Day 3, Sunday 19th
As it was a day off work I decided to leave my single lensed spectacles off as long as possible to see how things were shaping up. The bruised feeling has subsided greatly to the point of noticing it only if I looked for it. Wandering around the house without specs for the first time in seven years was odd, normally I fail miserably pouring boiling water into the tea pot, let's not go near sharp knives! I could do all breakfast tasks without problems, with the brain using the new eye which could see well, and ignoring much of the information of the blurred image coming in from the untreated eye. I still had binocular vision though, and could judge distance easily. Outdoor tasks of splitting logs (on an electric splitter) and light gardening were easily accomplished and everything was clear and had good focus.
Testing later in the day yielded results of astounding improvements in such a short time. Near focus for Left eye at 35cm, text was readable down to 3 point! The un-corrected eye at same distance was 36 point and not sharp, binocular was 14 point. Far vision was clear for trees and birds etc from 3 metres to 40 metres. Trees at 100 metres were good, with small branch definition on large Sycamores but leaf canopy on evergreens was blurred (right eye cannot define trunk, much less branches). Intermediate computer work, as against intermediate general vision, is the weakest area. At 80cm, best text for comfortable reading on-screen is 14 point. Smaller than this, I can use a computer, but edges are quite blurred. This is being written on an iPad at 45cm at approx 12 point, slightly blurred, but I want to lessen reliance on corrected right eye.
Thoughts for the day
Pleasantly surprised and pleased with the vast improvement in near focus. If this is the standard of vision with one new and one uncorrected for general intermediate and far vision things are looking really positive.
All bruised feeling now one, even when trying to notice it. Vision continues to improve in the Far field. Near simply cannot get better, it is now at 20/15 j1. Computer use, my daily task, is improving, but unfairly I am using one uncorrected eye along with the new lens. The pair in binocular sight are so far removed from each other in focus I am surprised to be able to see anything in binocular.
Time for the second exchange. I have no qualms of having the second eye done. I can then really learn to use them together. The implant went without a problem. By late afternoon there was no bruised feeling, as though it had not been done. Will leave till Saturday to evaluate vision, especially reading on screen.
Thoughts for today
So far all has gone at least to expectations. More work to do with intermediate, but near and far are really good. Everything on the whole looks promising
Thank you for this extensive description of your experience with this multifocal lens. I believe this is the first mention of it on this discussion board.
I failed to find a 'real life' explanation of what to expect. More disturbingly, in the UK, where there are a range of premium lenses available, little information is offered about them to cataract sufferers. I have spoken to three acquaintances in the last week who have had NHS ( 'free' Social medical care in the UK) cataract lens exchanges and when comparing notes, none had been told of the availability of premium lenses. Two would have paid for the premiums.
The Finevision lens took some finding as far as a surgeon locally who fitted them.
Second eye had astigmatism manually removed when the +21 standard lens was fitted so a toric IOL wasn't required.
Eyes are now used binocularly. The difference in ability to see at varying distances (compared to the one IOL and one unaided eye) is so pronounced it is scary.
Driving at night, on rural roads with no street lights, in driving rain, was an experience. Oncoming headlights had a bright circular ring surrounding them producing a small 'spiderweb' pattern. No glare was thrown and I did not feel driving vision was compromised. Shifting vision from dash to road and further to road signs was seamless. If neural the adaption mentioned for the Mplus is needed, it has happened almost instantly.
Reading and writing on an iPad at 35-40cm is really comfortable. Reading a newspaper is easy. Newsprint text or the paper it is printed on is not the highest quality, but I have the ability to read the fine print for conditions of loans etc that advertisers rather you didn't.
I tried my hobby of wood turning on a lathe today, focus at point of tool to wood contact is vital for control and safety. I felt totally in control and found it so much more comfortable than wearing specs which steam up under the face-mask. Depth and field of vision is now excellent.
From first thing in the shower, the ability to read every label on the shampoos etc was the biggest novelty. Sharp focus at 100 yards is not there yet, although I would not be greatly disappointed if it never came, the 12 inch to 40 feet distances are what really matter. Computer use is now clearer with a comfortable reading size of 12 point, but able to see 10 point adequately if a little blurred.
Will post weekly in future to report on focus developments at computer and very long distance.
Thoughts for today.
I think even if things got no better, this has already been a totally worthwhile procedure. I feel my months of research has paid off handsomely and find it unbelievable the FDA drags it's feet and places so many obstacles in the path of these small companies preventing clinical trials and general availability in the U.S.A.
I'm very glad you're writing this journal, and wish more people would do so.
Let me briefly interfere with a question - I am also in the research phase now, looking for the best option out there... Finevision sure seems interesting, however I also have high astigmatism. Are you familiar perhaps with how the toric version of this iol might be doing?
I notice you have cataracts in the early stages, my procedure was elective of the clear lens exchange type, I did not have cataracts. I have used specs from waking to sleeping for seven years and just found them inconvenient, for general life, hobbies and shooting sports.
When presented with my old prescription my eye surgeon initially thought the right eye had sufficient astigmatism to warrant a toric lens. His thoughts were to use standard on the left and toric on the right, and had no reservations in doing this.
However, after the IOL Master diagnostics, it revealed a lesser astigmatism than my usual optician had prescribed for. At -1.2 it was felt he could remove just over half this, leaving 0.5 which was within the scope of the standard lens. Mr Luck errs on the side of caution, but still rates and uses the toric version where all other indicators are showing a positive outcome. Replacing clear lenses puts more pressure on the surgeon to achieve a result at least as good as the patient had before using specs or contacts. This lens ( and the AT Lisa tri) currently offer a very good alternative to vision aided clear lens or cataract surgery.
At your age, if replacement is not required immediately, I would wait to see the results of the new hydro accommodating lenses undergoing trials. Physiol have only released the Finevision Tri in the last couple of years after several years of trials. Who knows what will be available in the next five years. If more immediate action needs to be taken, these seem to be a very viable solution. I can already see myself being glasses free for the rest of my life.
Talk with a proper surgeon though, not a high street chain, one is led by bottom line, the other by ethics. I will let you work out which is which.
It's now more than 3 months since I had my AT trifocal lenses implanted. The bright circular ring around headlights is still there but it doesn't bother me and, as Phil states, there is no glare. My near vision is excellent and so is my distance. My computer use is fine though I have a tendency to lean towards the computer when in fact my vision is better if I sit back. Just years of habit that I need to change! The only area of slight difficulty is reading a broadsheet newspaper but this is solved my turning on a bright overhead light (perhaps I should swap to a tabloid!). A superb result!
You say, "Talk with a proper surgeon though, not a high street chain, one is led by bottom line, the other by ethics. I will let you work out which is which."
I don't know whether this is entirely fair. My experience has been this:
I decided a few weeks back to pursue IOL surgery, did some research, spoke to my GP and set about speaking to a "proper surgeon" as you put it. I contacted two.
I got through to the PA of the first and explained what I wanted, asking whether the surgeon performed such an operation. She needed to go away and check. When I asked what lenses the surgeon used, she asked me what lenses I'd like! I was told I would need to see my GP for a referral (a chore in itself) and I was not sufficiently impressed with the situation to go to the trouble of doing so.
When calling the second surgeon I was again transferred to his PA. Who was clearly working from home because whilst speaking to me a child was asking for help with his homework. She had slightly less clue than the PA of the first surgeon, but set up a call with the surgeon himself. He proved to be a very helpful chap, and I am sure he would have done a fine job. However I was not sufficiently convinced to book a consultation, mainly because his dialogue came across as a bit of a sales pitch and an attempt to slate his competition.
By contrast, I spoke to the Optical Express and had two free consultations. Each member of staff I met, regardless of their role, knew what the company did, what it offered and what its aims were. They were also extremely careful to ensure that I was entirely happy with their offer. I subsequently had some questions which were answered by phone in a couple of minutes. Later I had more questions and they too were answered quickly (by this time I had paid a deposit). I was told categorically that if I had any further questions, however trivial, that I should call again.
An aside: I was reading an article about lens exchange recently and a leading specialists stated that he won't operate on any patient who asks more than five questions, because they are likely to be "too demanding".
I am also slightly more wary of "non commercial" surgeons for want of a better description than "commercial" ones. Over the years I have been referred to a few, including one or two highly regarded ones (in fact one Prince Charles uses), and I haven't been hugely impressed. I have found that it is quite difficult, too, to gauge accurately their historic performance in order to estimate the probability of future success. Commercial operations, however, live or die by their reputations (and I have used some excellent commercial providers o healthcare).
I have four friends who have had len replacement surgery with Optical Express, all have had Mplus lenses, and all are happy. One requires glasses to read fine print in low light. Two of the four have three friends who have had the same surgery and they are glasses independent.
My concerns about the surgery have been twofold. Firstly, will the outfit concerned look after me and how close are they if something goes wrong? I am as sure as I can be that Optical Express is as safe as possible, furthermore the operation will be conducted about 6 miles from my home, so if I have issues it's not too far to go. They also seem to have diarised extremely frequent return visits for check-ups.
My second concern was about lenses - am I getting the best? This was more difficult to answer. I am aware that new lenses are coming along that will be better than the current ones. I am also aware that the FineVision gets some good reviews. However, the Mplus has a broadly successful history and research suggests that it is more popular with those who want better distance vision. I have also read that the approval rating amongst males is greater than for FineVision. I am therefore, in light of the above, happy to pursue the Mplus route.
I am due for my first eye surgery imminently and I will report back, warts and all, to provide some basis for comparison.
Yes, some comparisons would be good. I did not intend to start a big company v small debate, I was put off OE after my consultation in Bristol. The whole examination and testing seemed rushed, with little time to ask questions, then taken to a small untidy office to make an appointment with a surgeon for a £500 deposit. Can I talk at home with the wife? We cannot guarantee the price then, was the answer. After choosing not to proceed with them, the texts came twice a week upping the offers, firstly a voucher to take £500 off the price quoted, then increasing the free interest period up to two then three years. This is what I refer to as commercial company looking at bottom line. I have two friends who have had theirs done with OE, both were happy with the surgeon and procedure, neither were happy with the aftercare (or lack of it), which was done in a branch that had little knowledge of the procedure.
I paid a premium, both for the chance to have this lens, which none of the major chains use, and to deal at all times with the surgeon performing the procedure. Also like you, location is a big consideration.circle bath is a 15 minute drive away and the consultants at Circle are partners in the medical centre, chosen for their expertise. The consultation was free, and I was sent away to think about it, with the opportunity, and indeed encouragement to ask questions.
The question was asked by a patient who has a known high astigmatism, I would be fearful of pressure to return a profit over telling a prospective client not to proceed, based on the follow up texts to entice my custom. The beast needs feeding. I am sure they have a very large and loyal client base, and as a simple numbers exercise, they will have a higher number of complaints, albeit probably no higher percentage, than a smaller outfit.
The choice of lens was based on the desire for a decent intermediate focus as my work involves working on computer repairs and therefore a separate focal point for this was very attractive.
I believe a diary of yours would also be very useful for others as well. My distance focus, over 10 metres is the weakest point, at the moment I don't know if this is part of the adaption required as I can find no journal to describe progress for the first few months. I don't believe I have a problem, but to have read someone else's progress and seen the results week by week would have been very useful.
Best wishes for you procedure and please do run a diary.
I must say when I first spoke to OE, about 18 months ago, they were not doing IOL surgery locally and the branch was uninspiring to say the least. However when they refitted the place to do IOLs I took a second look and was greatly impressed. I have not been aware of any hard sell, but then I didn't need much persuading.
Hopefully your distance vision will come, however at least you have what you needed / desired most immediately.
I will report back with my findings re the Mplus. Thank you for your best wishes.
Just a friendly note of warning, at Centre For Sight where I had my surgery I believe they no longer implant MPlus lenses as there were too many people dissatisfied with the outcome.
Two weeks and one week respectively.
A week of binocular training.
All traces of feelings relating to the surgery are long gone, no numbness or bruised feeling. I know the healing process is far from complete, but there is now no distraction from sight training.
Near vision, this has been the strong point from day one, and has continued to improve in clarity as the week progressed. Black newsprint is not as dark as it used to look, more a dark grey, but with reasonable light, it doesn't present a problem. Minimum text size to read is three point and reading instructions and ingredients on bottles and boxes is easy, as is seeing fine detail on anything at 30-40cm. At work with computer repairs, the very small screws used are fine if they are dark, the bright silver on some reflect off the work light making life a little more fiddly during assembly work. I have improved the workbench lighting at work and in my home workshop, and this has helped tremendously.
Intermediate vision, anything in the same room up to 3 metres, ten feet, is seen well with decent focus, reading across a room, is much the same as with spectacles before. Preparing meals in the kitchen is fine, no issues at all doing any tasks, including using using knives safely. Reading on a computer at 80cm is adequate at 12 point albeit a little soft edged, although not yet as clear or sharp as previous corrected vision. Driving during the day is perfect, with no issues, at night, the bright rings, not halos, appear around all points of bright light but are not a great distraction, get smaller as the light comes closer, and look pretty in a weird sort of way. Strangely, road signs are not as clear as they were a week ago. No rings are evident indoors off any room lights.
There is a difference between seeing well generally and good computer use, I can do the first, and the second is work in progress.
Long distance, faces at 10 metres are soft and fuzzy, and with me being not good with faces anyways, I have trouble identifying people until they get a lot closer, down to 5 metres. Similarly, outside in the high street, hanging signs and shop signs beyond 10 metres are quite blurred. Probably as a result of too much information reaching the brain from all the rings in the lens and me not filtering out the info not required. Getting around outside is comfortable, with no great issues despite far focus not being particularly brilliant at present.
It is early days and I do not feel there is a problem, just a learning curve.
Unless anything untoward happens, will report again in a week.
Sounds like you're doing fine.
Now that you have had both implants done I think it's a question of just enjoying the ride, making friends with any limitations and letting your brain get on with adjusting to a new way of seeing.
Weeks tree and two respectively
All tasks now performed bifocaly and everything about day to day life is at least comfortable.
Near vision, up to 70cm, is now at least as good as my previous vision with spectacles, with an improvement in very fine detail. Reading magazines and newspapers in usual lighting is problem free. Writing this on an iPad at 40cm not zoomed in is quite comparable. I can now read hallmarks on gold rings including the symbols and carat rating. I couldn't see the hallmark detail before even with glasses.
Intermediate. Everything up to 4 to 5 metres indoors and out has good definition and vibrant colours, fuzzy edges on everyday objects are a thing of the past already. Most notably, whites are brighter than I remember them. TV at 4-5 metres is extremely clear and all text on screen perfectly sharp. Computer use at 80cm is still work in progress, pictures and icons are clear, text is still the weak point with soft edges and no hard edge definition. Even so using a computer all day is still achievable.
Mid range, 5 to 15 metres. Less fuzzy, but a way to go yet. Faces are now clearer from 6 metres but beyond that start to loose definition. Driving during the day presents no problems, although road signs are readable but not sharp at a distance.of 20 metres. Light ring during night driving are thee, and I think this is a 'feature' of this lens and will always be there, although not an intrusive phenomenon.
Far distance. A good level of detail can now be seen. Building edges are sharp, trees show a decent level of branch detail. At the extremes, star clusters can be defined to individual stars in the main constellations. The seven individual stars of the Pleiades can be seen.
In summary, very pleased with the total freedom from glasses and all is progressing well considering the time since implant. Areas still to improve are reading on screen at computer distance, more so onscreen text at laptop distance of 60cm. Focal range of 6-20 metres is the least detailed as far as edge definition, but very gradually focus is extending outwards.
Next report in a week after my one month checkup.
Good to hear you are making progress and clearly adapting well to the lenses.
Thanks for sharing.
Nice to read your diary.
We communicate personally about those changes, so all in the normality.
Let me share these thoughts below with you and your friends.
Right now I am at 7 months and 10 days since the surgery with PhysIOL Finevision.
I'm 49 years old.
Before the cataract in August 2011 I had Laser PRK to correct Hyperomy (I had +1.75 in one eye and +2.25 in the other)
The surgery didn't succeed and in May 2012 had to be done a second time.
Second time was better BUT I got cataract because of the extensive use of Cortisone and Desametazone, so my vision was spoiled.
So at the end of June 2013 I did the cataract surgery using PhysIOL Finevision trifocal lenses. (The first eye was done on June 29th and the second on July 1st - done close because I did it in Italy and live in another Country)
My surgeon wanted to place the M-plus bifocal since he had more data on those (he placed them in over 2000 eyes) while when I asked for the Finevision he had done in only 7 eyes.
He said that the Finevision seemed better than the M-plus, giving better light in dark places and better intermediate vision due to the third ring but because of lack of data on long term results he wanted to wait before proposing it to his patients.
The same day that I had my surgery using the FINEVISION few other people had theirs done by the same surgeon but they all put M-plus.
At the first visit my vision was way better than all the other people. One had problem seeing close, one could read a J3.
I was the only one able to read perfectly and without effort a J1 for close (wonderful feeling for someone who had Hyperomy).
After 7 months this is the situation:
My vision for close is still perfect as day 1 (still J1 without efforts)
My vision for intermediate is superb (PC - TV - Phone etc.) and it surpasses my former vision with specs
My vision for far is almost as good as it was when I had Hyperomy and I could see sharp for far distances.
I test myself from time to time. I can read a car plate from 80 meters with effort, but it is sharp at 60 meters.
Overall, this surgery was a success beyond my best hopes.
The eyes are working perfectly and the brain is adapting in clearing all the data that is coming from three different rings.
The rings are visible only at night when I see a light over 100 meters away
(in the beginning almost every light
even small and close had rings).
I was told by my surgeon to give it more time and in another 6 months - 1 year also those last rings that I see at night from far should disappear.
For Vizard (who put the M-plus) I hope all went well for you.
Also the M-plus are very good but I did many researches before switching my decision from M-plus that was suggested by my surgeon to Finevision (that I insisted).
Today I'm very happy I insisted on Finevision.
I read in several tests results that while overall 90% are satisfied with M-plus, the ones satisfied with Finevision are above 96%.
Just for a reference, after my surgery results started to become more clear, my surgeon told me: QUOTE " this means that when it will be my time to do the cataract, I'm going to use these lenses" END QUOTE
Also his assistant said he wants these lenses instead of the M-plus.
Finally, Bauch + Lömb were so impressed by these lenses that they started to brand them as theirs and took several lenses of PhysIOL:
Here one of the articles on that:
Just write Bauch-Lömb Finevision on Google and you get more.
I think that says a lot.
This doesn't mean that M-plus is not good. For some people could fit even better than the Finevision
But with the Finevision I think for many is better.
You get about 7 % more light (that helps you to read even in the dark), you get a INTERMEDIATE vision for PC - TV and have more probability to have a "FINEVISION" :-)
Well that is my opinion and of course when all went well is normal to be happy. However every person and every eye is different, so listen to your doctor and trust him only.
Even me, I was happy when my surgeon agreed that the Finevision could in fact be better than M-plus for me, so we went ahead. If HE would have said "no, that lens is not good for you" I would have listened him and use the M-plus.
Well, I hope all who had surgery can be happy with whichever lens.
Have a nice day you all.
Weeks three and four respectively.
On waking, the eyes can take fifteen to twenty minutes to function properly. They feel a little 'tight' most mornings and extreme close focus is not possible. A shower and cup of tea and everything then starts to function as it should.
One month checkup at Circle Bath with the consultant surgeon Jonathan Luck.
Standard sight test gave a result of 6-4.5 or 20/15 at 6 metres. A result that I could not match with spectacles before. A very slight infection was noticed in both eyes, and whilst not a cause of concern, a further course of drops was prescribed.
Playing pool, I have played the best games for the last four years, not looking over the specs whilst playing is so good. General vision in all lighting conditions indoors is excellent, regardless of light levels. I am getting used to what I can and can't expect to be able to do. I have set up three static test areas at work so I can better judge improvements for the 5-15 metre range.
Near vision, no change, absolutely perfect, all detailed work with circuit boards easy, sometimes with a work light employed. A superb light is the Ikea Tertial at only £8.50. I have put three of these in the workshop. Reading at 35-40cm is excellent at 8 point and can easily read down to 3 point.
Intermediate, very little change in focus but an improvement in the overall clarity. Computer use is good at 80cm, but text at 12pt still has a slight blur, fortunately I know computers well and don't rely entirely on what I can read. I now run my monitor display setting at 110% and find this makes life more comfortable. The tendency is to lean into the screen and I am trying to pull back 20 cm to fully use the intermediate zone of the lens. All objects though in everyday situations are perfect with no edge blur through a wide focal depth of 0.5 to 5 metres. In a darkened room of an evening, illuminated by two wall up lighters, looking round, the furniture all has excellent definition.
Near distance, again little change in focus but an improvement in general clarity. Facial recognition at 7 to 15 metres is not particularly good as they appear very soft. Reading the large road signs is ok, street name signs are good from 8 metres, so room for improvement there. Driving still good. Light rings are less noticeable on the smaller lights and are prominent only on new traffic lights and cars with LED headlights.
Far focus. No issues, not pin sharp, but perfectly good, and not really concerned whether this distance improves, although I have been led to believe it will.
Seeing my life is mainly lived in the range 0.5 to 20 metres I can cope perfectly adequately as is, but believe there will be improvements in time. The benefit of not needing specs to do any of it, is a superb outcome already, although some areas could do with improvement. Mr Luck offered a tweak to the long focus at a future date if I wanted it, but I am really happy with progress at present and wouldn't even consider anything for 8 months. I believe the lenses will work perfectly, when I learn how to use them.
Will update in a couple of weeks.
Very nice Phil. Please be RELIGIOUSLY serious in not missing to use your drops at the appointed time every day.
If you miss even once you risk to get your eyes too dry or an infection.
Also be careful with WIND. It's very bad after this surgery.
You will not ruin the results but might slower a lot the full healing.
I remember I kept using the tears until the end of the fourth month. After that I stop all kind of medication and now I'm fine.
For intermediate vision, I had the same situation as you after 4 weeks.
I was eager to get to see sharply my 40" TV but from 3 meters it was not sharp yet.
It became sharp at the 9th - 10th week, but it keeps getting sharper and after 7 months is so sharp that you wonder how could it improve so much when on week 10 it seemed already very fine.
Enjoy your vision and your day,
Thank you Alberto for the insight into the progress still to be made. It really is unbelievable that there can be so much more improvement still to come. Still on an exciting journey.
Interesting that we are experiencing different things, but have some challenges in common. My PC monitor is back where it was pre-op and I am now finding that most comfortable. Not perfect but getting better.
I concur with Roberto's comments about wind and would actually go a stage further; I am finding it wise to avoid any situation where air is being moved around, which includes car heater and fan heaters in my office.