lens replacement advice
Posted , 16 users are following.
im almost 52, and been having to wear reading glasses for past cpl years. I tend to wear them all the time now, as use a computer and phone a fair bit. Without glasses near and intermediate txt is too blurry, and i think my distance vision is declining aswell. I have been in contact with praga medica, with a view to having lens replacement at a reasonable cost. They have offered me either panoptix trifocal or the vivity EFOF lenses. After some research i am totally confused as to my options, as i do drive often at night. This is a concern over trifocal with halos etc, and although the vivity reduces the halo effect, i may still need reading glasses, which is not an option, as i want to be glasses free
any help or advice will be greatly appreciated
0 likes, 34 replies
RonAKA carlspaced1969
Edited
If you are planning a clear lens replacement (no cataract) with an artificial intraocular lens (IOL) I would highly recommend against it. Defer that procedure until you need to do it as the result of a cataract that is significantly impacting your vision. I would recommend against Lasik as well, as that will complicate the implantation of IOL's when you do get cataracts.
Bookwoman carlspaced1969
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What Ron said. At age 52 you're not going to be glasses-free pretty much no matter what you do, but please do not undergo eye surgery, with its attendant risks, unless absolutely necessary.
Sue.An2 carlspaced1969
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I really don't think there are many if any on cataract forums that would recommend clear lens replacement (which is basically cataract surgery). not worth benefit versus risk. Reason why CLE is done on both eyes same day is so you cannot compare. There is a definite drop in contrast - I could see that after first surgery as the eye that still had cataract could see more contrast in dark situations. I was 53 at time of diagnosis - it was devastating.
My brother in law recently had CLE and when we visited him 2 months ago he didnt even know his natural lens was removed. He still wears glasses for some things to sharpen up images - something he did not want. however there are no guarantees you won't need glasses.
This surgery is usually a covered expense for cataracts so don't waste your money
carlspaced1969
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yea i do understand the risks, but cant believe how much my eyesight has deteriated over last cpl years, and i really hate wearing glasses. Maybe ive made them worse by wearing my readers all the time, but with looking at phone and pc almost all the time, i had to kinda get use to wearing them. Im not sure about contacts as would probably irritate my eyes, as they mostly dry. I was hoping that iol would be the answer, and rid of these pesky things i have to wear all the time.
Guest carlspaced1969
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Nope. Using your readers didn't make your eyes worse. Being 52 made your eyes worse. It happens to everyone. 100% of people lose their ability to focus sometime after age 40. Nothing you do or didn't do would have any impact on that. It's just a normal part of aging.
Guest carlspaced1969
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Wait. Use readers or progressives. All the multifocal and EDOF options right now suck compared to what will likely be available in 5 years or so (a true accommodating implant that can actually focus just like a natural human lens). We debate those options here because we have no choice. Most pre-op people here have no good vision at ANY distance. Today's implants are far better that what was available 5-10 years ago. It's amazing what they've been able to accomplish with a rigid piece of plastic. But ultimately it's still just a rigid piece of plastic. It can only do so much. The more range of focus they give you, the worse the overall image quality will be. There is no avoiding that trade off with today's technology. If the surgery is not 100% medically necessary I'd strongly recommend waiting. This is a destructive surgery that is essentially irreversible. Once it's done, it's done. You can't upgrade to better technology later on.
carlspaced1969 Guest
Posted
i get what you mean with regard to surgery, i guess it is a permanent op. I hate wearing glasses, and they dont suit me at all. Im also recently single, and not gonna land myself a new woman looking the way i am...lol. 5yrs there prob will be more advancements, but il be 57 then, we dont get any younger. I want to try enjoying life now, whilst i still can, had major back surgery, hips are on way out, eyesight is deteriorating
RonAKA carlspaced1969
Posted
I would think about using contacts to give you monovision. Places like Costco are pretty good at giving you trial supplies of contacts and letting you try different powers to see what you like. I have one eye corrected for full distance with a monofocal IOL, and use a contact in my non operated eye to give me monovision. I under correct to leave me at -1.25 residual. That allows me to read a computer easily, my iPhone reasonably, and all but the smallest text - all without glasses.
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I tested about 5 different brands of contacts and settled on the Costco Kirkland ones. They are CooperVision 1 day disposables and I find them really comfortable. And they are the least expensive of the choices.
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The upside of trialing monovision with contacts is that you can try different amounts and see what you like. Then later on when you get cataracts you will know if doing monovision with monofocal IOLs is for you or not. They tend to be the best way to get a full range of vision with the least risk of optical side effects. And also the least expensive way to go.
Bookwoman carlspaced1969
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If you go to a high-end eyeglass store, I'll bet they could find you a pair of glasses that would suit your face. And that would cost much less than having surgery. Also, anyone who wouldn't be interested in you because you're wearing glasses is not worth being with!
assia99778 carlspaced1969
Posted
I received trifocal IOLs (Zeiss AT Lisa) in both eyes one year ago - they are similiar to PanOptix and my advice is: If you don't have bad cataract in your eyes, stay away from these lenses and the surgery!
A piece of plastic - whatever it is called - will never work as good as your own lens. In fact you will have problems afterwards.
Unfortunately I had no access to this forum before the surgery and I wasn't told the truth by the surgeons about these IOLs. I'm now suffering from severe dysphotopsia which means large concentric rings and spider webs around point light sources. Night driving is a nightmare. It didn't decline within the last 12 months and it won't in the future. The farer away the object, for example a car, the bigger the circles. I can't see the object behind the rings, whether it's a car, a truck or a motor cycle. Glare even increased in the meantime. It hurts in my eyes and brain. I always have to wear a visor cap. Because of the glare I avoid using the highbeam headlights: There is too much glare from street signs. Brake lights from SUVs are now surrounded by up to 12 rings which increase the cars size up to double. Approaching cars or traffic lights are now looking like monsters. You are powerlessly submitted to this. Nothing can be done about it. I tried special glasses, lit up the drivers cabine, it didn't help. LED lights are causing the dysphotopsia as well. I can no longer enjoy Christmas and the beautiful lights but have to hide from them.
I got floaters as a result from the surgery. Again the visor cap helps to see less heaven, less white walls but it doesn't help during my work in front of the computer screen. In addition: They didn't hit the refractive target. I have significant residual astigmatism left in both eyes. I never wore glasses since my childhood but now have to wear them all the time. Varifocals or multifocal contacts are no longer possible with these lenses. These IOLs are not good for intense and demanding work in the intermediate range. I have to put readers in front of the far specs to manage it (computer work). There are gaps between near and intermediate. There is contrast loss. This although inhibits your driving ability. Be aware of this with the Vivity IOL as well. I know a man who got these lenses and now suffers a lot from it.
There a people who have less issues after IOL implantation. Maybe you are lucky, but maybe you are not. If I were you, I wouldn't gamble with my vision. And I wish I could go back to the woman I was before that surgery. Note: Explanting IOLs is a high risk procedure. I know what I'm talking about. There are top surgeons who told me about it and some of them even stay away because I'm rather young with high visual demands related to my work and 20/20 if corrected with glasses. 5-6 weeks after the surgery the capsular bag has shrinked completely. The artifical lens is much smaller than the natural lens therefore the bag shrinks. If you need a toric lens and if you have a higher degree of astigmatism combined with a higher degree of myopia, than you are facing a high risk of lens rotation. Just be aware of this.
I hope I have helped you in your decision. At least that you are able to make an informed one which I wasn't one year ago.
author11 carlspaced1969
Edited
I have an ironic answer/suggestion...
Short version: Your natural lens is best. Avoid surgery if you can. Keep your natural lenses.
Long version: I have PanOptix in both eyes, and I'm very pleased with them. Some people have problems with glare and halos. I don't. Vivity promises a lot, but math and people will tell you that Vivity depth of field is shorter than PanOptix. From a practical standpoint, depending on your eye, Vivity will give you good distance vision, good intermediate vision, and acceptable close vision down to about 20 inches. But stuff WILL be out of focus at 14 inches. You'll still need readers. If you shift the correction to close vision, you'll get that extra 6 inches close, but you'll need glasses for anything beyond 1 meter (about 3-4 feet). So PanOptix is really the only option to fix the vision problems you experience, without using glasses or contacts.
If you get a good surgeon, then about 299 times out of 300 you'll be satisfied with the results. Unfortunately, about 0.33% of patients are unsatisfied and need a lens replacement (according to one leading cataract surgeon, Shannon Wong). That's a low percentage, but it still translates into tens of thousands of patients around the world who are dissatisfied.
Now here comes the ironic part... Individual people may be MORE satisfied with monofocal IOLs or EDOF, but sometimes they have problems, too. They're stuck needing glasses. Sometimes they get glare and halos and other visual phenomenon similar to PanOptix. There are no guarantees of success. Also, between 30% and 50% of IOL patients (depending on who you ask, sometimes it's 100%) develop a condition known as posterior capsular opacification (PCO). Eventually, you'll need an additional procedure called YAG to handle that.
So... getting an IOL is not a panacea, and I don't recommend it unless you have cataracts or some other condition that requires the procedure. I had severe myopia... and now my vision is PanOptix-near-perfect at 20/30 in both eyes (two weeks after surgery and hopefully still improving). BUT I would have kept my bad eyesight if cataracts had not been progressively dragging me toward blindness.
carlspaced1969 author11
Posted
ah this is sad news. So its either carry on looking like s**t and relying on awful glasses or take a very huge risk. The whole IOL idea looked promising initially, and i was excited to rid myself of theses stupid glasses once and for all
jettesun carlspaced1969
Edited
a very gentle reminder... the right woman won't care if you wear glasses or not. i'm a single woman, older than you, but still... i'd be happy to find a sweet guy to share my life with, and i can promise you i wouldn't think twice about his looks. kindness, honesty, integrity, open-mindedness; those qualities are what matter and keep couples together.
carlspaced1969 jettesun
Posted
agree those qualities are most important, but we judged on looks initially....id be a swipe right...lol
Guest carlspaced1969
Edited
So to be clear… and maybe you're just joking or half-joking… and I'm trying not to judge but… you're worried about what you look like with glasses?
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Anyway it's your choice of course. I hope you carefully your motivations and the advice you've received here. Best of luck with whatever you choose.
author11 carlspaced1969
Posted
Dude... Guys like Bono, Ringo Starr, and Jim Peterik are famous for wearing glasses and looking hot.
There's a lot that goes into looks... and ya... you're judged by them (even tho good-hearted people sometimes claim otherwise)... but glasses are just a thing... like a jacket or shoes... the style in the piece either adds or detracts from your overall good looks.
If you want to try no glasses, then consider contacts... maybe contacts won't work with your dry eyes, but maybe they will. And the cost to find out will be near zero.
Or Google Bono, choose images, and start from there.
Sue.An2 carlspaced1969
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Agree with jettesun - women care more about character than looks. Don't go through an unnecessary surgery to rid yourself of glasses. There are lots of super cute frames today. Plus you may need them anyways as there is no guarantee with IOLs that you'd be completely glasses free. aside from healing process ending up a possible .25 D either way they also come in increments of .50 diopters vs .25 like glasses. Have you ever considered contacts vs glasses to give you that glasses free look you want?
assia99778 author11
Edited
The information given by Shannon Wong is not right. The truth is that for example in more than 25% of the cases the refractive target is not achieved. I quote from an article written by David F. Chang, who is one of the wordwide leading refractive eye surgeons:
"The second problem is our inability to consistently achieve
LASIK (laser-assisted in situ keratomileusis)-like refractive accu-
racy. The 2018 European Society of Cataract and Refractive
Surgery Eurequo study showed that 27% of eyes failed to land
within 0.5 D of the target refraction.
Despite improvements in biometry and IOL formulae, and the availability of intraoperative aberrometry, we must still correctly estimate the effective lens
position (ELP), and surgically induced and posterior corneal astig-
matism." Origin: "Disruptive Innovation and Refractive IOLs: How the
Game Will Change With Adjustable IOLs" from 2019 (Asia Pac J Ophthalmol (Phila) 2019;8:432–435).
Multifocal IOLs are very demanding, if they should work properly. Significant residual astigmatism is much harder to correct with LASIK than residual refractive error related to sphere. And monofocal lenses are more forgiving than the multifocal ones during the surgery and afterwards, if secondary intervention is needed. In addition to refractive errors and ELP there is decentration, tilt and bending that might occur after the surgery. And as David F. Chang stated: No surgeon in the world, no matter how experienced, can exclude unwanted surprises and outcome. In my case the surgeon was highly experienced and he made no mistake during the surgery.
Everybody who gets multifocal or trifocal IOLs with a diffractive optic will have dysphotopsia afterwards. It's physics due to the principle how the optic works. But they differ individually in size and intensity. If the refraction target is off and tilt, rotation or other deviations occur, you will surely have an increase up to intolerable phenomenas which are incredible and not imaginable for people who never experienced them. As I learned from this forum: Even if everything went right and patients see fairly well with their multifocal IOLs, there are still people who suffer from severe dysphotopsia several years after the surgery.
That's the truth and should be told every patient before the surgery. Everybody is then able to make an informed decision.
carlspaced1969 Sue.An2
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im going for a contact trial fitting on Tuesday, but not optimistic as my eyes are always dry
RonAKA carlspaced1969
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I use eye drops called HydraSense Advanced for Dry Eyes which contain 0.15% sodium hyaluronate. My wife has dry eyes and uses HYLO eye drops which contain 0.1% sodium hyaluronate. They seem to help. My wife uses drops regularly, and I just put a drop in occasionally when my eyes feel uncomfortable.
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My advice would be to get contacts made from silicone hydrogel, not just hydrogel. And I find the daily disposable ones convenient. I currently use the Costco Kirkland daily ones. They are the best I have tried and also the least expensive. They are made by CooperVision. Alcon and J&J make silicone hydrogel lenses as well, but I did not find them as comfortable as the Kirkland ones. I also believe B&L just came out with a contact made for dry eyes, B&L Infuse, but I have not tried that one. Alcon Precision 1 just came out as well, but I have not tried that one either. My advice would be to try a few different ones to see which work the best for you. I think I am up to about 6 different brands that I have tried.
author11 assia99778
Posted
The info published in a YouTube video by Shannon M. Wong, MD titled "Panoptix v Synergy – Which is the BEST lens for presbyopia-correcting premium cataract/lens surgery?" ... was reported by Dr. Wong about his patients, of which he has many thousands. The item we're discussing is at the 9:00 minute mark. He reports the "rate of explantation due to patient dissatisfaction" at 1:300 for PanOptix, and he indicates a comparable number for Synergy.
These are Dr. Wong's reported numbers. If you have a dispute about the veracity of what he reports, then please provide us evidence how Dr. Wong is misrepresenting the results observed in his own patients. Until I get further evidence from you, I'll believe Dr. Wong.
In another message you mention about your lenses that "both lenses are off-axis (residual astigmatism)". I'm sorry to hear that, and it sounds like your surgeon made a serious error. Based on your reports, my heart aches for you. Your reports about visual problems are significantly more serious than Dr. Chang's statements about "refractive accuracy" where he's primarily discussing the advantages of LAL which can be adjusted after surgery. I think conflating the three (surgeon error vs refractive accuracy vs trifocal satisfaction) is a mistake.
I'm not a doctor, but my lay opinion based on your reports in this forum is that you're legitimately very unhappy about the results of your surgery and that your current vision problems do not seem to me to be a failing of technology but rather significant mistakes by your healthcare providers in applying technology to your case.
assia99778 author11
Posted
Rotation occurs after the surgery when the capsular shrinks. It's not a fault made by the surgeon. It doesn't apply to people who don't need toric IOLs. Because 1° causes 3.33% loss of astigmatic correction, people with higher degrees of astigmatism will have higher residual astigmatism in case of rotation. I had secondary intervention for retotation. It's not that easy as you think it is.
For interested readers: The European Study cited by David F. Chang is to be found under:
Lundstrom M, Dickman M, Henry Y, et al. Risk factors for refractive error
after cataract surgery: analysis of 282,811 cataract extractions reported to
the European Registry of Quality Outcomes for cataract and refractive
surgery. J Cataract Refract Surg. 2018;44:447–452.
john20510 Sue.An2
Posted
if a young Brad Pitt was wearing glasses women would women no longer find him attractive ? l dont think so