Your Post Lasik Cataract Surgery Results (Trifocals, EDOFs, Multifolcals and Halos—oh my!)

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I posted this on the 7th of August but it has been in moderation and it is now the 10th so I am posting it again. If it gets posted twice, I will attempt to remove the duplicate...

My name is Jorge. I am in the US. I had Lasik in 2004 and vision was great until about 3-4 years ago. I initially saw an opthalmologist who told me that I had a cataract forming in my left eye and another just starting in my right.

I was also told that they were not "ripe" and that I should wait about a year before looking into surgery. It has been about 3 yrs now and the vision in my left eye is really annoying me. I have been trying to drink water and carrot juice and all sorts of other things but the vision continues to worsen. I have done a lot of research on IOLs and it seems clear that in the US our IOL options are very limited compared to what is available in Mexico, Germany, Turkey, Greece and Belgium (probably many other places too).

I was seriously considering traveling to another country to have the surgery done because of the options (trifocals such as the Reviol Tri-ED or the LIght Adjustable Lens. The LAL was developed here in the California yet is still not yet approved by the FDA but I believe it has been available elsewhere since 2009. I hear they are "close" to approving it here).

I am now thinking that I should maybe NOT go elsewhere because if there are any complications or adjustments that need to be done, they would not have any experience with those lenses here and because I had chosen to go around them, may be all too pleased to tell me that I would have to fly back there for them to deal with me.

I would like to ask people who have had Trifocals, multifocals and EDOFs what results they have had. I have been told that none are perfect and that I will have to compromise on one of the following:

near vision

intermediate vision

long distance vision

night or driving vision (halos and glare)

low light vision (the ability to see properly in low light situations)

I was told that almost all lenses other than monofocals will produce halos/glare but that after about 3-6 months my brain would adjust and I would not notice them.

I have been dealing with the cataract getting worse and worse for 3 years now, I am wondering if the halows I would see after the surgery could possibly be any worse than how I am seeing now. Maybe it would be a marked improvement!

One doctor told me that that I should try the "small aperture" IOL because by using a small aperture it extends the depth of field. That made sense so I then followed up with a question about low light sensitivity (since just like a camera, you can get almost infinite DOF if you stop the lens down but you then you can almost not see anything unless it is bright daylight), he never responded.

There was another lens, the Reviol Tri-ED. I contacted the author of an article: "The Lens: Reviol Tri-ED” (/). The article made the lens sound great because it had great light distribution. He sent me a research article: 

RESEARCH ARTICLE Open Access

Clinical outcomes of a new diffractive

trifocal intraocular lens with Enhanced

Depth of Focus (EDOF)

Banu Torun Acar1*, Erkan Duman2 and Saban Simsek1

Everything sounds great until I ask him:

Besides the Reviol, are there any other IOLs that you recommend to eliminate halos as well as providing continuous focus from close to far?

His response: In Reviol and Zeiss, there are complaints about halo glare. Alcon Panoptics gives us better results.

Keep in mind that this was the doctor who penned the research article that stated: 

"All our patients achieved spectacle independence without an incidence of photic phenomena, such as halos and glare at 6 month-follow up."

I cannot ask any of the local doctors what their opinion is on these other lenses because they will only recommend what THEY can do and claim that the FDA only approves the latest and greatest and if they have not approved it, then they are "obviously not having good results overseas".

So at this point, I am completely confused.

1) I can get the surgery done here in the US knowing that there are more advanced and probably better lenses with possibly fewer post surgery abberations and side effects.

2) Go to another country where I will have to stay 1-3 weeks and then hope that when I come home nothing needs anymore work

3) I can go to Mexico and get the LAL but I do not really know how competent they are there. The LAL is adjusted post-op and after your eye has healed (about 2 weeks). Up until your eyes heal, you must wear a pair of UV blocking sunglasses for those 2 weeks so as not to inadvertently expose and thus alter the lenses. After 2 weeks you go back, to the office, they measure your eyes as they are now healed and then adjust the lenses and then once it is dialed in, lock the lens in with another Laser that then prevents any further changes to the lens. The thing about the LAL is that they change shape and can get bigger than when first implanted and if they need to be removed (I don't know under what circumstances you would need them removed) it can be a chalenge since they will be bigger than when they went in.

4) Go to Canada and see what options they have there

5) Go to Greece to visit a doctor who practices both in NY and Greece. If I had to make any changes I would only have to go to New York but that might also be a PITA if I had to do it more than once.

6) Go to New Zealand. There is a doctor there who is one of the few in the world who has worked with the Harmoni lens and I do plan on moving to NZ within 2-3 yrs but that is a much bigger hassle if I have to go there because of the long flight times and their expense.

So, in closing, I would like to hear from people who have had Lasik. I would like to know what type of lens you opted opted for (multifocals or mono) and why. I would like to know if you are happy with them and if you would recommend them.

Thanks in advance and sorry for the long post but I wanted to give as much background as possible.

Sincerely,

Jorge

 

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  • Posted

    I saw some information about LAL before my cataract surgery 1 1/2 years ago. I called and emailed a few professional in Canada and USA. It wasn't approved in Ontario that time. And I checked some forums and it is new. I don't want to take it. I made the diciition to go with mono. if I chose distance mono. I am fine with distance and middle. And I have only one eye is working now.  Depth is a problem for me to decent ( may be only one eye is working)I am using reading glass for reading and waiting for the cataract surgery for the other eye. I prefer less trams for my eyes. And I am reasonably happy with the left eye which has mono focal implanted for distance and I see middle ground also. 

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    • Posted

      Hi Rose,

      I grew up  with glasses and would hate having to use glasses for both near AND far. I think that I can tolerate having to use glasses for one of the extremes, either very, very close, tiny text or for very long distance. So I am willing to give up some visual acuity for long distance but would rather not have to wear glasses most of the time.

      Since you have monofocals, I am gussing that you at least are not experiencing any halos, correct?

      Jorge

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  • Posted

    I would also appreciate hearing from anyone who opted for accomodating lenses!
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  • Posted

    Hi

    Thought I would weigh in on my experience.   You didn't mention your age but I am guessing you are young for cataracts.  It is definitely not something I wanted at 53.  However with 20/70 in one eye and 29/60 the other I couldn't hold out for better lenses.  I have had a Symfony EDOF implanted in right eye just over 4 weeks ago.  The other eye will be done in a couple of weeks.

    I use a computer 80% of my day at work, have a child in high school and lead an active life.  I did not have prior lasik surgery - have worn glasses since I was a teen.  I am near nearsighted (-2,25 in one eye and -2.75 the other.  Still didn't need glasses for near so thought of monofocals set for distance didn't appeal.  I know some people get them set with a mini monovision however never tried this set up.

    My surgeon prepared me with pros and cons saying at my age and given good near vision I would need to compromise.  I live in Canada and Symfony was approved just over a year ago.  

    My vision is good - tested 20/20 day after my surgery and I see well from 16 inches away which is a little further out but acceptable.  For pill bottles and ingredients on soup cans will need readers.

    The compromise is night vision.  Although with cataracts (and with one eye operated on I still compare) halos and glare and contrast is worse. Streetlights do not bother me.  Nor neon store signs or porch lights.  Mostly red taillights I see concentric circles around these when brakes applied or on dark highways where there is. I overhead streetlights.  Glare from traffic coming towards me has lots of glare especially new LED headlights.  

    I figure I wanted good daytime vision without glasses (and in reality it would be bifocal glasses for near and intermediate or 2 pairs) with monofocals.

    If you don't need the surgery right away wait.  Likely better are in the wY to being approved.

    I did learn in my research that a number of surgeons are comfortable with implanting Symfony vs multifocal lenses in those who have had prior lasik.

    Good luck.  Sounds like you are researching everything you can and have the means to explore options.

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    • Posted

      Hi Sue.An,

      I'm just recently 59.

      When I got Lasik, my surgeon convinced me to try monovision and I HATED it. So, I am not interested in one eye set to close and the other set to intermediate/distance.

      I believe that I prefer to have close, medium and good night vision with a compromise on long distance. I use intermediate and close far more than long distance so that would mean the least use of corrective lenses.

      I've not heard good things about Symphony. I read that about 9 months ago there was a recall of the Technis Symphony lens but I don't believe it had to do with the lens itself.

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    • Posted

      The only thing I would recommend is to get a consultation from a couple of surgeons.  I came on these forums about 2 months before my surgery for info and patient experience.  And also because when I had settled on Symfony lenses my own optometrist advised me against multifocal lenses due to glare and halos.  My surgeon said when I went back for 2nd consult that those that end up happy with MF lenses (83% are happy) don't need glasses so opticians would not have a balanced view.  Likewise with forums.  Those with good results don't post.  but my surgeon did say due to fact my near vision was good and I was younger than most for cataracts that I am in that category if hard to please patient.  Most cataract patients are well into their 70s 80s so they are gaining something they haven't had in a while.  I would need to compromise.  If I had poor near vision already and was retired I likely would have made a different decision.

      So happy so far with just one eye done that I chose Symfony.  Daytime vision is seamless.  Yes I have done. Ugh this time issues butbfar less than I was ecpectidue to my surgeon's comments and these forums.

      I do know this decision is more complicated if you've had prior lasik so getting the power right is more challenging for the surgeon.  Also if you have significant astigmatism or other eye disease.  There is no way to test that out with current lenses on the market.  

      find a good, reputable surgeon.  If you can talk to some of his patients (I was able to talk to a few of my surgeon's patients - 1 that had Symfony lenses implanted).

      Be willing to accept their advice for you.  In Canada it is easier as none of surgeons get paid more if you chose a premiums lens so those are t pushed here. Everyone in the waiting room with me for the surgery did not know there even were lens options.  Post op

      we were also together for eye test and post op check-up.  We could hear when each other went on for eye exam.  When I came out to wait for my turn with surgeon a lady asked why I could see near and far with just one eye done.  She didn't know there were lens options.  I am sure I would have received standard lens (not that there is anything wrong with them) if I hadn't asked about that at my first appointment.  They really don't push the lenses.  I had to pay hospital for the upgraded lenses $900 per lens.  Doctor gets covered by Medicare for surgery and cost of standard lens.

      I was miserable prior to surgery and upset I had to make this decision at 53.  Can't tell you how relieved I was at post op check up.  And still feeling anxious about 2nd eye.  Nature of my personality I am sure.  

      Wish you all the best in selecting a good surgeon.   Go to a few if you can.  Hopefully you'll find one that doesn't push any one lens but is totally honest about expectations.

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  • Posted

    I have a ripe cataract in my right eye, but the left eye won't mature probably for several years.

    In considering the available IOLs and what I have read from others experiences with them, I consider what distance viewing ranges are most important to me to help decide which IOL types would help meet that.

    Its a tradeoff, so if you want good distance vision as a top priority, near vision will have to suffer or vice-versa.

    It is possible with some of the premium IOLs to get distance and intermediate (computer, 2-3feet) vision without glasses like with the accommodating crystalens.

    Another approach to get distance and intermediate is to use monofocal IOLs with one eye set for distance and the other set for intermediate (about -1.0D or so).  You could alternatively set one eye for close near vision, but that can be difficult for some to get used to if the difference between the eyes is too great.

    The Symfony IOL can achieve distance+intermediate a little better than the accomodating IOLs (or could be set for intermediate+near) but that IOL along with multifocals have the greatest risk for night vision artifacts (halos, starbursts, circles around bright lights, etc) compared to the other types of IOLs.  So that too depends on your priorities - if you rarely drive at night but desire a good range of daytime/indoor vision that might be a good choice.

    I think for the best overall chance of distance and intermediate vision as top priority, leaving only the need for near reading glasses, plus good night vision the choices are limited to monofocal IOLs or accomodating IOLs. And that is what I've been considering for myself.

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    • Posted

      Yes, I read that the multifocals are most likely to produce nighttime artifacts.

      I read that accomodating lenses only achieve what is expected of them about half the time and in another article, I read that people fear that as you get older and your mucles do too, that there will be even less accomodation and thus it will become more and more like a monofocal.

      I think my highest priorities are good close and intermediate indoor vision as well as good nighttime vision but another thing that I saw mentioned was contrast and that cannot be corrected for with glasses so that is yet another factor to be considered.

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  • Posted

    I'm having a monofocal IOL set for distance next week. I had Lasik around 15 years ago. My brother also had Lasik and then had cataract surgery with a monofocal IOL set for distance and he can see at all ranges including up close except for the tiniest print. Good luck!

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    • Posted

      Oh and he's a software consultant for a Fortune 500 technology company, so he has to be sure his vision is excellent.

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    • Posted

      Actually it's one of the 5 top software companies in the world (not saying which though!).

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    • Posted

      Would they know at scanning that this is what distance correction you need for lens and this is what you will need for reading glasses.?
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    • Posted

       Ina if your brother got that test from monofocal lenses I would say he got lucky - that is not what any surgeon would advise you would get with monofocals.  
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    • Posted

      I would love to be able to see at all three distances with a monofocal because from what I hear, they are the only lens that does not produce halos. I just don't understand how, if they are not accomodating lenses, one is able to see well at all three distances. Your brother is very fortunate.

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    • Posted

      Actually I've read of several people who got monofocals set for distance (I assume all were aspheric) and can see all distances except for the smallest print. Someone on here posted about it on the thread where at first he said wished he had his IOLs set for near distance instead of far. He had one eye done and then the other eye done and he was able to see all distances with both eyes except, I think, tiny print. Maybe it has to do with the individual's particular eye, but I have read several stories like that already. Most people who have good outcomes don't post online though.

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    • Posted

      I've read plenty of stories online with the same result as my brother got.

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    • Posted

      And for me personally, I would rather have to wear reading glasses for small print than have trouble driving at night. I particularly don't like how the brochure for the Symfony IOL actually says "Because the TECNIS Symfony® IOL may cause a reduction in contrast sensitivity compared to a monofocal IOL, patients implanted with the lens should be informed to exercise special caution when driving at night or in poor visibility conditions."

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    • Posted

      If we could post links, I would post the stories I read which are not many because most people with good results don't post things online. Anyway, I'm not making it up....I read at least 10 stories of people the same as my brother's result. I just hope mine turns out the same as his.

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    • Posted

      I do want to add that you will probably need to wear reading glasses for small print if you had a result like the ones I read about with monofocal IOLs, but apparently that can also happen with the Symfony IOL, except those run around $2,500 per eye in the US while the aspheric monofocals like the Bausch & Lomb SofPort and Akreos brands are totally free in the US with insurance. My brother (ok he's in one of the top 3 global software companies, not the top 5 haha) is working all day in front of a computer and traveling all over the place on business with his monofocal IOL and after Lasik with no prior records no less. It's really up to the individual and if you want to take a risk on being unhappy with nighttime driving being hazardous, etc. vs maybe having to wear glasses a little more than otherwise. And I'm not saying this happens to everyone, but of the monofocal outcomes I read so far, there were quite a few who told the same story.

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    • Posted

      And so far I read at least as many horror stories about multifocals (ok a given), symfony, etc. as monofocals, if not more. I'm just posting this to try to give a balanced view since it's extremely hard to find that online.

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    • Posted

      And PS, my brother has more than enough money to have gotten the symfony but didn't even research it. He just made the doctor's appointments and had the surgery. And I asked him which brand/type of monofocal IOL he has and he said he didn't know! I hope everyone eyes turn out great regardless of what you choose. Like I said, I just wanted to report what I read various places online and also my brother's experience.

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    • Posted

      soks - I'm not sure what you mean by this question "Would they know at scanning that this is what distance correction you need for lens and this is what you will need for reading glasses.?"

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    • Posted

      If I can find links again easily of people who had the same outcome as my brother I will private message them to you. I have been reading hundreds of articles in the past few days though so it may take a bit. Of course even if other people have good outcomes, everyone is different and there are no guarantees, but I did read quite a few who said they could at least see clearly at 18 inches and beyond and some closer than that.
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