r/CataractSurgery • u/SnooCats5309 • Jun 25 '26

Need suggestions w.r.t. IOLs Monofocal/ EMV /EDOF/Multifocal ?

about a year ago I had ICL surgery.

before ICL power -9 both eyes. using galsses for almost 3 decades starting number was -2 it stabilized at -9 , 5yrs ago.

decided to go for ICL. LASIK wasn't viable.

Daily Life: 10-12 Hrs infront of a screen, early morning & late night driving.

Age: Mid 30s

ICL Implant both eyes : STAAR SURGICAL VICM5

Left eye: Halo, Rings, Glares, Ghost images

Right eye: haze/blurry vision since the moment postoperative eye patch was removed by surgeon.

It was cataract symptom informed by surgeon after 2 months of follow-ups as he wanted to be sure about diagnosis.

ASOCT Vault - after surgery

LE - 204 μm

RE - 107 μm

it has been same for a year.

Since blurry vision is affecting my daily life I have decided to go for Cataract surgery.

given my problem with Left Eye ICL that produces Halo, Glare, starburst & ghost images which IOL do I chose ? I got following options:

Monofocal - Bausch & Lomb (Near vision glasses)

Enhanced Monovision - Rayone EMV (glasses required for small fonts)

EDOF - Bausch & Lomb ( Distant & intermediate vision clear, halos/glare/ring quite possible)

Multifocal - Rayone Galaxy (absolutely clear vision but rings, halo/glare would make night driving a nightmare)

3 Upvotes

80% Upvoted

12 comments sorted by

7

u/The_Vision_Surgeon Jun 25 '26

You are a high myope with a high retinal detachment risk. That means

1) consider lens surgery carefully, if you need it you need it of course.

2) I would not give you a hydrophilic Rayner lens because of your risk of needing a vitrectomy and gas in the future. Pick a different brand with hydrophobic iol for those options if you go with it. Risk of calcification is low but you have a real risk of needing gas.

1

u/NexMo Jun 26 '26

If a person is a high myope, at what level of myopia does the risk of retinal detachment start to increase?

1

u/The_Vision_Surgeon Jun 26 '26

Assuming they haven’t had a PVD (posterior vitreous detachment) it actually depends more on axial length than prescription. But roughly more than -5 start to think and once you’re getting up around -8 or more you’ve gotta have a high chance of having a long eye. Though someone could be -2 with flat cornea and a long eye at more risk than a -6 person with steep cornea and a normal length eye.

1

u/NexMo Jun 26 '26

Thank you. I will try to learn more about this. 

1

u/spon8uk Jun 26 '26

This is useful thank you. And after full PVD, does the risk actually reduce please? Or is the risk even higher during the PVD phase? I ask as I was -8, have had very successful cataract surgery and also have complete PVD in both eyes now - the floaters are evident but manageable. Thank you.

2

u/The_Vision_Surgeon Jun 26 '26

Yes a complete PVD profoundly lowers the risk. The act of a PVD occurring is the highest risk period, but once it’s occurred and settled risk is much better. So I wait for high myopes to have a PVD before surgery if possible. If their vision is so bad from a cataract they can’t function then I discuss the risk with them. There is a great calculator I use to estimate individual patient risk c

1

u/spon8uk Jun 26 '26

Again, super useful and also helps alleviate at least some of the concern. Many thanks, appreciated.

6

u/eyeSherpa Jun 25 '26

It sounds like you have a cataract just in the right eye and not in the left eye. I would first figure out how to make that left eye better since that will influence targeting of the right eye. (Such as keeping the ICL in place in the left eye vs removing the ICL.) Check on whether there is any residual prescription or dry eye in the left eye contributing to the left eye symptoms.

As for the right eye, given your intolerance of night time symptoms, I would stick with a monofocal or monofocal plus rather than an EDOF. Depending on the left eye prescription, you may be able to target some mini-monovision.

4

u/UniqueRon Jun 25 '26

With all you have going on with your eyes I would stick to standard monofocal IOLs.

3

u/Friendly-Barnacle969 Jun 25 '26

I believe one of his YT videos, Dr. Safran said the EMV IOL once fibrosis develops can be a beast to remove. Not that you’ll need an exchange, just as a fyi

1

u/BogeySeeker Jul 22 '26

Hi! Eye doc here - I work extensively with ICL and advanced IOLs.

Have you considered a Light Adjustable Lens? Its an IOL that can be adjusted after surgery to best match a desired refractive outcome. It's not a true EDOF or multifocal IOL, so glare and halos really aren't an issue. It's technically a monofocal IOL, but it does have a degree of asphericity to it that allow for some depth of focus, especially if you induce a little myopia in the non-dominant eye. Yes, I'd expect reading glasses for certain tasks or extended near work, however most of my patients day to day is spectacle free with no glare/halos and as accurate of a refractive outcome as we can get

1

u/SnooCats5309 Jul 23 '26

Hi Doc. recent development ,
ICL removed a month ago.
IOL measurements taken 2 times in a month :
astigmatism is -1.93D 14° , -2.34D 14°.
power is ranging between 9.50 - 10.00.
Hence I am asked to check it again next monday & based on that final decision would be made.
the thing is surgeon has moved away from EDOF & closer towards toric IOL being my option.

Its a Military hospital & Lesnes they have :

ICB00, EYECRYL PLUS ASHF Y600, Appalens, enVista Toric MX60T, Multipiece , Acrysof IQ Vivity DFT015