Need Cataract Surgery. Monofocal or Multifocal?

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I have narrow angle glaucoma and my doctor wants to replace my lenses. He just assumed that I would get torric multifocal lenses at $2000 each eye out of pocket. I'm reading through the forums and I see many issues with the multifocal lenses. I am normally far sighted, cannot read up close. I'm thinking momofocal would be better because of all the issues I'm reading about. I work a computer every day. Help. Need advice.  Our eyesight is so important. 

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  • Posted

    My suggestion will be to stay away from Multifocal lenses. Those don't seem to provide clear vision to a large group of people in the day time and also have the most night vision issues of all the types of lenses. They provide a reasonable focus at 2 or 3 discrete distances, but the in-between distances are out of focus.

    This leaves us with the choice between the monofocal lenses and the Symfony lens (which is an extended focus lens, even though some opthamologists lump it with the multiple focal lenses). While the Symfony lens also does have the issue of halos and glare  more often than the monofocal lenses (although it is better than the similar night vision issues with the multifocal lenses), it does provide a good day time vision over a longer range than the monofocal lenses.

    A combination of 2 monofocal lenses will result in you having the least night vision issues, but may require glasses more often. A good way to reduce the amount of the times you will need to use glasses is to use a little bit of monovision or blended vision, where you would have the IOL for the dominant eye set for the best focus at far distance and the IOL for the other eye set for about 40 inches. This should provide you a good vision from about 26 inches to far distance. Most people adjust to this slight difference in the 2 eyes settings quite easily.

    If you do want to have a reasonably good vision at the reading, intermediate, and far distances with minimal chances of having night visions issues, you should consider a combination of a Symfony lens in the non-dominant eye for the intermediate (and near) and a monofocal lens in the dominant eye for the best focus at far distance. Most of the surgeons don't suggest combinations of different types of lenses. So, you will have to bring it up with them and get their feedback.

    As for my own background. I have a Symfony Toric lens in my right eye for distance and a monofocal lens in my left eye for close-up. (opposite of what I am suggesting to you). With this combination, I have good day vision at all distances beyond 16 inches. However, I wish that my night vision were better, the main issue being the seeing of multiple concentric circles or halos around lights at night time. Many other people seem to have had the same issue. Rather than repeating the details here, I will encourage you to read my post, “Has Any One Else Had This Very Unusual Vision Issue with Symfony Lens?” on this forum. You should be able to find it by clicking on my name and then looking under “Discussion”.

    Any way, the problem with the multiple circles or halos, around lights, associated with the Symfony lens is at distances beyond about 20-30 yards. If you use the monofocal lens for the distance in the dominant eye, you should not have that issue. That will provide you with a good vision for driving at night. If you start with having the monofocal lens in the dominat eye and that turns out to be as planned, then have the Symfony lens in your non-dominant eye set for about 32-40 inches best-focus range, which will give you the capabilty of reading as well as overall good vision at all distances with both eyes.

    For any of these lens combinations, if you need to get their toric versions to corrrect astigmatism, you should do that. However, please be aware that even with those, the astigmatism is not always corrected completely. The spherical prescriptiom may also be slightly off from the desired target. So, you may still require some  LASIK enhancement (or another similar procedure) to get the best vision. Many surgeons perform LASIK enhancement as part of the Premium lens package without any additional cost, but that is not always the case. So, you will need to check on that.

     

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    • Posted

      Thanks so much for your in depth comments. Will discuss this with my doctor at my upcoming appt. 
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  • Posted

    I need cataract surgery on my non-dominant eye first and plan on getting a monofocal lens set for distance in that eye. I can see up close fine with my dominant eye now, so I'm hoping that will help me stay out of glasses as much as possible at least until I have my dominant eye done. I think they can do monovision with the dominant eye having the closer vision, but I'm not sure how great it turns out compared to the other way around. I have no choice in the matter though, so I'm going to have to hope for the best (and I also had lasik in the past which makes the entire thing even trickier).

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  • Posted

    I also have glaucoma (in my right eye) and need cataract surgery in that eye. I also have moderate astigmatism in both eyes (2-2.75D cylinder).

    However eye doctors have told me that glaucoma can reduce contrast sensitivity so its important to use an IOL in that eye which doesn't reduce contrast further and multifocals do that, except for the accomodating IOLs (Crystalens, Trulign).

    Symfony reduces contrast a little too but not as bad as the multifocals, however a good acrylic monofocal would provide the best contrast sensitivity so has been recommended as the best choice for that eye for me.  Reading info at the IOL manufacture websites, the Tecnics monofocal (including toric version) appears to have the best contrast sensitivy of IOLs, so that would be my first choice for my right eye.

    Eventually for my left eye since it has good contrast sensitivity and no glaucoma and also corrects to 20/15 or better, I could consider a Tecnics Symfony Toric IOL in that eye set for a slight nearsighted (-0.5D) and still probably get near 20/20 distance and good intermediate and some near vision, to go with good distance vision in the right eye with a toric monofocal.

    I am also considering Trulign (toric) accomodating IOLs in both of my eyes, since they have OK contrast sensitivity and would get me good distance and intermediate in both eyes, plus some near if I again did a slight offset in the left eye.

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    • Posted

      I know that it is hard to compare the pros and cons of various lenses. However, for whatever it is worth, my wife was rather disappointed in the focus adjustment provided by the Crystalens (it seems to depend a lot of how good the eye muscles are). Also, we learnt after the fact that the Cystalens has a much higher probability of causing Posterior Capsule Opaqueness, or PCO, (compared with a good monofocal lens), which requires getting fixed with a YAG laser treatment (my wife ended up needing that also 2 months after the cataract surgery).
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  • Posted

    Hello Shelly, I am not not a doctor, let alone an eye surgeon. However, I did have my right eye operated for cataract 80 days ago and have since then done research on lens choices due to problems after the surgery. My problems are not related to multifocal or monofocal, therefore I would not bother you with them.  However prior to the surgery, I needed to use  a pair of multifocal glasses with just a tiny bit of correction of astigmatism, when I finally decided to deal with the cataract, my doctor selected a monfocal IOL for me, I can now play tennis, drive,watch tv  and use my smartphone without glasses, when I really want to see things, read books for long without tiring my eyesight, then I use a pair of glasses for far sight, and another pair for short sight. He does not recommend multifocal lens implant,  he explaines that the implant itself requires a lot of adjustment from the patient ( I am still adjusting to watery eyes, negative disphotopsia), the simplier the IOLS are, the less troublesome it may be for the patient, of course there are the lucky ones, but can we count on luck? So the bottom line is to talk to your doctor, ask him what is the power of the IOL he would recommend should you opt for the monofocal, the power should provide you a fair far sight  and a reasonable short sight vision so that you do not need to have glasses unless you want to a perfect vision for long hours,
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