What are the Pros and Cons of a Monofocal vs. Multifocal Lens?

September 2, 2011

I am 51 yrs old and have a cataract in my L eye that needs to be removed; R eye is still “baby cataract”. Highly myopic (L -9, R -10) with slight astigmatism in L (1.0). Length of eyes approx 26.3mm at exam. Since age 16 have been told that due to lattice I am at risk for detached retina, though annual exams note no change, no holes, only thinning. Have been wearing hard or gas perm contacts since age 16. Have used readers or bifocal glasses since age 39.

Since I will have to have one eye done to reduce blurriness and hopefully also reduce eye strain headaches from trying to focus through the blur, I am having both done. Can’t imagine the migraine I would get upon taking off glasses or removing contacts and having one eye at 20/20 and the other uncorrected.

Decision time – toric lens in one eye with “regular” IOL in R? Or should I go with multifocal lens in both?

Concerns – want best possible vision (don’t we all), and am concerned that I might have to sacrifice some long and mid range vision with the multifocal to get the near vision.

With the increased risk of retinal detachment, I am nervous, and want to make the right decision the first time – not interested in an “if it doesn’t work for me I can get it removed” approach.

Doc is experienced, knows my history well, has said previously she wouldn’t touch me for LASIK due to lattice and dry eyes, but now the cataract HAS to come out. Says my risk of retinal detachment is double, but that is still <1%. If I want the multifocal she said she can do the surgical adjustment for the astigmatism.

How do I know what my vision would be after surgery with Multifocal vs monofocal so that I can decide whether the degradation is too much?




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8 Responses to “What are the Pros and Cons of a Monofocal vs. Multifocal Lens?”

  • Rebecca

    I need cataract surgery in right eye only. I also have astigmatism. The Dr. has recommended the TruLign multi focal lens for me. Any comments from people who have this lens. Pro/ Cons?

  • Bethany

    I’ve had very poor vision for most of my life. They do not make contacts strong enough for me, so I wear the strongest lenses available with glasses on top of them. I’ve been told that I am not a candidate for laser surgery, but that I am a good candidate for lens replacement surgery.

    Have any of you had experience with the multi lens implants? Were they hard to get used to? I’ve never even had bifolcals so I’m a little apprehensive.

    Thank you!!

  • ari

    trulign comes in 1.25, 2.00 and 2.75. powers for astigmatism, so use trulign if your astig is in that range.
    synchrony/tetraflex–who knows? we’ll see!

  • Nelson

    Dr. Ari Weitzner,
    Have you had any success implanting the Trulign (Crystalens Toric) IOLs? At what diopter does a Toric lens become a valid alternative?
    I am looking at having Cataract surgery, probably in the coming year. Age 74, male, not a big fan of glare and halos.
    When (If) the Synchrony and/or the Tetraflex become available in the US, how will they compare with the Crystalens?

  • ari

    there is no treatment for crao. sorry

  • Derek MacDonald

    Multi-focal CLs may have given you a bit of an idea about likely multi-focal IOL vision, but if you are looking for the best possible acuity, you’re likely best with single vision distance IOL, surgical correction (limbal relaxing incision) of the fairly low astigmatism, and reading glasses when required. I most definitely agree with the recommendation of regular peripheral retinal assessments after your surgery, although it sounds like your current OMD has a solid handle on things.

  • Elise Leval

    I wish this lady well, and am sure she will make the right decisions.

    I continue on my search for someone who can tell me whether my own eye condition can be corrected. About three months ago I was stricken with
    Central Retinal Artery Occlusion in the left eye. It left me totally blind in the left eye. I need to know whether this condition has ever been reversed and sight restored. Can anyone help?

    Elise Leval (340) 774-0222

  • ari

    cant show you pre-op what the vision will be like. all we can say is that the vast majority like it. very small number are so unhappy they demand that the multifocal be removed.

    if you want best possible quality vision, then multifocal is bad idea. multifocal is a compromise. crystalens has no compromise, but many require reading glasses–its more ideal for intermediate vision.

    risk of retinal detachment very small. irrelevant at this point, really, as the cataract must come out. be sure to have the retina checked soon after the surgery by a retina specialist.

    your surgeon sounds like h/she knows what she is doing. But get a second opinion if it will reassure you.