High myopia, vitrectomy inbound and anticipated cataract surgery afterwards, any advice appreciated
Posted , 13 users are following.
Been reading on here for a little while, anticipating cataract surgery later this year so looking for recommendations and information.
A little background in case anyone is interested:
At 40, I had what I feared was a retinal detachment, I was walking outside and had a big black shape come down from above. I'm a high myope, so I've always read I was at risk for that and the next morning was being seen. I was told it was a large floater, right in the middle of my vision and shown a picture. They said I had no retinal detachment, and that it would either go away on it's own or I would adapt to it and learn to ignore it.
3 years went by, and it was still sitting dead in the middle of my vision, moving only slightly left and right. I began to notice when I looked in the mirror, that my right eye was turning inward where my left eye was straight; it was as if I was trying to always look around the floater, it looked like I was crosss-eyed just in the right. I heard about the laser vitrectomy (essentially using the laser to break up the floater), and there was a doctor within driving distance of here. I made an appointment, was told it wouldn't be a problem, and had to go twice because he couldn't do it in one go, it was too dense. A piece of the floater he couldn't get an angle to hit, but my central vision was clear and I could ignore the remaining small ones. I was happy for about 5 months, then I started to get more floaters of all types. What was different now is that rather than the one large floater (and smaller ones that were easy to ignore, I always had lots of small ones), it's more like looking through a cloud of floaters.
This has been going on for 7 more years, I'm now 50. This last year I've somewhat hit a wall; the cloud has become denser, I'd describe it more like looking through soup. Everything in that eye is several shades darker than the other, similar to a cataract. Unlike a cataract, I think I can't adapt to just using the other eye because of all the constant movement of the floaters and the soup. If I move my eye rapidly, I can sometimes get it to clear in the center and I can see that my vision is quite good (other than the myopia of course).
I've seen two top retinal surgeons, both say my retina is healthy, and that I suffered a PVD in that eye, probably at 40 when the large floater first appeared. Interesting comments they made included that a doctor there had a vitrectomy for floaters and they had "less than you have" and that they understand why I'm having issues because I have "more than my fair share" of them. Obviously I don't want to risk my sight on eye surgery (the vitrectomy and the cataract surgery that will follow typically 6 months later).
While my vision is better some days then others, I started getting double vision on occasion due to the difference between my eyes looking through the soup. It seems to have become a little thicker. I try to avoid driving at night whenever possible, as I otherwise have to close my right eye. I need to drive 2 hours every day to from work and taking the kids to school, so... the vitrectomy is in 3 weeks. I don't want to do this, but if it hasn't become better after a decade, it's probably not going to. Quite terrified, actually, even though I know it will probably be fine. I tell myself on the brightside, that with the cataract surgery and lens replacement, I can know what it's like to not need contacts (or hopefully need a lower power). I mentioned I've always been highly myopic since I was a child, -15 in the right and -13.5 in the left. I've been told I will see really well with any replacement lens, better than I ever have in my life due to my myopia, can anyone say if that is truly the case?
After reading here, I was really convinced the Symfony was the way to go; then I read about the Panoptix. While I'm used to visual oddities, I think I've come full circle back around and think if I have to make a choice that the mini-monovision is the safest way to go with some myopia, I don't mind if I still need glasses, but it would be nice to not need them for everything. Anyone a high myope or has experience with a vitrectomy and this process, and any advice, particularly with recovery or selecting a lens? It seems there is praise and criticism for every lens, no real consensus or a safe choice. Thanks for taking the time to read this and if you respond.
0 likes, 47 replies
mjcg scott10751
Posted
Hi Scott10751! I don't have any wisdom to share with you, but I'm sending you positive healing thoughts for your upcoming surgery. Trust the recommendation of your surgeon when it comes to choosing a lens for cataract surgery. As you noted, everyone has a different experience. One thing you seem to have that you will need is patience during the healing process. And please keep us posted about your journey. Your story will help others!
scott10751 mjcg
Posted
Thanks for the comments, I will post after the vitrectomy and follow up as it may help someone in a similar position as me, searching the internet for information. I somehow missed several threads on here regarding people asking specifically about high myopia, so those are really helpful. I don't think you can have too much information.
Chris53317 scott10751
Posted
It is unimaginable that you have suffered with this for so many years, but it will soon be fixed. No need to be terrified.
There are many options for IOL replacement, each with some compromises. Mini-monovision is one of those options and it should be discussed with your eye specialist before making your final decision. Doing a mini-monovision test with contact lenses should likely be performed to confirm that you are a suitable candidate. This was an option that I strongly considered but finally selected trifocal IOL's as I did not want glasses.
If you are prepared to wear glasses full time then IOL's adjusted for distance/intermediate or near/intermediate along with progressive lenses in glasses will give excellent results. The prescription of lens in the glasses will take care of any minor astigmatism along fine adjustment of the your near/intermediate/distance vision that the IOLs did not provide.
scott10751 Chris53317
Posted
Thanks for the reply. I'm making the assumption that an IOL experience is going to be similar to wearing contact lenses, is that correct? I ordered my first pair of glasses in 15 years since I can't wear contacts for at least 4 weeks after the surgery, and the fish bowl affect is proving challenging to adapt to; contact lenses don't have that, I'm assuming due to the proximity to your eye, so IOLs will be the same?
cazms53 scott10751
Posted
Yes, that is correct...the iol is similar to wearing contacts. There is no distortion like you get when wearing glasses with a strong prescription. I had to give up my contacts for several weeks prior to my cataract surgery, until my eye measurements stabilized. Fortunately, I already had a pair with high index lenses so it wasn't too bad but I really missed my contacts.
cazms53 scott10751
Edited
I have never had a vitrectomy so I can't respond to that, however, I am also a high myope and have recently had cataract surgery (March and April 2019). I was -10 in both eyes (as my cataract progressed, I was -13 in my right eye at the time of my surgery) and, yes...my vision is now better than I ever remember it being. I was advised by a retinal specialist to not go with a multifocal so I chose a toric monofocal with a mini-monovision. My right eye is set for mid-range and my left dominate eye is set for distance. I'm not sure what my vision is now but after surgery I was close to plano in my left eye and -1.25 in my right. I don't think my distance vision is quite as sharp now but it's still very good. I no longer need contacts or glasses for most of my activities, with the exception of reading glasses for close reading or crafts. I do have floaters, mostly in my left distance eye, and this can be an annoyance when they are in the center of my vision but I doubt it's even close to what you have been experiencing for so many years. So, although not perfect, I am very pleased with the results I achieved. To be free of contacts after 50+ years of wear is a wonderful thing! Good luck with your upcoming procedure!
scott10751 cazms53
Posted
Thanks so much for the information! I'll post in this thread as I go along. Today was one of those days when I happened to be seeing really well in that eye, I'd say the best in a year. Made me start to second guess going through with the vitrectomy, it's not like it's reversible. Then when I was driving, five dense floaters dropped down from the top of my vision, completely obscuring my view. I needed that to remind me that yes, I really need to follow through on this.
helenIllIII cazms53
Posted
Can you share what the retinal specialist cited as justification for not doing multifocal lenses?
With a -13.25 in each eye and pay later twice in my non-dominant eye for retinal tears, this makes me wonder if my cataract surgeon is missing something in his Panoptix recommendation.
How is everything now?
RonAKA scott10751
Edited
I have no experience with the vitrectomy, but from what I read, the recovery from that is not the easiest. I have had myopia for 60 years or more (now 70), and was diagnosed about 10 months ago with a cartaract in both eyes but one much more so than the other. The bad one was giving me double vision, blurriness, and whites are now a yellow colour. Black to white contrast is way down compared to my better eye. I just had my pre-op appointment this week, and have been facing the decisions on what type of IOL to go with. I still have a 6 month wait until it is done, but I can share what I have learned and the decisions I have made so far. I guess nothing is really final until one gets the lenses put in, and while that is not permanent permanent, it is close.
I have considered a multifocal lens like the PanOptix, pure monofocal lenses, and monofocal lenses in a monovision correction. I have ruled the multifocal PanOptix solution out, although it appears to be one of the best multifocal solutions. I concluded that they do have certain side effects like poor night vision, halos around lights, and poor close vision in lower light. I have a friend that had them put in about 9 months ago and while she thought they were OK initially and would get better as she got used to them, they have not. She confirmed the side effect issues I had done from my own research exactly. The final nail in the coffin was when I saw my surgeon this week. He is university professor that has done contract work for Alcon, seems to prefer Alcon lenses, but still said he could not recommend multifocal lenses because he would not put them in his own eyes. He wears glasses. My conclusion is that multifocal lenses are really for people who are tolerant of less than perfect vision, and will put up with those issues to be primarily glasses free. That was just not me. I am a bit of a perfectionist, like my friend., and possibly (hopefully?) my surgeon. If you do some on line research I would suggest looking for article about the suitable personality types for multifocal lenses. You should determine where you fit fairly quickly.
So my situation is pretty much decided. I will go with an Alcon AcrySof IQ Aspheric monofocal lens in the current bad eye. I do not have enough astigmatism to use even the lowest power toric lens. If I had sufficient astigmatism (>0.7 residual after lens removal) then I was prepared to go with the toric version. I saw no downsides to a toric lens, other than cost.
My decision on the second eye has been deferred until the first eye has had the IOL, and the second eye is bad enough to justify replacement. I do plan to consider monovision, and will try it first with contacts that undercorrect the second eye by 1.0-2.0 diopters. I will use a toric lens if needed, or just the same type of lens as planned for my first eye.
I think that is about all I can answer, and unfortunately none of it is from direct experience, and I am just sharing my research, and conclusions to date. Hope that helps some.
scott10751 RonAKA
Edited
Thank you RonAKA, that is very helpful. I am an engineer (the type they say are not a candidate, although I'd just be happy seeing what I used to see with contacts, I don't expect perfection and expect to need glasses depending on the situation). I know many people post here that are very happy with the premium lenses; It's a really difficult decision. I get the impression, right or wrong, that the 80/20 rule is at play here. 80% of people are in the range of satisfied to extremely happy with a multifocal/edof lens. 20% are unhappy to extremely troubled by halos/starbursts/can't neuroadapt to the point they are seeking a lens exchange (I found a video presentation for doctors somewhere and they threw out the 20% number of unsatisfied premium IOL patients; they referred to the 20% taking up to much "chair time"). If the numbers were lower, say 95% satisfied vs 5% unsatisfied, I think it would be a much tougher decision for me. Paying an additional cost, to potentially see well enough at all ranges to not need glasses, but still worse than if I paid nothing additional for a monofocal lens would make me feel like I paid more to get less (if that ended up being my result). Something else I've read, maybe you have as well, is that the multifocal/edof lenses are slightly softer, not as sharp as a monofocal at the same distance. Is that your friend's experience with the PanOptix?
RonAKA scott10751
Posted
I am also an engineer, but retired. I think we tend to believe that if we look hard enough and pay enough there is a perfect solution out there for us. My conclusion is that in the multifocus category there is no perfect solution at any price. Cost was a zero factor consideration for me, as this is kind of a once in a lifetime (I hope) expense, and I would pay whatever. So then what it really comes down to is identifying the issues with a less than perfect lens, and deciding whether or not one can put up with them. That is difficult because in our work we don't like to make compromises.
What my friend said was that her distance vision in the daytime is essentially perfect. She has always had issues with glasses as she has a prism correction and has found it hard to get glasses that worked well for her. And she has always been a perfectionist both with vision and other issues. In retrospect I can see that she was not a good candidate for multifocal lenses. In any case, when she says distance vision in daytime is perfect, I have to believe her that it is. She also says she can read in bright light as long as the text is not OTC ingredients medicine bottle small. Her issues are in dim light for reading, and driving at night. In fact she refuses to drive at night.
Hope that helps some.
Sue.An2 scott10751
Edited
Ho Scott - perhaps some day we will be able to look through each lens and see before buying until then this is a game if odds. Unfortunately if you wind up in 20% of unhappy patient category stats really don't matter.
If you are wanting the crispest of vision monofocals are your safest bet. The other distances can be made perfect with glasses or contacts. There will be some contrast reduction no matter which lens you choose (again monofocals are safest bet). What it comes down to is how badly you want to be glasses free or less dependent on them? Harder when you are younger facing cataract surgery as near vision isn't an issue and whole thought of that disappearing with this surgery isn't a pleasant thought. I know it played into my opting for Symfony lenses.
scott10751 RonAKA
Posted
Thanks RonAKA, every bit of information helps. You mention above you're considering the Alcon AcrySof IQ, based on comments in another thread, I'll be taking a closer look at the same lens. I like the blue filtering. I'm in front of a computer 10 hours a day, about 2 years ago I started getting headaches which I've never had. I bought a cheap pair of blue blocking "computer glasses" online, and they made my headaches stop. If I forget to wear them, headache will begin almost immediately, so some blue filtering certainly isn't going to hurt, despite the number of articles I've found where the topic is hotly debated. I only know that they definitely work for me, and it's not a psychosomatic effect.
scott10751 Sue.An2
Edited
Hello Sue, I agree, if you end up in the 20% of unhappy patients, it's no consolation to know a majority had a good result. I'll see what the doctor says after the vitrectomy, but I know I'm fairly convinced that monofocal is the way to go for me. I only want to do this once if at all possible, and glasses, especially if they are lower than my current prescription, are no big deal to me.
From the posts of yours I've read, it sounds like you are in the 80% successful on the Symfony lenses; they aren't perfect (none are) but you sound happy with your outcome. I think if someone posts here and has a good outcome, it would be understandable that they may never post again after posting their results; it's nice that there are users like you and many others that continue to post long after their surgeries to help new folks looking for information and answering questions.
RonAKA scott10751
Posted
I looked into the pros and cons of the blue light filtering in addition to the UV filtering that almost all lenses have. It seems unnatural that one would tint the lenses yellow. There are some reports that eye damage can result if you don't have it, and other reports not documenting any evidence of damage without it. In the end there is one graph in the Alcon sales materials that convinced me that the filtering is probably the safe way to go. It basically indicates that the natural crystalline lenses have a very similar effect in filtering as the yellow blue light lens does. Seems to that when in doubt the safe way to go would be to match the natural lens as close as possible. See the graph below:
The other issue that troubled me some with the AcrySof IQ lens is that it does not fully correct for the so called residual aspherisity when the effect of the natural lens is removed. The Alcon has a -0.2 where the Tecnis has a -0.27 which exactly reverses the so called average lens. Alcon claims the net residual of 0.07 can result in some potential supervision. Well OK... I was more encouraged by some information I saw suggesting that for Caucasian people that 0.27 may be too high, because Asian people are included in the average and they tend to have a higher value. As I am Caucasian perhaps I really will be closer to zero. I recall I have read somewhere that some surgeons actually select the lens based on the actual measured asphericity of the individual eye. I have a suspicion that my surgeon is not that sophisticated. To date he has indicated that the AcrySof would be what he would use, unless I insisted on Tecnis. Here are the differences (according to Alcon):
Hope that helps some. I've still got 6 months or so to change my mind, but so far that is the way I am thinking.
Sue.An2 scott10751
Posted
Yes content with result. Very hard to choose and realize there is a sacrifice to make. Wish night time was better but it isn't unbearable or impossible - likely worse if one drives s lot at night and in unfamiliar places.
I also realize that it doesn't end with cataract surgery. I have an appointment later this month. LE is starting to see blurry all distances - although not noticeable with both eyes open. I suspect pco (or perhaps increased astigmatism). Will find put and likely post a question myself on this. PCO laser treatment often creates additional issues.
PS I also suspect due to my particular eyes I would have gotten good results with monofocal lenses. Some people see all distances with monofocals targeted BOTH for distance. Really a shame doctors cannot predict results.
Chris53317 Sue.An2
Posted
Sue An hopefully that blurry vision is just pco. I had the YAG laser procedure with both eyes 4 months after cataract surgery and no issues so far.
I agree that doctors do not seem to be able to reliably predict the results, and we also have to take into account their biases. My opthamologist strongly advised against trifocals and recommended monvision, and my surgeon recommended trifocals (more revenue), and was indifferent about monovision.
Sue.An2 Chris53317
Posted
thanks Chris - am anxiously awaiting that appointment to see why LE is now seeing blurry.
scott10751 RonAKA
Edited
Thanks again, RonAKA. What are your thoughts about glistenings? As I've been researching this lens, it's the one big drawback I see. I've found plenty of articles saying they are there and visible, but don't affect vision so they aren't a particularly relevant factor and just cosmetic. I would agree if that is true, but I've also found articles and studies saying they do affect vision and of explantation due to the affect on vision, particularly in low light, in as little as 12 months. It's making me take a closer look at the enVista MX60E and MX60T. Curious if anyone on the forum has had this lens implanted and their results? Seeherenow49806 has mentioned having an enVista monofocal, not sure if it's this particular model.
RonAKA scott10751
Edited
I asked my surgeon about glistenings. He said that they can happen, but he has never seen it in his practice where it had any impact on vision. He also claimed and I have seen the same on the net, that it is basically a quality control problem, and that Alcon have made significant improvements to address the issue, but the stories do not go away as easily.
Both Alcon and Tecnis use a hydrophobic acrylic, but they are not the same. The Technis material is more resistant to glistenings, but may not be as resistant to PCO issues. That seems to be the most frequent cause of intervention (YAG). Alcon claims this is due to their better adhesion between the lens material and the capsule. Both have square edges, but the Alcon may have the advantage in material.
The Alcon lenses have a high refractive index and there are some studies that claim that it may be more sucepable to pseudophakic dysphotopsia. However in the bigger picture this seems to be much less common (1-2%) than PCO (45%). I also found one study called "Refractive index and its impact on pseudophakic dysphotopsia" which compared the Alcon and Tecnis lenses and found no significant difference in the frequency of PD.
One of my earliest articles I read on IOLs was "Surgeons Share Their Views on IOLs Review of Ophthalmology". In it they reported the use of lenses as follows for monofocal lenses:
"Fifty-four percent of the surgeons say they use the Alcon IQ Aspheric IOL for most of their cases, while 31 percent prefer the J&J Vision Tecnis one-piece lens. Six percent use the B+L enVista, 4 percent like the B+L SofPort AO, 2 percent prefer the B+L Akreos AO and 2 percent like the Hoya iSymm/iSert."
For Toric the results are in this graph:
It seems to me that IOLs are a complex package with many factors, and not the least of which is the ease they can be implanted, and how well they stay put after they are implanted. The Alcon lenses seem to have a reputation of staying put, while the Tecnis ones are much more likely to move. That may be due to the haptics design, or the material and how well it adheres to the capsule. Not sure, or if I ever will be. However, my experience is that when you are not sure, then it seems to never hurt to go with the consensus views. In lenses that seems to be the Alcon Acrysof product. And, if you are wrong, then at least you share lots of company!!!