Monofocal IOL for NEAR: How far can you see?

I've been in the same spot as you as I am setup for my first eye cataract surgery later this month.

I decided to start with a monofocal IOL in my dominant eye set for good distance and then will wait and see how that eye turns out after it heals to make a future decision for the other eye.

If I don't get good intermediate focus in addition to distance focus with the first eye, I would definitely want to set the other eye for good intermediate with a monofocal or possibly even a Symfony otherwise. But I want to start with a monofocal  in the first eye to have the best chance for artifact-free distance vision in at least one eye.

If you set monofocal for intermediate you may need glasses for distance.  If going  with monofocals why not set first surgery for distance and 2nd for intermediate (mini monovision) to get a better range.  

How much was your surgeon going to charge for Symfony lenses?  As a Canadian getting Price shock for what you pay in USA.

That sounds like a good plan.

Well first eye is the really bad eye so i think my surgeon suggested going with not quite intermediate but more distance with a slight inclination towards inside. He said he recommended that for my active lifestyle. I was a bit disappointed that what he would suggest because I wanted to avoid having to wear glasses on different sides of the spectrum so to speak; have best distance especially after reading some of the results of others with monofocal here in this forum. I will have to disscus further again with my opthamologist again in the next few weeks to help me make my decision. We will be doing my left eye first which will be non dominant eye so that's why I think he also suggested not going best corrected distance as of yet. That's if I choose monofocal, Symfony I think we will be going best corrected distance if I choose that IOL. I'm on Medicaid insurance here in USA at kaiser Permanente and Symfony will cost $2,500 extra. Monofocal will be no additional cost

Will expense be hard to cover?   Given you are doing non dominant eye first and opthamologist is suggesting slightly near - maybe targeting 30/30 or 20/40 vision with Symfony - you’d likely get great vision and Symfony set for best wouldn’t likely produce the night time visuals.   Then chose a good monofocal for distance in your dominant eye.  This cuts the cost too if one Symfony and one monofocal.   

Just as a side note my second surgery Symfony was set slightly nearest (we were aiming for 0D both eyes) and I have been getting a lot less glare from lights.  Drive on a dark road that 3 weeks ago was a little scary. This time on same road no issues at all .  So I am wondering if having one Symfony set for nearer for me has helped produce less halos and glare.

In the USA, the cost of the premium IOLs appears to vary quite a bit in different parts of the country.

In southern California, the price quotes I got for the multifocal, Symfony, and Crystalens were all very close and just under $2000 each.  For a monofocal toric its a little cheaper, around $1300-$1500.

Another very expensive addon is the femtolaser assisted surgery, thats quoted up to $1400 or so!

The ORA addon isn't too bad, I got quoted $300-500 for that.

So I am starting with a Tecnic monofocal toric in my right (dominant) eye with ORA, but no femtolaser.  Thats still just under $2000 out of pocket total I figure including under $100 for the two prescription eyedrops.  The estimate from my insurance for the basic cataract surgery covered for my part of the cost is $400-$700.  So probably close to $2500 total for one eye for me I figure.

That’s pretty pricey.  From reading I have done in Canada surgeons across the country used to charge differently for the premium lenses until June 2012.  Then our government centralized that through the hospitals and we all pay same price.  These are bought in bulk so cost savings there plus you get credit of $300 cost of monofocal lens.  I paid $900 per Symfony Lens- nothing else.  I would be finding a surgeon who was very busy - not desperate for clients.  Don’t want the money factor influencing the d decision- it’s hard d enough without that.

Mind you you have more options for the surgery - latest equipment etc.  And less wait time.  Pros and cons to different systems.

It's a bit pricey but If i do decide to go with a Symfony it's definitely something that my family could afford of the extra cost. Interesting that your Symfony set to nearer produces less glare/halos. thats something that I will keep in mind. Really glad to hear that; That's absolutely Awesome that night driving is becoming easier. Do you think that your also just neuro adapting to the Symfony lens as well? I know you also said in other posts that the glare/flares from headlights are starting to subside but your noticing the concentric circles more often after a several weeks postop. Also wanted to ask have you gone to any major downtown urban environments now that you've had both eyes done with Symfony. I know you said it's more difficult in darker secluded roads with oncoming glare from headlights but what about vice versa where there's hundreds of cars, over lights and billboards? Like New York City or Los Angeles for example?  

I don’t live in a major city and more - moved to Atlantic Canada.  But have family in Quebec and likely will dive and visit next summer.  It will be interesting to see how that is driving wise.

We do have highways here just not anythibg like Quebec and Ontario with 5 or 6 lanes.

When I saw strong glare I think that hid the concentric circles.  It was blinding.  Now those are less intense I see the circles but they aren’t blinding.    Possibly brain adapts.  Surgeon did say that over time but he was saying 6 months and more brain can learn to tune them out like floaters.  So as I am only 6 weeks out from 2nd surgery tend to think that the bit of mini monovision with one eye set for a bit nearer had helped the night time visuals.  I didn’t actually mean to turn onto the highway as I have been planning going my night driving routes on well lit streets.  I turned onto the highway and was halfway home before I clued in that I was t having any difficulty.

Lately been playing a game like Katniss and PETA in Hunger Games where she asks him questions and whether they are true or not true.  My good friend I walk with each night says she thinks me it has been so lo g I saw ‘normal’ that must of the night visuals are normal as she describes them same way and she doesn’t have cataracts.  Just the concentric circles are ‘true’

Anyways I do find it easier for whatever reason.

Something I cannot tell as I have not tried monofocals but my surgeon says daytime vision is more panoramic with Symfony whereas I would have found the focus more narrow with a monofocal.  But again hard for me to compare as I don’t have monofocals.

I will say it again. I found 2 studies done by Abbott that both say 95% to 96% of people who have monofocal IOLs set for distance can see well without glasses at distances between 2 and 5 feet. Why do you think there's not more people coming on here complaining about monofocals set for distance? Most people who have cataract surgery get that type of lens. If it was so terrible they would be complaining all over the place online. I see far more complaints online about Symfony lenses than monofocals set for distance.

But if money is no object to you, then go ahead and get the Symfony lens. If you get the monofocals set for distance you have a 4% to 5% chance of needing glasses to see at mid-range. I have read plenty of complaints from people who can't read without glasses with the Symfony lens and because I didn't want to spend over $5,000 along with the possibility of having problems driving at night, I went with the monofocals set for distance.

Also, I'm pretty sure that statistic of 5% to 6% of people who need glasses for mid-range distances of 2 to 5 feet with monofocals set for distance doesn't include refractive surprise (error in the calculation I believe usually due to physician error) after cataract surgery, so you have to be prepared for anything.

And refractive surprise can occur with premium IOLs like the Symfony also.

I am in the same dilemma.  I like Symfony but dread the night issues.  If I went with it I would probably try to make near vision better (good from 12 inches) and have distance vision needing -0.5 correction.  I am skeptical about the ability of the process to get accurately predict the results though.

I am not sure if some of the good results reported on here for monfocal IOL set for distance with good near vision as well are a norm or an exception.  The doctors are definitely not promising it.

I have considered this option of monofocal in one eye and symfony in other.  But would probably be bother by spider webs in one eye and not with other. 

I found 2 studies done by Abbott (the company that makes the Symfony lens) that found 95 out of 100 people didn't need glasses to see intermediate distances of 2 to 5 feet after getting monofocals IOLs set for distance.

That sorta sounds like the norm to me.

And in case you don't realize what that really means, it means 5 people out of a 100 people who get monofocal IOLs set for distance can't see mid-range distances of 2 to 5 feet without wearing glasses and the other 95 people can.