IOL Exchange - let's get serious
Posted , 8 users are following.
Hi,
I've been trying to deal with positive dysphotopsia for the last 2 years, but I'm done. It's too much, I can't stand it any longer.
Tecnis monofocal.
Pilocarpine is killing me, it's so painfull and uncomfortable, it's not a solution at all.
What is your opinion about IOL exchage?
On one hand, removing the IOL which provides 25/20 seems like madness. On the other hand, not removing it sounds like madness too.
Moreover, there's no IOL on the market that guarantees any improvement.
Is there anyone in such trouble?
0 likes, 15 replies
Tramontj adamadam
Posted
Ive been dealing with this since last September! Unfortunately i haven't found a solution. There's no guarantee that a lens exchange would help and I'm not willing to risk my good vision. Sorry:(
It is disappointing! I do love my daytime vision!
I hope a solution may come in the future.
gmag21 adamadam
Posted
Adam,
I'm in the same situation as you! It's definitely possible to get an IOL exchange done and get good results that totally fix the issue. Have you had the YAG laser treatment? If so, the lens can still be exchanged, but it adds an additional risk/difficulty to the surgery. I've unfortunately had this laser treatment which is why I'm still on the fence about moving forward. I also have 20/20 at distance and near with my multifocal lens. I have disabling glare from indoor lights above the head but I've been able to manage by wearing a hat or controlling my light environment. I also get horrible ghost images around white text against dark backgrounds so I totally understand the frustrations with positive dysphotopsia. I'm also only 30 which puts me in an unusual situation since I have a need for many more years of good vision compared to the average cataract patient. If you do your research you can find surgeons that specialize in treating complications of cataract surgery. I flew up to New Jersey to meet with Dr Safran (he's one of these doctors). Even with the lens being in my eye now since 2007 and a history of YAG, he seems pretty confident he could remove my lens with relatively low risk. I think he told me he does 3-4 IOL exchanges every week so he's extremely experienced. Is your main issue halos or do you also get glare/ghosting?
gmag21
Posted
You could also try Alphagan drops instead of Pilocarpine. The Alphagan works better for me and isn't as strong compared to the pilo.
adamadam gmag21
Posted
My main issue is everything - starburs, galos, glare.
adamadam
Posted
*halos
adamadam
Posted
No PCO.
What do you think of Steven? What was your impression? He offered Sofport right? Are you going to do that? It's a bit complicated for me as I live in Europe.
I'm 28.
gmag21 adamadam
Posted
My impression of Steve was that he knows his stuff. I also talked to other doctors who know about his reputation. If you search youtube for IOL exchange you'll find many of his surgery videos. The sofport is made of silicone so it's less prone to positive dysphotopsia compared to an acrlyic lens. I'm still not sure if I will do the exchange since I can reduce my issues by wearing a hat or avoiding uncomfortable situations (however I think about doing it all the time)
adamadam gmag21
Posted
Actually I think about doing it all the time too and it drives me crazy. I'm afraid we should go ahead anyway, regardless of the risk. It's gonna be harder and harder each year.
You're lucky that you have Safran nearby (same country). It's not possible for me to fly across the Ocean to see him.
Tramontj adamadam
Posted
I am interested in learning about Sofport . This is the first I heard of it. Wonder if it was available when I last saw my doctor.
gmag21 Tramontj
Posted
The Sofport lens is pretty old (I think it's been around since early 2000s).
adamadam gmag21
Posted
That's correct yet supposedly there's no better IOL available (shame).
RonAKA adamadam
Posted
I think the concept of the Sofport being "better" may be to some degree in "the eye of the beholder".
.
As best I understand it, PD is more likely to occur in someone that is younger (like you) and has a larger pupil diameter. It lets light in at a more sideways angle to hit the edge of the IOL. Light hitting the edge of lens causes reflections and the problem of PD images. These reflections are more likely to occur with a higher index of refraction lens material, like a Tecnis (or Acrysof) acrylic. The reflections are further aggravated by sharp edges at the outside of the lens, compared to rounded edges. Also the further the lens sits back in the eye the more sideways light can get to the edge, although that is considered to be a minor contribution for PD.
.
What that suggests is using a lens with a lower refractive index like silicone, and having rounded edges. The lower refractive index also makes the lens thicker and it may sit further forward in the eye. From what I read silicone is a common choice for an exchange where PD has not been tolerable.
.
So why isn't a silicone lens with rounded edges used in the first place? It used to be, but the market has moved to about 80-90% acrylic lenses. The main reason is that the lens is thinner due to the higher refractive index, and as a result it can be folded up smaller requiring a smaller incision in the eye that is less likely to cause damage to the eye and induced astigmatism. Silicone lenses with rounded edges at least in the past have been associated with more PCO issues. And the silicone material may not bind to the eye as well as an acrylic and move from where it is supposed to be. It may also be more susceptible to calcification over time. And, relevant in your case, most IOL's are implanted in much older people with cataracts. Their pupils are smaller, and the issue of PD is less likely in an older person.
.
I think you are on the right track with a silicone lens. If it is bad enough to go through a lens exchange, I would look for someone that is experienced in doing an exchange and with using silicone lenses. They should know the pros and cons of the silicone lenses available. The Sofport while old, may still be the best of that type available.
.
Those are just my thoughts based on doing my research of available lenses on the market. I'm much older and will be 71 before I get my lens so my priorities are much different as to what the best lens is. I will probably go for an Acrysof aspherical acrylic lens, knowing there still can be issues with it.
.
Hope that helps some
tamarinda adamadam
Posted
Hi adamadam,
I'm sorry you're suffering with this so much.
I also have a Tecnis multifocal in my non-dominant eye and a lot of positive dysphotopsia with that eye. Halos, ghost images and starbursts with oncoming headlights. The ghosting and halos bother me the most. I have 20/15 vision at distance and very clear vision at 17".
I got a B&L Sofport L1A16 (I think that's what it is...it's the same one everyone talks about) in my other eye, set for distance. I got a fair amount of intermediate with that eye, which fills in the multifocal nicely. It's a much nicer quality image with the silicone...more natural. Richer colors. But of course I don't go comparing eyes anymore.
The Sofport does have some haloing around stoplights, like a haze rather than concentric rings. And it's 20/20 with a slight astigmatism so not perfect either. The specialist said my retina is still young. The two eyes together give me excellent acuity deep into the night as long as I'm not looking right at lights.
The monofocal in my dominant eye didn't make the dysphotopsias go away, but it made it neurologically and psychologically tolerable. It took the stress out of it.
I also had so much freak out about this before the second eye, that I realized the only way out was going to be to meditate every single day. So I took that seriously and am still doing it. I lapse for a few days, and then notice that I'm irritated or upset more...and remind myself to start each day with at least 5 minutes. I'm grateful for the impetus...I've been admiring meditators for some time now. And now I am one too.
I will say I love the evenings (which it is right now)...when the lights stand out but still don't halo....and meanwhile everything else is crystal clear and bright. It's like a Magritte painting. 😃
I also noticed that depending on what I've been doing recently, what I see changes. So when I stare at the computer all day long, then the halos are worse at distance because my brain is selecting the non-dominant eye more. If I spend the day looking at distance (hiking or something), then my dominant eye is more present and I can feel my brain selecting it. This means maybe I should stop staring at the computer! Hehe.
I am technically still considering a lens exchange, but it's been a year now. I do love my daytime distance vision and the lack of need for glasses except for very tiny print or dim lighting or prolonged computer work. In all those cases, I can "force" my eyes to see anyhow, so my stubbornness usually means I don't wear glasses ever. I probably have more eye wrinkles from squinting as a result! (I'm a very youthful 51.)
I'm assuming you have multifocals in both eyes? If so, then one exchange (your dominant eye) might really be worth it if you can find an excellent surgeon. Because it sounds like your mind is still stuck on this and so not relaxing into accepting the aberration.
One thing that helped me was talking to friends and family, and asking them what exactly they see. Some with no glasses and no surgery said if they looked hard enough they could see a little haze around stoplights. Or others would say, "You can read that sign way over there??" That showed me that everyone's vision is imperfect and some Lasik folks have even had halos for decades and never mentioned it. One said, "Yeah, driving at night sometimes gets pretty glaring, but you make do! I'm just glad I'm not blind anymore."
That's when I started focusing on what I'm capable of doing (everything) even with the dysphotopsias, rather than focusing on what I thought I SHOULD be seeing. Reading this forum showed me that there are lots of folks who have issues, some far worse than mine (bless them), and so that made me grateful for what I have. And I also looked around at my young friends and colleagues: all of them in their 20s and wearing glasses!
It sounds like you could do a thorough search for exchange specialists in your country and Europe, interview a few of them (information eases uncertainty) and have faith that the right one will come to you. Or that you'll get clear that you can be happy as is.
adamadam tamarinda
Posted
Hi, no, I do not have multifocals.
I have a MONOFOCAL IOL in ONE eye only (bloody Tecnis 1-piece). The other eye is young and natural.
So it's a super difficult case as I'd exchange one monofocal IOL for another.
In my case, it does't matter that my other eye is natural. The IOL still provides extreme dypshotopsia, espiecially starburst which is DISGUSTING and there's no relief from my natural eye - a marged image is as awful as that provide by the IOL alone.
ad12345 tamarinda
Posted
tamarinda Is it possible to get you email and ask few questions?