Monofocal IOL (Intermediate) + Extended wear contact lenses y

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.

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.

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.

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)

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.

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.

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. 

 

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!