Planning to exchange monofocal IOL for premium

Hey folks,

It has been super helpful reading many of your discussions, I only wish I had read some prior to my second cataract removal. For anyone willing to listen my story and offer any feedback at all, THANK YOU and please buckle in for a novel:

I’m in my very early 30’s, just one of the lucky ones with congenital cataracts. First, non-dominant eye operated on 13 months ago. Second, dominant eye operated on 3 1/2 months ago.

Going into both surgeries, I had no idea what accommodation was, or even the concept of presbyopia. My surgeon told me he was going to “leave me near sighted” because for my age, that would be what I was used to, and I was already accustomed to wearing my -1.25 myopic glasses prescription for driving/distance.

First surgery, fantastic, I now see textures and color that I didn’t even know I was missing. I wanted the same result for my second eye, which wasn’t nearly as advanced a cataract as my first, and was really livable, but insurance covered it, so I did it.

The day after my second surgery I was CRUSHED. I had lost my remaining accommodation that I didn’t understand I still had, and I became fully presbyopic in an instant. I cannot believe that I had no idea this would be the result, I was so ignorant, and so so regretful.

Fast forward almost 4 months to today, and I’m making peace with it. The way I see it, my cataract was progressive, I maybe had a couple years at best, and I’m making the hard adjustment now to losing my near vision, and in 10 or 15 years when my peers are griping and moaning about it, it’ll be old news to me.

Because I had no idea what accommodation was, I also had no idea why my surgeons office was having me watch a PanOptix promo video and check the box stating I was offered it, I was thinking “y’all want SIX THOUSAND DOLLARS so I don’t have to wear my distance glasses! HA!!”. But of course I now know there’s much more to it than that.

If you’re still reading, thank you. So I now have my fixed monofocal vision with what I feel is a fairly constrained sweet spot of 18”-20”. Around the house, I’m fine without glasses, still a -1.25 prescription for distance. I tried progressive glasses, couldn’t do it. Tried several brands of multifocal contacts, they’re all pretty terrible. I’ve settled on lined bifocals for now just so I can read my phone without taking of my glasses. As a craftsman and an artist, not being able to see closer than 18” was a huge(and frankly, really emotional) loss for me, but I accept it as my uncorrected near vision now.

The most normal I have felt to date is recently when I started wearing a distance contact in my dominant eye, and seeing with monovision. The pseudo-accommodation it gives me was such a joy at first, but the glee was short-lived when I started noticing the huge gap in intermediate vision. But I’m contemplating a solution, and I want to get it right, because I have an opportunity.

My surgeon is willing to discuss exchanging the IOL in my dominant eye, as it’s still relatively new, and he knows how disheartened I am with my outcome. A week ago I was super excited about exchanging for Vivity EDOF for my dominant eye. My thought was, if all went well, I’d still have binocular near vision at around 18”, with the huge perk of full time monovision WITH the intermediate I’m sorely missing(car dash, GPS/media display, grocery shopping without leaning in to read, etc), and I’d simply get glasses to correct my near eye if I wanted binocular distance clarity for night driving, or going to the movies. Sadly, my “Vivity is perfect for me” bubble burst when I discovered the nighttime contrast loss. God willing, I have decades of night time driving ahead of me, and I dont want to be guessing at what’s a deer and what’s a shadow. So unless someone can tell me otherwise, Vivity is out for me. I’d rather deal with halos, because I see them as a nuisance, not a safety issue like nighttime contrast on a dark highway.

Sidenote: I’m fortunate that I have no driving halos currently, but I did for a couple days post-op, so I understand the concept.

Which brings me to Symfony Plus. I have yet to find any actually patient reviews who had a newer Plus lens put in, but if it’s even a little better than the original Symfony, I’m hopeful it would reach back to 18” for me and let me keep my binocular “near” vision, while giving me intermediate and distance for my monovision.

I don’t want to consider PanOptix for the same reason as Vivity, I don’t want to lose any more contrast than I have to. I wish Synergy were in the US to consider, but who knows when that’ll be.

Lastly, I’m considering the conservative “safe bet” to avoid halos, with is Tecnis Eyehance to give me distance and some intermediate, to pair with my 18” non-dominant eye. The downside, I lose my binocular near vision, I’m simply trading it for monovision. However, I gain the intermediate vision I’m currently missing, and probably 90% spectacle independence, so that’s something.

All of this is to say that the IOL exchange goes perfectly. I understand there’s a risk, but I’m pre-YAG(in both eyes), so I’m hoping it’ll be a smooth operation. At the end of the day, I just don’t think I’m prepared to live out the rest of my years with my current, unaccomidating vision, I want more. I know I can’t have it all, but I just want more. I have an appointment for pre-op measurements in a couple weeks, and I want to be prepared to make a lens choice.

If you’re still reading, thanks for commiserating with me, and please drop a comment is you have any thoughts,

Justin

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