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Cataract surgery: multifocal or monofocal?
Facing cataract surgery, which lens to have? must decide, pros and cons of each, and is it worth the added cost of the multifocal? additional $4-5,000. please let me know soon, have to decide tomorrow or Monday.
thanks
thanks
Multifocals are less tolerant of residual astigmatism than single focus lenses, which merely means the astigmatism should ideally be corrected via incision or by using a toric lens. If there is residual astigmatism postop then it can be corrected via incisions (which can be done separately from the cataract surgery, some surgeons do it in a minor procedure room in their office/clinic rather than needing an operating room), lasik touchup or wearing correction.
I think it should be mentioned in these posts if certain types of lenses are not suited for people with astigmatism..I read somewhere that multifocals are the enemy of astigmatism...
As people have suggested, it is worth taking time to consider options (just as most people do when say buying a new car). This is a decision that will impact you the rest of your life since they try to avoid exchanging lenses if at all possible due to added risks (but it is almost always possible, worst case, to do a lens swap).
Unfortunately there is no perfect lens these days, they all have tradeoffs. You need to consider how important it is to try to avoid the need for wearing glasses/contacts and for what visual range you would prefer to wear them if you need them (i.e. distance, intermediate computer&social distance, or near hardcopy reading) since no current solution works well for all distances and there are tradeoffs.
You could post what your visual needs are for work/hobby and preferences.
Monofocal lenses tend to be only good for one range of focus (usually set for distance), with monovision improving that. Monovision can reduce stereopsis, 3D depth perception, with less of an impact for smaller levels of monovision to improve intermediate. You can't usually get too much near with monovision, it partly depends on your eye's natural depth of focus which varies with each person (some tiny % can read even with monofocals set for distance).
Multifocals in the US are really bifocals, usually set for distance&near but with intermediate that isn't as good. Newer low add lenses just approved this year like what rwbil got give a bit better intermediate and lower quality near. There are trifocals available outside the US which give very good distance&near, and decent intermediate.
Multifocal lenses can reduce contrast sensitivity a bit (lower quality vision in low light), but even monovision can a bit as well. Even monofocals can lead to issues with halos&glare, but less than with multifocals.
Although there is some risk of halo&glare issues with multifocal lenses, it is much reduced in the newer low add lenses, but unfortunately someone winds up being the "statistic" even if most don't have problems. rwbill above mentions his halo issues, though he got his IOL fairly recently and often those who have problems with halos initially see them disappear over time. Even most that do see halos with multifocals think the improved vision makes it worth the minor annoyance (though a tiny number find it problematic enough to exchange lenses).
The Crystalens accommodating lenses risks not accommodating (if it doesn't then its like a monofocal), but if it does accommodate it provides good distance and intermediate and some chance at workable near vision (I've seen some surgeons suggest 50-50 chance of needing reading glasses), without the side effects of multifocals. There are however other potential side effects for it like "z-syndrome" which apparently are much lower in the newest version of the lens, but I don't recall seeing good statistics.
The extended depth of focus Symfony rwbil mentioned is only available in randomized trials in the US (i.e. a 50-50 chance you'll get a monofocal instead) but is available in Europe where I went to get it and may be approved in Canada soon as well (someone on this site has already gotten it there, though I suspect that may have been in a trial). It gives excellent distance and intermediate (one study I linked to suggests it has the best visual acuity on average for 46 cm outwards of all the IOL choices), and a chance at decent near (I got 20/25 at near but a small minority need reading glasses). It seems to have contrast sensitivity comparable to a good monofocal, while having risk of halos&glare also comparable to a monofocal.
If you get a monofocal or the Cystalens and don't have enough near vision, it may also be possible to later add a corneal inlay, a small lens inserted in the cornea just under the surface which will provide better near vision and is removeable if you don't like it. The Kamra inlay is approved in the US, and the Raindrop is being tested here and already available outside the US. (though I don't know if the Kamra is officially approved in the US for use with an IOL, rather than just for presbyopia, but it has been studied with IOLs so its likely doctors will offer it for that use here "off label")
Unfortunately there is no perfect lens these days, they all have tradeoffs. You need to consider how important it is to try to avoid the need for wearing glasses/contacts and for what visual range you would prefer to wear them if you need them (i.e. distance, intermediate computer&social distance, or near hardcopy reading) since no current solution works well for all distances and there are tradeoffs.
You could post what your visual needs are for work/hobby and preferences.
Monofocal lenses tend to be only good for one range of focus (usually set for distance), with monovision improving that. Monovision can reduce stereopsis, 3D depth perception, with less of an impact for smaller levels of monovision to improve intermediate. You can't usually get too much near with monovision, it partly depends on your eye's natural depth of focus which varies with each person (some tiny % can read even with monofocals set for distance).
Multifocals in the US are really bifocals, usually set for distance&near but with intermediate that isn't as good. Newer low add lenses just approved this year like what rwbil got give a bit better intermediate and lower quality near. There are trifocals available outside the US which give very good distance&near, and decent intermediate.
Multifocal lenses can reduce contrast sensitivity a bit (lower quality vision in low light), but even monovision can a bit as well. Even monofocals can lead to issues with halos&glare, but less than with multifocals.
Although there is some risk of halo&glare issues with multifocal lenses, it is much reduced in the newer low add lenses, but unfortunately someone winds up being the "statistic" even if most don't have problems. rwbill above mentions his halo issues, though he got his IOL fairly recently and often those who have problems with halos initially see them disappear over time. Even most that do see halos with multifocals think the improved vision makes it worth the minor annoyance (though a tiny number find it problematic enough to exchange lenses).
The Crystalens accommodating lenses risks not accommodating (if it doesn't then its like a monofocal), but if it does accommodate it provides good distance and intermediate and some chance at workable near vision (I've seen some surgeons suggest 50-50 chance of needing reading glasses), without the side effects of multifocals. There are however other potential side effects for it like "z-syndrome" which apparently are much lower in the newest version of the lens, but I don't recall seeing good statistics.
The extended depth of focus Symfony rwbil mentioned is only available in randomized trials in the US (i.e. a 50-50 chance you'll get a monofocal instead) but is available in Europe where I went to get it and may be approved in Canada soon as well (someone on this site has already gotten it there, though I suspect that may have been in a trial). It gives excellent distance and intermediate (one study I linked to suggests it has the best visual acuity on average for 46 cm outwards of all the IOL choices), and a chance at decent near (I got 20/25 at near but a small minority need reading glasses). It seems to have contrast sensitivity comparable to a good monofocal, while having risk of halos&glare also comparable to a monofocal.
If you get a monofocal or the Cystalens and don't have enough near vision, it may also be possible to later add a corneal inlay, a small lens inserted in the cornea just under the surface which will provide better near vision and is removeable if you don't like it. The Kamra inlay is approved in the US, and the Raindrop is being tested here and already available outside the US. (though I don't know if the Kamra is officially approved in the US for use with an IOL, rather than just for presbyopia, but it has been studied with IOLs so its likely doctors will offer it for that use here "off label")
I had cataracts for years trying to decide which IOL. I really wanted MF, but had issues with the existing MF so put off surgery to the last minute. You can read why I went with MF and read about my experience in the post I wrote. I finally went with MF because I thought they had finally invented some pretty good MF IOLs. There were some real issues with some of the earlier MFs. I think the 2 best out there are the Tecnis 2.75 D and the Tecnis Symfony IOL. Actually Symfony Extended Depth of Focus IOL.
Most people get monofocal, probably because insurance pays for it and most complaints are with MF, though I think most were from the older lens.
But as I explained in my article I do see Halos at night. As I have written before, I really which they had a realistic simulator so you could have some idea of how things would look.
I would suggest you do what I did call and talk to some of the trial doctors who did the Tecnis Symphony and Tecnis 2.75 and get their assessment of their patients opinion.
As for me I am happy I went with MF over monofocal even with the anomalies I see. I am just glad I do not need reading glasses to see my computer, or labels at a grocery store or text messages and so forth.
If you have any question about my experience just ask.
Most people get monofocal, probably because insurance pays for it and most complaints are with MF, though I think most were from the older lens.
But as I explained in my article I do see Halos at night. As I have written before, I really which they had a realistic simulator so you could have some idea of how things would look.
I would suggest you do what I did call and talk to some of the trial doctors who did the Tecnis Symphony and Tecnis 2.75 and get their assessment of their patients opinion.
As for me I am happy I went with MF over monofocal even with the anomalies I see. I am just glad I do not need reading glasses to see my computer, or labels at a grocery store or text messages and so forth.
If you have any question about my experience just ask.
No, you DON'T have to decide immediately!
I'm assuming you have insurance, at least Medicare, and you are considering SURGERY which Medicare, and any secondary insurance, covers 2nd & 3rd opinions, or more if you need them.
Find highly rated surgeons that have experience with different IOLs and let them tell you what they would advise for your vision, and why.
I don't think you can put a dollar value as the biggest decider on your best vision for the rest of your life.
I'm assuming you have insurance, at least Medicare, and you are considering SURGERY which Medicare, and any secondary insurance, covers 2nd & 3rd opinions, or more if you need them.
Find highly rated surgeons that have experience with different IOLs and let them tell you what they would advise for your vision, and why.
I don't think you can put a dollar value as the biggest decider on your best vision for the rest of your life.
You may find this helpful.
http://www.medhelp.org/user_journals/show/1539608/New-Article-on-Multifocal-IOL-vs-Mini-monofocal-2015
http://www.medhelp.org/user_journals/show/1539608/New-Article-on-Multifocal-IOL-vs-Mini-monofocal-2015
To make the best decision possible, you should take at least as much time doing research as you would if you were considering the purchase of an expensive TV or sound system.
You need to know exactly what kind of vision you have (nearsighte, far-sighted, astigmatism, etc), how large your pupils are (because that can be a factor), and you personally must spend the time on reading and research, because strangers cannot make this decision for you.
I made three--three--separate appointments with my surgeon to discuss what I read about the possible choices. He was very patient with me, and with the proper lens choice, I wound up with the lovely eyesight I had when I was a kid.
I strongly suggest you postpone your surgery, because you need much more than a weekend to get the information necessary for the best outcome.
You could begin learning about this by doing a Google search for something like "how to choose the best intraocular lens."
You need to know exactly what kind of vision you have (nearsighte, far-sighted, astigmatism, etc), how large your pupils are (because that can be a factor), and you personally must spend the time on reading and research, because strangers cannot make this decision for you.
I made three--three--separate appointments with my surgeon to discuss what I read about the possible choices. He was very patient with me, and with the proper lens choice, I wound up with the lovely eyesight I had when I was a kid.
I strongly suggest you postpone your surgery, because you need much more than a weekend to get the information necessary for the best outcome.
You could begin learning about this by doing a Google search for something like "how to choose the best intraocular lens."
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