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Understanding pre IOL prescriptions better

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Maryland2018
Maryland2018

I'd miss a name or 2 if I tried to thank all of those who have provided insight directly to my questions, or who have shared personal experiences that have helped me understand my options better so i will just start by say Thank You to all that contribute here.

I'm trying to better understand what pre IOL implant refractive prescriptions might mean for outcomes, or even if there is a high correlation. For example, if someone had a -3.5D prescription, would that patient be able to theoretically see near and far with something like a Symfony or ReSTOR 2.5D lens, or is there a limit to the range?  My sense is that there is a limit, but for anyone that knows, please share.

Quick background for those who haven't seen my 'story' here.  I'm 51yo male who had a long standing stable RX for 10-15+ yrs, until the past year when my LE (dominant) vision went downhill fast. Long story short, a nuclear cataract was discovered, and that now has my LE vision estimated to be approximately -3.75D.  Previously I was LE -1.50 -0.50 160 and RE was/is -2.00 -0.50 180.  I was able to read comfortably by lifting up my glasses pre-cataract. LE is now just too blurry to read, but can read just fine with RE.

My thought is that the reflective depth of my eye is still the 'old RX', meaning that I'm only -3.75 because of a really cloudy lens. My first consult recommended a monofocal IOL undercorrected to 0.50-0.75D, which, if I understand correctly, would make me approximately 20/40 in my Left dominant eye.  I've read that the dominant eye should generally be corrected for best distance vision.  I'm also still weighing whether a Symfony IOL would make more sense since I should (hopefully) have it for 30+yrs.

Some of my questions for the group are: 

- Is it not a good idea to get a dominant eye undercorrected for Plano? 

- Am I correct that my long standing pre-cataract RX of -1.5D more relevant than the current -3.75D with the cataract?

- If the -1.5D is more relevant, has anyone, either from reading or from personal experience found better (or worse) outcomes with a Symfony (or ReSTOR 2.5D)?

- From what I've read, even with a monofocal IOL, I'm strongly considering the laser approach with ORA, as I've come to believe the best outcome will be achieved, but interested in what others think on this as well.

I know that some of these questions should first be prefaced with what my outcome goal would be, and what my lifestyle is.  Utopia is eliminating glasses, which in the short term would mean a contact in my RE until that needs cataract surgery in the next 5-10yrs. Absent that, in today's world, I use my smartphone & tablet frequently for work & leisure, and do a fair amount of computer work, mostly on a 24" monitor.  I also do drive some long distances for work (3-4hrs) so it would be ideal to comfortably see my dashboard as well as having good distance vision for driving of course. 

I do recognize that more precise measurements will be taken prior to surgery, and that will dictate what my focal depth is.  I have 2 (maybe 3) cataract surgical evaluations coming up in July and plan to ask these questions, but responses here definitely help me ask better questions, so thanks in advance for comments and suggestions.

0 likes, 9 replies

9 Replies

  • Sue.An
    Sue.An Maryland2018

    Posted

    Hi Maryland - have a few suggestions to make but would like to know if those hours of driving are usually daytime or nighttime or mixture.  Reason I ask is that Symfony (what I have) is really great for all what you do - iPhone tablet computer TV driving (daytime) however the night vision is a treade-off for seeing well at all distances.  I haven’t worn glasses since my surgeries 11 months ago (first eye) and 10 months other eye.

    I do drive at night and night vision has improved but not sure I would want to do a lot of night driving on a weekly basis.  I see 10 or so concentric circles around certain light sources (traffic lights - brake lights when applied (for some reason they are fine when following a car and they are on) and certain LED porch lights.  Don’t see them on streetlights.

    If you drive a lot at night I would not consider these to be for you.

    • Maryland2018
      Maryland2018 Sue.An

      Posted

      Thanks Sue.An.  Your outcome is what all of us want!!

      My long drives would not tend to be at night, although it would happen more in the shorter winter days. I have some limited control of when I drive for work so would adjust if I found the halos to be an issue.  Then there are always the occasional long night drives for pleasure, but not often enough that I would consider that a true hindrance.

      If I was recently reading an article correctly, then higher prescription strength pre-surgery correlates to higher severity of halos. If that is correct, and my pre-cataract RX was -1.50 then it would appear that I would be less likely to have as severe nighttime issues as someone with, say a -3.0.  It was on a website for millennialeye if anyone has not seen but interested in locating it.

      I was also reading some suggestions of getting a monofocal lens in the dominant eye to Plano, with a Symfony lens later in life in my nondominant eye. This approach would seem to minimize nighttime issues as the dominant eye takes over for distance which is where the majority of the halos/glare/starbursts seem to come from.  By the time my RE needs cataract surgery, maybe a newer lens, such as the Zeiss atLara comes out by then as well. 

    • Sue.An
      Sue.An Maryland2018

      Posted

      Yes it has been recommended to minimize the night time halos by having a monofocal in dominant eye targeted for plano and Symfony targeted for a bit nearer.  Still waiting for someone to try that setup and post results.

      My only thoughts on that are is that enough to give good reading as one eye has to take that on.  Never thought to ask at the time of my surgeries as surgeon recommended both eyes with Symfony to maximize reading and I had 6 weeks with one but other eye although still with cataract took over for reading and Symfony for distance till other eye was done.

      Glare and starbursts do subside with healing and time.  Those concentric circles do not.   I didn’t like driving much after dark and it was summer when I had my surgeries.  By the time I had to drive home from work in the dark glare and starbursts had diminished and I was ok with the circles.   With a daughter playing sports we did drive 2 hours away for games with return trip after sundown and I managed.  But would I want to do that everyday- likely not.  

    • Maryland2018
      Maryland2018 Sue.An

      Posted

      Sue.An - I'm assuming that you have been asked this before and have responded in other threads, but do you find your halos from the Symfony IOLs as pronounced as the ones that are simulated in those images by David Taylor?  Those images certainly give me pause.  Also, are there certain colors that seem worse? For example the different colors on a traffic light, or the newer high intensity car headlights?

    • Sue.An
      Sue.An Maryland2018

      Posted

      I know the images you are referring to (David Taylor Stevenage).   He had Symfony in one eye and Testor in the other.   Symfony produced round thin concentric circles not the spikes (Restor) like wagon wheel effect.  Mine are 10 with outer 4 rings lighter than inner ones.   They mimic light source.  So red producers red circles etc.  Yes they do entend out large and are bright meaning noticeable. As you approach the traffic light they disappear at a certain distance.  The drawings are yellow on black so I would say they are more vivid than my own.   I notice them most with red than other colours.    green lighs aren’t as noticeable.   I don’t want to downplay them as I would notice them first 6 months and was distracted and would focus on them primarily.  Hard to explain but it’s like I am accustomed to them now and I ignore them somewhat.   If on a highway - the cars in front of me have  no circles till driver brakes.   Oncoming traffic there is some glare but to me who has always struggled with glare having light coloured eyes no change with Symfony.  What is hard are those new blue-white LED headlights.  But my husband finds them equally as distracting and he doesn’t have cataracts.

      It is a definite trade-off for seamless day vision for sure.   but I wouldn’t say it is as debilitating as I thought it would be.   In the first 6 weeks I didn’t see the circles - glare and starbursts were so bad it hid them.  I planned my routes with overhead streetlights everywhere because dark roads were so hard to see.  After 3 months driving on dark roads got easier.  I keep eyes averted from oncoming car headlights focusing on white line to right (Canada - UK guess would be left).  I honestly get on my car without a thought now and drive daylight or nighttime without a second thought.

      Again I drive night during winter months - short trips or for pleasure but that is usually spring through fall and more daylight hours so no more than a couple of hours at night for those trips.   

  • soks
    soks Maryland2018

    Posted

    Hi Maryland2018

    You are somewhat in the same boat as me and cautious too.  I have had 4 ophthalmic evaluations so far and still no surgery.

    You bring up a good question about correlating pre-cataract prescriptions to outcomes with different types of lenses.  I can regress such a model but we do not have enough sample size for statistically significant prediction.

    My thoughts on your questions

    - Is it not a good idea to get a dominant eye undercorrected for Plano?:  I AGREE to get dominant eye at plano.  That is what I plan to do.  Majority of the time we use our distance vision and being plano int he dominant eye helps with that.

    - Am I correct that my long standing pre-cataract RX of -1.5D more relevant than the current -3.75D with the cataract?  CORRECT.  Pre-cataract prescription is more relevant than the current cataract affection prescription.  But they will know about it after measuring your eye at the appointments.  I have had doctors measure pre-cataract from one to six machines depending on the doctor.  The doctor with the six machines then recommended the IOL that showed up on most of the readings.  Getting ORA is an excellent idea.  They will order 3-5 lenses and depending on the ORA they can change what to use last minute.  More so if you have had Lasik. 

    - If the -1.5D is more relevant, has anyone, either from reading or from personal experience found better (or worse) outcomes with a Symfony (or ReSTOR 2.5D)?  I am at -2.25D with no astigmatism in the affected left eye.  This makes you and me low to mid myope.  I am interested in knowing is we would just be OK with a monofocal.  But I am 42 and still have a few work years ahead of me so I cannot lose my computer vision.

    I am leaning Symfony but the night time circles are something that I am still wondering about.  I am interested in your findings so pelase do share what you find..

    • Maryland2018
      Maryland2018 soks

      Posted

      Thanks Soks.

      If I get my Left dominant eye to plano, then in the short term I may have too much of a diopter difference from my RE at -2.00 so I need to factor that in as well.  Could be solved with trying to find an undercorrected contact RX that still allows me some ability to read in my RE, giving me some monovision so we will see.

      My consults are the week of July 9th which can't come soon enough because I swear that my LE vision is getting worse by the day due to the cataract.  I'm still a little concerned that there could be a different issue, but with 3 docs saying they see a cataract, one of them being a retina specialist, I will just go with that for now.

    • Sue.An
      Sue.An soks

      Posted

      If relevant I too was low myop before cataracts with right eye -2.50 and .25 astigmatism and -1.75 left eye with .50 astigmatism.
    • Sue.An
      Sue.An Maryland2018

      Posted

      I can relate to both you and Soks - never been an indecisive person but depending on day (some several times in one day) I went back and forth on this decision.   I did spreadsheets with all my routines included hobbies sports work related activities you name it.  And put a % if time I am at those activities.  I even extrapolated for retirement thinking of what life would look like afterward arcs.

      Came down for me to one thing and that was quality of life with vision.  Where is that time bring spent?   I could not have it both ways and needed to find that compromise.  It came down to daytime for me and glasses free.  As time has gone by almost a year now I have no regrets and the things I struggled most before the decision and loss I would experience in trade-off are distant memories now.   And today I can drive at night - wasn’t a complete trade-off and I am more than content.  My vision was rapidly deteriorating and I could not delay the decision and continue to work and drive.

      I REALLY am not trying to sell you on Symfony.  Derek likely came to a similar decision in choosing Restor lens.   If I had to drive at night for my job vs pleasure then I would have chosen a different lens.  

      the one thing once you make the decision that will nag at you till that surgery is over is the ‘unknown factor’ and that is terrifying.  It was for me.  My biggest concern was to accept the trade-off and not get my great all round vision.   I would have had regrets for sure.  But that can happen with any lens results.  But even with that small percentage of doubt - I couldn’t base my decision on fear and what if something goes wrong.

      I do wish you both peace as you come to a decision.  I know how hard it is.  I too was so thankful for these forums and only reason I keep on them is to give back.  I drove my family crazy with all my back and forth a and this was a safe place to ask questions over and over with people going through same thing I was.

      I am a person of faith - let me know when your surgery dates have been fixed.  Would love to pray for you.

      All my best.

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