Multi + Mono

Are your monofocal set for distance in both eyes or one for far, one for close? How is it working out?

My monofocal are set for distance . I only need to use +1.25 reading glasses for very small print . I just buy them from a local shop for £1 sterling 

Monofocal are very good for distance vision. My multifocal resulted in good near vision, but failed miserably in distance. I thought if the 2nd eye has a mono that it would makeup for the failure of the multifocal.I'm new at this so it's just an assumption.

I thought multifocal is suppose to be good for all distances, so why did mine turn out good for just close distance?

That's a good question, how long have you had it and what lense is it?

I have the Carl Zeiss Toric Trifocal, and I have to say, the distance vision is crisp, very clear all the way to infinity. I feel there could be improvement in the near vision but it's generally very good, I can read very small print if the lighting is good, but interestingly I feel that looking at pictures or videos on my phone or laptop, definitely leaves room for improvement. 

In regards to the distance vision, I should also point out that my distance vision was a blur for at least 3 weeks to one month after surgery, so it might just be taking time to settle if it's a recent thing? 

Do you know what the multifocal was targeted for (and what was achieved)?

Usually if both eyes need cataract surgery surgeon targets first eye (dominant eye) for distance unless a patient requests otherwise.

It can take an eye a few weeks to settle - usually by time drop regiment finishes at 4 weeks post op.  If you are beyond 4 weeks likely that is as good as it will get unless you opt for a laser tweaking.   

If your first eye operated on has not provided good distance vision then you aren't wrong to looking into a lens that will provide for that.

There is no fundamental reason for not using a monofocal lens together with a trifocal lens. (or with a Symfony lens or with a Crystalens etc)

Obviously, it would have been better if your trifocal lens would have given you good vision at all distances. However, it has not and therefore, your thinking about getting a monofocal lens set for good vision is completely reasonable.

By the way, I use a monofocal lens in combination with a Symfony lens and my wife uses a monofocal lens in combination with a Crystalens (which provides adjustable focus). There has been no vision issue due to different lenses in the 2 eyes. The doctors don't suggest combining 2 different types of lenses, but will usually do that if you ask for it.

Agree - surgeons will also have no problem with that combination if there are years separating the 2 surgeries if cataract developed at different paces in your eyes.

Question for you a201 - when you first were implanted with Symfony did you notice any change in night vision with time.  I am now 4 weeks tomorrow and had to drive again on an unlit dark road as well as lit roads.  The lights now have a little less glare or starburst effect (less and intense for streetlights, etc) but now I see the conentric circles more.  I am guessing with the glare/starbursts were so intense before they hid the concentric circles which aren't nearly as bright.  Exception oncoming cars those are still intense.  Kept eyes averted to side of road and did ok.  Less panicked than last time I took those roads 3 weeks ago.

Oh and since my daughter was a passenger I got her to try this tip that I found online for driving at night and that is to drive with interior dome light on.  Was a little odd - but it actually worked.  Pupils dilated less and I could actually see a bit better.  Had my daughter turn dome light on for a few minutes and then turn off.  

Just thought I'd share in case.

Hoping night vision continues to improve.  Much prefer the circles to the intense glare/glare that blinds me to anything  surrounding it.

Oculentis Mplus X. The left eye isn't dominant and he set it for close vision.

Did you request this multifocal lens be set for near or did surgeon make that decision without consultation?  

I know there are many posts about setting dominant eye for distance and if doing mini monovision the left for close vision.  My surgeon didn't think it mattered (perhaps bevauthe was aiming for plano for both my eyes not sure).  

Whatever the case I would think you'd want to target 2nd eye for distance.

The multifocal was set for close vision in the left non-dominant eye. I thought multifocals are good for all distances. Why would it be set for close distances? Then what's the big difference between multifocals and monofocals if it's going to be set for a certain distance? Maybe because my eye was bad to begin with -8.5d that the multifocal can't guarantee good vision for all distances so they have to set a certain distance? If that's the case, why waste money on a multifocal? It can be a little confusing.

The doctor set the eye for close vision. From the time of my 1st visit to the surgery was 1 week. When I went in I knew "zero" about intraocular what? It was learn as-much-as you can in 6 days. I had to choose what lens and there are a zillion options. I just pretty much went along with his recommendation.Of course now I know more from the internet and this forum.

Did your surgeon ever explain why the decision to set multifocal to close?

Multifocals normally give good vision for 2 distances - there can be a dip in vision in the intermediate.  Symfony is not really a multifocal although lumped in that category mistakenly.  It is an extended depth of focus and there is no dip in vision.  However it doesn't usually provide as near a vision as a multifocal would unless the surgeon targets one eye a little closer but then you sacrifice both eyes seeing distance well.  If a multifocal is targeted for OD you should have gotten a good range of vision distance to near.  But if surgeon targeted for closer you would not get the distance vision as you've experienced.

After first surgery always good to have some time to see where eye had settled and visual acuity achieved so that adjustments can be made for 2nd eye.  Given you don't have distance vision you likelybwanted a lens targeted for that unless you want to balance eyes for near and wear glasses for distance.

Do you have another consult before your surgery?  Hopefully you can get his or her thoughts on lens selection and what would work well with lens already implanted.  

Initially he was going to use an IOL by Alcon, but because my vision was bad, he went with Oculentis because a senior ophthamologist had Oculentis implanted in his eyes. The senior's vision is similar to mine. Oculentis is good to -10.0d.

That was quick.  From diagnosis last Jan to initial consult was 3 months and another month for 2nd appointment and then a month and half to surgery.

Take your time before making a decision on this 2nd eye.  Cataracts grow slowly and not life threatening.  Decide what you'd prefer and discuss with your surgeon.  If he is insisting on a solution just based on his comfort level you may want to see someone else for further assistance in making the decision.

If Alcon lens is what he will suggest gorvdisyance in your 2nd eye please read up on glistenings.  That brand is know to develop glistenings which affects night vision and contrast sensitivity.  Particularly where your first eye doesn't have distance vision you'll want a better lens like a Technis.

Sorry auto spell error  meant if surgeon suggests Alcon lens for distance

On the other hand, there are patients that don't care. I ran into an older gentleman yesterday who had cataract surgery in Hong Kong. I asked what is his IOL? He doesn't have a clue except it's a monofocal. He never had the curiousity to even asked the doctor about the brand or model.

What is the name of your monofocal IOL? How do you like the Symfony? Why did you go with that combination? Was your 1st implant the Symfony?

I have not noticed any change in seeing the concentric circles due to the Symfony lens over time. As you mentioned, if at times when my eyes are dry (and the vision is not as sharp), I may see more of the starburst effects, which tend to overwhelm the concentric circles (since the dark bands in between the circles are also partially lighted due to the starbursts).

That is so true - ran into a few myself.  And if they are happy with result ignorance is bliss.  If they aren't happy they post on forums.  Some things I don't care one way or another but something like vision that impacts so much I want to know.  Especially at 53 vs 80's but I would think even some older ones want to be informed as well. My parents are in their 70's and still don't have cataracts.  I can tell you they are more informed now with me going through this and will have questions when it is their turn.

Thanks for confirming that.  Would seem then my vision with starbursts too will come and go due to dry eye etc.

My monofocal lens was installed in my left eye more than 18 years back. and I was never given any information about the lens at that time. I was left with significant needed spherical and cylindrical corrections for distance in that eye, decided to use that eye for reading with contact lens for a number of years (I was used to monovision) before having a LASIK enhancement couple of years back to make it suitable for reading without a contact lens.

After reading about the new Symfony lens, I decided to go for it for my right eye last year. As expected, it has provided me good distance and intermediate distance vision well. That complements my vision in the left eye for reading well so that I have good day time vision at all distances more than 16 inches. Having the night vision issues with Symfony lens was a surprise to me because at the time, the published studies seem to pretend that the night vision issues with the Symfony lens were comparable to those for the monofocal lenses (saw the warning about the night vision issues for Symfony lens, hidden in fine print on the Abbott web site, much later)

When I told one of the guys I cycle with that I had cataract surgery, he told me he had cataract surgery too when he was 46 (he'd now 59). I asked him what type of IOL he had implanted? He didn't even know about implanted lens! I was shocked! I said how can you see now without an IOL? Talk about not caring or not being aware. That take's the cake!

..... (he's now 59). [Missed the bad spelling].

He just might not be aware a replacement lens went in.  When I was in the holding/wIting area for my surgery we all chatted while we waited for our turn.  A few didn't know there were lens options and one didn't realize her natural lens was being removed.  We all had same surgeon so I figured unless patient asked they all got regular monofocal lens.   But if someone didn't in the interim between diagnosis and consult didn't have questions they likely were content.

I spoke to the ophthamologist yesterday about combining mono IOL with a multifocal and he said it would be hard for the eyes to adjust. It's best to go with a multifocal for the second eye. He'll set that lens for good distance vision.

I had same response from mine - gathering most don't like you to have 2 different ones.  Even the way you see colours are different.  Only exception to that is when patient had cataract surgery many years ago on one eye.

Are you able to select a different multifocal?  I haven't heard much or can find online much about your lens.  Just what manufacturers say about it which may be different than trials or patient reviews.  Are you looking at different lenses?

I'll stay with the same IOL company. It's pretty good. Symfony has rings and glare problems. Zeiss trifocals also has rings. Crystalens rekys on the eye muscle to contract in order to focus. The IOL can fall out of place. Since my eyesight is bad in the 1st place, no IOL will be perfect. Still no date to do the 2nd eye.

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The IOL corrects poor eyesight so outcome should be good.  It may be harder for the surgeon to get the power spot on if your eyesight is very poor but with today's equipment they can get pretty close.

I am just wondering why your surgeon would target your first eye for near (especially if not discussed or agreed upon) vs distance particularly with a multifocal lens that they should aim (at least in first eye) for plano?  Multifocals should provide a good range of vision vs a monofocal.  Most of what I have read when both eyes need doing due to cataracts the surgeon will want to give a patient good distance vision and then see where that lands to adjust the 2nd eye.

The cloudy cataract was in the left eye. The left is the nondominant eye. He set the close distance for this eye. Close vision is good. Far distance improved by 5.75d. Not perfect, but better. The right dominant eye has no cloudy vision. There are cataracts. He will set this eye for distance. I could get about and see okay with the left eye. Images are not sharp. It didn't seem to bother me. I spend a lot of time on my mobile phone streaming the internet, texting friends, playing games etc. I have good close vision for this.

Do you need glasses to drive then?  Prior to cataract surgery I was nearsighted - seems odd now to drive without glasses - but sure getting used to it quick!

I used to drive a lot, but choose not to drive for the last 27 years. It allowed me to save money rather than blow it on cars, insurance, petro + maintenance. In Asia public transportation is very good.

You will not have any more issues by using a monofcoal lens for the right dominant eye than you will have with a trifocal lens in that eye. May even have less issues with a monofocal lens.

More of an issue with either lens may be because of you ending up with monovision if the left eye is set for near and the right eye lens set for distance. (I don't have any problem with monovision, but many  people do). Have no idea why your surgeon would have opted to use a monovision with trifocal lenses! The only possible reason for having a trifocal lens is to try to avoid using monovision. Otherwise, it does not make any sense!

You will have a lot more night vision issues with a trifocal lens for distance than with a monofocal lens or even with a Symfony lens. You haven't felt the night vision issues with the trifocal lens in the left eye yet, because you are not using it for distance right now.

This has been all green pastures for me. Never been this route before. Yeah it seems a little strange why a multifocal would be set for close afterall a multifocal should be good at all focal points. Maybe it's nature of this Oculentis? In any case distance vision improved by 5.75d. Okay, but not perfect.

I haven't been out at night since the surgery 6 weeks ago. I wanted to wait and get my revised glasses. Got them yesterday. I'll venture out for a look. This IOL is suppose to have minimal glare because it doesn't have rings.

That definitely would not work here - too tough getting through our snow!!   Our public transportation isn't great.  A 12 min drive to work would take 90 mins if you're lucky.  Runs only every 30 minutes.

Just read through a201 response.  If I were in your shoes I would definitely seek out more consults (with another surgeon who is willing to dialogue about options for your right eye - monofocal included)  Fear you may end up disappointed in outcome if you go with same lens you have in left eye.   

Can't understand why he would target for near without discussing it with you.  One thing if a patient requests it another thing if no discussion took place - as most surgeons will assume good distance vision needed.  And with a multifocal you should have gotten good range anyways if targeted for distance.  If both eyes needed doing why wouldn't he have operated on your dominant eye first?

Just trying to help - really think you should explore your options .  Better than having regrets afterwards.

Just on my lunch break and came across a Singapore surgeon Por Yong Ming (you can google name or All Things Eye).   He has a forum that he responds to patient questions.  Anyways wonder if you've heard of him?  He sounds like he has a lot of experience.  There may be something there you'll find helpful on lens selection or even posting a question to him directly.

Yes I will. Thanks for that lead.In life I make the best decision at the time, then life unfolds. Life is a series of decisions and unfolds. No regrets in life.

Sincerely wishing you the best of outcomes.  

I checked him out - looks very experienced.  I may try to get an appointment with him if I feel I need a second opinion.  Have decided to see a surgeon in Singapore rather than going to Malaysia.

Yeah read through his blog and patient forum.  Nice that patients can dialogue and he'll answer back.   Good luck.  Let us know how you're doing and what you decide.

Yeah don't try to save a few Sing$ when it comes to your eyes. Many good ophthalmologists in Singapore. Plus you need several followup appointments. What go to Malaysia for all the followup appointments? You'll end up spending more money!

It certainly isn't only "a few Sing$'s" I could save by going across the border to Malaysia!  It's about half the price in Malaysia so it's quite a few Sing$'s! 

My main reason for deciding to do it in Singapore is that I'm hoping if there is evidence of a cataract forming then I may be able to get it done on my medical insurance (at least one eye anyway).  Plus I really don't want the hassles of having to cross the border four or five times (it's quite a mission) and finally, I would have to do it all on my own as my husband won't be able to come over with me.

I have my initial appointment tomorrow so I'll have a better idea then what the story is, what my options are and how much it's going to cost me.

I will discourage you from having a cataract surgery if you don't really need it. In spite of some surgeons starting to push it saying that you won't have to wear glasses (or contact lenses any more), if you get an IOL after a cataract surgery, there are too many potential issues after any IOL to have it done instead of just using glasses or contact lenses (or even correcting vision by LASIK).

I take your point, but having refractive lens exchange (or clear lens exchange) is the only option available to me partly due to my age (nearly 50) and partly due to the fact that I have thin corneas and borderline keratoconus which means I have never been able to have lasik.

I can't wear contact lenses (too uncomfortable - especially the toric ones) and my glasses just don't seem to be able to give me decent vision anymore. I wear progressive glasses and I find that my distance vision isn't great (I don't own a car as I live in Singapore, but if I were driving I don't think I'd be safe on the roads!), I'm not too bad with intermediate and thankfully I can take off my glasses for close up reading (although I have to hold the book/phone/iPad 20cm away from my nose!). 

I'm thinking monofocals set for close-up is my best option (so I'd probably have them set to around -1.5 in both eyes).  I'm happy to wear glasses for distance (driving etc) but hopefully the rest of the time I'd be glasses free.  Having monofocals should minimise the glares and halo problems that come with tri/multifocals. 

Anyway, I'm waiting to see what my surgeon has to say at my appointment tomorrow before I make any decisions.  I know this is a big decision to make and its potentially going to cost me a lot of money but this is something I've wanted to do for many years but have never been able to. 

When I was in my 20's and 30's I couldn't afford Lasik, when I was in my early 40's (and finally could afford it) I was told I couldn't have Lasik due to thin corneas/keratoconus, in my mid 40's I was told I was too young for RLE and to wait until I'm nearly 50.  Now I'm nearly 50 and I can afford it and hopefully I'm a good candidate for RLE!  I've waited long enough methinks!

Looks like you have already considered all the alternatives. Thus, having thought through all of those, if you feel that having the refractive lens surgery is the best option for you, then that is perfectly fine.

Going with the 2 monofocal lenses is a good choice. However, rather than setting both of them to -1.5 (which will provide you good intermediate vision, but require you to wear glasses for reading as well as distance), you may want to have one at -1.5 and the other one at about -2.25. With that combination, you will have a mini-monovision, which is not hard to deal with, and more importantly you will have good near and intermediate distance vision. Having to wear glasses for distance only is a lot easier than having to use for reading as well for distance. You should discuss that option with your surgeon.

 

Thanks for the tip - I will discuss the mini-monovision option that you suggested and get the surgeon to simulate it for me if possible. 

I don't think I could handle full monovision (I tried it with contact lenses once and I gave up after a few days as it was awful - I probably didn't give myself long enough to get used to it though).  I had to work (I'm a teacher) and I just couldn't cope with not being able to see close-up, intermediate or distance and feeling dizzy all the time.

Just not having to wear glasses every waking moment will be a huge positive change for me - having a small amount of myopia is better than my current situation (-5.25 ish in both eyes). I'd prefer a small amount of myopia if it means I don't have to wear glasses for close-up or intermediate.

Got my glasses back with the new prescription for the IOL eye. Although it's suppose to improve overall sight because now both eyes should see better, I still prefer not to wear glasses eventhough the right eye is blurry. Have gotten accustomed to the IOL sight. It's now 6 weeks and distance vision has improved. Oculentis says it takes 12 weeks for the vision to stabalize. Got spoiled by not wearing glasses over these last several weeks.

Got my glasses back with the new prescription for the IOL eye. Suppose to be better now for both eyes. However I've been spoiled from 6 weeks not wearing glasses and having monovision thru my IOL eye since the other eye is blurry at -700d. Now

I prefer to go without glasses. It's a "new freedom" after wearing glasses since 5 years old.

Hi thought not sure if you've had a chance to read through the website 'All things Eye' and blog from Dr Por Tong Ming in Singapore.  Here is an extract of his comments on the Oculentis lens

The MPlus (available in Europe/Asia) has a wedged shaped section on the lens to focus for near. Point 1 above applies to this lens as well. However, although this lens does not give rings around lights, it can still cause 'halos' of a different shape-it is more like a smearing effect in one direction. Occasionally if a patient's pupil is small and not aligned with the lens, the patient may only have a far focus or a near focus and not both.