Cataracts - Which lens?

[nwsteve]

I had cataract surgery 12 years ago this month at age 43. I had worn corrective lenses for 33 years.

I had the ReStor multifocal lens implants. Overall, I'm very happy. One thing to be aware of: you will have great distance vision. You will also have great reading distance vision. Now, extend your arm fully in front of you...from the tip of your fingers, out to 6-8 feet, you will have problems reading things in this range. Think shopping, the GPS in your car, etc. You will also have trouble reading in dim light, like in a dark restaurant. This is because of the way the multifocals refract the light onto your retina thru the pupil that dilates in the dark. You'll possibly/likely need a set of progressive lens glasses to cover this deficiency. I have a couple pairs of them. I keep a pair in each car, in case I have to rely on the gps to get me where I'm going. This will depend on the GPS unit in your vehicle...I can see the GPS on its massive screen in my 2017 Honda Ridgeline just fine, because the letters are large enough and with proper contrast. My 2014 Honda CR-V is not as good, but let me tell you, in my 2012 Ford F-350, the contrast was odd and the screen was small, so without the progressive lens glasses, the gps was useless. You may have this issue with standard single vision lens implants, or maybe not. One think I like about the ReStor Multifocals is that I can wear any sunglasses that I like, such as my favorite Maui Jim polarized sunglasses. If you have to wear glasses post op (like my mom who had hers done 30 years ago, and my dad who had his done 7 years ago, both with single vision lens implants) then you are stuck buying prescription sunglasses, or those big weird old people sunglasses that go over your prescription glasses. They are a bit more expensive. I think I had to pay $500 extra per eye, because the insurance would cover single vision but not multi focal, at the time. These had just come out not too long before I had my surgery so they were relatively new and still not covered by insurance. As far as I'm concerned, though, this was the best thousand bucks I could have ever spent. I do wear glasses occasionally, for the gps and for seeing the prices on the shelf while shopping, and on the rare occasion that we go out to eat in a dark restaurant, but not every day by any stretch of the imagination. Hope this helps.

+1
Rambler's experience closely match mind EXCEPT I combined a Restor lens with ReZoom lens. One lens (ReZoom?) strength was its mid to far and the other provided a different balance which provided relatively more clarity in the mid to near. I had my procedures after wearing contact lens for over 40 years including multifocal contacts for the last ten years. Having been accustomed to the muti-focal contacts the transition was pretty seamless. I paid about $1500/eye premium for the multi-focus lens over what Medicare provided. Best money ever spent--appreciate the benefits every day!

I have been pretty much glasses free since the procedure. I do occasionally use a reader if the light is low, the image is small (think 4 pt type) or there is poor contrast. No issues with reading dash instruments. My current optometrist said his clients have had mixed success with multi-focals and was surprised just how successful my experience has been. I attribute it to a couple thing--many years wearing multi-focal contacts so had realistic expectations about what I would get, great docs who only do cataract and similar procedures, letting my first eye (distance) completely heal (several weeks) and then having the prescription verified for the second eye done to insure it would optimally work with first lens (it changed from the initial).

A significant factor in choosing a multifocal lens is how strong your stigmatism is. My DW just completed her procedures and her stigmatism was too strong for a good results from multi-focal. She had a ReStor lens in both eyes and enjoying excellent distance vision but will wear progressive eyeglasses for near distance clarity. Medicare paid for 100% of the cost including a $125 contribution to the eye glasses.

Good luck and fear not ;-)

 

[madsquopper]

I was extremely nearsighted my whole life, and the doctor said that in his experience people who were that nearsighted seemed to do a bit better if they were "set" to be slightly nearsighted than attempt to be corrected right at 20/20. So I took that recommendation and did the straight monofocal lenses and was set at a diopter of -1 which approximates out to around 20/30 or 20/40. One lens was toric due to astigmatism, the other was the basic one and he did some laser astigmatism correction during the cataract surgery.

I still use glasses for reading/computer (if needed, I can do both without but not for extended periods and anything really close-up needs readers) plus distance glasses mostly for night driving as those correct me to 20/20.

Both operations were really easy and recovery was quick, although I did have to do the not uncommon YAG laser capsulotomy a couple of years later. That takes about 3 minutes and permanently solves the cloudiness problem.

Larry

 

[Cobra9777]

I got the basic monofocal lens for distance vision. What a difference; it's like a brand new set of eyes. But of course I need help with reading and other close-up work. After 2 years of fumbling around with various strength readers spread around the house, I purchased a very pricey pair of Hoya progressive lenses that I wear almost all the time now. I don't really need them for distance vision, although there is a minor correction in one eye. But they flawlessly fill in all the gaps from 6" to 36" and they're far more convenient than multiple readers. They also work great for activities like driving where I need to see distance but also close up like the dash and GPS.

 

[Pilot2013]

My wife just had cataract and lens IOL surgery less than a year ago, by the supposed "best Dr" in Greenville, SC. They are completely messed up, and we are now working on a 2nd surgery at another Eye Dr as the first one says "there is nothing wrong with the IOL itself, or the surgery.

She has blurred vision on the bottom, and terrible star bursts, etc for night time driving.

 

[Walt34]

How do you know if you want near/near or near/far or far/far? This is a once in a life decision - whatever I choose I am stuck with it for life.

I've been living with near/far for almost all my life, I started wearing glasses for my right eye only in elementary school. Up until about age 45 my left eye needed no correction and still needs very little. I'm so nearsighted in my right eye that I cannot read the top numbers on the eye chart but it is convenient that I don't need glasses or contacts for almost anything but driving or flying model airplanes. (Depth perception matters a lot for either activity.) The eye doc said that disparity in visual acuity is not that uncommon.

So for me I would pick near/far admittedly in part because that's what I'm used to but a lot of that has to do with convenience in your lifestyle.

 

[eytonxav]

I selected mono-focal to improve my distance vision. I still wear progressives around the house for close up and it does slightly improve my distance as well. When I play softball, just use non-Rx sunglasses.

Why did I choose the mono-focal:

1) heard that multi-focal may not give as good distance vision, and that also may result in starbursts when driving at night. Also, medicare will not pay the full cost of these IOLs

2) monovision supposedly may not adopt well with some people and generally works better for those that have successfully used this approach with contacts.

3) did not opt for torics as my astigmatism was not bad enough to need them.

4) having worn glasses for distance most of my life, I really wanted to get rid of them for distance and the mono-focals are supposed to provide the best distance vision, so the decision was an easy one for me.

 

[Spanky]

Has anyone considered the Tecnis Symfony® intraocular lenses for near, intermediate and far away distances?

 

[ShokWaveRider]

I had cataract surgery 4 years ago, I opted for Near sighted lenses as I had worn glasses for distance all my life and felt naked without them. I like not having glasses for reading and the computer.

They at starting to get a little film over them and I will most likely need the Yager Laser tune up soon. A WAY Bigger problem is floaters. I have a load and they are VER VERY annoying.

 

[Spanky]

I had cataract surgery 4 years ago, I opted for Near sighted lenses as I had worn glasses for distance all my life and felt naked without them. I like not having glasses for reading and the computer.

They at starting to get a little film over them and I will most likely need the Yager Laser tune up soon. A WAY Bigger problem is floaters. I have a load and they are VER VERY annoying.

Other than the floaters, do you like the lenses for near as opposed to distance?

 

[MissMolly]

Has anyone considered the Tecnis Symfony® intraocular lenses for near, intermediate and far away distances?

I had not heard of this particular brand of lens until just now. A quick read indicates it was developed to deal with presbyopia which, being extremely nearsighted, I do not suffer from. However, I would assume that anyone who chooses to go with the distance only lens would then have issues with presbyopia.

Apparently wearers of this lens also can have problems with dim lighting conditions and problems with halos, glares and starbursts when driving at night. Although I do not drive at night very often any longer, it was driving at night a few weeks ago that really made it apparent to me I was having some worsening vision problems which prompted my visit to the eye doctor (along with no longer being able to read close captions on the TV).

It seems from all I am reading/hearing about, there is no perfect or easy answer to the question "which lens is best for me". But I thank you for bringing this new option to my attention. Another one to add to the list for consideration.

 

[Spanky]

Apparently wearers of this lens also can have problems with dim lighting conditions and problems with halos, glares and starbursts when driving at night.

This is evident for typical multi-focal lenses but not Symfony (based on my limited research).

 

[ShokWaveRider]

Other than the floaters, do you like the lenses for near as opposed to distance?

Yes, it was my sister who convinced me in the first place. She had distance lenses, and told me she regretted it every day as she spent more time reading than driving and was forever with glasses around her neck. She said if she had to do it again she would opt for near sighted lenses, and advised me to do so too.

 

[W2R]

Night driving

I didn't drive at night for several years before my cataract surgery, because of the glare and vision problems at night that to me were very confusing.

Then I had my cataract surgery, and the "plain jane" regular lenses implanted.

But now I STILL prefer to avoid driving at night, because of the glare. Is age a factor? Maybe in my case it is just due to age. I just don't feel that I see as well at night and the glare just overwhelms me. The confusion factor (starbursts? something that disorients me) is gone now. But still, I just don't feel safe driving after dark. I have driven about six blocks on residential streets to Walgreens after dark, twice. I would do that again if the need was urgent, but there is no way I am going to drive on bigger streets where I might encounter a car driving towards me and headlights in my eyes. On the residential streets I can just park until a car passes.

 

[Koolau]

I didn't drive at night for several years before my cataract surgery, because of the glare and vision problems at night that to me were very confusing.

Then I had my cataract surgery, and the "plain jane" regular lenses implanted.

But now I STILL prefer to avoid driving at night, because of the glare. Is age a factor? Maybe in my case it is just due to age. I just don't feel that I see as well at night and the glare just overwhelms me. The confusion factor (starbursts? something that disorients me) is gone now. But still, I just don't feel safe driving after dark. I have driven about six blocks on residential streets to Walgreens after dark, twice. I would do that again if the need was urgent, but there is no way I am going to drive on bigger streets where I might encounter a car driving towards me and headlights in my eyes. On the residential streets I can just park until a car passes.

I would have this glare issue evaluated. It doesn't seem right. I don't like driving at night as much as I used to. I know my reaction time and overall ability to see are not what they were 40 or 50 years ago. Still, following my cataract surgery, most of the glare issues were gone. It may be your doc can fit you with some kind of driving glasses which limit the glare. You might even try some of those yellow-tinted "shooting" glasses. They do really cut the glare in the day time - maybe they would work at night without cutting too much of the needed light. Just a thought as YMMV.

 

[W2R]

I would have this glare issue evaluated. It doesn't seem right. I don't like driving at night as much as I used to. I know my reaction time and overall ability to see are not what they were 40 or 50 years ago. Still, following my cataract surgery, most of the glare issues were gone. It may be your doc can fit you with some kind of driving glasses which limit the glare. You might even try some of those yellow-tinted "shooting" glasses. They do really cut the glare in the day time - maybe they would work at night without cutting too much of the needed light. Just a thought as YMMV.

Thanks! Good suggestions. I haven't tried any special glasses and that might work.

 

[madsquopper]

A WAY Bigger problem is floaters. I have a load and they are VER VERY annoying.

I had floater problems, and after at least a year of online research decided to do the somewhat controversial laser treatment. In my case I was extremely satisfied with the results, but YMMV a lot with this. My floaters were the type with the highest success rate.

Happy to provide more details, either on here or PM me.

Larry

 

[Amethyst]

My eye dr. recommended anti-glare coating on our glasses (neither of us has had cataracts removed yet). Also, the anti-glare coating on our new car's windshield made a big difference. I don't like oncoming headlights but they don't bewilder me, the way they did with our old car (and its old windshield).

 

[MissMolly]

This is evident for typical multi-focal lenses but not Symfony (based on my limited research).

I read it here FDA Approves the Tecnis Symfony® Intraocular Lenses, the First and Only Extended Depth of Focus Lenses for People with Cataracts - Jul 15, 2016

RISKS: Routine cataract surgery risks, irrelevant to lens selection, could be minor, temporary, or affect patients' vision permanently. Rare complications are worsening of vision, bleeding, or infection. Risks related to use of this lens include a slight loss in vision sharpness with decreased use of glasses. Even with glasses, loss of sharpness may worsen under poor visibility conditions such as dim light or fog. This may lead to driving difficulties, and not detecting road hazards as quickly at night or in fog. Patients may also notice halos, starbursts, glare, and other visual symptoms with extended range of vision IOLs. This may impact patients when there are bright lights at night. Patients should discuss all risks and benefits with their eye doctor before surgery.

 

[MissMolly]

Yes, it was my sister who convinced me in the first place. She had distance lenses, and told me she regretted it every day as she spent more time reading than driving and was forever with glasses around her neck. She said if she had to do it again she would opt for near sighted lenses, and advised me to do so too.

This is something for me to consider. I spend far more time reading/on the computer/watching TV than I do driving. What would be ideal for me are lenses that provide clear vision (without glasses) for those activities and only need glasses for driving. I could live with that. Although I am not clear on whether getting getting your eyes set for "near" allows good working ability on the computer and TV watching or only for reading/close work. Can you elaborate on how well you can see the computer and TV without needing glasses?

 

[Koolau]

This is something for me to consider. I spend far more time reading/on the computer/watching TV than I do driving. What would be ideal for me are lenses that provide clear vision (without glasses) for those activities and only need glasses for driving. I could live with that. Although I am not clear on whether getting getting your eyes set for "near" allows good working ability on the computer and TV watching or only for reading/close work. Can you elaborate on how well you can see the computer and TV without needing glasses?

My doc said I would have no trouble adapting to one eye for reading and one eye for distance. I have had nothing but problems with this Issue. True, I can read the computer screen for short periods by effectively turning off the distance eye - it sort of wanders around. What I find the most effective for computer work is to simply increase the size of the print by blowing it up. Reading books virtually requires reading glasses since the page can't be blown up. TV isn't too bad for most of the time. I don't notice the degradation as I CAN seem to focus both eyes at the same time. But driving is noticeably degraded by having one eye at 20:40 and the other 20:20. In fact the BMV requires me to use glasses for night driving.

Now, I would assume if both my eyes were 20:40 then reading would be a breeze without glasses - either computer or printed. I know this because the 20:40 eye works well - especially if I block the other eye. But that's not only inconvenient, but it also requires enough concentration that it interferes with the reading process. I would strongly suggest discussing this with the doc and be certain he understands any concerns before committing to anything. I do think having both eyes "set" to the same acuity would be best - but then again my doc swore it wasn't a good idea. I think he was wrong so YMMV.

 

[Spanky]

Yes, it was my sister who convinced me in the first place. She had distance lenses, and told me she regretted it every day as she spent more time reading than driving and was forever with glasses around her neck. She said if she had to do it again she would opt for near sighted lenses, and advised me to do so too.

I think it is good advice for someone who does more readings and looking at computer screens than driving.

I have been wearing glasses (20/100) for distance and removing them while reading and looking at monitors for years. Thus, I would opt for correction for near lenses also.

 

[Amethyst]

Based on this thread, it's far from a "snap" getting your cataracts taken care of. It does not sound like one can count on really good vision, just "better than terrible like it was" vision.

I'm starting to think a little glare from oncoming headlights isn't such a bad thing. Hope it doesn't get a lot worse!

 

[Spanky]

Based on this thread, it's far from a "snap" getting your cataracts taken care of. It does not sound like one can count on really good vision, just "better than terrible like it was" vision.

I'm starting to think a little glare from oncoming headlights isn't such a bad thing. Hope it doesn't get a lot worse!

You could always wear a polarized anti-glare night vision glasses.

 

[Koolau]

Based on this thread, it's far from a "snap" getting your cataracts taken care of. It does not sound like one can count on really good vision, just "better than terrible like it was" vision.

I'm starting to think a little glare from oncoming headlights isn't such a bad thing. Hope it doesn't get a lot worse!

With all my whining, I'm happy with the improvement in my sight following cataract removal. What I whine about is that I still need glasses. WITH the right glasses for the right application I see WAY better than just before my surgeries. I was literally going blind and now I can see. I just think you have to understand the limitations of the "after" vs back when you were a kid with fully functioning "adjustable" lenses. YMMV

 

[Spanky]

I read it here FDA Approves the Tecnis Symfony® Intraocular Lenses, the First and Only Extended Depth of Focus Lenses for People with Cataracts - Jul 15, 2016

RISKS: Routine cataract surgery risks, irrelevant to lens selection, could be minor, temporary, or affect patients' vision permanently. Rare complications are worsening of vision, bleeding, or infection. Risks related to use of this lens include a slight loss in vision sharpness with decreased use of glasses. Even with glasses, loss of sharpness may worsen under poor visibility conditions such as dim light or fog. This may lead to driving difficulties, and not detecting road hazards as quickly at night or in fog. Patients may also notice halos, starbursts, glare, and other visual symptoms with extended range of vision IOLs. This may impact patients when there are bright lights at night. Patients should discuss all risks and benefits with their eye doctor before surgery.

Gee - given these risks, one would think deeply before committing to cataract surgery. There are other risks as well, i.e., retina detachment.