How is your vision after Cataract Surgery?

[orbitnw]

How is your vision after Cataract Surgery?
Please specify whether you got a monofocal or multifocal/accommodative IOL.

I would like to know what distances you are able to see clearly. What distances are slightly blurry, but acceptable, and what distances are just unbearably blurry.

I am particularly interested in those who have received Monofocal IOL set to Distance but I would also really appreciate hearing those experiences with different IOLs. I have heard from several people that with a IOL Set to Distance, they are still able to use the Computer at about 18 inches. This has confused me since I had thought IOL set to distance makes intermediate distance blurry.

Thanks!

[TechDeveloper]

I had my retinas examine today. The specialist indicated that while I have epiretinal membrane in both eyes, it's not enough to warrant surgery at this time given my current visual acuity.  He also confirmed the cataracts were very mild and felt cataract surgery would not be advised at this time either - in part both reasons due to having only one good eye to work with.   Although my eye test indicated, surprisedly, a corrected 20/25 today (oddly it was 20/40 a few months ago) using the standard eye chart, I should not have the difficulty in reading far distance traffic signs.  I told him I do, which may be the glare I perceive that interferes with the ability to read the letters.    Consequently, I don't have much faith in the Snelling eye chart results because it's only measuring my visual acuity under certain contrast conditions, and not the real world. He suggested that I try to see a very good optician, who might be able to provide some color filtering that may improve my contrast, particularly for far distant reading. So I will be off to the optician he referred me to and see what happens then.

[SoftwareDeveloper]

btw, Canada reportedly may have the Symfony available within 1-2 months. The AT Lisa trifocal is available in Mexico now, and there are some clinics that are within walking distance of California that *might* be US quality and just over there to use newer technology. (I didn't check into them once I decided to go for the Symfony).

re: "I can't think of any reason to skimp on the cost of this procedure,"

One reason btw would be to instead spend the money to travel to get a better lens, which is likely in most cases to make more of a difference in the years following surgery than having spent the money on laser vs. regular surgery would (though it depends on the case, some with specific issues like a mature cataract may benefit from the laser noticeably, with others its hard to say when the surgeons are still debating the issue). Though of course insurance issues may raise the costs too much, it depends on things like a deductible and budget.I had a high deductible so it was cheaper to go abroad it turned out  (costs are cheaper in Europe,   due to cost of living or other factors, in the Czech Republic especially. I'd only recommend it though to people willing to do their research to be sure they get good treatment, which should be a higher priority than cost of course if possible).

[SoftwareDeveloper]

re: "I sure wish I could wait for the Symfony! From what SoftwareDeveloper reports, it's the best Mutifocal yet."

I think it was the best choice for me (people's needs vary, some might prefer the trifocals that also aren't approved here for better near with not quite as good intermediate).  I admit now I'm curious how well using a corneal inlay providing extra depth of focus (Kamra or Raindrop) over something like the Crystalens would  work. (though I guess the risks of  Crystalens complications and need for 2 surgeries likely would still tip me towards the Symfony).

I mentioned above the Tecnis +2.75 which looks like a decent bet among US lenses. I know someone from this site who got it last week after he decided not to go abroad for the Symfony, I'm guessing he'll post about it.

I will note again that the Symfony isn't a multifocal, it is a new class of lens, an "extended depth of focus" lens:

http://www.eyeworld.org/article-new-tools-in-the-cataract-surgeon-s-toolbox
"The Tecnis Symfony has an elongated focal point, giving the wearer a continuous, full range of vision. Although the lens has diffractive gradings, it creates only 1 image on the retina, not the 2 images characteristic of multifocal IOLs. "

http://reviewofophthalmology.com/content/i/3110/c/52313/
" The first thing to understand is that the term diffractive optics doesn’t necessarily imply multifocality,” says Daniel Chang, MD, an ophthalmologist from Bakersfield, Calif., who is an investigator for the U.S. trial of the Symfony. “This is not a multifocal lens, but it does use diffractive optics to do two things: First, it corrects chromatic aberration. Second, it uses these optics to extend the range of quality vision.” As Drs. Holladay and Chang explain it, with optics you can’t gain an expanded range of vision without losing something in terms of the sharpness of vision; this is just the nature of the beast. However, by correcting chromatic aberration, even without using diffractive optics to expand the visual range, the lens would have extremely sharp distance vision on the order of 20/12 or even 20/10. The process is not yet done, however, in the Symfony. The diffractive optics are then used to expand the range of vision. Expanding the depth of focus degrades the tack-sharp “starting point” (something must be lost, as Dr. Chang pointed out), but since the lens started with such sharp vision, it only degrades to about the level of 20/20. “So the amount you degrade takes you back to the level of a good monofocal IOL,” Dr. Chang says. "

There are a few other extended depth of focus lenses on the near horizon abroad that there isn't enough data yet to know how they compare, like the Mini Well in studies now in Europe. A bit further out are better accommodating lenses.

In the case of the Symfony, part of the benefit comes from correcting chromatic aberration that even natural eyes have :

http://crstodayeurope.com/2015/01/the-evaluation-of-new-presbyopia-correcting-iols
"The average eye has approximately 2.00 D of longitudinal CA between 400 and 700 nm and 0.80 D between 500 and 640 nm."

[GreenBikeRider]

I wonder if one of the reasons that "they still do not use it" is because of the huge financial hurdle to get one in the first place.

A surgeon can only recoup the cost of this equipment from the small percentage of his total patients that want or need it - at an upcharge of $1500-2250/eye, Like any new tool, it must justify itself financially. I'm assuming that it is bought on credit as well, which up one's credit line for years.

I can't think of any reason to skimp on the cost of this procedure, but I know several people who have. And regretted it - all just saw one doc, listened to the spiel, and went forward. Others will research and travel to find and get the best.

I sure wish I could wait for the Symfony! From what SoftwareDeveloper reports, it's the best Mutifocal yet.

[TechDeveloper]

When I sought my second opinion on whether or not to use laser cataract surgery, I went to a major university's eye institute. I was told that even though one of the faculty members was a pioneer of this technology, they still do not use it because there is no clear evidence that it is any better than phaco. An as SoftwareDeveloper pointed  out there were numerous studies shown in the scientific literature that suggest it can indeed cause other issues.  Although expensive, I am not at all considering the cost, rather than the safety and best outcome.  While I am sure a lot of the results depend on the surgeons experience with the laser (as would it with the knife), it may be too early to know whether it indeed is 'better" or not.  I was told or read somewhere (I can't recall which), that it may be a better technique if using an accommodating lens or multi-focal. But that should be researched.  

[SoftwareDeveloper]

re: "I  have yet to ready any studies that claims that the manual method is better. "

The incidence of some complications is higher, while others lower. Actually some of the studies I listed  above noted for instance a higher incidence of anterior capsular tears. Anecdotal comments I quoted indicate that they can "read" the capsule better via manual surgery to provide them with clues as to whether there might be a problem with a capsular tear.

Techdeveloper suggests in his case with certain retinal issues, the literature suggests manual surgery is better (I don't recall the details, since I didn't have retinal issues, nor do others I know looking into it, I hadn't paid attention to that). I don't know if its more beneficial in your case or not. I had asked a surgeon if the laser might decrease the risk of retinal detachment  due to less phaco energy being used, and he considered it unlikely since that isn't near the retina. (I was highly myopic so I'm more at risk of retinal detachment, but I've never had any retinal issues). I haven't seen anything published that contradicted his view.

Newer technology isn't guaranteed to mean better initially (even if it has the potential to be so in the future), as I've observed from decades in the high tech world. It is often merely different.  In the case of IOL technology, I felt the newest lens had enough benefit to go to the trouble to travel to Europe to get it. Usually with a new technology, especially one with higher costs, the issue is for it to demonstrate an advantage, which it isn't clear the laser has yet except in certain cases like with a mature cataract. I chose  manual surgery  even though my surgeon offered laser treatment ( for not much more so cost wasn't a factor, since its much lower cost in the Czech Republic where I went), he didn't see any real advantage in my simple case.

Even though people are also led to expect more expensive means higher quality, in a case like this that may or may not be the case depending on the person's situation. Unfortunately the technology is changing all the time, which may mean it has a benefit that isn't yet demonstrated... or a complication (like say due to a new software bug for a laser) that hasn't yet been noticed since its still a rare glitch that will only be noticed in a large statistical study.