Zeiss AT Lara edof (like Symfoni) implant

i joined your club soks. one symfony and one natural eye!

welcome. 😃

Thanks 😃

Well yes, the lens I need is quite different from mainstrean, I have a lot of astigmatism in that eye (both eyes actually) so the lens I needed is not a combination they keep in stock.

But it still within the range they offer on the normal Lara platform, I do not think they can make a bigger lens than normal, sorry.

Well, right now just a walk down the street is amazing. I have never seen light, colors and contrast like this, it is really breathtaking.

Each hour I discover something new I have not been able to see before, so right now I am just enjoying it 😃

But I am really looking forward to ride my motorcycle with all these new impressions coming in, I drove my car today, and just to be able to see the dashboard crystal clear was a pleasure.

I noticed that I suddenly could see the faces of all the other that were driving their cars, I have never been able to see inside other cars like that, it is really strange, but nice 😃

It is amazing how much "normal" humans take things for granted! Really happy for you!

Hi Tamarinda

I read your other posts as well, thanks, and yes I am thrilled 😃

I understand your thoughts about lens choices, I guess we all have doubts in this regard. I have off course gathered experience from other people I have met all my life, it is naturally a point of interest, when you are born with cataracts like me, that does not make me an expert, but anyway, here is my opinion about your thoughts 😃

I understand you have limited lens choices, here in Denmark bifocals are considered old school, the trifocals have been used for the last 7-8 years instead of bifocals.

But even trifocals have a little bit "muddy" midrange, because not so much contrast is allocated to this distance in the lens, so people that have an active lifestyle and/or uses the computer a lot often get the mix and match with a trifocal and an edof lens to boost midrange.

I know 4 guys well that have monofocals and monovision.

One of them rarely uses glasses, his brain have adapted to monovision really well. He do need reading glasses for reading and small stuff, he just do not read much, and he is probably a bit stubborn, and do not want to wear glasses.

The second guy uses contact lenses and reading glasses on top of the monofocals, he have never really been satisfied with his result, he is considering getting add-on lenses that are also available here in Europe, add-ons are placed within the eye in front of the lens capsular, add-ons can be trifocal and they can be removed again.

The third and fourth guy both wear glasses on a daily basis, with progressive glass, to have their reading vision with them all the time.

I think one of them have both monofocals set for distance, he says everything closer than 6 feet is a blur.

If you choose to go for monofocals and monovision, from my experience, you will never get reading vision like you have now with the bifocal, I am affraid you could get a chok, when you realize how little vision you have up close, unless you brain is super adaptive.

The more difference you make on the monofocals to add vision up close, the more risk you have for some of the same side effects you are having now, because some of the side effects comes from the picture that are out of focus, and not from the lens in it selve.

Off course we can find many studies on the internet about this subject, most of them payed for by the manufactorers, and not really trustworthy, but I have seen a couple that is supposed to be impartial, and I find them trustworthy because the results are similar to the impression I have got from people in the real world.

When it comes to side effects, that you are bothered with now, the study says that 36% of the receivers of trifocals have them, 13% for edof and 7% for monofocals with monovision, and 2% for monofocals both set on distance.

Bifocals were not in the study, since they are no longer used here, but bifocals are known to be worse than trifocals, because the bifocals are older designs.

I am not trying to make you even more confused, or choosing a specific lens, but my point is, even that monofocals are the safest choice by far, it is not 100% safe when it comes to side effects, especially with monovision, i think this is an important point you should take into account.

Cheers

Christian

Hey Christian I totally value your wide range of knowledge, so thank you! And I will weigh what you say about your friends with monovision carefully. So very helpful because I only know one person with monovision IOLs and two with monovision LASIK. They all are female and all love it. I will start a new post about gender because I think it plays a part, perhaps surprisingly. Or perhaps, not. 😕

One thing you have been saying has been confusing me a bit so I researched to clarify.

I do not see anywhere that stated the Tecnis ZKB00 +2.75 is a bifocal. Funny...my surgeon, in his disappointment with MY disappointment, said, "I really wanted you to love this lens." I said "I want to love it too!" and maybe I am starting to do so because now I want to defend it, haha!

I found an article titled Giving Multifocals a Second Look, and here's a paragraph from it:

"Patients are willing to trade a little fine print reading ability for better intermediate vision. Also, a low- or mid-add doesn’t just improve their functional vision, it also gives a more continuous range of vision.”

Jeffersonville, Ind., ophthalmologist Asim Piracha says this smoother transition between intermediate and far vision in the low add powers is a result of pushing the focal point out a little farther. “I think of the mid- and low-add multifocal IOLs as kind of progressive lenses vs. the high-adds, which are more like bifocals,” he says. “With the high-add, you get near and you get far, and nothing else. And it’s a really close near, so the intermediate to far-intermediate vision is just gone. This is why the patients with +4 D multifocals will need computer glasses. So the near vision is great, but the overall vision isn’t very functional for many patients with a high-add lens. The low-add patients get intermediate to near vision, and they can see beyond arm’s length, so it’s good for phones, iPads, computers, laptops, the dinner table, car dashboards, and the like. It’s a range of vision, while before, with a high-add, it was more like a bifocal, where you’d have near and then it would just drop off, and then you’d have distance vision."

Perhaps you are thinking of high-add multifocals (the first Tecnis ones were +4.00: oh my!) when you refer to bifocals?

I couldn't find anything saying exactly how many focal points the lens has.

At any rate, given the lens availability in the US, and now that I've done more reading (mostly here- so grateful!), I'd probably have to say there is no other lens I would have chosen to start with. He offered me Symfony kind of at the last minute and said that's what he would choose for himself, but that most folks do need readers (maybe since I'm young and stubborn I would have been able to push that, though: seems Sue.An2 has). So I said, "I want the lens with the least need for glasses." And this, in the US, is definitely it.

Hi Tamarinda

Well - please do not get me wrong, I want you to love your Tecnis Lens as well 😃

And sorry for my English if it gets a little weird reading, here in Denmark we speak Danish (and also eat it, but then we call it cake, it is all very confusing) but I will try to explain the best I can 😃

I also think you have the best lens for reading, with the choices you have.

They do not say your lens is bifocal, when the bifocals hit the marked, they were called multifocals, which stuck with them, but it is a bifocal with a lower add than some of the other bifocals that have +3.25 or +4.

The "add" is what decides the distance from your eyes to where the focal point ends up.

I guess you know this, but just to get the basics in place - the distance vision is covered by only one "add" of dioptier, or one focus point you could say, this is the add your natural lens have in its relaxed state, this add is covering all from about 6 feet and all the way just as long as you can see above 6 feet.

The eye needs about +30 for this, but it depends from person to person, but this is the basic "strength" your monofocal would have if set for distance, and what your natural lens would have in its relaxed state before it was removed.

And the closer you get to the eye from 6 feet, your eye needs more and more add of dioptier on top of the distance vision, to focus the light in a single point on the retina.

It is very mechanical, if the add is wrong compared to the distance from your eye to the object, the focus point of the light inside your eye ends up behind or in front of the retina, and the vision gets blurry.

So if you want to see something at a distance at about 32", you need about +1,6 add to the distance vision, and if you want see something at a distance of 16" you need about +3,2 add.

So a lens with 2 focal points, you will set one focal for distance like your natural lens in relaxed state, to cover from 6 feet and upwards, and the second focal point you can set at your desired distance, and you do that by choosing how much add.

With an add of +2,75 I guess the focal will be somewhere about 20".

On both "sides" of the focal points, it tapers off and vision gets worse.

Earlier days often bifocals with more add were used, maybe +4, and this would give you a focus point at around 12", i guess this is for readers with short arms 😃

Actually in Asia they are using higher adds than in Europe, because people are smaller and have shorter arms, kind of funny 😃

The vision quality will dip between the two focal points, becuase image gets out of focus, so the shorter step you have between the focals points (meaning the less add you have), the less your vision dips between the focal points, and the more you will feel like your vision is continuous. This is the selling point of the bifocals with low add like yours (less dip), and the reason why they say it is good for midrange.

If you search for "Tecnis ZKB00 defocus curve" you can see how the focus curve dips between the focal points, very typical for bifocals, but the lower add, the lower the dip, but also the less reading vision.

I will try to upload the picture in another post....

And if you search the defocus curve for a trifocal, such as the At Lisa tri, you can see that the focus curve do not dip quite as much.

The Lisa tri have the three focal points at distance, +1,66 and +3,33.

And if you search defocus curve for an edof lens, such as Symfony or At Lara, you can see that it have no dip at all in midrange, but it tapers off at above +2 (At Lara), so you do not get the +3 you need to get real reading distance with that type of lens.

But if you add +1 with a set of cheap reading glasses, on top of the +2 the Lara lens is making, then you have +3 in total, that moves your vision into normal reading vision distance at about 18", and that is exactly how my vision is with this lens.

But I see my phone and stuff fine without glasses, I have long arms, so I really have not used reading glasses for other than experimenting yet 😃

Hope it makes some kind of sence....

But as I said, if you do not want reading glasses at all, you need something about +3 or near that to read, and in that case I think you have chosen the perfect lens from what is available, so you have every reason to love it 😃

Cheers

Christian

Thanks for the crystal clear explanation! Your English is fantastic. Tak!

I think depending on a variety of aspects ie eye shape pupil size - results will vary person to person. I read perfectly fine without glasses with Symfony except in low light conditions but I may have been able to do so with monofocals too - unfortunately I just will never know..

Yes I agree, I think it varys a lot, much more than all the theoretic stuff can explain.

I found out today, that if I really focus hard a few seconds, I can read J1 in a distance of only 12" in good lighting, and that should really not be possible with the Lara.

It is really strange, the first couple of seconds I can not read it at all, but if I really focus hard, then after a few seconds the text gets clear so I can read it, I guess the brain can do stuff we do not really understand.

Anyway, it just makes me even more happy with my choice 😃

I can read J1 at 11inches which shouldn't be possible with Symfony lenses - and both eyes targeted for plano. Need good lighting fie that. In low light or extended periods of reading do have +1.25 readers.

I get what you mean by the focusing. I find it takes a few seconds for things to come to sharper focus - like on screen TV Guide or street sign. It has been almost 2 years so not sure if that is a normal thing or not.

sometimes it takes me a second or blink-blink to get things into focus when i change the distance of the object i am looking at. this generally happens only outdoors. i think they r discussing the phenomenon in the 'near vision poor with symfony thread'. when i told the doctor about it he brushed it aside saying it is tear film and i need to blink or get drops for dry eye.

Wow so you inspired me to check mine just now, because I'd never done that with the Jaeger chart. With my ZKB00, I can see at 11 inches and make out the words of J1, but they're definitely blurry. Everything goes very clear between 17-20". (the font they chose is a bit hard to distinguish anyhow, but the clarity I speak of is just that: when they look clear.)

If you check you may be able to find and print a chart with a better font. There are also some free apps that you can use to check bear vision - although I usually find a back lit iphone easier than a printout.

You thinking it is a dry eye or tear film thing? Thinking it may be if words do after blinking or putting in drops but in near vision after surgery there doesn't appear to be any accommodation like prior to surgery if I squint could bring more clarity.

its great to hear you guys enjoying good outcomes. it makes me optimistic about the symfony. it is the sixth day since i got a symfony in the left eye. my vision was colorfully rich again. but i am still finding it difficult to see things at any distance with that eye. is it still early. i feel i have some level of cyl power. i guess i ll have to wait another week before doc gives me a prescription.

Yes early days to know where your vision will end up. A lot of people are affected by the drops and do not get sharp clarity till those are over and done with. I was fortunate in that the drops didn't affect me - just a little sting as they went in. But could see quite well within 24 hours but I know that isn't case for everyone. There could also be swelling from the surgery affecting it as well.

I had an appointment at 24 hours with surgeon after surgery and again at 6 weeks. Hopefully you have a follow up to see how things progress?

yes i have a follow up after a week. maybe there is some inflammation then. i am really anxious all the time. hehe! i dont want to use bifocals or have to wear glasses all the time due to cyl power. anyway

hi gaurav

i think by cyclinder u mean astigmatism. i have -0.5 astigmatism and i prefer to wear glasses for it for the IoL eye, especially outdoor as it sharpen things up. inside the astigmatism glasses make things blurry.

are you in the US?

I was not astigmatic. can it occur due to surgery. no i reside India. From within i really hope its some kind of inflammation which will eventually subside and things will become sharp maybe.

i had no astigmatism either. So my astigmatism is from the surgery and even -0.5 is sufficient for me to want glasses. however the astigmatism is only impacting distance vision and the -0.5 correction for astigmatism makes near blurry.

is there a reason you chose Symfony and not LARA as both are available in India. I was considering LARA until Por Ming said that the plate haptics may not be suitable for all capsular bag sizes and I have a long eye.

Try not to worry at this stage (easier said I know). For many blurriness due to inflammation and drips. Be sure to write your questions down and ask at your next appt.

my doctor was more inclined towards symfony. he has had good results with it. he said that with a normal good eye that sees well at all distances every lens is gonna be unsatisfactory in someway or another. he prepped me very well mentally. however i am just feeling off because of this residual astigmatism. otherwise photic phenomenon are not that bothersome. i read somewhere that in cataract sugeries, the surgery is the art and the lens is the science. the art part might have suffered in my case.

I will do so. The time is passing at such a slow rate. 🙄

If you had no astigmatism prior to surgery there would be no recommendation for a Symfony toric lens to correct. I had minimal prior to my surgeries .25 RE and .50 in LE. Not something a toric lens can help with as it has to be over 1.00 I believe.Now 2 years after the astigmatism is zero in RE but increased to .75 in LE.

It isn't something to be concerned about at this stage and if in 3 months it is you can always have a laser procedure to tweak the vision vs glasses if you want. Some offer it as an add on package when implanting premium lenses.

Again this all might be irrelevant and your vision will turn out fine in a few short weeks. Dies blurriness come and go or constant? Is it blurry all distances?

it is blurry at all distances. i wont do anymore procedures. i will learn to live with whatever is left. some times at intermediate distances i see comparatively well. but i won't call it comfortably sharp.

and yes you are right about toric lenses.

After 9AM surgery my eye was blurry until 8PM that day. Blurry as in extremely blurry to the point that the cataract was better. Next morning at 10AM at doctor's appointment there was a lady who had her surgery with me a day earlier on her second eye. She said she was still blurry and for her first eye she had not been blurry for that long. It could be cornea swelling or ocular pressure or drops.

i am trying not to think hard like aunt Sue said. and really hope for the best. truly appreciate that people here always respond. its not easy to find someone to talk about all the thoughts of "what ifs".

my father really hates when i am like that.

so yes I am gonna exercise patience and be a good patient.

thankyou sir.

How you doing?