Monofocal IOL (Intermediate) + Extended wear contact lenses y
Posted , 11 users are following.
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.
0 likes, 20 replies
miguel20862 derek40125
Posted
My opthamologist actually recommended that I go with monofocal set for distance and just use a multifocal contact lens as it's less risky than opting for a Symfony IOL. I'm having a difficult time weighing the benefits of either choice as on paper the Symfony really appeals to my active lifestyle. But I am a bit worried about the nighttime experience of Symfony and the fact that you may or may not get sufficient adaquate extended range with the Symfony. If everything works out ideally you probably get around 18-20 inches near inwards to far distance of 20/20 but nothing is guaranteed, I'd be pretty satisfied if I got that range though. Monofocal is a lot more safer than Symfony hence the reason why it's the workhorse tried and true lens for most people who aren't candidates for premium lens options. My question for anybody who's reading my post that has had a monofocal set for distance how easy is it for you to play sports that require hand eye coordination and seeing variety of distances on the fly. Although I am concerned about losing my ability to read up close and what not I may opt for a monofocal if it's decent doable to function. Some people have gotten spectacular results ( in that they have gotten a wide range of vision) with monofocals but I just find it hard to believe that those can be the norm to expect
Macjazz miguel20862
Posted
I mostly do running and golf for sports these days ... golf does require hand/eye coordination, though not so much seeing various distances on the fly. I'm able to play just fine (well, to the extent that I ever could, anyway
^), and I can see where the ball goes now, which got to be a real problem before the implants!
If someone throws something to me, I can catch it, though that's not really the same thing as playing a sport at speed. I haven't played basketball or tennis for a number of years, nor recently, so I can't speak to how a mono lens would affect that. I suspect I might be able to play them, though I'm just a little old for fast twitch sports now. But I don't know how much focusing issues might be a factor there - logically it seems that they could be. But for everyday living, focus doesn't seem to be an issue. Much less so than I thought it might be, though that's just me. I feel pretty lucky to have gotten the results I have.
derek40125 miguel20862
Posted
Miguel, under your scenario the contact would be 0D for distance (which is corrected by the iol) and whatever add you choose for the intermediate or close range, correct? I'm now going to trial multifocal contacts on Monday (doable since fortunately my the cataract in my left eye is not causing issues yet). I'm curious to see how the thicker lenses feels and how this affects my contrast sensitivity. I might end up doing what your suggesting too. When is your surgery? I have my eye measurements and iol selection in mid December with surgery the beginning of February.
One thing I'm wondering, one of the main criticisms of multfocal contacts that I see frequently is a small loss in the crispness of distance vision. If you ended up perfect for distance with the iol, would the multifocal contact worsen your distance vision or, since it's already perfect, not have any effect?
miguel20862 derek40125
Posted
Hey Derek, I actually haven't scheduled a date for my surgery as of yet, as am still in the process of consultation and pre op exam with my opthamologist. Most Likely in the next couple months though. Regarding Your question about the contact lens, I would not know that answer. I don't have any experiences with contact lens just going on the advice of my surgeon. I would think that their may be a gradual change to your IOL lens vision once you insert a contact lens over but it would probably be for the better in function so to speak. Also with contact lens it's more conservative than premium IOLs because if you don't like how your eyes react to them you can always take them out and wear glssses or try a different brand variation. (Cant quite do that with intranocualr lens , And contact lens technology is always improving as well so more often every few years you will have more choices to use for contact lens. However, I do like the capabilities of the Symfony in that it should provide more enhanced range of vision without requiring spectacles but it is riskier than monofocal. And apparently it's almost certain you will get some form of halos/rings at nighttime where some people are having regrets or unhappy about getting a Symfony, although I already am experiencing some degree of problems at night with halos because of my cataracts in both eyes. Just something to think about... I will have to make a decision soon as well, which Im hestitant but I really do want to move forward
pg128 derek40125
Posted
Having tried more than a dozen types of multi-focal contact I can confirm there is a significant variation in what they do well and where their specific compromise is.
When multi-focal contacts first came out the manufacturers really seemed to aim for good distance and close leaving poor intermediate. With a growing market for such lenses and more use of phones and tablets the choice has widened. In my case I favour a lens that gives good contrast and distance/intermediate but not so much reading add as some others lenses.
Just like multi-focal IOLs each multi-focal contact lens is aimed at a certain balance of features and compromises, although IOLs are better quality so should be a little better overall. So to answer your distance question, you can try various multi-focal contacts and experiment with different adds and offsets from your prescription to get what suits you. You shouldn't lose much sharpness from distance vision but ultimately any lens whether contact or IOL that is multi-focal/extended depth of field is trading one thing for another.
For me being tied to a multi-focal or EDOF IOL that has a fixed compromise and always loses some contrast and sharpness is a concern as I earn a living by spending many hours in front of a bank of computer screens. I notice the difference in how tired I get with less than perfect vision at the required range, but if I was retired I may have decided differently.
One thing I would suggest with your trial is please be aware it can take several days for your brain to get the best out of multi-focal lenses. It's amazing our minds can work out which bits of image to use so its not surprising it improves with time.