Cataract at 35 - which lens to choice?
Posted , 10 users are following.
Hello, I am 35 years old without health problems and without vision problems until yesterday.
I was recently diagnosed with cataracts in my right eye and need immediate surgery. My left eye is healthy, with vision 10/10.
The two ophthalmic surgeons I visited suggested multifocal lenses rather than monofocal. In fact, one of them asked me to choose between Alcon PanOptix Lens and AcrySof IQ Vivity. What scares me, apart from the procedure of syrgery, is the fact that my doctors have made it clear that I will lose some ability and quality of my sight and I have to choose whether I am more interested in having near or far vision.
They are also concerned about the fact that I will have to get used to a different way and function of vision in each of my eyes, as my left will work with its natural lens and my right with the additional multifocal.
Due to my age (35) and work, my vision is the most valuable ...
I am very confused and disappointed, as I feel that after the syrgery I will not see better but worse (today even the eye with the cataract has vision 8/10) ...
I would be grateful if you could answer some of my questions below:
- Does anyone have experience with these two lenses Alcon PanOptix Lens and AcrySof IQ Vivity?
-How does one see with the use of these lenses (I mean how it differs from normal vision), the doctors told me that I will see multiple images and in the process of months my brain will get used to it!!
- Does anyone have an multifocal len in one eye and a natural len in the other? What is his /her experience with this?
Thanks a lot
0 likes, 48 replies
Sue.An2 DG12345
Edited
DG12345
I am not of the opinion that this cataract surgery is urgent. It certainly is isn't life threatening.
I would be very wary of any surgeon rushing me into a decision. There is a lot to consider and pros and cons no matter which lens you chose. The IOLs being suggested ate premium lenses and the cost of cataract surgery isn't cheap. Unfortunately greed can play a factor in their rushing you to a decision.
Can your vision still be corrected with glasses or contact lenses? Usually one considers the surgery when vision can no longer be corrected. And in the meantime you should research surgeons and lenses. Take your time and get several consults. Fortunately your eye without cataracts will compensate and offer near vision should you decide on a monofocal lens. monofocal lenses are usually covered by insurance when you have a cataract that requires surgery.
DG12345 Sue.An2
Posted
@Sue.An2 Thanks for your reply
I am also surprised by the pressure of the doctors to undergo surgery immediately, as I can see blurred by the eye with the cataract but with the help of my other eye which is healthy I have no problem in daily activities such as reading, driving etc. and in fact without the use of glasses.
In terms of cost it is indeed high. But as I am 35 years old and I need my eyesight for many more years, I care about the best possible result even if it costs.
I feel despair because what is proposed to me as a solution is worse than my current vision ...
Sue.An2 DG12345
Edited
I live in Canada so our cataract surgeries are covered if the cataract has advanced to point of needing surgery - usually that is when one cannot pass vision test to drive. If you opt to have the surgery earlier here it is your own expense. Not sure what it is like in Greece.
But as others say cataract isn't life threatening or urgent. Best thing you can do is read up on it and your options. There is no perfect lens and there is a tradeoff to make. I was diagnosed at 52 and my eyesight had deteriorated to the point surgery was necessary. I did choose an EDOF lens Symfony. most situations I do not need glasses. Just for super fine print but i do need good lighting. If i am in a dimly lit restaurant I use the flashlight on my iphone to read the menu. There is a bit less contrast sensitivity than with a monifocal lens. I also see huge concentric circles around light sources like streetlights.For some people these are intolerable . If you drive a lot at night you may not want a lens like this.
If there are other good surgeons you may want to see a few armed with some questions.
wishing you all the best
rwbil DG12345
Posted
I have a MF in one eye and my natural lens in the other.
But first why do you need surgery immediately if you are seeing 8/10 in the cataract eye and 10/10 in the other eye. I know I am a procrastinator as it was years from the day I found out I had a cataract to getting actual surgery and even now that my other eye needs cataract surgery I am procrastinting.
My point is unless you really need immediate surgery, I would suggest to take some time and read up on your option, because all options in Cataract surgery come with tradeoffs and only you can determine which tradeoff is best for you. For example, personally I don’t want either one of those lens you mentioned for my 2nd eye.
Second if an Ophthalmologist said, “choose between Alcon PanOptix Lens and AcrySof IQ Vivity.” I would probably run out the door.
Based on you IOL options I am taking a wild ass guess you are in America and only looking for FDA approved lens.
Before I talk about my experience with MF, I will start out with IMHO the IOL options from least risky to most risky.
1)Monofocal – True and Tried and what most people get. On comment on distance vision. Some people I think are confused by that term. If you look at the defocus curve on a monofocal you should get pretty good vision down to about 2’. As you get in closer; vision quality drops off rapidly.
2)Light Adjustment Lens (LAL) – Many doctors miss the refractive mark (1 Diopter or more) and this lens lets you adjust it after surgery. And from what I read you might be able to adjust it more than once, so you can nail plano or whatever your goal is.
3)Crystalens - You hardly hear about this IOL, but it is supposed to provide excellent distance (no contrast loss) and maybe it will adopt and provide some intermediate and close vision.
4)The “New” EDOF Refractive IOLs (Tecnis Eyhance and IQ Vivity). They don’t give a lot of EDOF. I think the IQ Vivity provides for an extra -0.5D, but that can be an extra line. But these are “NEW” IOLs and so comes the Early Adopter Risk. And personally, I believe there has to be some tradeoff, and am guessing it is contrast sensitivity.
5)Defractive IOLs - Whether be Trifocal or EDOF, they all come with tradeoffs including dysphotopsias.
One of my biggest beefs is Ophthalmologist are not 100% honest with patients about dysphotopsias when pushing defractive IOLs. You should make sure he shows you simulation of what to expect. I am going to attach a photo simulating dysphotopsias. My dysphotopsias fall somewhere between what they show as mild and moderate. If you are not willing to accept this risk, DON’T consider a defractive IOL.
Here is some potential bad news for you and you need to realize it ahead of time. Because you are young and had such good vision prior to surgery, your expectations will probably be a lot higher than what my expectations were as my vision was so bad for so long before surgery.
I have the Tecnis Low Add MF +2.75 in my left eye and my natural lens in my right eye. This means I get dysphotopsias, but the trade-off is worth it to me as I get Functional Close vision. What that means is I can see a menu in a restaurant or read a label at a grocery store. And yea if I find the right sweet spot I can read an article, but to do any serious reading I need a good light and readers. At this point my right eye cataract has gotten so bad I pretty much just see out of the left eye so I am worse than you are.
I want to comment on the statement, “my brain will get used to it!”
I read someone else explanation of what really happens and it was so much better than how I would have explained it I will paste their words and it also applies to defractive EDOF IOLs:
“To be clear, multifocal visual disturbances never "go away". You can't change physics. A more accurate thing to say is that the brain habituates to them. The visual disturbances are still there and if you THINK about it you will see then exactly the same as you always have. It's just that if your DON'T think about it you don't notice it. You brain learns to "filter them out". But they're still there.”
So you will have 2 different lenses. In general you brain will neural adopt and choice the best image presented from the 2 lens, but you can get Depth perception can be impacted by having a difference in the 2 lens.
There is no 1 perfect lens selection for everyone. You really need to take you time and think about what activities are most important to you.
And before I forget it, PLEASE make sure you are using a highly regarding Ophthalmologist. Have they been involved in clinical trials and written papers. Do they have a lot of experience with this particular IOL.
As for me I don’t want another light splitting IOL, as they will effect vision in dim light. I am waiting for Tecnis Synergy (not FDA Approved) or Tecnis Symfony Plus (FDA Approved but not commercially available). The Synergy, hands down, has the best defocus curve I have seen for any IOL. Of course, Real-World results after 100K Plus people have it implanted might tell a different story, so that is what I am waiting to see.
DG12345 rwbil
Posted
@rwbil Thank you very much for the answer and the time you spend to explain it all.
I live in Greece, here the following distinction is made between lenses: monofocals for the elderly who are familiar with presbyopia and the use of glasses and multifocals for young people and those who want to get rid of the use of glasses.
The two doctors I saw are considered very good, however I will get other opinions ... but no one did an analysis with simulations on how I will see after the surgery and I do not know if there is a doctor here who can do such a thing!!
They told me about halos around the lights with the use of multifocal lenses and difficulty in driving at night, but good near and far vision without the use of glasses. In this forum, however, I find that it is not exactly like that ...
They are completely negative in the use of a monofocal len as there will be a great contrast to the visual ability of my other eye with natural len. Also, they consider that my cataract is hereditary and in the coming years it will affect my other eye and I will have to put the same lens that I will choose now in my other eye in the future. So if I choose single focus I will be obliged to wear glasses for all my activities for the rest of my life.
The truth is that I have never use glasses, I always had good vision and I do not know how I would feel not to see well without glasses. I think this will make me feel claustrophobic!
Ideally I would like to see both near and far and use glasses for reading or driving, without other side effects, but such a lens tells me it does not exist !!
Guest DG12345
Edited
It sounds like the reason they are anti-monofocal is because you are young and your eyes can still focus for close distance. So switching to a monofocal will be a big lifestyle adjustment. That said, monofocals will give you the best vision quality. It just won't be as functional.. i.e. no ability to focus up close / need glasses / progressives. Older people don't usually mind this because they've probably already been using readers and/or progressives for years or decades. So they know what to expect.
The bottom line is there is only so much light coming into the eye. And IOLs today are just static pieces of plastic. They don't have the ability to focus / change shape. So in order to give you more focus range they have to rely on tricks.
The trick of a multifocal is to split the light to make 3 separate images that are in focus. Your brain then learns which one to use at any given time. Since a multifocal is splitting the light it might only use 40% of the light for distance (for instance). Obviously you can't get the same image quality if you're only using 40% of the light versus 100% of the light (like a monofocal). This light splitting also causes glare, halos and starbursts at night. I believe that's caused by the stray light that gets lost in the splitting process. Most people get used to it and don't mind though. The slightly less sharp vision and less contrast and halos are tradeoff's younger people are often willing to make for the benefit of more functional vision without having to mess with readers all the time (which can be difficult if you have an active lifestyle).
The trick of the new monofocal-plus IOLs like Eyhance and Vivity is to stretch the light out rather than split it. Again though you're not focusing 100% of the light in one spot so there are still tradeoffs. With Vivity the tradeoff is contrast. With Eyhance I think the tradeoff is just very slightly less sharpness. Very slight. But it's contrast is as good as a mono. But it's extension of focus is pretty minimal. It might only give you another 8 inches of closer vision (so you can see clear maybe from 2.5 feet vs. 3 feet).
As for cost, a monofocal should be free through insurance or public health if you have universal healthcare where you live. For anything other than a monofocal you'd typically being going to a private clinic and paying a fair bit of money.
Personally I'm a perfectionist. But I'm also young(ish) at 52. And extremely active (yoga, hiking, running, skating). So the perfectionist in me wants the highest quality, high contrast, super sharp vision of a mono... but the young active me is worried about the pain of having to carry readers everywhere and the pain of putting then on/off/on/off every 2 seconds when you're shopping or looking for the right key on your keychain or checking your phone / dashboard / price label / etc. Progressives would work or bifocals but you'd have to wear them all the time to get rid of the annoyance of constant switching of glasses on and off for day to day living. And I feel like it might be weird to wear glasses all the time when you have perfect distance vision without them. So for ME personally I think the happy medium may be the Vivity or Eyhance. I personally would not consider a multifocal.
Oh ONE more thing. If you have or ever develop any kind of ocular pathology (glaucoma for instance or macular degeneration) multifocals would be contraindicated. The idea being that, if you already have less than perfect eyes, using a lens that gives you less than perfect image quality (more functional but poorer quality) is a bad idea.
rwbil DG12345
Posted
By simulation I just meant they show you simulated photos of realistic halos. I forgot to attach the image before.
“They are completely negative in the use of a monofocal len as there will be a great contrast to the visual ability of my other eye with natural len.”
The vast majority of the people in the world get monofocal IOLs. I basically only see out of 1 eye and am surviving. As I was older I already suffered from Presbyopia, so in your case you will notice a bigger difference in the 2 IOLs. At first after my left eye cataract surgery I would do the cover up the right eye left eye thing and I would notice differences. And there were lots of differences, too many to list. Even how a light source would come and hit objects would make a difference. One of the big differences was vision in dim light. I was surprised how much a MF makes things darker. But having said all that I was and am happy with the MF overall.
“I will have to put the same lens that I will choose now in my other eye in the future. So if I choose single focus I will be obliged to wear glasses for all my activities for the rest of my life.”
I find these statements disturbing to put it mildly and disagree with both. There are so many options including monovision. Ron will probably chime in on that option as he has done self-experiments using contacts to simulate the effect. I am a big believer on only doing 1 eye and evaluating the results, because you very much might want to do a mix and match IOL. You absolutely do not have to get the same IOL in both eyes and mix and match is done to give you the best overall vision. I plan to do Mix and Match. I have no plans to get the same outdated MF in my other eye. You want to evaluate the weakness of the first eye and then try to compensate for them in the second. But if you are thrilled with the first eye then by all means get the same lens in the second eye.
BTW if you are in Greece is the Tecnis Synergy not available there? I know how medicine works is different in Greece, but I would look for a TOP Ophthalmologist who has implanted many Tecnis Synergy, IQ Vivity and PanOptics and get their assessment, which should include both the pros and cons. By the way I have self-interest here as I am thinking about the Synergy IOL so want to know what you find out. From what I read that IOL will provide you the best vision at all distance, but I am guessing that comes at the cost of increased dysphotopsias. So if you get too many dysphotopsias that lens might be a great mix and match with Symfony Plus.
You cannot do links here, so here are some videos to look up to get some information on the Tecnis Synergy.
2)On Vimeo Search for, “Tecnis Synergy IOL: The Newest Member of the Tecnis Family – Dr. Chang Presentation”
DG12345 Guest
Posted
Sincerely thank you for the detailed information !!!
I feel very lucky to have found this forum on time! The good and well-known doctors with private ophthalmology clinics in Greece are trained well but rarely spent the time to give you all this information. They are like stars, there are so many people waiting after you ...
By the way vivity will be available in my country after March 16
Guest DG12345
Edited
I would just add to the other replies saying, unless there's something we don't know, with one perfect eye and the other actually not that bad yet, there is no need for surgery right now. In fact depending on how it progresses you may not need surgery for years. I'd wait until driving starts to become an issue. By that time something like the Juvene (the "holy grail" of IOLs) may be available.
DG12345 Guest
Posted
@david98963 Thanks for your answer.
This is what I would like, the surgery to be done when my vision will be so bad that a len will make me feel that cataract is evolving rapidly and the surgery will become more difficult after months ...
DG12345
Posted
@david98963
Some words are missing from my answer so I repeat it here:
Τhanks for your advice.
This is what I would like: the surgery to be done in the future, when my vision will be so bad due to cataract, that i will have the impression that the len improves mi vision and not now. However the doctors claim that my cataract is getting worse rapidly and the surgery will become more difficult after a few months.
rwbil Guest
Posted
"By that time something like the Juvene (the "holy grail" of IOLs) may be available."
Been watching that one and at best IMHO it is years away. I would just be happy if they worked on the modular part where that base makes PCO unlikely and makes it easy to change IOLs.
Guest rwbil
Posted
They company is saying 2023 but who knows
Guest DG12345
Posted
Ok I'm NOT A DOCTOR but if the surgeon is saying it's progressing rapidly then I assume you've been seeing this doctor for a while? There would be no way to judge progression from a single visit. Progression implies a history of visits.
The bottom line is, it's a cataract. It's not life threatening. It's elective surgery. it's completely up to you when to have it done. Usually the decision point is when people start to notice that driving is difficult.
The place you live will have vision requirements for driving. That's worth looking into. Where I live you need ONE eye (just one) that's at least 20/40 or better (so 7/10 I think on your scale). And you have one perfect and one 20/32.
As for progression, it varies. In some people the cataracts get bad quickly. In others it take years. The surgery used to be so invasive that they used to wait until you were almost blind. Now they do it even on people who do NOT have cataracts (for presbyopia).
Personally I would get a second opinion. Again I'm not a doctor but from what you've told us I don't really see what the rush is. It is true that if you wait until the cataract gets really bad it can be more difficult to remove because it's harder, but I think it would have to be really far gone for that to be any kind of consideration at all.
rwbil Guest
Edited
Will bet you a steak dinner that lens is not FDA approved in 2023. LOL!!
Guest rwbil
Posted
Oh I'm sure. That info was provided "for what it's worth". LOL. That said she is in Europe I think? And it seems like all new IOL's are first available in Europe, then Canada, then the USA. Now sure why that is. But yah 2023 is probably highly optimistic. That's what the company is saying... but yah. And even then, it's such a radically new approach that I imagine it may take awhile before clinics even want to use it.