Trying to decide on multifocal or monovision IOLs

Bella, everything you've stated is true, except (as SueAn. noted previously), Symfony is an extended depth of field lens, functioning differently than a multi-focal. And as with most of the eye diseases you mentioned, it is well-known that monofocal IOLs don't work well with them either.  My mother, with macular degeneration, was not helped at all with her monofocal IOLs, even though her cataracts were removed.   So if you don't plan to drive much at night, and would like not like having to wear glasses for most everything AND doubt you could adjust to much mono vision (like me), then Symfony can be a good choice, too.  As we get older (I'm already 66) I know that many of us will value having mid-range vision without having to find our glasses, and if I want to get rid of my moderate astigmatism, I'd have to pay for premium lenses, anyway.   However, time will tell, and I've definitely got my fingers crossed, but that would be the case with any lens I chose.    

I'd like to present still another option with monofocal lens with little or no monovision. Both BellaD and I have -1.25/-1.50 after cataract surgery. In my case, I ended up with that combination "by mistake". I was or actually my surgeon was shooting for -1.75/-1.00 mini-monovision. You could say that my surgeon botched the plan and ended up with little or no monovision of -1.50/-1.25. Well, I actually like the results if you could believe it. As BellaD would put it, she calls it "walk around" vision. Indeed, I could do almost everything without glasses. The intermediate vision is superb. The distance and near are passable, not great but functional. You don't have night vision artifacts to deal with and no monovision to adjust to. And if you really desire great distance and near visions, you can easily obtain them by either glasses or contact lens. Otherwise, I find no problem >90% of the time.

Just one more option to consider...

But yes setting monofocals to see intermediate and close is a good alternative.  My surgeon didn’t really suggest that option or I may have considered it more.  Wearing glasses for reading and computer considering where I spend large chunks of time was not a good solution for me.  I had good vision for those prior to cataracts and that seemed hard to deal with.

Robert, you are correct; my vision is also -1.25D/-1.5D, and I do feel that the intermediate/near monofocal IOL provides great ‘all-around’ vision. I only need glasses for driving/distance, and almost never need readers (which was my main goal as I would find it very handicapping to lose near-vision).  I had to sacrifice the ability to read very fine print by holding up close as I used to, but overall I’m happy with the compromise.  Intermediate vision (such as computer use) is excellent.  Distance vision is a bit blurry without glasses, but not a problem as I was used to being near-sighted.  I think eye surgerons don’t promote intermediate correction because they are afraid patients will be unhappy if they end up needing glasses for both near and far.  Just a guess.  My -1.5D eye doesn't need cataract surgery yet, but I'll likely stay with something similar when the time comes. (I think your original plan of -1 and -1.75 might also have worked well!).

BellaD, yes, "all-around" vision for us, not "walk around", lol.

I forgot that your -1.50D eye has not been operated yet. That explains the near vision you describe, which is a little different from mine. I can read newspapers okay but not up close(after cataract surgery, your unclose vision will be shot). My eyes gets tired quickly so prolonged reading is still best done with a reader. For me, to be able to read newspaper comfortably, it needs to be ~1.75D or even -2.00D.

As to distance vision, I'm borderline in passing the driver vision test. I drive around town all day just fine. I will wear glasses, however, in a unfamiliar city just to be cautious.   

Also I wonder whether we can ‘train’ our eyes to see better/improve when it comes to reading.   Newspapers are fine for me.  I sometimes struggle with the tiny print on back of sauce mixtures.  Also they tend to be white lettering on green (making that more challenging than black on white) so in order to read need very good lighting in the kitchen .  Best when day light streaming through windows!

Lighting has become more important for near vision after cataract surgery, probably because of two reasons: one we have to move the subject a little farther away and another the clarity and contract are somewhat compromised in going from our natural lens to acrylic lens.

I see so much advertising lately (maybe I am just sensitive to it after having been through this) for what they term as ‘PresbyVision ‘ surgery.  Unbelievable how medical personnel can tout this for a cure vs reading glasses.   

Robert, it is wonderful that your results worked out so well for you! You're fortunate, indeed.  I'm afraid I'm not one of those people who would be likely to adjust well to mono vision, in fact I know I'm not, as I once had contact lenses set for mono vision, and disliked them because they made my overall vision "so-so", not sharp and clearly-focused.  (My current opthalmologist mentioned that this might be due to having more than 2 diopters difference in nearsightedness between my two eyes.)  Then, too, what I want most is good distance AND good mid-range vision, and if I have to wear glasses to read, that'll be OK. I could probably adjust to mini-monovision with a difference of no more than .50D, but that's what I might reasonably expect to get with any lens set for OD (which is what I plan to ask for.) I was truly set on making the tried and true choice of toric monofocals, but I kept reading repeatedly on this board about people unhappy with no close or even sometimes, decent mid-range vision without glasses, and I'd have to chance mono vision to some degree to achieve that with a monofocal.  I really think we all need to think long and hard about what we most want for ourselves and what our needs are likely to be in future (as Sue.An noted earlier) because we are all so different.  Then we need to pick an excellent surgeon, though that can be tricky even with recommendations, it seems.  (In the US, they mostly seem to have turned into shoe or car salesmen or the like, all pushing the premium, pricey lenses, to the detriment of what might be in the patients' best interests.)  But in the end, we've got to finally choose and go for it! (I'm almost there!)

Yes we all have different needs and functions we need to perform.  My one thing was not to lose that computer distance as I work with one and spreadsheets at work - 5 days a week.   I too don’t think i’d Be a candidate for much monovision- reason I chose Symfony.  Perhaps if I lived in USA and see the prices people pay I might have not gone this route.  But for $1,800 I paid for both eyes total I am totally ok where I wound up.

Wishing you all the best!!!!!

I think that the pricing depends a little bit on the package offered by a specific surgeon and the area. Thus, the extra cost depends on what one considers important.

For example, in my case, when I had the Symfony toric installed in December 2016,

The Symfony toric lens with LASIK enhancement (my package) was:

$2300 more than the non-toric monofocal lens (with no LASIK enhancement),

but only $700 more than the non-toric monofocal lens, if one were to pay $1600 for LASIK enhancement as a separate item (I had that done to get the desired vision from my 18 years old lens, so it was important to me),

and only $200 more than a toric monofocal lens plus included LASIK enhancement.

The basic message is depending on the package offered by a specific surgeon and one's specific needs and desires, the difference between getting a Symfony lens and a monofocal lens can vary widely.

That sounds about the same here in Vancouver (BC). Singapore touted as no 1 on the World Health Organization's rankings, cataract surgery is not covered by Medisafe and is an out-of-pocket expenditure that can cost as much as $15k-$20k depending on the operating surgeon's seniority and reputation.

I read your post about your and BellaD monofocal IOL outcome with much interest and really appreciate learning from your experience!. I’m -6.5D Right and -7.5D left and will be getting the Tecnis monofocal IOL. I’m also afraid of losing my near vision and don’t mind wearing distance glasses to get 20/20. I believe you ended up with -1.50/-1.25 ...  what was your original prescription?

Can you provide me a range of vision you see both near (e.g., J-Chart No. 5 .75M @ 14”)  & far (e.g. 20/40) in both good and bad lighting conditions. How far away do you have to hold you smart-phone? In layman’s terms how would you describe your range of vision, and are you happy with your end results for near vision?

I’m confused on what would be the best target range (between -0.75 thru -1.75) for me to AIM. I was thinking of -1.25D RT / -1.75 LT or just go with both eyes at -1.75D to be safe for near vision; and leave some weak distance vision.  If you had to do it over would you make any adjustments? I don’t think I would want to go any higher than 0.5D differences between the two eyes. Do you have any experience with monovision?

Sorry for all the questions I’ve stressed over this decision for 4 years and now have to get this surgery done. Thank you!

Peter,

My prescription before surgery was -6.00/-6.50. The surgeon targeted -1.00/-1.75 but ended up -1.25/-1.50. You are quite myopic, so it would not be a surprise if the results are a little off target like mine.

I can read the smallest print in J-Chart with a little guessing. It is important to point out that near vision will suffer after surgery due to loss of vision acuity; monofocal ~10% and multifocal a little more than that. So reading long newspaper article or paperback will tire out your eyes easily, especially in low light conditions. As a result, I find reading glasses a great help for prolong reading.

My distance vision is about 20/40, borderline acceptable to drive. I drive locally without glasses with no problem but wear glasses in unfamiliar places. Unlike reading, distance vision is quite forgiving unless you're a professional golfer or military sniper...etc. What bother me more is TV watching as I have a hard time making out small taper tape on TV from 10' out. For this reason, I wish my -1.25 eye is a little less myopic, like -1.00 or -0.75.

My intermediate vision is excellent. I can see smart phone well anywhere from 15-40".

The surgery target is highly personal, depending on what vision you value the most. Personally I wouldn't want both eyes at -1.75. In going from -1.25/-1.75 to -1.75/-1.75, your near vision will improve but you will lose a lot in distance vision. Near vision is a lot tougher to be good due to loss of vision acuity.

I don't much experiences with monovision. I do experiment with contact lens and find 1.00 difference or higher in monovision to be bothersome. In contrast, my surgeon herself is plano/-1.75 and she is very happy with it. She said it takes about 6 months to get used to it. I'm an avid tennis player and I worry loss of depth perception.

Hope this helps.

Hi robert20416, I am also happy with my monofocal IOLs outcome. I have good near and intermediate vision, and passable distant vision. I ride my bike and drive my car in my neighborhood without specs.

You say that your "surgeon herself is plano/-1.75", has she had IOLs implanted in her eyes too?

Hi CoolP, I would gladly repeat my experience. I left the pre-operative refractive targets (for both eyes) with my eye-surgeon. Most people with good targeted postoperative results were previously mildly myopic (around or less than -6D).  My good eye was highly myopic between -9D to -10D (in walking sticks). My other bad eye was and still is "Low Vision", a condition worst than those in the double-digit diopters category (in crutches) imho. The targeted result of my good eye was -2.5, but 6 months later is now more like -2. All the same I am enjoying the “glasses-free” vision range almost 100% of the day. So far I have put on my prescription glasses to look at the bald eagles flying by.

I also noted he hasn't referred to night vision issues, perhaps he doesn't drive at night very much?

Also he only has one eye with a Symfony IOL and his other eye is natural lens that gives good distance vision, so perhaps that combo helps reduce the Symfony night vision effects like the circles compared to two Symfony eyes?

That doctor was in is late 40s I believe and didn't have cataracts - he just wanted to see better up close without glasses!

My husband has both eyes implanted with Symphony lenses. In the past 2 years, I have never once heard him complaining about "halos" "starbust" or "night vision" issues. Since joining this forum 2 months ago, I have been bugging with questions I read here and nearly got my head chewed off. LOL

Very interesting! From those of reading forums like this, we think that all Symfony IOL patients must be bothered by the night vision issues - good to hear there are some that are different.

Does he just ignore them, perhaps doesn't drive at night that often? Or does he actually not see any halos, starbursts, or the coincentric circles around some lights at all?

Very interesting - thanks for that info!

Makes me again consider the Symfony toric IOL for my other eye when it needs surgery years from now.

But I'm still hoping they get an improved EDOF lens in a few years with less night vision issues.

Hi at201, thanks for responding. May I respectfully point out that there is an error of semantics to suggest that our "surgeon can promise 20/20 vision only with the Symfony lens". My apologies for giving you that wrong impression.

What was promised to my husband was tied to having both his eyes IOL Power calculated and using the same type of lenses. Hubby was in the civil aviation industry before, both his eyes were equally myopic and he opted for glasses-free. Had he chosen the monofocal lenses, he would still need a reader or a distant eyeglasses.

The same surgeon operated on my LV eye 8 years ago and implanted a monofocal soft lens. Then last year he operated on my good eye using the same type of monofocal soft lens; he rejected my request for a Symfony lens out of concern for my LV eye.

Cataract surgeons are paid by our local government health authority C$420 per eye/cataract surgery. If a patient chooses a prime lens (such as Symphony), he/she pays the government hospital C$1102, or C$1177 or C$1302. The surgeon's clinic will charge the patient a specific measurement & calculation fee of C$950 per eye, which also include the laser (PRK) touch up.  Given that his clinic hires 4 technicians, 2 receptionists, a book-keeper and a manager, he does not make that much.

Hi Robert,

Haven't read the forums in a while, but couldn't help but notice your comment about the TV; the one thing that made me notice my vision changing from -1.0 immediately post-op to -1.25 after several weeks was that I started to want to wear my glasses more for TV!  I have to squint or move closer to see some of the sports scores, since certain numbers look similar.   Funny how that little bit made a difference, just like you said.  I'm just as happy to have that extra bit of near vision now, though, since I don't mind wearing glasses for TV.