I'm 29 and have uniliteral cataract - help needed
Posted , 5 users are following.
Hi,
First of all I want to say I did my best to keep this post as short as possible. If any crucial info is missing please let me know and I'll provide necessary data. Secondly - it would be great if you could help me out or point my actions into the right direction.
Ok, so let's start:
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I'm 29 yrs old and I live in Poland (Europe). I'm software developer (so a lot of work at intermediate distance). About year and a half ago I noticed that vision in my left eye have worsen. I thought it was due to being tired, but it eventually turned out to be a cataract. It think it's developing fast - I'm not totally blind on this eye but vision is so blurred I can't read with it, so all the work is done by my right eye.
I've visited (so called) professional eye clinic in my country March this year, been there like 3-4 times since then (I had some questions and doubts) and eventually arranged cataract treatment on the 1st of December, 2015. But the more I read about IOLs and cataract the more I feel I was mistreated at this clinic as far as being informed well by doctors:
- I've visited 3 different doctors: 1st recommended multiofocal, 2nd recommended toric multiofocal (I have 1.2 diopter astigmatism) and 3rd recommended multiofocal (without toric) again. But OK - different doctors, different approaches.
- I haven't thought of that until I start reading more about cataract but none of the doctors asked me about my expectations regarding treatment OR about my lifestyle. Just "I recommend multifocal".
- Regarding IOLs: what I've found strange they all were using just term "multifocals" - not bi-, tri- just multi. I'm going to call them today or tomorrow to ask which one they're planning to use, but my bet is it's going to be bifocal. And as far as I know it's not so good for intermediate distance. What is also a little bit weird it's even hard to find which IOLs they're using. I've found in some deeply buried FAQ on their website they're using Alcon and AMO IOLs.
As for now I think I'm going to give them a call and ask about the IOL but to be honest I am leaning toward cancelling the treatment and check out another clinic. I've found one that offers new Alcon Acrysof Panoptix IQ (trifocal). But I would really like to know what you think first.
Here are some questions/doubts that I still have:
1. Monofocal vs Multifocal? The more I read the less great mutlifocal seem to be. Not that they're bad, but all this reading about halos, poor contrast, explantation in some cases got me worried. On the other hand I really would like to do without glasses/contacts. I mean I can live with using glasses for computer related work, but other than that I'd prefer not having to use them.
a) Which one would you choose in regard to my age and fact that my second eye is healthy?
b) Is it possible that when going with bifocal I still won't need glasses/contacts because my second eye is OK?
2. Toric or not? I have no idea should I go with toric IOL or not - as mentioned earlier I have about 1.2 diopter astigmatism in the left eye.
3. What else should I know / ask my doctor about before surgery?
Thank you for taking time to read my post and sorry for it being somewhat lengthy.
Best Regards,
Kris
1 like, 6 replies
artfingers sdsdsd
Posted
frankiefoo sdsdsd
Posted
I don't have an answer but am now seriously looking into IOL's as NOT once in the 4 pre-ops I've had in 15 years have IOL's it ever been mentioned. Neither am I happy with any doctor I've seen as each one just eager to remove my natural lens - do the surgery, regardless of my allergies to the poison they use to dilate my eyes - hence not had cataract removal yet.
Thanka to your post I've cancelled my pre-op and am seriously looking into IOL's of which there are several types of IOL implants available that I did not know about.
sdsdsd
Posted
Unfortunately the more I read about the IOLs the more lost I feel.
Could You clarify something for me please?
If I understood everything I've read correctly there are following types of IOLs:
- monofocals - for far OR near vision,
- bifocals - have two rings; for far AND near vision; glasses might be needed for intermediate vision,
- trifocals - have three rings; for far, near AND intermediate vision. Highly possible that glasses won't be needed,
- multifocals - have mutliple rings; for far, near AND intermediate vision. Highly possible that glasses won't be needed.
Am I right?
My problem is I don't understand why to use trifocals if there are multiofocals available? But I assume there are some valid reasons for this because from what I can see trifocals are newer type and they're more expensive. I just can't find any info why to use them over mutlifocals.
softwaredev sdsdsd
Posted
In terms of "Toric or not?" , that decision will depend on your surgeon's preferences since some prefer incisions, and some prefer toric lens, with usually low levels being corrected with incisions and higher levels with toric lenses (though some use incisions even for high levels). Surgeons differ regarding where to draw the line to use a toric lens instead of an incision since the studies so far on the topic are inclusive enough that there isn't a firm guideline. With the low level of astigmatism you have, there will be some surgeons who will prefer to correct astigmatism where it comes from, the cornea, with an incision during surgery. Others will prefer to use a toric IOL since they feel the result is more predictable, but for such a small amount many won't think it is worth it since toric IOLs do complicate things since they need to be oriented in the right direction and can potentially turn and the correction will be off.
One important thing regarding astigmatism is to find out if your surgeon has the latest scanning equipment to determine total corneal astigmatism, which includes both posterior and anterior astigmatism. It used to be that surgeons only used anterior astigmatism, which is what shows up in the scan of the shape of your corneal surface, but that often led to minor errors in the results. The most recent equipment will detect the usually small amount of posterior astigmatism which can in some cases be enough to make a difference noticeable to the patient.
re: "monofocal vs. multifocal"
Unfortunately there is no perfect IOL yet that is right for everyone. You need to determine how much risk you are willing to take of visual side effects in order to avoid wearing glasses. The vast majority of people with multifocal IOLs are happy with the results, but a minority of patients do experience problematic halos&glare, in some cases enough to lead them to get the IOL exchanged (which is fairly safe, but like any surgery not entirely so). Also you need to decide if you wish to risk wearing glasses, for what distance you'd prefer to need them.
The only commonly used accommodating lens now is the Crystalens, and some percentage of people don't see any accommodation at all and it is therefore merely like a monofocal (perhaps 10%-15% if I recall what I've read right, I've only seen surgeons making comments about it and not a study). I've read some surgeons suggest that perhaps half of those with a Crystalens will need to wear reading glasses for near (vs. far lower fewer with the multifocals). The crystlens also has some potential complications like z-syndrome that other lenses that aren't intended to accommodate don't have, though I gather that the risk is lower with the latest generation of Crystalens, I hadn't seen statistics.
The other issue with multifocal lenses is that since they split the light, they can reduce contrast sensitivity, low light vision, since you have less light for each focal distance, and because in the splitting process some light is scattered and lost. The latest multifocals tend to have less lost light.
Although you refer to bifocals as being for far and near vision, the newer lower add bifocals tend to have the 2nd focal point located somewhere in the intermediate realm instead, which leads to some risk of needing reading glasses for near. Intermediate vision is useful for computers&smartphones, but also for much social distance and household tasks, even for say finding your footing on a rocky trail if you are into hiking or running.
Some people use monovision to get better near vision, one monofocal focused far and the other at intermediate/near. The probem with that is the greater the difference between the two, the harder it is to adapt. In addition, if there is too much difference, then you are effectively only using 1 eye for each distance and your depth perception starts being reduced as well as your contrast sensitivity. There is however lower risk of things like halos than there is with a multifocal, however there is still some risk, there isn't a lens in existence that doesn't lead some people to have halos unfortunately.
The trifocals do have better intermediate vision than a high add bifocal, but their intermediate isn't as good as their near, and isn't as good as a low add bifocal that targets intermediate. If I were getting a multifocal, personally I'd go for a trifocal probably rather than a bifocal. They reportedly have lower risk of halos than the old high add bifocals, I don't know how they compare to the low add bifocals. The low add bifocals aren't all created equal, for instance although I haven't seen a head to head comparison, the data submitted to the US FDA for approval seems to show that the Tecnis low add multifocals have a lower risk of halos than the Alcon low add multifocals (however it may be that they merely asked different questions so it is hard to compare the data to be sure).
The Tecnis and Alcon bifocals also differ in the issue of glistenings (do a search for "point, counter point on glistenings" to see an article on the topic), with Alcon being prone to them and Tecnis not. There is debate over whether they are visually significant. In addition the Alcon lenses tend to be "blue blocking" IOLs. Many, I think perhaps most, surgeons feel there is no need for that, that it is a marketing gimmick and people can just wear sunglassses as usual rather than having that in the IOL since that can have some negative consequences (that are again up for debate, some issues are still unresolved in terms of the best features for an IOL). Also Tecnis lenses use a material which is a higher abbe number, which corrects better for chromatic aberration. Do a search for
""iol optics and quality of vision" to see an article from Eyeworld which talks about the issue. Overall I'd personally go for Tecnis lenses over Alcon lenses, I think Alcon just does a better job of marketing or they wouldn't have as large a market share as they do.
I almost went for a trifocal lens, but then the Symfony came out which is a new class of IOL, an "extended depth of focus" IOL. It uses diffraction technology and has rings like a multifocal, but it isn't a multifocal. Instead of having multiple focal points, it extends one focal point so more distances are in focus at the same time (or at least that is a high level approximation of a complicated optics approach). It reportedly therefore contrast sensitivty which is comparable to that of a good monofocal, as well as a risk of halo&glare issues which is comparable to a good monofocal. It provides great intermediate vision (better than a trifocal), with a decent chance of good enough near so that most people don't need reading glasses. I decided that had the best mix of features to meet my needs and got the Symfony in both eyes last December. I have almost 20/15 vision at distance (perhaps better than that by now, since vision does improve for a few months as you adapt to a multifocal, or the Syfmony) and 20/25 at near, I can read the small print on my eye drop bottles, and my smartphone). I had multifocal contact lenses before this, and my low light vision is definitely better than it was with those. I do suspect that a trifocal might have given me better really close vision, but I don't need that as much. I'd say its vision is probably a bit better at intermediate than a low add bifocal, but likely not too much different, but with a lower risk of halos&glare and better contrast sensitivity.
One thing some people with multifocals experience is a need to hunt for the "sweet spot" of where their best focal distance is, since there are multiple peaks of best visual acuity at the different focal points. The Symfony is more like natural vision, as you move something further away it gets clearer, but smaller, so it is easy to find what the best tradeoff is. People often get a small amount of micro-monovision, or mini-monovision with the Symfony to improve their near vision a little bit, while not being enough of a difference to reduce steropsis noticeably or induce other problems.
I don't know how myopic you are (I was -9.5D or so in my worst eye before the cataract made it worse), one issue with highly myopic people is that it can be hard to predict the right IOL power, I don't know if that issue applies to you, if so that is another issue to research and be prepared for, that the lens power may not be exactly what they target.
In terms of "What else should I know/ask", an important issue is whether to get laser cataract surgery or regular surgery. There is controversy within the field as to whether laser cataract surgery has benefits that are worth the cost for the typical patient. (there are some special cases where it has been shown to have a proven benefit, such as for hard mature cataracts which are rare in developed countries since usually people get treatment well before the cataract gets to that point, unless it is develops very rapidly). Studies seem to show that laser cataract surgery so far merely provides comparable but *different* complication rates (and perhaps even some rates that are higher than manual surgery) without demonstrable benefits for the average patient. The main benefit appears to be that it is better than an inexperienced surgeon, and that in the future as technology improves it may eventually demonstrate concrete benefits but that it isn't there yet.
softwaredev sdsdsd
Posted
Also the optics of an IOL are different from a natural lens. Most people adapt just fine to having an IOL in only one eye, but there is a small chance it might be hard to adapt, so you might be prepared for a small risk you might wind up wanting to have the other eye operated on as well. In my case since I had the beginnings of a catarct in one eye, and since I was old enough to be presbyopic already, I went ahead and had both eyes done. In your case obviously its best if possible at your age to keep the good eye with a natural lens and take advantage of the acommodation. I just know of someone younger than you that had posted about having had an IOL implanted in only one eye, a monofocal, and that he was struggling to adapt to the difference even well over a year later I think it was. Again, you should expect all wil be well with only 1 eye done, but you might wish to at least make your IOL choice being aware of the possibility there is a chance you might want to get surgery on your other eye as well if you can't adapt, or if you get a problem cataract in that eye as well.
sunny68454 sdsdsd
Posted
My other eye does not have cataract but I need -3.5 for distance. Accommodation for near still works for near with this eye.
I am 40 years old.
Tried progressives but can’t adjust.