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Best IOL for young patient with cataract in one eye

I was hoping I could gain a little more clarity in deciding which IOL to choose for my cataract-induced eye. I have been researching extensively, but haven't succeeded in finding too many applicable answers since my situation is a little unique. In short, I am in my mid-20s and have recently developed a cataract in my left eye - will be getting surgery in about 2 weeks. My right eye is healthy with no signs of cataracts. The doctor isn't exactly sure how the cataract developed, as I have no major health issues.

Currently I wear contacts daily (-3.0 LE and -2.0 RE) and also wear glasses at times, am slightly myopic in both eyes, and have slight astigmatism in my left eye. I am having trouble deciding whether to opt for a monofocal IOL or a multifocal IOL. My doctor recommended inserting a multifocal IOL in my cataract eye, and said my eyes will eventually adjust to the slight difference. I have been reading differing opinions about getting a multifocal lens when the other eye is perfectly normal, and am also concerned about halos, contrast problems, not  being able to adjust, and so on. I am not considering getting LASIK on my good eye after surgery. I don't want to rely too heavily on glasses, but don't mind wearing them from time to time. I also don't mind wearing contacts. What is the best IOL option, considering my age and situation? If I choose monofocal, what distance should I set the lens to? If I choose a monofocal lens, would I eventually be able to wear contacts in this left eye to help me see near and far?

I know I will be the one to make the ultimate decision, but I'd like to get as much advice from those who have experienced the same thing or are familiar with this issue. Thanks in advance!
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177275 tn?1511755244
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177275 tn?1511755244
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177275 tn?1511755244
Yes you could develop a diopter of astigmatism in a year. Sometimes the cataract can do that and its called lenticular astigmatism rather than the usual corneal astigmatism and the cataract astigmatism goes away when the cataract is removed.  You would need for your surgeon to confirm that you have corneal astigmatism of 1.5 Diopters otherwise if you don't you don't need to consider toric IOL for 0.5.   If it is corneal and it drains your budget its probably not worth the extra expense
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Great this was very helpful, thanks for the quick response.
177275 tn?1511755244
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Avatar universal
I'm a bit late responding to this, but which country are you in? (this is a global site). If you are outside the US there are likely more options available.  As I've posted in another thread, I chose to go outside the US for the Symfony lens which isn't yet approved here in the US (and Dr. Hagan's post is from a doctor based in the US).  It   has a lower risk of side effects than conventional multifocals, and likely better intermediate than multifocals, which seemed a better fit for my needs. However each person's needs are different. Before the Symfony came out,  I had been planning to risk the side effects of a trifocal. I figured the odds were tiny that I'd need a lens exchange due to problems, and that risk was outweighted by the potential of having better binocular near&intermediate vision for a few decades than I would have with  monofocals using monovision. I think the tradeoffs are different for younger patients than they are for the average cataract patient who in the US is in their mid 70s and may on average be less active and expects to live with the results for a shorter time.

There are other options available outside the US like trifocals and other extended depth of focus lenses like the Mini Well (which has been used and  studied less than the Symfony so its not clear how it compares, there is a lab bench study that suggests it might have a slight advantage but sometimes the results in real eyes can vary a bit from what is expected from  lab bench results alone. I consider the Symfony likely a safer bet at the moment since its material and shape are the same as the widely used Tecnis monofocals and multifocals so its merely the optics that are different, and there are more study results).
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Thanks for the suggestion. I am in the US, but am not considering going outside of the US for surgery.
If I were getting this done in the US now I'd likely consider a low add multifocal, which seem to have lower risk of halos compared to the older high add bifocals. The vast majority of people with them are happy, but everyone's risk tolerance is different and there is some risk you'll find the side effects bothersome. I figured in my case it was worth the very slight risk I'd need a lens exchange in order to have decades of better vision if I was happy with the result. However if you do get a monofocal IOL, you can also consider the possibility of using a multifocal contact lens over top of it to provide better near vision. In addition to multifocal contacts, there is also a  new contact lens which is "extended depth of focus" thats been approved by the FDA, but hasn't yet hit the market, I think I'd heard it might be out later this year.
177275 tn?1511755244
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177275 tn?1511755244
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Thank you Doctor for the helpful link. I am now deciding between a Tori lens and regular monofocal. I have astigmatism of -1.5. Would you recommend a Toric lens for my severity of astigmatism (also considering the out-of-pocket costs involved)?
Also, my prescription a year ago noted astigmatism of -.5 and now they say it is -1.5. Can astigmatism worsen that quickly? Thank you!
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177275 tn?1511755244
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