Trying to decide on multifocal or monovision IOLs

Hi Susan - don’t want to ‘muddy the waters’ for you but my optometrist strongly advised me against multifocals due to glare and halos.  Outright told me I’d regret it.  I had seen her once between her diagnosing my cataracts and before my surgeries as I was there for my dsughter’s eye exam (she’s 15).  Her comment rattled me do much I went back to my surgeon to further discuss lens options.  This delayed my surgeries a month but I was fine with that.  Needed the time to make a decision.  

I ended up going with Symfony lenses and am happy with them although I thank my surgeon and these forums as both made me aware of the night vision trade-off.

I had such good vision that it wasn’t my intention to see my optometrist for any follow up.  Night Hawk encouraged me to go to get a base line to have for any subsequent future visits so 2 months after my surgeries I went.  My optometrist texted me and rechecked everything and said she was surprised how well I could see and said I got ‘lucky’

What I think is most people who see well don’t go back to their optometrist.  I honestly wasn’t until encouraged to go.   So the patient the optometrist sees after cataract surgery are those with monofocals who need glasses of some sort but get good clarity at one focal point or the unhappy multifocal patient who may need glasses or have so many night time visual artifacts that they complain to their optometrist.   They rarely see the happy patient who forks out $100 to an optometrist who confirms their vision is good.

Please don’t take my comments to mean I am pushing you towards Symfony or any multifocal lens.  I didn’t (and don’t) have any underlying eye issues.

What you want is for someone to let you know what the trade-offs are: and there is a compromise to make with every lens make no mistake about that.  

Take into consideration what you do for a living or hobby.  How much night driving do you do.  What personality type are you.   I read a humorous post before my surgery about IOLs and personality types.  It was advising surgeons to choose patients carefully.  Multifocal lenses for someone who is an engineer and who notices a knat on the far wall of a theatre with astronomy as a hobby and a Jewish lawyer for a brother in-law would be your worse case scenario patient.

All kidding aside, if you have AMD in your family and it is hereditary perhaps scales for you should tip in the monofocal category.  But do your research - I am no expert and perhaps Symfony would be no worse than a monofocal if you developed AMS too but I don’t know the answer to that.  Might be a question to pose to a few specialists for an educated response.

Good luck to you Susan.  Wish you the best.

You are defining monovision correctly.

I just wanted to be sure about that because of your statement, "My optometrist said her patients who have opted for monovision are more likely to need reading glasses." That is definitely not true if one of the eyes is set for reading, as is in my case.

I have had monovision contacts for 20 years and never needed glasses for anything until the cataract-now I sometimes need reading glasses.

I was using the term Multifocal as interchageable with Symfony and perhaps I should not, though my dr calls it a multifocal.  It is the Symfony I have been talking about here vs monovision and the Symfony that they said would not be as good were I to get AMD.

When your optometrist advised you against multifocals he/she didn't mean Symfony too apparently.

I think even if people are happy with their vision,  they'd still see an optometrist to be checked for glaucoma and macular degeneration.

I don’t think optometrists (or at least mine) know the particulars on a given lens.  Seems to me they lump them altogether.  In any case I think I was first patient she had that like multifocals and when I mentioned to her this was a new category of IOL she didn’t seem to me that she had heard much about Symfony lenses.  But these are new in Canada and New Brunswick where I live started implanting these late Dec 2016.   

As for follow up visits to optometrist I doubt I would have gone unless I was experiencing a problem or at least waited 2 years as my insurance company only covers visits every 2 years.  I paid out of pocket for my last visit (due to these forums) which I can understand now is beneficial to know what my exact prescription is 8 weeks after surgery.   Both my eyes are plano (so no mini monovision) and I see well from 11 inches and beyond.  Very pleased with the result as I thought I would be holding my iPhone out at arm’s length to read it.   I have t needed glasses since my surgeries.  I am young to get cataracts at 53 and I need reading and computer distance for work.

Susan - why does your doctor say that having Symfony Lens would be more difficult than a standard monofocal lens if you were to get AMD later?   Just curious.  None of us had a crystal ball and I have no idea what else I will have to face vision wise down the road.  Will my having Symfony lenses complicate things if I were to get AMD?  None of that was even mentioned during my consults.  

To clarify, when I said dr,  I meant cataract doctor- not the optometrist.

Here is what they told me-

A family history of ARMD is something we like to take into account.  Having family history increases your risk of developing macular degenration (though doesn't guarantee it).  In folks that have macular degenration we typically advise against getting the multifocal as the quality will likely be limited.  In people who have no sign of macular degenration at the moment (such as yourself), we are certainly ok with people pursuing the multifocal.  However, if you wanted to pursue the most conservative approach, pursuing monovision would over the multifocal would likely be a better option if you were to develop macular degenration later in life.

On the issue of Macular Degeneration- 

"It is true that multifocal lenses have an extended depth of field which is achieved by spreading out the light, whereas monofocal lenses focus all of the light at a single point.  Dr. XXX does not typically recommend multifocal or Symfony lenses for people with AMD.  

The complex optics of a multifocal lens do not work well in patients with vision limitations from other eye conditions (like AMD, glaucoma, etc).  "

Regarding AMD I was told—

The Symfony does have far less issues with contrast issues than the traditional multifocal IOLs do.  If you are going to have a multifocal IOL, the Symfony is the one to have.

Glad to hear thst - not that I have much choice after the fact.  All in all very pleased with vision outcome.  Good you’ve had the experience of monovision with contact lenses.  When I was diagnosed with cataracts eyes were affected and couldn’t do a trial to see how I would do.  If not for my history of migraines I may have gone mini monovision but couldn’t take the chance that would make those worse.  In the end no regrets with the decision I made and can’t go forward in life with eyes on rear view mirror all the time.

Take your time to make a decision - there’s no rush.  Do what’s best for you with the info you have and if still uncertain - gather more info.