Posted , 9 users are following.
Alot of people like myself with cataract surgery upcoming spend alot of time worrying about whats the right choice of IOL. But is it true no matter what IOL we choose as long as we have a good surgeon who does a good job we will have good vision , with or without glasses . Every IOL's on the market must provide good vision otherwise they would not be on the market
0 likes, 19 replies
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RonAKA john20510
Edited
"But is it true no matter what IOL we choose as long as we have a good surgeon who does a good job we will have good vision , with or without glasses."
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It is always good to have a good surgeon. But, a good surgeon cannot turn a sow's ear into a silk purse. If the lens is not suitable for your eye, or does not meet your expectations, then it is going to leave you dissatisfied. You have to remember that in IOL's the old saying "you get what you pay for" is totally wrong. Essentially all IOL's including the lowest cost ones from a reputable manufacturer like J&J and Alcon are going to be very high quality. The real question is what expectations do you have for the lens. Those that think they will get more quality when they pay more and go for a MF or EDOF lens may be very disappointed in the outcome even when they are implanted by a good surgeon. Those who are well informed and are prepared for the lower quality of vision with halos, flare, and spider webs at night, may be ok with them and appreciative of not needing glasses.
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I have followed your posts and I recall your priority is to be without glasses for driving including seeing the dash well, but you are prepared to use reading glasses for closer vision. If correct, I will suggest again that you get a good monofocal like the Clareon or Tecnis in your dominant eye first. I suspect that you have about a 75% chance you will get very good dash distance vision, and of course will need reading glasses for closer vision.
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If you get this vision and you are happy with it, then get the same monofocal lens in the second eye, again set for distance.
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If you don't get vision at dash distance that you want, then consider other options for the second eye. They would be another monofocal but set to be -0.75 D or so myopic, or a Vivity, or an Eyhance. That is a decision to be made after you have the first eye done. There is no need to sweat over it now.
john20510 RonAKA
Posted
THe most important thing for me is to have good distance vision without glasses for driving , tv and outdoors, l dont want to risk that by going with premuim to avoid glasses for close up, if l went with Eyhance or standard monofocal in both eyes set for plano / distance , at what distance will l need glasses, for example arms lenght or longer, and would l be able to do things like read car dashboard and make a meal? or Is perhaps the best option vivity in one eye and a monofocal in dominant
RonAKA john20510
Posted
Based on your objectives I would go for a monofocal aspheric lens in your dominant eye. A monofocal aspheric lens set for distance (target -0.25 D) is going to give you the sharpest image and highest contrast sensitivity at distance. I would expect you have about a 75% or higher chance of getting very good car dash distance vision. Once you see what you get in the first eye, then make the decision on the second eye. If you are a little short on close vision then go with an Eyhance or Vivity in the non dominant eye. And, if you are happy about the close vision with the monofocal set for distance, it will get even better if you do it in your second eye. But that is a decision to be made later after you see what you get in the first eye. I wrote you a more detailed reply but it got sent to moderation.
catherine85027 RonAKA
Posted
I just had cataract surgery on my dominant eye, and the vision is now 20/15. I can see so clearly now, and see details at great distance. I'm thrilled with the outcome.
I had surgery scheduled for the left eye later this month, but I rescheduled it to December because I need time to think about what IOL I want because the near vision in my new right eye is such that i can't see anything well closer than a foot.. My dash vision is fine; any closer, though,
and it would be fuzzy. I don't mind wearing glasses and was told I'd probably need 3 strength readers.
This site is a godsend, much to digest, and i haven't read through all the posts yet. i really like my surgeon, and he had suggested I could correct the left eye for near sight. I'm a bit nervous of doing that!
RonAKA catherine85027
Edited
That is excellent distance vision. My thoughts would be to wait a bit to ensure the dominant eye is fully healed. If there is a desire to essentially be eyeglasses free, I would ask to be left at -1.5 D in your non dominant eye. But, if you have reasonable vision in the other eye, it would be a good idea to trial that arrangement by using a contact in your non operated eye first. The power should be selected to leave you -1.5 D under corrected.
Guest john20510
Edited
I guess the key there is, define "good". Good will vary a lot from patient to patient based on their lifestyle, personality, expectations (see personality) and any pre-existing ocular pathology. But I get your point. The technology is so good now. It's like trying to choose between an Audi and a Lexus. But still, it's a big decision. And there are, I think, objectively better and worse decisions for some people (esp. regarding ocular pathology of course). But yah.
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One thing a friend said to me was "No matter what option you choose SOMETHING is going to change. And whatever that is, you will get used to it". The key I guess is trying to predict what you (for your lifestyle and personality) will most easily get used to. For me, as an extreme perfectionist, I think I'm going to play it safe and go for quality (monofocal / Eyhance) over quantity (EDOF / Multifocal).
john20510
Edited
with all the modern technology they have these days why the hell can they not give us some sort of accurate simulation so we can see what each IOL would be like before we choose, that would make things alot easier, maybe some sort of contact lens we can put in our eye so we can see what each IOL vision will be like
Night-Hawk john20510
Posted
Can't get a true simulation with contact lens or similar because your current natural lens in the eye may still have some accomodation which the IOL will not have. Also how close vision a monofocal IOL will give you clear focus can vary between each person even if it ends up perfectly at the target, plus the end result can end up being off from the target by typically up to 0.5D with even the best surgeon. Hence why most surgeons shoot for a slightly nearsighted target like -0.25D to avoid the error ending up farsighted which makes intermediate/close vision even worse. Also can end up with some residual astigmatism as well - usually due to how the eye incision ends up healing with also is unpredictable.
I had cataract surgery just in my right eye a few years ago with a Tecnis toric monofocal IOL targeted for clear distance vision. Ended up at +0.25D so within the 0.5D error range, but with a little more residual astigmatism than expected. Target for cylinder was -0.5D but ended up -0.75 to -1.00D that did compensate for the slight farsighted power so overall its similar to hitting -0.25D overall.
With this end result I get 20/25 (somedays near 20/20) distance vision with my right eye without glasses. I can read my computer screen from my typical viewing distance of full arm's length maybe 24"+ but its not as clear and sharp as I prefer it, so I use a +1.25D computer reading glasses at the computer for more comfort and best intermediate vision. My left eye needs correction anyway, so that also corrects for that eye's bigger astigmatism. For reading closeup I use +2.25D, I also have progressive glasses for general use (mainly for the left eye correction) that also has the +2.25D in the lower reading portion - so that works for general distance and smartphone viewing.
I probably won't need surgery in my left eye for years, but I plan for that eye to be set a little nearsighted to shoot for getting clear/sharp intermediate vision for computer screen distance and maybe smartphone viewing too. With the right eye's sufficient distance vision that would cover most of my vision needs. Just would use a reading glasses rarely when I need to thread a needle or similar super close sharp vision case.
Night-Hawk
Posted
I've noticed lately the new Light Adjustable Lens is being recommended more since it can eliminate the error after surgery and really get the result perfectly on target. Maybe even allow you to adjust it from distance to closer focus point if you find you prefer that after surgery. That lens appears to allow up to three adjustments before you have to lock it into the final setting. It uses UV light to make adjustment to the lens focus, so until its fixed you have wear special UV blocking glasses for the few months after surgery to avoid sunlight or other sources from affecting the lens.
Guest john20510
Posted
A contact wouldn't work since the cataract is inside your eye. With glasses the best correction I can get is 20/40 due to my cataracts. Contacts might be somewhat helpful to trial monovision but that's it. Maybe a contact could simulate the halos? Which might be somewhat helpful. But again without being able to correct your vision the simulation wouldn't be that helpful or representative of an actual outcome.
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The best hope are the new modular platforms under development. The idea is to implant a scafolding first and then the lens snaps into that holder (done in one operation just like today). If you don't get good results the modular nature of the system makes a lens exchange trivial and essentially no riskier than the original operation. Alcon has such a system in development but it's probably a ways off yet.
RonAKA Night-Hawk
Posted
I have been investigating Lasik to make a small correction to one eye post cataract surgery. It may be possible with Lasik to reduce your astigmatism to closer to zero. They tell me that reducing the sphere in the direction of more myopia (make cornea steeper) is very difficult. But taking your astigmatism down should improve your distance vision.
RonAKA john20510
Posted
For sure you can simulate monovision with contacts providing you still have reasonable vision prior to surgery. It is not a perfect replication but does give you a very good idea as to whether or not you like it.
There are MF contact lenses. I have never used them, so I can't say how well they replicate the vision of an EDOF or MF IOL.
rwbil john20510
Edited
"Every IOL's on the market must provide good vision otherwise they would not be on the market"
Not TRUE!!!!!
Yes having a Good and competent doctor is key, but a lot of people have come here stating they had a good doctor that suggested some inappropriate lens for their particular situation.
And that last part is KEY! Everyone is different. The diffractive IOLs I have, could be a disaster in another person's eyes as everyone eye health and condition vary. Even eye conditions such as having Long eyes or Short eyes make a difference.
I cannot stress this enough it is all about tradeoffs and understand those tradeoffs and then deciding which on is best for you and how much risk you are willing to take. And I suggest getting just 1 eye done and evaluating those results before doing the other eye.
I have a mix and match IOLs and I think that combo for me is better than if I had gotten the same IOLs in both eyes as each brings a benefit and each offset a disadvantage the other one brings.
I would highly recommend going to a few (yes more than 1) top doctor and see what they suggest and how your rapport is with them. I can tell you I went to many Opthmalogist before I chose the one I used and some of those Opthmalogist I would not have let operated on my eyes if my life dependent on it. I had done my research including understanding the advantages and disadvantages of the materials the IOL are made from and wanted a doctor that including me in the decision making process.
john20510 rwbil
Posted
what IOL's did you end up going with
rwbil john20510
Edited
I have the Tecnis Low Add MF in one eye and Tecnis Synergy in the other eye. IMHO the Synergy is the highest risk IOL out there and definitely not for everyone. It can provide the best close vision but at the risk of high dysphotopsias.I think it is best as a mix and match.