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
ss1985 DG12345
Posted
I just turned 36 last month and am facing the same choice, which lens and what am I really getting into. Currently, my vision last tested was OD 20/30 Glare 20/100; OS 20/25 -2 Glare 20/70. It is hard to see a lot of things when light is involved. I have everything on the computer in dark mode/high contrast and use very low lighting at work. This works perfect and text is not blurry at all in these modes. However, it isn't always offered for everything. Bright lights and black text on white paper is just blurry to me from the light. I can read it in very low lighting. I have not had glasses before, except readers that I had to basically beg for to use in some instances. Especially, when my eyes are tired the extra magnification seems to help. I drive with an anti-glare fishing pair of sunglasses all the time. typically day or night.
I have read many of the posts here and am more confused at what the best decision is for me. The surgeon recommends PanOptix if I can live with halos. That is a majority if my issue now and after reading posts here seems like a terrible Idea!!
Vivity was the second recommendation.
Vivity was offered as the option for best range of vision for an active lifestyle. I am confused if I should just go with the mono lenses offered or if the difference with a Vivity would be that different. I had a friend who is older by 10 years who has 20/20 and just got the mono-focal and says his vision did not change just that he does not have the glare. I asked a previous doctor if I chose mono-focal if I would be sacrificing my vision and see worse with a mono-focal lens and was told I absolutely would. I do not want to lose good vision, I just want the glare and halos gone. I still want to be able to put on make up. go to the gun range, read a label in a bright ass grocery store! I am the sole provider for 2 teenagers so the ability to drive day or night, is a big deal. I'm confused the reality of mono lens vs Vivity or something that will cost thousands. If the difference isn't much, might as well not spend the money? This is where I am at with my choice between the two....
Guest ss1985
Edited
The problem is that everyone's outcome is different and there's no way to know until you have the surgery done. My dad got monofocals and he can read his watch from less than a foot away! No problem. Maybe he ended up a little too undercorrected. Maybe he ended up with some unintentional monovision. Maybe his cornea shape helps. Who knows. But what the data tells us is that his result is in the 10% range of people (i.e. 90% of people do NOT get this result with a monofocal... not even close).
The best you can probably reliably hope for with a monofocal (but again your milage may vary... could be better or worse) is good visual acuity from 3 feet out (and blurry for anything closer than 3 feet). In reality that might be 6 feet for some people and 2 feet for others... who knows. Either way you use readers, bifocals or progressives to deal with that.
With something like the PanOptix (multifocal) most people will get pretty good vision at 12", 24" and distance. But there can be slightly blurry gaps in-between. And you will lose some contrast. And you'll have halos. But you have a very good chance of almost never needed glasses for anything.
With Vivity (mono-plus... not really a true EDOF) trial data shows you should get pretty good vision down to 24" and no gaps and no halos but you lose some contrast sensitivity... a little bit more than you lose even with one of the new Multifocals. And you will need glasses for really close up (reading, pill bottles, etc.)
So take in all the information, consider any pre-existing eye conditions (the doctor would test for that), and consider your lifestyle and personality and make a decision and hope for the best. I suspect the vast majority of people are happy with whatever they choose. But they're not the one's posting on the internet. You're only going to find unhappy people posting on the internet. Trials find that well over 90% of people are happy with a multifocal and would do it again. But there is always the risk that you're one of the few people that hates the halos and never gets used to them.
Personality plays a big role. If you're a perfectionist / type-A you may not do well with a multifocal. Vivity or Eyhance might be a good middle ground that will give you good enough close vision for all those little day-to-day things without the hassle of putting glasses on/off/on/off every 10 minutes (or progressives) but if you're sitting down for a couple hours to read or whatever you won't mind using readers.
rwbil ss1985
Posted
One important point is even if you look at a defocus curve for your IOL, the 1 sigma deviation can be quite a bit and not everyone will even fall into that category. So as others have said results will vary.
Reading your concerns I think you might be a good candidate for the light adjustable lens (LAL). Do both your eyes have cataracts or just one.
With the LAL you can have the IOL adjusted after surgery to hit the Plano Mark in your dominate eye. If your other eye does not have a cataract you can use contacts to simulate monovision and see if that works for you and what power level is best.
Then you can get the LAL in the non-dominate eye and nail the monovision power level. Or if a little more gutsy go for the IQ vivity in the non-dominate eye and do -.75D monovision.
This is the least risky option and it should give you most of what you are looking for. I think this will give you great distance and at least functional close. To do serious close-up reading you need readers.
RonAKA DG12345
Edited
As others have said, I would not rush into cataract surgery with 10/10 and 8/10 vision. In North America that would be called 20/20 and 20/25. Lots of people do not have that kind of vision even with glasses. Because you are so young, I would put off getting IOL's as long as possible. You will get older and the lenses available may get better over time.
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Presbyopia correcting lenses have pros and cons. They offer a wider depth of vision but often at the cost of visual side effects. Of the more commonly available and newest of the lenses available here I would rate them in this order:
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Tecnis Eyhance
Alcon AcrySof Vivity IQ
Tecnis Symfony
Alcon PanOptix
Tecnis Synergy
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As you go down the list the lenses offers more depth of focus but also a higher potential for visual artifacts.
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My thoughts with your vision still so good is that you should consider using contacts to simulate monovision to see if you like it. Monovision uses standard aspheric monofocal lenses but the non dominant eye is under corrected by about -1.25 D. Because your vision is so good, you may have to use a +D contact to achieve this difference. This eye then can be used for reading while the other eye is used for distance. Since you are so young, your eyes can probably still change focus, and it will not be a perfect simulation, but it will give you some idea what it is like. The advantage of using monofocal lenses is that you get the best quality of vision without the visual artifacts of the presbyopia lenses. Monovision gives you a functional vision across a wide range of distances.
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I have one eye with a monofocal IOL for distance and get 20/20 vision with it. I can see down to about a half a meter. My other eye has a mild cataract and I correct it with a contact lens to be -1.25 D. It actually works quite well and I almost never uses glasses unless I want to do some really close fine work. But, with the computer, watching TV or driving it is just fine.
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There is no problem with using an IOL in one eye and having the other eye natural. I see a difference when I close one eye or the other, but when they are both open the brain blends the images. The colour from the natural eye is more yellow due to the cataract, and is more dull. The IOL eye is amazingly bright and clear. Overall the image is much brighter and sharper than before when I had the bad cataract in one eye. There is no problem at all with using one natural eye and one IOL eye, especially with your very low refractive error difference. Since you are younger your natural eye will accommodate for distance and should let you read well.
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If I were you I would hold out as long as I could, and then go with a monofocal in the bad eye when you have to. You can probably wait longer for the second eye. And there is no real problem with having a different lens in each eye. About 25% of surgeons now use a different lens. The hope is to cover the weaknesses of one lens with the strengths of the other. In your case for example, you could go with a distance eye first in monofocal (hopefully your dominant eye), and then a Vivity or Symfony in the second eye for reading.
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Hope that helps some,
ss1985 RonAKA
Posted
I have seen two different doctors and they both did not recommend using two different lenses. I'm not really sure why other than because of my age. They did not seem to be very confident in Vivity, due to the lack of data or maybe their experience with it. I guess you are right, just hope for the best with whichever I choose. Unfortunately, I cannot wait much longer as driving is becoming more and more difficult each day. If I can have someone else drive me, I do. But options are limited and no public transportation in my area. I'm leaning towards Vivity and wonder if I just get my right eye done and see how that works before deciding to do the left eye. I often cover my right eye (worst cataract issue) and use my left eye to focus on what I am trying to read.
DG12345 RonAKA
Posted
Thank you very much for the informative answer.
Monofocal lens seems restrictive but a safe solution. What worries me is the absolute denial of all three doctors I have visited in the monofocal lens. Obviously I will see and other doctors.
RonAKA ss1985
Posted
I really do not see much wrong with using two different lenses especially if they are from the same manufacturer. A Vivity and a AcrySof IQ Monofocus are the same material from the same manufacturer. I have the AcrySof IQ Aspheric in one eye now and vision is excellent except for up close. I am considering either the same AcrySof lens but under corrected by -1.25 D, or alternately the Vivity under corrected by 0.75 D. In theory the Vivity would give me better distance vision with the second eye and about the same near vision.
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What you might want to consider is doing the non dominant eye with the Vivity at -0.75 D and see how you like it. If you like it then do the second eye with Vivity set for plano at distance. If you don't like it then you could do the second eye with the AcrySof IQ Monofocal lens.
RonAKA DG12345
Posted
I don't like to be cynical but I am sure they make a lot more money putting in a presbyopia lens than they do with a monofocal lens. My surgeon is kind of the opposite of the ones you have seen. My eye was done 4 months ago and the Vivity was not available then. However the PanOptix was, and my surgeon said that he would do it, but he really had trouble recommending it because he would not be prepared to have that lens in his own eyes. I found this article very helpful in deciding whether or not to consider monovision and how much under correction to use.
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Optimal Amount of Anisometropia for Pseudophakic Monovision Ken Hayashi, MD; Motoaki Yoshida, MD; Shin-ichi Manabe, MD; Hideyuki Hayashi, MD
Guest RonAKA
Edited
The private clinic I will be going to if I get a premium lens told me the Acrysof monofocal costs $200 and the Vivity costs $1450 (just the cost of the lens in the quote, not the entire procedure). I would guess they are pocketing a fair bit of markup on the Vivity.
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Not to hijack the thread RonAKA but I was amazed to read that you say you have good vision down to 50cm with your Alcon IQ Acrysof monofocal? Is that right? it that eye under-corrected? That's amazing.
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The more I read about people getting amazing close vision with monofocals (my Dad has Tecnis mono's and says he can read his watch from 9 inches away) the more I wonder if maybe I should just forget about the premium lenses.
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I guess the point with the premium lenses is just that your chances of getting good close up with them are statistically MUCH higher than with a mono. It can happen with a mono but you have to be among the very lucky few. And it's not meant to be a reversible surgery (it can be re-done but they don't like to do it). So no matter what you do there's some small risk that you won't like the outcome.
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Regarding surgeon IOL preferences... in Canada we have surgeons that work through the hospital with public healthcare and surgeons that work in private eye clinics. If you go to a doctor that works in the hospital through public heath they are biased towards monofocals. I suspect that's because that's the only option available for free through public health. You could theoretically pay more for a premium lens but with probably 99% of their patients just getting a mono and likely not even KNOWING about premium lenses, those surgeons may have limited experience with them or may have outdated opinions on them based on early designs that were not that great.
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In Canada you really have to go to a private clinic if you're interested in "premium" IOLs. Those surgeons will be more up-to-date with all the "latest and greatest" IOLs and have a lot more experience working with them. My point is, the differing opinions you get may just be due to their own biases, experience, public vs. private, etc. Ask 6 surgeons and I bet you'd get 6 different recommendations. Unless of course you have some kind of ocular pathology or you're an airline pilot or something in which case almost all surgeons would likely agree on monofocal.
Guest DG12345
Edited
That's a bit weird to be honest. In Canada and the US most doctors tend to stick to the "tried and true" monofocals. And in Canada you have to go out of your way (to a private clinic) to get a premium lens. Maybe it's a European thing? I think multifocal lenses are much more widely accepted there. Also they are probably considering that being so young you may end up very unhappy trying to adjust to the loss of accommodation (natural focus ability) that would come with a monofocal. But yes as far as image quality, sharpness, contrast, hitting the right refractive target, etc... monofocals are the lowest risk.
DG12345 Guest
Posted
In Greece in Public Hospitals you can only have monofocals lens. Insurance also covers a part of the cost only for monofocals lens (about 1/3 of the total cost). For premium lenses you should go to private clinics where the cost is around 2000 euros
RonAKA Guest
Edited
Yes, I can see down to about 0.5 meters with my monofocal IOL eye, AcrySof IQ Aspheric. I can read the 20/20 line with it, and about half the 20/15 line. My eyeglass prescription for it is 0.0 D spherical, and -0.75 D cylinder. The astigmatism probably does help me read a bit closer. That is equivalent to about -0.35 D spherical.
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The surgeon I went to is a teaching professor at the University of Alberta. I suspect he is quite up on the latest lenses. He operates out of the Eye Clinic at the Royal Alex hospital. He does toric lenses, but I was not a suitable candidate for them. We never did get to the point of discussing price on the premium lenses. He does consulting work for Alcon, but was also willing to do a Tecnis monofocal if I wanted it. The price is apparently $100 more, but our healthcare system pays for either.
Guest RonAKA
Posted
This is very encouraging. I actually think "monofocal" may be a bit of a misnomer because today's aspheric monofocals (Tecnis and Acrysof) both have a -.25D shift towards the centre. The Eyhance increases that to -.5D to give you an extra line. The point is, when I first started researching this I was under the impression that I'd be basically "blind" for anything within 6 feet! But it's not nearly that bad. I think most mono patients can probably count on seeing clearly down to 3 feet / 1 metre. Add a touch of under-correction (since they always aim on the myopic side) and some corneal luck and you could do quite well. Especially with something like Eyhance (I'm a little too risk-averse for the Vivity… the contrast sensitivity warning label scares me). The other thing to remember is you can still read at 20/40. It just not super sharp. If your goal is just good enough intermediate to function for day-to-day stuff like aisle shopping without glasses, mono or mono-plus is probably fine.
RonAKA Guest
Posted
I suspect there is a hair splitting difference between the Eyhance and Vivity. It does not seem possible for the Eyhance not to have some reduction in lower light contrast sensitivity.
Guest RonAKA
Edited
I've read that Eyhance contrast sensitivity is essentially identical to the Tecnis ZCBOO but it is profoundly difficult to compare apples to apples. Every trial shows different charts with different criteria etc.
RonAKA Guest
Posted
I believe the Eyhance uses variation in asphericity from the center of the lens to the edge to stretch the focus. Vivity appears to be doing the same thing, but with a very tiny step in the profile. Unfortunately when you stretch the focus I believe you lose contrast sensitivity. I suspect pretty much all presbyopia correcting lenses compromise contrast sensitivity to some degree.
robert80020 DG12345
Posted
Is the RxSIGHT light adjustable lens available to you?
DG12345 robert80020
Posted
This is the first time I have read about this light treatment. Unfortunately it is not available in Greece. Even the alcon vivity is considered something very new in my country and will be available after March 16, while I have read that in other countries it has been used for about a year!!!
RonAKA DG12345
Posted
The early reports of Vivity use I believe has been in Australia, Spain, and Italy. It was just recently approved in Canada.