Help with Lens and Targeting Choice
Posted , 5 users are following.
66 Male. I had retina w/ macular off reattachment surgery 5/2/23 on my left eye. As expected a cataract has formed fairly quickly and I’m scheduling surgery for January. Surgeon will be doing my LE first followed by my RE 2 weeks later. I have worn glasses (progressives now) for 50 years and have no problem with continuing to wear them after surgery to achieve the best vision possible. Surgeon has recommended Tecnis Monofocal lenses with a -3.0d target. Obviously, progressives will be required after surgery. I’m trying to get the best vision possible for night driving as I commute 1 hr each way in the dark. Also, do computer work and paper work at typical distances. Cell phone and Ipad use in addition. I play golf and have been having issues following the ball even before the retina surgery.Current prescript after retina surgery is: RE: -6.75/-1.50/105 Add +3.00, LE: -10.50/-2.00/010 Add +3.00 Thanks for your thoughts !!
0 likes, 17 replies
trilemma BklynBoy1957
Posted
I think it would be a shame to leave so much astigmatism. Maybe you are planning to get the torric version.
In addition, driving without glasses has some perks.
RonAKA BklynBoy1957
Edited
I think it basically comes down to what you want to see with your glasses off. If you want some much better than average close vision without glasses then -3.0 D makes some sense. It appears you like better than average close vision as your progressives add for close vision is +3.0 D. An add of +2.50 D is more standard. But, the reality is that you can pick pretty much whatever you want for close vision without glasses, and then correct it with glasses. A -3.0 D target is going to give you much thinner and lighter glasses than what you have been used to. You are going to lose that highly myopic super close vision that you have been used to.
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Another option is to target distance in both eyes. That will give you better vision for golf without glasses. When vision is set for distance most are going to see from 2-3 feet out to infinity. Close vision will require reading glasses.
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A third option if you want to be more eyeglasses free is to target the dominant eye for distance, and the non dominant eye to a more mild myopia of -1.50 D. This will not give you the close vision of a +3.0 D add, but it is good enough for most tasks like reading a monitor, phone, and normal paperwork. This gives you two options for vision. One is eyeglasses free with some compromises. The other is to also get some progressives which you could use for more difficult tasks like fine print in dimmer light, or driving at night.
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Correcting astigmatism is not necessary if your plan is to wear glasses. You will not know until the detailed eye measurements are taken whether or not you will benefit from toric lenses or not.
BklynBoy1957 RonAKA
Posted
Hi,
Thanks for the responses !!
Surgeon advised that because of the retina surgery, he wouldn't advise going with the Toric lens.
Also, because of the retina / macular reattachment I have some slight distortion in my LE vision so I'm reluctant to depend on that eye. I'm ok with progressives, so I can get the best all around vision possible. But, I am wondering if I would be sacrificing night driving vision going this route
Thanks !!
RonAKA BklynBoy1957
Edited
"Surgeon advised that because of the retina surgery, he wouldn't advise going with the Toric lens."
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That does not really make sense. You have eyeglasses with astigmatism correction as indicated by the cylinder and axis. The lenses are correcting for the astigmatism, so toric lenses will also correct for astigmatism in the same way. That said the range of cylinder powers in eyeglasses are finer than with IOLs. And, as I said correcting astigmatism with toric IOLs only makes sense if you want eyeglass free vision.
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If you go with a near and distance correction with IOLs as long as you use a standard monofocal IOL you do not back yourself into any corner. You likely will get good to very good vision without glasses, and with progressives you should get the same as what you are getting now, without the effects of a cataract of course. It will be better, and night vision will be better. It is easier to correct eyes at -1.5 D and -0.25 D than the highly myopic eyes you have now. The lenses will be very thin and light.
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I think I would pick the Clareon or B+L enVista over the Tecnis 1 lens though, if they are a choice. The Tecnis 1 is good too, but perhaps not quite as good as these one. All will be correctable with eyeglasses and should give good night vision.
Lynda111 BklynBoy1957
Edited
Did your cataract surgeon say why a toric lens is contraindicated after retinal detachment?
Google "Cataract surgery update for retinal surgeons" See last sentence.
"Other than out-of-pocket expense for a “premium” IOL upgrade, few downsides argue against the use of toric implants, which unlike multifocal IOLs, are not associated with unwanted optical side effects or reduced contrast sensitivity. For this reason, toric IOLs can be used even in patients with significant comorbidities, like the many patients we share with our retinal colleagues."
RonAKA Lynda111
Posted
Perhaps the surgeon is just saying that if the target is to be -3.0 D and the plan is to use progressives it would be a waste of money to get a toric lens. Where I am, a toric costs $1,100 more per eye. But I agree. I can't think of any risks of using a monofocal toric other than the cost. They not at all like a MF or EDOF lens.
Guest RonAKA
Posted
Yah the Toric thing makes no sense at all to me. The lens is essentially identical except that it has to be rotated to a specific angle. I could 100% understand and agree with contraindicating a multifocal but a regular monofocal vs. toric monofocal I don)t understand… unless I'm missing something. My concern with forgoing the toric is I don't know how well progressives work when cylinder is added.
RonAKA Guest
Posted
There is no problem with progressive when cylinder correction for astigmatism is added. It is like an overlay to the whole lens and impacts all parts of the lens the same. I have worn progressives with astigmatism correction higher than the OP has and there is no issue.
Guest RonAKA
Posted
Good to know. I tried some recently and they are horrible but I think the segment measurement was off so maybe that's why.
trilemma Guest
Posted
There is a significant differences in progressive lenses.
Also, the optician may have a more important role than the optometrist in getting the progressive lens right.
Guest trilemma
Posted
So FYI (and sorry to veer off topic) my astigmatism causes ghosting. I see it mostly in thin high contrast subjects like twigs, power lines, text on TV, or especially character "ink" outlines in animated shows. I have single vision distance glasses with astigmatism correction which completely fixes all of these issues and makes the world (and TV) look astonishingly good. So I wear them all the time even though that eye is now essentially plano.
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I thought as long as I'm in glasses full time now anyway I should get them in a progressive to give me some convenient near vision help, especially in low light like going for a run at night and seeing my watch. I bought them cheaply as they are an experiment and temporary (because I don't have my second cataract surgery done yet) and they are horrible.
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They don't fix the ghosting very well. And as I go to look down passing through intermediate the ghosting is absolutely horrible. It gets better once I'm looking at something near through the VERY bottom mm of the lens or at something far through the very top mm but everything between including my normal distance viewing eye position is horrible with very bad ghosting.
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So I'm not sure of there is some astigmatism from my ELP that is interfering (biggest fear) or if the glasses were just made wrong or if this is just the nature of plano progressive astigmatism glasses… but I will probably go to my optician and try again. These glasses were bought online because I only have one eye done so I don't want to spend big money on glasses that will change after the second surgery. But its probably impossible to buy progressives online as there is no way to measure segment height. Maybe if I go to my optometrist I can just get them to use my current frames (they hate that but too bad) and only replace the right lens (my IOL eye).
RonAKA trilemma
Posted
I agree. The most important part is adjusting the nose pads so the progressive transition is at the right height.
RonAKA BklynBoy1957
Posted
Regardless of the IOL and target you pick, you should discuss risk of retinal detachment due to the cataract surgery. You will be at higher risk due to being male, under 75, with higher myopia, and previous retina issues. There is probably not much you can do other than be fully aware of the retinal detachment symptoms and be prepared to get immediate help if they occur.
Lynda111 BklynBoy1957
Posted
Google "IOL Selection for Retina Patients." Excellent article about special considerations for retinal patients having cataract surgery. It says this about toric IOLs
"IOL selection. Hydrophobic acrylic monofocal IOLs are generally the safest bet in retina patients. Toric IOLs are an excellent option for patients with regular astigmatism, and several companies manufacture them on hydrophobic acrylic platforms."
Lynda111 BklynBoy1957
Edited
Looking at your name, are you in Brooklyn, NY?
There are some world class eye hospitals in New York City, such as the Manhattan Eye and Ear Hospital and the New York Eye and Ear Infirmary.
BklynBoy1957 Lynda111
Posted
Thanks again for the great responses. Will be speaking again with the surgeon about the Toric lenses. Yes, I'm originally from Brooklyn, NY but living in central NJ now. I will be seeking a Dr in NYC for another opinion before moving ahead with surgery.