IOL Replacement

[Chepe]

I had successful monophocal IOL implant in my left eye 6 years ago.  Since then I have developed cataracts in my right eye, and need curgery. Can I have a multiphocal IOL implant on my right eye? and later have the left eye monophocal IOL replaced with multiphocal?

[John C Hagan III, MD, FACS]

Bad plan.  

Use the search feature and archives to read about all the problems with multifocal IOLs.

Leave the monofocal IOL alone.

Don't be pressured into having the extra cost (average about $3000) ReZoom, ReStor or Crystalens.

Talk to your surgeon about doing a modiefed mini-monovision if you wish to reduce your dependence on glasses.

JCH MD

[peakhope]

I agree with the doctor (I am not one) about leaving your existing monofocal lens alone.

I believe you could have a second monofocal lens installed in one of three ways: monovision, mini-monovision, or "plano" (distance, which I assume your first eye already is). This would be worth a discussion with your own doctor. maybe you could experiment with monovision contacts before deciding.

Doc: Is there any reason someone couldn't have a monofocal in one eye and one of the premium lenses in the other? Or would that be too disorienting? I know there are problems with the multi-focals, but there are some happy customers too.

[Chepe]

I am 52 years old and my work requires allday reading. In my left eye, which was successfully operated wi a monofocal IOL implant 6 years ago, I need 1.5 reading glasses.

Now that technology has advanced, I´d love to be able to do away with reading glasses and, of course, get rid of the caract in my right eye. I thought that multifocal would solve that.

As peakhope asked above:  Is there any reason someone couldn't have a monofocal in one eye and one of the premium lenses in the other?  I´ve herd that some patients can focus for reading with one eye and use the other for far away vision.
What should I do? I really have no preasure from my surgeon. I just want to know what can I do.  Fortunately, cost is not the issue I have to deal with.

[John C Hagan III, MD, FACS]

No there are people that have mono IOL in one eye and multifocal IOL in other and are happy but..................(fine print)

These are usually people that don't need to read all day and have strong occupational need not to wear glasses (example saleswomen in high end department store, only need to see well enough to see price tags and check out customers). It doesn't work well for people that use their eyes all day since in that situation the person is using only one eye for reading (the multifocal IOL). That is a problem for most people as there is the strain of only one eye doing the work and the monofocal IOL will be blurry.

If you wear glasses to let the mono eye help the multifocal eye you defeat the purpose of it and why spend the money extra (avg $3000) for the multi IOL with all the night vision problems if you're going to wear reading glasses.

JCH MD

[Lerbea]

The freedom of not wearing glasses does not outweigh the risks of bad vision you might possibly get from the Multifocal IOL.  Once you have the compromised vision it's too late. Good vision with glasses should be appreciated.  I got the Multifocal because it was supposed to be a better lens. It was not a choice to do without glasses. I'm very sorry I did this.  I've had to go another surgery and get a IOL exchange with monofocal.

[John C Hagan III, MD, FACS]

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[peakhope]

Your comments (aside from the money parts) sound like they would also apply to pure monovision, with one monofocal lens set at distance, and a second monofocal lens set for near sight. I thought that was a fairly common configuration that many people like, but some hate.

[John C Hagan III, MD, FACS]

As we've discussed many time true monovision say -0.00 distance eye and -2.50 reading eye can't be tolerated by many people.  Then its hard to "undo". Mini-monovision either -0.25 for distance and -1.50 for year works pretty good but will not make a person glasses independent.

Use the search feature to read all the posts about monovision.

JCH MD

[JodieJ]

Unfortunately, just about any correction you choose involves compromise.  Monovision can provide reasonably good (i.e., less than perfect) vision at all distances for many people--but you may still need glasses in some situations.  Mini-monovision can provide very good vision at two distances, but you'd definitely need glasses for some tasks.  And many people with two multifocal IOLs still need glasses for some (or all) tasks.  I've read that outcomes for a multifocal/monofocal combination are less successful than those for two multifocals, and there are sometimes problems using both eyes together.

It's my impression that monovision works best for people in their 40's or early 50's.  One of my friends with monovision (who is over age 60) never wears glasses but has to have someone read the menu to her at some restaurants.  On the other hand, my mother's friend (who is over 80) with monovision (with monofocal IOLs) seems to do fine with small print without glasses and also drives at night.    

[John C Hagan III, MD, FACS]

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[Chepe]

Thank you for sharing.

[Chepe]

I was reading over your previous comments.

Could you specify what are the night vision problems associated with Multifocal IOL? You see, wearing reading glasses to help the multifocal in exchange for being able to glance at a menu or the dash board without using reading glasses, sure seems worth the 3000 dlrs; but if that impers my night vision is something I had not herd before. Is night vision worse with Multifocals vs Monofocals?

[peakhope]

Different multifocals have different properties. Use the forum search feature for rezoom to find out why you probably want to avoid that lens. Search for restor to find stories of nighttime glare and halos, but some happy users too. The third search would be for crystalens, which until recently only usually offered distance+medium (not near) vision, but with the new HD model it may, in some cases, give near vision as well.

If all you want to do is see a car dashboard without glasses, perhaps crystalens would work for you. Of course you should discuss the options with your doctor.

[Chepe]

Doctor:  I found a statement you made back in 2007: ¨I have said before that if I was going to have cataract surgery on myself at this time I would not choose a Premium IOL.¨

Does it still hold?

[Chepe]

Doctor:  I found a statement you made back in 2007: ¨I have said before that if I was going to have cataract surgery on myself at this time I would not choose a Premium IOL.¨

Does it still hold?