Monofocal or EDOF - Near vision after surgery vs before

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Hi. I have still relatively early stage cataracts (first spotted during and eye test 3 years ago). My vision is still good most of the time but I'm having increasing difficulty in low light situations. Night driving has become an issue in the last few months and I'm now avoiding it except for short trips on roads that I know are well lit, I think I'm still safe but I'm not confident. I'm also getting halos and glare, at night, and to some extent in the daytime and have noticed that my contrast sensitivity has declined in all conditions (I've not had a contrast test). I've recently noticed some occasional ghosted, or double vision of illuminated things like traffic lights, etc but only for green & blue coloured lights. So I've decided to press on and get them done now & have found and met with an ophthalmologist who I'm comfortable with and I'm planning to go ahead in a few months time.

So I have to make a lens choice. I don't want multifocals as I want to reduce my chances of photodystopias so the choice is between monofocal or EDOF lenses.

I use a computer a lot and sit about 3 or 4 feet from the screen. With contact lenses I have no issue seeing the screen but the keyboard is a little blurry (but still usable). I can see a car dashboard with no problem but food on a plate in front of me is blurry. I do need readers for anything printed, unless quite large font) and for my phone and ipad. Without correction I have a bit of accommodation left but have to hold a phone/ipad or printed page about 8 inches from my eyes to focus. My near sight prescription is -4 in both eyes (could be -4,25 now as that was a year ago and I think it's declined a little), very little astigmatism (-0,25) and no other eye problems.

I understand that the best type of lens in terms of clarity and relative certainty of visual outcome is monofocal (the ophthalmologist is happy to offer mono or EDOF)

My query is, after surgery, with a monofocal lens set to distance would my near vision be as functional as it is now? I know that I would need readers for anything close, but how close? Is it likely that I'd see a dashboard or a keyboard as well as I can now? Would the PC screen 3 or 4 feet away still be clear? I realise that I wouldn't be able to read up close without correction. Currently I use +1.25 readers when I'm wearing contact lenses and actually prefer the near vision I get with those over my uncorrected near vision (seems brighter and larger)

And would an EDOF lens be likely to offer an improvement on my current corrected vision, and if so, at what cost to my distance?

I generally value my distance vision over my near vision and would be happy to use readers some of the time but obviously would prefer to be as free of them as possible

I realise that everyone is different and there are no guarantees of outcome but would appreciate others real world experiences with both.

Thanks in advance.

1 like, 51 replies

51 Replies

  • Edited

    The Lentis EDOF iol is designed for far and intermediate vision. Their MF iol includes near, far, and intermediate without the rings of Panoptic. The MF category sounds more attractive to me than the EDOF.


    "Oculentis issued two lens recall notices relating to the Lentis Foldable Intraocular Lenses in 2014 and 2017 to alert providers and users of the surface calcification of the lenses which could lead to opacification.

    They subsequently stopped using the cleaning detergent which they identified may have been the cause of the opacification problems.

    Oculentis were declared bankrupt in September 2021 after grappling with legal issues over its defective intraocular lenses over several years."

    • Edited

      Thanks for that, I was aware of the recalls and the subsequent bankruptcy. These lenses are now made by a different company, Teleon.

      I did ask the surgeon than I saw about this and he explained the cleaning detergent issue. He still rates them as the best lens he has used and continues to offer them. He also said that he hasn't seen a problem with any of them for years now.

      The new company also make a similar lens using the same optics but from a different (hydrophobic) material. I understand that this reduces the chances of calcification. I mentioned this to the surgeon and he said that he still thinks that the hydrophilic version is the better lens (he didn't elaborate as to why but I will ask when I see him again)

    • Posted

      Hydrophilic IOLs are not very popular in the US and surgeons here will often say that is due to the potential for calcifications.

      They are very popular in Europe and the surgeons there will tell you that the calcifications issue only happens now in cases where the IOLs have been come into contact with intraocular gas or air bubbles that have been injected during certain eye procedures, such as retinal detachment surgery. Even after such procedures calcifications are rare and happen to the unlucky few.

      Reasons surgeons like hydrophilic IOLs are because they are more flexible and can therefore be implanted through very small incisions. They also unfold more quickly inside the eye. The material also has a better ABBE number than hydrophobic acrylic, which means better optics.

      Hydrophilic IOLs tend to develop PCO more quickly than hydrophobic on average, but there are many factors that contribute to the speed of PCO development, such as age, gender and other eye pathologies. So there is a large range for how quickly it happens from individual to individual, regardless of IOL material. Hydrophilic material also seems to be more resistant to pitting as a result of improperly done YAG.

    • Posted

      I have also seen it written that hydrophilic acrylic was more biocompatible than hydrophobic acrylic but have not been able to find any research publications to back up that claim. In fact the only research that I did find did not back up the claim. Both materials are biocompatible enough, and small differences would only really matter for a patient with uveitis or other inflammatory eye conditions.

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