Confused About IOL Choices
Posted , 15 users are following.
Hi, everybody. I apologize in advance for the Great Wall of Text. I know it can be seen from outer space, cataracts or no, but I really need your help and hope you will forgive me.
I am 48 and have been in glasses since age 20. I have significant astigmatism in the right eye and have been wearing prescription reading glasses for the last 10 years. 3 years ago my prescription was updated, but I couldn't see well. A month later I had my eyes checked again, and the prescription was very different. Investigation showed fast-progressing posterior cataract. Today I have 20/200 vision in the cataract eye and pretty good vision in left eye with glasses. The cataract eye is rife with light disturbances at night. I can see 5 or more of each light-related image (such as road reflectors and reflective signs), and all lights are J-shaped "halos" with glare everywhere. The left eye is fine, but the doctor says he sees a "blister" which he deems the beginning of another cataract and says I will need to have it replaced in 3 years.
For now, he offered me 3 choices:
- AcrySof IQ IOL (basic monofocal lens)
- AcrySof IQ Toric IOL (monofocal astigmatism-correcting lens)
- AcrySof IQ ReSTOR Toric IOL +3.0 D or +2.5 D with Activefocus Optical Design (multifocal astigmatism-correcting lens)
I don't know much about these options, and they didn't tell me. He said there are no bad choices, but he did highlight the "premium" lenses. The difference presented was:
- Basic monofocal: Wear glasses all of the time (and "end up with the eye of a 70 year old" after he removes my lens--what does that even mean?)
- Toric monofocal: Only wear reading glasses
- Toric multifocal: Never wear glasses again
NOTHING was mentioned about light phenomena at night or pros and cons/tradeoffs. Just that it would "be a shame" to put 48-year-old eyes in the basic monofocal IOL, and if I have the funds I should consider a premium IOL. The scheduler said that whatever I put in my right eye I will need to put in my left later. They wanted to schedule me right then and there. I said no and went home to research.
It took me 3 days to even find a forum where real people talk about their real experiences, blood, guts, halos, and all. I've read articles galore and still feel I am no closer to understanding or making such a HUGE choice. I sure would appreciate your help.
A little more about my personality:
- I don't mind wearing glasses--it's kind of my style.
- Although I dislike it, I would rather have 2 pairs of glasses and switch back and forth, than have progressive spectacles, because the bother and risk of not neuro-adapting scares me (however, my brain has done a pretty good job of adapting to the 20/200 cataract eye...but still, I would not want to be this way for life).
- One of the things I dislike the most about having a cataract is the light disturbances.
- I do a lot of reading, writing, and crafting (knitting, sewing, stained glass cutting, etc.)
- I also like target shooting but had to quit, because I site with my cataract eye.
- One thing I do dislike about wearing glasses is that it makes me lose depth perception (and the frames do appear in my peripheral, which gets in the way of the sense of my visual field being "the whole wide world").
- I try to be thorough and am type A.
Some Questions
- Are nighttime, light-related visual disturbances (NLVD) eliminated with basic monofocals?
- If you have basic monofocals, do you achieve crystal clear day and night vision with glasses?
- Is there a period of neuroadapting with basic monovision?
- In comparison, do toric monofocals have the same or worse risk of NLVD?
- Do toric monofocals have the same risk of NLVD as toric multifocals?
- When doctors say "basic monofocal" are they both set for distance?
- What is the consequence for setting both for distance rather than one for distance and one for near (a scary prospect for me since it results in "mismatched" vision, which I'm mot enjoying now).
- If you no longer need glasses because of multifocal implants, does it restore the depth perception lost by wearing glasses?
- What is the "diamond-eye" effect of multifocals that I read about, which makes others uncomfortable when they interact with people implanted with them? What is this, and does anyone here experience it?
- Are there other questions I should be asking or considerations I should be pondering?
Many, MANY thanks!
❤
0 likes, 171 replies
gmag21 AshMac
Posted
I personally would go see another doctor. The notion that multifocals are better or guarantee "glasses free" vision just doesn't sit right with me. These doctors frequently try to push premium lenses because they can make more $$ off them. If i were you I would be highly considering a monofocal lense since you are okay with wearing glasses and don't particularly enjoy light disturbances. It's not to say light disturbances are 100% impossible with monofocals but its much less likely than a multifocal. Multifocals literally have to split the incoming light rays in order to produce vision at multiple focus points (so it makes sense why light problems are more likely). I have a multifocal lense and considering exchanging it to a monofocal but its a risky surgery. I would also look into the B&L Softport AO 3 piece silicone monofocal IOL if you're really worried about light problems (this lense is known to "do no harm" and my specialist doctor is recommending it for me since I have so many issues with my current multifocal).
AshMac gmag21
Posted
I agree about doctors. How long have you had your multifocal lens? And which one do you have? I don't know how to get the Softport. I think the dr. I saw only implants AcrySof. And his practice is the only one in town with ORA. Weird thing: my regular (non-surgeon) eye doc advised the basic, non-premium, nonxtoric lens but recommended I absolutely pay the extra $400 for ORA. The eye surgeon said they only use ORA for premium lenses (toric or multifocals). Does that sound right? How has the Softport lense gained its "do no harm" reputation? Is there data I can look at?
cazms53 AshMac
Posted
I am 6 weeks out from my second cataract surgery with the first completed 11 weeks ago. I had to meet with a retinal specialist prior to surgery because of my high myopia and he advised me not to go with a multifocal lens. In addition, I had read a lot on these forums and wasn't willing to risk the side effects that can go along with them. I chose a toric monofocal because my surgeon said someone "with my personality type" would not be happy if my astigmatism was not corrected. My right eye (non dominant) was purposely undercorrected at -1 to give me better mid-range distance and my left, dominant eye was targeted for better distance vision. A week after my second surgery, I was seeing 20/20 with my left eye and with both eyes together and 20/30 with my right eye. Five weeks later, I am not sure where they have settled but I do not need glasses for driving or for any of the activities that require mid-range vision. I do need glasses for reading and any close work (I am also a sewer/crafter so this was a concern of mine) but 2.0 over-the-counter readers work very well. I had read about the "diamond eye" effect and, even though it is only cosmetic, I knew it would make me self-conscious so I wanted to avoid it, if possible. During my research, this effect seemed to be attributed to the AcroSof brand. I asked my surgeon if we could go with a different brand so he used the Tecnis Toric. Overall, I am happy with my results although I sometimes experience this sense of blur with my left eye. Part of this I attribute to my floaters, which I had prior to surgery, and I think eye dryness may also contribute. Good luck with whatever you decide! It's a big decision knowing that you will live with the results for many years.
AshMac cazms53
Posted
Thank you for your reply. What about your "personality type" made him say that?
Hudsongrl cazms53
Posted
hi there! I have been very nearsighted my entire life. had cataract surgery on my right eye in February. i chose a monofical toric . i ended up slightly undercorrected and still need a contact lens for distance in that eye. no surgeon should guarantee no glasses after surgery. that being said if you have astigmatism I'd recommend getting the toric lens. you will not be happy if you leave your astigmatism uncorrected.
a bigger issue for you...and me...is with only one eye done, you cannot wear glasses after surgery because the difference in refraction between the 2 eyes will give you double vision. so, i still wear contacts in my surgery eye and my non surgery eye. one eye is -4.50 and other eye is -.50. i have no halos at night, but i did have some ghosting initially until my eyes started working together.
another option you have is set your surgical eye IOL to a prescription close to your left eye. in other words,if left eye is -3.0 leave right eye -3.0 too. then you can wear glasses after surgery with no issues. if you set your right eye to plano glasses are likely out. sorry this was so long. but there are lots of scenarios to cover here. do NOT be rushed into surgery until you get every question answered and you are comfortable. my doctor did not e
AshMac Hudsongrl
Posted
Hi. Thanks so much for your reply. I have been farsighted since 20; nearsightedness happened in the last decade. so I have never had good distance without spectacles. I have severe astigmatism. Did your doctor use ORA for your operation? RE: glasses...this outfit told me that after the implant in the right eye, no matter what lens I choose, I will have to wear glasses until the left eye is done years down the road. they said I will just need a clear lens for the IOL eye. That actually sounds a little crazy to me now from what actual patients are saying. But maybe they are referring to your second option. IDK. The place I go to is definitely an eye mill, but the only one with ORA. What does "plano" mean?
cazms53 AshMac
Posted
I think because I researched and asked lots of questions, he considered me to be a perfectionist.
Hudsongrl AshMac
Posted
hello again...what is ORA? plano is when they correct to 20/20 vision and no glasses or contacts are needed. do you know what your current glasses prescription is in both eyes now? I had them put a blank lens in my old glasses on the surgical eye side and the other non surgical eye in glasses is like -6.50. i get terrible double vision if inattempt tomwear them. the magnification is so different the brain cannot meld the images. they did tell me this would happen. i was hoping it wouldn't as i miss my glasses to wear in the evenings watching tv.
Sue.An2 Hudsongrl
Posted
Hi Hudsongrl - ORA System™Technology is a sophisticated device used to provide real time measurements of the patient’s eye during cataract surgery. Usually used for premium lenses and there is a surcharge if cataract surgeon uses it.
Hudsongrl Sue.An2
Posted
thanks...new term for me. ipaid $1500 extra for my toric lens but have no idea if new technology was used.
Sue.An2 Hudsongrl
Posted
We don't yet have that machine at the hospital where I had my surgery done. I think Vancouver Toronto and Montreal all have it. Definitely not available in all Canadian provinces.
RubySlippers AshMac
Posted
I had the ORA and it worked for me. No more contacts ever and I did not pay for extra lense, just the ones that come with the normal cateract removel. The ORA lets them get a better prescription after the cateract is removed and then they will pick out the correct prescription lense that they have in the room. They have all the prescription lense in the operation room. I was wide awake when the procedure was done and the doctor told me when he was doing the ORA machine and then I heard him tell the assistant in the room what prescription lense he needed. I really think that helped me to not wear contacts anymore.My RX was -5.50 in both eyes before the cataract removal. Thanks Ruby
Hudsongrl RubySlippers
Posted
that's great. i too was awake and heard a lens power discussion. next appt. will ask if I had ORA.
AshMac RubySlippers
Posted
My dr won't do ORA for regular monofocals, and I don't know if he performs refractive surgery. Betcha anything he won't do it for free even if he does. Your doc seems pretty awesome!
AshMac Hudsongrl
Posted
I have never worn contacts. I definitely don’t want to get my eye done and then have to wear a contact in it. Is that the only way I will be able to see (if I don’t go with option 2)? No one ever mentioned this to me. I’m so confused. I was told I will have to get the other eye done in 3 years, so eventually they will both have lenses implanted. Re: option 2: with a toric implant and really bad astigmatism in one eye I’m not sure this can be done, right? How much of a difference can the eyes handle before the brain just won’t put up with it? PS If I get a toric lens it will cost me $1,800.
Hudsongrl AshMac
Posted
getting one eye done is more of an issue than i thought. my doc said the eyes can't handle much more than 2.0 diopters difference. so, if you did plano in your surgical eye and your other eye is -2.0 you could still wear glasses. much more you will probably have double vision. that would force you to do other eye that doesn't need it yet.
i have 4 diopters difference now and my glasses are useless. i am wearing my contacts way too many hours cuz i used to take them out around 7 pm and put my glasses on.
let's hope you will only have 2.0 diopters difference.
AshMac Hudsongrl
Posted
Thanks so much for this. Are you happy overall? From where you are standing today, do you wish you had picked a different lens?
Hudsongrl AshMac
Posted
other than being slightly undercorrected the toric lens is good. no issues with comfort, halos, etc. it is an AcrySOFT Toric.