pars plana vitrectomy (PPV) and lensectomy to remove the RLM and vitreous opacities. The retinal guy performed these surgeries the next day (literally) and my vision was restored to 20/20 uncorrected at distance. After just a few months though I started to become more myopic (back to wearing about -1.0 for distance) and the halos/dysphotopsias are noticeably worse. Ever since the 2013 surgeries I've suffered from nearly intolerable glare & halos and still contemplate IOL exchange surgery to this day. Currently I now wear -1.75 glasses for distance so I think my lens has definitely shifted over time!

check out my response to Danish. The original target was plano but things shifted over time

Wow, that is not a good situation, I fully understand all your frustration.

I think you are right, it is not uncommon that eyes changes until we are in the mid/late twenties, so what was a good result to start with, are now the wrong lenses.

And these lenses are known for giving much worse visual side effects when they are hitting to short of target.

I was born with cataracts, In my teens I had 20/32 vision when I looked with both eyes, with really poor contrast, and severe blinding and stuff from light sources in the dark, driving at night have always been very bad.

Now I am mid forties, and my vision 6 month ago was less than 20/40 with both eyes, so I really could not wait any longer, so I had both eyes done with premium lenses.

My point is I know how much you must be struggling, I have been there.

Have you tried a contact lens instead of glasses? I know other people are using contacts when the refraction is off, and it is much different than glasses, in many cases the contact can "reduce" the side effects to what they would have been, if the lens had the correct refraction.

I had my eyes dilated today. I can only report back on daytime effects. I can't really comment on glare because I had a hard time with observations because the light was so bright and I would only take off my sunglasses for brief periods. Without sunglasses, I guess I felt tremendous glare in both eyes! But, basically my dysphotopsia was exaggerated from its normal state. Starburst/flares were noticeably bigger or longer. My RE (Sofport) is worse than my LE (Alcon) - both normally and when dilated. Although it is improving, I do still have a mildly swollen retina in my RE. I am on steroid and anti-inflammatory drops for 6 more weeks.

do you notice the yellow tint difference between softport and alcon?

Yes. Whites are most noticeable. With both eyes open, I see a blend of the colors. It doesn't bother me.

my monofocals Acrysof SA60AT have the same problems. Doing a lens exchange on my right rye next month with a silicone lens.

Best of luck with your IOL exchange! Please keep us updated. Have you had the YAG laser capsulotomy? Do you mind sharing what specific IOL you'll be changing to? Maybe its the Sofport? Also are you seeing a particular doctor for this?

Regards,

Grant

Any updates on your eyes, gmag?

Did you get the lenses changed or did you choose to keep them?

How is your dysphotopsia today?

i decided to keep my lens due to all the risks. My positive dysphotopsia is still there, but my brain is pretty good at filtering it due to my other eye being natural (although it does have a developing cataract, becoming more problematic with glare). i will definitely go with a monofocal type lens on my next eye; not just because of the dysphotopsias, but also the loss of contrast. I really depend on my natural eye in low light situations

i will definitely go with a monofocal type lens on my next eye; not just because of the dysphotopsias, but also the loss of contrast.

You can start thinking about what best-focus target you will request for that new lens.

yeah I’ve been thinking about that a lot. I will likely go with -2.0 D since this will allow me to have similar uncorrected vision in both eyes (the multifocal in my non-dominant eye has left me a bit myopic, but I appreciate it as a heavy computer and phone user, and I’m OK wearing glasses for distance). my multifocal lens Also has another focus point at around -4.25D so I have exceptional near vision in that eye, and semi- intermediate vision around 18". I think this combo of monocal -2.0 (dominant) and multifocal -4.25/-2.25 would work really well since it would give me super clear near & computer vision, uncorrected, while i wear glasses for walking around/TV/driving. I would say my goal is to have the clearest vision, even if it takes glasses. I also want the most comfortable vision (i.e. very little monovision)

i might have to lean on LAL lens to give me the highest chance of achieving this type of vision target