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
Deb03 tamarinda
Posted
Have you tried the drops that constrict your pupils to see if the problem is that your pupils are dilating beyond the edge of the IOL? I'm now wondering if I may be having that problem at night. I think I may ask my doctor for a prescription to try them out.
tamarinda Deb03
Posted
Hi Deb!
Yes, after reading Demystifying Dysphotopsia blog online, I asked my surgeon for Alphagan. He had not offered it. It did not help beyond maybe a touch of placebo effect, and in fact caused weird pain in my eye and a headache the third time I used it. It ended up being a waste of $50 (and they originally wanted to charge me $150), but I'm glad I tried it because of course I would have always wondered.
The concentric rings I see with any light source are from the lens itself, not the outer edge. My surgeon had said, before surgery, that 5% of people had a glare issue at night for the second before the pupil constricted. Maybe I have that but it's hard to say given the other effects I get.
Walking on a dark street at night, there are some lampposts that I can look at and see a very wide diameter hazy circle that ends almost in a rainbow. Sort of like a sundog or the moon with faint clouds around it (except it's not white..it's like reddish black. My guess is THAT is probably wide pupillary dilation. It is only at certain angles and doesn't fuss me.
Deb03 tamarinda
Posted
Last night I tried OTC Lumify which contains .025% brimonidine. Gave myself a second drop after about 1/2 hour. Not sure if that would constrict pupils more or not. Anyway, my pupils were quite small. I did not notice any difference. I'm going to follow up with my doctor and see what he says.
tamarinda Deb03
Posted
Way to give it a go! Seems like the pupillary constriction was successful so a fair trial. The prescription brimonidine is 0.15%.
The only thing that has made the halos better is correcting my dominant eye so it takes over. If I close that eye, the halos are still there with the IOL.
You're all good with your IOLs though, if I recall?. Both monofocal for distance. But you're heading into a vitrectomy?
I do see more floaters now: my surgeon warned me about that. They interfere a bit but I'm not fussed.
I think the whole game here is to not be fussed about any of it! Repeating often, "Life works out!"
Deb03 tamarinda
Posted
It was not successful actually. 😦 But I agree to try not to stress so much. It will work out one way or another.
tamarinda Deb03
Posted
Aw, shoot. The vitrectomy didn't work? I recall you writing somewhere that you didnt have any desire to change lenses...did I misread that or get confused somewhere?
Anyway, I'm sorry you're feeling some disappointment. 😦
ls87030 tamarinda
Posted
I was very myopic, had my left eye cataract removed and the same lens as you placed in June of 2017. The results despite the MD chart reading of 25/25 or 25/30 in that eye were frightening to say the least. It was a horrible experience despite all the 'targets' that were expertly hit by a terrific surgeon.Ghosting was horrible and disconcerting despite the wonderful 'success' . Letters are lighter with contrast and ghosting like graffiti on a train car when reading. Night driving was near impossible, but acceptable with glasses and the offset of my natural right eye. I canceled the scheduled date of placing the same lens in my right eye, the cataract is there but in comparison not so bad.
It has been two years and only recently within the last three months have I acknowledged that I have adapted or at least accepted the result. Halos are definitely still there at night, as is the graffiti on letters when reading. +2.50 readers help clear things up and they cant explain that either.
My advice: Forget looking at anything with the multifocal lens eye alone, it will drive you crazy. Use both eyes together as they are meant to be and all may at least be acceptable eventually. I am putting off surgery on my right eye as long as possible. I will go with a monofocal set closer to near, unless something better comes along. Glasses still set me straight in the meantime at night or when watching movies due to my right eye deficiencies. I no longer panic while driving at night, or am as upset as I initially was while looking at the moon. It is what it is. My brain seems to have adjusted and uses my right eye more. I appreciate daylight vision without glasses with the same clarity as wearing glasses previously.Also with more vibrant colors without the cataract. So that is an added bonus from prior and I continue to try to move forward. Good luck to you. I can appreciate your struggle, its similar to my own.
tamarinda ls87030
Posted
Oh, wow, our experiences are so very similar, thank you for sharing yours! Is your left eye your dominant eye? That must make it extra hard to adjust.
I went back today to my original surgeon, and we scheduled the left eye for a Bausch and Lomb monofocal for distance on October 29. My left is my dominant eye and so I am confident that correcting that will eliminate the aberrations at distance. I am truly hoping it makes the moon and stars clear! I love that you mentioned that sadness... it's so deeply part of being human, and yet people dismiss it.
And yes, my surgeon is also very proud of the numbers, as I guess he should be. It's reassuring to me that technically the lens placement is perfect... at least I know that we don't have to go looking for other reasons. However, when he said today that he hoped I would consider leaving the multifocal lens in because it was so good, I told him I was sure it looked good from the outside, but from the inside it's pretty horrible.
I understand why the surgeons defend their work... it's partly a defense against facing their limitations. Probably also it's an attempt to convince our brains to relax in the hopes they will neuroadapt and the halos will disappear. But it sure leaves one feeling lonely if they don't acknowledge what you're feeling/seeing.
Still, I do take seriously the risks of an IOL exchange, and am also trying to assess the benefits of bilateral summation. That is a hard task because one doesn't know what one has until it's gone. But if I exchange this multifocal for a monofocal and aim for monovision, I may lose some richness of depth perception. I'll just have to see how it is once I have a left dominant eye that sees 20/20 and go from there. Step by step.
Thank you for sharing your experience and I too wish you the best outcome.
Deb03 tamarinda
Posted
Please let us know how your surgery goes Tamarinda. I hope it helps to offset the visual artifacts in your other eye.
ls87030 tamarinda
Posted
When I do the test for dominant eye, left and right are equal.
centering something with both eyes in the middle, closing each eye it moves equally left and right. So perhaps in my instance, this is very lucky! I will not consider a lens exchange because of the risks involved. That being said, i am also going to hang on to what I have as long as I can. Yes, I have major issues. But it is so awesome not always having to wear glasses , or freak out trying to find them. lol.
kwilson2019 tamarinda
Posted
I have been trying for 3 weeks to find this type of results with an actual patient. other said reviews do not give the explanations you have, neither are physicians!!!!!
they deter from REAL results and are just selling! More people to post actual detailed results everywhere, facebook, forums, etc. Thank you, thank you, thank you.
tamarinda kwilson2019
Posted
Hello kwilson,
I'm glad my post provided you some help. Do you have this lens in your eye?
I have now seen four additional very accomplished ophthalmologists besides my surgeon. One prefers monovision. One prefers accommodating lenses. One frequently implants multifocals, and the other didn't specify, other than to say, "keep it simple."
I think each individual ophtho has their preference, and because they want the best for their patients, they recommend what they think is best. As a patient, that is difficult because we want to believe their advice without questioning it (they are the experts, after all)...but the truth is that medical science isn't perfect and neither are doctors.
To make it worse, appointments are very short and because they do the same thing over and over and over again, they often don't realize that they haven't explained all the detail to a given person. And so, as patients, we have to advocate for ourselves, seek the answers to our questions, and see more than one ophthalmologist in order to get a variety of opinions. (I'd say that seeing three is probably the best: I saw too many!)
I do want to agree with you that the studies underestimate the side effects (you said all they want to do is sell, but I infer this is what you mean), but that may just be because I happen to have a lot of side effects. I have read other patients' experiences without any halos at all...so for some, this lens is fine.
Note: with my current surgeon, I asked him whether he had any financial conflicts of interest in our very first meeting. He appreciated the question and said he did not.
kwilson2019 tamarinda
Posted
Fantastic discussions. I am 59, located USA. Very outdoor activity, night and day, computers being profession. I have been wearing Gas permeable contacts since age 14. Started wearing soft monthly lens in 2008(?). Using readers for near vision, reading, computers since 2011(?). Right eye dominant. Did PRK on L eye in 1991 for an experimental trial. Restored almost half vision in L eye, did not do R eye, but left me with some what obtuse vision. Increasing prescription every 2-3 years. It was mentioned in 2014 and again in 2015 might consider cataract surgery. Cataracts were not yet that developed but Stronger scripts were no longer getting sharp vision at any distance and some hazy foggy in R eye. The colored halo ring has been very minuscule, not even noticeable until radiation. Before cancer R eye was -7, L eye -3.5. Its believed due to radiation treatment for tongue cancer in 01/16, cataracts have developed and progressing, every 4-5 months need stronger contacts. R eye currently correctable with -16 soft contact to 20/60 and having the heaviest cataract, I barely notice cataract in L eye. Left eye currently correctable with -9.5 soft contact to 20/60 . I have not worn eye glasses since age 16. Recently had a pair made to get off contacts to do eye testing, measurements, etc. Talk about wobble eye ! Culture shock! It was like looking thru binoculars backwards ! Every thing very small, no depth perception, Brain couldn't figure out which eye was to be dominate. Used an eye patch back n forth trying to adjust. Did that routine for three weeks! Finally got the testing done and can now go back t contacts until surgery. Thats my history, now proposed...Physician has recommended I do similar, trifocal Panoptix for the R, . multifocal Symfony for the L, or vise versus, think he is a bit perplexed on proper approach due to Left eye PRK and being close to half the Right in diopter size slight astigmatism, not enough to do toric and heavier cataract being in R eye. Appears FAA in USA will not allow pilots to fly having multifocal or trifocal IOL's. Monofocal IOL's are allowed with glasses or contacts for correctable to 20/40(?). Military is same with exception to certain aspects of contacts and eye glasses due to visual aid equipment and devices. Which brings me to believe that multifocal and trifocal IOL's have enough halo, night vision obscurity to make my decision to go monofocal IOL's in both eyes. I can continue to live with readers to keep the best possible night vision. Night driving, Moon, star gazing is still an activity I do. Havn't seen many stars in a few years. I can understand the brain 'learning', ignoring the rainbow halo, starbursts. But sounds like it does not go away. Simply ignored, as some say give it a couple weeks you'll get use to it. I've been dealing with it now for quite some time and I can not get use to it. Maybe its different after cataract removal due to sharper vision. But if being a pilot, how does it effect the runway lights at night? I am due for R eye cataract surgery on 11/1. Any and all thoughts, and results are a plus to assist in my choosing the IOL.
tamarinda kwilson2019
Posted
Ah, okay, so I understand you have not had any surgery yet and are considering whether to go with your surgeon's recommended blend of EDOF and a trifocal. First, it's super good you are doing the research now...that will always help you because you'll know YOU made the decision, whatever you choose.
Sounds to me like you do nighttime activities, and despite my own bad experience, other things I've read say that if nighttime driving is important to you, then any multifocal or EDOF is probably not recommended.
I don't know if one monofocal will make my vision sufficiently clear so I don't have to exchange this multifocal out, but yesterday I got a stronger pair of cheap distance glasses for my still-cataract eye, and IT WAS SUCH A RELIEF to look at the city skyline. I simply can't wait for clarity, it's going to be delicious.
There are other options in the pipeline to achieve better focal depth, from what I've heard (but not researched so take this with a grain of salt): piggyback IOLs, corneal implants, etc. And there are always multifocal contact lenses. If I'd known about how multifocals cause halos and ghosting (I only was told about glare), then I probably would not have chosen this lens. There is nothing one can do for halos and ghosting except "get used to it". There are and will be things one can do for depth of focus.
If you need night vision, I'd avoid fancy lenses, and choose between monofocal both set to distance, or some form of monovision where one eye is set to far and one to intermediate or near. Just be sure to figure out how to test that monovision before you go for it.
And I'd make sure your DOMINANT eye is the one set for distance, no matter which eye they choose to operate on first. They seem to always want to set the first eye to distance, even if it's not your dominant. In my experience, having my non-dominant become dominant was very distressing. I think it would be easier to live without distance vision for a period between eye operations, than to ask my brain to switch dominance.
kwilson2019 tamarinda
Posted
Thank you for your response. So many very helpful personal results on this site, wish I had found this weeks ago. My surgery day is 11/1, not much time left to decide, and postponing could push out 2 more months. janus381 posted comments on night vision with the Panoptix, impressive. I would like those results. that amount of halo/rings I could deal with. I should probably retracts my comments on military and pilots not allowing multifocals, trifocals. Seems the pages, reports I read may have been pre 2015, so I correct myself on those statements. My physician first approach wants to do the Panoptrix IOL for my dominate R eye and I made such a concern he mentioned a mixed between R eye and ?? Left, maybe a Symfony, I cant remember where we left the conversation at. It sounds though the Symfony may be more prone to side effects than Panoptix. I've been cramming, reading digging for all the results, reports I can find. Starting all run together. But your suggestion on the monofocals R eye Dominate for distance and L eye Intermediate and near, I believe was my physicians option instead of Panoptix. It appears from every ones results there will be some halo/rings and degree of such is relevant to each persons eye and conditions, etc. I've been allowed to go back to soft lens until surgery. Eye glasses are just too wobble eye for me. I was a useless non functioning person, very disturbing. I think I'm going to go for the Panoptix R eye and see how it goes, possibly postponing L eye 4 weeks or until next available surgery date. I am still reading thru every ones results here. I will also be returning here to continue with my results. Again thank you all for your time to post results.
tamarinda kwilson2019
Posted
Sounds like you're doing everything you need to do in order to arrive at a decision you feel good about. And then, it's all a bit out of everyone's control in the end...one just has to hope the eye and brain settle out well.
I agree with Sue An: one shouldn't rush between eyes. They say it can take months to adjust, and so I did wait to see if the halos and ghosting improved. Now five months, and they are basically the same. I am not as startled by them, but they still obstruct vision.
The counter argument to that is the idea that our eyes work together, and so until both eyes are done one can't know for sure. So, its good you want to wait four weeks between eyes: that might be the right balance.
Will look forward to hearing about your results!