Dr's recommending EDoF/MF IOL.I'm not yet convinced
Posted , 9 users are following.
I have Kaiser insurance so went to see an ophthalmologist in the network who confirmed my cataracts. He first asked me if I would consider monovision and when I replied negative immediately jumped to Panoptix as his recommendation. It was a short conversation and ended with the nurse informing me it would be 4 or 5 months before surgery and they would call me about a month out. They also told me to come back in 2 weeks for eye measurement and that I could not wear my contacts during those 2 weeks (wth?).
Understanding that I would have to pay for a premium lens anyway, I sought out another opinion outside the network with a Dr. that did my wife's lasik. It was a much more comprehensive and enjoyable experience. I spoke with the Dr. at length about my visual priorities which are in order:
1 Distance vision
2. Contrast sensitivity
3. Low light vision/night driving (lack of halos)
4. Mid-range vision
5. Near visiion
Interesting but besides the point, they measured my eyes right there and then and had no concerns about whether I had been wearing contact lenses or not (wtf?)
He confidently offered the Symfony lens as his recommendation. His reasoning was that my relative youth (55), good eye health other than the cataracts, and active lifestyle (triathlete) would be better served with an EDoF IOL. He felt that I would be able to adapt to the lens well, and claimed my distance vision and contrast sensitivity would be as good as a monofocal IOL. He did not seem too concerned with night driving or light aberrations. The delta in cost between the EDoF and monofocal IOLs was an eye-watering (pun intended) $9K. Honestly, the more I read about the drawbacks of EDoF/MF IOLs, and better than expected outcomes with monofocal IOLs, the less I'm convinced these recommendations are right for me. If any professionals are willing to share their expertise, or any patients to share their experiences, I would be most grateful. Thank you!
0 likes, 34 replies
charles94562
Posted
UPDATE: So went back to Kaiser for eye measurements and spoke with the aid for their head of ophthalmology. She set me up with a phone appointment with him and hopefully I'll get some better answers then. In the meantime I made an appointment for a third opinion with another private office. Did a lot more research before selecting a Dr. for a third opinion so feel like it should be fruitful. A few new questions have come from my continued research.
Thanks again everyone. I continue to follow the many great conversations on this site and have learned a lot from everyone.
RonAKA charles94562
Posted
My thoughts, and somewhat fading recollection is that there may be some benefit in laser assisted cataract surgery especially when using toric lenses for astigmatism. It may help get the lenses in the correct angular position. The correct angular position is critical in getting the most out of toric lenses. Probably the only downside is finding someone that has the equipment and skills to do it, and the potential additional cost.
As far as avoiding PCO, there certainly are some ways to help avoid it with lens material and design choices. Here is a graph of the risk of post operative YAG requirements based on lens material and edge design. This comes from a study suppored by Novartis (Alcon/AcrySof) so it may have some bias. That said, it seems to be somewhat consistent with other sources on the issue of PCO. The risk of 1 is assigned to AcrySof square edge material. Other materials are compared to this risk of 1. PMMA sharp edges have the lowest risk of PCO. However they are almost never used in North America as they are rigid and require a larger incision to put them in the eye. Silicone sharp edges are next lowest, but have other issues, one of which is that they are not that popular. The hydrophobic acrylic sharp edges shown in the graph, I believe are the Tecnis ones which are a slightly different acrylic material than the AcrySof, and have a higher risk of PCO.
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This sharp edge solution does not come without some down sides. One is a higher risk of dysphotopsia. I believe Alcon have made some changes to where the power of the lens is applied, and to the edge design to minimize this, but the risk is still there. Dysphotopsia is a higher risk with multifocal lenses though.
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Guest charles94562
Posted
About the laser thing - you will find mixed opinions about it, even among surgeons.
The clinic where I had surgeries done have the newest laser thing from Germany, and they offer laser assisted surgery for cataract surgery to those who wants it.
But my surgeon thinks it is a waste of money for the patient, he have found no advantages in real life, only in theory it sounds better - in his opinion.
He could easily have charged me extra for the laser stuff, but I chose no laser based on his experience.
Regarding pco my surgeon found that laser or no laser was equal in real life outcomes.
Pco is very common, you could say we all get pco, if we live long enough.
Pco is building up of new human tissue on the capsular bag on the backside of the iol, that makes it difficult for the light to get through to the retina.
When the iol is implanted, the surgeon makes a hole in the front part of the capsular bag, either by hand or with laser, so we never get any problems with the front part of the capsular bag.
But he leaves the back part of the capsular bag intact, because the vitreous in the eye is right on the other side of the capsular bag, and the surgeon does not want the vitreous to get inside the capsular bag during implant of the iol.
If and when new tissue builds up on the back side of the capsular bag, it can be treated quickly with yag laser, where the surgeon makes a hole in the back side of the capsular bag, equal to the hole in the front part of the capsular bag that was made during implant.
At the time where the yag laser is used to treat the pco, the human tissue will have secured the iol in place, and therefore at this stage it is much more safe to make the hole in the backside of the capsular bag, the secured iol will make sure the vitreous stays in place.
Pco is not an on/off thing. We all get some build up of new tissue on the capsular bag, it is a question of how much it is and in what way it affects the vision, that decides if we should do anything about it or not.
When I was at a 4 month check, we talked about pco, and she said I had what was to be expected and nothing worth mentioning, i don´t feel anything either.
She pointed at the matte desk pad under her pc, and said, this is how it looks like for me, when we need to take action. She said if your vision starts to get affected, come see me, and we fix it if necessary.
When it comes to lens design, all lenses today have the sharp square edge on the backside, that is believed to slow down pco. Some manufacturers use the sharp edge design as a selling point, some manufacturers just have it and does not mention it.
No matter what lens you choose, you can/will get pco at some point, there is no magic solution, even that I wish there was....
charles94562
Posted
UPDATED: I had my call with Dr.3 (Chief of Ophthalmology) this past Monday, and in general it was a much more comprehensive discussion than those I had with Dr. 1
and Dr. 2. I've requested the switch to Dr. 3 and am now waiting for schedule dates. The only items that gave me pause were 1) when I asked him what refractive targets he would shoot for (monofocal for distance in both eyes) he said 20/20, and when I asked if that meant Plano he said yes. So I'm a little concerned if we overshoot and I end up farsighted. 2) His go-to lens is the Alcon Natural (blue-light filtering). When I mentioned that I was concerned with the incidence of glistenings in Alcon lenses (especially the Alcon Natural) he seemed to not know what I was talking about. In any case I asked if we could go with a Tecnis SZB00 and after checking with his surgi-center he said no problem and no extra charge for Tecnis. I still have an evaluation with the Dr. I had originally selected for my 3rd opinion, I'll call him Dr. 4, on 3/20. On paper he looks to be by far the most experienced and competent of the lot. However, I would have to pay out-of-pocket if I decide to go with him, so I'll have to be pretty convinced of an excellent outcome. In any case the saga continues, and my left eye is pretty useless at this point with sever blurring and glare. Sigh...