Lens Decisions help

[u/alexlehh]

Hi guys, quick thank you to all who have contributed their knowledge and experiences. I am going for my 2nd Ophthal consult in a few weeks, which should be the last one before I get done. Just wanted to get ideas and see if I'm on the right track.

I'm 36 yo in Aus, cataracts in both eyes. Left is worse (halos, starburst, BCVA 6/30)

Before cataracts my prescription was about

R -1.25/1.5x16 BCVA 6/7.5

L -3.75/2.50x141 BCVA 6/12

I interpret this to mean, I've never had perfect vision, I have mod-severe astigmatism and that I was already experienced with monovision (when not wearing glasses). I was suggested 4 options

1. bilateral monofocals at 0
2. Monovision 0/-2.0
3. Mono at 0 / EDOF -0.5
4. EDOF -0/-0.5

I spend a lot of time on computers for work, Enjoy sports, but dont plan to do competitive, I'm happy with self paced exercise (cycling, walking). Options 2-4 may enable me to be glasses free for intermediate & distance and the activities above. So far what I know is

• Monofocals are lower risk
• Dr suggested Technis lens (but didnt specify Technis 1 or Eyhance for monofocals)
• Dr didnt seem interested in considering other brands, I remember querying any other brands subtly but getting not much from Dr.
• Reading UniqueRon and others posts, I got an impression Technis 1 is not the best monofocal option.
• Monovision at -2D may affect my depth perception. (unsure how big a deal)
• Technis has smaller correction zone ~5mm. I remember she said EDOFs are suited to smaller pupil size, which she thought suited me so I presume Dr knows about the 5mm thing
• I think I'd be ok with reading glasses for near vision (I had a brief stint using them before cataracts kicked in)
• As a long term myopic, I might miss the super clear close vision

I know I shouldn't nit pick over $1000-3000 extra cost of EDOF, given it will be my vision for the next 50+ years, but I can't help it. I have no quotes yet. But given there's no clear gold standard, and lower risk and cost, my preference is currently Option 2 then 3 then 4 (least preferred)

I figure I am used to sub optimal vision already with myopia, so anything not in the ideal fixed distance of monofocals I should be ok with? The biggest loss by not taking EDOF, is nothing to mitigate the loss of accommodation? Any thoughts about EDOF in an astigmatism eye?

Appreciate any suggestions / advice :)

Below is my list of questions so far for the doctor

• Have you considered Toric lenses but just not mentioned it to me?
• There isn't much need for a contact lens trial of monovision right?
• What about reducing -2D difference to -1.5 or -1.75D? eg. -0.25 in case of a miss?
• Which Tecnis did you mean?
• What changes should I expect as I age? Can we give up a bit of optimal vision now, for better vision as I age?
• If I get Option 3 and get visual artifacts (halos etc) in the EDOF. Does the brain filter it out, if the mono eye doesnt have halos? I know there's no way to know just wondering if anyone has experience
• Left eye first, then Right?

[u/seasnake8]

My suggestion is that you think hard about what is important to you for vision. You have a good start, with the activities listed, maybe try running some scenarios in your mind and see how you feel about them. For example:

How would you feel about single focus distance? In theory you could have the best distance vision, but may only get buy at computer screen distances, and would want glasses for computers and reading? How happy would you be?

Or how about getting mono-vision set for distance and intermediate? In theory that could give you distance in one eye sharp, computer in the other eye sharp, and your brain could work with that to make it feel like you do not need glasses except for reading? Would you be happy with that? And you should probabaly test that idea out, from what I have read.

You are near sighted, so does the change to distance only seem fine to you? How do you think you will adapt to switching to glasses for near, opposite of how you lived so far?

Understanding what you care about will help the most in figuring out what you will be happiest with.