iol to choose

[Redbreast15]

Hi, I have to decide which kind of iol has to be implanted in my eyes and I am in trouble...I have both yes myopic, - 3,75 S -3,75 D, since I was seventeen, now I am 66 years old. I have always worn rigid and semirigid conctact lens, every day, from early morning to night, without problems. Before cataract I needed +1,50/2,00 glasses to read very small characters, wearing them on my contacts. Now I have -7,5 S and -4,5 D. I had 3 different suggestions: 1) monofocal iol to see well at far, 2) monofocal iol -2.50/3.00 in both eyes to have a very good near vision, and 3) the Symfony lens (available here in Italy). I am accostomed to have a very good near vision even without any lens or glass and I am very sensible to colours. I think that the solution n. 2 might be the more "natural" for me, but also the new lens Symfony seems very interesting even if also "complicated". I would like some suggestions. I have to decide in a few days...
Thank you for any help.

[SoftwareDeveloper]

re: " I think that -1, -1.50 could be enough to "compensate", balance the other eye hyperopic."

Yup, that is the micro/mini-monovision I was mentioning, those are a "bit myopic", a bit nearsighted. Usually with the Symfony they do 1D or  less, the Symfony page (if you click on the clinical tab) shows the results of a small bit of monovision:

http://www.tecnisiol.com/eu/tecnis-symfony-iol.htm

however you may decide you want a bit more. The thing to do is to find out what the prescription is like on your first eye, if it is truly farsighted (vs. perhaps just merely still recovering from surgery), and then what sort of add you need to do with that to see the size print you want to see at a comfortable distance. That should guide how nearsighted you want the second eye.

[4ndrew]

Go for 3 diopter EDOF lens, you don't need mini mono vision, symphony only give you 1.5 diopter depth.

[Redbreast15]

What do you mean with "a bit myopic"? I think that -1, -1.50 could be enough to "compensate", balance the other eye hyperopic. I'll try to talk about this target with the surgeon. I hope to solve the thing.

[SoftwareDeveloper]

re: "was able to read small characters wearing +1.50 lens"

The question is what your prescription is. I'm suspecting there is a very good chance the lens power they used was wrong, that they left you farsighted, which takes away your near vision. Though as I said it is possible that may be off since:

re: "first postop check"

Usually that is the day after surgery, and the eye is still very much recovering from surgery and the measurements may change and improve quite a bit.

re: "suggested the same correction in the two eyes"

If possible a tiny bit of monovision, making he 2nd eye a bit myopic,  is often used to get a little bit more near.

re: "understand by him that the Symfony iols cannot be set up even a little myopic"

They have studied mini(/micro)-monovision for this len. I suspect I've read everything on the net about this lens, and a number of surgeons talk about  doing a slight bit of monovision, and no source I have seen says there is anything wrong with having one eye be a bit myopic. If your first eye is farsighted, even if trying to get the 2nd eye to be plano (neither myopic nor hyperopic), it is best to aim to err on the side of making the next eye a little myopic worst case rather than hyperopic again.

I'm hoping that you didn't understand him correctly. If that is what he claimed, that would indicate he doesn't know what he is talking about and you should consult another surgeon.

[4ndrew]

Mono vision because symphony only provide 1.5 diopter depth of focus, not like Miniwell or INFO from SAV-IOL which give you 3 diopter depth.

[Redbreast15]

I have already had my first postop check. The surgeon sayd that my left eye was able to read small characters wearing +1.50 lens. For the right eye an equal Symfony was ordered, as the surgeon suggested same correction in the two eyes. Furthermore I understand by him that Symfony iols cannot be set up even a little myopic. I think that at the end of the story I have to wear 1/1.50 glasses for near vision. Anyhow I thank you for telling me that your night vision became better with the passing of time and I'll wait some weeks hoping the same for me.

[4ndrew]

That is because symphony only got 1.5 diopter depth, that's why they promote mini mono vision, Miniwell or INFO from SAV-IOL will give you all distance vision.

[SoftwareDeveloper]

re: "but I must wear glasses (+1,50/2,00) to write for instance now."

Your eye is still healing from the surgery (which may cause some visual glitches) and getting used to having a new lens, my near vision was poor for a couple of days before it became good. (and with multifocals it can take a number of weeks/months for the best near vision to come in, which may be true with some patients with the Symfony as well). Many people with any type of lens   experience some visual glitches the first few days after surgery, so I wouldn't worry yet about glare and night vision. Most studies that talk about things like night vision issues are referring to the results at least 1 month or often 3 months postop.

In addition of course with your other eye not being operated on yet it won't have good near vision in that eye, and the difference in near vision between the two might lead you to do better with correction until you do. The brain can deal with some visual difference between the two eyes (like in monovision) but it may take a little time to adapt to. If your left eye doesn't have enough near vision, the can target the right one to be a little myopic, monovision.

I am suspecting unfortunately that you may have wound up being hyperopic, farsighted, in that eye, which would reduce how much near vision you get while still leaving good distance&intermediate. I'd suggest at your next postop (usually 1 week) you see what they say your prescription(/refraction) is, and what your vision is in that eye by itself.

The prescription unfortunately can vary the first few weeks until the lens fully heals into place. Usually they don't even consider prescribing new glasses until 1 month postop if the prescription seems stable (sometimes a few weeks more than that).

In terms of glare, part of what might be going on is after the lens clouded by a cataract has been removed, more light can enter the eye. Most people after cataract surgery (especially if they had both eyes done around the same time) comment on how much brighter the world is at first. I had to turn my monitor brightness way down.  It may be that at night the lights will seem brighter at first until you get used to the difference (and that the difference between your eyes may also be confusing your visual system if one eye is seeing it more brightly than the other).

[Redbreast15]

I had my operation five days ago. Now I have the first eye done, the left one, with Symfony implanted. I had asked for Mini Well, but the surgeon told me that he did not have good results with them, so I confirmed my choice for Symfony. I have a good vision far, good intermediate, but I must wear glasses (+1,50/2,00) to write for instance now. I don't know if the situation will be better when I have also the right eye done. I fear I have to forget my near vision... But I can see the trees all around me, and the leaves, and the windows of my neighbor with their small particulars. I am worried for the glares I saw yesterday night looking at the lights of the cars. They were very large and not transparent, so that it was Necessary to look away. I hope it will get better!

[4ndrew]

Symfony only have 1.5 diopter depth of focus, which means the near vision is not good as we need 3 diopter depth to get near vision. Miniwell or INFO from SAV-IOL will give you all and better distance, intermedia and near vision. US surgeons got no access to Miniwell and INFO from SAV-IOL.