Doc says I require multifocal lens - I'm not so sure

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Hi, I live in Thailand and will seek treatment at a for profit, private hospital. I do not have insurance. Many of these hospitals have excellent facilites and doctors, but also many over test and over treat, simply to run up the bill.

First guy I went to says I *require* multifocal lens - POD F (MIOL). The explanation as to why I *require* it was vague. Does anyone know if indeed in some cases monfocal is not a good option?

Thanks.

 

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  • Posted

    I had a cararact done with just over a year ago. I did learn about multofocal lens but felt that they were comparitively recent and not everyone is happy with them. I had a standard lens that matched the contact lens that I used to use in that eye. I use a contact lens in the other eye and they matched perfectly. Now I just use reading glasses for close up work. I am sure someone is trying to charge for a more expensive option and I would not go for it. Hope that helps. I know Thailand very well so don't blame them for trying!

    I am sure that there is no way you would require them. Keep it simple is my opinion and you could go and get another opinion?

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  • Posted

    A multifocal isn't "required" for anyone, its always merely optional. What lens you get depends on your finances (since all "premium" lenses cost more) and your visual needs, how much you care about avoiding the need to wear correction.  Some of us who always needed correction (as I did  all my adult life before surgery) like the idea of not needing it much anymore for a change, while others don't mind it. Aside from convenience, if there is ever an emergency like a home fire,  I won't need to worry about whether I had contacts or glasses.

     

     The POD F is the Finevision trifocal which provides better intermediate and near vision than a monofocal lens would. The tradeoff is added expense, and an increased risk of problematic halos at night, and reduced vision in dim light (due to the fact that the light is split into 3 different focal points: distance, intermediate and near). Unfortunately some people get problematic halos even with a monofocal, no lens yet is perfect, but the risk is higher with a trifocal. Most people are happy with them. There are other trifocals on the market, including the new Alcon  Panoptix which was recently approved in Europe, I don't know about Thailand, and the only article I'd seen giving details on it suggests it might be a slight improvement on the existing ones, a bit better intermediate. 

    In my case a bit over a year ago I actually traveled from the US to Europe to get a new lens which still isn't  approved here, the Symfony lens which isn't a multifocal but a new class of "extended depth of focus lens".  Since I had my surgery at age 52, I decided I'd have a few decades to live with the result so it was worth some more effort. I was diagnosed at age 49 with a problem cataract, and gave up waiting for the US to approve a trifocal, and by then the Symfony had come out and I got that instead of a trifocal.  

    The Symfony has a risk of problems like halos that is comparable to a monofocal (though some people get them even with a monofocal, no lens is yet perfect), and contrast sensitivity (low light vision) comparable to a good monofocal.  It typically provides good distance&intermediate vision, and a decent chance of good near, a majority don't need reading glasses but some do. I have almost 20/15 distance vision, and 20/25 at my best near. Unfortunately at the time I didn't get micro-monovision (setting one eye slightly nearer, but not enough to impact stereopsis much) which might provide slightly more near. On average the studies show the trifocal has better really close up vision and the Symfony is better at intermediate. 

    The Crystalens, labeled an accommodating lens (though there is debate over whether that is how it works) also has low risk of halos and provides good distance with likelihood of good intermediate, and a bit higher risk of neading reading glasses for near than the Symfony, but  a minority only get similar results to a monofocal (I've not seen a good figure, I've seen guesses by some docs of 10-15% but I hadn't hunted for an accurate study based  figure), and there is a slightly higher risk of some complications (like something called z-syndrome, which is rarer with the newest model and perhaps not a concern).

    The problem with a monofocal is that if both eyes are set for distance, most people need reading glasses both for intermediate distance for a computer and for near (or progressive glasses to handle both, or multifocal contacts). A tiny minority can do some reading without correction, but that isn't something to count on since the vast majority can't.  It is possible to use monovision with monofocals to get more near, which many people are very happy with.  That sets  one eye to focus best at distance, and one eye to focus at intermediate or near. Most people adapt well to monovision, but how much varies with the person. Ideally they'd have people test it with contact lenses before their cataracts get to bad, but most don't. In my case when I hit presbyopia I wore contact lenses set for monovision at first, but then later on switched to multifocal contact lenses which I prefered.  I discovered that suddenly the world seemed more 3D closeup, since when using monovision I was mostly using one eye for near and that had reduced steropsis, 3d perception. Many people may not notice or care. The fact that I liked multifocal contacts   led me to initially figure I'd risk a multifocal (and then went for the Symfony when it came out).  

    Monovision likely doesn't cut down on intermediate steropsis much, but full monovision (say -1.75D) might a bit.   I appreciate the fact that with the Symfony when I'm hiking/running on a rocky/icy trail that I have good 3D perception of the trail ahead of me and where I need to place a foot. I don't know if monovision would have reduced that.  There are some studies suggesting in the elderly that there may be some slightly increased risk of falls with monovision, and falls can be a problem when people get older. I also figured that this way if I ever have some eye health problem in one eye, I'd still have a decent range of vision with the other without glasses. I figure micro-monovision of perhaps -0.5D or -0.75D might be something I'd risk, perhaps a laser enhancement sometime.

     

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    • Posted

      Hi, 

      Thank you for the detailed report on the various lenses. I have a further consult scheduled with this doctor in a few days, and that has already cleared a few questions, raised a few others, and clarified yet others. BTW, I don't mind wearing reading classes for computer and books, even different ones for each.. been doing that for years.. But also I only drive at night rarely, so that is not a major factor either.

      I did find references on the Internet saying that presbyopia requires multifocal. Your post suggests that is not so. Anyway it is something I will discuss further with him, and also he did not mention anything in his diagnosis about presbyopia. His current recommendation is POD F (MIOL).  Maybe age is a factor also. I am 74, so yeah, falls are definitely a concern. That could easily result in a one way trip to the hospital here. 

      I'm also trying to arrange for a 2nd opinion elsewhere.

      Thanks again. Let me know if you have any further thoughts about this.

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    • Posted

      I should add that due to the extra costs, the vast majority of people get monofocal lenses. Some surgeons also don't like any risk at all that a patient will have problems, so they avoid multifocals since they don't want to deal with patients complaining of halos, even though the vast majority are happy with the lenses, there is a tiny percentage that do have lens exchanges. Many surgeons think the Symfony is the breakthrough lens that will lead far more patients to get a premium lens since the risk of problems seems to be fairly comparable to a monofocal based on studies so far. It is a fairly new lens though so there is always the chance as with anything new that a problem they haven't seen will crop up, but it seems the odds are it'd be rare since many people have gotten the lens.

      ​Presbyopia is the age related loss of accommodation,  loss of ability to see near, which at 74 of course you have already been through and need different correction for near than for far.  (or only need glasses for near if you don't need them for far).  Or at least most do, some tiny minority of lucky folks your age can still see near. When someone gets a monofocal IOL, it is like the presbyopia of someone elderly, they lose all accommodation no matter what their age is. (though some lenses like the Crystalens claim to accommodate a little bit to give more near).  Using multifocal contact lenses is one approach to dealing with presbyopia, as is using contact lenses set for monovision, which is why I had experience with the issues before I had a problem cataract.  Those who don't wear contact lenses before they have cataracts usually unfortunately don't get to try out the options like that, it  is a shame doctors don't encourge people who don't usually wear contacts to try a short test of contact lenses before they get cataracts to be prepared. 

      Age isn't much of  a factor. I had no idea of your age, many who post online are younger than typical cataract patients. Those of us who are younger than the typical cataract patient can expect on average to live with the results a few more decades than those in their mid seventies so the investment may be more worthwhile (and often those who are younger are more active and so the visual needs are different).   There is also a need to neural adapt to a multifocal lens, for the low level part of your brain that deals with vision to get used to choosing the best image. Although people can adapt at any age, the vast majority of people adapt well to a multifocal,  but  the brain changes as we get older and is  more adaptable in younger patients so if anything there is a slightly higher risk of issues with older patients, but likely nothing to be concerned about. There is at least some risk patients won't like multifocals.

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  • Posted

    Turns out to have been a miscommunication from a nurse. While  natually pushing the more expensive option, he says mon lens is fine.

    In case anyone is interested, the cost from this hospital (Thailand)  is $2,100 for monofocal, $3,000 for multifocal. One eye.I will go for monofocal.

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    • Posted

      Is your doctor in Bangkok?  if so can you recommend?  I also want to have this surgery.  Thank you
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    • Posted

      Hi, Bangkok is not convenient for me but that would be your best bet. There are literally a dozen or more hospitals you could choose from. 

      I chose my guy on the basis of price, convenience, CV and consultation.He says he has done 2,000 of these. Of course I can't actually recommend him - haven't had the operation yet! :-). but compared to my one hospital stay in my native Canada, I'd chose any of these hospitals over it. Doctor is more important than the hospital, IMO. 

       Let me know if you have any other questions.

      Emis Moderator comment: I have removed product/company names as we do not allow repeated posting of these in the forums. If users wish to exchange these details please use the Private Message service.

      http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

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  • Posted

    We can't mention a hospital name here? Seems like a policy that should be rethought. :-(
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    • Posted

      Looks l ike it.  It's a pity as I think that the doctor who performs the surgery is probably more important than the method chosen.  Anyway thank you so much for your input.
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