Ok going for Mini-Monovision...

surgeon 4. reasons:

1. zeiss is more well known than hoya.
2. make right at -0.55. and left at -1.4. or -1.05. looks like he obviously knows what he is talking about. there is rarely such a thing as plano. in ur wife's case the plano is -0.20 or +0.15 . +0.15 wastes that much diopter from the near.
3. zeiss more prone to pco but with her young age she is going to get it anyway. hopefully she can prolong the YaG.
4. dont touch right is vision not impacted. allows you to compare iol vision with natural eye.
5. try not to replace lens on YAGd capsules.

good luck.

Doing one eye at a time is more common, both for "safety" and financial reasons (in US, where reimbursement is cut in half for second eye if done on same day).

But doing both eyes at same time is common in some centers in Europe. Article: "Two for One: Bilateral Cataract Surgery" for discussion. So I wouldn't hold it against Surgeon 4 that he is willing to do both eyes at sametime.

I didn't look as deeply into mini-monovision, but most articles target dominant eye for distance. Did you get chance to ask Rockstar why he suggests non-dominant eye for distance (he says it doesn't matter, but if it doesn't mater, why this recommendation)?

Since Zeiss IOL not available in Canada/US, I didn't look into that either, but I would assume hydrophobic surface is going to be very similar to entirely hydrophobic as far as how the eye tissue reacts.

Would be interesting if you go with Surgeon 4 for Mini-monovision, when Surgeon 3 was the one who strongly prefers mini-mono.

I vote for surgeon no. 4.

I love it when a person can learn from his experience/mistakes, and that he is man enough to say he was wrong. He have told you he have promoted edof, but now he have stopped doing it for several reasons.

He really did not need to tell you this, but he did, for me that makes him very trustworthy.

And by the way I agree with his findings, in my own experience the Lara is not better (or worse) than Symfony, my personal experience with Lara is very similar to everything I have read about the Symfony the last month. So to get near vision with these, you need mini-monovision with the Lara as well, unless you are one of the lucky ones as Sue.

Therefore the trifocals must be considered better than Lara, if you go for premium lenses, and probably the reason why my surgeon from the start wanted to mix Lara with a trifocal, so they can balance out each soft spots.

About hydrophobic/hydrophilic material. I have really searched the net about this subject since I am getting Zeiss, it seems to me that there was one other manufacturer some years back, that made a couple of batches where 0,008% were faulty with the hydrophilic material, and this have given it a bad reputation among some.

The main reason for the faulty lenses have never been found, but it is believed that is was a fault in the material in those two batches, some suggest left over cleaning material in the machines.

And the manufactorer that had these problems, are still using hydrophilic acrylic, because they found it was not because of the material in itself they had issues, it was something that happened during the manufacturing process back then.

And beside that hydrophilic acrylic have some very good characteristics, in some areas better than hydrophobic acrylic, which is the reason that many uses this material. So personally I am not scared of it at all, i don´t see it as a bad thing at all.

I also find the targets from surgeon 4 better, here in Denmark people that I know with monovision have been targeted for 1.5 on the near eye, otherwise you just don´t have enough near vision for using your smartphone and stuff without reading glasses.

With the 1.5 people are often glasses free for many daily activities, I know one guy with this setup very well, I would say his vision is as good as my vision with one Lara, maybe his is actually a little bit better at near, but he have also had some years of training, I am still a rookie 😃

Worried - I would never have the surgeries at same tine - who does that benefit? I am not sure why your wife would consider it especially given one eye isn't as impacted as the other by a cataract. Even if both eyes need surgery it is so much more beneficial to have one eye heal and IOL settle (especially when having mini monovision). Any adjustments if first eye is off target can be made to second eye.

I would think dominant eye does matter.

IOL types mentioned I have not much knowledge of living in Canada.

Curious to know what tipped the scales in favor of monofocals and mini monovision approach.

By the way - the Zeiss CT Lucia is their latest monofocal, it is hydrophobic acrylic.

I will reply to all your questions in one post instead of individually to keep it simple.

Also for ease of understanding....

Doc No.4 = Dr Zeiss

and

Doc No.3 = Dr Rockstar.

zeiss is more well known than hoya.

Dr Rockstar does Zeiss too but he said Hoya's lens division is quiet big too.

Dr Zeiss on me asking about Hoya said they are good too, no difference in quality. He also said you need different skills to insert different type of lenses ( I assume he means mainly the haptics) so he teaches surgeons what to do and what not to do with various types of lenses.

Dr Zeiss said that he does not know anyone personally who once starts using Zeiss then stops using them.

make right at -0.55. and left at -1.4. or -1.05. looks like he obviously knows what he is talking about.

Yes Dr Zeiss does seem like he knows what he is talking about. Although he is VERY eccentric, mad scientist type (actions not looks). We basically could not talk. He was talking 99% of the time. You can't interrupt him either or answer his question, he seems to go inside a thought tunnel when he talks, auto pilot. Me and my wife were looking at each other constantly with a wtf look 😃 We had a list of questions and we could not even look at the list! Although all the questions inidirectly or directly got answered by his though tunnel chat!

zeiss more prone to pco but with her young age she is going to get it anyway. hopefully she can prolong the YaG.

I know but why not delay it if possible. Dr Zeiss does not feel YaG is big deal.

Dont touch right is vision not impacted. allows you to compare iol vision with natural eye.

It is impacted now too gradually. Dr Zeiss thinks wife should operate both eyes within 8 weeks as he does not want my wife to have an accident or something.

Dr Rockstar's assistant said I would drag the right eye as long as possible. Dr rockstar said maybe 6 weeks later if you like the left eye so much that you want to operate it too.

try not to replace lens on YAGd capsules.

Yes no way 😃

I didn't look as deeply into mini-monovision, but most articles target dominant eye for distance. Did you get chance to ask Rockstar why he suggests non-dominant eye for distance (he says it doesn't matter, but if it doesn't mater, why this recommendation)?

Well left eye has dense cataract so left eye has to be operated first. Currently right eye is dominant but he Dr Rockstar thinks it could very well be due to left eye being covered with cataract. He does not think it is a big deal.

Dr Zeiss thinks right eye is dominant simply based on the fact that my wife is right handed...so hmmm!!!

Would be interesting if you go with Surgeon 4 for Mini-monovision, when Surgeon 3 was the one who strongly prefers mini-mono.

Dr Rockstar was actually more human, looking back lol He obviously cares enough for stressing on us not to do EDOF etc!

I love it when a person can learn from his experience/mistakes, and that he is man enough to say he was wrong. He have told you he have promoted edof, but now he have stopped doing it for several reasons.

Yes we though that too. Although DrRockstar did Multis too (not as many as Dr Zeiss maybe) but now he does not do them regularly. One could also say that Dr Rockstar was smart enough not to jump on any bandwagon in the first place?

Worried - I would never have the surgeries at same tine - who does that benefit? I am not sure why your wife would consider it especially given one eye isn't as impacted as the other by a cataract. Even if both eyes need surgery it is so much more beneficial to have one eye heal and IOL settle (especially when having mini monovision). Any adjustments if first eye is off target can be made to second eye.

I would think dominant eye does matter.

I don't see any benefit either. I guess when people fly from other countries then can have it all done and dusted or not have to go through the stress of operating twice? No we won't operate both at the same time.

By the way - the Zeiss CT Lucia is their latest monofocal, it is hydrophobic acrylic.

Says excellent for far vision (only?). Why not aberration neutral?

I assume based on the shape Dr Zeiss described, he uses ZEISS CT ASPHINA or ZEISS CT SPHERIS. I can ask both docs about the Lucia too.

Ok I think i replied to every post 😃 I see positive and negative in both surgeons. I wish I could combine both of them lol