Post LASIK cataract surgery
Posted , 9 users are following.
This is my first post to this board. I found this board after doing a search on cataracts, and have been thoroughly impressed with the knowledge that some of the posters exhibit. I have been diagnosed with a cataract in my right eye. I had LASIK surgery in 2001 on both eyes, and vision had remained 20/20 up until a couple of years ago when it started degrading a little bit. I had glasses prescribed that I wore some of the time but not all time. At that time, I found out that I had a cataract developing in my right eye, by Dr. said it would be a while before we needed to worry about it. Distance vision was still good up until about 6 months ago when I noticed that distance vision in right eye was slowly getting worse. I went back to optometrist, and he said cataract was getting worse. He said he could correct me with glasses to 20/30, but that was the best he could do. I asked about cataract surgery since I wasn't keen on wearing glasses full time, and he referred me to one of the ophthalmologists in his office. This doctor said since I had previous LASIK surgery it would be difficult for him to measure and get the best lens strength, and he made me an appointment with a specialist. My appointment with him is 01/13/21.
Since I have been using reading glasses for the last twenty years after LASIK, i could probably go with a monofocal lens and use readers. I play a lot of golf(retired), and want to be able to see the ball on the ground while hitting it. Right now with my right eye the vision is very blurred looking down at the ball. I do not have a clue as to whether this distance would be good with monofocal lens or whether I would possibly need to go to an EDOF like Symfony, or possible multifocal lens. Right now vision in left eye is still pretty decent, but I do have a cataract starting to develop in it. I also spend quite a bit of time on the computer, but can see the computer without using reading glasses just fine. Only need readers for smaller print and up close reading.
I guess what I am most curious about and concerned about is will I be able to see the golf ball if I go with monofocal lens, or would something else be better. I will discuss this at length with the surgeon before any decision is made. I was just curious as to others that might have had post LASIK cataract surgery and their vision using monofocal lens. Thanks in advance for any info you can provide!
0 likes, 34 replies
RonAKA bricks609
Posted
I tried to find an article on the basics of IOLs used in cataract surgery. Here is one that is pretty basic on what the options are. It does not get into the intricacies of each of the types of lenses and is pretty generic. Try googling this:
.
Choosing an Artificial Lens for Cataract Surgery Written By: Cheryl terHorst Reviewed By: J Kevin McKinney MD May. 14, 2020
.
If I were in your position based on what you said so far, I would suggest:
.
The only other complication would be if you have enough corneal astigmatism to correct it with a toric IOL. The two lenses mentioned above are available in toric versions. With a toric I would select the AcrySof over the Tecnis because they tend to rotate out of position less.
Sue.An2 bricks609
Posted
Hi Bricks 609. Lots of good advice and opinions offered. Agree if you want to explore premium lenses seek out a surgeon who is confident and skilled implanting them. This is a decision you'll make affecting your vision for rest of your life so ask lots of questions at your consult and perhaps seek out another 2 or 3 prior to making the decision if you can.
Another option to explore is a mix and match of a monofocal targeted for distance in your dominant eye and a premium lens like Symfony targetd for -1.25 in your other eye when that one needs operated on. That would minimize the night time concentric circles as the monofocal IOL will be the view your brain will select for distance. For reading the other eye will take over.
rwbil Sue.An2
Posted
I have a Tecnis MF in left eye and one option I am thinking about is the New Tecnis Symphony Plus in the other eye (maybe with -0.25 to -0.5 Micro Monovision), so I have to ask you about your comment. My analysis might be off so appreciate any comment if I am off.
“like Symfony targetd for -1.25 in your other eye”
From what I have read the more myopic one goes the more issues with dyphotopsias, not to mention the possible of lack of stereopsis. I am trying to decide the best amount of micro-monovision.
I would think anyone thinking of the Symfony IOL would wait (if in US as already FDA approved) or go with the Symfony Plus IOL.
I show the defocus curve for the Original Symfony and from what I have read the Symfony plus gives another -0.5 D or so of EDOF. Really like to see the defocus curves for the Symfony Plus IOL.
Looking at the attached Symfony defocus curve, one would get 20/40 at -2.5D or approximately 17”. If you move that out another -0.5D then you would be getting 20/40 or close to 13”. It looks to me if one just did -0.5 one would be getting 20/25 or better at 17”.
Just wondering if a larger monovision is needed for Symfony Plus when weighing possible increased vision issue against more close-up reading.
Sue.An2 rwbil
Posted
does your Technis MF provide good distance vision? If yes and you'd prefer to have better near vision a Symfony should provide that. Your surgeon should be able to determine that target. I find it varies person to person. I have older generation of Symfony - both implanted 2017.Looking at defocus curve on newer version looks like you could get closer vision. To avoid seeing the concentric circles you'll want to target it less than the MF you have (I assume it was targeted for plano(?
rwbil Sue.An2
Posted
"To avoid seeing the concentric circles you'll want to target it less than the MF you have (I assume it was targeted for plano)?"
My current IOL was targeted for Plano. The Symfony plus is supposed to have less dysphotopsias, but not sure if that includes seeing concentric circles. I have read about patients descriptions of the Concentric Circles such as, "My intraocular lens experience" by David Taylor.
Do you have any links about Concentric Circles and their sizes in regards to vision refractive targeting?
soks Sue.An2
Posted
that is not the defocus curve of symfony plus. it is comparison between monofocal and symfony. symfony plus is fda approved but not available in the market.
soks rwbil
Posted
rwbil
wearing +0.5 readers on my symfony eye does NOT improve my near vision by one line. the improvement is barely noticeable. more diopters are needed for better near vision.
soks rwbil
Posted
the circles are not going to be a lot worse than the tecnis multifocal.
rwbil soks
Posted
Maybe I miss-interpret the defocus curve or everyone will get slightly different outcome or maybe the defocus curves are created in ideal office setting that do not represent the results obtained under Real-World conditions (amount of light and every other factor). And of course there is standard deviation around the curve that is not shown.
Below is the Symfony defocus Curve. After about -1.5 D VA drops off rapidly with a curve that looks like a linear 45 degree line.
I drew arrows on the curve. The definition of close is debatable, but for this example I selected -2.5D and from the curve at -2.5D, one would expect to see just a little shy of 20/40. If I were to move the curve out -0.5 D it would be the same VA as the current curve shows at -2.0D (as the line looks pretty linear at this point). Again I drew arrows at -02.0D. At -0.20 D one would expect to see a little better than 20/32.
Therefore I would expect one to gain about about a line with -0.5D adjustment for close range. I read some article that call anything less than -0.75D myopia Nanovision. One problem is that amount can be within the range of refractive error. So even hitting the target is a problem. It is talked a little about in this article:
"Dr Pande explained: “Nanovision aims to achieve an extra line
of near vision by using less than -0.75D myopia"
Search European Times for , "Helping Patients to See the Maximum: New Treatment Options in Presbyopia and Astigmatic Correction"
Do you have any articles or videos showing the VA results achieved using different monovision targets. Be nice to see the effects on both distance and near vision.
Cataract Surgery and IOL are so frustrating, as it seems you just have no idea what your results will be until after surgery.
I
soks rwbil
Posted
i dont have any research or articles so i am inly saying from trial and error on my own symfony eye. with a +1.25 my computer distance becomes great. with +2.5 (+1.5=+4) the video on iphone becomes HD quality. so even with synergy at +3.33 defocus curve, i would still need +0.75 to see iphone in HD.
also +0.5 does not really improve the near but distorts distance considerably.
rwbil soks
Posted
"+0.5 does not really improve the near but distorts distance considerably."
That's a bit depressing.
Question: Did you doctor test your VA at distance, intermediate and close. I am wondering what refractive target was hit. If so what were the numbers he showed?
Sue.An2 soks
Posted
ok was thinking the newer versuon of symfony was available and perhsps it is in Canada and provided better nesr vision thsn one we had implanted.
rwbil - I fo have readers +1.25 to read very fine print or reading gor long periods if time. Most of the yime I sm glasses free. But this varies person to person.
Sue.An2 rwbil
Posted
i do see concentric circles with my symphony lens. They appear dusk and st night on certain lights. Cars when they break will have them but not normal break lights when travelling behind a car. They also appear on traffic lights and certain LED porch lights. As I approach the source they disappear. The inner circles are brighter than outer ones which are very faint. Guess after this much time I am used to them and see through them. But after 3 years I don't think they will ever go away.
Sue.An2 rwbil
Posted
Do not have any links and I have yet to see even from manufacturer anything about them. Only learned about the circles here on the forums. I do not believe they are related to vision refractive targeting. They are part of the lens design enabling one to have a better range of vision than a monofocal lens. Where it does relate to refractive targeting is in relation to what's implanted in your other eye (or better yet if it's paired with your natural lens). Your brain will choose the better view so if there is a lens with less visual night effects in one eye that is corrected for best distance that's the view your brain will select (and why the suggestion to target Symfony for less than plano as the concentric circles will be minimized). Trying yo recall person on the forums who had that setup and he was very pleased with it.
soks Sue.An2
Posted
synergy became available in canada. symfony plus was not released anywhere.