Highly myopic eyes and cataracts
Posted , 10 users are following.
What kind of IOL s did people with high myopia { -8 though -13} get with your cataract surgery and how do you like the outcome? Thanks in advance
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Notes on Highly myopic eyes and cataracts
Bookwoman rusanna
Edited
I was -8 in both eyes until my surgeries in September, having been highly myopic my whole life. After reading a lot (including this very helpful forum) and consulting with my ophthalmologist, we decided that a -2 monofocal lens in each eye was the way to go. I spend roughly 80% of my day reading or on the computer, and the thought of not being able to see close up when not wearing glasses was horrifying. Close vision is what my brain has always been used to, and I wanted to keep it that way.
I was not interested in multifocal lenses, given the issues that some people have had with them, and I don't mind wearing glasses...in fact, I prefer it. My doctor suggested mini-monovision as an option, but since I was planning to wear glasses all the time anyway, I didn't want to risk any discrepancy between the two eyes that would be too great for my brain to handle. (As you probably know, while there are targets for what your vision will be after surgery, the outcomes can vary.)
It's been roughly two months since my surgeries - my eyes were done 2 weeks apart - and I am beyond thrilled. The fact that my unaided vision is now so much better than it has been at any time since my adolescence is still a source of delight and wonder to me. I can, without glasses, read and work on the computer (a desktop with a large monitor), see clearly when I look in the mirror (yikes!), walk around my house and see reasonably well, etc. But most of the time I wear my glasses, which have progressive lenses and allow me to see perfectly at every distance.
Good luck with whatever you decide!
rusanna Bookwoman
Posted
Thank you for your reply !
mak73 rusanna
Posted
I'm -10 in my LE and was -15 in my RE.
I was considering monofocal lenses very seriously. I was back an forth between monofocal and premium (multifocal) for few weeks and it was one of the toughest choices in my life I had to make. I decided to go with multifocal lenses after all. I only operated one eye so far. Started with the RE since it was much worse. I picked EDOF lens for it - Zeiss AT Lara, that is supposed to provide good distance and intermediate vision smoothly, without soft spots. It is not very good for near vision though.
I had the eye operated 2.5 weeks ago and I can say that my distance and intermediate vision are fantastic in sense of sharpness and clarity. No glasses or contact lenses in the world would give me anything even close to this. I visited the clinic yesterday and they measured it as 1.25 (that corresponds to 20/16). As my surgeon said - "this is the vision of a young man". Surprisingly (for me and the surgeon), I could also read the smallest text on the test card that I was holding in my hand at about 40-50 cm. from my face. I said "surprisingly" because I don't think that my near vision is good enough (for ex, reading small text on my smart phone pretty often becomes a challenge). But it is expected for Lara. I was and am going to fix the near vision with 3-focal lens (Zeiss AT Lisa) in my LE.
So... that was the PROS but there are also CONS of course. Unfortunately I do have side effects - halos etc. They are not very noticeable or not noticeable at all at day time. But at night they are getting pretty bad as for now. I wouldn't probably dare to drive at night if I had all these halos, starburst and circles in both eyes. My LE sucks big time comparing to my RE but it helps a lot with night driving. This is basically the only thing that I can appreciate my LE for. Other than that I'm starting to hate it more and more and want it to be operated ASAP. But I decided to hold on with the second operation until I can handle the side effects better. And usually it gets better within few weeks or months. I'm just 2.5 weeks after the surgery so I'm pretty optimistic so far.
There is a statement that (high) myopic eyes are bad candidates for premium/multifocal lenses. I'm not a specialist but I don't buy it. I think it is a misconception. Yes, high myopic eyes are difficult but the type of IOL has nothing to do with it. I can't see how the risk of retina detachment (the first thing they usually mention) can depend on the type of the lens to be implanted. Nevertheless, if you have problems with retina it is always good idea to fix them before the surgery, no matter what lens you chose. I had peripheral retina degeneration with a risk of tears zones. I fixed it with a quick laser procedure 4 month before the surgery without even knowing that I'm going to do a surgery soon. It was even in another country. When I showed up here and the surgeon checked my eyes, he didn't find any issues with the retina and said that I did very good that I fixed it so we can go ahead with the surgery, even with the multifocal lenses.
By saying this I don't mean that monofocal is a bad choice. Of course not. It is also a great option and as I said I was considering it very seriously till the very last day before the surgery. Who knows, maybe I even end up with a monofocal instead of 3-focal in my LE if I cannot adopt to the halos. Where to target the monofocals - it is another tough question. I totally understand a fear of losing the near vision - the only thing that high myopic people have. But you know what... Now, when I lost it in my right eye I do not regret it. The truth is - the near vision I had was not a vision. I could basically only see things more or less clearly in 3-4 inches from my nose. Is it really a treasure? 20/20 vision - this is the treasure! I can still do all the sings in the morning as I used to. I need to adjust to some thing but this is not a big deal. In the worst case I can wear reading glasses if I really need them. I didn't order any glasses yet though. I'm waiting for my LE to be operated so then I will see if I need any. Anyway, I'm going to have photochromic glasses (like I used to have) to protect my eyes from UV and blue light from computer screens. They can easily be progressive so I could have perfect near vision as well if what I'm going to have is not enough.
micheline16004 mak73
Posted
Hi mak73,
Very interesting post. I'm one of those who couldn't get multi-focal lenses being miopic, but I have other issues who didn't make me a good candidate for it. I got the RE done a month ago for intermediate and the LE done 3 days ago for far. I love my intermediate vision which was a surprise to me, but that's the way they do it now apparently. Then you choose either far or near for the other eye. This is the tricky part. What to choose. This is when you wish you could go with multi-focals, but there are side-effects with these also. I had better pc vision with both my RE intermediate and my cataract LE before she added distance to it. Makes sense. I just hope my brain will adapt better with time. If not, I guess I'll need glasses. What are photochromic glasses and where do you get these? I have always used glasses for the computer with a tint for the blue light, and non-prescription sunglasses for far outside for UV protection.
rusanna mak73
Posted
Thank you for sharing. According to my doctor I am not a good candidate for multifocal lenses so I am considering monovision .I have to do a trial with contacts to see if it works for me.
W-H mak73
Posted
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Chance of retina detachment as you said is not dependant on type of IOL but cataract surgery can increase chance of retina issues for some.
Also if in the future someone ends up having retina or cornea issues (cataract or non cataract related) then a mulitfocal will cause more issues than a monofocal. Which is why multifocals are not recommended for people with already known retina/cornea issues.
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Anyway good recovery and hope you neuroadapt good and fast.
mak73 micheline16004
Posted
Photochromic glasses (lenses) are also known as chameleons. They become darker in lighter conditions and get back to normal when it is getting darker. You can google it for more info. But here is what wikipedia says:
Photochromic lenses are optical lenses that darken on exposure to specific types of light of sufficient intensity, most commonly ultraviolet (UV) radiation. In the absence of activating light the lenses return to their clear state. Photochromic lenses may be made of glass, polycarbonate, or another plastic.
This is actually pretty common option. You can ask for this any optic shop. This is essentially just another type of glass (lens) coating. And you can have multiple different coatings on the same lens - anti-glare, anti-uv, anti-blue, anti-scratch, anti-anti-anti.... It just costs extra.
Regarding the lenses targeting. As far as I know it is usually recommended to target a leading eye for distance and not leading eye for near or intermediate (whatever you like better). Anyway, I hope your combination will work good for you.
mak73 rusanna
Posted
It is actually very good idea to try it with contacts before you go with monovision. In my clinic I red that about 40% of people cannot adopt to monovision so the strongly suggest to check it with the contacts first. I believe they don't even do monovision without the contacts trial in that clinic.
I also thought about monovision but didn't find this option too attractive for me after all.
As for "I am not a good candidate for multifocal lenses" - could you ask your doctor to elaborate it? I don't mean to discourage you from going with monolenses. I'm just dying to know what exactly they really have on mind when they say it. That was one of the first things I heard from my optometrist and then from the surgeon and I was ready to accept it. But I took 2-3 weeks to think about it. And the more I thought about it and looked for an answer on Internet the more I become confident that this doesn't make any sense. This is like "we do not recommend to install an energy window in your room because your wallpapers are old and about to fall off in few places. so we recommend you to go with an ordinary window." - What???
They sell it like "if you go with multificals, there is a higher risk of damage to your eyes. But if you go with monofocal then you are safe". But it cannot be true. Both types of lenses are made of the same material, have same size and shape. Why would one of them be more dangerous?
I have theory (and it seems that Viking agrees with it) that this is not about the risk for your eyes. This is about a risk of getting less satisfied patient. High myopic eyes are difficult to measure precisely and even small inaccuracy in calculations can cause more noticeably worse results comparing with normal eyes. This is still has nothing to do with the type of lens. However, if you go with monofocal - then your expectations are not very high. You know that the miracle will not happen and you most likely won't be able to see at all distances. (sometimes the miracle happens though). But if you go with multifocals, you really hope to be glass independent. And you don't even consider it as a miracle. This is what multifocals are supposed to do and this is what you payed extra for. So the surgeons prefer to stay on the safer side from the reputation point of view.
Rusanna, if you can get more info about "Not good candidate" from your surgeon, please share it here. I'm really interested to know more. My surgeon retreated very easily from this point after I presented my 😃.
W-H mak73
Posted
Not always true!!!! We went with monofocals because our expectations were HIGH for the BEST QUALITY vision possible! 😃 Multifocals WILL reduce contrast and light level. This is a scientific fact! Being glasses free does not = quality of vision.
Personally I would take best possible quality vision and not diluted quality vision over anything else (with or without glasses).
It is not a mircale like it is made out here. Many people in last 4 months privately messaged me and said that they left the forum as people pass their excellent monofocal results as exceptions/miracle and they can't be bothered arguing.
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If someone has normal eyes and they set both eyes for say far or one for far and one for interemdiate/near. There is a very good chance that they will get an excellent range of glasses free quality vision. And wearing glasses for near will hardly be end of the world. When the vision is the highest quality possible.
Yet many multifocal people end up needing glasses too 😃 So it cuts both ways. Or they end up needing Lasik!
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I am not against mulitfocals, well atleast not against the good quality trifocals. Just balancing things out. Also people with bad eyes pre cataract are not the best to judge the quality of vision after getting multifocals. I now understand why the rejected surgeon No.3 that we visited said that he recommends people with excellent eyes (pre cataract) not to go with multifocals. At the time I thought he was being cruel towards old people and people with high spherical/cylindrical numbers.
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Anyway...carry on 😃
mak73 W-H
Posted
Thank you W-H. I'll do my best. I negotiate with my brain every single day. I'm sure we are gonna have a deal 😃
As for your statement regarding retina/cornea issues in the future. I can only think about the fact that mutlifocal lenses pass a bit less light through than monofocals. If/when retina gets into a state that more light would be more beneficial then yes, monofocal would be better of course. Cornea?... how can the lens type impact cornea issues?...
W-H mak73
Posted
Compare surface of latest ringed trifocal multifocals with monofocal. What do you see? One is smooth and one has circular surface distortion. Those ringed distortion is what bends the incoming light rays to form 3 different images on each retina and your brain does it's magic... or does the best it can.
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If someone's cornea ends up with issues i.e. the surface has erosion...microscopic valleys and peaks etc. Then that causes distortion too. So you can imagine that cornea surface distortion will have a greater impact on multifocals. As you know mulifocals even on perfect cornea have more side effects compared to monofocals.
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Vision is the trinity of cornea, lens and retina/optic nerve.
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Don't worry though. We are talking theory here. If your vision is good then all this is irrelevant irrespective of monofocals or Trifocals 😃
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Just relax and let your eyes heal and don't worry. Thongs will keep improving. One thing that i have learnt from this ordeal is that worry will do more damage than anything else 😃
W-H
Posted
Typo- Things not Thongs lol 😃
micheline16004 mak73
Posted
Thanks for your reply mac. Yes, I did look them up. They are expensive. But, right now my eyes are in the middle of a battle between my intermediate vision and far vision. I'm hoping the intermediate wins and I can read on my pc clearly. Right now, my pc vision is not quite on. But if it does win then I might need glasses for far. Just not sure yet, as it's too early to get the numbers yet, but if that is the case, it will be well worth the price to buy a pair of these for outside for not only vision correction, but also for all the other benefits. Thank you for that info. I'll keep it for reference. Good luck to you in your quest.
micheline16004 mak73
Posted
Hi mak,
I can only add my story as to why I'm not a good candidate and see what you think. I've been high miopic all my life. In late teens, I started wearing contact lenses, but had to stop because of irritation and calcium deposits. In 2001, I went for PRK (Lasik was the other) laser treatment. He ended up doing my RE twice to give me a full monovision. Thank god my brain adapted. This vision slowly dissipated in a short enough time ending up needing 3.25 glasses for near and 2.50 intermediate. Even eventually lost the fine distance vision. Three years back I experienced a most terrifying ordeal seeing only jagged white lines through my left eye. It was what they call an epiretinal lamellar macular hole. The retina specialist chose only to monitor it instead of surgery because of the risks involved. Now in my right eye while waiting for the cataract surgery I experienced a sudden blurriness where I couldn't even see my face in the mirror. It was what they call Pseudo-Exfoliation-Syndrome, fleck-like material gathering in the iris. On top of that, I have open-angle glaucoma in my left eye and exfoliation glaucoma in my right eye. Add to that, extreme dry-eye disease.
To me I understood why my surgeon didn't want to use the multi-focals on me, which I could have afforded. I think isn't something with more bells and whistles tend to break down more easily? As compared to something more simple but more reliable? I wish I could have the ability to see clearly at every distance, but if I can have very good vision I can adapt perfectly well to my way of life, why would I want more with more risk?
I hope everything works out well for you and I wish you all the best.
mak73 micheline16004
Posted
Oh wow. Your situation looks really complicated indeed. I'm very sorry about it.
Yeah... Perhaps in cases like this it really doesn't make sense to risk with multifocals. I don't think that multifocals are more fragile and breakabale. But the lenses are more complex of course, and in combination with a bunch of problems with your eye that you unfortunately have they may really give very unpredictable (in negative sense) result. Not just a little worse than you expected near or distance vision for ex. I think this is what W_H means explaining "bad candidate for multifocal" statement.
I wish you good luck with your surgery. Monofocal lenses are also very good and I'm sure they will work good for you.
micheline16004 mak73
Posted
Thank you mak for your understanding. Everyone is different with different problems. And I fully understand where you're coming from. You want to reach the highest goal you can and if you can, why not. I've had my two surgeries and am now waiting for the results. Too early to tell, but it seems to be evolving well, hoping that there will be no upcoming complications. But I have to be positive and that is easier to do with the support I can get from all the people here. You're all angels. Please let us know what happens. I'd be really interested to know.
rusanna mak73
Posted
What do you mean if " you go with monofocal your expectations are not very high " ? Multifocal lenses don't work well for everyone regardless of expectations
mak73 rusanna
Posted
But if they worked well for everyone which one would you chose?...
rusanna mak73
Posted
I would chose the ones that would work best for my situation and eyes which I am trying to figure out now. I know some people got monofocal and they are very happy with their results. It all comes down to - what are your expectations going into the surgery and did the surgery potentially lived to your specific expectations,high or not.That's why I don't think multifocals are the only ones with high expectations
mak73 rusanna
Posted
Of course, one can expect from monofocals to get excellent or at least decent vision with each eye in all distances without glasses. This is actually not impossible and very few lucky people get it. So it is a fair expectation. Why not?.. But it is very high. It would be difficult to reach this level with multifocals expectations 😃
By the way, one of the main reasons why I picked multifocals over monofocals was that I couldn't decide about the target. My first thought was - I'm myopic the whole my life so I would feel the most comfortable with targeting both eyes for near (like -2.5). Then it was - wait... it means that I most likely won't be able to properly see computer monitors at distance 70-80 without glasses. Maybe -1 -1.5?...Then I will need readers and of course I will need distance glasses. Maybe mini-monovision? Still will need glasses and who know how comfortable it will be to have this difference between the eyes? Then - why on earth should I stick with myopia (lack of distance vision) for my whole life. Why not to target for distance? Oh no, then I won't be able to see my hands in the morning. Aaaahhhh. And then starting another loop again and again and again - madness. So I shifted to multifocals. It was another loop of madness there as well. Going through all pros and cons. Including "am I good candidate or not?". I made a decision 2 days before the appointment with my Dr. where we were supposed to decide about the lenses. And I was relieved after that. No, I still worried, of course (I still do), but that is absolutely different level of worrying.
rusanna mak73
Posted
I feel you. It's not an easy decision either way and I am only in my 40s and lead an active lifestyle where I need to read near and intermediate and such. We are all in the same boat agonizing over the "right" decision but there is really no right or wrong ,just whatever will work for each of us. Thanks for your input 🙂