Best IOL for near/intermediate vision?

[abrahamic]

I'm a 30 yr old male with cataract (due to injury) in the right (non-dominant) eye. My dominant left eye is slightly farsighted and has good distance (20/30) vision enough for driving, etc. I currently wear reading glasses for prolonged reading. Extended computer use strains my eyes (probably due to the cataract eye), so I also use glasses for that.

I've to decide what IOL to choose in the next four weeks. I work on the computer all day, so I would like to have best near adn intermediate. I'm not expecting cataract surgery in the distance left eye for the next 20 years at least.

I'm confused between  aspheric AcrySof IQ SN60WF and aspheric Softec HD, which I heard provides great near/intermediate vision, but my only "concern" is that it doesn't have blue-light blocking feature. I'm not sure if this feature is crucial for long term eye health.

Any suggestions or experience with Softec HD IOL

[abrahamic]

Thank you both for taking the time to respond with wealth of info.

I'm in the US state of Tennessee. Upon seeking a second opinion, I realized that my case is little bit complicated, which means I may have to postpone the surgery. The second ophthalmologist noticed that I have Uveitis (an inflammation of the middle layer of the eye) and possibly some signs of Fuchs' corneal dystrophy. So they will have to do a lot of diagnosis before it's safe to perform the surgery.

Regarding the IOL options, I decided to go with monofocal IOL to avoid all the side effects of multifocals/accommodating IOLs, such as glare, halos, etc.  I'm more inclined to choose Softec HD with near/intermediate focus. It’s aspheric on both sides , which reduces spheric aberrations and increases field of depth.  After some research, I concluded that blue-blocking is not a necessary feature that I would want. For final IOL decision, I will talk to the MD to consider best option for my specific case. I'm not sure what IOL options are available in the state of Tennessee but for now I may have to focus on treating my eye conditions before the cataract surgery.  Meanwhile, I’ll keep exploring IOL options within the US.

Thank you.

[SoftwareDeveloper]

re: "doesn't have blue-light blocking feature. I'm not sure if this feature is crucial for long term eye health. "

There is dispute within the industry about this, many doctors (and lens companies) suggest that it is better to *not* block blue light, or that at a minimum that blocking blue light is more a marketing gimmick than it is something useful to do. Obviously others disagree.   I hadn't researched the issue in depth though since I didn't consider that to be as important as other factors. That was partly since the issue seemed under dispute and  I figured that if anything then I'd prefer to *not* block blue light since although I could always choose to wear glasses that block blue light, glasses can't un-block blue light. None  of the lenses I was considering among my final options blocked blue light so I didn't delve into it further.

re: the AcrySof monofocal. Aside from the issue of other lenses having greater depth of focus, there are also other concerns like glistenings, this page has a good explanation of the concerns:

http://eyesurgerysingapore.blogspot.com/2013/08/an-overview-of-cataract-surgery-lens.html
"Although any hydrophobic acrylic material can have this problem, it has been reported especially in lenses made by Alcon, and these include all Alcon Acrysof lenses that are currently being used including the SN60WF (IQ lens), SN6ATT (toric lens), SN6AD1-3 (multifocal lens) and SND1TT/SV25TT (multifocal toric lens).

To be fair, not all Acrysof lenses get such significant glistenings, but it is disturbing that firstly, we cannot predict which particular Alcon lens will get a more severe problem with glistenings, and secondly, among those who develop the problem the glistenings tend to get worse with time."

Monofocal IOLs can differ in terms of things like chromatic abberation which varies depending on the material the lens is made of. This industry publication has an article describing its impact on vision, and then a later comment from an eye surgeon that:

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 might note that many people adapt to a monofocal in one eye, but I have seen reports (including from a 19 year old on this site) of  some younger  cataract patients that seem to have trouble adapting to a monofocal lens in one eye and the natural lens in the other which still has a full range of accommodation (unlike the average cataract patient who is  usually old enough that they have lost so much accommodation that their natural vision is almost like a monofocal).

The options available in part depend on the country where you (which you don't mention)   since there are many options approved in Europe which aren't available in the US (and this site gets posters from around the world, even if most are in the US).  Had you looked into multifocal or accommodating lenses, or the new Symfony extended depth of focus lens (not available in the US, which I travelled for and have threads about on this site), or have you ruled out those options in favor of a monofocal?

As my user name implies I'm a software developer (/entrepreneur) and therefore computer/intermediate vision is particularly important, which is one reason why I chose to go outside the US to get a lens better for intermediate vision since the bifocal lenses available in the US tended to skimp on intermediate vision in favor of near and far, and the accommodating lens doesn't always accommodate, and too much of a difference using monovision can impact stereopsis, depth perception.  After I got my surgery,  two lower add Tecnis bifocal  lenses have been approved in the US this year which are targeted at good intermediate vision instead of good near vision (with some chance also of good near).

Initially I was considering one of the trifocal lenses which provided better intermediate than the US bifocals available then,  but then the Symfony was released  which seems to be a better bet for intermediate and distance compared to trifocals. There are a few threads on this site about it.

[Pacerfan]

I'm in a similar situation to you only a little older. I'm 49 and have a cataract in my left non dominant eye. My right eye is still able to see 20/20 distance, is healthy and shows no signs of a cataract. Although I haven't had a recent eye trauma the surgeon from my consult asked repeatable about this as the type of cataract that I have is consistent with an injury. Since the cataract was diagnosed in late Jan. the cataract has taken off to the point that I have no usable vision in that eye. I've been researching lens option constantly since the diagnosis. I thought that the Lenstec Tetraflex might be a great option but after weeks of wasted time in searching Canada for surgeon that offered the lens and being misinformed by Lenstec that is was available there I've found that they've all but given up on that lens and aren't distributing it to Canada any longer. In that process I learned of Dr. Dougherty in southern California who has made strides with the Lenstec Softec HD lens. This is a lens option that I'm considering due to it's increased depth of field. I contacted Dr. Dougherty who said the following in his e mail.
"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."

I would recommend that you contact him if you're interested in this lens, I'm pm you with is contact info.
I haven't found anyone in Colorado that is using this lens. Do you have someone in your area that is using it in this manner?

I'm also looking into the Hoya Isert that was recently approved by the FDA for this same reason. So far I haven't found anyone in my area using this lens either but I have found a list of doctors who were used in the U.S. FDA trials and I've contacted some of them.
I'm also strongly considering the Crystalens however I'm a little concerned with it's long term safety with regards to the Z syndrome issue. Like you I hope to make a final decision in the very near future.