Now I have near, intermediate & far. After monofocal lens exchange, I will lose my near & interm?

Thanks so much for your reply. Your info is very technical and I need some time to digest. Sorry I am a non-optometrist layman struggling with all these jargons.

.

Could I ask you very critical questions on your first paragraph?

.

If I understand correctly, set to Plano (set to zero) means no correction at all. Base on all the literature available for standard monofocal lens, they always mention about setting it for distance vision and then using glasses for near and interm. They did not mention about setting to zero like what you described.

.

Critical questions :

1)Is it technically possible to set to Plano on standard monofocal lens?

2)If set to Plano, whatever focus that I have before lens exchange remains exactly the same after lens exchange. The difference is I have a more transparent synthetic lens resulting in enhanced contrast. Is this correct?

.

If your answers to these 2 questions is yes, it would be wonderful and life will be very much simpler for me.

.

That means I can do like what you said (standard lens exchange set to plano), and then go for Supraco after that. That means I am spectacle free but traded off nothing by losing no focus, losing no contrast, and also much reduced halo/glare. But I will burn a hole in pocket due to Supraco.

.

If the above is possible, I won’t need all these Eyhance, vivity or symphonie. All these premium lenses involves trade offs

Sorry, I admit I am being very picky and difficult by being unwilling to accept any trade-offs. I was very myopic since age 7 and when I did Lasik 15 years ago, my world suddenly becomes so beautiful and no words can describe the happiness I experienced back then. I cherished this gift of sight so much that I am going to do everything possible to maintain and secure this gift. I would want my world to continue to be this beautiful and won’t want to compromise a single bit of contrast loss. Now I am depressed over my loss of ability to read tiny fonts and trying to addrss it. Hope you understand my feelings

Do you have cataracts or the beginnings of presbyopia? Personally I do not think you will get much support for clear lens exchange (basically cataract surgery) here on the forums. You stated you are particular - that has it's own concerns when it cones to lens selection and all lenses have a trade-off. If reading fine print your only concern glasses would be your best option. Perhaps there will be a perfect lens when you need this surgery for cataracts.

Don't mean to put you off but read through a few of the threads and you'll see there are worse outcomes than having to wear glasses.

thanks very much Sue for your reply. Except for the loss of ability to read tiny prints, I don't experience any blurred vision, so i guess i don't have cateract, or very mild at worst.

Reading glasses and progressives........ very depressing. I had thought the synthetic materials are way superior to natural ones, so it makes sense for an exchange, didn't expect so much objections and also didn't know that there is such thing as "accomodation". Let me sort out my thoughts. I am inundated with too much info. Cheers!

I would really encourage you to read up and research before going ahead with clear lens exchange. Very expensive and chances are you will end up with glasses for at least one distance anyways. No surgeon (a good one) will promise glasses free. The lenses that provide more range of vision (often called premium lenses - trifocals or EDOF - extended depth of focus come with a compromise of less contrast and night vision issues like halos glare and concentric circles . Not saying they do not serve a purpose - I myself have Symfony lenses EDOF. but i do have some glare and see huge concentric circles around lights at nifht (ie red traffic street lights). But my cataracts were bad enough at 53 that I could no longer get a good enough correction with glasses (ie could not read license plate on car in front of me at a stop light. I had to have the surgery or lose my driver's lic. Most people of cataract age cannot recall good vision so these IOLs provide something list long ago. Younger you are there are more compromises to make. Make no mistake this is a very profitable business and often these IOLs are over sold and people aren't told much about the trade-offs. Many countries pay for this surgery for cataracts. I live in Canada so my surgery was covered. I paid for the difference between standard monofocal and Symfony ($900 a lens) If I did this for any other reason the expense would gave been easily $5,000.

Take your time before deciding to do this. It cannot be undone.

Yeah I am reading up and researching. Hopefully something can be invented in near future without any trade-off.

.

If you could not read license plates, that means your cateract would have caused you to lose quite a significant amount of light transmission such that you experience a net gain of light transmission after installing Sympony.

By the way, can you read the very tiny fonts on drinks cans or biscuits packaging? How about reading newspapers? Or mobile phones> It is known fact that Sympony gives not so good near vision.

oh another question Sue:

.

According to RONAK, your accomodation is completely lost when your natural lens is removed. What do you experience with this loss of accomodation? What bad experience that is attributable to this loss?

.

The glare and concentric circles and the not-so-ideal near vision focus is inherent shortcoming attributable to sympony.

Loss of accomodation means you can no longer change the focus of the lens in your eye. This is the case will all IOLs commercially available today. All of them are just a tiny static piece of plastic. EDOF and Multifocal and Vivity have no accomodation. That is, they can't take 100% of the incoming light and focus all of it for near at one moment and then all of it for far at another moment. Instead they rely on tricks like splitting the light up or spreading it out. A multifocal essentially creates THREE focused images (near, intermediate and far) and superimposes them. Your brain then learns which of those images to pay attention to in which situations. It's pretty freaky. But no lens offers true accomodation. That's why they ALL have image quality trade offs (except monofocal but you'd need glasses). And that's why people here are recommending that you don't do an IOL implant if you still have a clear crystaline lens. You will be degrading your vision quality no matter what you do. Unless you choose a monofocal IOL And use glasses. But what would be the point of that since you don't have cataracts.

.

As for reading licence plates, there are different kinds of cataracts. They can cut down on incoming light (especially a nuclear cataract) but also they can simply scatter incoming light. So you may still have plenty of light entering your eye but it just can't be focused because it's being scattered in a million random directions. So it's not necessarily the case that Sue's implant is transmitting more light than when she had a cataract (although that likely plays a role as well). It could also simply be that the light is now being properly focused instead of scattered all over the place.

thanks David. I learnt a lot of very useful info from you.

What RONAK means is by liss of accommodation is that following surgery, the accommodation system is still intact however, the IOL lens is now much more rigid than your natural lens. I was near sighted prior to surgery a d by squinting could bring distance into focus. That doesn't happen with IOLs now. There are some lenses when I was looking 3 years ago that are what is considered accommodation lenses (think they were Crystalens Accommodating lenses). Not sure if in the long run they worked well. Everyone who has cataract surgery or clear lens exchange will experience complete loss of accommodation. One of the many reasons most of us who had this due to having cataracts would not recommend clear lens exchange. Perhaps only in case of very poor vision. definitely not because we had to wear readers. Surgeons are pushing that as it is very profitable and their patients who had lasik to correct distance vision are prime candidates as they really don't like glasses. But be aware with no guarantees one might end up not seeing as well as they did for distance or mid.

I got lucky with my Symfony lenses. I have very good close up vision. i hold my iphone with bent arm. It's about 12 inches from my eyes. I rarely wear glasses - only when light is dim or I read for extended periods of time. My optometrist says I have plano achieved in right eye and 20/25 in left eye (prior yo developing an issue in left eye (epiretinal membrane). i have readers +1.25. It is possible I would have gotten decent mid vision with monofocals - some do like RONAK - has to do with a few factors. Some say pupil size. You cannot get a guaranteed result. not doing s lens exchange to find out. I have learned to live with the night visuals. All I can say is I drive at night and don't think much about it any more. The more of a perfectionist you are the more these things bother you I guess. I am somewhere on that scale. I would say anyone looking into this ahead of surgery would have those tendencies.

Yes I see huge concentric circles around certain light sources - red traffic lights, cars when brakes applied LED porch lights but the circles are faint (especially outer rings - more vibrant are the inner rings.

I had very fast developing cataracts both eyes. Within 6 months of getting checked by my optometrist and renewing glasses prescription I could not read lic plates, road signs etc. I mention that because in Canada the surgery is only covered when vision cannot be corrected with glasses to 20/40 or better. My best corrected vision at that time was 20/60 right eye and 20/60 left eye.When vision is that poor it is very hard to recall what it was like prior to having cataracts. It would have been nice if I could have experimented with contact lenses to see how well I could adapt to monovision.I did have 6 weeks between surgeries and even with a cataract in left eye the contrast was better in cataract eye than Symfony eye which surprised me then.

even with a cataract in left eye the contrast was better in cataract eye than Symfony eye

Wow. That's interesting!

.

I'm also in Canada by the way. But my best corrected vision is still about 20/32 and 20/40. Not great but I'm getting by for now. I've been debating Vivity because I've never worn progressives and I'm worried I will hate them. Choosing any kind of "premium" IOL will come with quality trade offs though so I'm not sure what to do. I'm younger and presbyopia happened at the same time at the cataracts so I'd never made the switch to progressives. If I had used them for years and was happy with them I imagine I'd just get a free monofocal without question.

I should add that that noticeable difference in contrast was in low lighting or dark situations. in daylight or well lit rooms I did not notice a contrast difference.

Not an easy decision to make. i made the choice for symfony as I was beginning to wear progressives and did not like them at all. Suffer too from migraines and thought with monovision that might play a part. without trying it out (which I couldn't) wasn't going to gamble with any type of monovision.

Hope you are able to get the info you need on Vivity - it wasn't an option for me 3 years ago.

noticeable difference in contrast was in low lighting or dark situations. in daylight or well lit rooms I did not notice a contrast difference.

Yes that's my understanding as well. Which is good. It means the not so great CS numbers for Vivity are probably only an issue to me for night driving or poor visibility (fog, snow). I'm not worried about reading since 99% of my reading is on devices. I also do a lot of hiking and camping (including at night) so maybe that scenario as well.

.

I tried Progressives a year ago and HATED them. So that's my issue as well. However I just bought them online for $60 so they are not "good" progressives (according to my Optometrist). And I never really gave them a proper try. I put them on for 5 minutes and was like "NOPE!". But I was reading about them online yesterday and they say you have to give them at least 2 weeks to see if you'll adapt. I saw more than one person say you will hate them for the first week and then you'll love them.

.

So I'm giving them a proper try this time. Trying to wear them for everything except work for 2 weeks. If they work out well I may just forget all this premium IOL stuff and get a free monofocal IOL from public health (Acrysof IQ probably).

.

I was considering Eyhance as well since it has no trade-offs. But I'm being told the close focus isn't great. Best they can promise is 70cm (fully extended arm). So you'd still need glasses to see your watch / phone. What's the point of being able to see rough terrain underfoot when hiking if I can't also read my compass? I may as well just be in glasses all the time. If I was going mono anyway and public health offered it as a free option of course I would choose it, but I don't think it's a Vivity alternative.

.

Apologies to kctestingeas1 for hijacking this thread. Although I am still talking about my thoughts re: presbyopia I guess.

Yes I do get it and some things as you age you learn to adapt (or it will drive you nuts). Wait till you experience tinnitus. How I wish I could hear nothing!!!!

Give progressives a try - good ones. It dies take a while and best start when you don't fully need them to get accustomed to them. It gets better.

Wait till you experience tinnitus.

Actually I've had Tinnitus for 27 years. Fun! I went through hell for the first 2 years. Intense anxiety and zero sleep. My perfectionist brain wouldn't stop listening to it. But now it's like I don't even have. I'm hearing it now because I'm talking about it but if I wasn't talking about it it would be like I don't even have it. Our brains are amazing.

.

I'm actually considering paying for "good" progressives to try them out properly before deciding. It's a very expensive experiment since they will be useless after surgery, but $6000 for Vivity implants that I'm not sure I will like is also a very expensive "experiment". I will give my cheap ones from Zenni a shot first though.

out of curiousity, i checked out on vivity.

.

Summary for Vivity :

.

Monofocal gives only distance. Vivity gives distance + inter. Unfortunately, again, contrast loss as compared to monofocals. Still need reading glasses. The only positive is no halos.

.

There is nothing to be excited about Vivity. Compared to Sympony and Panoptix, it involves the same amount of gains and trade-offs. Just that the gains and trade-offs appear in different aspects. It just offers a different combination of gains and trade-offs. There is no net gain over sympony or panoptix.

.

Hope by the time i have cateract, there will be something that provides at least some net gain if no compromise is not possible.

There is nothing to be excited about Vivity

No halos, spiderwebs, starburst and glare (very little) is a very big deal for a lot of people. Aside from price (of course) these side effects are the #1 reason people don't choose a multi-focal. Only about 1% of IOLs implanted world-wide are multi-focals. Also the vision with Vivity has no gaps like multi-focals can have. And although near is not perfect it's "good enough" to casually check your phone / watch. Intermediate is 20/25 which is very good. Too bad about it's contrast sensitivity.

.

But you're right, as I think I said in another reply, there is no perfect lens. It doesn't exist. There is only so many ways you can slice and dice the incoming light with a static unchanging piece of plastic. That's just physics. The real "holy grail" will be a true accommodating IOL. There are a number in the works but I think the Juvene is the most promising. Unfortunately it's still many years away. No soon enough for most people on this forum.

Davi, I have used Costco, I think Freedom Accolade, progressives for many years and liked them. They generally cost me around $450 a pair, depending on frames. My most recent pair which I got after my IOL surgery and I was expecting to wear them less was the Costco Kirkland progressives. They were about 350 a pair. I am not liking them quite so much, but I have had a lot of changes with IOL, and wearing no glasses much of the time, and a cataract developing in the other eye. My brother has tried Zenni for progressives and has had lots of trouble. I think they tend to use a much narrower zone for the intermediate and close vision.

.

I have gotten kind of spoiled now with my contact lens simulated monovision. I can use the computer and look up, down and in any direction and still see well just moving my eyes, and not my head. When I try the progressive eyeglasses I find I am always tilting my head up and down to try and get the screen in focus. I suspect I was used to doing it before, and now I am spoiled.

I have had tinnitus for a few years bow. Brought on by a virus (at least I think so). Had fluid in my ears too long - wouldn't clear. Took 18 months to see an ENT

Yes it is amazing what you get used to.

I am hoping one day instead of a lens exchange someone would come up with drops that remove cataracts altogether

Sue,

Me too which is one of the reasons I procrastinated on my first IOL surgery. There have been news stories, but then nothing. I remember about 10 years ago there was a news story on Photo bleaching for cataracts and how it was the future of cataract treatment and then crickets. You can search for it for more information on photo bleaching. Then about 5 years ago I read about Lanosterol eye drops for cataract treatment and then once again crickets.

My guess is they will come up with a drug to prevent cataracts before they come up with anything to reverse cataracts.

They continue to do research in exactly what causes the proteins to clump together, but I doubt any non invasive treatment will be available any time soon. I think we will continue to see newer improved ways to remove the cataract, better devices to determine accurate power and better IOLs.

Technological advances - all too late when having to make a decision. Perhaps we are never ready. My mom and dad still do not need cataract surgery - so somewhat feel cheated out if those one day newer lenses and procedures.

I can use the computer and look up, down and in any direction and still see well just moving my eyes, and not my head.

I will NOT use progressives for computer work. I'm a web designer / developer / programmer so I need the best possible vision at work with a very wide field of view and no "head moving" nonsense. I use a MASSIVE dual 5K 40" ultrawide monitor so that's a LOT of real estate for my eyes to cover. My plan no matter what I do for IOLs is to get single vision prescription computer glasses that make my computer vision as wide and sharp and bright as possible.

.

Thanks for the info re: good progressive glasses (they'd be for everything BUT work). Yes I think Zenni is not a good way to go. The intermediate on them is useless. And I'm having a lot of peripheral distortion.

.

I wonder if the peripheral distortion is less when you've had cataract surgery and the main field of vision has virtually no correction? Still would be the same ADD though so maybe not. Although with something like Eyhance getting you that much closer to your near target maybe your progressives would only need a 1D ADD which should minimize distortion?

.

Anyway I think I'm going to go ahead and spend $350 for progressives BEFORE surgery to try them out. I know that's completely crazy because that will be $350 down the tubes as soon as I get surgery. But spending $7000 on Vivity and not liking them would be a much bigger mistake.

.

Everything I've read and watched and learned about Vivity (along with a few very positive anecdotal reports on here and elsewhere... although a couple bad ones too) seems to indicate that yes there is contrast loss but it's only noticeable in low light and NO one is complaining about it. The vast majority of patients are extremely happy with their full field continuous and very good vision down to about 26". But I'm a perfectionist and when I see that MTF50 with that horrible 0.25 peak focus contrast... I don't think that's a quality sacrifice I'm willing to make.

.

Maybe glasses are not the end of the world. I'm just thinking if my vision from distance to 5 foot is amazing and closer in is blurry but "good enough" I won't be motivated to get into the habit of wearing them all the time. So those few times I'm out and about and really need them I won't be wearing them or have them on me. The answer of course is to just wear them all the time. Which doesn't bother me at all (I've worn glasses since age 14). But I do wonder if I won't even form that habit. Dumb thing to worry about I guess. It's just hard to fully predict what life will be like post-surgery. And I DO hate presbyopia. But I'm also a perfectionist and I just don't think I'm willing to give up ANYTHING in terms of vision quality. A conundrum. One that the original poster can relate to I'm sure.

I read a post on reddit about a guy with bilateral Vivity, and he hates driving at night now. I was really excited about Vivity but the night contrast really bursts that bubble for me, now looking at Eyhance. You can find it if you just google "Vivity reddit", should be the first result.

davi98963

Remember there are no guarantees whether premium or monofocal lens is selected. Odds are better with monofocal for night vision issues but for some there are issues. Unfortunately no matter how many studies, peer reviews or real life experiences you read it there is always a chance it isn't what you hope for. For that reason I am not a fan of clear lens exchange or even doing the surgery for beginnings of a cataract. If vision can be corrected with glasses or contacts that's the better solution. there may be a better selection of lenses come along in the future.

Another consideration not usually discussed by surgeons is pupil size. Younger you are your pupils dilate more in dark more than an older person of usual cataract age. This causes an added visual disturbance. All IOLs are roughly same diameter of 6mm

Sue... I know. And I agree about not doing clear lens exchange. In my case my cataracts (posterior subcapsular) started 5 years ago and they really do need to be fixed. The best I can achieve now with glasses is 20/32 and 20/40. It's actually still ok in most cases and I'm still legal to drive and feel very comfortable driving at night or on overcast days... but on bright sunny days (oddly) I'm started to feel uncomfortable driving.

.

Yes I know you can get glare and other effects even with a monofocal. And as a perfectionist I do obsess over studies and data too much. But I can't ignore the Vivity peak contrast of 0.25 (MTF50 bench test) vs. about 0.50 for a mono. That's significant. Clearly a monofocal will give me a better chance of achieving quality vision in a broader range of lighting conditions (but with glasses).

You may be interested in searching for a Alcon presentation by Cathleen McCabe called:

.

Clinical Outcomes of a Novel NonDiffractive Extended Vision IOL

.

This of course is Alcon's view of it and it is only simulated. YMMV! The Symfony is the Tecnis lens, AT Laura is from Zeiss I believe, the AcrySof IQ is Alcon's monofocal.

Yes I know too well that uncomfortable feeling and 3 years my RE was 20/60 and LE was 20/50

I recall going into larger spaces like grocery stores and feeling very disoriented. Everything was fuzzy when I looked up. Only close vision was good. I would sit in the bleachers watching my daughter's soccer games and could read their jersey numbers or see the ball. I was most miserable. I delayed surgery once due to indecision. In all from diagnosis to first surgery it was 7 months. I had 6 weeks between surgeries. You'd think that would have been an easier wait but I waffled between another Symfony or a monofocal. I had good results with Symfony - but the concentric circles and glare made me hesitant. If I had thought about it more that first surgery maybe should have been s monofocal set for distance and Symfony targeted at -.5 D to eliminate the circles and glare from Symfony. But with that first surgery already done with Symfony targeted for distance it would not help my night vision issues to go with a monofocal.

Wish you well with your decision.