Monofocal IOL for NEAR: How far can you see?

Yes, I am nearsighted since 8th grade (age 13).  Been at -2.25 and -2.5 for distance correction from age 18.  Since age 39, presbyopia kicked in as well as some astigmatism in the right eye.

I can read very well by taking off the glasses.  But it is an inconvenience than from before when I kept my distance glasses on all the time and the eyes automatically adjusted to near vision while the glasses were still on.

Since presbyopia I cannot eat and watch tv at the same time.  I am torn between symfony and monofocal. 

 

Your prescription sounds similar to mine pre cataract surgery although presbyopia didn’t really set in.  could read and see near quite well.  My prescription was a bit stronger than yours in right eye at -3.0.  

I didn’t really understand I could get much intermediate vision with monofocals prior to my surgery and I guess it worried me as I work full time with spreadsheets and computers so didn’t want to have bifocals for that.  I decided on Symfony lenses and have been happy with my decision.  if I had know otherwise with monofocals perhaps my cautious nature would have kicked in and I would have chosen differently.  I remember being very tempted by Symfony lenses and read just a few good reviews (most were not good).  One blog I liked on the net was Dr Por Yong Ming who has been implanting Symfony lenses much longer than here in Canada.  He had a blog about his experience in using Symfony and a forum which he writes answers to people’s questions.  Forum called ALL THINGS EYE.

All in all I am relieved and pleased I got the result I did with these lenses.  I know others are equally happy with their monofocal lenses here on these forums.  

So maybe the options are good and good.  Most people are pleased with their cataract results.

Hi Sue,

Did you have astigmatism in any eye?  Could you read with your distance glasses on? 

I have read Dr. Por Yong Mings blog and Shanon Wong's youtube videos.  Ming is from Singapore and I was able to consult with top eye surgeon in Singapore through a friend and she mentioned that she has had patients with near vision issues after symfony so she put patients on aberrometer to determine their tolerance. 

 

That is interesting!  Hadn’t heard if that.  I asked at my 2nd consult with my surgeon if he saw anything in my file that made me not so good a candidate for Symfony.  He said no.  I asked about astigmatism too and he said it was negligible.   I had regular Symfony lenses implanted - I know there is a toric version too with Symfony to correct for astigmatism.

For reading with my distance glasses it depended on the print.  Sometimes I could other times I would read without them.  My very last prescription my optometrist wanted me to get used to progressives as she said a small prescription allows people to gradually get used to these lenses.  I did not like them - whenever I looked at ground (running or walking for that matter) ground looked warped.   now everything looks normal again and at 6 week post op I am cleared to start training again - yeah!!  

That's a tough call.  About how long until you think you'll need the 2nd eye done?  

I am glad for your results Sue.  I hope that is the norm for everyone who opts for Symfony.  I absolutely hated progressive lenses.  Couldn't get used to them.  Most thing would get blurry by getting out of focus.

I fear it will be years.  While there is a cataract it is at the periphery.  It is in the line of sight of the affected eye.

I am saying years as my mom's were 7 years apart.  But then mine are posterior sub-capsular so they supposedly advance rapidly.

Mine cataracts developed rapidly.  In Aug 2015 no mention of cataracts.  Prescription hadn’t changed but that is when I first tried progressives.  Jan 2017 diagnosed with cataracts both eyes.  Best correction with glasses was 20/70 in right eye 20/60 in left.

Both surgeries this past summer.  It was a roller coaster ride for sure.  I suspect more than what you find online have had success with Symfony.  If I hadn’t been posting here prior to my surgeries for info likely I would have gotten it done and not posted anything - it would not be on radar.  Here just to give people my experience- not to be substituted for real advice on what anyone else decides.  They are perfect for day and night time I see concentric circles - I am living with that however I knew in advance and was willing to accept compromise.

I also was able to chat with 2 of my surgeons patients who he had operated on (coincidentally through friends) one opted for Symfony the other had a monofocal that from 7 years ago and now needed 2nd eye done who went again with a monofocal lens.  Both were happy with their result.  Symfony one not wearing glasses monofocal one had computer glasses as she couldn’t see that as clear as she needed to for her job.

My first was pretty rapid, too, but don't know about my 2nd eye.  Thankfully the correction combination ended up ideal for now, anyway.  Sounds like in your case that "in-between" time frame will be awkward, correction-wise no matter which lens you get.  Could you tolerate a contact lens?  If even for a short time, then after the 1st surgery you can maybe test out a few monovision corrections.  For example, if you get a monofocal IOL correction for 1st eye for distance, you could put in contact lenses in the 2nd eye that makes it .5D, or .75D more myopic just to test it out.  I am actually going to test a couple of lenses (making my 2nd eye the same or better than the 1st) before the cataract gets too bad just to test it out, even though I think I'm inclined to stay about where I am.  Being very risk-averse, I'd lean towards the 'tried and true' monofocal for eye #1 in any event, then use the time between surgeries to explore the possibilities for the 2nd. Symfony sounds ideal if you get the right surgeon and best outcome like Sue.an, but just so hard to predict.

For the in-between time I will use glasses with no power for the operated eye and probably use that eye for reading (monovision) if I get it biased for near.

Night issues with Symfony are more of a consideration for me than the poor near vision with it.

Soks, So have you decided about the Symfony? 

No, not yet decided.  However, Symfony sounds attractive coz I find Presbyopia very bothersome.  (Can't eat and watch tv at the same time, the car dashboard become blurry during the winter months when it is dark outside).  I have actually worn shirt inside-out in the initial days of presbyopia.

Getting monofocal for near would get to what I have been for the last 2 years.

I don't drive too much at night but don't like the idea of carnival vision at night.  This whole things sux really.

What do you mean by carnival vision at night?  I certainly would not describe night vision with Symfony like that.

Hi soks, as someone who had close to your correction (mine was -2D in both) for many years, I have to sort of disagree that getting monofocal 'near' would necessarily be the same as you've been (-2.25/-2.5?).  Now that I'm only -1D with the IOL in my better eye, I've found it to be a vast improvement from -2D for overall function. Since I don't need distance Rx as often, the "glasses on/off" problem is lessened and reading is good (results vary, of course, but -1 will likely preserve more near vision than -0D, for example).  Mid-range is great. Getting monofocal a little on the minus (intermediate?) side would buy you time to evaluate your post-op fixed range, and give you some time to figure out which way to go for the 2nd IOL (same, more +, -, multifocal, etc) without worrying about the potential multifocal artifacts for the 1st eye, which seem to be concerning you. What does your surgeon think? I really feel your pre-op anxiety here as I had it for months.

One thing to bear in mind - I would think every single one of us on these forums who have been through the decision process can say it wasn’t easy comfortable and wrestled with the options.  This surgery has a high success rate and no matter which way you go there will be compromises but you’ll end up with better eyesight.  The compromises you’ll adjust to whether it’s wearing glasses or dealing with a few night vision issues.  If you need night vision for your job or drive a lot at night you may want to write off the multifocal or EDOF lenses and go with a monofocal solution.   There a few who’ll attest that monofocal setbfor distance will also give intermediate distance ie dashboard.  You may want to have first eye targeted forbdistance so that you can drive without glasses and when it comes time for the 2nd surgery you can target for a little closer (mini monovision) so that you can live quite comfortably without need for glasses.  That surgery is performed usually in most countries for free if you have cataracts.  If funds not a teal concern there are accommodating lenses and Symfony for which the night vision issues isn’t as bad as multifocal - I have Symfony lenses and drive frequently at night and live in a place where it is dark after 5pm four more months of the year.   

I know this is a stressful time but honestly you’ll look back and realize that the result you get is good and something you can live and enjoy life again with.

I was referring to driving in traffic at night with Symfony.  Some people including Dr. Wong say that it is not a big deal.  While some others are bothered by it. 

I wish there was a way to test Symfony vision to see if one could live with it.  I am happy for those who are not bothered by the night issues coz now they are really glasses free!

I wonder if someone with Symfony visited Las Vegas and how was their experience.

Yes would be interesting to have someone’s opinion with Symfony on driving in Las Vegas.  I will be in Montreal next summer.  I am no longer bothered by night driving.  Really settled since I had operation.  Took about 6 weeks.

Some are more bothered for variety of reasons.  If there is an amount of uncorrected astigmatism or lens power miscalculated or other eye issue and others who are perfectionists may be more bothered than others.  

Based on my experience with Symfony lens, while I hate to see the multiple circles around lights at night and was really mad to experience those because the manufacturer and the promoting surgeons never mentioned those, I have learn to live with those. So, this night vision issue is a nuisance (and something I will rather not have), but I don't let it deter me from driving any to any place at night.

What  is a perfectionist or a type a personality?  I have seen this criteria for Symfony suitability in one of the blogs making it almost sounds like one is making a compromise on your vision with Symfony when the exact opposite is true.  Theoretically, Symfony gives you the best possible vision barring the night time issues.

Does ORA take into consideration astigmatism?

-0.75 for distance is a correction for which I won't wear glasses.  That is what my power was when I was first prescribed glasses that too because they checked my eyes at my Mom's cataract surgery for fun on their fancy computer equipment.  Not because I was complaining about poor vision.  So I see your point.  If -1 for distance give you a lot better near vision its a great option to be glasses free.

Are they able to tell you before hand that by going for near vision your distance will require -1 correction?

 

You can google personality tests for descriptions on various personality types.  No one is 100% one type but likely will have 1 type that they are dominant in.

Basically some personality types are more accepting than others of compromises.  And given premium lenses come at a substantial cost patients will tend to expect more.  Perfection cannot be achieved with any IOL.   If you opt for a monofocal these are covered under health care and no out of pocket expense.  Not to say one is better than the other (monofocal vs multifocal or EDOF) how vet the compromise for each is different.

That is why you are best to look at your lifestyle and see which would be best for you. 

Short answer is yes, "sort of."  You can pick a specific "target," based on what distance you'd like to see with/without glasses, etc.  Your final result, however, may vary by half a diopter or so, since it is not an exact science.  Furthermore, you may end up with a greater/lesser range than the next person.

I have the impression that patients getting monofocal lenses are asked if they want to see "near or far" (with "intermediate" occasionally mentioned but not recommended, at least in my cataract class).  They are then told that they will need glasses "for everything else."  Fair enough.  Hard to predict exact outcome.  ("Far" being around 0D, and "near" being around -2D). I don't think the average patient is even aware of the numbers, exactly.  

People on this forum, however, seem to be more keenly of what the exact numbers mean, and are looking for ways to achieve or predict a more specific outcome for their needs. Unless you decide to go for a multifocal, you really need to think long and hard about what exactly you most want to see without glasses, and start from there. If the idea of wearing readers for near vision doesn't bother you, then something close to the  0D end makes sense. This seems to be the most popular choice.  Some people (like nina234 and others I've met) luck out and still see pretty well close up, but most at that end will need readers..  Losing near vision would drive me bonkers so I picked a target closer to the other end (-1.5) but due to that "margin of error" ended up at -1.0 which turned out to be even better (pretty good for distance and reading).  So that is where the -1.0 came from.  Are you saying you didn't feel you needed glasses when you were -.75D? Then being a little near-sighted might not bother you too much. Mention that to your surgeon in picking a target. Long answer but hope it helps!

I once found a YouTube video (I'm sure there are more) made by someone who is very happy with his multifocal lenses, even with the slight distortions.  He designed photos to simulate what exactly he sees (slight halos, or whatever).  I thought it was interesting. 

Sue.An, did you have posterior sub-capsular cataract?

Was never told what type I had but in reading types of cataracts I assume that is what I had.   I had a lot of glare which is one of the characteristics of this type.  Also had used steroid creams for eczema which can also bring this on.