Trying to quickly wrap my head around my options

Hi

Your question could very well be the answer - I mean, I agree with all you have mentioned 😃

And yes, we are all having a hard time choosing the right lens.

The Symofony as you mention, will fully cover two of the three distances in real life, and often these are used with micromonovision to give you enough reading vision to get by on a daily basis without glasses, only having to wear reading glasses for the demanding tasks.

I have had the edof (like Symfony) implanted in my left eye 3 weeks ago, in two weeks I will have the second eye done.

My vision is really good with this lens from far distance into approx. 22", I am very happy with my choice.

I do have some of the side effects with halos and starburst, but they are minor compared to the fantastic vision I have got from the lens, I have got really good night vision as well now compared with having cataracts, although the halos and starburst is something you do need to get used to, but already now after 3 weeks, I do not think about it much when it is dark, maybe also because they have gotten more fainted.

If I put on a set of +1, my far vision is almost the same, it is still very good, and reading vision becomes very good as well at 16" on the one eye only, so I am looking very much forward to get the second eye done, and get the final results, the waiting is killing me 😃

But all in all I think you have not missed any information, I think you are fully equipped to make a choice - or as equipped any of us is going to get...

Forgot to mention - the Symfony is widely used in the US, but other newer lenses from the rest of the world do not have FDA approval, and is therefore not a choice for people living in the US.

The multifocals that are used in US are therefore still the same platform as the older generation bifocals, although in recent years lower adds have been made on the platform, to boost midrange.

When it comes to side effects with halos, starburst and glare, the multifocals are still not that good, but it depends from person to person, in many cases the side effects will be much lower within a year when the brain adapts, but you don´t know in advance how it will turn out.

And maybe the surgeon have not mentioned Symfony or multifocals because of your myopia, but you should discuss this with your surgeon, the Symfony could be a possible choice for you, if you are willing to trade in some of the side effects.

Hi Ivan - sorry been dealt with this diagnosis at 52. I can certainly relate having had that same diagnosis at 53. Mine too developed very rapidly to point where glasses couldn't correct. I was nearsighted prior to cataract surgery at -3.25 RE and -2.75LE bit that fluctuated a lot by .50 diopters last 2 years before being diagnosed with cataracts. I had my surgeries 2 yrs ago (Canada) with EDOF lens Symfony.

You seem to have a good grasp on options and meaning of those. The other negative which affects those younger being diagnosed is pupil dilation. The younger one is the more our pupils dilate in the evening/dusk low light light conditions. Pretty much every IOL out there is same diameter 6mm. So for some whose eyes dilate beyond that it creates a frustrating extra dissatisfaction of seeing arcs day and night.

If your vision is such now that it cannot be corrected with glasses (and you've not experimented with contacts and monovision) personally I would check off that option. Mini monovision is easier to adapt to (usually setting eyes 1.00 diopter or less apart). Important to target your dominant eye for best corrected distance in that case.

USA and Canada are limited in IOL options. Europe now has much better trifocals and EDOF lens options that we don't have. Depending on your financial situation and if your wishes are to be as glasses independent as possible you may want yo explore those markets.

Personally I didn't want monovision of any type due to migraines and possibility that it might aggravate those and my wish to be as glasses independent as possible I went with Symfony. Whether I lucked out or my surgeon was good or my personal mapping I ended up with a very good result. I have more near vision than expected (11 inches vs the 18 to 21 expected) and rarely wear glasses at all. Day vision is good. I do see concentric circles around certain types of light sources - I won't minimize thst and I expect they are permanent due to Symfony's design. Glare first 6 months was more bothersome than the circles and once that subsided driving became easier and the circles - although large are light and at this point I don't focus on them. Recently came back from UK and thought London would be full of concentric circles at night and it wasn't bothersome at all. The circles don't appear on every light source for me.

Only other thing I would recommend is to wait much longer between surgeries. To me that has much more to do with surgeon and getting their money. It takes 6 weeks for eyes to heal. That IOL shifts back and forth and you can end up .25 diopter either near or far sighted so that is particularly important if opting for monofocal lenses and any sort of monovision (full mini or micro). You'll want to know where that first eye ends up so any adjustments can be made for 2nd surgery.

One more thing you might want to consider is a max and match approach. Maybe monofocal for best corrected distance and EDOF lens targeted for intermediate - that would minimize the circles. Important that the monofocsl be in your dominant eye.

Some put a trifocal in one eye and EDOF in the other - so lots of combinations to consider. Hopefully you can find a surgeon who will be good at discussing all these to find best solution for you.

Best wishes - sorry about my lengthy rambling on reply.

1. you are correct that many US eye doctors don't like multi-focals, but that is because the only multi-focals approved in the US are older bi-focals which have a lot of issues with artifacts and have greater loss of contrast sensitivity.

2. Mono-vision can be a good answer if testing with contact lens shows you can adapt to mono-vision.

3. Don't know if you have the option to wait a few months, because the latest and greatest Tri-focal. the Alcon PanOptix is expected to receive FDA approval in the US by late 2019 or early 2020. I don't know if it's possible for you to wait, but it may be a great option, as is significantly better than the bi-focals currently available in the US, and is also a material improvement compared to the Symfony.I'm in Canada, and here, PanOptix has very quickly taken over the premium IOL market and has displaced the Symfony edof as the premium lens of choice. My surgeon also used to discourage multi-focals, but loves the results with the PanOptix.

Search for article: "Trifocals outperforming other premium lenses"

Search for : "Trifocal IOLs rank high in European surgeons’ preferences" (you will need to register to read this one, registration is free).

Finally someone whose symptom is triple vision. I had triple vision and it was maddening. Thanks for posting.

Thanks all for the replies. They've given me lots to think about. (Sue.An2: no worries about the "lengthy, rambling" reply - I'm the king of TL;DR. 😉 )

One aspect of this whole process of which I'm becoming more aware is that reported individual outcomes and satisfaction levels are very dependent upon the situation of each person prior to diagnosis and treatment, particularly with respect to the person's existing self image. For example, the expectations and resistance-to-treatment of an 80yo person who already has had to come to terms with one or more permanent medical conditions are likely going to be lower than a 30-40yo person who up until that point has had perfect vision and no physical issues. Add to that the fact that results will significantly vary from person to person, and generally the best that one can do is look at general outcomes over a larger data set ... which unfortunately for my case is going to be skewed to a much older population.

As far as I'm concerned, since I've had significant prescriptions since childhood, and since I've had sleep apnea (genetically-related) for many years, any self image of perfection and invulnerability isn't really present anymore. In my case, my concerns hinge mostly on the fact that on average I can expect to deal with this problem a decade or two longer than most, so I need to choose not only based upon the current options but also making sure that I don't somehow exclude myself from medical advancements that come further down the road.

Regarding questions about the relatively-short time between each eye, although I can't write off the doctor wanting money earlier (and this practice isn't hurting), I was explicitly scheduled one week shorter than the normal two based on two main circumstances: first, because of my stronger prescription (greater than +/- 2D), I can't simply wear my existing glasses with a non-prescription lens for the corrected eye - the difference in image size between eyes will be too great. Second, I wore contact lenses for about a year in my late teens, and gradually developed a significant allergic reaction to the preservatives and cleaners used. Several years later, I tried again with a fresh lens, and my ability to tolerate the burning sensation could have been measured in minutes. Even with advances made since then, the assumption is that I likely won't be able to tolerate a contact lens in my "better" / second eye for any length of time, and that between procedures I'd be dealing with whatever the correction would be in the first eye, and 20/squat in the second.

This brings up an interesting point that I had not considered previously: the doctor's current plan has been to go with a single-focus lens in my right/dominant eye, set for distance. I would then (hopefully) wear a contact lens in the uncorrected eye to determine whether or not I could tolerate monovision, before the decision was made on the second eye. The bigger risk with this plan is that, assuming that I can't handle monovision, I end up with both eyes with single-vision set for distance, or maybe one distance and one mini-mono at a slightly-closer range. Unless I'm mistaken, this would give me a high likelihood of needing to either carry around two sets of prescription glasses (one near, and one likely an intermediate/distance bifocal), or to end up wearing trifocal glasses. The first option is kind of a big pain, and wearing visible trifocals in my early 50s kind of runs up against what little vanity I have left at this point.

Frankly, this kind of causes me to favor the EDOF Symfony lens at this point. (Unfortunately, I really can't wait six months+ for the newer-tech trifocal to show up here, and a related trip to Europe isn't a lot more feasible.) However, I'm also going to try to push for the contact lens "test run" between pre-op and first surgery, just to give myself more data before the first eye has been decided.

More fun than I should be allowed, but at least I'm becoming more informed. 😉