Multi focal contact lens confusion?

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I'm hoping those with more knowledge of contact lenses can clear this up.

I underwent cataract surgery last week on my right eye and had a monofocal iol implant set for distance. So my distance vision is good but I can't read my smartphone or a book. I've been experimenting with different contact lenses in my left eye prio to surgery in that eye in a few months.

my left eye needs a -6.0 contact lens for distance and when I have one in both my eyes have good distance but no intermediate or near. When I wear a -4.0 in my left eye I have poor distance in that eye but can see my smartphone and watch but still can't read, both eyes together give me distance and intermediate.

Today I took delivery of multifocal contacts -6 with high add, however when wearing them they're just like normal -6's, i.e. good distance but no intermediate or near.

What's wrong? I was expecting to have both distance and near with these contacts.

cheers!

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8 Replies

  • Posted

    First of all, congratulations that you had a successful cataract surgery in your right eye and that distance vision is good with the monofocal lens in that eye.

    Firstly. your experience with the multifocal contavt lens does not surprise me. I tried multifocal contact lenses many years back, but those did not work out for me either and I went back to the monovision with the left eye for reading and the right eye for reading.

    Secondly, the fact that your intermediate distance vision is good (but the near vision is not) when wearing a -4.0 contact lens in the left eye is also to be expected (if you need -6.0 for distance). You will need to go to -3.5 D in the left eye to be able to read well. But, then your interemediate distance vision will not be as good. However, you should still be able to see the smartphone or the computer screen at the usual 18 inches or so distance. Based on my experience, this should work out fine without glasses in most of the situations (the hardest for me was not being able to see the small captions next to displays in a museum, where you can't really get very close).

    Thus, please try that and see if it works out. Anyway, if you are doing this testing to see what IOL will work out best for you, if you choose to have a monofocal lens in the left eye, go for the similar prescription (as the contact lens) for reading in the left eye. If you decide to go for a premium lens in the left eye, I would suggest a Symfony lens with the best focus at about 32 inches. You should then have a good vision at near. intermediate, and distance when using both eyes.

    Actually, you will end up with the lens combination which I have suggested to a few other people on this site during the last couple of weeks. This is a modification of what I have. I have a monofocal lens for reading in my left eye and a Symfony lens for distance (and intermediate) in my right eye. I have good day vision at all 3 ranges of distance, but have the night vision issue of seeing multiple circles around lights in the distance with the Symfony lens. The advantage of my suggestion to you (over what I have) is that you should not have the night vision problem of seeing the multiple circles around lights in the distance with the Symfony lens, because you will be using the right eye (with the monofocal lens) for the distance.

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    • Posted

      Thanks for the detailed reply, it was interesting reading  - I didn't realise the margins between near and intermediate were so slim (-3.5 vs -4.0).

      Looks like the multifocals are a bust for me but I'll try again tomorrow just in case it was a duff lens. I'm still in the progress of trying to find out my preferred options, I really like both eyes at distance as I've never seen so sharp before but then it bugs me that I have to put on readers to see my watch! Likewise with the -4.0's in seeing my watch and phone is great but my overall distance is slightly reduced (tbh it's on a par when I used varfocal glasses before the op). I'll ask my optician to try out the -3.5 contacts to see if I like them.

      Cheers

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    • Posted

      It is great that you are used to wearing contact lenses, which makes it easier to try out various options.

      If you need -6.0 for distance, the -4.0 prescription was really giving you best focus at about 20 inches (the usually used intermediate distance of 26 inches would have required -4.5). Any way, it does not matter because the proof is in what works out best for you.

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  • Posted

    Altough some people just don't get on with multi-focal contact lenses there are many types and several designs in how they work. You also need time for neuroadaptation to take place so your brain can learn how to use the images in different degrees of focus its receiving.

    I've tried over 15 different types of multifocal and the results vary greatly and the one thing I've learnt is not to go with just a days test. Over a few days results will usually improve and this can continue for some time.  If switching between types of multifocals it can take even longer.

    Different types and even adds of the same type can use different designs and this means some lenses are good at distance and near but not intermedidate whereas other have a more even mix. This is why I've tried so many.

    So although they may just not be for you, its worth making sure you've given them a chance and tried a few makes to be sure.

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    • Posted

      Thanks, that's good advice.

      What got me with this particular brand of cl is that I didn't get any effect at all apart from good distance.

      I did go back to my optician whose refused to let me try any other multifocals and instead has given me a trial of -4.25's - these actually work great for near/intermediate but in the meantime my iol implant has went from 20/15 a few days after the surgery to 20/30 today. Looks like I'm back to square one as far as decisions on my left eye are concerned 

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    • Posted

      Sorry to learn that your uncorrected vision in the right eye has worsened from 20/15 to 20/ 30.

      However, even though this is upsetting, this issue can be easily fixed.

      Every eye changes significantly over the first few weeks after the cataract surgery, specially in the amount of astigamatism. Am not sure if your monofocal lens in the right eye is toric or not. If it is toric, its rotation in the eye from the installed position can also cause astigmatism.

      Any way, what was the best corrected vision with the right eye and what was the corresponding prescription required to achieve that?

       

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    • Posted

      Hi, I take it you mean pre-op?

      Before surgery both eyes were -6.5 spectacle prescription, the right eye also had -0.5 astigmatism (can't remember the angle offhand). This gave me 20/20 corrected.

      my left eye is still 20/20 corrected but with a contact lens as I can't wear my glasses anymore.

      cheers

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    • Posted

      No. Actually, I meant post-op at the time the time (1-2 days back) when the optician said that the vision in the right eye is 20/30. Hopefully at that time, he/she would have also checked the best corrected vision at that time and jotted down the prescription needed to achieve that (even though there was no need for you to get any glasses made with that prescription at this time). The value of that needed prescription will be useful to know to determine the best step going forward.
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