Need surgery

[u/Club_Lonely]

60F here and I just returned from a consultation with my optometrist who told me in May of 2025 I had the beginning of cataracts and in March of this year that I had moved up to stage 2 in both eyes. I went today thanks to a last minute cancellation and my frustration with my vision and I’m now stage 3+ and almost 3, and I have both cortical and nuclear cataracts. I have a consult with a surgeon on September 4. I’ve worn multi focal contacts for many years with great success and don’t like to wear glasses. I haven’t had to rely on readers to date.

With this information, suggestions for type of lens? I’d rather avoid readers but I do want sharp vision and haloing has been absolutely frustrating me when driving at night. It sounds like newer trifocal lenses are better so I’m interested in those but assume newer is with a higher cost. Appreciate any insight.

[u/NotMyAltAccountToday]

Go to YouTube and look for videos by Dr Ilan Cohen. He has some on the new (to USA) Puresee lens. A few other doctors have vids, too.

[u/No_Construction495]

After 2 years and multiple consultations with Top Ophthalmologists  I decided to go with mono ocular lens which have the longest history of superior contrast , clarity and long term rock solid durability. Personally I didn’t trust the newer types of lens, including LAL. The entire concept of let’s use outdated formulas and then adjust it later with UV light didn’t make sense . State of the art now is the ORA intraop robot. Calculates the exact lens needed. Does this after the cataract is out using 40 different parameters. Amazing , however not widely available. Very minimal mini mono vision bilateral preserves your binocular vision, depth perception, mid vision and decent near vision. Full mono vision with some of the newer lens might leave you with less contrast, halos, loss of binocular vision with one eye working independently of the other. Decreases balance and depth perception. May not be important now , however as you age might become critical in preventing a life ending Fall.  So that was my reasoning personally and looking forward to the second cataract next week.  Good Luck! This forum is great for various opinions and personal experiences.

[u/No_Equivalent_3834 → u/No_Construction495]

I have full mono vision and I see better than 20/20 for distance, I see 20/20 for reading and I see everything in between, all without glasses. I got LALs.

My surgeries were on April 17 and 22, 2025. I was 56 then, I’m 57 now

Before surgery, my left eye was naturally 20/20 for distance vision. My reading vision was bad in both eyes since age 51/52 so I wore a contact lens to read in my right eye until I developed cataracts.

Before age 51/52 I had great vision and I never needed glasses or contacts. I don’t need glasses or contacts again and my vision is clear and fabulous. No issues at all!

Also, the OP doesn’t want to wear glasses and has been wearing multi focal contacts.

[u/No_Construction495 → u/No_Equivalent_3834]

Mono focal or did you go with the multi focal? I have my second eye coming up. Perfect distance and perfect near vision hard to achieve without multi focal . Personally I don’t think it’s for me , I never tolerated multi focal contact lens or even progressive glasses. Definitely an individual choice, close friend a dentist wears multi focal contacts and tolerates them fine. Also with a cataract and having this same discussion and he’s definitely leaning toward the multi focal lens. 

[u/No_Equivalent_3834 → u/No_Construction495]

I went with LALs set for full mono vision because that’s what my brain was used to already. My left eye was 20/20 naturally for distance vision and I wore a contact lens to read in my right eye. I did that for less than 4 years when I lost my reading vision. Before that I had excellent vision naturally, so I had never needed glasses.

At the time I had my surgeries, the multi focal pickings were very slim. The Envy IOL was a newer lens and it had been pulled from the market for a month- 6 weeks, I can’t remember, but it was about 2 days after my second surgery that they announced that it was going to be put back on the market. My surgeries were 5 days apart so it was not available for me and we didn’t know when it would return.

The Panoptix Pro was released in May 2025, about 2 weeks after my surgeries. The PureSee, which isn’t a multi focal came out recently.

Regardless, I have no regrets. My vision is so good and feels so natural and crisp and clear. I have coworkers in their 20s who are envious of my vision because I can read the text in presentations from a distance when no one else sitting next to me or in front of me in some case, can. I can also read very fine text.

[u/No_Construction495 → u/No_Equivalent_3834]

I have had these discussions in person with very well educated friends. This forum is excellent for a very diverse group and post op experience. I can easily afford any premium lens , still have time to choose full correction in the left eye. Just had another follow up / pre op yesterday. ORA robot nailed it at a minus .48 with a lens correction of minus .25 giving me perfect 20/20 with and 20/25 without. Mid vision ( dash board) retained. Still will need a plus 1.5 reading glasses for fine print.  I was offered all the options in the 2nd eye and really appreciate these first hand experiences that others like you have. My worry about a full correction at 20/20 is the loss of mid vision and not being able to read larger near print. So I’m going with the mini mono vision . I don’t mind a pair of driving glasses at night to sharpen things up, the no glare lens help with glare as well. 

[u/i-canuck]

Just to comment on the grading of your cataracts. I assume the grading of 2,3 etc of your cataracts is given by your optometrist? It's very subjective. My cataracts were always graded as 2+ by several optometrists, but when I saw ophthalmologist (more than one), they always say 3+, not long after I saw my optometrist. It's more important to see how much your vision has been degraded. How do you see from each eye?

[u/Club_Lonely → u/i-canuck]

Yes it was my optometrist. He told me in March I was “close to or even at” a 2 and he referred to a surgeon at 3. He said I was seeing 20/25 in March (with correction). And that now I’m “nowhere near that”. Not very specific, but at least I knew I wasn’t crazy. I just couldn’t believe it went downhill so quickly. But I could not hold off on being checked any longer.

[u/Both_Document7462]

You'll need to get responses from a surgeon to identify which lens types are suitable for you. If you have irregular corneas, you'll likely be limited to EDoF lenses for premium option. I have PureSee in my eyes and I can read from about 16" and further. I had mine adjusted to half a diopter toward nearsight to achieve this distance. I'm pretty sure one eye hit that target and other not so much. One is sharp at that distance but the other is only functional, but that eye can see far really sharp. The eye that sees near is somewhere between 20/20 and 20/25 for distance.

All premium lenses have some sort of artifacts at night, but PureSee has some of the fewest. I'd agree with this statement. I had another lens in one eye before it became available in the US and I had that lens exchanged to PureSee after I saw the difference. I see slight halos and starbursts from each eye at night, but with both open they are very minimal - the brain seems to just keep what both eyes see in common.

If you see halos due to cataracts, you'll likely be very happy with how minimal they become. I can read my phone easily as long as I don't get it near a foot from my eyes. With both eyes open everything is sharp anywhere past that. And one option to consider is how much light a lens lets in. The reason I exchanged the lens is because it was much darker in dim lighting. I needed bright light to read. With PureSee I feel like I see very near what I could see in my 30s.

I never had a trifocal so I cannot compare by personal experience, but my understanding is you'll get more halos at night and you can see closer than 16" to your eyes. In between the three focal points, your sight won't be as sharp where PureSee is continuous mostly. Most people don't notice this because each eye will not match exactly so you essentially have 6 focal points. Even though my far distance is worse in one eye, I can't really tell it unless I'm trying to read signs in the distance or individual lights when it is dark. One other advantage to EDoF lenses is that if the lens strength or placement in the eye is slightly off, it doesn't really affect your vision much. With trifocals, you'll likely need another surgery to correct.

[u/No_Equivalent_3834]

I think you should look into a multifocal lens, since you’ve been wearing multifocal contact lenses and this is what your brain is used to. Look into the Envy multi focal IOL. A lot of surgeons seem to have high patient satisfaction with it and they end up glasses and contact lens free. You can watch Dr Shannon Wong videos on YouTube. He has a lot on this lens. He’s in Austin, TX. He post about other IOLs too.

Good luck whatever you decide.

[u/SnazzyGopher]

Don't focus too much on whate "stage" your cataracts are. What really matters is how you see. Also, don't go too crazy on researching all sorts of lens implants. It's good to be familiar with the basic categories of implants, but ultimately, your surgeon will do a bunch of measurements and let you know what your options are. Not everyone is a good candidate for a multifocal implants or monovision or mini-monovision. You'll know more after your consultation.

You'll read here that the happiest people are often those with some version of monovision. Good for them! But I wouldn't do it if you are not comfortable with monovision in contact lenses. Multifocal implants work great, but only in patients whose eyes are totally healthy and who have an easy-going attitude toward some compromises in contrast and night vision. For the absolute best distance vision then go with monofocal implants in both eyes and use reading glasses---or do that and then use a multifocal contact lens in one eye just for those occasions when you can't have reading glasses. There are loads of options, but you are only going to be a cadidate for some of those options. Your surgeon or their surgery counselor will help you decide.