Tecnis ZKB00 multifocal combined with a monofocal?
Posted , 7 users are following.
Hi there,
Dearest thanks to all who offer advice on this forum, helping others (like me) sort out this confusing world of intraocular lens choices. Sorry for the LOOOONG description below, but I figure it's all relevant.
I am 50, have had cataracts R>L for 5 years. Prior to that, R eye has been -2.5 since age 20, and L eye (dominant) was -1. Always wore contacts. Minimal to no astigmatism. When I became a little presbyotic around age 40, I opted for monovision with contacts, went against the advise of the optometrist who wanted to correct my L eye and leave my R eye nearsighted because the difference was so jarring I couldn't drive. So instead I corrected my R eye for distance and within a year my L eye went back to 20/20 naturally. Sometimes our bodies react to being over-splinted, but that's another topic.
I'm a very active, outdoor person but also use computers and do crafty tasks. I expect near and far vision. I expect a lot out of life. I'm kind of a boot-straps person: like to be tough, but am learning just how very sensitive I in fact am (joys of middle age). I don't want glasses, but could survive with contacts if I had to. The worst thing about reading glasses for me would be the need to always have them, say, even for grocery shopping reading labels, or looking at my phone. If I had to keep a pair with my laptop, well, I guess that wouldn't be so bad. But cooking...that's intermediate too, right? I'm aiming for another 50 years, so this is a long term decision!
7 weeks ago I had Tecnis ZKB00 multifocal +2.75D put into non-dominant R eye (the worse cataract). Love my surgeon (the third one I saw over the years, and the first one to spend time really talking to me). I didn't do any research about lenses: life often brings me what I need if I stay in the flow, and so I went with his conviction that this was the right lens for me. Said he put this lens in his mother, and in a two-year old. Also, I was of course nervous and felt that exposing myself to the overload of the internet wouldn't really help. My mother is a happy monovision patient for the past 20 years. My aunt who reads all the time opted for both eyes distance (oddly) and uses reading glasses. Neither of them are very active outdoor people although they are also high-performing individuals.
The surgery went well and he is overjoyed with the numbers. It was a quite advanced cataract and he did a great job adjusting the ultrasound so as to not damage the posterior capsule. And, I spent the first five weeks in a state of shock and panicky anxiety. He'd mentioned I might have temporary glare at night with the first glance at headlights, that would fade as the pupil constricted in the moment. Said 5% of people are bothered by that. But I had no idea I'd get these huge halos and ghost images around lights, day and night. Computer text, even a written page, has large ghosts. So did white lines on the street. So do any fluorescent or halogen or LED lights. Halos are several bright concentric rings that, say, with a bicycle light will obscure the cyclist they are so large in diameter. Once the oncoming headlights obscured a parked car in my lane at night (didn't hit it). Those lit up No Left Turn arrows? Forget it: almost the whole lane is whited out. Computer work is also affected, because I occasional graphic design and the ghosting interferes with that.
My visual acuity with that eye is superb far and pretty great near and intermediate. The distance vision is startlingly beautiful. The world is much more three-dimensional. When I go hiking during the daytime I can get so euphoric because everything is so clear into the distance. Night vision is also fine when I look where there are no lights. Beautiful, in fact.
So a couple weeks ago I got a grip on my upset and anxiety, because of course anxiety will not help the neuroadaptation happen any faster. I'm looking hard at the emotional reasons for eyesight loss (another huge topic) and dealing with that stuff. And three days ago I started doing some exercises with Gabor patches with an app called Extreme Eye Exercises (paid programs for these are $400 and since they can't measure glare and haloing, clinical results aren't available with those, so I'm opting for the free app and hoping that it's comparable). I tried Alphagan drops and they didn't really help and caused very uncomfortable eye and head pain.
So grateful for the many posts by @Sue.An2 and others...I understand that these might improve over months to years, but not really go away. Just become something one accepts.
Having the moon and stars affected makes me profoundly sad.
I don't know that I can accept this. Which also makes me sad.
It felt right when we made the decision.
I volunteer for a living overseas, and so can't get a second opinion in the U.S. Timing becomes a factor because I travel home in order to get these done. We weren't going to do the second eye until January, so this totally changes everything. And now I'm doing all that online research...boo.
So: after talking to me for an hour one Sunday, his algorithm would be the following, although he definitely did not want to exchange the lens that was so perfectly placed (understandable):
- do the L dominant eye with a monofocal for distance soon, so we can see if my eyeballs and brain are going to be that sensitive with a monofocal
- Lens exchange or not, based on what happens after correcting the L eye.
- We did chuckle a bit about whether taking the plunge and putting in another multifocal was an option. I said that was like having a rough marriage and wondering whether to have a baby or get divorced.
He wants the lens exchange done within 3 months, which would be early August. Said it starts to get messy in there after that. I do trust his skill. And when someone says they're not comfortable, one should pay attention, right?
My thoughts/questions:
I'd like to wait longer to see how this adapts or if I can work some emotional/energetic magic, but...maybe by 7 weeks we already know? Is waiting longer just wasting time?
I know some surgeons will do an exchange even years out, but a friend of mine told me that might be like getting an abortion at 8 1/2 months: sure, you can do it but it's not recommended if at all avoidable. Should I wait in order to slow the process down and see about adaptation? Or is that just creating risk?
If we do monofocal in the L eye for distance, he might want to do it slightly undercorrected to help support near vision. But if we then do a lens exchange on the right, I'd go for a monovision set up, and so then would want the left to be 20/20 for distance. So that confounds things...argh.
If I stay with just the multifocal covering my near vision, it won't be as good as it could be with a nearsighted monofocal lens on the R eye...
It doesn't seem like there are any glasses or contacts that can fix a multifocal lens problem. That's one benefit of the monovision approach: one can always correct the near eye to see bivisual distance, or correct the far eye to see bivisual near. That seems like an advantage to me. My mother hardly ever uses glasses: only when dim reading. (Although now, after 20 years, her distance vision faltered and she's using a contact lens again in that eye.). Also, my surgeon did mention that there are multifocal corneal things in the pipeline. So those who get monofocals might eventually be able to get multifocal vision anyway.
I didn't even think there was a choice to be made about WHICH monofocal to use. Reading here, you all seem to have opinions about different brands, acrylic vs. silicone, which focal point to choose, etc. Isn't the branding and such best left to the surgeon?
Okay that's about enough over-explanation to a bunch of strangers...thank you all for whatever input you might have. And thank you again for sharing your experiences because just hearing what others are living makes it easier.
0 likes, 35 replies
W-H tamarinda
Posted
Hi I am new here for my 42 year old wife who went from no glasses/contacts to cataratct 2 weeks ago. So I am all new to this and I don't have any advice for you.
Just hope things improve for you and wish you the best. It seems like you got cataract at a young age too 😦
derek40125 tamarinda
Posted
Hello.
Here are a few comments:
It sounds like your Left is still 20/20? If that is the case, I would delay the second surgery as long as possible. Your are pretty much getting the best case test of a monofocal in that eye now and your depth of focus will likely decrease with a monofocal IOL (unless your cataract has reduce this already).
Neuroadaption takes time and this can be up to a year. You're only at 7 weeks so I wouldn't give up on the halos decreasing to the point where they no longer bother you. It sounds like you've already done this, but also discuss your case with your surgeon to make sure that the artifacts that you are seeing which bother you so much are FOR SURE due to the overlapping focus points from that IOL vs a fold, scar, or some other irregularity int he physical structure due to the surgery.
You are correct that there is no contact lens that will eliminate halos. However, you can test the halos with a range of over the counter glasses. Look for "nearsigted glasses" on Amazon or similar. These are the opposite of reading glasses and you'd probably want a pair at -0.5D, -0.75D, -1.0D, etc. They are pretty inexpensive, and you simply pop out the other lens. These will have the effect of pushing your focus point outwards which should reduce the size of the halos. If you reach a point where you are happy with the results, then test it with a contact lens for a while and, if still happy, have your surgeon perform Lasik or PRK to adjust your vision.
If you do go with a monofocal in the other eye but leave the multifocal in the other eye, you could try multifocal contacts in the eye with the monofocal IOL. They do make them with 0 power (only the add for reading).
-derek
Deb03 tamarinda
Posted
I have monofocals set to distance so I can't really answer. I did see a surgeon who suggested that lens and said to "give it 6 months" and if I wasn't happy then he would do an exchange.
I don't know how much risk increases the longer you wait. It makes sense that there would be some increase, but is it worth the risk of getting the other eye done now if it doesn't need it? How advanced is left eye cataract?
How well is your near vision with just your right eye now (covering it with your hand or something)? Not sure how bad your left eye cataract is. Can you simulate 20/20 (plano) using a contact lens and also simulate .5 diopters more myopic (or whatever he is suggesting) using a contact?
How well did you tolerate monovision before? I think it's a great option for people who can do it.
Totally agree. And back to number 3, if you go 20/20 and keep the multifocal, you could pop in a contact to get more near vision.
Ask your surgeon which he uses. I have Alcon but probably would have picked Tecnis. Went with what the surgeon used. Are you having your surgery in the US or somewhere else? I have no familiarity with lenses outside the US.
tamarinda Deb03
Posted
Thanks, Deb! Maybe I actually can simulate better vision with my left eye...I think I have an old contact lens lying around! Thanks for the idea!
May I ask why you would have used Tednis instead of Alcon?
Deb03 tamarinda
Posted
From my research, it appears that Alcon lenses are more prone to glistenings. Studies vary on whether this can impact vision. Also I wonder if the frosted edge on the Tecnis might cut down on positive dysphotopsia. Both Alcon and Tecnis have square edges which are supposedly more prone to positive dysphotopsia. I do like that the Alcon has the blue light filter. Studies have shown no proof that it can reduce chances of macular degeneration, but my father has macular degeneration so if there's a chance the blue filter helps, I'm happy to have it.
tamarinda Deb03
Posted
Hi Deb, thanks for the informative answer. May I ask if you have positive dysphotopsias with your monofocal lenses?
Also, I have to tell you that your suggestion to simulate 20/20 with my left (still with cataract) eye was, well, simply amazing. I found an old lens and yesterday when I stepped out of the house...HALLELUJAH!! Like my soul was floating on clouds...all the clouds were so clear and each leaf on every branch... the world in clear 3D, and NO STRESS.
I had suspected that a component of my stress was due to the switch of eye dominance....making my non-dominant eye the clearer was disturbing to my reptilian brain. The unease was unsettling and made me overreact to the halos.
They are still there but at least now I know there will be a fix eventually.
(((Thank you)))
Deb03 tamarinda
Posted
I have 2 things that I believe fall under positive dysphotopsia. First is a flicker that occurs with rapid small movements of the eye (like reading). Doesn't occur in lower light conditions . This has been subsiding over time. I don't notice it in my right eye (7+ weeks out), but it may be there slightly. My left eye is 2.5 weeks out and I do notice it, but it has started to subside. Could be neuroadaptation. The second is with my left eye only. I see halos around lights and I think some starbursts around headlights. Nothing bothers me at all during the day. Headlights bother me the most, but so far I am doing okay. My left eye vision is so good - plano with no astigmatism - I have no desire to change anything.
Ask your doctor which lens he/she uses. My understanding is positive dysphotopsia is more common/significant with multifocal and EDOF lenses, but can occur with monofocals. IOLs which are known to have less dysphotopsia are those with rounded edges and also those made of silicone, but there are drawbacks to them also (higher risk of PCO, etc). The frosted square edge of the Tecnis is supposed to help with dysphotopsia, but I'm not sure whether studies have proven it.
Regarding eye dominance, I had a hard time between my first nondominant eye surgery and my second. At times I would do the dominance test and it would temporarily change.
tamarinda Deb03
Posted
Thank you Deb. I wonder, are your monofocal halos very large diameter, i.e. the edge of the lens? I saw that kind of halo just once or twice with street lights on a dark night...It was like a very clear-edged round haze with a ring of maybe rainbow. I could tell exactly what it was (I was seeing the lens) and it was more interesting than anything else. Only occurred with a certain angle between my eyeball and the light.
The multifocal halos I have are just as bright as the light itself, about 7 concentric circles. They maybe perhaps are decreasing a bit but I'm not certain and tend to think not.
Deb03 tamarinda
Posted
I'm not sure of the cause. Also, I'm calling them halos, but maybe glare would be a better definition. I have noticed when my eye was dilated for an exam I saw large rings that extended well beyond the light source.
tamarinda Deb03
Posted
This inspired me to post drawings of what I was/am seeing...in a separate post. Maybe others will post theirs!
Deb03 tamarinda
Posted
That's a great idea. Thanks for doing that! I have posted in other places, but my decision to have cataract surgery was in part driven by significant floaters that hang around the center of my vision since PVD (posterior vitreous detachment) within the last year. My cataracts were only moderate, but I was told to get cataract surgery before vitrectomy. Anyway, in trying to figure out what I see around lights for you, I noticed it's not so bad when I can blink and temporarily get the floaters out of the way. I guess I won't know for sure until I have surgery whether it's positive dysphotopsia or just the floaters. The IOL flicker is definitely positive dysphotopsia. Sorry for the confusion.
Guest tamarinda
Posted
Hi
I am one week away from my own lens exchange, so I have no experience yet to share about outcome of lens choices.
But the multifocal corneal thing you mention, I think must be what are called add-on lenses here in Denmark, for us they are not that new.
These lenses are put in the eye behind the cornea, and they are normally trifocal.
And yes, people with monofocal lenses can have these, and have advantage of the trifocals.
Cheers
Christian
tamarinda Guest
Posted
Thank you, Christian for the information about the trifocal posterior corneal implants available in Denmark. May I ask why you are exchanging your lens? Would you be willing to share a bit of your eye story?
I hope you tell us about your experience!
With gratitude,
Tamarinda
Guest tamarinda
Posted
Hi Tamarinda
Yes off course, I am more than willing to share my story 😃
I am born with quite severe cataracts, right in the middle of the lens in both eyes. It was discovered when I started in school at the age of 6, my brain had obviously adapted in some way, so nobody had ever noticed my poor vision.
Back then techniques was far more brutal than today, so the doctors advised my mother to wait as long as possible. When I got old enough to make my own decision I still waited, because even that I have had poor vision all my life, I have been free of glasses, and it suits my active lifestyle very well.
I have about 20/40 distance vision on a good day, and even worse near vision, my overall contrast vision is horribel, but I have taken different educations and have my own trading company now, I am allowed to have a drivers license (just barely, but have a friendly doctor) and I enjoy riding motorcycles and drives cars as well, so life have been very good to me despite of cataracts.
Now I am 45, and I have followed the advance in eye surgery all my life, I feel now is the right time to take the step.
Germany is a neighbor country to Denmark, where Zeiss among others are located, so Danish surgeons are always up to date with everything that comes on the marked.
The Zeiss At Lara EDOF lens (similar type as Tecnis Symfony) came on the marked 1 year ago, and this lens is the one I think will suit me, with good distance and intermediate vision, and well enough near vision so you can get by with daily activities without bringing glasses with you.
They are made for an active lifestyle, and for persons that are ok with reading glasses if they ever should sit down to read a book, EDOF are not for bookworms, who would prefer better near vision from the multifocals.
Regarding negative side effects, the At Lara should be somewhere in the middle between trifocals and monofocals.
Also, the EDOF lenses, both Lara and Symfony, have almost the same contrast loss as a monofocal, where the multifocals have quite big contrast loss, because the light are being shared among the images it makes.
It is possible to mix and match lenses, initally I had made arrangement with the surgeon to have the AT Lara lens in my dominant eye, and the AT Lisa trifocal in the other eye.
But lens choice is hard, just as you are experiencing, so a couple of days ago I changed plans with my surgeon, and next Wednesday I will only have the AT Lara in my dominant eye, and then wait for 5 weeks, to decide if I will go for the trifocal or one more Lara in the other eye.
When you mix and match you can get the best of both worlds, the brain tends to take the best it can get, but when you are born with cataracts like I am, there is a risk that other stuff are not fully developed, you do not know how well a vision you achieve, before after the new lens have been implanted, and if it turns out my vision is not that good even without the cataracts, the contrast loss from the trifocal can be really bad for me.
But no matter what I will get a much better vision than I have had all my life, so I am looking very much forward to the new lenses, and I take what I can get, with no regrets.
Anyway, it sounds to me like you live in the U.S. where you do not have that many choices in lenses, Zeiss and others do not want to spend a lot of money on FDA approval.
It is insanely expensive for European companies to achieve FDA, so some of the lenses from Europe never get to USA.
When you look at this as a European, it makes you wonder if the FDA really does what is best for the population, or if they have a different political agenda...
A guy from Belgium have made some very informative videos about his trifocal lenses, the last video is 24 month after surgery. Actually he had the lens exchange just because of presbyopia, and not because of cataracts, a lot of people here in Europe get the trifocal lenses for this reason.
He mention a really good point, that I think/hope will make sense to you to.
He said, that as time passes by, at some point he started to forget how his vision was before, and it was at that point, that the real progress came, and a lot of his side effects disappeared.
He said, that it seems like as long as the brain remember how it was before, it does not really accept the changes, but when you forget how it was, the brain accepts the new input and learn to get the best of it.
His biggest progress came between 6-12 month, but between 12-24 month there was still significant improvements, a lot side effects disappeared and his contrast vision was raised a lot.
The first 6 month he had severe side effects like you are having, he had all the types you can mention, but after 24 month he had almost no side effects any longer, and he never ever noticed side effects any more, it just was not in his mind any longer.
I fully understand your feelings and frustrations, and your worries - but hey - life is great, each day is a gift - right? 😃
Cheers
Christian
tamarinda
Posted
Edit/addition: My left eye cataract is advancing pretty quickly so that eye does needs to be done too and the blurry light effects confound the evaluation of this multifocal lens, unfortunately. Basically I cant "let the eyes work together" except wt near distance, since the left cataract makes that eye very nearsighted. (and takes over so that I don't see the screen halos caused by the multifocal. )
W-H tamarinda
Posted
Tamarind, any update?
tamarinda W-H
Posted
Hi! Thanks for asking...I've been reading a few other threads too.
Deb's suggestion to put a contact in my dominant L still-cataracted eye to simulate 20/20 there was ingenious. Mostly because it gave me the relief of having my dominant eye be dominant again. The unease of that change was much more than I thought it would be, especially since I've seen my eyes switch when doing presbyopic eye exercises and find it more entertaining than worrisome. But in this case, with the light disturbances, it was stressing me out.
Having my L eye corrected is like the world is new again. HUGE relief, I know it will work out somehow. Maybe that means I'm leaning strongly towards monovision, with a monofocal into my L eye and a lens exchange to take out this multifocal and put a monofocal for near in my R nondominant eye.
Since my cataracts developed first in my R eye, I've basically been living monovision for a few years, and also before because my R eye was always more nearsighted (although often corrected with a contact). I think I could handle it. The switching from eye to eye, as I said, fascinates me more than bothers me, although sometimes it leaves things blurry for a split second as my brain switches over.
I am doing Gabor patch exercises and I do notice much less contrast sensitivity in my R eye with those. I had not particularly noticed that in any other context, however.
The light effects persist if I look through just my R eye. Since a monofocal L with multifocal R would mean the R eye would be the main one for, say, computer work, I may find that to be unacceptable.
It is abundantly clear that we use both eyes in concert and two blurry images can basically make a clear image, which is sort of amazing.
W-H tamarinda
Posted
Are you saying in context of mini-mono vision, dominant eye should be set for far and non dominant for nearer?
In my wife's case it seems like her alleged dominant eye, right eye we will avoid operating as long as possible as it has very good vision currently.
The first clinic suggested left eye that will be operated on be set for far vision 0.00.
It is all so confusing!!!
tamarinda W-H
Posted
Also, I appreciate your sharing the details of your wife's journey. I am following and am anxious to see what you think of the second surgeon. I know it will all work out stupendous for her...the fun, I guess, is the ride along the way...watching it all unfold even as it stresses us out. Here's to the roller coaster!