Mini-monovision with Symfony: Is it possible?

In that combination what correction for distance would be left with Symfony?  -0.5, -0.75...?

May be you already know the answer to my earlier question, but before you decide on the combination of lenses or the amount of mini-monovision for your eyes, you must decide and share your priorities on the type of vision you will be happy with (far vision, intermediate distance vision, being able to read without glasses and with glasses, not seeing multiple circles around lights at night etc). There is no right or wrong answer which applies to everyone. Every combination will have its pros and cons. So, it is better to be clear on your priorities and then ask about / figure out the best choice specific to you.

I didn't see a question in your earlier post.  My preference is for Symfony so I can at least have intermediate and far.  At 42 I have not lost a lot of my accomodation yet.  While I don't like it, I don't care too much about night artifacts as I am not much of a night person and consider night highway driving to be unsafe anyway.  If they are indoors too then it could be a problem.  My original post was about the feasibility of mini-monovision with an EDoF like Symfony as I got conflicting feedback from the surgeon I consulted with.

If you are suggesting mon-vision and Symfony then my question was how much correction would you keep for Symfony to make it near biased. 

Based on what your desired vision is, I don't think that you need 2 Symfony lenses with mini-monovision. You can probably achieve that without the mini-monovision.

If you don't mind using minimonovision, then my suggested order of preference will be:

1, A monofocal lens set for -0.25D in the dominant eye and another monofocal lens set for -1.0D in the other eye. This will provide good vision from far distance down to about 26 inches, but you will need to wear glasses for reading. You will  have the least amount of night vision issues. This is also the most economical option.

2. A monofocal lens set for -0.25D in the dominant eye and a Symfony lens set for -1.0D in the other eye. This will provide good vision from far distance down to about 16 inches. So, you will not need to wear glasses for most reading. You will also have less amount of night vision issues and less cost than  having 2 Symfony lenses.

Hope that this helps.

For the #2 approach you suggested the surgeon says the Symfony with -1D will cause lot of glare. 

If you are concerned with #2 approach because of the surgeon saying that "Symfony with -1D will cause lot of glare.", you should go with approach 1.

However, my personal opinion is that the glare with Symfony with -1D will not be that much higher than a monofocal lens with -1D, which is used all the time in the mini-monovision combination. Essentially, the dominant eye with good distance vision takes over and so, one does not see the glare as one will see if both the eyes are set for -1.0D.

Thanks for your input.  What is your Symfony set at?

The Symfony in my right eye is set for distance, while the left eye has a monofocal set for reading at about 17 - 18 inches. Good day vision at all useful distances, but don't like the multiple circles around lights at night.

I did not have the choice of approach no 2 above because my left eye (with the monofocal lens) had a cataract surgery in 1999, 18 years before the right eye.

How close?  Is -0.5D doable?  The doctor I saw said they shoot for -0.25D anyway because they don't want to overshoot the distance vision.

If your plan is to go with 2 Symfony lenses (or even for a monofocal lens) the surgeon usually implants the lens in your dominant eye when both eyes need cataract surgery anyways.  And they target -0.25 so you don’t end up farsighted.   Most surgeons wait till healing takes place before operating on 2nd eye (minimum 2 weeks) - vision can change in 6 weeks following surgery.

If that eye ends up plano you could aim for more than -0.50.   Even -0.75 to 1.0.

That would ensure you good near vision.

There may just be a difference in terminology being used by your surgeon when it comes to monovision.  Monovision or mini monovision has generally been used with monofocal lenses but any combination of premium IOLs can be used for monovision cataract surgery. When accommodating or multifocal IOLs are used, the term "modified monovision" often is used, since these lenses offer an expanded range of vision by nature of their design in addition to a prescribed monovision effect.

I have good near vision and both eyes are plano (confirmed by my optometrist,).  Can read very well even small fine print (in good lighting) - anything 11 inches away.  I wasn’t expecting that but am happy it turned out that way.  There are variables unforeseen that play into that like your cornea and eye health.  How near or farsighted one is prior to surgery.  Reason why surgeons cannot guarantee perfect vision or glasses free.

That being said no reason why you should not aim for something and then hope for the best.

Guess you must be getting closer to a decision?

I did read and post about a new Extended Depth of Focus lens by Zeiss.  Called at LARA.  I imagine Europe will be using it soon.  Will be interesting to see the patient outcomes on that.  Word is they allow a bit more range of focus than Symfony and fewer halos.  But one would need to see what patients have to say before those claims are confirmed.

Good luck to you Soks.  

Thanks for letting me know about LARA.  It is a beautiful outcome for you that you can see well from 11 inches.  I would pay extra for that outcome.

I am getting near to getting my left eye operated on.  My right eye is now starting to show a tail for green stop lights.

I asked for 0.5D mini-mono vision with Symfony and two surgeons said that that would increase glares, halos.  One of them said that it is not worth it going beyond -0.25D with Symfony.

He did talk about looking at where this eye ends up but this is my non-dominant eye so the preferred correction is best left on the non-dominant eye.

 

Due to my migraines and desire to have eyes balanced both eyes were targeted for plano.  

So given how well I see at 11 inches it is entirely possible that others will too.  

You could also go with suggestion if a201 will a monofocal lens targeted for distance and then have a Symfony tRgeted for -0.50 in the other eye.  Likely would minimize the halos.

Good luck Soks.

I just did an internet search on that new Zeiss at LARA EDOF IOL and found a graph comparing it with Symfony and pictures of the lens too.

Appears very similar to Symfony with the concentric circles visible on the lens, so might have similar night effects around certain lights.

The focus range looks impressive, appears to go out to nearly -2.0D compared to Symfony range to about -1.5D.

However I didn't see any mention of a toric  version with Zeiss, so for those with significant astigmatism to need a toric IOL, the Symfony Toric may still be the only option along with the toric version of the Crystalens (Trulign) for an extended focus toric IOL.

When Symfony was on trials was there both a regular and Toric version announced?  Shame there wouldn’t be one with at LARA.   I too noticed the rings in the lens - not sure how

night vision would be better than Symfony - unless rings further apart?  In any case will be interesting how that lens does when patients start reporting their experiences.

I also found the subjective ranking of the different lenses in night driving conditions interesting.

The Zeiss site states: "In pre-clinical tests using the "virtual implantation" setup, 48 subjects compared four different IOLs in a typical night traffic situation in a random blinded manner: one monofocal IOL, two EDoF IOLs (ZEISS AT LARA and J&J TECNIS Symfony), and one trifocal IOL."

The rankings for night  driving conditions(1 being the best and 4 being the worst) were about 1.1 for monofocal, 2.5 for AT LARA, 3.0 for Symfony, and 3.4 for the trifocal lens.

Still double the rating of a monofocal.  I also don’t know how you’d rate findings.  Very subjective.  It’s not as though the same person could try different lenses and then rank them.   If they had a viewer for you to have a look at the halo effects each lens causes - that would help.

In this case, everyone did try ALL  the four lenses using the "virtual implantation" setup, even though it is hard ti know how representative that is of the real world conditions.

After looking at the night vision with all 4 lenses in simulated conditions, everyone rated them 1 through 4 (1 being the best). The posted scores are the average of the ratings by all 48 people.

That "virtual implementation" sounds interesting - they should provide that technology for patients to try out the view with different IOLs prior to choosing!

Couldn’t agree more.  Or if too pricey at least provide photos of the type of glare/halo you would expect.  

That’s interesting - didn’t pick up on thatvwhen I read it earlier in the week.  I thought trial involved different patients with different lenses.  

I will be interested in seeing how atLARA really compares once it’s approved.  Those who have time to wait it out might have a good option worth spending on.

I really think better lens options will be pushed by the lasik patients who already corrected distance vision to be glasses free and now need a viable option for near vision.  The demand will be there by a market group who are willing to spend for it.

It is not just the LASIK patients who want to stay glasses free after the cataract surgery.

For example, I had been using contact lenses for more than 50 years before my last cataract surgery, without using glasses at all, and I would have hated to go back to using glasses. Fortunately with my combination of  a Symfony lens and a monofocal lens, together with using monovision, my vision is good for all useful distances.

Yes no doubt everyone will want better lenses me included.  I used contact lenses for 15 years but pregnancy changed my eyes and I could no longer tolerate them.  But contacts gave me freedom to enjoy sports.  Didn’t enjoy having to go back to glasses.

I only meant by my comment that the lasik demographics will likely drive the market towards better lenses because they’ve been willing to pay for perfect vision - whereas that vision could have been achieved by glasses or contacts.   And now look at how many clear lens exchanges are going on (and actively promoted).   Once the perfect lens is available people will opt for that as soon presbyopia starts.  Interesting to think cataracts could be a rare occurrence in developed countries.

Anyways just wanted to clarify.  I in no way meant that only lasik patients would benefit from the advances.   Me too (someone who never explored lasik - more out of fear of possibility something could go wrong) opting for 2 Symfony lenses!!!!  but I have gained a new freedom and can’t express how much I like being glasses free!   It was the perfect storm I guess for me.  Had to have procedure regardless so went for broke!!!  😊 

I want to be glasses and contacts free with vision from 6 inches out to infinity and no night time issues!

I know - me too.    I feel ripped off that my parents will have better lens options than I had.

But then life is rarely fair.  There are those suffering far more than I.  Currently thinking of The Humboldt Broncos bus tradegy and all those young lives cut off at prime of life and anguish and loss their parents will live with rest of their lives.

No life isn’t fair- but our attitudes towards the unexpected shape our future.  Too many people miss the silver lining because they’re expecting the gold.

Interestingly, it seems that at least  some doctors have started letting people evaluate the vision they may get with the different IOL designs after cataract surgery (even though obviously, simulation cannot match reality perfectly), For example, in one of the articles in 2017, Barbara Fluder OD states:

"I also use an online visual simulator which shows patients simulated visual results with an IOL for activities including golfing, gardening, shopping, and night driving. Enter the patient’s astigmatism, level of cataract development, and IOL option to demonstrate the visual outcome. Obviously, results may vary, but it is a great way to demonstrate a patient’s expected visual results with various IOL options.

Thanks for sharing the information, Sue.An.  You are amazing.

Welcome jantje32476.