Trying to quickly wrap my head around my options

Posted , 8 users are following.

Greetings,

(Warning: long-winded background…)

I'm a 52yo guy in the US who was recently diagnosed with cataracts - both eyes; developed over the course of several months; no real clouding, but enough distortion that I get triple vision and blurring that isn't correctable with glasses. The triple vision is more obvious at night with street lights. I have pretty-strong myopia (around -9, prior to the last ophthalmologist's altering my prescription before he actually detected the cataracts), but oddly-enough no notable prior astigmatism. I've worn prescription glasses full-time ever since I was nine.

Due to my prescription (and the ease at which a lot of optometrists have screwed it up), I've gone to ophthalmologists for years. One thing that I couldn't help but notice is that most of my fellow patients have always been (well) in their 70s or older. Realistically, this generally means that the doctors are more used to dealing with patients who are at a different point in their lives. Even though I think that I've selected one of the top eye surgeons in my area, I therefore still want to ensure that we're both going into this with the appropriate perspective.

All that out of the way, I want to make sure that I understand what's being proposed, and what my options are before the preop appointment later this month. As I understand it, my doctor is currently considering using the TECNIS ZCB00 for both eyes. He leans heavily toward monovision, but I'm supposed to wear a contact for a few days before making that determination. (Surgeries are only about a week apart.) He hasn't suggested the Symfony or a multifocal lens at this point. (I get the feeling that most doctors in the US shy away from these, due to bad experiences with first-generation multifocal lenses.)

From what I've gleaned from here and elsewhere, here's what I think that I understand about single-focus lenses and extended focus lenses (please correct me if I'm wrong):

Single-focus:

  • Sharp focus at a specific point in one of the three ranges (distance, intermediate, or near)
  • Low incidence of night-time effects (halos, rings, etc.), although some edge effects can occur.
  • With monovision: each eye will be in focus in a smaller region somewhere within one of the three ranges. However, the remaining range (usually near) will definitely require glasses to accommodate. Even for the other two ranges, there will be distances that aren't in clear focus with either eye. In addition, depth perception will be compromised, since the focus of the two eyes won't likely overlap.
  • With mini-monovision: most of the above is true, except that the individual eye focus ranges overlap at some point, which gives better depth perception at the overlap points. This comes at the expense of a smaller total combined focus range (read: glasses likely required for part or all of two of the three ranges).

Extended range (specifically Symfony):

  • Focus at a broader range of distances, covering all of one of the three ranges and part of the adjacent one. Focus not quite as sharp as a single-focus lens at the best point of focus (?).
  • Higher incidence of night-time effects (halos, rings, etc.) than with single-focus. These are reduced in severity compared with the old multifocus (really bifocal) lenses, but still show up. Issues with halos, rings, etc. aren't noticeable during the day (?). Unlike multifocus, extended range lenses do not have issues with reduced contrast, and do not interfere with visual field testing (?).
  • Due to the extended focus range, "monovision" is more like mini-monovision, except that 2+ of the ranges are covered by the combined focus, and there's more range that overlaps between both eyes.

What am I missing? Overall, it seems like the big choices are related to focus coverage versus night-time effects.

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  • Posted

    After stumbling across a blog post about higher levels of dysphotopsia seen with EDOF lenses (Symfony specifically) left with residual refractive error (and the doctor taking the - hardline IMO - reaction of never using dual EDOF lenses in any monovision situation, including mini or micro), I was curious about what a more general study would say.

    Here's what I ran across - found it interesting: Influence of the level of monovision on visual outcome with an extended range of vision intraocular lens

    • Posted

      Issues with the embedded link above, here's what I tried to reference: "http://ncbi.nlm.nih.gov/pmc/articles/PMC6239114/"

    • Posted

      Yes, there are many of these studies published, I have read a lot of them last couple of month, and I have tried to compare some of them - results and conclusions vary a lot, I would say it is possible to find a study to prove just about anything, where other prove them wrong.

      But no doubt, with edof or other multifocal, you will get some visual side effects, it is a part of the package.

      If you look in the post in this forum called EDOF Zeiss At Lara started by worried husband, some of us is comparing side effects.

      That said, most people really like their vision with edof lenses, but if visual side effects are a deal breaker, monofocals are the safest choice, although some also have visual side effects with monofocals, but with monofocals it is more rare.

    • Posted

      Wishing surgeons spent more time in consult with patients to determine which would be better candidates for EDOF or other premium lenses. At my initial consult my surgeon didn't go into depth about the lenses. Afterwards when I researched and stumbled upon this forum where there were a few commenting on Symfony's unusual side effect of concentric circles I called to ask for 2nd consult (not something you get a lot of if public and not private clinic). Anyways it was at that consult surgeon explained a lot more about side effects and asked me questions about my hobbies, reading and work life. He didn't push one lens or another - made it clear under Canada Medical system he gets paid same amount no matter which lens I chose. After my 2nd surgery 24 hour post op he did say he was my age and if he had to have cataract surgery he would choose EDoF lens.

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