I'm a late 20's with double cataract surgery and chose mono focal iol.

Imo from when I had the option, you trade off sharpness and lack of halos (or lower impact of halos) for some accommodation, but it will never be the same as the natural lens. I chose to have mono focal lenses instead so as to have clearer vision and I have not regretted the monofocal route. I do miss being able to see close but tbh I can get away reading without readers, although it is difficult to do. I can't see small details so for things like bike maintance etc. I typically use a strong pair of readers, but you can just get those at Costco. I do have a fear that I will eventually just become sloppy becuase I won't see like small stains on my shirt etc. and I forget that everyone else will notice things I no longer notice, but Cest le vie; being blind is way worse, trust me. Plus you will not really need glasses ever again.

As for night vision, at least for me, I do have some difficulty driving at night so I try to avoid it if I can. I would assume with a multifocal lens it would be much more difficult.

Listen to your opthomologist and do what they say in recovery. Use the eye drops. Your recovery and success is tied to your adherence to post surgery, so keep that in mind. Also enjoy racing without contacts or glasses. I am not slowed down from my eyes so you should be able to be the exact same athlete you were before. Might impact your bike computer readings slightly but again I can read them fine. Only thing I would struggle with would be like reading say nutrition labels on my GU packages in the run... Which is really useful...

Thank you for sharing. Sounds like your intermediate vision is pretty acceptable. Is that a fair statement?

It's acceptable but it will never be what it once was. With that being said, I prefer being able to see without glasses 98% of the time and having to fiddle with contacts or glasses daily. But it's fair. But I think it's also case by case and due to some complications I do have a slight different prescription in my right vs left eyes so I do have some flexibility in my "reading" ability. Anyways I wouldn't worry about it too much. Monofocal are tried and true. Multifocal may be better for your use case. I can't answer that, but there are a few tradeoffs going multifocal and imo I would rather have perfect vision in 80% of my use cases rather than a good/decent all around but still likely need glasses to see fine details. Anyways I have the experience of basically going completely blind so I don't think too hard about it. I don't take my sight for granted.

As I am facing similar surgery in the coming months I am curious about the options as well.
So far I am a little suspicious of the advice on various sites as they appear to be industry"supported" .
And the two people I do know who did have surgery have completely different takes.

I had cataract surgery in 2014 in both eyes at the age of 51. My surgeon recommended monofocal lenses for all of the reasons the other poster stated. Given my active lifestyle, she suggested that we go with a distance lens in one eye and a mid-range lens in the other eye, to maximize my middle and distance vision, which is what I need for tris. I also told her I didn't mind having to keep using reading glasses.

As it turned out, the correction in my "supposed to be intermediate" range eye ended up giving me great near-range vision, so I ended up with one eye that's nearsighted but perfect for reading and one eye that's 20/20 for distance. I couldn't be more thrilled with how it turned out. I don't need glasses for anything. During tris, my distance vision is great (no more struggling to see buoys, no more worrying about getting kicked in the face and losing a contact or getting dirt in my eye under my contact). When I ride, I can actually see the numbers on my my bike computer, and I can have multiple fields on the same screen (no need for one field per screen so I can actually read the numbers). When I swim and run, I can quickly glance at my watch and see the numbers. Having good near-field vision is also great for doing bike intervals; no more needing to wipe off my glasses every two minutes so I can see what power I'm putting out. I've had zero problems with my monofocal lenses. AND I now have good vision at night, which is great if you do IMs and are out there after dark.

Had the same procedure in my early 50's with near focus/distant focus lenses and love it. I don't even know which is which unless I put a hand over one eye. I had a second opinion for multi-focus lenses at the Boston eye group and they felt I wouldn't be happy with them.

I guess the biggest questions are how much are you willing to pay out of pocket and what are your goals with your vision?
The extra costs for these special lenses can get really expensive. Anywhere from $2-3,000 per eye, and up. This is out of pocket. Insurance will cover the basic lenses but not these "special" ones.
As someone else pointed out, if you are good with never needing glasses, except when you read, then you would be good going with just a regular IOL........this is what the majority of cataract patients end up getting. It corrects for your distance vision but means you will need reading glasses for up close activities.

I've seen patients who are exceedingly happy with their multi focal lens replacements and others who wish they could have em taken out and a "regular" IOL put in its place. Problem is, it's very easy to put any of these lenses in but it's A LOT more difficult to take them out and replace.

Cost is not an obstacle. i see it (pun intended) as a once in a lifetime investment in my vision. Personally $2-3K per eye doesn't seem expensive at all. It will certainly pay for itself in contact lens and eye glass savings over a lifetime.

My visual priorities are:
1 Distance vision
2. Contrast sensitivity
3. Low light vision/night driving (lack of halos)
4. Mid-range vision
5. Near vision

I'm not opposed to a regular IOL, as I don't mind reading glasses, but I do need to be able to read my bike computer or watch face when I'm down on the aero bars. Is this a reasonable expectation with a regular IOL? The reason I asked about the Symfony IOL is it seems to give reasonable reading at near distance without the halos, poor night vision, and impaired contrast sensitivity of some of the other MFIOLS on the market.

it's very easy to put any of these lenses in but it's A LOT more difficult to take them out and replace.


Agreed,I saw a youtube video of an IOL being replaced by another IOL and it was brutal to watch. I only want to do this once. Thanks so much for sharing your expertise!

Make sure you tell your surgeon this order of priorities because it may help you both decide. I've seen patients who are happy with both regular IOLs and with their multifocal IOLs but I almost never hear a patient complain of contrast sensitivity issues or lack of crystal clear quality with their regular IOLs. And I'm glad you listed contrast sensitivity because a lot of folks do not understand how much this can impact your quality of vision

Thanks again. I feel much better prepared for the next conversation with my doctor.
:-)

"Make sure you tell your surgeon this order of priorities because it may help you both decide. I've seen patients who are happy with both regular IOLs and with their multifocal IOLs but I almost never hear a patient complain of contrast sensitivity issues or lack of crystal clear quality with their regular IOLs. And I'm glad you listed contrast sensitivity because a lot of folks do not understand how much this can impact your quality of vision"


Having done some more research I'm now considering a mini-monovision approach. The objective would be to have excellent distance and mid-range vision, with ability to read at least some of the time without glasses, but totally ok with readers for fine print or short work. Additionally want the best night driving/low-light/home theater experience possible. Any thoughts you have on this approach would be very helpful and appreciated.Thanks!

I'm a little late to this thread but am happy to add to it. For reference, i'm now 49 years old.

Last November I had a Symfony extended depth of focus to replace my cataract in my left eye. The year prior I had a monofocal IOL inserted in my right eye. The year prior to that I had a detached retina in my right eye and subsequent scleral buckle surgery. Still at a loss on how that happened, no trauma...

Initially, my Dr. was recommending a monofocal IOL for my left eye. There was some concern about mixing IOLs. After much discussion regarding lifestyle, expectations, bike computers (!), we elected to go with the Symfony IOL.

This was mainly because I rely so much on my left eye as even with the surgeries, I am left with poor vision in my right eye (20/40).

I was warned about halo's at night, and I do have those now. I see them as neat artifacts and frankly they don't bother me. But I was coming from pretty poor vision to start with.

The other downside was cost. There was a premium.

That said, I can see much better and would do it again. I can see my bike computer well providing I do not have too many data fields. I do need 'readers' to read smaller print. I regret that I don't have a good data point in my right eye to make the comparison on how much better my near vision really is though.

Good luck to you!

OP UPDATE: Aloha. After much COVID-19 related delay, I finally had my cataract surgery on both eyes on 6/22. After much research and interactions like this on different forums, I opted to have monofocal IOLs implanted in both eyes set for distance. My main criteria for this decision was the desire for the highest quality of vision over the greatest range, lack of visual side effects especially at night or in bright light, and a willingness to be at least somewhat dependent on reading glasses. The end results have been outstanding. I was tested at 20/15 uncorrected distance vision the day after my procedure. This quality of vision starts at about 3'+ and goes to the horizon. The amount of detail and contrast I can see in this range is astounding. Inside that range things are slightly out of focus, but not nearly as much as I thought it might be. The degradation in focus as things get nearer to me is very subtle and doesn't actually approach "blurry" until about 9" from my face. I can comfortably interact with my cell phone with a bent elbow (about 18" - 20") and can see the screen on my Wahoo Bolt while down in the sleds (about 12") with the screen configured for 3-fields. I am super happy with my decisions and results, and thank everyone on this forum who contributed to this thread. If someone contemplating cataract surgery stumbles onto this thread in the future, I will be more than happy to answer more detailed questions. Thanks again everybody!

Do the discussions here depend on the vision correction required pre-IOL surgery? I am super near sighted with contact lens corrections of -10.5 and -12.5 (to provide near and long distance vision - sort of). I'm looking at vitreal replacement in the next year or so, and am told that it's a virtual guarantee that cataracts will follow with an IOL. So...is the IOL decision different depending on the correction required pre-cataract?

That's great news, and I had followed this when you first posted it. I will be getting the procedure in the next year, have been waiting for medicare to kick in. Maybe EyerunMD can chime in and fill in the blanks on what that entails. But as I understand it, I will save a lot of money using medicare rather than my insurance I have now. I got a quote over a year ago, and it was going to be about $10k out of pocket. I guess insurance really sucks with this procedure.

Good luck, and keep us up to date on any changes, good or bad...

Thanks for your kind information.

such an informative one.Great thanks

I'm 53 and recently diagnosed with cataracts in both eyes. I'm also 5 months post vitrectomy for a retinal detachment. I'm trying to decide on which IOL to go with but the IOL options along with the benefits and drawbacks are a little overwhelming. First I was considering single focus, then multi-focus than EDOF, then back to multi-focus. If I go multi-focus do I select Panoptix or Synergy or do I do a combo of Panoptix and Vivity??? I'd love to hear more cataract stories including what IOL type and brand you selected for each eye and why along with what your outcome was. Also, does anyone have experience with the light adjustable lens (LAL IOL) from RxSight that is UV adjusted post-op and can be fine tuned for each person and their vision goals? It sounds very interesting.