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Tecnis 2.75D MF IOL Experience
I had the recently FDA approved Tecnis MF low-add 2.75D IOL implanted in my left eye 3 weeks ago and I thought I would share my experience with others researching MF lens options. First I think it is important to understand my vision background and why I selected this lens, because my assessment might be 180 Degrees opposite from someone that had perfect 20/20 vision all their life and just had a minor cataract and has the same lens implanted.
Vision before surgery:
I am a 53 year old male with cataracts and have had cataracts for a long time. I am myopic in both eyes and have worn contacts since I was 16 year old. It has been a long time since I had “Good” vision. My vision had gotten worst with time and finally got to the point that I could no longer procrastinate and had to make a decision. My daytime vision was getting so blurry it was becoming dangerous for me to drive. At the time of surgery I could not see street signs until I was right under them and sometimes not even then and I could not read my instruments on my dash board. I also could not read labels at a grocery store or a menu at a restaurant without both reading glass and using a light.
Why I selected the Tecnis 2.75D MF:
I had procrastinated getting cataract surgery because I wanted a MF lens and I was not happy with the options available. Most of the doctors in my area use the Restor 3.0, but from my research the Restor is pupil dependent; so nighttime vision is not so great. You go into a restaurant and you cannot read the menu in dim lightening. I also worried about, glistening, haloes, glare and other visual distortions associated with the Restor lens.
From my research the material used by the Tecnis IOL is a better option, but the original Tecnis 4.0’s focal point was to close for me, plus patients had a high incidence of glare and halos. The halo size is proportionate to the add power. I work on the computer a lot so the Restor 3.0 had better intermediate vision. Below is an article that discusses chromatic aberration and the material used for various IOL and you can see the Tecnis material is better including the Abbe number over the Restor lens.
http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
For these reasons I procrastinated until the Tecnis Symfony came out. From everything I have read including the Defocus curves, the Symfony is a very exciting new lens. It actually is an Extended Depth of Focus lens and not a MF, though it has rings like the Tecnis MF Lens. The Symfony lens has been shown to give excellent distance and intermediate vision, while having the same rate of glare and halos as a monofocal lens. Instead of me discussing the details about the Tecnis Symphony lens, I suggest you read Software Developer’s posts, shown below, which will have the article above and many others. He went to Europe to get the Tecnis Symfony lens implanted and his posts are very informative.
http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258#post_11793863
http://www.medhelp.org/posts/Eye-Care/experiences-with-Symfony-IOL--or-trifocal-IOLs/show/2338847
I was so interested in the Tecnis Symphony lens I started to look into going to Europe at the end of 2014 to get the lens. It is on the FDA Fast Track list, but who know when the FDA will approve it. They are not exactly known for speed. I also looked into getting into the Symfony lens trials, but was told there was a 50/50 chance I would be in the control group that received the Tecnis Monofocal lens. I was not interested in the monofocal lens so I decide not to be part of the trials. But during that time I talked to several doctors who were doing the Symphony trials and they all said they had just done the new Tecnis low add trials and that the new Tecnis MF 2.75D IOL would be a great lens for me and it should be approved in early 2015. At the time I did not even know there was a new Tecnis low-add 3.25D and a new low-add 2.75D in trials. So I started to research these new low-add lens. The more I read about this lens and the more I talked to Doctors who had done the trial the more interested I became in the Tecnis low-add 2.75D lens.
This lens was made from the same excellent material as the Tecnis 4.0, but designed to have great intermediate vision. I was hopeful that after surgery I would be able to read labels at the grocery store and menus at a restaurant and I did not care if I had to wear reading glasses to read small print. Also the lower the add power the lower the incidences of glare and halos. Below is information about the lens from AMO. You can see, from the article below, the lens has a high 97% satisfaction and the number of patients reporting Halos is much lower than the other MF lens.
http://www.amo-inc.com/products/cataract/refractive-iols/tecnis-multifocal-family
Another article, shown below, written by Dr. Chang, who was clinical investigator in the FDA trials states, “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."
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
My Experience:
The Day of Surgery my eyesight was blurry. I was a bit worried but the next day things cleared up. Post Op the next day I was 20/30 distance and 20/20 close. Post op 2 weeks later I was 20/25 distance and 20/20 close. But the real question is, “how is my vision in the real world”.
Day Time Vision:
Distance, Intermediate and Near vision is great. In fact, the best my vision has been in a long time. I was surprised how bright everything looked. I had to turn down the brightness setting on my monitor. I can actually see street signs again. Prior to surgery if I was in a meeting and someone was against a window I could not even make them out; they were just a blur. But now I can see them clearly. Intermediate I can see the speed I am going and my fuel gauge again. And the most important thing, for me, is I can clearly see my computer with no reading glasses required. Close I can read my text messages, even in the sunlight, something I could not do before surgery. Gosh I remember trying to find some shade to read my messages before. I am not a big book reader so hard for me to comment on that as I mostly read on the computer, but I can read all my mail, newspaper and magazine articles. Remember I only had one eye done so far and the other eye cannot focus at close range very well, so my reading speed might not be the fastest. For an experiment I put on reading glasses. The reading glasses did not make much difference in my left eye, but did in my right eye. With reading glasses I could read up close pretty fast, so I think if both eyes were done with the Tecnis 2.75 I would be able to read fast up close. I can easily read grocery labels and so far been able to read menus at a restaurant, but I have not been to a particularly dark restaurant since the surgery. Now for the big question; the medicine bottle test. Can I read those little bottles? Well it depends on the bottle and light. I was able to read the instructions on the box for the eye drops I am using with ease. If the print gets super small then it is harder to read, but if I take it to a well-lit place I can read even tiny prints. So the amount of light makes a difference.
********* I guess I am verbose as I have gone over the 8000 character limit. So I will finish my post via the comments section below *********
Vision before surgery:
I am a 53 year old male with cataracts and have had cataracts for a long time. I am myopic in both eyes and have worn contacts since I was 16 year old. It has been a long time since I had “Good” vision. My vision had gotten worst with time and finally got to the point that I could no longer procrastinate and had to make a decision. My daytime vision was getting so blurry it was becoming dangerous for me to drive. At the time of surgery I could not see street signs until I was right under them and sometimes not even then and I could not read my instruments on my dash board. I also could not read labels at a grocery store or a menu at a restaurant without both reading glass and using a light.
Why I selected the Tecnis 2.75D MF:
I had procrastinated getting cataract surgery because I wanted a MF lens and I was not happy with the options available. Most of the doctors in my area use the Restor 3.0, but from my research the Restor is pupil dependent; so nighttime vision is not so great. You go into a restaurant and you cannot read the menu in dim lightening. I also worried about, glistening, haloes, glare and other visual distortions associated with the Restor lens.
From my research the material used by the Tecnis IOL is a better option, but the original Tecnis 4.0’s focal point was to close for me, plus patients had a high incidence of glare and halos. The halo size is proportionate to the add power. I work on the computer a lot so the Restor 3.0 had better intermediate vision. Below is an article that discusses chromatic aberration and the material used for various IOL and you can see the Tecnis material is better including the Abbe number over the Restor lens.
http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
For these reasons I procrastinated until the Tecnis Symfony came out. From everything I have read including the Defocus curves, the Symfony is a very exciting new lens. It actually is an Extended Depth of Focus lens and not a MF, though it has rings like the Tecnis MF Lens. The Symfony lens has been shown to give excellent distance and intermediate vision, while having the same rate of glare and halos as a monofocal lens. Instead of me discussing the details about the Tecnis Symphony lens, I suggest you read Software Developer’s posts, shown below, which will have the article above and many others. He went to Europe to get the Tecnis Symfony lens implanted and his posts are very informative.
http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258#post_11793863
http://www.medhelp.org/posts/Eye-Care/experiences-with-Symfony-IOL--or-trifocal-IOLs/show/2338847
I was so interested in the Tecnis Symphony lens I started to look into going to Europe at the end of 2014 to get the lens. It is on the FDA Fast Track list, but who know when the FDA will approve it. They are not exactly known for speed. I also looked into getting into the Symfony lens trials, but was told there was a 50/50 chance I would be in the control group that received the Tecnis Monofocal lens. I was not interested in the monofocal lens so I decide not to be part of the trials. But during that time I talked to several doctors who were doing the Symphony trials and they all said they had just done the new Tecnis low add trials and that the new Tecnis MF 2.75D IOL would be a great lens for me and it should be approved in early 2015. At the time I did not even know there was a new Tecnis low-add 3.25D and a new low-add 2.75D in trials. So I started to research these new low-add lens. The more I read about this lens and the more I talked to Doctors who had done the trial the more interested I became in the Tecnis low-add 2.75D lens.
This lens was made from the same excellent material as the Tecnis 4.0, but designed to have great intermediate vision. I was hopeful that after surgery I would be able to read labels at the grocery store and menus at a restaurant and I did not care if I had to wear reading glasses to read small print. Also the lower the add power the lower the incidences of glare and halos. Below is information about the lens from AMO. You can see, from the article below, the lens has a high 97% satisfaction and the number of patients reporting Halos is much lower than the other MF lens.
http://www.amo-inc.com/products/cataract/refractive-iols/tecnis-multifocal-family
Another article, shown below, written by Dr. Chang, who was clinical investigator in the FDA trials states, “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."
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
My Experience:
The Day of Surgery my eyesight was blurry. I was a bit worried but the next day things cleared up. Post Op the next day I was 20/30 distance and 20/20 close. Post op 2 weeks later I was 20/25 distance and 20/20 close. But the real question is, “how is my vision in the real world”.
Day Time Vision:
Distance, Intermediate and Near vision is great. In fact, the best my vision has been in a long time. I was surprised how bright everything looked. I had to turn down the brightness setting on my monitor. I can actually see street signs again. Prior to surgery if I was in a meeting and someone was against a window I could not even make them out; they were just a blur. But now I can see them clearly. Intermediate I can see the speed I am going and my fuel gauge again. And the most important thing, for me, is I can clearly see my computer with no reading glasses required. Close I can read my text messages, even in the sunlight, something I could not do before surgery. Gosh I remember trying to find some shade to read my messages before. I am not a big book reader so hard for me to comment on that as I mostly read on the computer, but I can read all my mail, newspaper and magazine articles. Remember I only had one eye done so far and the other eye cannot focus at close range very well, so my reading speed might not be the fastest. For an experiment I put on reading glasses. The reading glasses did not make much difference in my left eye, but did in my right eye. With reading glasses I could read up close pretty fast, so I think if both eyes were done with the Tecnis 2.75 I would be able to read fast up close. I can easily read grocery labels and so far been able to read menus at a restaurant, but I have not been to a particularly dark restaurant since the surgery. Now for the big question; the medicine bottle test. Can I read those little bottles? Well it depends on the bottle and light. I was able to read the instructions on the box for the eye drops I am using with ease. If the print gets super small then it is harder to read, but if I take it to a well-lit place I can read even tiny prints. So the amount of light makes a difference.
********* I guess I am verbose as I have gone over the 8000 character limit. So I will finish my post via the comments section below *********
re: "It sounds like some of the issues with reading in poor light and halos"
Unfortunately there is no lens currently existing that doesn't cause halos in some minority of patients, even monofocals. As you say, no perfect lens exists. The frequency of halos will vary with the lens type. Here is a link to the FDA data they submitted to get approval for the Tecnis low add lenses which includes comparisons with a monofocal:
http://www.accessdata.fda.gov/cdrh_docs/pdf/P980040S049d.pdf
I find it interesting to compare with the level of halos in this document used for approval of the low add Alcon Restor lens, which is higher:
http://www.accessdata.fda.gov/cdrh_docs/pdf4/P040020S050c.pdf
I hadn't taken time to figure out of their methodology is different perhaps (the questions they used, etc), since on first glance at the raw data it appears the statistics show more halos in the Alcon monofocal than the Tecnis multifocals. A minority of people even with their natural lens without cataracts have halos. I suspect that one factor with rwbil is that since he mentioned not driving much at night that his brain hasn't had as much chance to neuroadapt and learn to tune out the halos. Many people with halo issues see them resolve the first few weeks/months, though others can take a couple of years, or they never go away.
In terms of "reading in poor light", that also seems to be an issue with many IOLs, though it seems to vary with the person. I've seen many comments that generally after surgery people should remember that brighter light helps for many. (though that is true as people age as well).. Someone here wrote up their experience with the Crystalens for instance and noted in one update:
http://www.komar.org/faq/colorado-cataract-surgery-crystalens/
"it's a challenge to read in low-light conditions"
The Crystalens is of course also a single focus lens, which merely may accommodate (or provide increased depth of focus, there is controversy over that). It doesn't seem to take much reduction in light for him to see a noticeable drop. I live in the same town as he does, and we talked after a lecture we both attended, and he'd brought a near reading test card. In a brightly lit auditorium, if he held a folder over the card to block the direct light from above with a shadow, it reduced his near vision quite a bit (I can't recall how many lines). It does vary with the person and IOL however. I tried the same thing, and in my case I have the Symfony lenses and my near vision remained the same when I held the folder over the near card, I could read just as well. (I had been testing at 20/25 near vision, though his chart didn't break that out, I could read 20/30 easily and some of the 20/20. I don't recall what his near was that day, he gives results on his page for other tests).
. I don't know how much the lens material plays a role in that, the Symfony is the same lens material as other Tecnis lenses like the multifocals this page is about, but a different optical design. The Symfony is reported to have contrast sensitivity comparable to a monofocal. I don't know how much of that may vary per person and depend on the status of the rest of their eye and their age, e.g. my particular eye's sensitivity to light (I'm comparatively young for having had cataract surgery, 52 , but thats about the same as rwbil and the fellow with the Crystalens). There has been one other person who posted on this site suggesting he was a bit concerned with his low light vision with the Symfony, but he had only recently had his surgery so perhaps being in the initial recovery phase played a factor.
I had worn multifocal contacts for a while before I developed cataracts, so it may be that I was used to reduced contrast sensitivity. In lower light things are noticeably brighter with the Symfony than they were with the multifocal contacts in my case.
Unfortunately there is no lens currently existing that doesn't cause halos in some minority of patients, even monofocals. As you say, no perfect lens exists. The frequency of halos will vary with the lens type. Here is a link to the FDA data they submitted to get approval for the Tecnis low add lenses which includes comparisons with a monofocal:
http://www.accessdata.fda.gov/cdrh_docs/pdf/P980040S049d.pdf
I find it interesting to compare with the level of halos in this document used for approval of the low add Alcon Restor lens, which is higher:
http://www.accessdata.fda.gov/cdrh_docs/pdf4/P040020S050c.pdf
I hadn't taken time to figure out of their methodology is different perhaps (the questions they used, etc), since on first glance at the raw data it appears the statistics show more halos in the Alcon monofocal than the Tecnis multifocals. A minority of people even with their natural lens without cataracts have halos. I suspect that one factor with rwbil is that since he mentioned not driving much at night that his brain hasn't had as much chance to neuroadapt and learn to tune out the halos. Many people with halo issues see them resolve the first few weeks/months, though others can take a couple of years, or they never go away.
In terms of "reading in poor light", that also seems to be an issue with many IOLs, though it seems to vary with the person. I've seen many comments that generally after surgery people should remember that brighter light helps for many. (though that is true as people age as well).. Someone here wrote up their experience with the Crystalens for instance and noted in one update:
http://www.komar.org/faq/colorado-cataract-surgery-crystalens/
"it's a challenge to read in low-light conditions"
The Crystalens is of course also a single focus lens, which merely may accommodate (or provide increased depth of focus, there is controversy over that). It doesn't seem to take much reduction in light for him to see a noticeable drop. I live in the same town as he does, and we talked after a lecture we both attended, and he'd brought a near reading test card. In a brightly lit auditorium, if he held a folder over the card to block the direct light from above with a shadow, it reduced his near vision quite a bit (I can't recall how many lines). It does vary with the person and IOL however. I tried the same thing, and in my case I have the Symfony lenses and my near vision remained the same when I held the folder over the near card, I could read just as well. (I had been testing at 20/25 near vision, though his chart didn't break that out, I could read 20/30 easily and some of the 20/20. I don't recall what his near was that day, he gives results on his page for other tests).
. I don't know how much the lens material plays a role in that, the Symfony is the same lens material as other Tecnis lenses like the multifocals this page is about, but a different optical design. The Symfony is reported to have contrast sensitivity comparable to a monofocal. I don't know how much of that may vary per person and depend on the status of the rest of their eye and their age, e.g. my particular eye's sensitivity to light (I'm comparatively young for having had cataract surgery, 52 , but thats about the same as rwbil and the fellow with the Crystalens). There has been one other person who posted on this site suggesting he was a bit concerned with his low light vision with the Symfony, but he had only recently had his surgery so perhaps being in the initial recovery phase played a factor.
I had worn multifocal contacts for a while before I developed cataracts, so it may be that I was used to reduced contrast sensitivity. In lower light things are noticeably brighter with the Symfony than they were with the multifocal contacts in my case.
I appreciate the quick follow up.
It sounds like some of the issues with reading in poor light and halos are part of the "compromise" that the cataract patient might expect when choosing a Tecnis multifocal iol at this point in time. There does not appear to be a totally optimal iol on the market.
I guess the biggest question of all is whether you would choose the Tecnis 2.75 again if you knew what you know now in advance. In your own experience, is your particular set of issues still better than the increased dependence on glasses with a monofocal/mini-monovision choice?
And, you mentioned that you use computers a lot at work? I assume that you are quite happy with this aspect since you have not mentioned it since the first post?
It sounds like some of the issues with reading in poor light and halos are part of the "compromise" that the cataract patient might expect when choosing a Tecnis multifocal iol at this point in time. There does not appear to be a totally optimal iol on the market.
I guess the biggest question of all is whether you would choose the Tecnis 2.75 again if you knew what you know now in advance. In your own experience, is your particular set of issues still better than the increased dependence on glasses with a monofocal/mini-monovision choice?
And, you mentioned that you use computers a lot at work? I assume that you are quite happy with this aspect since you have not mentioned it since the first post?
Before I talk about issues. I want to say there is no comparison to my vision before and after surgery. Both my distance and close up up vision is 20/20. The weakest part of close vision is light, but that is the case with any MF that splits the light between distance and close up vision. If there is enough light I can see crystal clear up close, if it gets dark things get less clear.
One thing I do is carry a flashlight key on my key chain. I seldom use it but if I am trying to see some small print in the dark it clears everything up.
I still have halos and floaters. In my opinion they never go away, but over time you get use to them and notice them less.
I think with halos I might have a hard time to adapt as I do not drive that often at night.
I am still holding out on the 2nd surgery for as long as I can to see the FDA trial Tecnis Symphony results and to see if any other new IOL comes on the market.
One thing I do is carry a flashlight key on my key chain. I seldom use it but if I am trying to see some small print in the dark it clears everything up.
I still have halos and floaters. In my opinion they never go away, but over time you get use to them and notice them less.
I think with halos I might have a hard time to adapt as I do not drive that often at night.
I am still holding out on the 2nd surgery for as long as I can to see the FDA trial Tecnis Symphony results and to see if any other new IOL comes on the market.
Thank you for the details about the Tecnis 2.75. It seems like the lens of choice at this point for a multfocal in the U.S.
If possible, please provide another 3 month update on quality of vision and your experience with halos. Would you make the same choice with what you know now?
If possible, please provide another 3 month update on quality of vision and your experience with halos. Would you make the same choice with what you know now?
First some updates. On the good news side my distance vision is now 20/20 -1 or -2 depending on the day. My up close vision is also 20/20 (the amount of light does have an effect on my close vision) The doctor never did an intermediate vision test, but I can see the computer monitor and my dashboard clearly, so I think my intermediate vision is pretty good.
On the bad news front, I am having issues with floaters after surgery. My doctor checked it out and says he sees no retina tear or bleeding. Apparently my floaters are from undissolved gel particles. From my research the floaters are not issue related to IOL selection, but just a possible consequence of this surgery. Surgery is traumatic to the eyes, which is why I would never recommend this surgery for a clear lens exchange. The doctor said over time they usually go away or I will notice them less. So only time will tell.
I am sorry to hear that someone only 31 years old has cataracts. At such a young age you probably had excellent vision prior to the cataracts and had not even suffered from Presbyopia yet. So it is very likely your expectations might be higher than mine were. Sadly, no IOL is going to be as good as the original natural adaptive lens.
To answer your question, I do see visual artifacts during the daytime. I am not even sure if it is glare or some other type of artifact. For example, when the sun shines off cars reflective parts I see a bright circle. It is kind of odd to look at when it occurs on multiple cars. I also occasionally see a light ray coming off of light sources. And there are other anomalies I see. But in honesty none of them really bothers me. What bothers me the most is the halos at night and the eye floaters. In fact if I did not have floaters I would rate my daytime vision as Great even with the anomalies I see.
You asked about faces and if they are blurry. Most of the time my vision is very clear. The only time things are blurry is what I talked about in my post. At a distance of maybe 75 feet when there is a light source behind the individual, like the gym example I gave. I see people very clearly up close, even when there is light source behind them, so seeing the baby should not be an issue.
You mentioned monovision as an option. Many people have done it and like it. I will tell you my personal experience and my thoughts. When I had contacts and started to get presbyopia my optometrist tried monovision with contacts. I absolutely hated it. Maybe it was due to being young at the time and still having good eye vision and I did not give it time. But having clear distance vision in one eye and not in the other was something I did not like. Now I have read some articles about Symfony doing Micro monovision. You might talk to some doctors who have tried that. I am talking though Micro, maybe .5D or so. If you can take the distance from 20/20 to 20/25 and gain some up close that might be a decent tradeoff. Below is an article
http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7B3e2a68c1-d262-48ca-be58-198a2041b8b8%7D/tecnis-symfony-iol-achieves-good-vision-at-all-distances
That is something I would definitely consider with the Tecnis Symphony. With the Tecnis 2.75 I am 20/20 near and do not need monovision.
You asked, “When is your next eye going to be done? Would you recommend these lenses to someone?”
I am glad I just did the one eye so I have time to see all the effect and make an informed decision. If there was nothing on the horizon I might just do the right eye also, but I want to see more about the Symphony lens once the FDA studies come out and see if anyone tries to do a Symfony with a Tecnis 2.75 and the results. Also want to see how my halos do in time. The problem with halos is I do not drive that much at night so maybe my brain never goes through the neural adaptation process.
I tell you I would give anything for a realistic simulator that would show you how your vision will be with various IOL options.
Right now I think they have 2 pretty good lens; the Tecnis Symfony and the Tecnis 2.75. The symphony is an extended range of focus and not yet FDA approved. From all my research I think those are the 2 best lens options out there if you want distance, intermediate and near vision without glasses. But keep in mind most people get a monofocal lens and it seems most of the people that complain had gotten the MF lens.
Hopefully, I answered your question, but feel free to ask if I missed anything, but in summary:
This is the bottom line for me. I could not drive safely during the daytime or nighttime before. Driving was getting downright scary. If not for the floaters, my day vision would be excellent. Yes there are those few anomalies I have talked about, but my distance is now 20/20 -1 or 20/20 -2 depending on the day of the test and my close is 20/20. I am writing this at the computer and everything is clear. Using both eyes the halos are not that bad and I can drive comfortably at night. So my vision is a heck a lot better now than it was before cataract surgery.
One one final note. If you want names of the Ophthalmologists I talked to who did the trials for both the Symfony and Tecnis 2.75, message me and I can email them to you.
On the bad news front, I am having issues with floaters after surgery. My doctor checked it out and says he sees no retina tear or bleeding. Apparently my floaters are from undissolved gel particles. From my research the floaters are not issue related to IOL selection, but just a possible consequence of this surgery. Surgery is traumatic to the eyes, which is why I would never recommend this surgery for a clear lens exchange. The doctor said over time they usually go away or I will notice them less. So only time will tell.
I am sorry to hear that someone only 31 years old has cataracts. At such a young age you probably had excellent vision prior to the cataracts and had not even suffered from Presbyopia yet. So it is very likely your expectations might be higher than mine were. Sadly, no IOL is going to be as good as the original natural adaptive lens.
To answer your question, I do see visual artifacts during the daytime. I am not even sure if it is glare or some other type of artifact. For example, when the sun shines off cars reflective parts I see a bright circle. It is kind of odd to look at when it occurs on multiple cars. I also occasionally see a light ray coming off of light sources. And there are other anomalies I see. But in honesty none of them really bothers me. What bothers me the most is the halos at night and the eye floaters. In fact if I did not have floaters I would rate my daytime vision as Great even with the anomalies I see.
You asked about faces and if they are blurry. Most of the time my vision is very clear. The only time things are blurry is what I talked about in my post. At a distance of maybe 75 feet when there is a light source behind the individual, like the gym example I gave. I see people very clearly up close, even when there is light source behind them, so seeing the baby should not be an issue.
You mentioned monovision as an option. Many people have done it and like it. I will tell you my personal experience and my thoughts. When I had contacts and started to get presbyopia my optometrist tried monovision with contacts. I absolutely hated it. Maybe it was due to being young at the time and still having good eye vision and I did not give it time. But having clear distance vision in one eye and not in the other was something I did not like. Now I have read some articles about Symfony doing Micro monovision. You might talk to some doctors who have tried that. I am talking though Micro, maybe .5D or so. If you can take the distance from 20/20 to 20/25 and gain some up close that might be a decent tradeoff. Below is an article
http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7B3e2a68c1-d262-48ca-be58-198a2041b8b8%7D/tecnis-symfony-iol-achieves-good-vision-at-all-distances
That is something I would definitely consider with the Tecnis Symphony. With the Tecnis 2.75 I am 20/20 near and do not need monovision.
You asked, “When is your next eye going to be done? Would you recommend these lenses to someone?”
I am glad I just did the one eye so I have time to see all the effect and make an informed decision. If there was nothing on the horizon I might just do the right eye also, but I want to see more about the Symphony lens once the FDA studies come out and see if anyone tries to do a Symfony with a Tecnis 2.75 and the results. Also want to see how my halos do in time. The problem with halos is I do not drive that much at night so maybe my brain never goes through the neural adaptation process.
I tell you I would give anything for a realistic simulator that would show you how your vision will be with various IOL options.
Right now I think they have 2 pretty good lens; the Tecnis Symfony and the Tecnis 2.75. The symphony is an extended range of focus and not yet FDA approved. From all my research I think those are the 2 best lens options out there if you want distance, intermediate and near vision without glasses. But keep in mind most people get a monofocal lens and it seems most of the people that complain had gotten the MF lens.
Hopefully, I answered your question, but feel free to ask if I missed anything, but in summary:
This is the bottom line for me. I could not drive safely during the daytime or nighttime before. Driving was getting downright scary. If not for the floaters, my day vision would be excellent. Yes there are those few anomalies I have talked about, but my distance is now 20/20 -1 or 20/20 -2 depending on the day of the test and my close is 20/20. I am writing this at the computer and everything is clear. Using both eyes the halos are not that bad and I can drive comfortably at night. So my vision is a heck a lot better now than it was before cataract surgery.
One one final note. If you want names of the Ophthalmologists I talked to who did the trials for both the Symfony and Tecnis 2.75, message me and I can email them to you.
Great post- so much real world/functional vision information for someone like me who is worried about that versus the "20/20" number charts.
I am 31 and unfortunately have cataracts due to steroid medication. I am at a point now where I am a candidate for surgery and my ophthalmologist has said that he suggests this particular lens for me and told me to research it and get back to him. My other option is blended monovision with 2 mono focals- one set for intermediate and the other for distance.
So you covered a lot of information but I still have some questions! When is your next eye going to be done? Would you recommend these lenses to someone?
As far as functional vision goes... How is your vision (near, middle and far) inside and outside? Just as a quick opinion- are there blurry areas? Are there any issues with focus? When you're walking down the aisle at a grocery store is anything blurry? Are faces blurry across a dining table or walking around a store? How about faces at a closer distance? I have a 2 year old baby girl and one of my biggest concerns is her face being blurry to me after my surgery when I am close by her face. It breaks my heart to think I may not see her clearly up close anymore. :(
Please let me know any other helpful details or things you've noticed at this point post surgery? Thanks so much!!!!
Sara
I am 31 and unfortunately have cataracts due to steroid medication. I am at a point now where I am a candidate for surgery and my ophthalmologist has said that he suggests this particular lens for me and told me to research it and get back to him. My other option is blended monovision with 2 mono focals- one set for intermediate and the other for distance.
So you covered a lot of information but I still have some questions! When is your next eye going to be done? Would you recommend these lenses to someone?
As far as functional vision goes... How is your vision (near, middle and far) inside and outside? Just as a quick opinion- are there blurry areas? Are there any issues with focus? When you're walking down the aisle at a grocery store is anything blurry? Are faces blurry across a dining table or walking around a store? How about faces at a closer distance? I have a 2 year old baby girl and one of my biggest concerns is her face being blurry to me after my surgery when I am close by her face. It breaks my heart to think I may not see her clearly up close anymore. :(
Please let me know any other helpful details or things you've noticed at this point post surgery? Thanks so much!!!!
Sara
**** Continuation from my Post Above ****
Day Time Vision issues:
I do not have many, but if I do the cover right eye, cover left eye and compare I do see differences. Remember my right eye has a cataract and gets blurry in the sunshine, but inside I can still see pretty well via that eye. I can see some objects at certain distance sharper in my right than my left eye, but that is kind of expected as the right eye lens can still change its focus point. But nothing I would notice if I had not done the cover one eye test. One thing I have noticed that is odd. At my gym the front is all windows. Even though close, as I mentioned earlier, I can see people against a window clearly, at the gym when back 100 feet or more people near the window are a bit blurry. And I know it is window light related as when I look at another person against a wall the same distance or even further I can see them clearly. Also as I walk closer to the window my vision gets clearer. So the cars outside the window become sharper. I did a test and at about 75 feet my left eye saw cars outside the window about as clearly as my right eye. But considering how bad my vision was before surgery this does not bother me at all, but thought I would mention it. The funny thing is when I walk up to the window the vision in my left eyes is very sharp, while the vision in my right eye, the one with the cataract, gets blurry.
Nighttime Vision:
Well this is where the rubber meets the road. 1st walking around at night is no problem. Driving is the problem! You can read about halos, but until you experience it is hard to fully understand. You do not know how much light there is at night until you see Halos. Every light produces them. Most of them are not that bothersome, in fact lamp post look like there is a force field around the light. It seems like everyone experience is different, so you just do not know until after surgery. Headlights are the biggest problem. One thing is the Halos are not consistent; they are bigger with distance and disappear as the object gets close. Even Business signs have Halos making them more blurry, but still easy to read. I cannot find exact pictures of how my halos look. This is probably the closest I can find for headlights, except my Halos are not this perfect and they are jagged and again halo size depends on distance. Basically at a distance the car is all Headlight.
http://screencast.com/t/lCGW2Dii
My Halos are not nearly as bad as this picture, but there are a couple of important things about this picture I wanted to point out
http://screencast.com/t/ZxsCX128myW
You see how the Halos are so perfect in that picture. My Halos are not perfectly shaped at all. But more important and this is the part that worries me the most. You see in that picture how objects outside the Halos look so clear, that is not my case. The light from the Halos affects my vision outside the area of the Halos. I can even notice this effect before it gets dark. When I go for my walk/jog in the evening when the sun start to set but it is not dark yet, if a car is in front of me I can see it crystal clear and then it applies its brakes and the car becomes less sharp. It is kind of odd.
With both eyes I can drive safely at night as the right compensates for the left lens halos. But I worry if I had 2 Tecnis MF 2.75 in both eyes could I drive safely.
They say in time your brain does neuroadaptation. But I really wonder about this whole neuroadaptation. I guess I will see with the passage of time, but I find it hard to believe my brain will lessen the halos. What I think happens is; you just get use to it. Like right after surgery things were so bright, that I could barely leave the house without sunglass, but now with the passing of time that brightness seems less and in time I am sure it will just seem normal. I think that is what happens with the halos. I hope I am wrong and somehow the halos really do get smaller.
If with the passage of time the Halos do not lessen I might wait for the Tecnis Symphony lens to get FDA approval or maybe even a lower add lens will be approved and I can implant that lens in my right eye.
Software Developer sent me the article below, where they are developing a simulator to predict IOL outcomes. If they can get this simulator to accurately predict halos based your individual eye characteristics it would be a great tool to assist in IOL selection.
http://www.eurotimes.org/node/1757
Binocular testing with an adaptive optics-based vision simulator can accurately predict patients’ visual performance under binocular conditions with different monofocal and multifocal intraocular lens (IOL) designs, according to a study presented by Pablo Artal PhD at the XXXII Congress of the ESCRS in London.
.
If you want more information about halos, below is a link to a google book. Chapter 73 is very informative and even has drawing from a patient on how his Halos dimensioned after 3 months.
https://books.google.com/books?id=R3lYDUkoxYoC&pg=PA273&lpg=PA273&dq=cause+halos+iol&source=bl&ots=hG1cnHkoCk&sig=zBzOQfewiZrDW1KfXR7rITXV5_I&hl=en&sa=X&ei=rqFDVYSaI4busAXg2YGgAw&ved=0CCkQ6AEwAjgK#v=onepage&q=cause%20halos%20iol&f=false
If you have any questions feel free to ask.
Day Time Vision issues:
I do not have many, but if I do the cover right eye, cover left eye and compare I do see differences. Remember my right eye has a cataract and gets blurry in the sunshine, but inside I can still see pretty well via that eye. I can see some objects at certain distance sharper in my right than my left eye, but that is kind of expected as the right eye lens can still change its focus point. But nothing I would notice if I had not done the cover one eye test. One thing I have noticed that is odd. At my gym the front is all windows. Even though close, as I mentioned earlier, I can see people against a window clearly, at the gym when back 100 feet or more people near the window are a bit blurry. And I know it is window light related as when I look at another person against a wall the same distance or even further I can see them clearly. Also as I walk closer to the window my vision gets clearer. So the cars outside the window become sharper. I did a test and at about 75 feet my left eye saw cars outside the window about as clearly as my right eye. But considering how bad my vision was before surgery this does not bother me at all, but thought I would mention it. The funny thing is when I walk up to the window the vision in my left eyes is very sharp, while the vision in my right eye, the one with the cataract, gets blurry.
Nighttime Vision:
Well this is where the rubber meets the road. 1st walking around at night is no problem. Driving is the problem! You can read about halos, but until you experience it is hard to fully understand. You do not know how much light there is at night until you see Halos. Every light produces them. Most of them are not that bothersome, in fact lamp post look like there is a force field around the light. It seems like everyone experience is different, so you just do not know until after surgery. Headlights are the biggest problem. One thing is the Halos are not consistent; they are bigger with distance and disappear as the object gets close. Even Business signs have Halos making them more blurry, but still easy to read. I cannot find exact pictures of how my halos look. This is probably the closest I can find for headlights, except my Halos are not this perfect and they are jagged and again halo size depends on distance. Basically at a distance the car is all Headlight.
http://screencast.com/t/lCGW2Dii
My Halos are not nearly as bad as this picture, but there are a couple of important things about this picture I wanted to point out
http://screencast.com/t/ZxsCX128myW
You see how the Halos are so perfect in that picture. My Halos are not perfectly shaped at all. But more important and this is the part that worries me the most. You see in that picture how objects outside the Halos look so clear, that is not my case. The light from the Halos affects my vision outside the area of the Halos. I can even notice this effect before it gets dark. When I go for my walk/jog in the evening when the sun start to set but it is not dark yet, if a car is in front of me I can see it crystal clear and then it applies its brakes and the car becomes less sharp. It is kind of odd.
With both eyes I can drive safely at night as the right compensates for the left lens halos. But I worry if I had 2 Tecnis MF 2.75 in both eyes could I drive safely.
They say in time your brain does neuroadaptation. But I really wonder about this whole neuroadaptation. I guess I will see with the passage of time, but I find it hard to believe my brain will lessen the halos. What I think happens is; you just get use to it. Like right after surgery things were so bright, that I could barely leave the house without sunglass, but now with the passing of time that brightness seems less and in time I am sure it will just seem normal. I think that is what happens with the halos. I hope I am wrong and somehow the halos really do get smaller.
If with the passage of time the Halos do not lessen I might wait for the Tecnis Symphony lens to get FDA approval or maybe even a lower add lens will be approved and I can implant that lens in my right eye.
Software Developer sent me the article below, where they are developing a simulator to predict IOL outcomes. If they can get this simulator to accurately predict halos based your individual eye characteristics it would be a great tool to assist in IOL selection.
http://www.eurotimes.org/node/1757
Binocular testing with an adaptive optics-based vision simulator can accurately predict patients’ visual performance under binocular conditions with different monofocal and multifocal intraocular lens (IOL) designs, according to a study presented by Pablo Artal PhD at the XXXII Congress of the ESCRS in London.
.
If you want more information about halos, below is a link to a google book. Chapter 73 is very informative and even has drawing from a patient on how his Halos dimensioned after 3 months.
https://books.google.com/books?id=R3lYDUkoxYoC&pg=PA273&lpg=PA273&dq=cause+halos+iol&source=bl&ots=hG1cnHkoCk&sig=zBzOQfewiZrDW1KfXR7rITXV5_I&hl=en&sa=X&ei=rqFDVYSaI4busAXg2YGgAw&ved=0CCkQ6AEwAjgK#v=onepage&q=cause%20halos%20iol&f=false
If you have any questions feel free to ask.
4 Comments
Hi there,
I am just about to have the same lenses you had put in how are your eye now 3 years on?
Andy
I am just about to have the same lenses you had put in how are your eye now 3 years on?
Andy
@Andy
Man it has already been 3 years. I know you read all the horror stories here about MF lenses, but I have not had any real problems.
Like all MF it does split the light so it is darker, but not anything horrible For example I can read a menu at dinner in low light. Mostly I can notice it if I close my other eye and I can then tell how much darker it is.
I still have to do my other eye. I am a procrastinator. I plan to see a doctor who is an expert in both the Tecnis low add and the Symphony as I am thinking of getting the Symphony in the other eye. That way I will get close up vision with low-add and hopefully less splitting of the light through the Symphony.
Man it has already been 3 years. I know you read all the horror stories here about MF lenses, but I have not had any real problems.
Like all MF it does split the light so it is darker, but not anything horrible For example I can read a menu at dinner in low light. Mostly I can notice it if I close my other eye and I can then tell how much darker it is.
I still have to do my other eye. I am a procrastinator. I plan to see a doctor who is an expert in both the Tecnis low add and the Symphony as I am thinking of getting the Symphony in the other eye. That way I will get close up vision with low-add and hopefully less splitting of the light through the Symphony.
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