Cataract Surgery - Below Age 40 - Best IOL Choice?

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All,

I wanted to start a thread dedicated to discussion about IOL selection for individuals below age 40. I'm curious if anyone who meets this criteria can comment about what specific IOL they selected and how the results were?

A little about me - I just turned 30 and currently trying to decide which IOL to go with in my dominant right eye. I'm leaning towards a monofocal IOL set for near/intermediate (I use my phone & computer almost all day). I'm curious if anyone around this age range has implanted a monofocal lens set for near/intermediate with excellent results? I'm worried about losing my natural accommodation and also having to potentially deal with edge glare due to larger pupils at age 30.

The lens I'm considering is the B&L LI61AO Sofport. It's a 6mm aspheric monofocal IOL made of silicone material (less prone to glare compared to acrylic) and it has square edges to prevent PCO.

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6 Replies

  • Edited

    Just to give us some background, what is driving the need for an IOL? Is it just your right eye only, or both eyes that will need an IOL?

    • Posted

      My right eye has a developing cataract that will need to be addressed soon (starting to cause issues). My left eye already has a multifocal IOL from 2007 but the glare/halos are nearly disabling so I want to go with monofocal on my dominant right eye.

  • Edited

    1. Setting the eyes for intermediate is a good idea. More diopters areneeded for near vision so setting for near gives limited range. For example -2.5 gives me great near vision from 8 inches to 12 inches only. setting both eyes to intermediate would give you better near due to binocular summation. Common approach with this set up to be glasses free is to set one for intermediate and other for distance. you will get binocular summation for intermediate and near with this approach as well.
    2. Edge glare is a real problem. I experience it. Softport may not necessarily prevent it.
    3. PCO will happen for younger folks.
    4. I believe the tradeoff is between accommodation by choosing a multifocal vs nighttime artifact.
  • Posted

    Hi there!

    This is a little long but I'm a bit starved for social contact, haha.

    Sorry you're dealing with cataracts at age 30. Are they bilateral? How far along?

    I started with symptoms age 45, very active and outdoorsy (sailor and other things). Also lots of computer work though. Got IOLs put in age 50 finally once blindness was no longer correctable with contacts. I had not lost all my accommodation but the central cataracts made me even more nearsighted than I was at baseline (which was mild).

    I have a few thoughts/experiences .

    1. It's great you're doing your own deciding because all ophthalmologists have a preference and they all differ. So knowing that YOU made the choice of pros and cons is what will help your satisfaction in the end.

    2. I got a Tecnis ZKB00 multifocal in my non dominant eye first on the ophtho's recommendation. I did minimal research. Turned out to have lots of halos and ghost images at night. Also very startling to have my non-dominant eye suddenly see farther than my dominant eye. Like when you interlace your fingers the wrong way, but far more disturbing neurologically. It generated unease that took some months to adjust to (and which got better when I corrected my dominant eye for distance).

    3. With the multifocal, near (17") and far were both clear. Intermediate was a little blurry which I noticed mostly in a museum.

    4. After five months of adjustment Γ nd deciding what to do, I got the lens you're considering in my dominant eye, set for far. It is much better, but does have some haze around stoplights. One ophtho told me it's because my retina is still young.

    That eye ended up with a small astigmatism too that creates a little ghost around marquee signs so my dysphotopsia issues are not really fixed. Time just wears one down and sometimes we have to accept one fault in order to get another benefit.

    1. Both lenses cause starbursts with headlights and bright white lights, about equally. I have heard that from many IOL patients so I expect that is just sort of standard.

    2. The quality of the silicone image is more natural than the acrylic (Tecnis) image. The acrylic is very sharp and a little startling. That eye did end up a bit farsighted so could be that affects it too. The color of the silicone is a tiny bit richer too. That may be due to contrast loss in the multifocal. With both eyes, the brain merges color and I don't notice.

    On first gut reaction, when I compare eye to eye, I prefer the silicone image quality.

    1. The industry-funded studies about multifocals, in my opinion, probably underestimate the numbers of patients who see halos, but I haven't looked at them carefully. Different ophthos told me different things because they each have their preference.

    2. So the B&L is probably the best quality monofocal out there (three different ophthos told me that). It would be a great choice.

    3. Whether you want to see near or far principally is a personal choice.

    I do stare at a screen a lot now and since I only have one near eye, it fatigues. The monofocal eye gives me a good amount of intermediate which helps for the computer: I got lucky but apparently it's a good percentage of folks who do.

    1. I know one person who got monovision and loves it . Another who is a huge reader surprised me by getting both eyes for distance. th

    I sometimes wish my near were more effortless or without ghost images, but I am definitely happier not needing correction when outdoors, looking at sunsets or birds or city skylines . Wearing light cheaters for extended computer work is not so inconvenient....just store them with the computer like you do the power cord and no biggy. I can make out most labels and can use my phone to shine a light on it in a pinch. Usually I don't need to magnify.

    1. Losing accommodation does suck and at age 30 you would totally feel that. It feels odd, like your eyes keep trying to move something (the muscles) to make the image clear. It took some time and some mindfulness to tell my brain and face to stop trying to see it better. I probably still squint some.

    There are other youngsters who have had IOlLs implanted and they could tell you even better what the accommodation loss is like. I had already lost some and my same-age friends are all dealing with it so we feel like dorks but what can you do. Now I only need cheaters for prolonged reading which is better than some with natural lenses.

    1. From the little I've read/heard, there's basically no preventing PCO so maybe don't get your hopes up on that. The ophthos I met with didn't seem to think it was a big consideration.

    2. Overall, this was a way bigger change than just getting a new contact lens prescription. It's permanent and that had a different feeling for me. Others seem to just take it in stride so maybe I'm over-sensitive (perhaps) or overly perfectionist (haha definitely).

    All that said, when I think about how blind I was becoming, there's no doubt that the operation is miraculous. What we can do for our bodies sometimes is beyond belief.

    • Posted

      Wow thanks for all the details! Very interesting that you get some haze in the B&L eye. I was told the Sofport is the best lens for preventing dysphotopsias so this is why I'm leaning towards it. I didn't mention this in my original post but I've already had cataract surgery on my non-dominant left eye back in 2007. I have horrible ghosting & glare from the multifocal IOL so I'm definitely looking for a lens that can help balance out these unwanted images.

    • Posted

      Ah yes I'm seeing that now and am putting it together from other posts you made a while back. πŸ˜ƒ

      I saw four or five opthos in between eyes because I was so stressed about my multifocal eye that I wanted to make absolutely sure that I was doing the right thing for the second eye.

      They all told me to get a monofocal for distance in the dominant eye.

      The halos and ghosting are worse at distance (yours are too, right?) and so the best chance to eradicate them is to give your dominant eye distance vision.

      Before my second dominant IOL, I had a very nearsighted dominant eye due to the cataract. Debbie on this forum suggested I put a contact lens in it and WOW, it just made everything better. Not that the halos totally disappeared but the unease from the dominant/non-dominant switch was relieved and I felt I would be able to survive. That's when I realized that having the non-dominant done first creates that issue.

      Can you correct your dominant eye now with a contact lens? If so, definitely try that.

      A good percentage (30%?) of people get intermediate vision with their monofocal. Mine settled in at -.25 although I think that returned to plano after a few months. The intermediate I get with that monofocal fills in the weak range of the multifocal. That helps in grocery stores and museums. So I understand your desire to get intermediate but you may not need it and could be sacrificing halo relief if you don't go for distance.

      If I close my multifocal eye, my monofocal eye is blurry even for my phone text when my arm is totally straight. But even that blurry image contributes to the brain input and so with both eyes I see acceptably. The quality of the blurriness (monofocal alone) is such that I can still make out words that I recognize. I couldn't make out words of a language I don't speak, or those long chemical names in food ingredients.

      Since the brain is now used to taking input from my non-dominant eye, and since that

      eye settled at +.25, the halos have not disappeared. But what's better is the overall feeling, the anxiety is gone. Even though when I'm reading close I'm using my non-dominant predominantly, that doesn't generate anxiety.

      When I read a lot, I use my multifocal eye more, and then when I get outside at night, the ghosting and halos are worse because my brain has to switch back. I've noticed that with the lockdown....not being out at night for a month. So I can see that the brain conforms to what we ask of it. Use it or lose it. In a sense that is good: it means that if I want to see better, I have to get the heck outdoors and look at the horizon and landscapes and lovely sky! πŸ˜ƒ

      [Aside: Frankly, now the dermatologists are saying blue light from screens can cause skin damage. I'm pretty convinced that staring at screens causes eye damage and it just hasn't been long enough for science to definitively conclude that. So I do wonder about what other eye structures (retina!) might get damaged now that the lens is artificial. I use dark mode or invert colors often...]

      I know two people who got Lasik and now have had halos for decades. They never mentioned them until I told them my problem. My mother, who had IOLs put in 38 years ago (monovision), said if she looks hard at stoplights she saw a haze around them. She had just never noticed.

      The rare times I use readers, I prefer ones that have one lens removed so that the multifocal eye has to work also: it keeps the brain balance. But I do use them rarely...only after hours on the laptop. I don't use them for my phone.

      I would assess your multifocal eye's near ability, and strongly consider your monofocal be set for distance.

      The B&L is a great choice. I am confident that what I got in that eye is the best I could have gotten. The image quality is delicious. II bet you'll find that once you fix your dominant eye, things will feel much better for you and you can get on with your life with more ease.

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