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How is your vision after Cataract Surgery?
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How is your vision after Cataract Surgery?

How is your vision after Cataract Surgery?
Please specify whether you got a monofocal or multifocal/accommodative IOL.

I would like to know what distances you are able to see clearly. What distances are slightly blurry, but acceptable, and what distances are just unbearably blurry.

I am particularly interested in those who have received Monofocal IOL set to Distance but I would also really appreciate hearing those experiences with different IOLs. I have heard from several people that with a IOL Set to Distance, they are still able to use the Computer at about 18 inches. This has confused me since I had thought IOL set to distance makes intermediate distance blurry.

Thanks!
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165 Comments Post a Comment
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Avatar_f_tn
Both my eyes are at plano with monofocal IOLs.  My distance vision is excellent.  It would be a strain for me to see my monitor without glasses.  Prolonged computer use without glasses would probably give me a headache.  If you set your dominant eye for distance and non-dominant eye for intermediate vision, you would probably be comfortable using the computer without glasses.

I had a cataract in one eye only but I chose to have cataract surgery in both my eyes.  My post-surgery distance vision in the eye without the cataract is at least as good as my best-correct vision was before surgery.  I've never had a problem with my IOLs.
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This past January, I had both eyes done with Acrysoft monofocal IOL's set for distance. I now have 20/20 vision and only need readers for close up reading. Depth of field is excellent from about 20 inches to infinity. I have a large monitor 24" and can sit back in my chair and read it perfectly without glasses. My wife also had hers done last month and needed the Acrosoft toric lens, she had minor astigmatism, set for distance as well. She's a waitress and was concerned about reading the menus and working their computer, but she has no trouble at all without glasses. Like me, she only needs cheap readers for close up work. You can search my previous posting about my experiences. Let me know if you are in Houston. I had mine done at Berkley Eye Center. Good luck.
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Avatar_f_tn
I had only one cataract, received same IOL set for distance as baggyrinkle, I now do not wear glasses at all for the first time since age 18 mos.  Can see to drive better than I ever could with glasses, and do not need glasses to use the computer or read normal sized print.  I use a magnifying glass for extremely small print, same as when I wore prescription progressive lens glasses.
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Avatar_f_tn
There are many factors that have to be considered with each individual's eyes. I have both eyes done with Tecnis monofocal lens after having the Restor multifocal explanted from the left eye . I have both eyes set for distance . I was astonished at how good my intermediate and close vision turned out. My vision is excellent.  I can use  the computer and sit back in my chair and read the  15" screen and do just about everything glasses free.  I need glasses for small print.  Like baggyrinkle I use the cheap readers.  I have no problem with driving and my night driving vision is terrific. No starbursts or glare as with the Restor.  I am so pleased with the outcome with these Tecnis lenses.  After having had both, I recommend the monofocal lens.  Tecnis has an informative web site you may want to check out. This site was recommended to me by JodieJ.   Good luck :)
  
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I had tentatively planned on getting the Tecnis monofocal set for distance. Your post is much appreciated because it answers my question about how closely one can see clearly. I presume you have the aspheric acetate 1-piece lens. Is that correct? Thanks again.
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Avatar_f_tn
It's not the brand of aspheric monofocal IOL that lets you see up close (or not) when your IOL is set for distance vision--it's your eyes.  Your pupil size can make a difference.  Smaller pupils are supposed to have more depth of focus than larger pupils (like mine).  On the other hand, larger pupils are better able to utilize the benefits of having an aspheric IOL.  (These benefits are explained in the patient education video at www tecnisiol com, and they don't apply to only Tecnis IOLs.)  Another point--conventional IOLs provide better depth of focus (i.e., better near vision when the IOL is set for distance) than aspheric IOLs.  But an aspheric IOL provides better distance vision than a conventional IOL.  (Whether or not these differences are truly meaningful is another question.)  There's a lot of marketing hype put out by the IOL manufacturers.  It's probably best to let your surgeon choose the brand of monofocal IOL.  If s/he has a lot of experience with a particular IOL brand/model, that experience can be factored into the power calculations to get you closer to your targeted refraction.  This will make a meaningful difference.  Having an experienced surgeon is a real advantage.  
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Avatar_m_tn
My Acrysoft monofocal left me at plano for one month. During the next month it went to +1.0. Vision is blurry at all distances. Lenses mostly correct this but also have glare, halos, etc.
Since this is my "good" eye my two doctors say I should live with it. So not a happy camper.
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Avatar_f_tn
"Live with it" translates to: "There is nothing that I know how to do to fix this."  You need to see another doctor--preferably someone with special skills at fixing problems.  You might try calling the ophthalmology department of a major medical center to set up an appointment with a senior faculty member who specializes in cataract surgery.  It might be worth traveling to see a doctor with special skills.
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Your comments are very helpful. (By the way I meant to say "acrylic" not "acetate.") I have small pupils and, before presbyopia set in, had no eye problems, not even astigmatism. Both my sister and brother have had excellent results with monofocals set for distance, and my brother mentioned that he does not need glasses for reading. Perhaps, since he had his surgery a few years ago, his lenses are not aspheric.

I certainly will take the advice of the surgeon, but it helps to be a knowledgeable patient. Otherwise I might become enamored of the ReZoom.
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Avatar_f_tn
I have the Tecnis Acrylic IOL. I was at a point where I would have gone back to progressive glasses again as long as the Restor was out!  After discussing with my surgeon just what I wanted achieve with my vision, he recommended the Tecnis for distance. As I stated before, the results were excellent.  I too had healthy eyes and needed glasses because of presbyopia until the cataracts.  Good luck to you.
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Avatar_f_tn
I have the alcon acrylic toric iols, implanted in both eyes one year ago (August 2009).  They are set for distance w/ slightly different powers.  I can see the tv clearly at 6' away with one eye, yet the other eye is set for about 10'.  I can see great outside, but for most things inside I wear progressive bifocals (clear at the top, 1.25 middle, and 2.50 bottom); this is sooo much easier than having different powered readers all over the house.  I have no problems with night vision or halos or astigmatism and all-in-all am very pleased.  I have tons of floaters (had these before) that I try to ignore.  Have not needed a yag (I'm keeping my fingers crossed on that one).
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Avatar_m_tn
Hi all,
I have the same question as orbitnw has - Can a monofocal IOL see distance object and computer at arm length ?

I am planning to have a cataract surgery on my left eye which has a RD surgery last year. My right eye is -1.75 and has quite a good vision (20/15). My doc expect my left eye to recover to 20/25 or better after the cataract surgery.
I am still making decision of alcon-arcysoft as I had some astigmatism or Crystalens. I just found baggyrinkle mentioned that has both eyes done for plano but his vision can cover from 20" to infinity. This makes me feel that I don't need to take the risk for Crystalens. I wear glass anyway and I have a big monitor as well.
One doc suggested me to have the left eye set at -1.5 to match my right eye. He thinks that if I put a glass near-sighted lens (-1.0), then I can see distance quite well and still have a fair intermediate vision.

Sally: Can you share with me your is the prescription of your IOL ? thanks

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Avatar_m_tn
I think the caveat with all these experiences is YMMV - your mileage may vary.  It's more important to understand the factors that affect depth of field, and to distinguish typical results from best case results.  
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Yes, I have decided to go with the Tecnis acrylic monofocal, set for distance. The only thing I have to decide if whether I want the aspheric. From what I have read you get better near vision from the non-aspheric, but better constrast from the aspheric. Which did you chose and why?
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Avatar_m_tn
Hi all,
I am in a similar situation as allmymarbles.
I also read an article mentioned that aspheric lens will have better contrast and quality with some sacrifice of the depth of field. But it also mentioned that a very good quality aspheric lens may have a good balance of both.

As I am going to lose accommodation with the mono-focal, depth of field seems to be important as well.  I just found disappointed66 and baggyrinkle messages that they can drive and read monitor (let say at distance of 25"). It seems mono-focal is not as bad as I thought. I remember both of you are using aspheric lens. Would you mind share some of your comment on the IOL you chose.
Thanks
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Avatar_f_tn
you know what, my doctor has never done a proper post op refraction, so I do not know exactly what my prescription is (they just gave me the prescription for bifocal readers...I was surprised that you do need a prescription for that even though they are only magnification).  I would like to know my proper prescription so I can make more sense of my vision, depth of field, etc, and when I do find out (perhaps when I go back to my optometrist), I will certainly post the results.  I think what I have is -.75 in one eye and -.50 in the other.  At ball games and outdoor events, I test my eyes by covering one at a time, and the more distant one lets me see more of the fine print on billboards, etc.  But w/ this nice distance vision, I do suppose I am sacrificing the computer range, because I am definitely unable to read the computer w/o my glasses.  No one has ever told me if I have large, medium, or small pupils (I will ask), but if I were to guess, I would say large.  Let us know what you decide and how it turns, because I think all of us find this fascinating and educational (even those of us who have already had our surgeries).  I wish that I had understood more of this before surgery and my doctor had discussed target prescriptions (many docs just seem to ask the patient what their hobbies are and what they do, and then decide what is best for them w/o getting into details). But having said this, I don't know that I would change a thing.

I was really scared about having surgery.  For the toric, an office emplyee was going to be marking my eye in preop.  That made me nervous, and I insisted that the surgeon do it (on the 2nd eye a few weeks later), and he did.  Both turned out fine.

Also, my anesthesia was injected.  Not the drops.  I know that Dr. K. has said that he usually uses the drops.  Again, mine turned out fine.  However, w/ the first, I had a shiner (black eye) the week following surgery.  With the second eye, after I got home and took the patch off 4 hours later as instructed, my eye was pointing off to the side like Marty Feldman, not funny.  It gradually straightened out over the next several hours. I don't think the drops would have this effect.

I have probably said too much here, I don't mean to scare anyone.  I just wish someone had told me about these things, so it wouldn't have been so freaky.  I am totally fine.  Vision is very crisp.  Surgery takes 20 minutes tops.  I highly recommend the toric (my prior astig. prescription was less than -2 for each eye).
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Avatar_m_tn
Sally:
Can you read big or header fonts in the computer with arm length distance like 28" ?
Thanks
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Avatar_f_tn
I think if both my eyes were the same iol prescription (ie both set at my closer range), then at 28' (that's pretty far from the compu), I would probably being reading the largest font (of the 3 on this forum) okay, not great.

just checked w/ a measuring stick..... I can read it from 34'.  If both eyes were the same, it would be better (because it's better when I cover the eye set to slightly more distance).

allmymarbles:  my contrast sensitivity is great w/ the acrylic aspheric!  I really like this end of the trade-off.  

Bottom Line:  it is so great to be able to make an informed decision.  we know we can't have it all (although it does sound like some of you are coming pretty close!).

  

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Avatar_m_tn
Sally,
Okay that means you can read it at 28' with the eye set to (-.75) and 34' with the eye set to (-0.5).
How big is your monitor ?
Thanks
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Avatar_f_tn
28 and 34 were supposed to say " inches ( i guess that was obvious~)

when do you think you will have surgery?   I do not want to give any wrong info since I do not know my exact refraction.

Sorry I am very not very clear in my posts.  Actually, the -.75 (or what I think is -.75) was the eye I was using for both 28 and 34 " measurements.  It's just clearer the further back I get.  

Perhaps some of the other posters can weigh in w/ their post surgery refractions.  That would be helpful ~            

My monitor is 15".

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Avatar_m_tn
Sally,
Thanks a lot for your info. I expect to see the surgeon in a month. Hopefully, I can have the surgery in 2 to 3 months.
I think you can read the computer without the glasses if you switch to a 24" monitor.
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I'm having surgery in two days.  Something I never thought to worry about (and trust me, I didn't think I had left anything unpondered) is will my eyes look different to others, aside from the fact I hopefully will not have four eyes post surgery?  In other words, can you see the lens in the eye?  I saw some photos in a cataract flier today and the lens looked creepy.
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While I cant comment on your situation since you had a RD problem. I can testify about my results and later my wife's. She had some astigmatism and went with the Alcon Acrysoft toric IOL set for distance, which corrected her astigmatism perfectly. I have a 24' monitor and can lean back in my chair and read the screen perfectly from about 2'. Close up I use a cheap pair of readers +1.0 power from about 12 inches. Since you are only doing one eye, it may be a problem balancing both eyes. My wife had minor cataract in her right eye and only the beginnings of one in the left eye. She could have waited for the left eye to "ripen", so to speak, but elected to have them both done one week apart.  Since you are only doing one eye, you may need to wear glasses afterwards to match your right eye. How long do you think before the right eye grows a cataract? They all do eventually. Having both eyes done eliminates the need for glasses other than readers. Good results all depend on the experience and skill of your surgeon. Mine does about 40 a week here in Houston.  Based on all the horror stories about premium lenses, ie Crystalens, Restor and Rezoom, I would not take a chance on screwing up my vision. Good luck and keep us posted.
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Avatar_m_tn
Thanks a lot for your info.
My right eye vision is pretty good and there is no cataract at this moment.The right eye has minor myopia (-1.5) and read 20/15 at distance and close with glasses. I will not touch it and I am fine with wearing glasses.
Originally my first priority is the Crystalens as I thought a mono-focal lens can function well at a limited range. I don't want to change glasses every 5 minutes to avoid straining my left eye. I am suffering a lot of eye-strain at my left eye due to weak vision induced by the cataract (a complication of the surgery)
It seems the mono-focal lenses of disappointed66 (I think she should change the userid  to goodsight101), your wife and yours can serve quite a very wide range (2ft to infinity) this is as much as a Crystalens. I am changing my mind to Acrysoft IQ.

When you read the monitor without the reader glass, how long can you read without eyestrain ? Have you try to use a light reader to read monitor ? Is there any difference ?

Thanks



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Avatar_f_tn
After having such trouble with the Restor lens.  I discuscussed with my surgeon as to the vision I would like to acheive  The left eye was seft for distance vision after the Retor was removed.  After the surgery I was able to see intermediate, close as well as distance.  He just  increase every so slightly the distance lense in the right eye..  My surgeon was the one who suggested the aspherical.  I trusted his jusdment. The right decicision was certainly made.  A good surgeon is such am important factor in making a decision.
Good Luck :)    ( Disappointed no more!)
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Avatar_m_tn
Hi Disappointed no more,
Your result (and the one from LynneAV) sounds too good to believe. Had your doctor mentioned this is just a special case for you ?
As you can see distance, intermediate and close with your mono-aspherical, there is no reason to try multi-focal. When I read the principle of the mult-focal, this sounds really unnatural to me. I don't understand how can the brain pick up the image from a lens set to different zones of focal length. If there is big bus picked in front of me, and this bus will span across all the zones of my multi-focal lens, I guess I will see the bus distorted with if I have the mult-focal lens.

BTW, just want to ask do experience eye-strain before the cataract surgery ?
Thanks
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Avatar_n_tn
Hi Taurus1203,
As someone with multifocal lens vision, maybe I can explain it to you (or confuse you further! LOL!).  The brain is a remarkable thing.  There is no difference in the vision when I go from a distance view and look down to read.  It's automatic, just as it was when I wore distance glasses (before presbyopia set in) and looked down to read.  Nothing different or wierd.  I think the brain does something to "filter" things.  Just as you don't have a "blind spot" in your vision from the space between your eyes.  The brain automatically puts it together.  It's that neuro adaptation thing.  And I do know it takes time, simply because my VA's continually improved over 6 months.  No weird vision during that time, just improving visual accuity.  So looking through my eyes, close, far, or in between, it's "normal".

I did have eyestrain the two weeks in between eye surgeries.  I work quite a bit on the computer at my work.  The operated eye kept improving for reading during the two weeks, and I only had a monofocal distance contact in the other eye.  By the end of the two weeks, I could only work on the computer for about 10 minutes at a time, then had to walk away as I'd get a headache.  Distance vision didn't bother me, but the intermediate and reading did big time just before the second eye surgery.

I don't think I would have done well with monovision.  I don't do well with any imbalance in my vision... I couldn't even walk straight when I tried bifocals once ;)

Did that help?
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You say your good eye is -1.5 and 20/15 distance and you need a small power reader for it?  I take it you do not currently need correction for it now. Which means that the bad eye will be set for distance to match your good eye? Do you have any astigmatism now, which may require a toric lens? The eyes should be balanced as I understand it. Both implants in my case are the same. Acrysoft SN60WF  Aspherhic 18.0 D power, 13.0mm L and 6.0mm Optic. ( I think most all monofocal IOL's are now aspheric). Before my surgery my right eye was completely blurred by the cataract and I had a minor cataract in my left eye. Like you I was reluctant to have anything done to it. But, after the right eye came out so good I felt,  why not fix the good one now rather than wait. My Dr. agreed and stated that best results occur when both eyes are done at the same time.  Another factor which effected my vision the most was glare caused by the cataracts. I had a lot of eye strain before, because of the unbalanced eyes. In your case, once you fix your bad eye both eyes should be the same.  The only time I use my readers at the monitor is when I'm up close typing from about 15". While I really don't need them in that case, it just makes it easier.  But, kicked back in my chair I can read the screen all day without eye strain.  I know all this is subjective and may be different for others.  I have a Kindle eReader and can set the font to where I never need readers to use it. Especially, outside in the bright sun, I don't even have to take my sunglasses off. I find that reading a newspaper requires my 1.5 readers. And I also need the readers for menus in dark restaurants .  The most important factor obtaining a good outcome is the pre op testing and measurements, and the skill of your Dr. I can't stress that enough! Judging from most of the sad stories here on the forum the pre op measurements and skills required seem to be lacking in those cases. You better live in a big city with top named surgeons and the very latest high tech machines! Good luck.
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My wife and I both had ours done, and have had people comment on how clear and sparkling our eyes appeared. Yes, they will improve your look! Your eyes will look young again. And, no more red eye in photos, instead they come out sparkly white.
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Avatar_n_tn
I never thought about the red eye.... that's a cool perk!  Camera's now a days have red eye reduction, but it doesn't stop it all together.  Thanks!  No more "red eye paranoia" when I get my picture taken!
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Avatar_m_tn
Thanks for your explanation. I think I understand your point. But I am thinking is everybody's brain can adapt to the new mechanism introduced by this lens or someone may take longer time.
In some of your previous posts, you mentioned your vision is 20/200. I think you meant the vision without glasses. Correct ?
After the surgery of your first eye, which eye did you rely on to see or read during that 2 weeks ? Does your headache induced by the imbalance of vision ?

thanks

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Avatar_m_tn
Thanks a lot for your info.
I don't have much presbyopia on my right eye. With the same glass (-1.5), I can read 20/15 for distance and small print (J2). My right eye can read J1 after taking out the glasses.

I plan to set my left eye the same myopia to the right to make it balance and correct astigmatism with toric. Then I can wear a glasses with 2 lens the same or very close.

My left eye has a myopia -4.5 and version is 20/50 due to the cataract. This is side effect of the RD surgery. I experience eye strain and sometime even headache. I also have light sensitivity. I asked my eye doc and the surgeon and they just thought that I paid too much attention to my eye. They advise me to be relax and take a break after reading the computer for 20 min and the eye strain will be much less. I got some 2nd and 3rd opinion from other eye docs. They think that taking a break and keep relax would help but cannot solve the problem. They think that my root cause should be the difference of myopia being more than 2 diopter and big gap in vision of 2 eyes. After reading stories from you guys, I am more convinced that the cause of my light sensitivity, eye strain and headache should be a direct or indirect side effect of my cataract.

Thanks
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Avatar_n_tn
Hi taurus1203,
Not sure if everyone adapts, or adapts at the same rate.  I know I was always pretty good at those covergence/divergence things.  I also practiced them awhile after my surgery.  It's on this site... about 3/4 down the web page.  http://www.eyecanlearn.com/  Not sure if it helped, or I just naturally adapted.  An example also is some people can tolorate the monovision or mini-monovision well, and others can't.  Why don't some adapt?

I was 20/200 before my surgery without glasses.  With glasses it was 20/20 and I could read with them on until presbyopia set in.  Then I had to take them off to read.  I think I relied more on my restor eye in the time between surgeries for computer work and reading, as I remember closing the unoperated eye sometimes to alieviate the eyestrain sometimes while working.  I wore my husband's readers in between that time for the newspaper at home which helped. Distance wasn't a problem, since the temporary contact was a distance lens.  I tried popping a lens out of an old pair of glasses for late night TV after removing the contact, but that didn't work at all.  I had double vision with that method.  I was glad it was only two weeks between.... I got along ok, but it wasn't optimal.  I haven't touched a pair of glasses now since that time between surgeries.

I agree that gap in your visual accuity is causing some problems.  2 diopeters is a lot, and I wonder if it has something to do also with correction by IOL in one eye, and correction by glasses in the other.....  Better I think both eyes corrected with the same method, and not to far apart in accuity.
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Avatar_m_tn
Hi,
Do you mean you can use your operated eye immediately after the surgery ?
If you don't close one of them, which eye do you have strain ? Or both.
Did you get headache from this eye strain ?

I actually have 3 diopter difference between my 2 eyes. I plan to  set the my left to be (-1.5) which is the same as my right one. Then I  will wear glasses as I don't mind.
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Avatar_n_tn
Yes, my eye (although not perfect) was way better than it was without glasses before surgery.  I rested awhile, and when I went back in the afternoon for re-check, the eye was 20/40, and then he popped the contact I could have into the other eye.  I wore sunglasses on the way home, but I was taking in as much of the scenery as I could!

The eyestrain would get like I just couldn't focus.  I would blink a lot and try to bring things into focus.  Then it would cause a headache from not being able to.  That's when I'd get up and walk away for a bit.

eye strain was in non-operated eye.  No problems now.  It's like I never had vision problems.... that my bad vision I had had since I was 7 was just a bad dream....
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Many thanks for all your help. I guess the only question not answered is which brand of lens  you chose. I was thinking of getting the Tecnis, but if there is one better, or just as good, that would be good to know. Some surgeons have a preference, so an alternative may be necessary.
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Avatar_n_tn
My eyes before my recent surgery were quite different, one much stronger than the other. The surgery was on the weaker eye with the other to follow soon. I received an Acrysoft monofocal IOL set for distance. I'm told I have some astigmatism that was not there before surgery. Before I needed glasses for distance but read and used the computer without them. Now I have 20/30 in the operated eye and cannot read with it unless the print is very, very large. My vision in that eye is blurry at any distance, but I can drive with it, yet not read with it.
Now I am wondering whether it put off the second surgery. I spend a lot of time reading and in other close work and am concerned that I may end up needing bifocals or even 2 pairs of glasses. Even with the mild cataract in the unoperated eye, I can use it to read without significant strain.
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Avatar_n_tn
Hi album,
If you've had a monofocal lens put in one eye already, I think the only option is monovision, or minimonovision if you want to get by without glasses after having the second eye done.  But you might need glasses for some very fine tasks, or for times you need absoultely clear distance vision.  I don't think they can put a multifocal lens in a second eye after the first eye was done with a monofocal.  I'm certainly no expert though.......  Sounds like you had monovision before your surgery so maybe that would be right for you.....
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Avatar_n_tn
Old thread here, but pertinent for me.  Seven days ago I had a left cataract extraction wtih monofocal lens implant at age 54.  I was a high myope, -7.5.   The doctor said I had some astigmatism and I was willing to pay the extra for a toric lens, but after additional readings the doctor said he could do the correction with a monofocal lens.

Even before the cataracts the world at a distance was a blur for me without glasses. The cataract grew quickly so that my vision with glasses couldn't be corrected better than 20/50.  Seven days out from the surgery with the monofocal lens set to correct for distance, I have 20/30 distance vision in my left eye without glasses.  I had forgotten how beautiful the world is!  To me, the detail is exquisite, amazing.  It's a rebirth of perception.

That said, there is a distressing downside.  I read all the time at work and at home.  I wore glasses to read (presbyopia starting in the late 40's) but could read with some small strain without glasses.  Now the printed page of a book is a complete blur with the left eye.  I can read on the computer if I magnify (zoom) to 150-200 and sit back a few feet.  This is a complete reversal of how I've lived most of my life.  I feel like Burgess Meredith in that Twilight Episode, the last man on earth happily surrounded by a mountain of books who then breaks his eyeglasses and can't read.

That said, I wouldn't change the way the monofocal cataract was set for distance vision.  I'll just be sure to keep a large stock of reading glasses on hand.  

Tomorrow I have cataract extraction in the right eye, and this time a toric lens will be implanted in the hopes that I can achieve unaided distance vision in the right as good as the left.  The right eye does have a higher degree of astigmatism.  From what I've read here, the toric lens does have a greater chance of suffering from complications. But I will take the chance to be able to walk along the beach without glasses, to actually see the waves on the horizon without foggy lenses.  Due to allergies and dry eye I've never tried to wear contact lenses.

As Miranda said in The Tempest when she "saw" others for the first time:

O wonder!
How many goodly creatures are there here!
How beauteous mankind is! O brave new world
That has such people in't!  
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Avatar_m_tn
Hello, I too am reading this old thread and found it helpful.. Am post vitrectomy patient who has developing cataract and am doing my homework.

Would you please share your results with us please?
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Every sort of bad result from cataract surgery can be found on the internet, but in my real life I know not a single person who is unhappy with his or her results. I think I can say truthfully that everybody I know, or else their mother and/or father, has had cataract surgery, and I don't know of a single bad result. Everybody I know received standard monofocal IOLs (usually what Medicare covers) and nobody did any personal research prior to just showing up and letting the doctor do his thing. Frankly, I am sorry I researched so much, because it put me in a state of unnecessary worry.

My personal experience was wonderful. For the first time in my entire life, I can function -- including driving -- without glasses. I now wear progressive lens glasses without correction on top a lot of the time because reading glasses annoyed me and I wearied of putting them on and off and losing them and toting them around.  But I only really need them for reading, and find them easy on my eyes for computer work without straining because of the slight correction for middle distance possible with progressive lenses. I wish I could have had this operation when I was 2 years old.
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Thanks for your response, and I am so happy you had great results.
I too am doing my "homework" and probably (?) have too much knowledge about this procedure and complications, however I had a Vitrectomy 6 ,months ago.  Prior Vitrectomies pose additional risk with the Cataract surgery, so I am of the opinion that I would rather be over-informed than under-informed and have regrets if I select the wrong Surgeon.
Some things cannot be controlled, and I understand that.  I just have to know for myself that I did the best I could.
Anyways, I am hoping for good results like you.  Best of luck in the future, and thanks again for sharing your experience.
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I was wondering how well the progressive lens glasses have worked for very close distances. For example, if you need to see something close up in the mirror, or need to read fine print, can you do so or is a separate magnifier required?  If close vision isn't good with the glasses, about how close can you get before vision becomes blurry again? Thanks.
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i had Cataract Surgery bit over week ago with a lense added, i cant see close or far with good focus of any kind. now im worried about getting my other eye done.. i am having a hard time to see this as i type.wil my eye get any better as  time heals?i do not turst all surgeones.. some say u can see clear  pretty good after surgery, they are pretty lucky if so.


Mr Angel
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Dear Friends,
I had cataract removal for both eyes on May 28, 2012 and June 4,2012. My vision has improved significantly and at 62, I feel that I am looking at things in real colours and splendours. I have similar experience as described.
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If I had to do it all over again, I believe I would have opted for a medium distance monofocal IOL instead of long distance.

Why? Because I see absolutely nothing clearly from inches to 6 feet without "readers". I was so used to being able to take off my glasses, do fine work up close, and read without glasses. My work and hobbies all require close work. Now, it's a struggle to find anything to use that works for both reading, detail work and also seeing the computer screen. I have 4 - count them 4 - different pairs of readers" that I'm constantly changing out for different tasks. Bifocals are useless due to the fixed focal length of each lenses, and progressives don't seem to cover all of the close in focal ranges with enough width in the progression. I tell people that I can see two gnats making love on the back of a bird 200 feet away, but can't recognize a face sitting across from me. Exaggeration, of course, but it's frustrating. I was not a candidate for multifocal lenses, so I cannot comment on them.

Having zero focus of accommodation at any distance was something I was unprepared for. I thought that at least there would be some range of natural accommodation, although very limited.

Having said all that, the ability to feel safe driving again (reading street signs - judging distance - headlight glare), seeing true colors again, and not being blind at the pool without my glasses is truly marvelous. I just think that for me, I could have made a different choice. It's well worth checking out options well ahead of time. I didn't do enough homework. I knew that a monofocal would be better for me than a multifocal and went from there.

I had inquired about the accommodating IOLs as well, but my practice stopped using them entirely, due to patient feedback and problems. They do use multifocals with select patients.
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Hi,
glad to read about this. Can you please tell us, which kind/brad IOL did you get?
I am planning my Ctaract removal in next weeks...
Thanks
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From this thread I can tell, that where you want your focus is an important consideration.  Because I'm quite nearsighted, I'm used to reading small print easily,  and even books by just getting close.

My surgeon post op is looking for me to be no longer near sighted, so  reading glasses will be my constant companions. Ick.

He would like me to consider a  toric lens -- an upgrade not covered by insurance -- after cataract removal for great vision unaided ... except of course for those readers.  Years ago, I wore contacts constantly and had to read boat plans which are TOUGH, so I resorted to a magnifier. I realized without contact lenses reading the tiny blurred type would have been  easy.

BTW, the vision in my non-dominant eye is messed up, so two-lens solutions for seeing at a range of distances won't work in my case. Drat.
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If I could do it all over again, my decision would be to try for intermediate and close for reading.  I would not mind wearing glasses for driving.
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I have read all this and still cant decide on just a simple question---do I choose to be set for nearsighted or far sighted? I am pretty bad either way at present and will be having one eye done with a lensd to correct astigmatism in one week from now. The other eye has a small cataract butm Im going to wait.
If I set for far sighted---it sounds likeI may need many different glasses for close ups. If I set for near sighted, I think Id only need one pair for driving, etc. Im now afraid that I will have ne focus at all after doing this. At present my vision in the one eye is so blurred that I cant drive with it so at least that will be better, right?
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Sorry about the delay in responding, but my implants were Bausch & Lomb LI61AO aspherical lenses.

One further thought regarding the long/intermediate/short thing.....

If you opt for long distance vision, and you lose or break your glasses, you can always get some cheap "readers" at any drug or variety store to get by with, but you can't do the same if you are fixed at short distances.

I don't think there is a truly clear answer. All I know is, I was used to taking off my glasses and seeing extremely fine detail, but that is now lost.

On the other hand, it's nice being able to not wear glasses at the pool, or walking, or other activities like that.

I spend most of my day at work on a computer, so short to intermediate would have been great for that.

I will be getting progressive lenses and try to stop agonizing over the decision I made. I've worn glasses since I was 6, so no big deal.

And yes, the clarity to be able to drive safely again makes it well worth doing, whatever you decide. The prime reason for the cataract surgery is NOT to eliminate totally the need for glasses, but to get that clarity back - with or without additional correction.

You will also be amazed at how your color perception will change.
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Hi Trapper,
I always discuss the "3 Visions" with my patients (Distance, Intermediate and Near) and I specifically discuss "which activities do you perform without glasses." These are very important and most cataract surgeons who are also refractive surgeons are well versed in this discussion. I am personally a big fan of blended vision: dominant eye for distance and non dominant eye for intermediate (-1.25 D = 32"). This gives a range of focus without the full need for glasses. I hope this helps.
Sincerely,
Timothy D. McGarity, M.D.
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Thank you Dr. McGarity.

Let me also qualify my statements regarding choices, in case it helps others. I have other eye problems that would preclude either multifocal or using alternate focal lenses in the individual eyes. Either approach might not be good for those with retinal problems, or visual field defects. I now realize why these approaches were never mentioned to me as choices, but the practice does offer them. I think my Dr. believed I already knew they would not be approprite for me, hence we spent no time talking about them

As you state, the professional who knows the status of your eyes would/should thoroughly discuss this with you in order for you to make the best decision. With multiple eye problems, the choices may be limited.

I remember talking to someone shortly after my surgery who was raving about her accommodating IOLs, and I got briefly disturbed that they were not offered as a choice to me. A few minutes of "googling" and a followup conversation with the practice quickly squelched my concerns.

For those of you who can take full advantage of the great technology available, go for it . . . . . . . . ..
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I am 43 and just had left IOL toric lens replacement about 6 weeks ago. And liike you, I can see super far but at 5-6ft and beyond. My right eye has a cataract but it is no where near needing surgery. I don't need to see that far away. I did virtually no homework and am very sorry I didn't. I used to wear bifocals and now because the vision is good in the left and so bad in the right I can not wear glasses. I have to have a contact for the right eye. My vision was so poor to begin with that finding a contact was virtually impossible. I have to wear so many different readers depending on what im doing. And since both eyes are so different they both kind of compete with each other and my eyes feel like they are crossing.
I have been to 3 different doctors and they just cant seem to get the eyes close to seeing the same thing. They say I may not need the other lens replaced for years.
The actualy surgery and lens replacement was fine. I just wished my vision wasn't set to see so far away. And waiting to get the right eye done is so frustruating. Just not sure what to do in the mean time. And what happens on the day I can't wear the contact for some reason? I just about can't do anything.
Just do your homework as others have stated. I am miserable in this in between time.
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Hi,

I hope someone who's had mini-monovision done will be willing to comment on the following concerns because I plan on  IOLs after cataract removal soon, probably mini-monovision. I have a very reputable ophthalmologist who is also recommended by my retina specialist, and many friends have been happy with their results from this cataract surgeon (but none of them know exactly what they had done)

I also suffer from severe dry eye & eye allergies (undoubtedly exacerbated by the dryness).  Right now, it's controlled to just-tolerable levels with Restasis, antihistamines (oral & drops) & multiple types of artificial tears, & I just learned about one other non-prescription option from one of Dr. Hagan's blogs that I've ordered to try.  I've worn glasses since about age 14, so I don't mind doing so post-op.  However, if I have one eye set for intermediate and one for distance, then I'm worried that I won't be able to check my eyes closely enough:  for filaments, redness, stray hairs, etc., not to mention apply eye drops inside or ointment to the margins to control chronic blephariiis  --  all of which seem virtually impossible while wearing eyeglasses.

BTW, I can't risk a trial of full-monovision, because even before my eyes were this dry (i.e., 30 yrs ago) I wore contacts and had to give them up due to dry eye & multiple related symptoms, and my work relies on decent vision.

Can those of you who have had mini-monovision done (i.e., IOLs for both eyes already) please comment on how well you are able to examine your own eyes or apply eye ointment to the lid margins,  If you do comment, please indicate what type of mini-monovision you had done, if you know.  Thank you!!
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I was near-sighted before cataract surgery.Now My dominant left eye has 20/30 vision with the IOL . So for 9 months I have been seeing distance  and near--and my midrange is pretty good because I have been able to use the computer. This seems like a good deal so I am considering monovision-- having my right eye done with  an IOL for near vision.  My doctor I would see the way I see now.

II'm informed that  with monovision there is some loss of peripheral vision
as well as depth ( I won't be able to watch a 3-D movie) . I don't drive very often and when I do  I don't  seem to have a problem, but  I am concerned about night driving, so I wonder if I could wear glasses that would correct both these problems .  I would appreciate hearing from anyone with monovision after cataract surgery as soon as possible  to know what your experience has been.  I am due for surgery very soon.  Thanks
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Can your wife see well enought to put on eye make-up??
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Hi Lynn,
I only 33 years old and trying to decide between getting a regular lens or the restor multi-focal.
I'm wondering if you would see well enought to read a text or put on eye make-up... things like that without glasses?
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I have similar issues as you.  My right eye was set for distance and my left for close.  Before, I was able to see very well at close range so I always took my glasses off to see close.  I needed glasses for distance.  Now, I was told that the Retina receives two images and the brain selects the appropriate one.. however, my brain refuses to do that and the result is that I can't see close or far!  Both are a blur.  If I cover either eye, I can see perfect, but with both eyes open, is a blur. I'm 72 and my Dr. says this doesn't help and that I need time etc. But after three weeks of the last surgery in my right eye, nothing has changed. I'm really frustrated because I can't see!  I opted to cover one eye and walk around looking like a "pirate"
but that was just to test each eye separately.  Obviously, I cannot "solve" the problem doing this.  I had the Standard Monofocal IOL lenses implanted.  Thanks for any suggestions. Helen
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I have a similar situation, though only 58.  I had one eye only with cataract due to Vitrectomy SX.  That eye came out with the IOL at approx. -.50=a little near sighted.  My good eye is +1=farsighted.  At first the eyes fought each other and did not fuse the 2 images well.
After several months of slow improvement, I am to a place where my brain does a pretty good job at it and I can live with the results. Wear glasses for computer and a different pair for reading.
My advice is to give it a few months if you can, and really try hard to take your mind off of your vision.  Let your brain do it's neuro-adaptation to your new eyesight.  The brain is an amazing organ that can adapt to most changes, but it takes time.
Good luck to you.  
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Hi, you really have a good result in explanting the iol. May I know what is the doctor's name?
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I'm similar to yourself!
I'm 67 and I've recently had cataracts removed from both eyes and toric lens inserted. I had severe miopia and astigmatism and also have Fuchs Dystrophy. I decided to go ahead with the operation because I was on the borderline for driving. I was struggling to read road signs and to recognise faces from a distance but could read and use my PC (I work in IT) without ,spectacles. I went to a reputable private Eye Clinic via my work health insurance although had to pay for the upgrade to toric lenses. I used a consultant with a good reputation and when I was examined, he told me that he belived I would be O.K. without any surgery for the Dystrophy. I had the operations with a 4 week gap between each eye. Both operations were totally painless and the consultant told me  they were clinically perfect. My eyes have been checked and I'm told that the Dystrophy has not deteriorated because of the operation and the new lenses are in the perfect position. The consultant gave me the choice of long or close vision and I chose to improve the long range vision and to get spectacles for reading and PC work. The consultant was very optimistic that i would have good long-range vision and that most - but not all - of my astigmatism could be removed. Sadly, although it's now 8 weeks since the first eye was done and 4 weeks since the second eye was done, I cannot see clearly either for reading, using the PC or at long distance. The right eye seems to be improved re the astigmatism but the left eye does not. The eyes definitely have different focal lengths and I'm getting floaters on a daily basis from the left eye, although not severely. The consultant has told me to continue putting in eye drops for another month before I go back to see him again. After the first eye was done I had an eye test at the hospital and with the addition of lenses found I got good vision. Hopefully, it will be better than what I had previouly with spectacles but it's still pretty disappointing!
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I just recently had cataract surgery done. I am  56 yr old female with dry macular degeneration in both eyes, and I have fuchs heterochromic iridocyclitis and glaucoma with an ahmed valve in my left eye. I have been near sighted all my life so was accustomed to taking my glasses off to read and do computer work. Since the cataract surgery which has given me 20/20 distance vision it has really messed up the rest. I can not even see without cheater aka reader glasses to cook with as I have no focus in the intermediate range.
There was never once any discussion on the lens type and the pros and cons of which way to go. I am very disappointed.
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From everything I have read I would stay away from the multi focal lens as there are many problems.
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I also forget to mention both my lens are Abbott's AR40e with a 17.5 diopter.
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I'm really surprised your doctor didn't discuss doing mini-monovision with your monofocals...then you would have been able to do mid  and most close activities without readers including things like computer or cooking (only needing them for extended reading)...although your distance would not be quite "razor" sharp: but very good nonetheless...that is what i had... i am "readers free" like 95% of the time...
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Hi,

I had Refractive Lens Exchange (or Clear Lens Exchange) beginning of December 2012 in both eyes (one week apart). I have LENTIS Mplus lenses in both eyes (multifocal lenses).

I was 44 years old when I had my surgery.  I was very longsighted and my vision was getting worse and worse before the surgery (in 6 months time it went from +5.75 to +6.25 in one eye).  

After the surgery I had dry eyes (my eyes were always tiny bit dry) though I panicked that something else was wrong - retinal detachment, glaucoma,...name it...I was paranoid that I had all of those.  The other thing which I noticed a little bit later was slight ghosting but that is only when I spend time in front of laptop screen or TV and eyes get tired.  I also can see in my right eye small tiny floaters, though I only started seeing them after someone mentioned those.

My night vision is okay though sometimes when I think too much about it, it can be annoying.... unless something else distracts my mind.  Though, on a bad day, inside every shop it looks like a disco.

Those are 'bad' things.  I use Clinitas Hydrate for my dry eyes and it helps.  From using it 6-8 times a day I now use it once or twice.  Ghosting is still there but my brain is getting used to it.  Floaters are there but they are only there when I think of them.  Halos etc...well, I always had them so they might be there but in slightly different shape.

And my vision????

PERFECT!

I wore glasses since the age of 3 when I contracted measles and due to high temperature my optical nerve weakened.  My sight got really bad though it got better over the age.  However, since my twenties I am wearing glasses and prescription was getting slightly bigger and bigger until last few year became really bad.

My left eye is now between +0.25 and +0.50.  My right eye is between +0.50 and +0.75.  I didn't wear glasses since I had surgery apart from couple of times my colleagues reading glasses when I tested the reading of the small print from some distance.  I have slight astigmatism since ever so that might be the reason for the slight ghosting in vision.

My vision is - left eye 20/15 and right eye 20/20 (though right eye sometimes does better).  

I visited more than one surgeon and optometrist to get the second, third and fourth opinion (we all love our eyes, don't we?).  They were all impressed with results, in particular with positioning of lenses, and they did thourough tests on my eyes.  My prescription didn't change since January (it takes some time for prescription to settle).  I know I might have to visit my surgeon for YAG laser of posterior capsulotomy. I was told about potential YAG so no problem there.

So....would I chose multifocals again?  YES.  

The ones I have are great.  I have no problem with the vision.  I had a problem how to adapt with new vision, what someone said here 'it is also in your brain/head'.  I see things I never could before without my glasses.  Eyes are also looking healthy with few bloodshots but that is due smoking in the past, computer use, exercise.

All eyes are different.  Some adapt to multifocals, some don't.  Some adapt to monofocals, some don't.  That is why you need to get a proper consultation with your surgeon who should explain to you all risks in details, including the side effects.  Also, you need to understand that your brain needs to work with your eyes.  Don't just expect 20 minute miracle.

Once you know what to expect - go ahead!  It will change your life for ever.  
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Greetings, I am a 57 year old male who has to undergo Cataract Surgery. I have very poor vision in my left eye that is basically non-correctable from an undetected case of  lazy eye when I was a kid. In my right eye with my progressive lenses I enjoyed good vision until the cloudiness of the cataract set in. Unfortunately that is the eye with the worst cataract although I have them in both eyes. I also have a touch of astigmatism and have been on lumigan for 3 years because of high IOP but that is now greatly controlled with the drops and my IOP is normal.

I am set to have my good eye operated on next week and am scared to death having only one good eye. I was all set to do multifocal because of all the benefits (marketing I read) but in my pre-op yesterday my doctor ruled that out. He shared some of what is on this thread about the complications plus other individual factors that make me not a good candidate. He is also uncertain based on my measurements if I am a good candidate for a toric lens. My eyes were pretty dry from the nightly lumigan so the measurements were kind of iffy and m doc wants to redo them after stop using the lumigan plus some lubricant drops for a few days and go back a couple of days before the surgery to get the measurements done again.

So.. now that I now I have to go with monofocal I am confused about how to have my distance set. Near, intermediate or distant. I live on a computer for my day job in healthcare technology. As I have worn glasses and until the lumigan used to wear contacts all the time, I am excited about the potential of no more glasses for normal activities and have no problem wear reading glasses for the close up as my eye doctor shared would be the case.

I want to make an informed choice. I have a highly skilled doc who has been doing this for 30 years and did both of my parents with great results.. so I have a lot of trust there.. Don't want to over think this but any advice before the surgery would be a big help!

Suggestions?? Thoughts?? Comments... MANY THANKS!
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I like the ability to see  computer, read a book as well as a small print newspaper/magazine in good lighting, and seeing well enough intermediate that I can get my without glasses. Keep pair o driving glasses in the car; keep a pair of reading glasses in living room, , and flashlight and magnifying glass in kitchen for package instructions and incredibly small print on electronics.
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I have lousy vision after implants. One eye now requires a +2 diopter prescription lens. The other implant must be overpowered, as I see nothing clear out to about 6 feet. Absolutely horrible depth of field. I was told this was all within the margin of error, as I was very miopic and the shape of the eye was the cause. I don't know what to believe, but it's made a real problem with getting glasses that will fix the problem. I can't get by with "readers", as both eyes are so different, and I cannot see clearly out to 6 feet without lenses.

Bah humbug.
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Oh, these were aspheric monofocal lenses.

If I had to do it over again, knowing I would still need major glasses after surgery, I think I would opt for an intermediate distance focal point so I could clearly see for most things without glasses (like faces, the TV and computer), and fairly equal degradation at both distance and close up. Progressive lenses would probably be easier to make for that type of eye, but that's pure speculation on my part.

I've never gotten a satisfactory explanation of why the two eyes came out so different. There's a lot more to the story regarding my eye woes, and the eye that requires the +2 diopter correction had an epiretinal membrane - since removed, but the retinal surgeon did not think that should have made the initial calculation that far off.
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What was it you and your doctor were aiming for  in each eye.  You have already had both eyes done?
On the one eye I had done, my surgeon was nice enough to admit he had done one of the measurements wrong.  He said he could do lasik adjustment but I declined. Because everything was blurry no matter what glasses or contacts I tried, an epiretinal membrane was removed and now images are clear.  I have very limited depth of field but can read and use computer. .  So sorry you are having an unsatisfactory outcome.  Hang in there and keep trying to find answers..
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Thanks.

I'm about to write an epic ranting post regarding what led up my current problems, in hopes that both the docs on this forum will take it to heart, and also hope patients can learn from the mistakes and how to take charge of their own care.

Rule #1 - don't trust what you've been told - independently seek out information and other opinions.

For example, lens implants can be quite amazing for restoring cloudy, discolored vision, but temper your expectations and ignore the marketing hype. Pay attention to the little "gotchas".
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I certainly  agree that you should learn all you can before cataract surgery. Also you should choose a surgeon who will explain all your options to you and explain his advice for you. I knew very little before my surgery, and my doctor listened to my comments about eye strain and simply said, "Let's do it."
I got no explanation about the loss of flexibility in my vision I would experience. My vision was set for distance in the operated eye, and I am glad the cataract in the other eye remains mild because I can still see well with it for reading. For reading captions on tv, I wear glasses; the correction is not very good, but I can do everything I need to: drive, read, and do housework, etc. I couldn't play tennis, but I wasn't doing it anyway.
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Had cataract surgery with ACRY Sof IQ IOL by Alcon implanted in my bad right eye on 1/23/012, 20/20 vision post surgery, with no issue, a year later same surgeon said he can easily take care of the secondary cataract in my right eye, with laser surgery in his office, now 19 months later, I am deliberating the pros and cons of YAG laser capsulotomy, and found this in depth article by New York Times about cataract surgery, if it was available two years ago, at the time when I was researching before my cataract surgery, I'd make sure requesting the best IOL and to triple check and remove all debris to avoid POC (Posterior Capsule Opacity) from my VERY reputable surgeon.

http://health.nytimes.com/health/guides/disease/cataract/print.html

I'd NOT elected to have my cataract surgery if it's 3 out 4 possibility to have secondary cataract as stated in this following link, plus, from all I read online so far, it's at least 10 times the risk of cataract surgery for YAG laser, NOT 1/100th as stated in this link " A YAG laser capsulotomy is a surgical procedure, however, the risks of a serious complication resulting from this procedure are about 1/100th of the risks associated with a regular cataract operation." -
http://www.prk.com/cataracts/yag_laser.html

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3 people (including myself) had IOL implants within a year or so of each other and with several diferent surgeons. I can thus say by experience, and from anecdotal evidence that the following "hypes" are not true.

1. You will most likely be able to get by with cheap pairs of reader glasses for small print.

Not even remotely true in our cases. All of us need prescription glasses - some quite complex -  for daily activities. Granted, more comes into play, like astigmatism, in determining the need for glasses, but the hype might lead you to believe otherwise. One did not need prescription lenses for a while, but now does, which leads to . . .

2. If you do need glasses, you will not have to change your prescription to get new glasses very often, if at all.

All of us have gone through several prescription changes since healing from the IOL implants.

3. You will have some limited focus of accommodation, so medium and long distance vision will be adequate with a monofocal IOL set for distance.

Only one of the three can say they see fine at medium and long distances and note that their eyes seem to focus by themselves slightly. In my case nothing is truly clear (in my one plano eye) out to about 6 feet.

4. There is a slight chance you will develop a PCO months to a year or so following surgery that can be taken care of with a safe YAG procedure.

All but one have had PCOs in one or both eyes removed by YAG. One has PCO in both eyes, but not bad enough yet to risk surgery. One developed bad floaters following PCO. YAG surgery can lead to floaters, increased IOP (glaucoma) and retinal problems, so it's not as safe as hyped.

5. Limbal relaxing incisions can be done at the same time as the IOL implant that will correct your astigmatism.

One had it in one eye, and the astigmatism became worse.


I have talked with others, other than we three, who have similar experiences,so we are not unique.

Please don't get me wrong. Modern cataract lens replacement is a marvelous, sight saving/improving thing, but just be aware of he realities.
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How much your vision improved post YAG?   What's the percentage of problems post YAG from all the people you know?  I truly regret having my cataract surgery 19.5 months ago, and worry about making another mistake for my impending YAG.  Thank you for sharing your experience!
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I have not yet had the YAG. Others in this group have, and saw a big improvement. One experienced additional fioaters, but says they gradually diminished.

My PCO causes loss of detail and some reduction (about 2 lines) of acuity.

I'm waiting - this is my only good eye left.
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By the way, Dr. Hagen has a post somewhere with a good description of what should be expected, distance wise, from near, medium and far IOL implants. I'll try to find it.
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Thank you for your info!  TrapperV, So glad the vision improvement post YAG of your group, I'm more confident to under go YAG in November now.

I've read Dr. Hagan's most informative report on Cataract surgery, I most likely would wait till my Cataract affects my vision then consider surgery, if that report was available two years ago.
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Avatar_m_tn
I have found this thread extremely useful and want to post my own experience.

I had cataract surgery in my right eye 7 weeks ago and in my left eye a little over 3 weeks ago. I got new progressive lens eyeglasses yesterday.

The broad points:  I have been extremely nearsighted since I started wearing glasses at age 13. I chose to have monofocal lenses (Alcon AcrySof IQ SN60WF) set for intermediate. With my new glasses I have excellent vision at all distances. Without glasses, I have excellent vision for reading and computer/desk work. (Vision from 1 to 2 feet is perfect) My distance vision is better than it has ever been without glasses. I could not pass an eye test for driving, but I can read a license plate at ten yards in daylight. The picture on my 55" TV is blurry from 10 feet, but I can read the onscreen program guide.

Here are the details: My eyeglass prescription before surgery was -7.50 in the right eye with astigmatism of +1.50 and -6.00 in the left eye with astigmatism of +1.00. My surgeon targeted -1.50 in both eyes as a goal for my surgery. The result of surgery in my left eye was -2.00 with +0.50 of astigmatism, and the result in my right eye was -1.75 with +0.25 of astigmatism.

The letters were blurry, but without eyeglasses I was able to read the 20/50 line with my left eye and the 20/70 line with my right eye. (I recognize that this result is not consistent with the prescription for my new glasses).

I was surprised that the surgery greatly reduced my astigmatism even though I did not have any specific surgery for astigmatism (LRI). I read somewhere that the placement of the incision for cataract surgery could somewhat correct astigmatism. This seems to have been the result in my case.

I also had ECP surgery to address my glaucoma. My pressure test a couple of days ago showed pressures of 13 and 11. I no longer have to use glaucoma eye drops.

Bottom line is that I found this surgery to be miraculous. One will certainly second guess their lens choice. I certainly have. I enjoy the ability to read and use my computer without glasses. I am happy with that choice. I expect that if I had chosen distance lenses, I would have enjoyed their benefits as well.

Chances are almost certain that cataract surgery will greatly improve your vision. Don't let second guessing your choices ruin your enjoyment of that improvement.
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Avatar_m_tn
I should also add that I do have diagonal light streaks when I look at street or car lights at night. My surgeon thought this was due to astigmatism and the streaks would disappear when I got glasses. They did not. The streaks are certainly liveable, but I will mention them to him when I have my next examination in 3 months.
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Avatar_m_tn
I think your Doctor has done best for you by setting for 10 and 6 feet. I think it is best Optics wise. Do you also use glasses for far distance beyond 10 feet or for driving?

My doctor has set my left eye for far distance vision during cataract surgery. Now I am in fix for my right eye.
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Avatar_m_tn
Lucky you are because your Surgeon gave you best advice for setting both eye for Intermediate and you can work on computer without glasses. (I am not so luck as I am set for far-distance in left operated eye).
Are there any updates on "diagonal light streaks when I look at street or car lights at night" issue you have met the doctor. Has the streak disappeared over time or you learnt to live with it? Is the streak in both eyes or only one eye?
I have same diagonal light streaks problem on my recently operated eye and wanted to know if it goes away with time. My surgeon said that these are optical aberrations and should lessen with time.
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Avatar_m_tn
I second whatever is described here. Though surgery is marvel, there is a lot of hype around it....
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Avatar_m_tn
Hi,
I suffer from exactly the same situation. I was strongly myopic and wore glasses since I was 15 years of age. But was very comfortable with close distance and could read very very fine prints after removing glasses and bringing object very close to eye.. Now After surgery I can see far-distance very very clear, but up close I can see nothing. Need spectacles to search spectacles, so to say. I feel surgeon should have corrected me for near-distance, but no such option was explained by surgeon. Also I never wore + dipoter in my life, so wearing +ve D glasses gives lense-ing effect, very uncomfortable and not used to.


My advice to future candidates for cataract surgery is to demand from doctors the explanation of "optics" option available and pros and cons. Optics is equally or more important.
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Avatar_m_tn
Certainly...

Future cataract candidates should request surgeons to explains all the "optics" option available - which vision to set to zero, near or far or intermediate,  and pros and cons. Optics is equally or more important. Surgeon seem to have perfected cataract procedure, not enough focus on Optics.
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Avatar_m_tn
Husband had cataract in one eye removed. Vision okay in that eye. Surgeon wanted to 'match up' the other eye that did not have a cataract so husband could go without glasses. This was to have been the 'distance' eye.  Husband cannot see distance at all now. He cannot see me (blurry) if I am five feet away. This comes and goes.  His eye can read prescription bottles, and should not be able to in that eye.  We are seeing the surgeon today. I'd sure as hell like to know what happened.  Is it possible lens was implanted reverse in the eye that is supposed to see distance? Either way, this is going to mean another surgery.
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Avatar_n_tn
Hi - glad you're having such good results.  Would appreciate knowing what the diopter settings are for each of your mono IOLs, since you mention they were set for distance.
thanks very much.
laura5121
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9424748_tn?1405134041
Hi LynnAV, Were you a nearsighted person before your cataract surgery? or do you remember your prescription strength? And, if you cannot see close up (you said you have the progressive with clear tops), how do you put on makeup, get an eyelash out of your eye, thread a needle, etc? That is my biggest concern since at the present time I can still see very close up to do those type things. Thanks for any help.
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Cedonulli, This thread is somewhat old, so I'm wondering what you finally decided on doing and if you are satisfied? Thanks!
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9424748_tn?1405134041
HI Baggyrinkle, How close up can your wife see perfectly CLEARLY? Was she nearsighted before the cataract surgery? I am scheduled for getting the astigmatic (toric) lenses but do not know whether to choose the distance or keep the close vision (which I've been used to all my life). I have to choose! I'm so afraid I'll hate that I cannot see to thread a needle (example) without glasses on! AND...with her toric lenses can she see clearly from way far away at all levels up to about arm's length (or closer)? Thank you!
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Avatar_m_tn
I am 37 years old and have been in gas perm contacts since age 12.  I am -19 & -21.  To the surprise of many I continue to see near 20/20 with contacts and can read extremely fine print.  Long story, a year ago I was informed I am a cleared candidate for RLE from a Canadian Surgeon (multifocal are not available for my condition).  With very little understanding of the procedure I scheduled the operation appointment and flew in from out of town but at the canceled at the last minute due to conflicting information about the results.   Despite my awful vision, I have only worn glasses 5 minutes a day for the past 25 years.  RLE is of strong interest to me due to the irritations too often associated with contacts and due to the personal vulnerability associated with dependency on corrective lenses.  Prior to knowing about RLE I just accepted the my condition as my only way of life. But ever since learning of RLE it is continuously on my mind especially during times of contact discomfort.  I think it has made me much more aware of the discomforts I have with the lenses.  Anyways, I have contacted the doctor who is very persistent in telling me to be brave and do it and if I were his soon he would insist I do it.  Despite my attempts to get a best case / worse case vision result scenario from him he just keeps saying I am getting older and will be pre presbyopia soon anyways so why not improve my life today.  When I ask him if I will be able to see my iphone he says “I do not know, maybe…just stop worrying and reading all the negativity…..if you are concerned about that I will give you monovision and if that is not to your liking then I will perform laski later to correct it back to distance”  I do not think I will like monovision  and am concerned that from what I have read in this blog that the far distance set results may be much worse than a natural presbyopia condition.  I really want to go forward with the procedure but not until I have a full understanding of what my worst case / best case scenario will be.   I think that taking the past year to make myself more aware of situations that would most likely require reading glasses has been good for me.  If my worst case condition will be that I cannot read 12 font print 12 inches away than I am ready for RLE.  If the worst case scenario is that I will not be able to see 6 feet in front of me, shave, pump gas, grocery shop or see my girlfriend’s face up close without glasses then I am not ready.  I have been seeking a second opinion from a US Doctor but they will not even talk to me because I do not have cataracts.  I plan to talk to my Optometrist soon about the option of using multifocal contact lenses after RLE as a backup plan in the event of disappointing RLE results.  The first three bloggers make it sound like a great choice but the next 100 make it sound like a terrible choice.   The thought of being free from contacts is amazing but maybe I am just being teased.   Maybe I should just wait for advancements in RLE but the Surgeon is telling me my best window of opportunity is fading as those advancements are far away.   Another thing I do not understand is why someone cannot follow the RLE with a mutifocal IOL.    
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I am a fine arts painter. my eyes are my whole.  My doctor convinced me to go for Toric IOL mono focal long distance.  First eye , the right one severe astigmatism. According to the Dr. it will clear the astigmatism. Long distance Okay, not sharp. Colors clear but not sharp.  Short distance a disaster everything is blurry even at 20 feetl

Second eye I am requesting  a classic cataract lense. Scare of the Toric
I am debating if it was an error in measurements. No one is eager to explain with common sense,  i am a 74 years old male, and scared. Could i go for a second opinion
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Avatar_m_tn
It is surgery, so Medicare and most other insurances will cover 2nd and even 3rd opinions.  
And you definitely need another opinion.
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Avatar_m_tn
I am 33 years old and about to have cataract surgery on my right eye on the 30th of this month. I am getting a monofocal distance in my right eye, my left eye is the natural lens so I see good in that eye. I am worried that I wont be able to see well how will having a monofocal lens in one eye affect my vision? I can't afford the premium lens and got denied for the credit to get one. So I have been trying to get donations, should I just live with having just a monofocal lens in one eye?.
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Avatar_m_tn
There is nothing wrong with monofocal lenses and they are regarded as a 'safe' option, if you read the problems some people have with multifocals on this forum you will perhaps also see monofocals as a safer option with fewer problems such as glare/halos ect.

The surgeon who fitted my monofocal lens only did monofocals and did not believe in multifocals. His advice was to go for a monofocal lens and then wear readers for reading and keep things simple.

Hope that helps.
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Avatar_m_tn
i have 20/20 vision in left with natural lens and cataract in right eye caused by trauma when i was 14, it is 6/20. Have lived with it till now, 57 years old.
I have no problem doing everything without glasses except reading and computer.
I am scheduled for surgery with an aspheric mono focal set for distance. But am worried i will lose my reasonable near sighted vision past computer distance?

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Avatar_m_tn
Hi Notxel

It has been sometime since your post and I wonder if you had the surgery. I hope not.

RLE immediately takes away your accommodation, which you still have at 37 years of age. The surgeon you talk about seems very unethical to me.

Why do people not use multifocals with RLE? The reason is that the RLE patient will feel that their vision is terrible with the multifocals. Even with EDOF lenses, RLE patients might notice a slight drop in visual quality. This is especially true of somebody who wears RGP lenses, as RGP lenses give you the clearest, sharpest vision possible of any corrective method. Anything that you do to remove the natural lens of your eye and replace it with an artificial one will seem like a step backwards from your RGP correction.

One option that you could consider is the Implantable Collamer Lens (ICL). This lens is implanted while leaving your natural lens alone, so you still have accommodation. Your power is right at the limit of what the ICL can correct, so it may or may not be able to fully correct your spectacle power fully.

But you absolutely should not have an RLE, especially RLE with multifocal. Don't ever see that doctor who keeps asking you to go for surgery again.
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Avatar_f_tn
Hehe, I emailed that poster with the exact same advice, literally, like, word for word. I never heard back from them though.
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If very near sighted, do NOT allow your MD to use ALCON Acrysof IQ SN60WF.    I was 14 Diopters with reading glasses.  Got a 7.0 Diopter  ALCON IOL  and it is a disaster.  Yes in the bright daylight, distance vision is good but I can NOT ever drive at night anymore as the specular refractions from white car headlights create white snow.    Also viewing a PC even with reading glasses is terribly fuzzy.  Depth of field is non existent.    A disaster happened in one eye.  i will NOT allow the same thing to happen in the other eye.
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Avatar_n_tn
Hi,
I have -9.5 myopia in the right eye because of a fast growing cataract.  My left eye is 20/25, onset of presbyopia.  I had 20/20 vision in both eyes all my life until 3.5 years ago when I started developing the cataract.  I am confused over the choice of a multifocal and monovision IOL.  I have been living with monovision these last 3 years and without glasses for the first year of that.  As the right eye has gotten increasingly myopic, I am using cheaters for the left eye.  My doc wants to set my bad eye for intermediate vision and leave the left eye as is as she says my brain has already adopted to monovision.  I did get a consult with a different surgeon who suggested a multifocal lens.  I have problems with depth perception lately, parking, reversing has become tedious, and halos and glares do not allow me to drive at night except around my immediate neighborhood.
Both docs are not very forthcoming and seem brusque.  I am scheduled to have the monofocal lens surgery this week, 23.50 diopter, Alcon lens SA 6080 (whatever than means).  I called the doctor's office and they were not sure if the right eye was being set to near or intermediate vision.
I would like to have the kind of eyesight I had 3.5 years ago or the kind that some of the people on this forum have achieved even with monofocal lens set to distance.  Should I ask for distance instead of near or intermediate?
Any suggestion/feedback is appreciated, thank you!
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Avatar_m_tn
The diopter lens each person needs for a particular distance depends on a number of eye measurements (axial length, chamber depth, corneal curvature, and even ideally a customization factor that is unique to the surgeon due to differences in how they position the lens). So we can't tell from just that lens power what they are adjusting you for.

I'd suggest if possible holding off on surgery until you are sure what lens you want since they strongly recommend against surgery to change a lens later if at all possible. I can understand if your vision is too bad to wait.  If you don't get enough advice here, I'd suggest talking to  other eye surgeons if you can. Some eye surgeon clinics do have free consults if you are considering surgery there if you'd prefer to find a doctor who isn't as "brusque" and answers your questions well. You could check to see if your eye doctor responds to emailed questions, some busy people prefer that.  Many people are used to researching things on their own, but others prefer to find a doctor willing to address their questions.

I don't know the various monofocal lens options in detail since I didn't consider using them, but  I know  they aren't all created equal. For instance here was a blog post from last year talking about issues with the Alcon lenses, though it doesn't specifically mention that model:

http://eyesurgerysingapore.blogspot.com/2013/08/an-overview-of-cataract-surgery-lens.html

Also the lens material that other monofocal lenses use may give better vision, this trade magazine supplement talks about the issue of "chromatic aberration"  and mentions that with better lens materials:

http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
" Cataract surgery with an IOL with an Abbe number greater than that of the natural lens (47) can improve CA, so that our cataract patients could actually experience better vision quality than they did as young adults. "

If your eye doctor can't address the issue of the Abbe of the lens then talk to another. There also   debates among doctors over correcting "spherical aberration", most seem to suggest lenses that correct for it (I hadn't looked into whether that one does or how it compares to others).

Have you tried a multifocal contact lens in your good eye? Some surgeons like this one:
http://www.reviewofophthalmology.com/content/i/1650/c/30426/

recommend that as a way to get a sense of whether you might wish to consider a multifocal IOL. Unfortunately it isn't quite the same, an IOL's optics are different and I assume better, but it may still give a sense of it.

If you don't like a multifocal lens, there are also accommodating lenses like the Crystalens that (if it works for you, it doesn't for everyone) may give you some better intermediate and near vision. If it doesn't work it winds up being like a multifocal.  Check the recent thread from a 35 year old looking for IOL suggestions where I posted about the other options, and in the unlikely chance you were willing to travel abroad for surgery you can check my thread on the Symfony lens or others regarding trifocal lenses like the Finevision or the AT Lisa trifocal.
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Avatar_f_tn
I will be having cataract surgery on my right eye in three weeks, and on my left eye a month after that.  I was all set to have one IOL for distance and the other for reading.  Now, after reading these posts from real patients, I'm having second thoughts.  I've worn glasses for over 20 years mostly due to presbyopia which has gotten progressively worse. I have about 1 diopter of astigmatism in both eyes which the surgeon is going to correct with a laser when he removes the cataracts.  I'm now thinking of just getting both IOL's for distance because I want clear distance vision for driving and clear intermediate vision for the computer monitor.  If I get different IOL's for each eye, I'm afraid It's a compromise and I won't have good clear vision at any distance. I know I have one shot to get it right and I don't want to make a big mistake just because I'd like to get rid of my glasses.
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Avatar_m_tn
"Blended" or "Mini" monovision would probably be an acceptable outcome.  With only about 1/2 diopter difference, it would be MUCH easier to get used to.  
Medicare and most insurances cover 2nd, 3rd, and more opinions before surgery so it is in your best interests to discuss your vision with more than one surgeon.
Crystalens might be an option, but they are a "premium" lens, with a premium out-of-pocket price, which could make them not affordable for you.  
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Avatar_m_tn
I am 30. I had my right eye go for cataract surgery 3 years ago and left eyes done on 2 months ago. My doctor failed to give me near vision for both eyes with the reason I was too nearsighted and cause the measurement inaccurate.
I ended with both very farsighted eyes at +2.5D. I am an accountant and do a lot reading and computer work. I was wearing contact lens for about 20years and now I am so mad everyday to have the difficulties to work with multifocal glasses.

Is anyone here know whether the IOL explantation is possible? I do not want my remaining life to be so troublesome! I hope to work without glasses and i don't mind to be nearsighted.
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Avatar_m_tn
Had you tried multifocal contact lenses? Unlike eyeglasses that are multifocal, with multifocal contacts you don't need to look in any special direction, you just use them like regular contacts. I had good luck with those (though that was for presbyopia, before my cataract surgery). Most people adapt to them, if you have any trouble then some people find a lower add version easier to get used to, and then you can try a higher add again.

Alternatively   some people try monovision with regular contact lenses to set one eye for near (or both if you prefer to be nearsighted), or you could even combine a bit of monovision with a multifocal contact.  Laser enhancement like lasik or PRK are an option to at least not need distance correction.

Another option would be a corneal inlay, which is like an implanted contact lens which can be taken out if it doesn't work for you and which provides either a multifocal effect, or an "extended depth of field" effect to give more near vision. The Kamra and the Raindrop corneal inlays both have good published results (and high profile surgeons that have reported on using the Kamra for instance in their own eyes), I don't know if they are available in your country yet or not (they aren't yet available in the US, waiting on FDA approval). They are have been mostly studied with patients that still have their natural lens, but I have seen reports of them used with good result in patients with IOLs.

re: "whether the IOL explantation is possible?"

It involves risks, however it can usually be done. The results partly depend on the state of your eye so I would suggest consulting a good surgeon (perhaps a different one than whoever gave you results that you aren't happy with). If you had complications with your initial surgery like the capsular bag tearing, or  have had YAG laser treatment for PCO, apparently often (I don't know if it is always the case) the capsular bag might be damaged/fragile and not allow a lens to be implanted in the capsular bag. If that is the case then you will need a different kind of lens that is implanted outside of the bag, which is ok if you merely want monofocal lenses set at different powers since those are available. However it would  limit your options if you want a premium lens (to give you better near) since most are designed for placement in the bag.
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Avatar_m_tn
Hi, thanks for your reply. It looks like there are still some options for me to enhance my current vision. I am so depressed with my current eyes condition which make me feel I wish to have shorted life so I don't need to stay with this irritating eyes!

My doctor was saying I am silly when i told him that I can't accept my current vision. He said he felt so sad that I not appreciate my current vision which i no longer need to wake up with blur vision. He said you never can read all the words during the eye test and now you can. He just ask me to bear with the presbyopia and wear glasses. :(

I am actually putting a hope on the multifocal contact lens when I first stated get mad with my eyes. I tried the multifocal contact lens and it just don't work for me. I can't either see near or far vision clearly with it. :(

Is the laser enhancement can help to correct my presbyopia problem due to the wrong implant lens power? Can i have better near vision with the laser?

The Kamra and the Raindrop corneal inlays that you mentioned sound good but i don't think in Malaysia have this technology now.

I am really hope I can do the lens explantation but I am not sure whether there is any doctor willing to do it for me. I am also not sure my very nearsighted eyes allow me to so.
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Avatar_m_tn
I an facing cataract surgery in 2 weeks, and my Dr recommended the Crystalens.  I have read that it may not accommodate as well (if at all) as its touted to do.  My other issue is I have only 1 good eye (now 20/40 corrected), and my lazy eye is not good enough for reading or driving.  I am confused about whether or not monofocal might be a better choice since clarity is really important to me.  I also don't know if I should choose monofocal the focal point to be set for distance or near. I was so use to having no need reading glasses and do fine work, including computer programming up until about 3-4 years ago.  I always had to wear corrective lenses for driving. I read about those that have monofocal set to distance, but can't see anything decently from 6' or closer. I think that would drive me crazy not to be able to see the clock at bedtime. But again, I am not sure if the accommodating lens will do the trick, since there is very little discusson on this.  If I chose monofocal set to near, after 6' does it get so blurry you can't see a persons face?  I wish there is some way to emulate the vision under different types of settings (near, mid, distance) to see how it "feels" before selecting a fixed distance.  .
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Avatar_m_tn
I hope you get a right and good lens for your cataract surgery. But think wisely before you go for the surgery as there is no turn back once the natural lens is removed.
Good Luck~
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Avatar_m_tn
re: " tried the multifocal contact lens and it just don't work for me. I can't either see near or far vision clearly with it. :( "

Sorry to hear that, though did your eye doctor let you try different brands? Not every brand works well for everyone. Did you try using a low add power at first? I know someone with monofocals ideally would use a high add, but some people need to get used to a low add power first, and then they can adapt to a higher one. You don't mention if you have astigmatism, I gather that toric multifocals especially may require a few tries to find the right one.

re: "Is the laser enhancement can help to correct my presbyopia problem due to the wrong implant lens power? Can i have better near vision with the laser?"

The laser enhancement (lasik, prk, smile, or whatever other variant) are mostly used   to adjust the distance vision, which would at least leave you only needing to wear correction for nearer vision. There is also the possibility of using monovision correction, correcting one eye for near and leaving the other eye for distance (which you can try beforehand with single focus contact lenses), though that approach can impact depth perception and stereopsis.   The corneal inlays  I mentioned require   correction for distance (usually via laser), then the inlay provides better near.

There are some laser  approaches they are trying to deal with providing more near vision like prebylasik, supracor being the newest, shaping the corneal to give a multifocal effect.    Options like contacts or even a corneal inlay are easy to stop if they don't work well for you so they seem like the first thing to try.  

The Kamra seems to be available in Malaysia, e.g. here:
http://www.vista.com.my/lasik/cataract/malaysia/vista/eye/specialist/reading/cataractreadingmalaysia.php

I don't know if the Raindrop is.
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Avatar_m_tn
re: "wish there is some way to emulate the vision under different types of settings"

If you do get the Crystalens set for distance and it doesn't provide enough near vision, then you can try some of the options I mentioned above like multifocal contacts, or a corneal inlay (which can be taken out if it doesn't work). Coincidentally,  the Kamra inlay was just approved in the US by the FDA yesterday (I see you are in the US, unlike the prior poster). Its  been available elsewhere for quite a while. The Raindrop inlay  is still in the approval process, but is available elsewhere. I will note that both of those have evolved over time, so if you look for studies the recent ones may be better due to improvements.

How much near vision you get will depend on your eyes, a tiny fraction of people have enough natural depth of focus in their eyes that even with a monofocal they are able to read some without correction, but it is best to plan based on average results.  

If you are concerned about getting enough intermediate or near vision if the lens doesn't accommodate much,  and don't mind wearing correction for driving, then you could consider getting the Crystalens set for some intermediate distance, e.g.  if you set yourself for 0.5D myopia that would be focused at around 2 meters, so that even if it doesn't accommodate, that would give you usable vision for around the household and at computer distance. Setting it a bit closer would ensure even better computer distance and perhaps some reading, e.g. 1D is focused at 1 meter, 1.5D = 66.7 meters = 26.2 inches which is around computer monitor range for many (laptops might be a bit less).  This page explains what diopters translate to what focal distance:

https://www.slackbooks.com/excerpts/67956_3.pdf

Studies on lenses  try to evaluate the average visual acuity at different distances (with the distances measured in diopters, though sometimes the distance in cm added) which lets you compare lenses. The graphs are called defocus curves, and are explained in this article:

http://crstoday.com/2010/11/feature-story-get-to-know-the-defocus-curve/

For example if you look on this site, and click on the "clinical" tab:

http://www.tecnisiol.com/eu/tecnis-symfony-iol.htm

You will see a defocus curve for the Symfony lens, but the graph also shows the curve for a Tecnis monofocal to see what those are like  (though not all monofocals are equal, I don't know how well the Crystalens does as a monofocal if it doesn't accommodate, I hadn't searched for that).

I know it is hard to picture what visual quality a particular measurement translates to, what say  20/40 actually is like, but I partly judge by the fact that 20/40 or better vision is required for driving in most places. In addition, for near vision, there is a chart here showing what sort of visual acuity lets you read different things, like newspapers or medicine bottles:

http://www.teachingvisuallyimpaired.com/print-comparisons.html

This page has a conversion chart for some of the different visual quality measures, from logMar to 20/XX for instance:

http://www.wikiwand.com/en/LogMAR_chart

I know some people are concerned about visual artifacts with multifocal lenses, but there seems to be lower risk with the new low add lenses just approved this year:

http://www.healio.com/ophthalmology/cataract-surgery/news/print/ocular-surgery-news/%7Bb5f870e3-fee3-4681-8e40-480bea7ddc70%7D/recent-fda-approval-expands-multifocal-iol-choices
" Recent FDA approval expands multifocal IOL choices
New low-add powers offer enhanced vision at intermediate distances, with improved night vision symptoms.
With the +2.75, the reported degree of difficulty with night vision was even lower than with the Tecnis one-piece monofocal control. What I found was that while patients noted halos, few were bothered by them; if they were, the effects mostly abated in weeks rather than months. "

The new Tecnis low add lens provides decent intermediate vision, which was a weakness of higher add lenses, even if the near vision isn't as good as the high add lenses. Here is the manufacturer page about it:

http://www.amo-inc.com/products/cataract/refractive-iols/tecnis-multifocal-family

The Restor also recently had a lower add lens approved, here:

http://www.alconsurgical.co.za/acrysof-iq-restor-2-5-d-iol.aspx


It doesn't seem quite as good, and overall I read better things about Tecnis lenses (things like lower risk of glistenings, less chromatic aberration, etc). If I were doing my surgery now and were having it done in the US, I'd likely either consider the Tecnis +2.75D or a Crystalens with the possibility of a corneal inlay if I wanted more near later.

I was also concerned about the idea of the Crystalens not accommodating, which is why I was initially planning to get a multifocal (I was considering going outside the US for a trifocal, to Mexico or Europe). Instead I went to Europe for the new Symfony lens, which has a lower risk of night vision artifacts than a multifocal, comparable to a good monofocal, and comparable contrast sensitivity (low light vision) to a monofocal,  while having excellent intermediate vision (e.g. at computer distance, social distance, and TV distance)  and decent near (I see almost 20/15 at distance, and 20/25 at near and can read my smartphone, and the fine print on medicine bottles, but some people need reading correction for those).  

Unfortunately the Symfony isn't FDA approved yet, but I heard from someone hunting for it  that clinics expect it to be available in 1-2 months in Canada. (one person posted on this site that she received the lens in Ottawa already, but I'm guessing she may not have realized it was part of a trial perhaps since people I  know were told it isn't available yet).
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I seek for another doctor for second opinion and he asked me to try for another few months for neuroadaptation. He said I already missed the good timing for explantation as it is better to do it within 2 months after the surgery.

The doctor suggest a few options to enhance my near vision if the neuroadaptation not work.
1)Piggyback a multifocal lens in non-dominant eye
2)Lasik to reduce the the presbyopia in non-dominant eye
3)Put a plus lens in non-dominant eye for monovision

How do you think about neuroadaptation? It was already 2.5 months i with this vision and i get mad with it everyday after i had the surgery. I am not so sure whether waiting for another few months is worth to wait.
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Your initial post gave the impression you got  monofocal IOLs (which seems to be confirmed by the suggestion of a multifocal piggyback as an option), and that you   wound up farsighted in both eyes. So I'm not quite sure what sort of "neuroadaptation" the surgeon is suggesting you wait for. Usually neuroadaptation is a concern in the case of   people who have multifocals or monovision. Unless perhaps he is talking about adapting to progressive glasses or multifocal contacts or monovision contacts.

The refraction changes a bit initially after surgery due to healing, rather than neuroadaptation. Before correcting refractive error, they sometimes wish for the refraction to stabilize, which usually happens within the first 1-2 months, at least to the level where they are comfortable prescribing glasses/contacts. They are more cautious to be sure things are settled before laser surgery, so  I'd seen comments about waiting 3-6 months from different surgeons (likely depending on the patient).

One concern I'd have with any multifocal option is that you didn't like  multifocal contacts. Other forms of multifocal correction like implanted lenses are different, so its very possible you may like them even if you didn't like the contacts. However  I'm curious whether you gave multifocal contacts enough of a try to see if you adapt, or if you've tried monovision with contact lenses and given that time to see if it works (before trying to make that approach more permanent with laser or lenses).

A corneal inlay would be essentially an alternative to a piggyback multifocal lens. There are multifocal inlays, as well as more popular inlays that extend depth of focus. If you don't like multifocal contacts, that seems added reason to consider trying an extended depth off focus inlay instead of a multifocal optioin. I hadn't researched how  an inlay vs. a piggyback would compare for sure, you should do so, but my impression is  the inlay is a less invasive and less risky procedure than a piggy back IOL, with lower risk of complications. It seems also easier to explant as well if it doesn't work well.
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Thank you for all the information.  I am going in for my preop on Apri 20th.  The publication of literature review of how accommodating these lens are is reported in http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/OphthalmicDevicesPanel/UCM346413.pdf

This makes me a little shy about the expense and possibly getting a result that is not significantly better (or could be worse) than a monofocal.  
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Yes, it is about adaption to my farsighted vision now with the progressive glasses. Both my doctor and the optician do not advise contact lens and said it won't work well.
I have about +1.00 astigmatism for both eyes and so far I am not trying any toric lens yet. There are very few multifocal contact lens brand available in Malaysia which make my process of trying is very frustrating.

I know the progressive glasses do help me but I hate the feeling to wear progressive glasses. I don't think to adapt the current farsighted vision is a good suggestion as I am just 30. Everything is just so inconvenient.

I wish to explant the lens if possible but it seems everybody said it is very risky. Maybe corneal inlay is a good one compared to lens explantation and piggyback.

I will visit an eye specialist that specialized in refractive surgery to let them assess what they can do to enhance my current "old lady" vision.
I will update again after the assessment is done.

Thanks again for your sharing! :)

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You mention a preop April 20th, but you posted that on the 20th, did you mean May perhaps?

Unfortunately no lens option is perfect yet, there are tradeoffs and risks (though in almost all cases, worst case a lens swap for a monofocal can be done if it really doesn't work,  though its best to avoid that of course)

Had you considered a multifocal? Some surgeons are overcautious about using them,  but in many cases thats due to their impression of older model multifocals. As I mentioned above, there are reports that the new Tecnis +2.75 low add lens has a risk of problems with things like halos comparable to a monofocal (even monofocals have a risk of halos), and in fact a study suggests people actually find their night driving vision better with it than a monofocal, as explained by this surgeon from in a video from a news site for eye surgeons:

http://eyetube.net/series/daily-coverage-san-diego-2015/enuli/

I think the Symfony is a better bet for good intermediate, but most folks don't want to travel for it (if the low add Tecnis lens had been approved in the US last year I would have been tempted to get that instead of traveling).

Many surgeons will do some amount of monovision with the Crystalens or other lenses to get more near even if it doesn't accommodate I had seen some surgeon comments (not in a study)  indicting a fairly good chance, some suggested perhaps 50%, of needing reading glasses with the Crystalens, though that it may provide a good chance at usable intermediate (with risk of some complications like z-syndrome, which I gather may be much reduced in the current versions, I hadn't researched how much).  It partly depends on what your priorities are, how much you would prefer to take a bet on not needing reading correction.

If I were doing the surgery again now in the US, I would be tempted to consider the Crystalens with the fallback of trying the just approved Kamra inlay later (or the upcoming Raindrop)  if needed for more near vision. One advantage of a single focus lens like the Crystalens or a standard monofocal is that you can also consider multifocal contact lenses over top of them. (I suspect it wouldn't work well to combine a multifocal IOL with a multifocal contact lens).

There are some monofocals that reportedly offer a bit better depth of focus, like the Lenstec Softec, but they apparently cost extra as well. The Hoya iSert Gemetric 751 lens is a monofocal with reportedly better depth of focus according to studies by Dr. Graham Barrett which was approved by the FDA last year, but strangely they appear to not be marketing it despite its approval. If you go monofocal, out of the more common choices, the Tecnis seems to have fewer glistenings, and corrects for chromatic abberation.


The FDA link is useful. In the past  think I'd seen a document that had given the literature list and comments on recent updates in  more detail, but I posted the wrong link in my Symfony thread for it and hadn't been able to find it again (perhaps it was just some private site that posted it and took it down).

A similar overview from another source mentions more about one of those studies calling into question how much near the Crystalens gives:

https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/AccomodatingIntraocularLens.pdf
"Zamora-Alejo et al (2013) performed an evaluation of accommodation with a  bilateral accommodating IOL versus monofocal IOLs.
.033). The groups did not differ significantly for mean distance corrected near vision  (logMAR 0.54 ± 0.12 [control], logMAR 0.42 ± 0.15 [Crystalens HD], P = .087).  However, a significantly greater proportion of Crystalens HD eyes achieved 0.4 or  0.3 logMAR for near wearing their distance correction (P = .013). "

here is that study:
http://www.pubfacts.com/detail/23380415/Objective-accommodation-measurement-of-the-Crystalens-HD-compared-to-monofocal-intraocular-lenses

and another study it mentioned:
http://www.ncbi.nlm.nih.gov/pubmed/23098630
"Comparison of visual results with accommodating intraocular lenses versus mini-monovision with a monofocal intraocular lens.
Binocular distance visual acuity at 4 m was 20/20(-) in all groups, intermediate vision was approximately 20/25, and near vision was 20/40 to 20/50. There were no statistically significant differences between the 3 groups in visual acuity or contrast sensitivity."
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re: "There are very few multifocal contact lens brand available in Malaysia which make my process of trying is very frustrating. "

I wonder if they can order samples from abroad? I don't know about shipping cost, but there are many stores on the net. Different designs work well for different people, in my case I had good luck with the Air Optix and the  Oaysys multifocals at different times, but there are some others.


re: "I will visit an eye specialist that specialized in refractive surgery to"

Of course any surgical option involves some risk, even if its usually safe, you might hunt around for the best doctor and get more than one opinion. If   possible they like people to try contact lens approaches like monovision and multifocals first to see if they can get some idea of preferences. The corneal inlays can usually just be removed, so they seem lower risk to try than laser adjustment if you aren't positive what will work for you.


re: " I don't think to adapt the current farsighted vision is a good suggestion as I am just 30. Everything is just so inconvenient. "

That is understandable, anyone who has hit presbyopia knows its inconvenient, however unlike your situation, the loss of near comes on gradually over the years so it is easier to adapt to. I'm a older than you and had already hit presbyopia,  but at 52 I also have hopefully a few more decades to live with my vision choices, which is why I was willing to travel to get a better IOL I couldn't get here (after postponing surgery perhaps longer than I should have in hopes of a better lens here).
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I had the preop today. The surgery is scheduled for May 6th. I had decided to go with the monofocal lens (mfr TBD). The reason is having only 1 good eye, and my desire to have the sharpest possible vision for distance and least likely to cause problems now or later.  I only really want to do this once and not have to mess around with the good eye.  The same conclusion was offered by the Dr.(via his assistance). Perhaps, since I had posed so many questions about the potential issues and my expectations, perhaps were over the mean of obtaining the highest clinical results on the final acuity.  It's interesting that the Dr wrote several of these articles (and also is a consultant to B&L) who make the Crystalens.  I am hoping that did not influence his original recommendation to do the Crystalens, but my desire to be glasses free for most of my daily work. These clinical results (of a rather small study) he wrote seemed to indicate that that 100% of those using the Crystalens had 20./40 or better distance and at least J3 for near.  About 96% had 20/32 or better. Right now I have 20/40 distance corrected (but glare makes it difficult to read highway signs), and my near range is probably J2 uncorrected and J1 with correction. I am fairly sure the clinical results were using binocular vision.  So  for those reasons, I decided to go with the monofocal and use my glasses for reading and computer work.  I think the symfony, if available, could have leaned me more toward that direction.  

I opted to do the laser incision & astigmatism to ensure best results. It's shown as Astigmatic Keratotomy (AKA), Femto.  I am surprised that to do this the cost is $1800 (for the one eye) which also is not covered by medicare.  Anyone else who has done this, I would like to know what their doctor's charges were.

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I can understand wanting to take fewer risks with one good eye of course. The Symfony is supposed to be available in Canada in a month or two...

The main risk with the Crystalens compared to a monofocal are any additional complications, in terms of distance visual acuity it seems likely there isn't that much difference (but there many be some, single focus lenses do differ in things like chromatic aberration).

There are some reports that the Lenstec Softec HD lens has a larger depth of focus than other monofocals, though the only study I'd seen doesn't seem to show quite as much benefit as one surgeon claims. I don't know what part of CA you are in (your profile shows CA), but a cataract surgeon in LA is one who recommends the Softec.

One poster reported on another Medhelp thread that Dr. Dougherty had said:
http://www.medhelp.org/posts/Eye-Care/Best-IOL-for-near-intermediate-vision/show/2503179
""In my hands, I feel that the HD and the Crystalens 5.0 are very similar in terms of depth of focus. However, with either lens, the depth of focus outcomes are variable from patient to patient. With either lens, if you are set for distance in both eyes, I expect you to still need reading glasses unless I do some mono vision."

This is Dr. Dougherty's site:

http://www.doughertylaservision.com/

An article says:

http://reviewofophthalmology.com/content/i/3110/c/52313/
'One monofocal lens that’s gotten some buzz for its near effect is the Lenstec Softec HD, a flexible acrylic IOL with an aspheric optical design on both the front and back surfaces. At the 2011 meeting of the American Society of Cataract and Refractive Surgery, Tampa, Fla., surgeon Jim Gills reported on a study from his practice in which 28 percent of Softec HD patients could read J3 [20/40] or better uncorrected monocularly.

Los Angeles surgeon Paul Dougherty says he’s experienced similar results. “The lens is composed of the same material as the Tetraflex [accommodating IOL],” says Dr. Dougherty, who thinks this may contribute somewhat to the lens’s apparent ability to give a better range of vision in some patients. “Though these patients don’t get full accommodation, I don’t need to do as much monovision on them as I would with a pure conventional monofocal lens to get them out of reading glasses. If we set them for distance, they’ll get distance and maybe some intermediate vision, but they’ll still need reading glasses.”  '


This study doesn't seem to indicate as much difference as they suggest, though it claims a benefit:

http://www.researchgate.net/publication/47543354_Clinical_evaluation_of_the_Softec_HD_aberration-free_aspheric_intraocular_lens

If you go with one of the more common monofocals, this eye surgeon's blog gives a good overview which points towards the Tecnis:

http://eyesurgerysingapore.blogspot.com/2013/08/an-overview-of-cataract-surgery-lens.html
"An overview of cataract surgery lens implants"

A recent trade publication mentions the issue of the material used:

http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
" Cataract surgery with an IOL with an Abbe number greater than that of the natural lens (47) can improve CA, so that our cataract patients could actually experience better vision quality than they did as young adults. "

The AcrySof material has a lower Abbe number, while the Tecnis material has a higher one. The Symfony lens has added features to correct for chromatic abberation.

I take it you don't have enough astigmatism for them to suggest a toric len? The cost/benefit of laser cataract surgery is under serious debate in the industry, there isn't enough demonstrated benefit (in most cases) for them to consider it worth the cost.  In some cases (like a very mature cataract, which yours isn't if you have 20/40 vision, or anything close to that) I have seen reports that the laser is very likely going to make a difference.  If you don't have some complicating condition that they've told you indicates a laser is of benefit, if you are interested I can post links to studies and articles on the issue. Its possible if you have a greater need for  astigmatism correction, that may tip the balance, I hadn't researched that issue in detail since I didn't have much.  In simple cases it isn't clear its benefit compared to an experienced surgeon (in my case my surgeon had done 40,000+ regular surgeries, and he didn't see any need for the laser in my case, so I opted for the regular surgery even though laser would have only been a few $hundred more).
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My astigmatism is mild, measured as -0.50 Cylinder.   They ruled out the multi-focal too (which I failed to mention in last post).
I was told that using the laser will minimize any bleeding, produces less complications, and lower the risk since I have only one good eye.  It's hard to challenge that.  So the question is also do I need the astigmatism adjustment? Since the laser is being used, they might as well.  But, I am extremely uncomfortable with the amount they are charging, given that I've seen an article in allaboutvision saying it would be a few hundred dollars more ( http://www.allaboutvision.com/conditions/laser-cataract-surgery.htm ).

From everything I've read, it seems that the Tecnis 1 piece monofocal might be the best (especially looking at the results of an earlier study in 2008 of an earlier model Z9000
( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589217/ )  
It also is very convincing when you look at the comparison Abbot did between their model and the other competitors
( http://www.amo-inc.com/products/cataract/monofocal-iols/tecnis-1-piece-iol  ) .
So I am curious what the surgeon will recommend (hopefully soon).
All though a bit late, I do have another surgeon consultation next week (1 week prior to the surgery!) just to get a 2nd opinion on lens recommendation and the cost of the LRI.  If it is quite different, I will probably cancel the current scheduled one, and re-think this whole thing again.
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I have not seen too many posts on the medications for cataract prep and post. I have been prescribed Pred Forte (10ml) = $238, Vigaox 3ml = $154, and Prolensa 3ml = $60 with mfrs coupon.  My part D insurance does not either cover it or is tier 4 pricing.  I had some idea these drops would be expensive, but not quite this much.  I also have been highly recommended not to use generics because they have seen some issues in the past.
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An LRI can be done with a blade and not just a laser. That amount of astigmatism is fairly small, so although lasers may be more accurate, it isn't clear it'll make that much of a difference which way its done.  Each person's case is different regarding whether there are  benefits of the laser (though if the surgeon isn't very experienced, the laser seems safer, as long as they are past say 100-150 or so laser surgery learning curve), but surgeons are still debating whether its better, or merely different, for most patients. Either way is very safe (though of course even with very tiny differences, someone can be the "statistic" for a rare issue.

This free ebook for cataract patients by a surgeon who is skeptical of the benefits of laser cataract surgery is a good place to start and provides perspective (although its a couple of years old or so, my impression of it hasn't changed yet):

http://david-richardson-md.com/wp-content/uploads/ctb.pdf

Recent studies:

http://www.eurotimes.org/node/1685
" Large prospective comparative cohort series found little difference in safety or visual outcomes between femtosecond (FS) laser-assisted cataract surgery and standard phaco surgery, Brendan J Vote MD, Tasmanian Eye Institute, Launceston, Tasmania, Australia, told the XXXII Congress of the ESCRS in London.

The study examined 4,080 consecutive cases operated by five surgeons at a single regional day surgery centre from May 2012 through to November 2013, Dr Vote reported.

“The visual benefits of laser cataract surgery have yet to be clearly established. As all of us are aware, cost effectiveness or the lack thereof for laser cataract surgery remains a significant obstacle to the uptake of this technology,” Dr Vote said."

The actual study journal article that article mentioned:

http://www.ascrs.org/sites/default/files/resources/JCRS_January_2015.pdf

And this is from a different large study late last year showing similar mixed results (e.g. a slightly higher complication rate with laser surgery.. but *what* the complications are is part of what matters).

http://bmctoday.net/crstodayeurope/2014/10/article.asp?f=news
"LACS DID NOT OUTPERFORM ROUTINE PHACO

Preliminary results of the ESCRS/EUREQUO Femtosecond Laser-Assisted Cataract Surgery (FLACS) study showed that laser-assisted cataract surgery (LACS) is as good as routine phacoemulsification, but currently does not outperform it, Peter Barry, FRCS, said during the XXXII Congress of the ESCRS meeting in London.1

The FLACS study, funded entirely by the ESCRS without the participation of industry, represents the first time that the outcomes of LACS have been compared with the outcomes in matched patients undergoing routine phacoemulsification in terms of visual acuity, surgically induced astigmatism, complications, and biometric errors.

The ongoing study currently includes 2,022 patients from 16 centers in 10 countries who underwent LACS between December 2013 and August 2014 and 4,962 patients randomly selected from a pragmatic sampling of 100,000 patients enrolled in the EUREQUO study, a database that includes approximately 1.5 million patients who have undergone cataract surgery. To facilitate honest reporting, individual surgeons, clinics, and patients participating in the FLACS study are anonymous in the database, Dr. Barry said. Additionally, all surgeons had previously completed 50 LACS procedures in order to avoid bias from a learning curve."

http://www.reviewofophthalmology.com/content/i/3190/c/53363/
" Femtosecond Cataract: What the Data Says
A review of how femtosecond-assisted cataract surgery is faring in the literature.
“I think most surgeons would recognize that femtosecond laser cataract surgery is brilliant—as long as they didn’t have to pay for it,” jokes Hyderabad, India, surgeon Kasu Prasad Reddy. Though Dr. Reddy uses the femtosecond in his practice, he acknowledges that his fellow surgeons have to think long and hard about investing hundreds of thousands of dollars in a device when they already get excellent results from conventional phacoemulsification. This thinking logically leads them to wonder what data exists on femtosecond that might shed some light on the kind of results they could expect with the new procedure. To help surgeons answer this question, following is a review of the major femtosecond research from the past several years, as well as thoughts from researchers on their findings."

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Continued on laser cataract surgery, here are clips related to the issue of manual surgery giving more of a "feel" for the eye (these were part of what tipped me towards going for the blade without enough evidence to suggest the laser would be of use in my case):

http://www.reviewofophthalmology.com/content/d/cover_focus/i/3110/c/52304/
"Dr. Kershner offers several reasons femtosecond laser technology may not be a major advantage when it comes to fine-tuning cataract surgery for better multifocal outcomes:
• A manual capsulorhexis provides information about the capsule that a laser capsulotomy does not. “Back in 1994 I developed the first capsulorhexis cystotome forceps,” says Dr. Kershner. “That simplified the capsular tear by letting the surgeon open the capsule and create the tear with a single instrument through a 1-mm incision. The added benefit of never letting go of the anterior capsular flap was to give the surgeon the opportunity to assess the capsule. We used to call it ‘reading the capsule.’ ...
  When you’re manually tearing the anterior capsule you can feel the nature of it. Is it elastic or brittle? Does it tear rapidly or slowly? This gives you insight into the nature of the posterior capsule. Thus, if you get an inadvertent posterior capsule rupture at the beginning of a case, you will have seen it coming because you had the ability to read the capsule. With femto technology, the surgeon is separated from his surgical field.”

http://www.outpatientsurgery.net/surgical-services/cataract-surgery/5-cataract-complications-to-avoid--10-14
"Robert F. Melendez, MD, a cataract and refractive surgeon at Eye Associates of New Mexico in Albuquerque, says history of eye disease or past trauma are red flags of a loose capsular bag. Even in expected routine cases, he'll know something is amiss after he makes the first manual slice of the capsulorhexis — if a femtosecond laser is making the cut, you're not getting the same feel and feedback, says Dr. Melendez.

When the bag feels loose, he makes the incision slightly larger — approximately 6.25 mm instead of his standard 5.75 mm — to relieve stress on the zonules. He considers the larger capsulorhexis a safety measure that lets him prolapse the lens into the anterior chamber if necessary."

This is from an eye surgeon's blog, one who tends to be concerned about evidence based medicine and what the studies say:

http://eyesurgerysingapore.blogspot.com/2014/11/femtosecond-laser-and-cataract-surgery.html

Entry on a surgeon's blog
http://www.freedomeyelaser.com.au/laser-vs-manual-cataract-surgery/
"4 Reasons Laser Cataract Surgery Is Not Dr James Genge’s First Choice
....

        Cataract laser surgery carries a 10x increased risk of anterior capsule tears that can compromise the outcome.
        Cataract laser surgery carries an increased risk of macular/retinal swelling.
        Inaccurate incision placement is more common with lasers than a manual approach."

Though some issues need to be kept in perspective, e.g. capsular tears are still rare so that 10x increase isn't quite as major as it appears at first glance (even if it is an issue), and small tears aren't a problem, and even large tears merely mean a different lens must be implanted outside the bag.

http://www.medscape.com/viewarticle/812070
"Anterior Capsule Tears After Laser-Aided Cataract Surgery"

The literature has a number of articles where surgeons debate both sides like these:
http://bmctoday.net/crstodayeurope/2014/02/article.asp?f=evaluating-the-impact-of-laser-assisted-capsulotomy
"Evaluating the Impact of Laser-Assisted Capsulotomy : There are two sides to the story. "

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/content/tags/barry-seibel-md/laser-refractive-cataract-surgery-benefits-eye-behol?page=full
" Laser refractive cataract surgery: Benefits in eye of beholder
Conventional phaco preferred by some, while transition to LRCS may appeal to others"
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From the research reports you've sited, it is disturbing that the safety of it does not seem to be any more than phaco, and in fact where they indicated that there were more anterior radial tears with laser, and other complications makes me disbelieve what I was told since I wanted the safest possible procedure having only one good eye.  Also, the visual acuity seems to be fairly consistent, although I did see the laser group had a larger target mean of error.  So I have to challenge the dr on these studies. It's difficult because they obviously have spent an great deal of money on the equipment and want to utilize and have the patient pay for it.  On the other hand, perhaps this surgeon's skill with the Femto is so good, that none of these issues have occurred within their group.  I have to ask that.  
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re: "disbelieve what I was told since I wanted the safest"

I think part of the issue is that as with many new technologies, it partly  has different pros and cons than the manual approach, some complications are less and some are more, so it is hard to evaluate.  If someone has any risk factors for a particular complication, that may tip the balance one way or another (e.g. as I mentioned, I gather that if someone has   a very mature cataract and the laser seems to have a clear advantage in that case). Many of these complications are rare and so they require large studies to assess which is better, an individual surgeon may not have enough data (and often may not collect data). And of course things may vary between surgeons depending on their skills.

One thing that happened I think is that prior to extensive studies, many people just speculate about what they intuitively assume will be the benefits of the laser, and they wish to assume the best about a cool new technology. Then they don't personally do enough cases to have data to be sure, so conformation bias can set in.  You'll notice that the AllAboutVision page on laser cataract surgery you link to states: "Using the laser should also result in less chance of capsule breakage.". The "should" indicates they were making an assumption,  but that large recent study indicated more tears:
http://www.ascrs.org/sites/default/files/resources/JCRS_January_2015.pdf
(though the posterior capsular tears difference wasn't statistically significant, just the anterior tears). Of course it may be that improvements in the technology will eventually lead to fewer tears.

All of this is in flux since new lasers and improved software are coming out all the time and it takes time for data on the results to be collected. There may be benefits that aren't yet demonstrated in studies from the latest tech.

That leads to another complication,    since a large amount of data is needed for rare problems, small studies can be misleading if the differences aren't statistically significant, so I don't know if there are other smaller studies that mislead people, the large studies I paid attention to are fairly recent. Unfortunately many doctors are busy practicing medicine and don't keep up with all the latest studies as much as people might hope. Some rely on anecdotal word of mouth from the sales reps (unfortunately) and or the impression they get from other doctors who may also be relying on anecdotes or intuition rather than data.

Some are now trying to eliminate the need for any ultrasound at all, using the laser entirely to break the lens up, as in this article just published in April:
http://crstodayeurope.com/2015/04/using-the-femtosecond-laser-to-eliminate-phaco/
That seems likely to have a real benefit, but there isn't data yet, and there may be unforseen tradeoffs that aren't apparent except with a large number of cases.
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re: "posts on the medications for cataract prep and post."

Unfortunately I hadn't researched that.   I had my surgery in the Czech Republic where costs are much less. The Vigamox was included in the surgery price,  the Tobradex I had to fill before surgery was like $9. I hadn't examined the issue of generics in this case, in most cases generics are the same active ingredient and aren't a concern (even if manufacturers benefit from people believing otherwise). I think the concern over generics arises in many cases since for some conditions not every medicine will work every time, and people look for something to blame the failure on. If its a generic, they can't know that the name brand wouldn't have worked either, and may complain that the generic is bad. That starts other people thinking that may be a cause and so if one ever doesn't work they are more likely to blame that. Unfortunately just as there is a placebo effect, there is a nocebo effect, something can work less well if people are skeptical, which can contribute. (though of course given that the placebo and nocebo factors do exist , if you don't mind the cost and have concerns about a generic, evidence based or not, then you can do the name brand).
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re: "disbelieve what I was told since I wanted the safest possible procedure having only one good eye.  "

This is a few minute video from this week with a surgeon talking about:

http://eyetube.net/series/daily-coverage-san-diego-2015/ohedo/
"The Ethics of Femtosecond Laser Cataract Surgery"

And discussing the issue  for instance of   being careful for instance to distinguish between the differing personal beliefs of surgeons, vs. what the evidence shows. The wording difference can be subtle, and patients are often not going to be paying close enough attention to realize the distinction they are trying to make.


As this mentions explicitly:

http://www.reviewofoptometry.com/content/d/ophthalmic_lenses___and___dispensary/c/50964/
"3. Who Really Needs Femto Laser Cataract Surgery?  
Surgeons disagree on this question, with some advocating routine use of femto, others believing its greater precision is primarily a benefit only to those patients receiving a premium IOL, and still others waiting for more compelling safety and outcomes data to show up in the literature before adopting the technology."
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Thanks for all the information. It certainly does steer me away from doing the laser cataract method (see my comment at the end).  

There is an interesting new development. I have postponed my surgery and  I sought a 2nd opinion on  the use of laser and the lens choices. Unexpected, was that he indicated that the cataracts were not that bad (especially in the good eye) and my issues may not all be cataract related, but may be do to the epiretinal membrane. I've always been a little uneasy that my symptoms mis-matched a bit with what classical symptoms were, but not realizing there could be other causes I did not pay much more attention. The consulting physician suggested I do a retina evaluation first  and could be causing some of my vision issues, aside from the cataract. In all fairness, the original surgeon did also report the epiretinal membrane, but did not suggest that I first check it out before proceeding to do cataract surgery. Also, in fairness to the original surgeon, in the initial visits he did suggest that I wait unless it was interfering with my daily life.  I just wish he had made the suggestion to see a retina specialist before getting this far!  Only today, I was told how they grade the cataract (2.5?), which is not very bad.

So I am going to see a retina specialist next and hopefully, and hopefully will know what to do after that.

By the way, the consulting physician suggested if later I do the cataract surgery, that NOT to use the laser in my case, for some of the reasons that were cited in the literature, as you have so well documented.
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Just read your insightful post. Good to hear that the left eye IOL helped you so much. I'm hoping that the right eye turned out as well.

I'm having my cataracts taken care of in a couple of weeks, one week apart. I'm a very high myope, -14. I'm debating whether to get both eyes set for distance and be farsighted forever (needing reading glasses for computer/reading), or get both eyes doe for something less than full distance correction, and then wear glasses for driving, playing golf, and the like.

Now that some time has passed, I wonder if you'd share your thoughts.
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I too have been researching this issue. My situation is likely very different than yours - I am -14 myopic, and have had a retinal detachment and now a macular hole. So I have elected to have the femtosecond laser procedure, as much less mechanical energy is transferred to the eyes using the laser technique.

That said, I've read a half-dozen posts on the issue of "laser or not". It occurred to me that the vast majority of cataract surgeons do not have the femtosecond laser or the training to use it. I expect they would likely defend their methods as "good, and good enough". And they seem to be doing exactly this. But the question really is - setting aside the cost issue for a moment, which method produces better results? I have yet to ready any studies that claims that the manual method is better. Just "good enough".

Fortunately, I have the money to pay for better results. I'd rather see slightly better, for the rest of my life. than to keep that money for something else. My car is 5 years old, and I'd like a newer one. But I'd rather keep driving it for a couple more years, than skimp on my vision.

Just my two cents.

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This is what I'm thinking I'd do for myself. Pre-surgical consult is now set for this Tuesday. I'm not even sure what to ask for - "mid-distance correction"?
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re: "I  have yet to ready any studies that claims that the manual method is better. "

The incidence of some complications is higher, while others lower. Actually some of the studies I listed  above noted for instance a higher incidence of anterior capsular tears. Anecdotal comments I quoted indicate that they can "read" the capsule better via manual surgery to provide them with clues as to whether there might be a problem with a capsular tear.

Techdeveloper suggests in his case with certain retinal issues, the literature suggests manual surgery is better (I don't recall the details, since I didn't have retinal issues, nor do others I know looking into it, I hadn't paid attention to that). I don't know if its more beneficial in your case or not. I had asked a surgeon if the laser might decrease the risk of retinal detachment  due to less phaco energy being used, and he considered it unlikely since that isn't near the retina. (I was highly myopic so I'm more at risk of retinal detachment, but I've never had any retinal issues). I haven't seen anything published that contradicted his view.

Newer technology isn't guaranteed to mean better initially (even if it has the potential to be so in the future), as I've observed from decades in the high tech world. It is often merely different.  In the case of IOL technology, I felt the newest lens had enough benefit to go to the trouble to travel to Europe to get it. Usually with a new technology, especially one with higher costs, the issue is for it to demonstrate an advantage, which it isn't clear the laser has yet except in certain cases like with a mature cataract. I chose  manual surgery  even though my surgeon offered laser treatment ( for not much more so cost wasn't a factor, since its much lower cost in the Czech Republic where I went), he didn't see any real advantage in my simple case.

Even though people are also led to expect more expensive means higher quality, in a case like this that may or may not be the case depending on the person's situation. Unfortunately the technology is changing all the time, which may mean it has a benefit that isn't yet demonstrated... or a complication (like say due to a new software bug for a laser) that hasn't yet been noticed since its still a rare glitch that will only be noticed in a large statistical study.
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When I sought my second opinion on whether or not to use laser cataract surgery, I went to a major university's eye institute. I was told that even though one of the faculty members was a pioneer of this technology, they still do not use it because there is no clear evidence that it is any better than phaco. An as SoftwareDeveloper pointed  out there were numerous studies shown in the scientific literature that suggest it can indeed cause other issues.  Although expensive, I am not at all considering the cost, rather than the safety and best outcome.  While I am sure a lot of the results depend on the surgeons experience with the laser (as would it with the knife), it may be too early to know whether it indeed is 'better" or not.  I was told or read somewhere (I can't recall which), that it may be a better technique if using an accommodating lens or multi-focal. But that should be researched.  
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I wonder if one of the reasons that "they still do not use it" is because of the huge financial hurdle to get one in the first place.

A surgeon can only recoup the cost of this equipment from the small percentage of his total patients that want or need it - at an upcharge of $1500-2250/eye, Like any new tool, it must justify itself financially. I'm assuming that it is bought on credit as well, which up one's credit line for years.

I can't think of any reason to skimp on the cost of this procedure, but I know several people who have. And regretted it - all just saw one doc, listened to the spiel, and went forward. Others will research and travel to find and get the best.

I sure wish I could wait for the Symfony! From what SoftwareDeveloper reports, it's the best Mutifocal yet.
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re: "I sure wish I could wait for the Symfony! From what SoftwareDeveloper reports, it's the best Mutifocal yet."

I think it was the best choice for me (people's needs vary, some might prefer the trifocals that also aren't approved here for better near with not quite as good intermediate).  I admit now I'm curious how well using a corneal inlay providing extra depth of focus (Kamra or Raindrop) over something like the Crystalens would  work. (though I guess the risks of  Crystalens complications and need for 2 surgeries likely would still tip me towards the Symfony).

I mentioned above the Tecnis +2.75 which looks like a decent bet among US lenses. I know someone from this site who got it last week after he decided not to go abroad for the Symfony, I'm guessing he'll post about it.

I will note again that the Symfony isn't a multifocal, it is a new class of lens, an "extended depth of focus" lens:

http://www.eyeworld.org/article-new-tools-in-the-cataract-surgeon-s-toolbox
"The Tecnis Symfony has an elongated focal point, giving the wearer a continuous, full range of vision. Although the lens has diffractive gradings, it creates only 1 image on the retina, not the 2 images characteristic of multifocal IOLs. "

http://reviewofophthalmology.com/content/i/3110/c/52313/
" The first thing to understand is that the term diffractive optics doesn’t necessarily imply multifocality,” says Daniel Chang, MD, an ophthalmologist from Bakersfield, Calif., who is an investigator for the U.S. trial of the Symfony. “This is not a multifocal lens, but it does use diffractive optics to do two things: First, it corrects chromatic aberration. Second, it uses these optics to extend the range of quality vision.” As Drs. Holladay and Chang explain it, with optics you can’t gain an expanded range of vision without losing something in terms of the sharpness of vision; this is just the nature of the beast. However, by correcting chromatic aberration, even without using diffractive optics to expand the visual range, the lens would have extremely sharp distance vision on the order of 20/12 or even 20/10. The process is not yet done, however, in the Symfony. The diffractive optics are then used to expand the range of vision. Expanding the depth of focus degrades the tack-sharp “starting point” (something must be lost, as Dr. Chang pointed out), but since the lens started with such sharp vision, it only degrades to about the level of 20/20. “So the amount you degrade takes you back to the level of a good monofocal IOL,” Dr. Chang says. "

There are a few other extended depth of focus lenses on the near horizon abroad that there isn't enough data yet to know how they compare, like the Mini Well in studies now in Europe. A bit further out are better accommodating lenses.

In the case of the Symfony, part of the benefit comes from correcting chromatic aberration that even natural eyes have :

http://crstodayeurope.com/2015/01/the-evaluation-of-new-presbyopia-correcting-iols
"The average eye has approximately 2.00 D of longitudinal CA between 400 and 700 nm and 0.80 D between 500 and 640 nm."
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btw, Canada reportedly may have the Symfony available within 1-2 months. The AT Lisa trifocal is available in Mexico now, and there are some clinics that are within walking distance of California that *might* be US quality and just over there to use newer technology. (I didn't check into them once I decided to go for the Symfony).

re: "I can't think of any reason to skimp on the cost of this procedure,"

One reason btw would be to instead spend the money to travel to get a better lens, which is likely in most cases to make more of a difference in the years following surgery than having spent the money on laser vs. regular surgery would (though it depends on the case, some with specific issues like a mature cataract may benefit from the laser noticeably, with others its hard to say when the surgeons are still debating the issue). Though of course insurance issues may raise the costs too much, it depends on things like a deductible and budget.I had a high deductible so it was cheaper to go abroad it turned out  (costs are cheaper in Europe,   due to cost of living or other factors, in the Czech Republic especially. I'd only recommend it though to people willing to do their research to be sure they get good treatment, which should be a higher priority than cost of course if possible).

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I had my retinas examine today. The specialist indicated that while I have epiretinal membrane in both eyes, it's not enough to warrant surgery at this time given my current visual acuity.  He also confirmed the cataracts were very mild and felt cataract surgery would not be advised at this time either - in part both reasons due to having only one good eye to work with.   Although my eye test indicated, surprisedly, a corrected 20/25 today (oddly it was 20/40 a few months ago) using the standard eye chart, I should not have the difficulty in reading far distance traffic signs.  I told him I do, which may be the glare I perceive that interferes with the ability to read the letters.    Consequently, I don't have much faith in the Snelling eye chart results because it's only measuring my visual acuity under certain contrast conditions, and not the real world. He suggested that I try to see a very good optician, who might be able to provide some color filtering that may improve my contrast, particularly for far distant reading. So I will be off to the optician he referred me to and see what happens then.
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re: "He suggested that I try to see a very good optician, who might be able to provide some color filtering that may improve my contrast,"

Also using higher abbe material might make a slight difference. I don't know how much of a difference customized wavefront lenses might make like the Zeiss iScription lenses.   (I wore contacts before my surgery so I decided it wasn't worth it for only rare backup use so I didn't research them in detail)

http://www.zeiss.com/vision-care/en_us/better-vision/products---technologies/i-scription-lenses.html
"i.Scription® lenses by ZEISS offer a new approach for better vision — enjoy clearer vision with better contrast"


re: "Consequently, I don't have much faith in the Snelling eye chart results because it's only measuring my visual acuity under certain contrast conditions,"

Many eye surgeons share that concern since they realize obviously vision can be impacted in ways that aren't tested by that. I don't have links handy, but I've seen a number of articles in the past talking about concerns about testing people for glare&contrast sensitivity issues, and about revising their approach as to how to advice people in terms of when they should get surgery. You might check for the articles and see if a local doctor does other tests, though of course the real concern is when you subjectively think your vision is reduced to the point where you think its worth the risk/benefit tradeoffs to   get the surgery done.

Obviously the longer you wait, the better the lens technology will become, and the more potential there is for say improved laser cataract technology to get to where it makes a demonstrable difference. The other concern is of course whether or not insurance will pay for the surgery since although some have been updating their approval criteria to make them more flexible, many rely  on the Snellen visual acuity test (I don't know how common each approach is now). Hopefully if they go by snellen acuity, then if your vision is fluctuating then if you keep getting tested perhaps on a bad day you'll meet their criteria and get approval.
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You're right - I should mentally separate the Procedure from the IOL's themselves. The Symfony, however it works, would give me a grater "in-focus" range. I'm 6 days away from the having the first eye done with a +5 Tecnis Toric  and I don't think that a Toric Symfony is coming along anytime soon. In fact, if I understand the "diffractive" part of its function, I wonder if it's even a possibility.

I once considered having a non-FDA Approved Hip Resurfacing done in Belgium, back when I was in need of it. I ended up chickening out and limping around for another two yeas til the FDA approved the device here. If I thought that there was something better in the works in a matter of months, I would "limp along" for them as well.

My Cataracts are fairly mild. My biggest, most threatening t visual issue is my Macular Hole. I had an OCT scan done yesterday, and I was actually giddy to learn that it has not increased in size since October. Since the vitrectomy procedure for Macular Hole just about guarantees a cataract, and the surgeon's view is improved by having the clearest possible lens to see thru. I hate to remove my crystalline lens, just to prep for another, later Retinal surgery. But I see no way around it. Pun intended.
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I'm guessing you mean the lens power is +5 (rather low) and a monofocal, rather than that being the add for a bifocal. Hopefully if you are that myopic they got the lens power right, since it isn't an exact formula but is instead based on statistics and for various reasons is more likely to be off for high myopes, as this page explains (somewhat technical):

http://www.doctor-hill.com/iol-main/extreme_axial_myopia.htm

That doctor apparently will consult for other surgeons on lens power choices in unusual cases.

Actually there is a toric version of the Symfony out now, with comparable results. Regardless the estimates I've seen suggest it won't be FDA approved until perhaps 2017, though as I said there are clinics in Canada that expect it to be available there within 1-2 months. Most multifocal lenses use diffractive optics, and many have toric versions.

btw, for those who are considering a monofocal, the Symfony is (or soon will be) in clinical trials in the US but it is randomized with a monofocal so you have a 50-50 shot. Unfortunately such trials usually exclude those with other eye conditions so that wouldn't be an option in your case, and I also don't know if it includes the toric version.

For those using a monofocal where it may be hard to get the lens power right, if the astigmatism is low, one option is the light adjustable lens (not yet available here either) which lets the fine tune the lens power after implantation (though the astigmatism has to be fairly low I seem to recall, but I hadn't checked lately).  The light adjustable lens is available from a prominent surgeon in Mexico, Dr. Chayet, who is just over the border from San Diego (I think there are posts on this site from at least one person who went there).

. Outside the US there are a number of other lens choices in addition to the Symfony like trifocals (which also have reduced halos&glare) and even lower add bifocals like Lentis +1.5D and +2D.

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They are actually studying using an extended depth of focus pattern for the Light Adjustable Lens, an article from January mentions these are the results from Dr. Chayet, whose Mexican clinic   is walking distance from the US border in California:

http://reviewofophthalmology.com/content/i/3110/c/52313/
"In a study of binocular vision results in 20 ABV patients at Dr. Chayet’s practice, 75 percent could see 20/16 or better at distance after lock-in. Eighty-five percent now see 20/20 or better and 100 percent see 20/32 or better. In terms of binocular intermediate vision at 60 cm, 60 percent see J1+ versus zero patients preop, 75 percent see J1 versus 20 percent at this level preop and 100 percent see J2 or better compared to 45 percent preop. Ninety percent see J2 or better binocularly at near (40 cm) versus 15 percent preop. Fifty-five percent now see at least J1, compared to 5 percent who could see that well preop. "
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Thanks again, SD. Yes, i am very myopic. My surgeon uses a system called ORA that allows the surgeon to have a final check on calcs of power and sphere, during the procedure.

www.myalcon.com/products/surgical/ora-system/index.shtml

At least thats what Ive surmised. Reading is kinda tough just now.

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The intraoperative measurements are an area which are still under debate among surgeons, just like with laser surgery.

http://bmctoday.net/crstodayeurope/2014/09/article.asp?f=pointcounterpoint-does-intraoperative
"POINT/COUNTERPOINT: DOES INTRAOPERATIVE ABERROMETRY MATTER?
Point: For those who consider themselves refractive cataract surgeons, this technology helps to nail the target refraction.
By Stephen G. Slade, MD; and Jonathan H. Talamo, MD
Counterpoint: Intraoperative aberrometry is not yet the best answer to guide the surgical refractive plan in cataract surgery. "

http://bmctoday.net/crstodayeurope/2013/03/article.asp?f=pointcounterpoint-is-intraoperative-aberrometry-worth-the-investment
"Point/Counterpoint: Is Intraoperative Aberrometry Worth the Investment?
Surgeons weigh in on the value of this technology in cataract surgery."

The issue is that the eye's state during surgery differs and the measurements some suspect are misleading. Since the results are based on statistical analysis of data (i.e. based on the out come they can compute what would have worked for a particular set of measurements) I would suspect that due to fewer highly myopic people that it might take longer before their results to be good (or perhaps not, if the glitches with myopic eyes turn out to be due to measurement errors which don't apply).

I don't know if the light adjustable lens might something to consider then since it provides extended depth of focus and astigmatism correction (though I don't know for sure if it'll do both at the same time), though its still in trials, there are some reports of patients on this site doing it.

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Well, I have all but given up hope that my Macular Hole would spontaneously close - it's been 10 months since first diagnosis. Now four days to go til cataract surgery. Done by a surgeon that has done thousands of procedure without lasers, and now thousands with. Fairly well settled (committed?) with Tecnis Toric IOL, Catalys femtosecond procedure, with ORA system.  This is based on my research. I am always ready to listen to alternate viewpoints. Pretty settled on a -1.00 correction, which I understand to mean a near point focus of 10 feet. So I'll wear glasses for driving, and different glasses for computer/close work. Maybe, at some point, a single pair of progressive glasses.

Given my high myopia, long eyeball, mild astigmatism, macular hole, and history of retinal detachment, I'm just hoping that I've minimized all the risks that I can. Having just typed all that, I feel lucky to be seeing as well as I am. Retinal Doc says that he can proceed with vitrectomy about 4-5 weeks after cataract surgery.

Most interestingly, my Retinal Doc tells me that he has had cases where Cataract Surgery has triggered a closure of an existing Macular Hole! My own research confirms this, and also that it may trigger a new one!
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Sending best wishes and healing vibes your way.  
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Thanks!
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A bit of a setback. Last Monday evening, I developed a pretty large sty, so Surgery is off for this week. I saw a doc on Tuesday and got some antibiotic/steroidal ointment, and this plus the warm compresses are bringing down the inflammation and swelling. However, I want to be damn sure that this issue is well behind us prior to Surgery. Does anyone have any experience with this issue, before or after Surgery? I'm now 6 days prior to the next surgery date, and the sty is smaller, but still there.

Any replies would be appreciated.
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My optometrist tried all sorts of lenses and astigmatism adjustments, and I tried different color filters, but none really change my visual distance readability in terms of contrast, glare, or clarity.  Interestingly, today's Snellen chart test showed between 20/30 and 20/40.  The optometrist indicated that there is no standard of contrast calibration on the test image and this is one reason it may differ from office to office.  Nevertheless, I still have trouble discerning the road sign text until within 200-500 feet (depending on the sign letter size), especially when you are moving. As with the university eye clinic, he said the cataract was very mild and doing the surgery at this time would not be advised. At some point, I imagine, I will do the membrane removal and cataract to hopefully achieve the vision I had 3-4 years ago.  I have a followup in 4 months with the retina specialist, and await to see if things get worse (or better!).
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My aunt developed a kind of skin condition around her eyes - kind of like white spots..permanant. Not sure if they were related to the surgery.
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I've discovered that I have blepharitis, and possibly MGD as well. So, surgery is postponed until I have healthy eyes, eyelids, tear glands and tear ducts. .

It makes me shudder to realize that my surgeon did not carefully examine my eyes and eyelids during my initial visit. This may not be a big deal to the outcome of the cataract surgery. But, treating blepharitis and/or MGD is much trickier after a cataract surgery - until it is fully healed.

Ultimately, our eyes do not see well without a steady supply of healthy tears - and dry eyes are a very common after effect of cataract surgery.
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re: "This may not be a big deal to the outcome of the cataract surgery"

The rate of postop infection is very low these days so usually blepharitis doesn't impact the outcome so I guess many surgeons will go ahead anyway if the cataract is causing trouble. However apparently since some blepharitis is caused by an infection it can be a risk factor for postop infection. I just grabbed some quick links mentioning it. I don't know if they simply consider it a low risk so they don't worry about it, but it is common:

http://www.healio.com/optometry/cataract-surgery/news/print/primary-care-optometry-news/%7B367caee5-3e70-4bf5-98db-9739c885db58%7D/treat-blepharitis-preoperatively-for-optimal-cataract-surgery-results
"November 2010
A poster presented at the annual American Society for Cataract and Refractive Surgery Symposium on Cataract, IOL and Refractive Surgery earlier this year showed that 60% of patients scheduled for cataract surgery have blepharitis. Considering the prevalence in this patient population, Katherine Mastrota, OD, suggests a careful preoperative evaluation.

'In any surgery, most ocular infection is from the skin’s surface,' Dr. Mastrota said in an interview. 'When you have high bacterial counts on the lids and lashes, the bacteria can invade the small wound. You want to prepare the patient for a successful surgery by having an optimum ocular surface and being sure the area around the eye is clean.'  "

http://crstoday.com/2009/05/CRST0509_14.php/
"THE ENDOPHTHALMITIS LINK
Anterior and posterior blepharitis has often been considered a nuisance rather than a serious medical problem. As our understanding of the condition grows, however, it is becoming apparent that blepharitis is more than an annoyance. In isolated cases, it can lead to permanent scarring of the lid margins and other significant problems. Some of the sequelae include common chalazion or internal hordeolum, dry eyes, punctate keratitis, phlyctenular or pannus formation, corneal ulceration, and most dramatically, endophthalmitis.3 "

http://cdn.intechopen.com/pdfs-wm/42715.pdf
"Case reports have described possibly inadequately treated blepharitis and rosacea associated with cases of endophthalmitis despite the use of good surgical technique."

http://cdn.intechopen.com/pdfs-wm/42723.pdf
"Blepharitis, vitreous loss and wound leak are major potential preoperative, intraoperative and postoperative risk factors for endophthalmitis."


re: "did not carefully examine my eyes and eyelids during my initial visit."

It is important to consider that before surgery, however I don't know what the context of that visit was, it may be the sort of thing they only do immediately preop. Often people wind up at an MD (referred to by an optometrist) regarding a specific issue like diagnosing a visual glitch and discovering it is a cataract and therefore that specific issue is  what the surgeon addresses rather than other issues a non-surgeon usually deals with. Also many people have slowly developing cataracts and wait a long time before surgery, so a surgeon who doesn't know that surgery is imminent may not bother looking at factors that may change before then (figuring some non-surgeon is dealing with them).
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Thought I'd post my experience here.  53 years old.  Hard contact lens wearer for over 30 years.  Cataracts diagnosed at the end of January.  I was getting deterioration of my vision in the right eye, and increased presbyopia (about normal for my age, probably).  Optometrist recommended cataract surgery and made a referral to the ophthalmologist.  Said I might not need contacts or glasses anymore after the surgery.  I had no idea they could do this.

Ophthalmologist confirmed I was an appropriate candidate for cataract surgery.  Scheduled the surgery, along with several pre-op appointments for measurements.  Everything went fine.  Selection of lenses was an issue.  They offered the Alcon standard, multifocal or toric.  I have strabismus (eyes don't focus together) and decided I wanted at least one multifocal.  Right eye had low astigmatism (about 1.00) which doctor thought would be fine untreated.  So they did the right first with a multifocal.  For about the first 24 hours I was worried but both the near and far vision cleared up within a couple days to the point I was pretty amazed.

Selection of lens for the 2nd eye was difficult.  Astigmatism of 1.76 needed to be dealt with.  So the choice was the toric lens, or I could do another multifocal with the surgeon doing LRI (limbal relaxing incisions).  She was confident she could adequately deal with the astigmatism either way.  I decided to go with the toric because my priority was to get the best distance vision and I already had the ability to read a computer monitor, a cell phone, and labels with the multifocal on the right.

I am pretty amazed by the result.  Both eyes tested at 20/20 after the surgery.  Before the surgery my better eye was 20/150.  I can read a smartphone and a computer monitor easily with the right eye multifocal lens.  Absolutely no need for reading glasses.  The right is very good for distance also, but the left is even better.  The contrast is a bit better and there is a bit less glare from lights.  I was worried that the toric without the multifocal would have such bad up-close vision that it would be distracting, but that has not been the case.  I can read the time on my digital watch with that eye.  I can read my computer monitor also, although if I had to depend on that eye for reading I would use reading glasses.

I hope this is helpful to someone.  If anyone has questions, please feel free to post.
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Hi

Which toric and multifocal lens did you use? Tecnis or another brand?

Where did you have surgery?
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They are the Alcon AcrySof lenses.  I am in Madison, Wisconsin.
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Avatar_m_tn
Thanks for this thread. It's been very helpful.

I'm 47 and have congenital cataract in both eyes and high myopia as well. Up until the last year and a half, my corrected vision was enough to be 20/40 in at least the right eye but in this past year and a half, I've noticed I'm not seeing nearly as well. Seems the usual cataracts that form at age is progressing and after yesterday's visit, cataract surgery has been scheduled for the left eye (worse eye) in late July with the right 3 weeks later. My initial decision was to go for near distance IOL since I sit in front of computer 12+ hours a day but I'm having 2nd thoughts. I don't care if I'd need to use reading or progressive glasses if they'd allow me to still see what I'm doing at the keys (programming, IT work, 2D/3D CGI, etc) and have clear distance vision without glasses. I'm concerned near focus might make it so I don't see things beyond arm's distance well enough (faces, tv, etc which I don't make out too well now anyway). I also don't know how well distance vision would be with a post-op prescription vs had I gone distance in the first place.

So much to research. So much bouncing in my head. I'm concerned I might make the wrong choice. My pre-op is at the end of June so I have time. Just a bit stressful. :)

My thanks to all that have contributed to this thread. I welcome any advice and information.
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Avatar_f_tn
like you, my job requires a lot of reading and computer work.  I chose close and intermediate IOLs.  I also wear progressive glasses which give me clear vision at all distances.  If you opt for distance IOLs, you would need glasses for all close vision, not just when you are at the computer -- think shopping, seeing your phone, etc.  Perhaps you can experiment with contacts before you have to decide.  Best wishes.
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Avatar_m_tn
Thank you for the info. I know I'm getting lost and confused. I really don't know what the expectations are post-op with any of the choices compared to how bad I see now or have seen most of my life. I don't now how well I'll see w/ glasses distance wise if I go near/near. Or how well I'd see with readers and close work/computing if I chose distance/distance. Would it be good enough or will I be frustrated with that choice. Or any choice.

I do see it common both here and from an uncle that had one eye done that many miss near when they've gone distance/distance. I don't know if that means glasses don't help them in that case or just a frustration to have to use different strengths depending on what they're doing.

It has been great to see other's experiences as found in this thread. I just hope between my ophthalmologist and I, the right decision is made and I can compute, drive, watch tv and do everything else I normally do and see it all better than what I am now. :)
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Avatar_f_tn
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Avatar_m_tn
re: "I don't know if that means glasses don't help them in that case or just a frustration to have to use different strengths depending on what they're doing."

It is most likely merely a case of frustration since those with an IOL of any kind but with no  other eye problems should be able to use correction to get good vision at whatever distance they need.  I don't know if before the cataract hit you had already needed reading glasses to get a sense of what that is like, or if you managed to avoid it (usually by your age you would have had to deal with that, but not always).

re: "distance vision would be with a post-op prescription vs had I gone distance in the first place"

Overall the corrected distance vision with a near focused IOL should be comparable to vision with an IOL corrected for distance. Obviously if you are a high myope you are used to glasses and perhaps contacts. The corrective lenses don't make that much of a difference in terms of visual quality, its mostly an issue of comfort and convenience (and with glasses the usual tradeoffs you are used to like any anti-reflective coatings, etc).  
    
You don't mention what IOLs you are considering, or whether you are considering monovision (adjusting one eye for near).

It sounds like your vision may be too degraded to get a good sense of what an IOL targeted at a certain distance  is like by using contacts. Otherwise CBCT had a good suggestion to try contact lenses to correct you to whatever target distance you might wish to try out .  If  you can't do even 20/40 in one eye,  I don't know if it would  give you a good enough  idea of what 20/20 vision at that distance would be like (since unless you have other eye issues you should be able to get 20/20 or better with an IOL). Most eye doctors can give you trial soft disposable lenses. If you were going to try that, you might consider going  to an optometrist for that rather than the eye surgeon since they are usually more focused on surgery and medical issues than on trials of different contacts.

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Avatar_m_tn
In my case, with congenital cataracts, I've been wearing thick glasses all my life and do have a contact prescription I wear when driving. So either way, either near/near or distance/distance, I'm OK with glasses.

I need to call my ophthalmologist and ask some questions as this past Friday was a blur once he mentioned how I'd like to see and between him, another doctor and myself, seemed arms distance focus would be good. A quick check for astigmatism was enough for them to rule out the need for toric so my guess is they're going with monofocal. Wasn't much discussion mostly because I did I know any questions to ask at the time. This visit surprised me.

It usually takes 3 weeks to get a contact prescription filled with my prescription so that rules out trying monovision. But then I feel I sort of have that going on now with my left eye being so bad compared to the right.

I've got time. The pre-op measurements and consulting is in late June and then late July for the left eye. You and CBCT have given me some piece of mind, wonderful advice and this thread has given me a slew of questions I can ask. I feel far more informed, some anxiety lifting and look forward to perhaps seeing better than I have ever seen since birth.
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Avatar_m_tn
re: "It usually takes 3 weeks to get a contact prescription "

Your profile indicates you are in the US, at least in Colorado most optometrists keep a supply of disposable soft lenses for trials in their office. Mine kept trial lenses up through -10, the odds are low you are more myopic than that. If your usual doctor doesn't, perhaps just pick a doctor at a large chain (.e.g one with an office at a Walmart or something) and due to high patient volume they are likely to have trials.  Had you tried multifocal contact lenses?

I'm not sure if I have your preferences right, but it sounds like you wish to have good computer vision, and that close-in reading distance, and driving distance, are less important.  If you are going with a monofocal,  if you are having one eye set at arms length to handle the computer well, you might consider setting the other at perhaps 2 meters out for a slight bit of monovision to give you good vision at social and household distances, in meetings and getting around  home/office, TV, etc. (I'm guessing those would be focused at like 1.25D-1.5D myopic for computer distance, and 0.5D myopic for 2 meters out).  I don't know if reading a smartphone is also a factor for you. I'd posted earlier on this page I think a link to a chart&formula for converting distances to diopters:

https://www.slackbooks.com/excerpts/67956_3.pdf

I would suggest you  consider whether you might want the Crystalens or a multifocal (  in my case I preferred to go abroad to get the Symfony).

I will add one additional approach to consider if you do go for a monofocal. There are new techniques for giving presbyopic people more near vision if their eyes are adjusted to distance. They  have also been tested on patients with monofocal IOLs. They have just approved the Kamra corneal  inlay in the US, and the Raindrop corneal  inlay is in wide use outside the US and is working on getting FDA approval (and may have less reduction in contrast sensitivity since they will implant it in 2 eyes if desired, whereas the Kamra usually just goes in 1). Those are lenses inserted in the front of the eye, which can be removed if they don't work well. In that case you would get your eyes set to distance, and use glasses/contacts for closer in, until you got an inlay in the future.
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Avatar_f_tn
Regarding Crystalens -- I would not recommend them.  I had them implanted in both eyes.  The surgeries were one week apart.   Accommodation was minimal and I had very severe positive dysphotopsia and light sensitivity.  A year later I had both lenses exchanged for monofocal lenses and I am much happier.  Good luck with your decision.
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Avatar_m_tn
My current contact prescription is -11 left, -12.50 right. That, at best, gets me 20/40 in the right eye. Due to where the congenital cataract is in the left eye, I don't see anything clear with it regardless of strength. Just got by with what I could.

I may be getting confused with the options, the pros/cons of each and which would be right for me with most activities I do now and the future. I do compute more than anything else so, initially, the thought of seeing that most clearly at arm's length seemed good. But now I think some answers to some questions first so I scheduled some consulting time.

Thanks again for the info.



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Avatar_m_tn
I should probably create another thread vs hijacking this one so to speak.

Another visit with the ophthalmologist this past Friday. Still targeting intermediate/intermediate via monofocal IOLs. When I asked for IOL details, they claimed they won't know for sure until the day of surgery with ORA  used after lens extraction. I know they attempted to use one machine to do some eye measurements that was hampered by the congenital cataracts and go in again this week where another machine will be used.

I'm having doubts on going intermediate vs distance. The decision on intermediate was based on my lifestyle (12+ hours per day computing and low driving working from home). But I wonder if targeting distance and wearing glasses for computing/near is a better option. They discussed mono-vision options as well (like the suggestion w/ the right eye 2 meters out) and they seemed to think that decision could be made after the left eye was done and how I respond/like the corrected eye.  

I also plan on drilling them on IOL details. I still have time. Just want to make sure I'm making the right choices in a land of confusion. :) Can't thank SoftwareDeveloper & CBCT for the info and insights.
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Avatar_m_tn
re: "But I wonder if targeting distance and wearing glasses for computing/near is a better option."

Its all personal choice, what is best varies for each person. It  depends on how much you'd like to get rid of correction and when (and since you are a high myope, the risk that they may be slightly off in the lens power since it isn't an exact thing, even with ORA which some are skeptical will do better, so you may need to rethink the 2nd eye after the first is done).

The nice thing about having good intermediate vision is (depending on the exact range you target) that in addition to being on the computer, its useful for most household tasks, social distance at a meal or meeting, and TV (depending on distance). After having been a high myope and needing correction all my life, its nice to not need glasses/contacts around the house. Though I went with the Symfony to get a larger range, most of my vision tasks are in the intermediate range so I appreciate that aspect the most.

However in your case with monofocals to target that,  you may  need both distance glasses, and reading glasses for anything near. If  you do target distance, you can then get one pair of  progressive glasses to help with intermediate&near both, but are going to be wearing them more often.
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Avatar_f_tn
Best wishes!
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Avatar_m_tn
Lots of excellent information here, I will be copying for reference. Please tell us about your Symfony experience?
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Avatar_m_tn
A little background, I enjoyed good vision all my life without glasses until my 40's when presbyopia set in...went to progressively stronger readers to the point where I was wearing +1.25 for driving, +2.25 for intermediate, and doubling them up for near. In the past 6 mos the left eye developed cataracts so I met with the surgeon today. I have healthy eyes and negligible astigmatism, so from my research, I thought the crystalens might be right for me. When it came to q&a, I quickly learned  he no longer implants CL, says he doesn't think they work, and all he does is monofocal or Restor, in fact he ran a clinical trial for restor in the past. I hadn't researched restor and was ill prepared to discuss them.

My objective is good far vision (driving w/out glasses), and good intermediate (computer, smart phone), I'd be ecstatic if I could accomplish this and only need readers for near...not sure how best to accomplish this yet, a second opinion will be next. Problem is, most of the forum discussion on iol's seems to be from myop's, Would love to learn more from some hyperop's experience....? With readers, I'm more comfortable undercorrected, as soon as I approach overcorrection, it gets uncomfortable.

Thanks for all the great info shared here.
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Avatar_f_tn
I highly encourage you to experiment with trial lenses and then contact lenses that simulate your proposed outcome.  That way you will be able to determine your tolerance for monovision or mini monovision. Best wishes.
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Avatar_m_tn
ty, I will be discussing this with my surgeon on Thursday
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Avatar_m_tn
re: "and only need readers for near"

The older multifocals were bifocals with  adds that targeted near and had lower quality intermediate vision. Just this year the US has approved lower add multifocals from both Tecnis and Alcon that do a better job of intermediate vision, while still leaving decent near with just a small chance of needing readers.  The Symfony (if you go outside the US) is a better bet for excellent distance&intermediate with a slight chance of needing readers for near. Trifocals (not available in the US)  give good vision at all three ranges, with perhaps not quite as good intermediate as the Symfony but very near might be better. There are a few models of trifocal, the Zeiss AT Lisa Tri and the Finevision trifocal are the most common (generally rated as being comparable, with some sources giving one or the other a slight edge in different ways depending on the patient), with major vendor Alcon just having gotten approval a few weeks ago for the Panoptix trifocal that I haven't seen any data on yet to see how it compares.


re: "Please tell us about your Symfony experience?"

I've already posted about that in perhaps too much detail in a thread here:

http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258

Your profile indicates you are in the US (which hasn't yet approved the Symfony). If you aren't going to go outside the US, there is a thread here by someone who received the new Tecnis +2.75D lens:

http://www.medhelp.org/posts/Eye-Care/Tecnis-275D-MF-IOL-Experience/show/2597910

He is one  of the rare people bothered by halos with the low add lens (which can happen even with a monofocal) but they may go away with time, often they disappear in the first few months for those who have them initially. Although the Tecnis lenses seem to be better in certain ways than the AcrySof Restor lenses (less chromatic aberration for instance) I just recently saw a video indicating that the new Acrysof +2.5D low add lens has a different design than the Acrysof +3D lens and isn't merely a different lens power:

http://www.healio.com/ophthalmology/refractive-surgery/news/online/%7B543dce4e-252f-4ad9-821d-30961b045e35%7D/video-speaker-discusses-acrysof-iq-restor-25-iol
" VIDEO: Speaker discusses AcrySof IQ ReSTOR 2.5 IOL"

Halos may be less of an issue with that design than with the +3. That video shows   simulated halos, but unfortunately the only Tecnis lens they show   is the +4 and not the low add Tecnis lenses. That is the only simulation of halos I recall seeing comparing the Restor and Tecnis showing the sort of difference I see there (though it may be I hadn't paid enough attention to the halo descriptions of those lenses  in the past, I think its more that they usually aren't shown).
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Avatar_m_tn
I'm having cataract surgery this coming Thursday with Toric implant in my right eye and will have the left eye done probably within one month.  I'd like to hear more experiences with toric lenses.  I work in accounting and have been very near-sighted all my life.  I'm having my vision set to distance, so I'm hoping my vision with reading glasses will be good. Otherwise, I guess there could be trouble.

Thx,

Nancy
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Avatar_m_tn
It's been a little over a week since cataract surgery on my left eye. The target distance was less than I had figured which I would classify as more near than intermediate. I guess I was figuring more on my "arm's length" vs normal. :) They were targeting 18" and nearly got that. Last week's follow-up had me seeing 20/25-20/30 with correction which is better than this eye has  ever been my entire life with a best correction of 20/70. I'm pretty happy with the results as are the doctors involved. I can sit much further back than 4-6" away from the monitor. I can also see the dashboard & center console in my car again.

The right eye is scheduled in another two weeks and they're going to try and target a little further out.  I could tell the wheels were turning in the doc's mind when he mentioned my right eye had a bit of a cone shape to it so the capsulorhexis will be a little more challenging.

The only complications were from anesthesia. I was put fully under and coming out of it had me groggy for a bit. Other than that, I don't know why I was worrying so much about and I'm REALLY looking forward to the right eye getting done!
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Avatar_m_tn
I had the lenses replaced in both eyes ten days ago
My distance is great I can also read a news paper and the very small print on the back of my eye drop bottles
My vision is better than it was when I was a teenager

I was awake throughout the op which lasted just over an hour
I could see everything that was going on but no pain
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