Mini-Mono or Multi-focal. Which one is better?

Posted , 7 users are following.

This is my second post since joining the board. I am a 56 y/o healthy male. I was recently diagnosed with an advanced cataract in my left eye and an early stage cataract in my right eye. I also have Glacoma in the left eye which is being treated with Lanaprost eye drops.

My left eye is 20/100 and my right eye is 20/40. I only see close to intermediate range in the left eye and medium to distance in the right eye. I have a slight astigmatism in my eyes as well. My optic nerve was checked and it’s in good shape and I am a good candidate for cataract surgery. I now see in mono-vision as my eyes have gotten worse in the last few years.

My medical provider is a large HMO. The original surgeon I spoke to said I wasn’t a good candidate for multi-focal lenses due to the fact I have an Asigmatism and smaller shaped eyes. He recommended single vision lenses. But just recently I met with a different surgeon at another location but same HMO, that is well recommended and has a lot of Cataract surgeries under his belt with a high success rate. He looked at my eyes and charts and said he didn’t see anything that would prevent me from getting the multi-focal lenses. His only warning is that I may get some artifacts at night which I already have with the cataract.

I did ask about doing a mini-mono arrangement. He said we can do that but he felt since I’m still relatively young I might miss having a full range of vision. He also said with the mini-mono I will probably need glasses for driving since I most likely won’t pass the driving exam without glasses due to having one near sighted eye.

After reading the posts on this board for a few months now it seems that many of you are having issues with multi-vision lenses due to blurriness or artifacts issues. I guess what I'm wondering is it that much different using a mini-mono arrangement vs multi-focal and will the artifacts (halos and starbursts) at night worse than what I currently experience or just slightly annoying. I think I would prefer the multi-focal lenses and independence from glasses but I don't want problems down the road.

0 likes, 18 replies

Report

18 Replies

Next
  • Posted

    I have Symfony EDoF. I would take the halos and starbursts all day and every day. Having said that, for me those are not the problem. The problem is the nighttime glare including possibly lens edge glare. You may not experience lens edge glare as you take glaucoma medication which constrict the pupils and limits the glare at night. Tolerance for halos and starbursts varies from individual to individual and it is difficult to predict who will be bothered by it.

    Report Reply
  • Posted

    Hi Jeff - soks is right in that no one can predict an outcome. Stats will indicate high percentage if satisfaction no matter what you choose however if you end up on the 5 to 10% that aren't happy stats mean nothing.

    Everyone is different. Most people tolerate mini monovision well. I personally didn't go that route due to my migraines and didn't want any chance of a depth perception issue (but that is me). I did go with EDOF Symfony lenses and they worked out fine for me.

    Since my surgeries have read some very positive reviews from this that targeted their monofocal lenses for intermediate distance and only wear glasses for distance. That setup works well for most usable vision. It really all depends on your personal preferences. Weigh that against not even multifocals will guarantee you glasses free. For dome glasses still needed for near vision.

    One hopes for the best but in the end one adapts to what is following surgery.

    If you want to base decision on stats monofocals provide best stats for night time halos and glare (although edge glare can still happen if you are going with a square edge IOL. But these also are better at preventing or delaying PCO. Round edge IOLs have less incidence of edge glare but do not prevent or delay PCO as well.

    Every lens has a compromise so it's a matter of which trade-off you are willing to take.

    If going for a mini monovision approach personally I would target dominant eye for plano or 0.25 nearer as the target is not always completely accurate. IOLs come in .50 increments of power and the healing process can alter it another .25. Better to be slightly near sighted than far sighted.

    Wishing you the best.

    Report Reply
    • Posted

      I would have similar strategy to Sue.An. The IOLs really come in 0.35D increments, so my strategy with monofocals would be -0.25 in the dominant eye and -0.6 in the non-dominant eye. I would then hope that I get as much intermediate and near as I can but that is difficult to predict.

      Report Reply
  • Posted

    hi, my experience with multifocal is that it must be exact, and make sure your surgeon does multifocal lenses primarily during surgeries. if you dr only does them once in a while find another dr who specializes in multifocal iols, and has an excellent history of exchanges. ive found out the hard way.

    as for night driving and low light conditions. the glare or starbursts could be an issue currently, i have two different multifocals installe (not by choice right now---will be exchanging in the spring) the recent exchange has 12 concentric rings, which cut down on what i used to see big starbursts coming from overhead street lighta and headlights. the other eye which will be exchanged has 9 concentric rings and has helped tremendously with glare, although im only seeing 20/40 with this lens and was installed a year ago. so for me, im happy with seeing the rings at night instead of the bursts that would give me extreme difficulty in wet roads and head on traffic( which is my town) .

    low light conditions just suck things get fuzzy, not to the point of blindness, but just enough out of focus to drive me a little nutty. i use the light from my phone to help with that. another thing my surgeon reminded me of, was pupil dilation women tend to have larger pupils, but shorter arms...so im wondering if some brand iol were built for a mans eye.

    my overall suggestion is research and visit with a few surgeons before you jump into multifocals. im in south florida, originally chose a dr closest to me in key west and it was a big mistake. i needed to exchange those lenses and chose to go to sight trust ( sister company to my previous lasik surgery) in sawgrass fl @3 hrs away. its an all day event for a follow up apointment but worth it when you have a dr/surgeon who knows what he is doing when it comes to multifocal lenses

    Report Reply
    • Posted

      I agree, low light conditions just suck. I don't know if that is because of the more lack of contrast with the EDoF. There is nothing like a crisp sunny day to see the best.

      Report Reply
    • Posted

      I have read that contrast is also more noticeable in younger patients vs older ones. Likely due to pupil dilation in younger patients so they notice it more after cataract surgery. Symfony in that respect not much different than a monofocal lens for that.

      Report Reply
    • Posted

      Yes must be so frustrating. This isn't new technology - one would think they'd have a solution for this (aside from having to take drops).

      Why are IOLs 6mm - could they not come in different sizes?

      Report Reply
  • Posted

    I had my mono focal lens set for distance and had the second IOL set -0.5D in for slightly better near vision for mini mono vision. I almost never wear reading glasses. I had to retrain my brain to hold things further away from my eyes (rather than 5", I now hold my phone around 12"). With regards to driving, I don't think you will have a problem at all with those settings. I see 20/20 or 20/25 in one eye (depending on the day) and at worst 20/40 in the other eye. My understanding from the driver test in California is you need 20/40 in one eye and 20/70 in the second / worse eye though it might vary in different states. With that said, I wouldn't recommend someone drive with that kind of vision without glasses. I had my surgery done almost 2 years ago when I was 55 and in my bad eye it's now 20/40 due to a secondary cataract (which explains the bad vision). We are going to wait a while longer per my doctor's recommendation, but if the vision gets worse or more hazy then he can do a quick in office laser on that eye to fix the secondary cataract.

    The reason I mention this is because I don't know if one would have more potential problems with YAG laser treatment for a secondary cataract with a multi focal (especially if they already have a prior condition such as astigmatism and/or glacoma). I've read as many as 70% will develop a secondary cataract within 5 years. It's a quick and simple treatment but as with anything there can be complications and I don't know if risks increase with a multi focal. Perhaps others can chime in on that.

    Either way, I'm glad I went with a mono focal set for distance and the second one -0.5D for mini mono vision. Ironically, my left eye was set for -0.5D and sees better at all ranges. But, I think it's best to keep the mini mono vision as close as possible should you choose that route so that your eyes work together.

    I have no glares, no halos, no problems whatsoever with driving at night. Everything looks clear and I see well at all ranges - although I will admit up close vision much less than 12" will look a little blurred. I can either wear reading glasses or if I just need to quickly read a medicine bottle and I don't want to get a pair of glasses, I can just turn on the LED light on my iphone. For whatever reason, it's always easier to read small fine print in good lighting. I can also pull out the credit card magnifier I have between my iphone and the silicon flimsy protective case but it's rare that I need to do that.

    I agree with your doctor's recommendation to go with a mono focal lens given that you have glacoma and other conditions. My vision was also somewhat compromised and my doctor also was against a multi focal. I work on the computer a lot, so I'm glad I went with distance and mini mono vision. I never need glasses when I work on the computer or when I drive. If I read books and magazines 24/7, then I probably would have had my vision with a mono focal lens set more to intermediate for the first eye and then if I still had a little trouble reading I would have set the second eye a little further in but if I had no trouble I might have set it a little further out (for better distance). Good luck to you.

    Report Reply
  • Posted

    Did your surgeon give you a recommendation on what type of multifocal he/she would suggest in your case? You are doing the right thing with all the research in advance. They often oversell these lenses.

    There are going to be a tradeoffs going with a multifocal vs monofocals (set the same) vs mini-monovision. I went with a Restor 2.5D (a low-add, fixed multifocal). I had also considered Symfony but ultimately went with the Restor due to the large concentric ring artifact that are part of the Symfony design plus my surgeon's familiarity with the different lens options.

    It was a good choice for me. I do have a "gap" in the mid range of my vision (4 ft to 10 ft) where that eye isn't as clear as my non-surgery eye (the second eye has a mild cataract). However, distance vision is fantastic and the nighttime halos are very small and not bothersome at all. I have "serviceable" computer/reading vision and rarely wear glasses anymore but that is partly due to the great vision in this range via a multifocal contact in my second eye. I think with two identical Restor's I would need reading glasses sometimes.

    When it comes time to do eye #2, I would prefer an EDOF design to a pure multifocal to gain the added range of vision. When I mentioned the "gap" with the Restor, I should mention that it is ONLY noticeable if I close my other eye and just rely on the eye with the IOL. With both eyes open, vision is really fantastic from about 20" to infinity and both eyes are working together without any issue.

    Report Reply
    • Posted

      This is an interesting strategy. Get an EDoF in one eye and a trifocal on another. In terms of refractions together they will give you great correction at all distances. But there could be a combination of night time artifacts from each. Now what they could be will be difficult to know.

      Report Reply
    • Posted

      No he didn't tell what lens he would use but he does a lot of multi-focal surgery and he said if it didn't work out he could replace the lens again as long as I didn't wait to long. He said if you wait longer than 6 months the lens may adhere itself to the eye and be tough to remove.

      Report Reply
    • Posted

      Yes it can be exchanged but that procedure comes with a little more risk than initial cataract surgery. Most surgeons do exchanges as a last resort. My own told me upfront that I would need to see someone else if I wanted a lens exchange. Surgeons that do this have considerable more skill and don't usually spend their days with back to back cataract surgeries. Actually there is no one in my province that would do an exchange - have to head to neighboring province.

      Just to say there is a lot to consider.

      Report Reply
    • Posted

      The surgeon did say that once he removes the cataract the Glaucoma symptoms may go away but that's not a guarantee. Other than the artifacts like halos and star bursts what other issues might I encounter with the multi-focal lenses if i decide to go that route?

      Report Reply
    • Posted

      There is a difference between EDOF (extended depth of focus) IOLs and multifocals. a lot of multifocalls provide vision at 2 distances but vision between the 2 can be a bit blurry. There are trifocals like atLISA which provide all 3 zones but they aren't available in USA or Canada.

      Symfony like I have provide really seamless vision but some won't find the near vision as good as they want. I am not sure why that is. I can see very well from 11 inches to distance. Although my husband who hasn't had cataract surgery still has a bit better distance vision than I have but he has been using readers for some time. At last optometrist visit I see at plano so no distance correction. I will be asking next visit if my pupils are small as some of on forums think that accounts for better near vision no matter the lens.

      I have no visual disturbances daytime. Had that from day 2 of surgery. night time was hard for several months - glare was bad. I needed to plan my routes driving with streets with overhead lighting. Now I drive in any conditions. I do see the 10 or so concentric circles around certain lights - stop lights car brakes (when brakes applied - they appear normal when i travel behind cars at night but as soon as person applies brakes i see the circles. Some LED porch lights. Not game field sports floodlights or overhead street lights. The circles will start appearing at dusk.

      I would say this may be more bothersome to some people than myself. Perhaps as I was aware of these prior to surgery my expectations were worse than reality. However if vision during day or if I couldn't read at all distances wasn't good I likely would have different opinion.

      With EDOF and multifocals power calculation is key and have little to no astigmatism following surgery also key.

      Report Reply

Join this discussion or start a new one?

New discussion Reply

Report as inappropriate

Thanks for your help!

We want the forums to be a useful resource for our users but it is important to remember that the forums 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 forums 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.

newnav-down newnav-up