Need opinions on choosing an IOL.

A 2012 article is outdated unfortunately. 

re: "Tecnis-1 multifocal"

In the US there are new low add Tecnis multifocals (a +2.75D and a +3.25D)  that studies show  have lower risk of halos than the older high add (+4D) Tecnis lens. WIth the lowest add, +2.75, people reported less trouble with night driving than they did with a monofocal. There was a higher risk of halos than the Tecnis monofocal still, but that was likely counterbalanced by other factors like being able to read the speedometer, GPS, or other things easier.  I don't know how the optics of the Restor low add lenses compare to the Tecnis, I hadn't seen head to head comparisions (though the FDA data filings suggest the  Restor may have a higher risk of halos, I haven't seen a head to head comparision, it could be that the studies worded their questionaires differently).

The Restor multifocals are  blue blocking lenses, and the Tecnis and Crystalens IOLs aren't, but many surgeons consider that marketing hype, I figured I can always wear sunglasses and I prefer the idea of having the full spectrum of visible light.

What add works best for you depends on what your visual needs are, the lower adds are better for intermediate (often used for computers, as well as things like social distance) with not quite as crisp really near. The high add multifocal has more of a drop in visual quality for intermediate, in between the two peaks.

The Crystalens has lower risk of problems like halos than a multifocal since it is essentially a single focus lens. The issue is  that a decent percentage need reading glasses since it doesn't provide as much near, and for a small minority of patients it winds up appearing to not accommodate at all and essentially be a monfocal (though not as high a quality as some monfocals perhaps). 

re: "then  AcrySof SN6OWF single-piece acrylic monofocal IOL for distance vision and use readers."

I haven't seen a head to head comparision, but the Tecnis monofocal uses a material with a higher abbe number which has less chromatic aberration. Chromatic aberration is issue some people are familiar with from research eyeglasses, though its usually more those with higher prescriptions that have an issue with it. I've also heard there is an issue with "glistenings" with AcrySof lenses, though doctors seem uncertain as to how much impact that has on visual acuity of whether its academic.

Also, I'd checked the FDA data for the new low add Tecnis and Acrysof multifocals out of curiosity to see how they compared regarding halos. They both included monofocal control lenses, and the reports made it sound like the Acrysof monofocal has a higher risk of halos than the Tecnis multifocals, let alone the Tecnis monofocal which had the lowest. That said, often surveys ask differing questions  so a direct comparison might not be appropriate, and I hadn't had reason to search for any head to head comparisons between the monofocals, I don't know if they exist. 

 re: "Syncrony IOL by Abbot were available"

Last I'd heard the Synchrony had been pulled off the market in Europe since there were poor results with it in a fairly large minority of patients (even though some had very good results).  It was in US trials when my cataract was diagnosed so I checked on it, but the folks planning the trial said I was too myopic for the trials, they wouldn't likely have a lens in my power,  and reportedly it wasn't as good for high myopes anyway so I stopped considering it. 

I have noted some people confusing the Synchrony with the somewhat similarly named Symfony which is also from Abbott, an AMO Tecnis lens (though it is a new category of lens,  "extended depth of focus" rather than an accommodating lens). I had hoped to wait for a better lens to be approved in the US, and had initially planned to go abroad to get a trifocal since none were available here, and then the Symfony came out a few months before my surgery so I went to Europe for that (it wasn't available closer then, its now approved in Canada and Mexico, but US approval is still in the works, it might be serveral months or a year or more, no one seems to know).  I'm guessing from your comment you are in the US and likely aren't into travelling for surgery, though the Symfony and trifocals are available now in Mexico, and there are some clinics just over the border from San Diego (walking distance from the border)  that at least from my cursory check appear to be US quality clinics located there to get access to new technology.  I just saw a post on Medhelp from someone  who flew to Mexico to get the Symfony there tomorrow.   

Regarding your earlier comment on multifocals: " when I saw the doctor yesterday he didn't recommend them and said most docs have stopped doing them. That they are no better than multi-focal contact lens (and I have Another sister who hated THEM!)."

 

Some doctors are inherently conservative and don't wish to deal with the minority of patients that may have complaints about multifocal IOLs, even if the vast majority of  people get great results, it is a risk and some doctors dont' like that. 

Some people need to try multiple brands/models of multifocal contacts before finding one that works for them. The idea that multifocal IOLs  are "no better" than multifocal contacts is questionable to say the least, because an IOL doesn't move around the way contacts do and are  made with higher quality materials and optics. That said, unfortunately it is true that while the vast majority of those with multifocals report great results, a minority don't.  Ideally people would try multifocal contacts before IOLs (though with a cataract degrading vision it is often too late). If they like the contacts, there are higher odds they'll like the IOL.. though if they don't like the contacts, they might still like the IOL.

I liked monovision with contacts, but when I tried multifocals contacts I prefered that. I hadn't noticed any reduction in stereopsis, 3D vision, while I was wearing monovision contacts, but when I switched to multifocals I noticed that things seemed subtly more 3D (since both eyes are used for the whole visual range).  Multifocals do split the light for the different focal points, which can lead to some reduction in contrast sensitivity, reduced low light vision. I didn't consider that a problem when I wore them, it was worth the tradeoff. I now have the Symfony IOL (I went to Europe for it, its not approved in the US yet), which is an "extended depth of focus" rather than a multifocal, and I do notice better vision in low light, like in a dimly lit restaurant I go to regularly.

I don't know how much contrast sensitivy varies by person, since I compared my vision with someone I know who got a Crystalens and who notices that his reading vision is affected quite a bit by light. We met after a public lecture in a well lighted auditorium and he had a near reading chart with him. He showed me how merely holding a file folder over the chart to cast a shadow reduced his near vision a few lines.. though it didn't change my near vision at all. That made me suspect that perhaps the Crystalens isn't as good as a dedicated monofocal, unless its just an indication of the benefits of the Symfony's optics that eliminate chromatic aberration (not just reducing it).

As far as I know most doctors that do premium lenses have continued to offer multifocals. Some doctors were turned off to older generations of multifocals, but just as with the improvements in cell phones and computers, lens technology improves as well and the newest lenses have lower risk of halo and glare issues than older ones. 

Ohhh , this is what I'm doing this coming Monday with Dr. Uday Devagan in LA. I'm ver excited about it and pleased to read that you are happy with your results . Wish me luck !

Have you had any problems with motion sickness with one eye for distance and the other for close up?

Hi Pete

No, i have had no problems with motion sickness. In fact now,eventually,i can see perfectly again at last. So i am delighted

.I have,however, always had one short-sighted eye and one long-sighted eye as i was born with this so perhaps i am used to it. 

Hi there, Are there any dead spots in your new vision (blurry) ?  What  lens are you using ? 2.75? 3.25 ? Halos at night ?  Have you tried driving at night ?  Do you need more light to see well in dim conditions . Thanks. I'am considering Technis MF as well as mono-vision  

I haven't checekd this site, but If you check the Medhelp site there is aslo a thread there with more details  from someone who got a low add Tecnis multifocal  in one eye who is happy with it, aside from halo issues that hadn't yet resolved last I heard. He is hoping he can hold off on the other eye until the Symfony is approved in the US  (and threads from myself and others with the Symfony, including one recently travelled to Mexico from the US to get it).