I am depressed about glistening effect of Alcon intra ocular lens.
Posted , 17 users are following.
I had uveitis in my right eye and developed cataract because of using steroids. i had cataract surgery 2 years ago. I have very large pupil and this Alcon IOL gives weird look to my eye. it sparkles and shines under most light conditions. many people notice that and ask about that. i hate that feeling. Everytime doctor told me there is no lens that doesnt give that reflection. Recently tecnis synergy lens has been approved in USA and i heard that it doesnt give that glisten or reflection. I asked my doctor today and she said she doesnt have any experience with that lens and she doesnt know about its cosmetic appearance. Is there anyone with synergy lens here? i want to be sure that its true before talking to doctor again.
thank you
0 likes, 86 replies
pal40446 nya47000
Edited
The issue with diamond/cat eye/ terminator reflection- (external surface reflection) should be taken much more seriously, since it causes distress for some people. It seems like a taboo and may cause shame for patients who are affected and observant of this. For instance women who more often than men look themselves in the mirror. Patients should be informed of the side effect and make an informed concent. Let patients decide for themselves if this side effect is ok. I have several time seen this reflection in others, and know it can be very hard to live with, even if you are very happy to get rid of the cataract. Some information: google escrs org amsterdam 2020 cat eye, And: Journal of refractive surgery vol 37 No 6 Intracular Lens Refractive Index Surface reflections. Too bad that an otherwise sucsessful surgery should cause psychological pain that easily could be avoided
nya47000 pal40446
Posted
you are right. yesterday my doctor said im the only one complaining about this. she said because i am young and i have large pupil. and she said the lens i have is best choice for me.
RonAKA pal40446
Posted
I think the underlying issue is that the condition is very rare and of no functional consequence if it does occur. The thought that surgeons should warn patients about it kind of reminds me of the US drug company adverts on TV. They say all these nice things about what the drug can do, and then spew of a list of 100 or so difference adverse reactions that can occur. Does anybody really listen to that stuff?
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On your suggestion that the issue can be avoided, I am not so sure that is practical. If it is really caused by a "high refractive index" then how high does it have to be? The natural lens is somewhere around 1.39, and varies quite a bit. The human body quality control is not as good as IOL manufacturers. The silicone lenses are about 1.41, so slightly higher. Tecnis is more significantly higher at 1.47. Alcon is slightly higher than that at 1.53. Is the effect that selective that it occurs with a refractive index of 1.53 but not at 1.47? I am not so sure. I tried to find your references and could not find the first one at all. The second one I found but I would have to pay to see the full version. The summary was somewhat vague. And on the large pupil size impact, that does not ring so true either. People have differing maximum pupil sizes in dim light, primarily based on age, but in normal light we all use pretty much the same pupil size even though we have different maximums.
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I really do not think there are other reasonable choices than the hydrophobic acrylics that both Tecnis and Alcon use. Silicone is only rarely used in North America. And there are much more important issues to consider such as how stable is the IOL in the eye? Do monofocals move off center, do torics rotate out of position? PCO is common. How resistant is the lens to PCO? What is the YAG rate of implanted lenses? How does the lens handle during the insertion procedure? How large of an incision is required to get the lens into the eye while minimizing the trauma to the eye? There are lots of issues that have a much higher impact on the lens implant outcome.
Lunabug RonAKA
Edited
Ron, you make sweepingly general statements about a topic which you admit you know very little. The external reflection is a consequence of the higher refractive index IOLs. Full stop. Nobody knows the cutoff, because no IOL exists with an index between 1.43 and 1.55. But we know up to 1.47 does not cause the issue.
Functional consequence is subjective; there is a difference between 20/20 and 20/unhappy. Silicone is still very much used in the United States; the Sofport IOL is a "do no harm" silicone IOL surgeons use as an exchange option. It is aspheric and very unlikely to cause visual aberrations in most patients. I know of a person who just had a Sofport IOL implanted last month, it was the surgeon's first choice. This is in Boston where surgeons do not need to shill IOL brands; they have enough patient volume that they recommend based on patient eye health and any pre existing conditions. The new LAL IOL is made of silicone as well.
Regarding your comments on pupil size, again, you are way off base. There are more factors than age when it comes to pupil size. Myopes have larger pupils than Emmetropes; the larger a pupil, the more lens is exposed and more surface to reflect. Not all pupils are the same in photoptic conditions. A myope is going to have larger pupils in all lighting. Large pupils will also come into play for IOL lens diameter.
All of the other concerns you mention are valid, but the answers are easily available to a patient. All foldable IOLs require small incisions. Stability is the combination of product, surgical skill and human anatomy.
Surface reflections do not impact a lens implant outcome, but it can certainly affect patient expectation outcomes. It is perfectly valid to be 20/unhappy because you were not informed of a cosmetic issue with an IOL which attracts unwanted attention. Now that more surgeons are discussing it, hopefully there can be an option in the future to eliminate it.
You may not be overly concerned about it, but it is rude to dismiss the valid concerns of others by contrasting it with issues you think are more important.
RonAKA Lunabug
Posted
I have nothing more to say to you than I have said before. I wish you well in your IOL decisions, and I hope things turn out well for you. I prefer to base my decisions on fact, not opinions.
swm1970 nya47000
Edited
The effect you describe is a cosmetic reflection, which is different from the glistening problem. I recently received PanOptix and noticed it right away when I look in a mirror, and occasionally my family members have confirmed they see it. I even noticed it in my mother-in-law's eyes recently now that I know what it is, but had never noticed it before. According to a comparison video of PanOptix and Synergy, Synergy lens does not produce a cosmetic reflection. Personally, although my lens experience isn't perfect, the reflection was a less than pleasant surprise, but worries me less than the ghost images and peripheral flickers I see, along with vision that is 20/20 but does not appear as crisp as what I saw with contacts and glasses before surgery. I have a lot of mixed feelings and have second guessed my decision to address my cataracts (which I had just found out about) and have wished I had waited for better technology. However, if anyone makes a comment to me about a reflection I will simply tell them that I am gathering their data with my robot eyes. 😃 In all seriousness, though, it is rude of people to comment on it frequently; I imagine most would have the good sense and manners not to comment on someone's use of a wheelchair or prosthetic limb, and maybe you should say as much. Or you could say, "I had my sight corrected with the latest high tech lens implants; isn't that amazing?" I agree with others who suggest that you could end up trading a cosmetic problem for a more serious visual problem, so give it some time and think of some rehearsed responses to comments and maybe you will grow to accept it in time. Perhaps reflecting (no pun intended) on the benefits your implants give you will help you be more accepting of this unwanted effect. I completely understand the feeling, though; this is an expensive, emotional, and stressful experience and no matter how much we say we understand everything won't be perfect, it is harder to accept when we discover what our unique set of imperfections are. My anxiety and perfectionism have made acceptance hard for me, but working with a therapist has been beneficial.I wish you luck and peace about your decision.
RonAKA swm1970
Edited
How about "They are my bionic eyes. I can see right through clothing with them!"
swm1970 RonAKA
Posted
That is a good one; filing that one away for later.
lucy24197 nya47000
Posted
Hate to break it to you folks saying "Tecnis won't do this", but I can make my Tecnis ZCB00 lenses give the same effect that's shown in Shannon Wong's video. If you're counting on Tecnis eliminating the problem, you may be disappointed. If your problem is exacerbated by large pupils, you might also want to consider that Tecnis lenses have a rim around the outside edge, so you don't have the full diameter acting as a lens. Saying "get Tecnis instead of Alcon" may be very, very bad advice. YMMV.
maria18743 nya47000
Edited
Here's another tactic you could try in social situations. Go with it. Embrace your glittering eye as something unique about you. I have cataracts and my surgery is scheduled for this summer. If after the surgery, someone is rude or bold enough to comment on my "glittery" eye, this is going to be my Plan A. I'm going to look them straight in the eye and in a completely serious voice say, "Well, now that you asked, I'll tell you my secret...I'm a Terminator robot sent from the future to save humanity from Skynet. Come with me if you want to live!" Then enjoy the look on their face and see where the conversation goes from there. Frankly, I'm kind of looking forward to it. 😃
RonAKA maria18743
Edited
It is good plan. However, you may be one of the large majority of people and will see no "glitter" in the eye. Both my wife and I, as well as one of our friends have had Alcon lenses and there is no glitter to be seen!
maria18743 RonAKA
Posted
I am going with Alcon Clareon monofocal/toric. My surgeon said the hospital is replacing the AquiSoft (?) with Clareon this summer so I figure I might as well wait and get the newer ones since I am 60 years old and will have them for (hopefully) a while
RonAKA maria18743
Edited
My wife got AcrySof IQ toric monofocal in both eyes. Our friend got PanOptix MF lenses in both eyes, and I got an AcrySof IQ monofocal in my first eye, and a Clareon monofocal in the second. I really can't see any difference between the two lenses. And none of us got the "glitter" effect!