Is it worth $1500 for laser? and mini-monovision vs distance IOL for 2nd eye
Posted , 6 users are following.
I have three main concerns re cataract surgery in my 2nd eye:
Is the laser worth it?
Choosing between mini-monovision and distance
Not doing 2nd eye for years, using contact lense instead?
I had cataract surgery in my R eye 5 weeks ago, and paid $1K extra for the Toric lense and $1500 for the laser, because my surgeon sang the praises of the laser as giving a better outcome and being safer, and he recommended the Toric lense as well. I was told that I was too nearsighted for multi-focal lenses, that I would get lots of glare and shadows.
The surgery went well and I now have excellent distance vision in my R eye. But I’ve since done research online on the femtosecond laser and have found that the consensus seems to be that laser isn’t worth the cost, esp for routine surgery. (I don’t have any complicating issues).
In fact, I haven’t found any experts online who recommend the laser. Some say that not only is it more expensive, it also causes more trauma to the eye (because of the way the eye must be “Locked in” to the laser, and the additional time under anesthesia). I had a very hard time waking up from the surgery, sleeping 30 hours out of the next 48! It was about 5 days before I could see well.
So now I’ve lost some confidence in my surgeon, since I learned that he has a financial interest in the surgical facility where it was done, and I know those laser machines are mighty expensive and they need to use the machine to pay for it. Also, he told me that Light Adjustable Lenses are not yet approved by the FDA, but someone near me is offering them!
Now I need to decide on how to do my L eye, and it feels like a big decision, since vision is so important and I hope to get it right the first time.
I am currently using a contact lense in my L eye for driving and when I go out, so one option is to put off cataract surgery in my L eye until the cataract has gotten worse, and just continue using the contact lense for now. Vision in my R eye could only be corrected to 20/75, and is now 20/20 after surgery—a great success! But my L eye can be corrected to 20/30, so that cataract is not too bad yet.
I’ve only been using the contact lense for two days, and I struggle to remove it, but hopefully that gets easier with practice.
Reasons to delay:
-Medicine is always advancing and they may have better materials or techniques in a few years.
-I do a lot of reading on my phone, and I can currently read my phone with my L eye with no correction. But with the contact lense in, reading requires glasses, so it would be the same with a new IOL.
-I can’t decide between mini-monovision and distance vision. I’d like to hear from others how your made this decision.
Reasons to do it now:
I know a man in the UK who has been told he can get his surgery only if he takes the Covid vaccine. I’m afraid it might come to that in a year or two in the US and it would put me in a terrible predicament, I will not take it.
It’s weird living as I am now: excellent distance vision in one eye and excellent very close vision in the other. Lop-sided.
I’d be interested in hearing your thoughts on these dilemmas, and esp any books or other sources that you’ve found helpful.
Thanks!
0 likes, 19 replies
RonAKA Mostly_healthy
Edited
Is the laser worth it?
.
I really can't comment on that. I did a little research on it early on, but the surgeon I go to does not offer it, so it became a moot point. I had my right eye done about 8 weeks ago now, and there were no complications. I just went for my eyeglass prescription check earlier this week and my spherical correction required in the eye is 0.00 D. Nothing. There is some residual astigmatism as I did not have enough to use a toric lens. I see a bit better than 20/20 still. My incision healed well with no complications.
.
Choosing between mini-monovision and distance
.
I am currently in that situation and am using a contact in my non IOL eye to simulate mini monovision. It is about -1.25 D under corrected. I can read my iPhone 8+ fairly easily and the computer screen. Distance vision is 20/20 mainly due to the good right eye. I am not 100% convinced I will go that way when it comes time to do the second eye, but it looks promising. I have no trouble driving day or night. I am also thinking about a AcrySof IQ Vivity EDOF lens in the second eye, possibly in a monovision correction power. They are said to give an extended rage of vision, but without the flare and halos associated with multifocal lenses. What you may want to consider is trying monovision out by using an under corrected contact in your left eye to determine if you like it or not. It is easy to try different degrees of under correction to compare as well.
.
Not doing 2nd eye for years, using contact lense instead?
.
I will go a minimum of 2 years before I am likely to be eligible for a second IOL in our Canadian health care system. I currently see too well with the left eye. I did order some progressive eyeglasses this week and will use them in more difficult vision situations, but I plan to do the contact lens monovision most of the time. I currently wear one contact about 15 hours a day. I got samples at Costco Optical and tried 5 different brands. I did not find that the hydrogel lenses (Acuvue Moist, B+L BioTrue) would last me beyond mid afternoon. They seemed to dry out. The three Silicone Hydrogel lenses were better (Acuvue Oasys Daily, Alcon Total1, Kirkland Daily). I decided the Kirkland Daily lenses stayed the most comfortable the longest for me. They are actually CooperVision My Day lenses rebranded by Costco. They are a bit more flexible and harder to put in than the other two, but I now manage to get them in on the first or second try. I find you have to do quite an aggressive pinch on them to get them out. That part is now almost always a one try affair.
.
If you need a toric contact, I believe of these three the only one that is available in toric is the Acuvue Oasys. I have some astigmatism but went with a spherical lens instead. I find I am constantly blinking with a toric lens to see clearly.
.
I can't comment yet on the eyeglass solution, but it will be interesting to see what I like over time compared to the eyeglass free contact solution. My current eyeglass solution is an old pair of glasses with the right lens removed. The correction is not quite correct, but in general I don't like it much. Seems to make me feel dizzy for some reason.
.
I hope that helps some. From what you are saying there is no reason to rush into doing the second eye. Take some time to consider the options.
Mostly_healthy RonAKA
Posted
Thank you RonAKA for that detailed response! One thing I feel sure of now, is that I will find a new surgeon. Cataract surgery requires a well-informed patient to make good choices, and I am resentful that I didn't get much counseling about my choices. Being pressured to spend $1,500 that I didn't have doesn't help either.
I'm using the Acuvue Oasys lense for astigmatism, and so far it's going well.
Late here so signing off. Thanks!
RonAKA Mostly_healthy
Posted
On the laser vs conventional surgery question you may have found this article already, but just in case. Here is a phrase that you should be able to google and find it.
.
Review of Ophthalmology MARCH 2017 Update: Is FLACS Better Than Manual Surgery?
.
My conclusion is that there is no slam dunk advantage to the FLACS method, and in fact actual outcomes may not be as good. It seems surgeon proficiency with both methods may be the most important factor in what the outcomes are.
.
I think the Acuvue Oasys lens is a good choice for a toric lens. You may find the 1 day disposable version to be better than the two week version, but also more expensive. When my current supply of spherical contacts run out in 6 months or so, I may try these toric ones to see if it helps with the vision.
.
One point to discuss with prospective surgeons is the need for a toric IOL. As you know there is a premium price attached to them, and from my research they are the best way to go for significant astigmatism. However, if your corneal astigmatism is less than 0.75 D (not your eyeglass cylinder, but what they measure on your cornea topography, which can be much less than the eyeglass indication), a toric IOL is not really suitable. This is because they typically come in a minimum correction step of 1.5 D. So, if you use this minimum 1.5 when you have 0.75, the post op result is still an error of 0.75. You have gained nothing. You only start to gain on the residual error if your astigmatism is over 0.75. An error of astigmatism of 0.75 or less is probably best corrected with a limbal relaxation incision post op after the eye settles down. The reason for doing it post op is that the incision for the cataract can change the amount of astigmatism you have compared to pre op.
Sue.An2 Mostly_healthy
Posted
I read the sane articles when looking at laser 3 years ago for my own surgery. wasnt available here in New Brunswick Canada anyways at the time. I believe surgeons get comfortable with a procedure and a particular lens and often undervalue what they aren't familiar with (not discounting a profit value factoring into it). You will want to research and then find a surgeon comfortable with that. I wouldn't go to someone who always uses laser and ask for conventional method.
Maybe start from scratch and take your time getting consultations from a few places.
Out of curiosity why wouldn't you take the covid vaccine? Most of us will gave to wait months unless we work on front lines. Plenty of time to know if there are issues. I do think those not taking it may see consequences like not being able to fly, etc.
Sue.An2 Mostly_healthy
Posted
My cataract surgery without laser went smoothly. I was see to see well within 24 hours.
janus381 Mostly_healthy
Edited
Is Laser Better?
Your first three response are from Canadians. In my province, doctors cannot even offer the more expensive laser-assisted option unless the patient is choosing something more than the most basic lens (at a minimum a toric lens is required before they can offer laser).
My doctor did not try to upsell me on the laser-assisted option at all; she said the outcomes are pretty much the same after one-year.But I picked the laser option for the following reasons:
• The thought of “more precise incisions, more precise placement of IOL, less energy to break-up the cataract” were appealing to me, particularly since I was going for the most advanced premium available at the time (the PanOptix tri-focal).
• While outcomes are “pretty much the same” after one year, is there even a very slight chance (say even a 0.25% chance of a better visual outcome with laser)? Even a very small improvement of odds of a great outcome was worth it for me, with a premium lens. Such a small improvement in odds cannot be measured in studies, but it seems logical that greater precision would at least very slightly improve odds.
• And the final reason for me is I’m a big chicken when it comes to eye surgery. I don’t like to watch videos of how cataract surgery is done. The idea of a laser making precise incisions, versus a surgeon (no matter how skilled or experienced) making manual incisions…well I just felt more comfortable with laser and even that is something.
• The other advantage with Laser is that if your astigmatism is modest, then the astigmatism can be corrected as part of the Laser Cataract Operation with Limbal Relaxing Incisions. I didn’t know at the time of my decision if that would apply to me, but in the end, it turns out my Right eye had astigmatism corrected with the laser, while my Left eye was borderline so they went with a Toric lens in the Left eye.
In the follow-up appointment with the surgeon, I asked her some more about her views on this. She said she does not want to make patients feel that they need to pay extra for laser to get better outcomes, but there is no doubt the laser is more precise than a human hand in making incisions. And if it were her mother (she is younger), and money was not a concern, she would choose laser.
I was not sensitive to the price, so I think I made the right decision for me, and my outcome has been very good.In your case, Toric monofocal is not a complex as Toric Trifocal, so I don't think it's necessary to go laser. The majority of cataract surguries are done the traditional way.I also would not get too hung up about a few articles that suggest outcomes may be worse with laser, there will always be articles with different opinions.
Sue.An2 janus381
Posted
Janus you are brave to watch the procedure beforehand. I am too squeamish.
janus381 Sue.An2
Edited
I didn't watch! Like you, I don't need to see everything. But I felt very calm going into my cataract surgery (and knowing it was laser did make me feel more comfortable). I provided a detailed summary of the steps involved with the laser-assisted option in my long post from last year ("Cataract Surgery Just Completed -- Sharing My Experience - PanOptix Tri-focal"). The laser portion was very comfortable.
RonAKA Sue.An2
Posted
If you work up the nerve, here is the surgeon that did my surgery demonstrating how to load and insert a lens. I watched it, but I also asked for the sedative treatment for the surgery, as he recommended. I was quite aware what was going on, but it was totally painless.
You Tube Chris Rudnisky How to load a single piece Alcon IOL
Sue.An2 RonAKA
Posted
Thanks do have courage to watch after my own surgery. Will watch this one. To be honest I assume New Brunswick doesn't have the laser equipment (so not 100% sure of what my surgeon used. He is our top paid one here and I have no complaints.
Mostly_healthy janus381
Posted
janus381, do you know why the laser would be indicated for the Toric lense but not a regular lense? I don't think there would be any medical reason for this rule. I got a Toric lens in my right eye, but the surgeon never mentioned that as a reason for choosing Laser.
Is it because, in Canada, the patient pays out of pocket for the Toric so gets an "upgrade" to the laser? I'm in the US so don't know much about the Canadian health system.
janus381 Mostly_healthy
Posted
Yes, it's because in Canada, the basic lens and surgery is paid for by the provincial health plan, and they don't think it is reasonable for surgeons to upsell the laser-option (paid for out-of-pocket) if all you are getting is the most basic lens (where the greater precision of the laser option has no benefit).
If you go for a more expensive lens (paid for out-of-pocket), then in Ontario the surgeon is allowed to offer the laser-assisted option for more precision incision, more precise placement, faster recovery, etc....
But aside from faster recovery, studies show that the results are pretty much the same after one year (which is what my surgeon told me). At the time, she was doing about 40% laser, and 60% traditional, whereas the famous/well-known doctor at the clinic was doing about 50/50.
janus381
Posted
Just to add a more recent article on laser vs traditional. From this year in the European Journal of Ophthalmology: "The benefits and drawbacks of femtosecond laser-assisted cataract surgery"
From article:
Conclusion:
Femtosecond laser-assisted cataract surgery seems to be beneficial in some groups of patients, that is, with low baseline endothelial cell count, or those planning to receive multifocal intraocular lens. Nevertheless, having considered that the advantages of femtosecond laser-assisted cataract surgery might not be clear in every routine case, it cannot be considered as cost-effective.
Biggest drawback is added cost, and for clinic, it takes longer because you need to move between equipment.Benefit is greater precision, which really is only beneficial if you are getting a premium tri-focal lens.If it's just a routine mono-focal toric, then there really is particular advantage to paying extra for laser (aside from maybe faster recovery).
scott10751 Mostly_healthy
Posted
You might be answering your own question by saying you don't have any complicating issues.
I had a vitrectomy in February due to a post vitreous detachment in my right eye and excessive floaters (think muddy swirling water, not the occasional dot or string). My left eye has also had a post vitreous detachment, but the floaters in that eye are fine to deal with. If possible, I'd like to avoid the vitrectomy for the left eye. From what I've read, regular phaco is breaking up the cataract with ultrasound and can cause additional floaters as there is a lot of turbulence as that takes place. The laser, while supposedly not necessarily having better outcomes, is a gentler procedure (if I understand it correctly). For that reason, I'm going to request the laser.
If I wasn't as near sighted as I am and didn't have the vitrectomy and floater issues, I'd probably go the phaco route.
Hoping I can get the go ahead this February, despite the left eye being fine (from a cataract standpoint).
RonAKA scott10751
Posted
Now that you mention it, I did see a few very tiny floaters in the first month after surgery. I had forgotten about it. I have not seen them for weeks now.
Mostly_healthy scott10751
Posted
Scott10751, sounds like you must be in Canada, since you refer to "getting the go-ahead?"
I am quite nearsighted (about 20/400 in the eye that hasn't had surgery yet) but AFAIK that's not relevant to whether the laser is good or bad for me.
scott10751 Mostly_healthy
Posted
No, in the US. I'm under the assumption that unless the cataract is affecting my vision to a far enough extent, insurance doesn't cover the procedure. My vision is definitely being affected, but is it enough?
The glasses prescription for my vitrectomized eye is -19.5, I can't find what that would be in the visual acuity scale, one chart says -8 is 20/1000.
It seems I've lost most accommodation in that eye. I've worn contacts for 38 years, just over 51 now and they are starting to give me trouble for the first time, and glasses are coke bottle types that are heavy to wear.
The other eye doesn't have a cataract but I would most likely have to do that one as well due to the extreme difference I would have between the two eyes.
I've read Bookwoman's posts and think I'd really be happy with an outcome similar to her, God willing. To be around -2 so I can see my monitor and do close up tasks without glasses, and wear glasses for driving/watching TV, etc. The MX60e looks like the lens I would choose if I have a choice.