Monofocal IOL (Intermediate) + Extended wear contact lenses y

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This site has really been helpful. I’m 50 and scheduled for surgery on my right eye in February with my left eye about 6 weeks later. I was all set to go with a low-add multifocal (Restor 2.5D), until I found this site and have been reading about peoples’ experiences (good and bad) with multifocals and the Symfony extended range IOL’s. I’m now re-thinking my lens choice and instead considering a monofocal set for intermediate distance (around 24”, but 18” to 32” would be my ideal range) coupled with a contact lens for distance. Most of the discussions and literature reference the need for glasses or sometimes glasses/contacts, but I feel the experience of wearing contacts is very different from glasses and I’m wondering if anyone else has done something similar and if my desired solution is even possible.

I’ve worn contacts for distance for 30 years and was considering RK surgery in my mid-20’s (and later Lasik) until I started using extended wear lenses. I just found these so good and trouble-free that I never saw the need to risk Lasik. This is a very different experience from wearing glasses for distance, where you constantly see the edge of the lens in your periphery and images are distorted depending on where you are looking. I’m generally on the computer for 6-10 hours per day and I have an array of monitors on my desktop between 24” and 32” from my eyes. Due to presbyopia, I use 1.25 readers for the computers and 2.00 readers or magnifying glass for close work and the constant on/off is what I find most irritating. If I can use contact for distance, eliminate the glasses for computers and only use readers for close work, I’d be very happy with my results.

Is this a valid outcome to hope for? I know that dry eyes and other issues are somewhat common after this type of surgery. I don’t mind wearing glasses for a few months post surgey if needed and, although I’d highly like to go back to extended-wear lenses, I’d settle for daily wear disposable instead if I couldn’t tolerate extended wear anymore. However, if there is a substantial chance that I would not be able to wear contacts, I’d probably opt for a low-add multifocal or Symfony now instead of the monofocal.

One additional reason is that my surgeon wants to do both eyes within 2 months because of the multifocal lens. The cataract in my left eye has no noticeable effect on my vision yet. It was noticed 2 years ago (the same time as my right eye) but still has no impact on my vision. I believe if I go with a monofocal IOL I would not need the surgery on my other eye until it interferes with my vision, but please give me advice on this. Thank you very much in advance for any advice or comments.

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  • Posted

    I am about to proceed with something similar but with multi-focal contacts. I am -1.25D and 1.5D with a +2D add for reading.   My plan is for monofocal IOLs set at a similar prescription or perhaps a little more myopic as I must have a little accommodation left in my natural lenses.  This should give me acceptable intermediate range and to be functional around the house without additional correction.

    I am intending to on occasion use glasses for distance (and possibly very close work) but also multi-focal contacts which I wear currently.

    If you've not tried multi-focal contacts they have similar issues to multifocal IOLs, however for playing sports and general activities they're great. I only find them a compromise for hours at the computer screen where the reduced contrast and focus is noticeable but at least I can choose my visual compromises to suit each day.  

    Given my plan I have tried to research about wearing contacts post IOL insertion and also standard or multi-focal contacts.  Sadly there don't seem to be that many people using contacts with IOLs but all the medical professionals I've spoken to have said there are no issues one fully healed.  However as expected the use of multifocal contacts over anything other than a monofocal IOL is not likely to work.

    I would also be interested to hear from people using contacts post IOL as I am assuming this will work and my first surgery is next month.

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    • Posted

      Interesting plan. I was actually thinking of very slightly different goals for the IOL's too (maybe 0.25D apart). I have an appointment on Monday to get a trial of mutli-focal contacts with the intent of using them to see if I could possibly tolerate a multi-focal IOL. I know that it's not a perfect analog but it seems to be the closest you can come to a trial. I never thought about actually using multi-focal contacts post surgery but if they work for me during this limited test, I may be interested in trying that. Can I ask, are you targeting close vision with your IOL and intermediate and far with the contacts or something else?

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    • Posted

      With that target prescription in theory absolute focus would be 66cm to 80cm so that would cover screen use (I use large screens at ~90cm) and phone/tablet not held too close. An extra -0.25D may be worthwhile on the target as mentioned in my earlier post but I may do that on one eye only to give 0.5D mini-monovision.  I appreciate target and results are often different but I'll adjust the second IOL based on results with the first.

      I am expecting to use MF contacts to improve distance and also slightly improve close as at present (best MF contact add is up to 2.5D but I think 2D is more where its at).  I sometimes put readers on for very close work currently I would expect to do the same after.

      It may seem odd to be setting myself up for needing additional correction at distance and very close but with my natural lens I love being able to read standard print/phones but also being able to see not too badly in the distance (just short of minimum driving standards). 

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  • Posted

    Such an outcome is possible. I was quite lucky in my surgery, with an outcome where I can sit at the computer (as I'm dog now) and read the screen without glasses, but still see for distance well enough to drive easily without glasses. I don't know that everyone is so fortunate.  Prior to surgery, my adjustment due to nearsightedness was about 10 diopters, so it was quite a welcome change to suddenly have such a new visual experience.

    I did have a complication with one eye, with flashing or strobing at the outside corner, which was concerning. I was told that this is not rare, though not usual either, and it would probably go away after a few weeks. It actually took several months.  It appears to have been related to the fluid in the eye causing the retina to move slightly, leading to the flashes. But it's all good now, and I'm delighted with the result. So this can happen, though it doesn't always.

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  • Posted

    I would suggest considering a Symfony IOL in one eye instead of a multifocal. The Symfony targeted near plano could get you good distance and intermediate vision for computer and smartphone use, might only need weak reading glasses for fine print and closer reading distance, or you could target the Symfony for slight nearsighted (-0.50D or so) to increase even close reading ability with still decent distance vision maybe 20/25-30 instead of 20/20.

    Multifocals and the Symfony IOLs however do introduce night vision artifacts around some lights (multifocals are worse in this regard) so a monofocal is better if you do a lot of night driving.  But if you put higher priority on your daily indoors daytime vision vs night time vision, the Symfony seems like a good compromise and could eliminate  the need  of contacts, which can be problematic with dry eye that can get worse after cataract surgery.

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  • Posted

    I essentially worked for years with a set-up similar to that being considered right now by you. Had to have a cataract surgery in my left eye almost 19 years back. Had the best focus distance set for that eye  for reading at about 18 inches. Continued to wear a contact lens set for distance in the right eye for years until I needed a cataract surgery in the right eye about a year back.

    With my set up, I rarely used glasses, although the intermediate distance vision was not good (the only time, I felt the need for glasses was while looking at the captions by paintings in a museum from about 26-30 inches away). If you need to have a good vision from 24-30 inches range, you should proceed with having the first eye set for about 24 inches, as you are planning. The degree of monovision for your combination will be less than my combination and will thus be easy to adjust to. (actually, I adjusted to monovision in less than 5 minutes, but everyone is not so lucky). However, please be aware that you may need to wear reading glasses for reading fine print with that combination (You will be fine with using +1.0D or +1.25D glasses available from drug stores for both eyes for reading)

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  • Posted

    I too have only one eye that had a cataract that affected my vision and made it worse than 20/50 corrected, while the other eye only has an early stage cataract that hasn't affected its vision at all and probably won't for years to come.  I have 2D-3D astigmatism in each eye as well.

    I had the cataract surgery for my right eye a couple weeks ago, and went with a Tecnis monofocal toric IOL targeted for good distance vision and its starting to stabilize now around 20/20-20/25.  That eye had the most astigmatism unfortunately and I might have gone with a Symfony toric IOL in that eye otherwise, since the highest cylinder Symfony toric in the USA wasn't enough for that eye. 

    The left eye however has lower astigmatism so I could in the future get a Symfony toric for that eye, which I will seriously consider but probably not until that eye's vision is affected in a few years. I do like that the monofocal IOL in my right eye has no or very little night vision artifacts, but like you, use intermediate vision a lot daily (computer and smartphone) so at least one eye to provide that without glasses would be great. 

    Another alternative I consider is mini-monovision by setting the left eye for about -1.25D to allow it to focus well for computer and OK for smartphone vision.  I can try that with a contact lens in the left eye in the future, but I do like to have good distance vision in both eyes as well, so I would myself definitely consider a Symfony toric in the left eye in the future as my preferred choice.  I have verified I can do well with only one eye corrected for intermediate vision for hours of computer use thats what I'm doing now by using my old computer glasses (Rx to correct astigmatism and effectively +1.0D power) with the right lens removed.

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  • Posted

    I absolutely agree with you. If it were me I would have a monofocal IOL and just get glasses to use when necessary.

    They can pick your IOL power so that you’re targeted at 50cm to 1m away for when you’re looking at screens - this overall would give you a myopic eye, with a corrective presciption of about -1.5D. You’d then be able to get glasses with this prescription for long distance.

    Good luck with whatever you decide to go for. smile

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  • Posted

    I was thinking that the Symfony was a good choice until I started reading this forum and some of the side effects. I think I understand that everything is a percentage and there are clearly complications that are unrelated to the lens. However, the loss of contrast sensitivity with a multi-focal and the concentric rings with Symfony are what I'm most concerned about. Knowing my personality, an irregular (but brighter) defect like a halo would be bothersome but less objectionable than a (lighter) but regular/geometric artifact like people have described (and illustrated) as concentric rings around a light source. When I tested monovision contacts a few years ago, I literally would alternate opening and closing my eyes hundreds of times per day to notice the difference in focus. I have the same issue now with the cataract eye, I'm constantly closing my good eye and checking the focus - it drives me crazy. A slight difference in near focus isn't that bad but I need my distance vision to be clear and very similar between my eyes. 

    I should also note that, as part of my job, I spend a lot of time working on lighting designs and directing adjustments to their installations in the field (basically, I spend an unusual amount of time looking at light sources). I contacts weren't an option for distance, I'd be doing Symfony or multi-focals for sure but since I don;t mind contacts at all i figured that this was a lower risk approach. I also think that technology will continue to improve so, in 20 years, there will likely be more accommodating options available and, I'm hoping, that replacement of existing, older, IOL's will be easier.

    At least it seems like some other have opted for something similar so I feel encouraged by that. 

     

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  • Posted

    I just had a monofocal IOL put in about 8 weeks ago; aiming for intermediate/near.  My recent exam showed that eye to be at -1.25D, which, combined with my other eye at -1.5D has been excellent for intermediate (computer use, etc.) and very good for reading most print. Like you, I wanted to avoid the constant "on/off" of readers, since most of my near and intermediate vision needs are frequent, urgent, and unpredictable, while my distance needs (e.g. driving) are more predictable and less frequent.  So far I am very happy with the result.  I only wear glasses for driving, meetings, etc., and plan to continue with a single contact lens for temporary monovision for occasional nighttime social events as previously.  I haven't tried a contact yet in the surgical eye, but just ordered some.  From what I was told, there isn't usually any medical reason you can't wear contacts post-surgically, it's just more inconvenient for reading, as you can remove distance glasses to read, but would likely have  to wear readers over the contacts.  Multi-focal contacts might also be an option, though I have no personal experience with them. I also have a small, asymptomatic cataract in my other eye, but would not have surgery until it is really necessary. The surgery may be low-risk, but it's not no-risk, as I was reminded many times before the first operation. Best of luck on your surgery!

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    • Posted

      Bella:

      Thanks for the post. Now I'm not 100% clear how the correction will work. You mentioned that contacts would be more inconvenient for reading as I'd have to wear reading glasses over the contacts. Can you elaborate a bit more? Before onset of Presbyopia, I could easily see close, intermediate and far (with contact lenses on). Now, I need readers (of differing strengths) for both near and intermediate. If I take the contacts out, I do have a single near focal point that doesn't exist while wearing contacts. If I have surgery with with a monofocal IOL, which let's say gives me clear vision from 20" to 28", and I wear contacts for distance, do I then lose the clear vision at 20" to 28" and need to wear readers again (for that range)? I thought that that range would stay in focus and I'd need to wear readers for clear vision near and maybe in the 36" range. This is most important to me - if I'd still need to wear readers for my IOL corrected range while wearing contacts I'll definitely go with multi-focals instead. 

       

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    • Posted

      Bella is correct.

      "If I have surgery with with a monofocal IOL, which let's say gives me clear vision from 20" to 28", and I wear contacts for distance, do I then lose the clear vision at 20" to 28" and need to wear readers again (for that range)?"  - YES, you would lose the near focus corrected by the IOLs as the IOLs are not accommodating like the natural lens.

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    • Posted

      Yeah, the monofocal lens doesn't accommodate or adjust any for distance. It is what it is. That being said, my monofocal IOL gives me something a little short of 20/20 vision for distance (both eyes), looking at the eye chart in the surgeon's office from about 15 feet or so, but still lets me read the computer screen from 1 1/2 to 2 feet away. So they work quite well that way, I virtually never have to wear glasses ... I occasionally wear light reading glasses to see fine print, or distance glasses to read a far off street sign, but other than that I don't need 'em.

      I was quite nearsighted before the surgery, about 10 diopters ... I don't know if that impacts how the monofocal lens works for distance and close-up once it's in, maybe the long eyeball of myopia has some interaction there ... don't know.  I do know it's possible for a monofocal lens to cover a reasonably wide range of distance, at least in my case. (Acusoft lenses).

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    • Posted

      Thank you very much for clarifying this for me. It seems like my idea won't work then as I'd constantly have to put contacts on and take them off or use glasses to see at anything other than far distance. I'd basically get an IOL to see at intermediate distance but the contact would wipe out vision in that range so I'd essentially end up in the same situation as if I had a monofocal IOL set for distance.

      It would seem that contacts are kind of pointless after cataract surgery unless you wanted to adjust your correction to a different point for an extended period of time (maybe changing from close to far for a long trip). I guess Symfony or a multifocal IOL would be better then. 

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    • Posted

      derek, I wasn't sure what you were intending from the original post, but others have clarified what I think you were wondering; that an intermediate IOL with a distance contact lens would essentially be the same as a distance IOL.  Looking at it on a practical level: if during your extended computer use you frequently need to see perfectly at a distance, then I agree, you'd need multifocal/extended IOL, multifocal contacts, progressives, etc.  On the other hand, if you work mostly alone on the computer or in an environment where you rarely "need" to also see perfectly at a distance, then the intermediate IOLs would work fine most of the time without correction, then you could put them on to drive home or whatever.  My intermediate vision works because I fall into the latter category, AND have a high tolerance for far distances being a little blurry.  I also fortunately ended up with good near vision for reading.

      On another note re. contacts, I just tried a contact lens to give me -.25D/ -1.25D monovision last night (as I've done before).  It worked great for distance (going to a play; brief driving) but was extremely annoying for computer use; similar to your experience.  I may test those multifocal contacts too!

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