From a friend who had it done:
"Here's some info that you might find useful when you consider your cataract options.
As you undoubtedly know, Medicare will take care of the costs for a "vanilla version" of intraocular lens implants and the associated doctor's costs. As you mention below, this is only for a mono-focal lens and you have to choose the distance you want to be permanently set to. Of course, that probably isn't a big thing if you've already got really bad vision, anyway, and are used to wearing glasses so choosing one distance may be fine. I've been using reading glasses for a few years so didn't really care about continuing to use them and thought I'd get "infinity" to see all the pretty things nature offers and just wear glasses for books and the computer screen.
However, I started asking questions as to what was really available both here and around the world (knowing that the FDA is usually way behind in approving things that the rest of the world has used for a while). There are two additional lens categories – "accommodating" and "multi-focal". The "multi-focal" has two or more fixed foci on a flat plane that it can be set to depending on what you want. (See below about “ranges 1-5”). The "accommodating" lens is actually a "bendable" lens that can be distorted inside the lens capsule by using both the normal eye muscles and the attaching fibers called zonules so it's more of a progressive lens. You can search for these two types and get some great info online. I found them by searching for "multi-focal vs. accommodating lenses" to see some comparisons.
My surgeon explained that they (sort of unofficially) classify the sight regime as lengths 1 through 5. One is being able to read a book really well, 2 is computer screen distance, 3 is for most run of the mill things around the house (kitchen counter, cleaning the floor, looking in the mirror or inside cabinets, etc.), 4 is good distance outside (i.e.: normal infinity like driving) and 5 is being able to see the stars and moon clearly at night.
I was leaning toward the "accommodating" type because it seemed more natural in its implementation from the descriptions. However, when I asked them about it, they said that they used to do them but have gravitated toward recommending the "multi-focal" lenses because of better performance and fewer complications (which have to do with a rare potentiality for the lens, once implanted, to “fold backward” and make the vision very distorted). It’s actually a situation that is more easily portrayed visually as to what happens and is hard to describe in words so I’d have to draw you a picture or show a sample of how the “accommodating” lens can be “folded” into a compromising position.
BTW, when we made our first appointment with this Hilo surgeon, Dr. Daniel Driscoll, we figured it would be a perfunctory, courtesy visit because our GP recommended him and because the reputation of specialists here in paradise leaves a lot to be desired according to everyone. However, after seeing his facilities and reading about his history and capabilities that would make the Mayo Clinic proud, we said yes. He attended the Bascom Eye Institute in Florida, one of the best eye clinics/educational institutions in the US, right up there with the Jules Stein Eye Institute at UCLA. He had all the latest equipment and procedures.
So, I did some further research and heard about a new lens that had multi-focal capabilities AND could take care of astigmatisms as well in one lens. Apparently, it was only approved by the FDA 2 years ago to include the astigmatic correction. I was leery about the short track record and wasn't sure about the infant mortality possibilities so I was stalling. Then, I met a new neighbor here in Mauna Lani two weeks before the surgery who was one of the first guinea pigs for this new combo lens 2 years ago and he raved about it. Case closed.
The lens is called the TECNIS "Symfony" Lens from Abbot Labs. You can search for it on-line using those words - lots of information on its construction and efficacy. It’s made in Germany and is termed the "Extended Depth of Focus" lens that allows for both MULTI-focal settings AND astigmatic correction all in one lens (no more need for glasses). My ophthalmic surgeon and his optometrist both acknowledged that it existed but I don’t know if they would have recommended it unless I had asked because no one ever asks for these things. Most just assume that mono-focal is all there is because it's the cheapest, been around forever and insurance covers most if not all of the cost.
The "Extended Depth of Focus" lens can handle roughly 3 of the 5 ranges described above. You have to pick the set that fits your lifestyle. I still picked 3 to 5 (basically infinity) as my favored range because we are more outdoors people than indoors and we wanted to see all the vibrant colors and scenes in mother nature and all the road signs when driving on a trip. I figured if I was lucky, I'd see some of the computer screen if I sat far enough away. Well, after using them for 3-4 weeks now, I can certainly see infinity but I can also use the computer with no glasses AND I can see most printed matter to read, too. The fine print is a bit difficult but plain old Costco readers are just fine for that but, if I really squint, I don’t even need them from time to time. Haven't needed my prescription glasses (that had the astigmatic correction in them) at all and will now donate them to the Lions Club, used glasses program.
OK, for every set of good news, there's always the "yeah, but……..". These Symfony lenses cost an additional $2,500 per eye (depending on the surgeon but they all seem to be about the same). Even my friend paid that 2 years ago so the price hasn't gone up yet but inflation could kick in someday. Maybe it'll go down eventually but I couldn’t wait that long. Being 68 now, I figured that, with an additional 40 years of life expectancy left ������ ������, the amortized cost would be minimal.
There are two recognized surgical techniques for cataract surgery – the blade and a laser. I looked for the benefits and the pitfalls of both before deciding on whether to have surgery here or elsewhere depending on the technique used. Turns out, after reading some detailed, medical journals, that there really is no great consensus that one is better than the other. There are a couple of small things that may favor one over the other depending on what the surgeon recommends after your exam but the preponderance of evidence seemed to say that either one is just fine. It's up to the preference of the surgeon and his expertise. Driscoll uses the blade for now but is getting the laser early in 2019 so he can do both. The blade has been fine for me and I’ve not noticed any complications AT ALL. He thought that both procedures were just fine.
I did a lot of research on how the cornea actually heals and it was really educational. The eye is amazing at healing itself – and quickly. One of the best websites I found for real detailed references was a professional one at
Review of Optometry – The Magazine Read Most by Optometrists. Lots of information there at very detailed, medical levels with all the jargon so you have to have
Medical Terms and Abbreviations: Merriam-Webster Medical Dictionary up on another screen while you're reading the articles.
And, you can be awake for the whole procedure with lots of really strong numbing and dilating agents all over your eye so that you don’t feel anything; however, that’s your choice as to how to proceed. I was talking to the doc during the whole procedure while watching the shadows of the implements go in and out of the eyeball. It only took about 15-20 minutes. An anesthesiologist has an IV ready with instant sedatives to be used if the BP or nerves kick up but I didn't need anything so I just got up and walked out of the OR and had a cup of coffee within minutes - and I could see the cream floating in the cup with both eyes!. The really strong dilation medicine lasts for about 30-36 hours so the first night and following morning are weird but not bad at all.
There is one slightly negative thing about the Symfony lens. The construction of this circular lens (which is about 6mm in diam) is such that there are multiple, progressively wider diameter, embedded annuli (separated by microns) that allow for various distances of vision by having these microscopic, annular rings transmit numerous, different foci to the retina. Because these molded annuli have relatively "hard" edges from one diameter out to the next, there is an abrupt "edge transition" that also gets transmitted to the retina from these ever-wider-diameter, sequential annuli. Because of this, there will be microscopic, concentric "halos" that appear around bright lights but you can only detect anything at night or with a really dark background in a dark room while looking directly at a dim light (like a night light). I was warned about this effect but didn't find any images on-line as to what it actually looked like.
After my sight calmed down a day or so after surgery, I didn't notice these halos and thought the glare from bright lights at night was just that: glare which I'd been seeing for decades anyway when looking right at a bright light. BTW, this is only at night or in a dark room, not when there is any ambient backlight visible such as daylight or lamps. Even in a well-lit room at night, they aren't visible. So, I purposely tried to find some halos by squinting and concentrating on trying to find them. I finally recognized very slight, concentric rings around a bright light when the night sky is really dark. They seem more pronounced with orange-ish light like certain street lamps rather than white light. But, when I don't look directly at any bright light (and why would I normally, anyway?), it just looks like a bit of undefined glare that seems to be what I've normally seen all my life when looking at a bright light (OK, maybe 10-15% worse). People told me that it would affect my night driving because of the "halo effect". If I don’t look directly at oncoming headlights, it's business as usual and I haven't noticed any detriment at all. Just don't stare at the headlights!! (Why would I, anyway?). Driving at night has been no problem at all. Even if I look at the headlights, it's more of a glare problem, anyway, and not a halo effect which gets overpowered by the high intensity glare, especially from these new LED headlights.
It's all in how much negative aspect the owner of the lens wants to make out of it. Some people complain and moan about the halo effect and want to make it their center of focus by concentrating on it while others just ignore it and look at it as a byproduct of restored vision. Nothing is perfect and for every positive, there's usually some form of negative tradeoff. Personally, I'd do it again without hesitation if I had to. Can't believe the colors that pop out now. Didn't realize how bad things had gotten over the past 3 years or so."
