Cataract plus very high prescription - which implants would you recommend
Posted , 6 users are following.
Hi all,
I have cataracts in both eyes and am also with extremely high prescription (-18 and -19). My ophthalmologist sent me to a cataract surgeon. The appointment is at the end of the month and meanwhile I started looking for more information about different type of implants. Thankfully the topic has been discussed a lot, but that also makes everything very overwhelming.
I understand that my situation is very rare (given the high prescription). I've never had glasses, only contacts, but even they can't correct my vision at 20/20 obviously. I am not a driver and don't want to be, if that's important.
I would appreciate any input as to what kind of implants should I consider, or what kind of questions should I be asking at the appointment. I am very anxious just thinking about it...
(I'm in Toronto, Canada, in case there is someone who underwent a procedure here).
Thank you so much in advance!
0 likes, 25 replies
RonAKA flower2016
Edited
One thing to consider is that your eyeglass prescription has to correct for errors in the lens of your eye as well as errors in the cornea. Because the natural lens is removed in cataract surgery and is replaced with an IOL, the IOL only has to correct for errors in your cornea. Not an eye doctor, but I suspect the IOL ranges available will deal with your cornea errors. For example the AcrySof IQ Monofocal lens I believe goes up to -34 D for power. It is probably the most common lens used in North America. However, the power required in the IOL is not the same as the power required for an eyeglass. The first step in getting an evaluation is a surface topographical measurement of your cornea. That will tell you what power you actually need with your natural lens gone, and if it needs to correct for astigmatism or not.
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At this point I would be thinking about whether your want a monofocal correction, typically for distance, and needing reading glasses to read. Or, if you want to be able to read a computer or book without eyeglasses. Those options are available but at a higher cost, not covered by healthcare. And, they do come with some visual issues that need to be considered.
I recall that "Chris" here is from Toronto and will be able to give you a better idea what to expect in Ontario. I recall that an aspheric lens will cost you a bit more than what health care will cover. A toric lens wil cost more, and the lenses that let your get computer or book reading ability will be substantially more than that.
flower2016 RonAKA
Posted
Thank you so much for your reply!
Since I was never able to see well, I would prefer the IOL to correct for both near and far vision, if that's possible. Cost is not an issue compared to the freedom of being able to see (in my case).
I'm curious to find out where Chris did his surgery and who was his surgeon.
Chris53317 flower2016
Edited
My surgery was done at Bochner Eye Institute and I highly recommend them.
Unlike you I was never able to wear contacts as my eyes were too dry, and I think my pre-surgery prescriptions were in the -14 to -15 range. Reports are that you must stop wearing your contacts for a few weeks before the measurements of you eyes. As appointments are hard to get check with the surgeon well in advance of your appointment to avoid delays.
At the appointment you are asked to fill out a questionaire to help them assess your lifestyle and vision needs. After this multiple measurements are taken. Then the surgeon meets you with to review the findings. Finally, you are then passed over on to a consultant who will discuss options, timings, and costs. You do not have to make a decision at this point.
If the surgeon indicates that you are a good candidate for trifocals then you should seriously consider that. That is what I did, and am happy with the results. This forum has lots of information on alternatives and views on this topic. You will have many months and maybe even a year to digest all of this before you have to make your final decision.
flower2016 Chris53317
Posted
Thank you so much for your reply! I'm glad to hear that you're happy with the final result. It's always good to read about positive experience.
I'm also referred to Bochner, with Dr. Gilani. I'm just about to e-mail them asking if I have to be without contacts for a certain period of time. If this is the case, I don't really know how I will be able to do it, I'm completely helpless without them.
Sue.An2 flower2016
Edited
Flower2016 - it is very important you do bot wear contacts for 2 weeks prior to the mapping if your eyes. can you order an inexpensive pair if glasses online to cope? Inaccurate readings can lead to power calculations being off. Better 2 weeks of feeling helpless than the rest of your life feeling that way.
RonAKA Sue.An2
Edited
I agree. Getting a good topographical measurement of the needed power for the cornea is essential to getting the correct power IOL. I believe some use two different methods to measure, and some use three to get the most accurate reading. I'm sure surgeon experience/ability plays a large part in it too.
Sue.An2 RonAKA
Edited
Agree surgeon selection is so important. Unfortunately where I live very few options but I am glad he was skilled and outcome was good. I heard recently he retired. He was in his early 50s like me when he did my surgery 3 years ago. Maybe he wanted freedom 55 - just hope wasn't his health - especially with pandemic going on. Many battle mental health and anxiety.
RonAKA flower2016
Edited
We are not allowed to post links in this forum, but if you google the title of the article below you should be able to find it. It is written by an optometrist for optometrists so it is a bit technical. When reading articles that use technical terms I don't know the meaning of, I just click and highlight the term, then right click and do a google search for the word. I find that helpful in getting through more technical articles.
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This article covers what the author considers premium lenses, which are Toric ones for astigmatism, and presbyopia for distance and close vision. In my view the term premium does not mean they are higher quality lenses. The are more specialized lenses for particular purposes, and they carry a higher price. But they are not side effect free, so it is important to determine what your priorities are for outcomes, and what side effects you are willing to put up with. In any case here is the article title and author. I would suggest that the more knowledgeable you are about the lens choices the better your first consultation will be. Also be prepared that each surgeon likely has their favourite lenses, and not all surgeons may even want to use "premium" lenses. So, you may have to see more than one surgeon to be sure you understand what the choices are.
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Picking a Premium IOL For Every Patient Victoria Roan, OD
rwbil flower2016
Edited
First and most important I would make sure you are choosing a top Ophthalmologist and even then go to a few for additional opinions. Not only did I do that I emailed several others that have written articles and are some of the Ophthalmologist in the US. IMHO one way to find top Ophthalmologist is to find the Ophthalmologist who are doing clinical trials. They are only going to use Top Doctors so their trials come out as good as possible.
Before I say anything else I do not know which IOL work for your particular condition, so these comments are general in nature.
I would highly recommend you research various IOL beforehand. Some doctors do not even tell their patients about all the premium IOLs available. So you need to go in knowledgeable about your options. And this includes bein knowledgeable about equipment, such as laser and if they will use a machine to verify IOL power in real time during cataract surgery such as the Optiwave Refractive Analysis machine. Many times they do not get the power calculation correct.
If you want to go the safest route possible then the standard Monofocal is probably the way to go. But there are options that might be better than just the standard Monofocal. First a high recognized doctor I emailed recommeded the Light Adjustable lens. This way if the Doctor is off and does not hit Plano (assuming that is your goal) your power can be adjusted.
The next step up from Monofocal are these new Monofocal Plus lens. These lens do not split the lights so theoretically the glare and halos should not be any worse than a standard Monofocal IOL. Tecnis Eyhance and IQ Vivity fall into this category. These lens will provide clear or clearer intermediate vision than a Monofocal.
I wish this site allowed links. But there are lots of articles on these new lens. You can search for the Dawn of the Monofocal "Plus" for one article I just read.
If you are willing to accept more dysphotopsias then my recommendation would be the new Tencis Symfony Plus or one of the Trifocals (In US there is only one FDA approved Trifocal).The Trifocal will provide you the best overall close, intermediate and close vision.
Again there are many articles on all these lens so lots of research to do.
In full disclosure I have on Tecnis Low Add MF in one eye and still need to get my other eye done and am leaning towards the Tecnis Symfony Plus.
soks rwbil
Posted
hi rwbil
why are you leaning symfony plus?
symfony plus is not yet available anywhere.
did u mean tecnis synergy?
rwbil soks
Posted
No Symfony Plus. The Dr. who did my first cataract surgery is one of the Drs. that did trials with Symfony Plus so he probably gets first access and I am in no hurry.
Why Symfony Plus. Well that is a good question and frankly I continue to do my research and hope for a Cataract Cure instead of new IOL. I remember when they talked about photobleaching of human lenses, but that seems to have disappeared. And then there are the next gen adaptive IOLs, but who knows when they will be released or there long term sustainability.
Here is my situation and everyone is different.
I have the Tecnis MF in one eye which gives me close and distance. I don't want another lens that splits the light. I cannot drive at night for long periods. In fact if going on vacation I have to stop driving after an hour in the dark, just to stressful.
So my hope is the balancing of those 2 lens will provide the best option.
So Symphony will hopefully help with the intermediate so I will be better at playing tennis and provide for more light for night driving.
A lot of people don't even know you can compare 2 lens say the Symfony and the Panoptix Trifocal and the results can vary depending on if it is daytime or nightime.
So again my hope is my brain will figure out the best image and provide that one. So it is about the balance of those 2 lens.
I thought synergy combines both MF and EDOF so more light splitting.
soks rwbil
Posted
whats the problem with night driving?
i have symfony and it is difficult for me to drive especially because of increased glare due to PCO. i do not know if it will be get better after YAG.
what do you mean by:
"A lot of people don't even know you can compare 2 lens say the Symfony and the Panoptix Trifocal and the results can vary depending on if it is daytime or nightime."
RonAKA rwbil
Posted
"I continue to do my research and hope for a Cataract Cure instead of new IOL. I remember when they talked about photobleaching of human lenses, but that seems to have disappeared."
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That sounds like a Trump Clorox solution for COVID! Not sure I would hold my breath for that kind of solution. The lens not only becomes cloudy, it also changes shape, and effective power, and it keeps changing. Gold mine for optometrists...
RonAKA rwbil
Posted
My thoughts would be to consider a monofocal in the second eye, assuming you can read well with your Tecnis MF, or a non diffractive EDOF lens like the Vivity. The Vivity would fill in the intermediate for you to help with keeping your eye on the ball for tennis. The image below is just a simulation by Alcon, and could be advertising "fake news", but it shows quite an impressive difference between the Symfony and Vivity. The plane Jane AcrySof IQ remains the very best however in avoiding night time driving glare.
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Sue.An2 rwbil
Posted
rwbil I sincerely doubt there are any solutions on the horizon to curd cataracts. more like wishful thinking. Thinking your multifocal is more a bi-focal and that leaves intermediate vision a bit wanting. A symfony would fix that and providing your MF le s provided decent distance vision even a monofocal targeted for intermediate would do fine and there would be better contrast. You will lose some contrast with any lens but the monofocal less would provide better than MF you have Symfony or tri-focal lens
rwbil soks
Posted
I can definitely tell the light is being split as I need to bring in extra light for many things. It is ridiculous you can not have links here but TMX Academy compared Sympfony and Panopitix and talked about this issue. Just search on youtube for , "Comparative analysis Tecnis Symfony vs AcrySof Panoptix : clinical outcomes"
I first notice just how much darker things were walking down a flight of stairs at night. I scratched my good eye and then wam bam I could not see the stairs. So I did the cover one eye think and there is a BIG difference.
Part of my nighttime driving might be the fact I only have one IOL and one eye with cataracts, but I can not tell when someone slams on their breaks if they are 10 feet in front of me or 100 feet. It is just stressful. Yes there are halos but that does not really bother me. In fact some times I see star burst and think that is "COOL", so again not a big bother.
I also can get glare but again has not bothered me, but maybe the glare would be worse with Symfony, I don't know.
I just think out of the available options combing Symfony Plus with my existing Tecnis MF is the best options I have seen so far. But I am still researching.
rwbil RonAKA
Posted
It was a real news story showing rabbit eyes before and after. You can search it for yourself.
rwbil RonAKA
Posted
I am looking into that, but just how much intermediate vision you get is not that clear. I think only time will tell as more Drs. report their results.
And I have not come across a doctor with experience with every IOL there expecially these newer one to make comparison.
I would love to see a study with Tecnis MF in one eye and Vivity or Eyhance in the other. If it exist I have not seen it.
rwbil Sue.An2
Posted
I am not interested in Monofocal or monovision. I am sure it is not the same, but I did monovision with contact and I absolutely hated it. I realized from that I have to have GREAT distance vision.
I am sure micro monovision with IOLs would work, but I would only do that using something like Symphony to get a bit more close vision on one IOL and again I would only do micro monovision.
soks rwbil
Posted
if you go that route then u should get eyhance to match the manufacturers.
RonAKA rwbil
Posted
Try a search for this presentation. That is where the image I posted came from. It is written by Alcon, so of course has a bias. Based on my research so far I think Vivity will give you intermediate vision, but good reading is questionable. It is rated at about 1.5 D. I think Eyhance is similar but perhaps 1.0 D.
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Clinical Outcomes of a Novel Non-Diffractive Extended Vision IOL CATHLEEN MCCABE, MD
rwbil RonAKA
Posted
I have read different article and people posting here. It is just not clear to me how well one's IV will be. If I knew 100% sure I would be able to see 20/20 12" and out, then yea no brainer. But that does not appear to be the case. Maybe in time I will find a Dr. who has a lot of experience implanting both Symfony and Vivity and can see what his patients experience has been.
One trick is finding a Dr. who is not affiliated with either company.
RonAKA rwbil
Posted
My view is that Symfony and Vivity are very different lenses for different objectives. The details are in the fine print.
Sue.An2 rwbil
Posted
i only suggested monofocal for that eye based on your comment about contrast. We would all like to have it all but this decision on cataract surgery and IOL selection is about choosing and prioritizing preferences. A monofocal will give you a better contrast - especially at night than other IOLs but you can only have clarity at one distance. Sometimes 2 but that is particular to a person's eye. Some say smaller pupils is reason for that (I don't know).
I do drive at night with my Symfony lenses. There is some loss in contrast at night but not enough where I wouldn't notice a car braking in front of me. I do manage stairs and finding the bathroom in the middle of the night without turning on lights. Is it possible that refraction error causes some of the issues you experience? How long ago was your MF implanted? If you have not had a YAG are you able to exchange that IOL?
rwbil Sue.An2
Edited
I think I am at or pretty close to Plano, so no refractive error. My problem might be that I am mostly just seeing out of one eye as the other eye's cataract is pretty bad.
I do not plan on getting a monofocal. That just brings up so many concerns. I read that if the 2 visions to the brain get too far apart that can cause some problems. And I read some articles where people mixed the MF with Symphony and the patient had good results. Also the New Symphony Plus is "Supposed" to give better close up vision and less visual disturbances.
I got the MF right after they were FDA approved. It was in the days before Symfony was approved in the US. I did think about going to Europe to get Symfony, but weighed the pros and cons and decided against it.
No YAG, but I have no plans to do an explant. I do fine with the MF, just want to make sure the next IOL will complement the weak spots.