To Do or Not to Do

Sue.An,

Thanks for your response. I wish I had national health insurance however I reside in the Philippines and paid via out-of-pocket. It is less expensive here than the UK or USA.The medical care isn't a lesser quality, but the cost of living is less.

Cheers

EKS

If it is an out of pocket expense regardless then you can determine timing of 2nd surgery.  Cataracts usually develop slowly so likely no urgency.  Also if you are managing with a contact lens in non-operated eye and are ok with that you may want to wIt and see if there are new IOLs coming on the market that would give less night time halos/glare.  Out of curiosity what type of lens did you choose?

I have an Oculentis Mplus X multifocal. It came out late 2013. It's a German brand made in the Netherlands. It wasn't manufactured with the typical rings found in many multifocals. Therefore there's less glare and halos. The glare is no different from glare when using spectacles. The IOL is available in Europe, but not the USA.

Interesting.  It is not here in Canada either.  Wish it were - great it isn't made with rings.  I have Symfony in both eyes.  Does it have any other downside?    Is there a reason you don't want it implanted on your other eye?

I found having both eyes with Symfony work a lot better than one for vision (minus the nighttime halos glare and concentric rings).

It's a highly rated IOL. It's a more advanced version of the successful Oculentis Mplus. It has excellent near vision, better light contrast, allows 95% light (most are at best 88%), minimal glare and halos. I read alot about the Symfony -- alot of mixed reactions. Need to go now to the ophthamologist apptmt. Later...

I don't have any problem at all with regards to glare and halos because I have a mono focal lens.  But, I'm curious for those that do have problems, I've seen these "night glasses" on Amazon.  Has anyone with a multi focal type lens tried them?  I've read posts from those with multi focal lens who say they have a hard time driving at night.  Wouldn't these night glasses be a solution?

I read up on night glasses for driving - apparently they don't work.   

I googled for tips for driving at night and haven't found anthing yet (still searching).  One tip I read but haven't tried yet is to keep some light on in interior of car.  Not sure that helps but maybe keeps eyes from dialating too much - waiting to try it.

As I hadn't heard of this lens - here is what I found on it.  Not FDA approved.  This is a small company that have difficulty getting into bigger markets .

Here is a copy & paste:

MPlus by Oculentis Billed as the "only presbyopia lens with HD-vision," the MPlus by Oculentis has a sector shaped near-vision segment characterized by seamless transitions between near and far vision zones. "There is great visual acuity with the MPlus technology," said Enrico Plessow, marketing management, Oculentis GmbH. "That's mostly due to the small loss of light. We only have a loss of light of between 5-7%, which is much less than other technologies." "It's a more forgiving lens for surgeons to use, which is why it's popular among them," said Sheraz M. Daya, M.D., Centre for Sight, London. "In terms of the IOL, it's a design where we've got a bifocal that acts like a bifocal in a spectacle frame. There are two focal points on the retina, and the brain tunes things in and out." The problem with the MPlus, said Dr. Daya, is patients don't always see well at near. In his experience, hyperopes are happier with the lens than myopes because myopes start off seeing well up close anyway. "Hyperopes can't see well at distance or near," he explained. "If they get [a lens] that gives them good distance vision and something more for near, they are very pleased. They don't mind wearing glasses to read fine print. Myopes don't forgive that." The MPlus does cause glare during night driving in some patients, which they tend to describe as a triangle reflecting off a headlight and down onto the road. But Dr. Daya has developed a rather unique way around this problem. "I started putting the lens in upside down in patients, and that seemed to help with night vision," said Dr. Daya. "They are able to drive because the glare is going upward now. They talk about [their vision] having a moon on top, but they are able to cope with that." Dr. Daya implants the lens upside down in all patients now, and it has not negatively impacted the lens performance. "It's a very good lens for ophthalmologists who are just starting out in the multifocal world," he said. MPlus is CE marked and widely used across the world but is not approved by the FDA. According to Mr. Plessow, Oculentis has no plans to bring the MPlus to the U.S. "We're trying to go to Canada and South America," said Mr. Plessow. "It's difficult for a small company to get licensed in the U.S. The American medical market is ruled by large companies, so the small ones don't have a chance to get there." 

Source: https://www.eyeworld.org/

You may want to try light tinted polarized sunglasses. The polarized feature may reduce the glare and halos. Although it's called sunglasses, it's very slightly tinted so I'm sure you could use it for night driving.

The doctor said the eye has healed perfectly. I'll need a laser followup in 1-6 months to clean up the eye. After the IOL is 100% well, then I can consider doing the other eye. I'd like to even out the vision. In the meantime my left lens will be updated with a new prescription for my glasses.

Best of all, the doc said I can return to my cycling.

This is correct. I've seen that article. The consequence was the Oculentis Mplus "X." This is a more advance version of the "Mplus." It's biggest improvement lies in near vision clarity in addition to less glare and halos at night. Frankly since I don't drive, I cannot verify this information. Oculentis is marketing their product in Asia with Singapore as a strategic location. The IOL is especially good for persons with small pupils. I suppose Asians fits that bill. Asia is a huge market which includes China. Apple IPhone production is in China to try and grab the mammoth China market. The "X" is pupil independent.

Good news - happy it is all turning out well.  Thanks for the tip.  Going to try a few things for night driving.  I have to live where data are short a few months of the year (maybe the dreaded snow will help with lighting my path - lol)

Thanks - I had t even heard of this lens.   I am young for having cataract surgery at 53.  One of the issues in younger patients is eyes dialate more which in itself my surgeon says gives one more halos and glare.   

A notable feature of the multifocal Oculentis Mplus + Mplus X is the manner of it's patented production: there are no rings. With rings, light enters the eye and reflects light off the edge of each ring. With a smooth non-ring transition, it eliminates this reaction. My doc recommended this IOL. A fellow senior ophthamologist had it implanted into his eyes and he testified the result was amazing. Therefore based on his encounter, he recommended this lens. There are a few horror stories in regards to this lens, however it may be due to the performance of the practioner rather than the IOL. In addition it's man made so there will always be some imperfection identified.

Yes agree that a surgeon's skill makes all the difference.  In Canada didn't have all the IOL options available.  Read the clinical trials on Symfony and experiences in forums here and was able to chat with a prior patient of my surgeon who was one of the first to receive Symfony once it was approved in Canada.  I spoke to her 5 months after surgery.  I believe when it comes to multifocals and trade-offs surgeon had to nail the refractive and person gets the vision they want - daytime.  If that doesn't get nailed the trade-off is not worth the money spent or whatever nighttime issues you have.

Myself I have not had to have one tweak post op.  I have great distance intermediate and near vision (surprised to see well at 11 inches out as the info out there is that would be 16 to 18 inches).   I think I will get accustomed to the glare and halos.  Night driving on well lit streets is fine.  It is dark highways that are more bothersome.  I get my husband to drive.  Overall very pleased with my outcome.

I have another 8-10 years of working full time ahead of me and work with spreadsheets and computer.  Was very concerned about functioning but I haven't used glasses since surgery.  Yeah.

Night time vision is bad with the IOL. Indoor poor lighting is also a negative. Sunny daylight is the best. I generally don't go out at night. I still have the non-IOL assisted with corrective lens to rely on for night vision however I'm wondering about night time limitations if I have both eyes with IOL's. That thought is a little scary. However it's a challenge. I thought I take a small rechargeable (brighter light than batteries) portable LED flashlight as assistance whenever needed. This makes for an interesting new life challenge. Life is no fun without challenges.

I must have misunderstood- I thought that new Oculentis lens you have provided perfect vision day and night?  Are you saying that lens does cause problems?

I definitely have no issues with anything during day (whether inside or out and no issues with inside lights at night).  Just dark unlit roads with headlights from oncoming traffic.

Frankly I haven't been out at night since getting the implant. I just stood on my balcony looking down on the traffic. I'll have to give it a go sometime to find out.

I didn't drive either at night till week after surgery.  But I like to walk every evening so knew around neighbourhood with streetlights I would be fine driving around the city.  Just a surprise first time I drove on a dark road - was raining too so that made it worse.

Are you considering a different lens for your other eye?

How soon did you do your 2nd eye after you had surgery on your 1st eye?

I was scheduled to have it a week after first eye but my surgeon went on vacation donit ended up being 6 weeks. Although difficult in some aspects was good in that eye settled and healed well before doing 2nd eye.

..... and you used the same IOL?

Yes Symfony IOLs both eyes targeted for plano.