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Unhappy with multifocal lens implants
Had cataract surgery 1.5 years ago. Very unhappy with results. Really changed how light is processed. Good distance vision. Bad mid range vision. Very poor close vision. The close vision only improved when in very good light (and only has a specific distance where I can see near) Please research when looking into multfocal implants. Do I have any options to improve my near and midrange vision? Have gone thru many pairs of glasses.
Including no line and lined bifocals. Also, seems that you have to take time to focus every time you look at something. What a pain!
Including no line and lined bifocals. Also, seems that you have to take time to focus every time you look at something. What a pain!
The odds are that if you'd gotten monofocal lenses you would have even more complaints about your intermediate&near vision, unless you did some monovision to give you some added closer in vision. If your distance vision is good you could try some level of monovision with contact lenses or lasik to move one eye's distance focus in a bit nearer, however that would waste the near point of the multifocal in that eye by bringing it in too far. It is added risk, but in some future year when better IOLs are available, if you really wish to get rid of glasses you could consider a lens exchange (like next generation accommodating lenses which would provide a wider range of vision with less issue of poor vision in low light and do so more consistently than the Crystalens). Its likely not worth the risk to consider any other lenses currently available in the US (the trifocals or the Symfony available outside the US might be a bit better, but perhaps not enough to warrant the risk of a surgery to do the exchange).
I don't know which multifocal lens you received, unfortunately when you had surgery the only thing available in the US were fairly high add bifocals IOLs which had lower quality intermediate vision (but still better than a monofocal) and their near point was targeted nearer than some people found useful. Now the FDA has approved low add bifocal IOLs that tend to have better intermediate vision. I think the newer lenses also may have designs that have less light loss and don't have as much problem in lower light than older bifocal designs. Outside the US there are trifocals which do a better job targeting all three distances, and the Symfony which is an "extended depth of focus" lens rather than a multifocal and has better low light vision than multifocals and better intermediate, with not as much really close near as a trifocal.
People should exercise caution before getting multifocals since there are risks involved. Fortunately the vast majority of people who get them are happy with them, but there are unfortunately a minority who are unhappy with them. If possible before people have cataracts that are causing visual problems, they should consider trying multifocal contact lenses to see if they like them. They aren't the exact same optics as multifocal IOLs, but they do lead to similar issues like lower quality vision in dim light (due to the light being split for multiple focal points) and can give some idea if you can adapt to multifocals well and don't mind the tradeoffs. In addition people can try contact lenses set for monovision to see if they prefer that to multifocals. I preferred multifocal contacts to monovision so I considered going abroad for a trifocal when I had cataracts, and then wound up deciding on the Symfony as a better fit for my needs. Although I didn't have complaints about the lower quality vision in dim lights from the multifocal contacts (it was worth the tradeoff to me), fortunately the Symfony provides noticeably better low light vision than I had with multifocal contacts.
I don't know which multifocal lens you received, unfortunately when you had surgery the only thing available in the US were fairly high add bifocals IOLs which had lower quality intermediate vision (but still better than a monofocal) and their near point was targeted nearer than some people found useful. Now the FDA has approved low add bifocal IOLs that tend to have better intermediate vision. I think the newer lenses also may have designs that have less light loss and don't have as much problem in lower light than older bifocal designs. Outside the US there are trifocals which do a better job targeting all three distances, and the Symfony which is an "extended depth of focus" lens rather than a multifocal and has better low light vision than multifocals and better intermediate, with not as much really close near as a trifocal.
People should exercise caution before getting multifocals since there are risks involved. Fortunately the vast majority of people who get them are happy with them, but there are unfortunately a minority who are unhappy with them. If possible before people have cataracts that are causing visual problems, they should consider trying multifocal contact lenses to see if they like them. They aren't the exact same optics as multifocal IOLs, but they do lead to similar issues like lower quality vision in dim light (due to the light being split for multiple focal points) and can give some idea if you can adapt to multifocals well and don't mind the tradeoffs. In addition people can try contact lenses set for monovision to see if they prefer that to multifocals. I preferred multifocal contacts to monovision so I considered going abroad for a trifocal when I had cataracts, and then wound up deciding on the Symfony as a better fit for my needs. Although I didn't have complaints about the lower quality vision in dim lights from the multifocal contacts (it was worth the tradeoff to me), fortunately the Symfony provides noticeably better low light vision than I had with multifocal contacts.
There is no easy, safe, inexpensive answer to your problem. First read this carefully: http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You ;
Also use the search feature and archives and read the many posts from people unhappy with multifocal IOLs. Since you have good distance vision without glasses its not likely there is a problem with the IOL being out of position or the capsule cloudy or having 'waxy vision syndrome'. If you go to the time, expense and risk of exchanging for monofocal IOLs you are still going to be in glasses. Hopefully whomever prescribed your glasses used a lower reading 'add' than needed with monofocal IOLs. (a monofocal IOL focused at distance RX 0.00 with need an add of +2.50 to +3.00 while a multifocal IOL add will generally be +1.00 to +1.50
Also use the search feature and archives and read the many posts from people unhappy with multifocal IOLs. Since you have good distance vision without glasses its not likely there is a problem with the IOL being out of position or the capsule cloudy or having 'waxy vision syndrome'. If you go to the time, expense and risk of exchanging for monofocal IOLs you are still going to be in glasses. Hopefully whomever prescribed your glasses used a lower reading 'add' than needed with monofocal IOLs. (a monofocal IOL focused at distance RX 0.00 with need an add of +2.50 to +3.00 while a multifocal IOL add will generally be +1.00 to +1.50
First read this carefully: http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You
Then use the search feature and archives and read other posts from unhappy patients.
There is no easy answer. Since you have good distance vision it is not at all likely that the IOL is decentered or that the posterior capsule is cloudy or that you have the 'waxy vision' syndrome. If you explant the IOLs you have additional risk, expense and will still be in progressive glasses. Your safest and least expensive option is to make your peace with wearing no line progressive multifocal glasses. It took me several months to get use to them but once I did its just like wearing single vision glasses.
JCH MD
Then use the search feature and archives and read other posts from unhappy patients.
There is no easy answer. Since you have good distance vision it is not at all likely that the IOL is decentered or that the posterior capsule is cloudy or that you have the 'waxy vision' syndrome. If you explant the IOLs you have additional risk, expense and will still be in progressive glasses. Your safest and least expensive option is to make your peace with wearing no line progressive multifocal glasses. It took me several months to get use to them but once I did its just like wearing single vision glasses.
JCH MD
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