When is the right time to do cataract surgery?

Thanks for such a fast reply. I have had double vision very occasionally & briefly but I don't think that's been related to the cataracts.

I'm aware that there can be issues with MF and EDOF lenses & have done a fair bit of research & would prefer to avoid the "concentric circle" type lens (Panoptix, etc). I think I would rather accept readers than risk other issues.

One of the surgeons I saw has a preference for the Lentis Mplus by Teleon and a relative has had those implanted by the same man (as lens exchange, not cataract) and is delighted with them.

I have not heard of those lenses, but they sure sound like multifocal lenses. It is essentially impossible to do multifocal without creating multiple images which usually shows up as halos and more. Be very careful. In my view the lowest risk way to get the full range of vision without side effects is mini-monovision. Surgeons do not often promote it because there is no extra money in it. Most often monofocals are used which are fully covered by healthcare systems.

I have tried monovision with contract lenses and didn't get on with it. Perhaps it's different with iols but I would be reluctant.

You might know them as Occulentis (company that used to make them), There was a recall a few years ago and company was subsequently sold to Teleon.

Not everyone adapts to Mini-monovision or are appropriate candidates. It simply is an alternative strategy that gives you a “blended” extended range through the sacrifice of distance vision in one eye for near sight. This can lead to stereo acuity, depth perception, and neuroadaptation issues. It is a compromise to highest quality vision possible. It’s essentially a “brain game” or trick, where two images from both eyes are integrated together to form a composite picture in the brain. It requires rivalry adaption by shutting off neurosensory processing of the blurry overlap images in the brain and the failure to do is what can contribute to dysphotopsias. Physicians don't promote it because of patient dissatisfaction and their belief in better in better options to achieve patient satisfaction.

Actually the brain is very good at selecting the best image from the best eye for the distance being used. We have evolved with two eyes that are not always in perfect identical correction. We have only had that since eyeglass correction started to get used. Many people have monovision and don't even know it.

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On the other hand it is much harder for the eye and brain to deal with multiple focus points in one eye after using a multifocal IOL. They are not at all the same as bifocal, trifocal, or progressive eyeglass lens. With those we learn to use different parts of the lens to get the best image. That is not possible with a MF IOL. You can't selectively look through different parts of the IOL lens. That is why optical side effects like loss of contrast sensitivity, halos, and flare are so common with MF IOLs.

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My ophthalmologist was fully supportive in getting mini-monovision and even recommended it. So was my optometrist. I saw another ophthalmologist looking for a Lasik adjustment and he said something like "I don't know if this (mini-monovision) was planned or you just got lucky, but you are very fortunate to have ended up this way ". Actually it was carefully planned.

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The real reason it does not get much attention is that there are no special lenses at premium prices marketed to do mini-monovision. I should not say "no" because Rayner markets the EMV (enhanced monovison) lens for that purpose. However in the scheme of things it does not offer much of an improvement over a plain Jane monofocal.

No two patients or eyes are the same and they may experience different visual image processing capabilities or sensitivities by their brains, thus surgical outcomes will vary from patient to patient. This is especially true since IOL implantation is not an exact science nor without risk in and of itself. Every procedure has its inherent trade-offs.

Every patient should consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment of a personalized nature due to the fact that non-clinical perspectives may not apply to every potential patient circumstance and can cause harm.

Surgeons will likely have an opinion on any approach based upon their own already established views and habits. If a surgeon is not convinced of the benefit risk ratio over other available options themselves, a patient will likely need to go somewhere else. Ophthalmologists/surgeons believe in the science of optics, visual system design/function, and doing no harm. Nothing beats natural visual design and function to date. Accommodating IOL's may offer the closest replication to that if and when approved.

Accommodating IOLs don't work any better than MF IOLs, which have all kinds of issues in themselves. That is why they are not being approved.

One of the things you should be considering is that MF and even EDOF IOLs are likely to have far more negative impacts such as loss of contrast sensitivity, halos, and flare, than you are currently experiencing with mild cataracts. Going from mild cataracts to these types of IOLs could be like jumping from the frying pan into the fire.

Thanks. This is something I have realised. Some people seem to have no issues while others have major problems.

If it weren't for the fact that I have cataracts, all be it early stage, I wouldn't be considering lens exchange, just to be free of specs/contact lenses.

That may be the company that I recall someone from the UK posting about here. They had some kind of package deal for vision correction that was short on specifics. Then the lenses actually failed to stay clear, and I believe the company is now bankrupt. Without doing a bunch of research I can't be sure.

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If you have tried monovision with contacts in a proper manner and did not like it, then that solution is probably not for you. I say proper manner because originally monovision with a high differential between the eyes as much as 3.0 D was used, and that had issues. It is simply too much differential that left a hole in the intermediate range and caused other issues. The current method is to use mini-monovision in the range of 1.25 to 1.50 D differential with that amount of myopia in the non dominant eye.

Occulentis was/is a Dutch company. The problem, as I understand it was that a large number of lenses were treated with a chemical during the manufacturing/packaging process that caused the lenses to undergo opacification some time after implantation. That issue has since been resolved. The same products are now made by Teleon-Surgical, another Dutch company.

The mono I tried last time, (earlier this year) was with -3,75 in my dominant eye and -2.75 in the other. It was fine for most reading, looking at a screen and that sort of thing but I found it quite disorientating when driving or walking outside. It was supposed to be a 10 day trial but I quit after 6 or 7 days deciding that I just didn't like it.

That would be a differential of 1.5 D so a fair trial of mini-monovision. I can't say that I had any of the issues you describe. I did monovision with contacts years ago but abandoned it due to the hassle of dealing with contacts, and that as I aged they seemed to get more and more difficult to handle (get into my eye). I tried it again just before and after I had cataract surgery in my first eye. This time I tried about 8 different brands of contacts and found some (CooperVision MyDay) that were far superior to handle than the ones I had been using before (Acuvue Moist).

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My monovision is crossed meaning that my dominant eye is my close eye, which is backwards to standard practice. Some studies have found crossed monovision may be superior to conventional. I can't comment as I really have only had experience with the crossed version, and now it is built in with IOLs. You may be able to try crossed by simply switching eyes with the contacts you may have left over from your trial.

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I don't think IOLs do monovision any better than contacts other than the avoidance of handling contacts. They do give a slightly optimistic view if the reading ability though as the natural eye will still have some accommodation. With contacts I found I could read well (Jaeger J1) with -1.25 D, but with an IOL I need -1.5 D to read J1.

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Cheers again. I've been a long standing Acuvue user, most recently the Oasis derivative which I can't now wear for more than a few hours without discomfort.

I've tried Daily's Total 1 recently and they are much better for all day wear but the vision is not as good. Saw my optometrist this morning and he has given me a trial of "Oasis Max" which are new and which he reports are as good as the Total 1s for wearability but have a "blue light filter" which gives them a noticable yellow tint which I'm not sure I'm going to get used to (they also make my blue eyes look green, but hey ho!) They're also quite a bit more expensive here.

So I've ordered a box of MyDay's that the optician also recommended but didn't have in my prescription. Thanks again for the recommendation.

When I did my testing which was basically for comfort as I was attempting to wear them full time, my rating of the top three were:

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1. CooperVision MyDay (Costco Kirkland)
2. Alcon Total1
3. Acuvue Oasys

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   At least for me the CooperVision ones were the Goldilocks solution. They were firm enough to handle, but not so firm as to be uncomfortable. As it turned out they are the brand that Costco sells as Kirkland and were also the least expensive. I was able to wear them the full day and only took them out about a hour before bedtime to give my eyes a bit of a break.

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   Alcon has released a Precision1 version which is cheaper than the Total1, but I got my second IOL before I got around to testing them. Apparently it is a very similar material to the Total1 but a different manufacturing process.