What do you think of these combinations?
Posted , 7 users are following.
- set both eyes with monofocal at -0.75. i got surgery induced astigmatism of -0.5. if i am going to wear glasses fir astigmatism might as well get some distance correction as wee and get better near in the process
- set one eye at -0.75 and other at -1. both monofocals. i need +2.5 on symfony eye to see hd video on phone. what would i need on a -1 monofocal. how does better monofocal quality benefit near vision.
- get vivity both eyes at -0.5. want the lens to last 30+ years. not really sold on clareon having eliminated glistening so worried.
- get both eyes clareon panoptix.
- get one eye monofocal and one eye panoptix.
- get one eye monofocal and one eye synergy.
- get one eye vivity and one eye panoptix.
- get eyhance in both eyes set at -0.75.
0 likes, 19 replies
Sue.An2 soks
Posted
Hi sox - tough choice yo make if explanting the symfony.
If it were me - the other eye that needs cataract surgery I would do first with a monofocal best corrected distance (usually targeted .-25 as you would not gain anything from being over corrected. This may diminish the effects of symfony and give you what you want in terms of intermediate vision (maybe decent near).
I say this due to what I am experiencing with epiretinal membrane. My left eye has difficulty reading and straight lines appear curvy. Specialist did not recommend surgery till vision was bad. With right eye open do not see any effects of epiretinal membrane as my brain chooses the better view.
so before explanting - see if a good monofocal will help. Just my opinion - I am sure others will weigh in.
valerio01538 soks
Edited
Really hard choice! I, in your place, would also be in doubt about what to do! If I'm not mistaken, your ultimate goal is to be without glasses and with good near vision. I don't know how degraded your vision is in the unoperated eye, but I would wait a little longer and solve the Symfony eye problem first and see what I get. I will speak for myself, from my experience with Synergy and Symfony lenses. I, being in your place, would perhaps first risk a Clareon PanOptix put in place of Symfony and solve the PCO. If satisfied with the end result, he would end up with his option 4, another Clareon PanOptix in the other eye. The reason for this is that Symfony gave me excellent medium and far vision, but not much near vision, whereas Synergy gave me excellent near and with low light vision, but definitely not so sharp vision. , from about 30 feet. But that would be what I would do, based on my experiences, surely there must be others with better solutions.
soks valerio01538
Posted
how about option 6 then? can you make distance sharp with glasses for your synergy eye?
is your near vision HD quality with synergy eye?
valerio01538 soks
Posted
Option 6 has the advantage that, with a monofocal in one eye, you can get good vision at a distance and without dysphotopsias, in addition to attenuating those caused by Synergy in the other (which are big!). I can't say how this combination would work for intermediate and near vision binocularly. Whether Synergy would take over these distances and how the brain would adapt.
At least for me, the Synergy's distance vision definitely CANNOT be corrected to be sharp! I believe that if I had gotten Synergy in both eyes after having bad eyesight for years due to cataracts, maybe I would accept the vision as being good. But as I had the chance to compare with the Symfony, definitely, the Symfony's medium and long distance vision is sharper. My doctor spent a lot of time with me trying to correct it, but even in the office's evaluation indicating vision close to 20/20, the Synergy's vision is not sharp (comparing to Symfony). Unfortunately I ended up having the same experience as some who complain about this in relation to Synergy.
The quality of my near vision with Synergy is very good, even in low light. I think that's the strong point of this lens. I can read small print and use my cell phone from 13". As for seeing detail in photos and videos, it's better at 16", but I think that's because I only have one Synergy eye, binocularly probably the near vision would be better.
rwbil soks
Posted
As someone that has Synergy, my guess is they will come out with Low-Add options so the halos and starburst are not so large, but that will come with the tradeoff of less closer vision.
Soks you are more familiar with the options and all the risk of the various options than most people. It is all about how much risk vs how much glasses independent you with to be.
soks rwbil
Posted
if synergy distance cannot be made sharper. how about getting high add multifocal set to -1?
rwbil soks
Posted
I am not sure Synergy IOl distance vision cannot be sharp. Mine is 20/20-2. I am sure that is better than some folks get. It if not as sharp as my Tecnis MF which is 20/20 though, but I have no idea if that is due the IOL itself as many factors.
I would not recommend high add multifocal set to -1D. In fact I would recommend any diffractive IOL to be set to Plano or darn close to it.
When I think of high add multfocal I think of the Tecnis +4.0, which has large halos and moving it more in the myopic range would make it worse.
The only lens I would shoot for myopic would be a refractive IOL.
soks rwbil
Posted
tecnis should leave their edof obsession and get a classic trifocal.
rwbil soks
Posted
I would imagine Tecnis has a lot vested in their EDOF technology and it would take a lot for them to abandoned it. It would be interesting if their was a large clinical trial comparing Synergy to PanOptics, but someone has to fund such a trial.
I will read one article from a doctor on how Synergy is better than PanOptics then read another one from another doctor saying PanOptics is better.
Heck Wong at first said Synergy was bettter then later switched to say PanOptics is better.
IMHO, take it for what it is worth, I think Synergy is the highest risk IOL out there. You have to nail the refractive mark and correct for Astigmatism. Being it has such a strong close ad, moving that refractive mark closer into myopic territory has "BAD" consequences.
valerio01538 rwbil
Posted
"Being it has such a strong close ad, moving that refractive mark closer into myopic territory has "BAD" consequences."
Yes this is true. In the Synergy manual, in the section that guides the correct choice of lens power, it says to choose the power that the residual refractive error predicted in the calculations is closest to emmetropia, but when the predicted residual refractive error calculated is the same between two available lens powers, the choice should NOT be for the myopic side.
soks rwbil
Posted
curious about synergy patient experience then where distance is targetted for slight hyperopia than myopia.
based on what i read it seems panoptix may have hit the right balance for 3 distances than their peers for most people. but tecnis material is superior. also it seems the tecnis multifocal like the one you have are probably giving better distance than synergy because they dont have the edof wasting lot of light for the intermediate distance.
RonAKA soks
Posted
About all I can say is that I am happy with two monofocal lenses with one at 0.0 sphere, and the other at approximately -1.25 D. I have -0.5 D cylinder in the 0.0 sphere eye and that is no problem. However I have -0.75 D cylinder in the -1.25 D eye, and that is a bit of an issue. I am still considering Lasik to get that eye closer to 0.0 D cylinder and -1.5 D sphere. To me that is the ideal vision for the near eye with a monofocal lens.
1Ellen soks
Posted
If you choose option 7, won't you have full range vision with minimum side effects? Clareon Pan Optix in the non-dominant eye is supposed to have full range vision and by implanting the Clareon Vivity in the dominant eye, you are minimizing halos without reducing your vision range, right?
soks 1Ellen
Posted
yes and i would make vivity myopic. glistening is stressing me out.
1Ellen soks
Posted
Please let us know what you decide because like me, many people have a "pick and choose" option and are trying to minimize side effects and maximize vision. I am getting frustrated with Alcon and the "there are no guarantees." Clareon is being marketed as an improved material and Alcon is not very open about study results.
soks 1Ellen
Posted
i am going the clareon route or just getting tecnis monofocal and moving on. i have been stuck for too long. being home because of covid has helped but now i am a blind man walking.
clareon monfocal has been out for 2-3 years so by this time we should know whether it is improved or not.
RonAKA 1Ellen
Posted
You can find a comparison between the monofocal Clareon and AcrySof lens materials at the article below.
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Comparison of Visual Outcomes and Patient Satisfaction Following Cataract Surgery with Two Monofocal Intraocular Lenses: Clareon® vs AcrySof® IQ Monofocal Smita Agarwal, Erin Thornell
soks RonAKA
Posted
thanks for sharing. they still indicate need for long term study.
what do think of getting both eyes at -1 with monofocal?
how bad is the near / intermediate vision with monofocal? i would like to think higher quality of vision should make a difference.
RonAKA soks
Posted
It is kind of like waiting for a long term study on mRNA vaccine, when the virus is knocking at your door... Unless you are willing to wait 25 years or more, there is not going to be long term study data to look at...
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I think the problem with both eyes at -1.0 D is that your close vision is not going to be great, and your distance vision is not going to be great either. Vision will only be really good at 1 meter. Unless you have some specific activity that you want to do at 1 meter without glasses, I am not sure what the value would be.
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I still think the lowest risk no eyeglasses solution is to target a -0.25 D monofocal in the dominant eye and -1.5 D in the non dominant eye. This will give you good vision across the whole range of distances. Some readers will likely be required for superfine print, and for the best driving vision at night, some progressive glasses are a good idea.