Lens Replacement & Vitreous Gel

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Hi, I'm in the UK and aged 52.

I went to see one of the top surgeons in the country in a private clinic about having multifocal lens exchange, he refused and advised me to wait another 3 years as my vitreous gel had not deterioted.

I have since been to see a national company that offers this service and they had no issues offering me lens replacement based on the scans and tests they did, I didn't get to talk to the surgeon, just the optometrist who said it could be years before my vitreous gel deteriorated.

I'd like to know if there are more risks involved if I had it done now or should I wait?

 

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  • Posted

    Andrew ate you looking to exchange a standard monofocal lens to a multifocal or other way around?   Why do you want to exchange lenses?

    My understanding is that surgeons will do a lens e change within first 6 months after that it’s much riskier.  And more so if you’ve had a YAG (laser procedure for PCO).

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    • Posted

      Your surgeon is to be commended for refusing to replace natural lenses with multifocal lenses. It is a terrible trade to try not to have to use contact lenses or glasses when you don't have cataracts, and end up with all sort of vision issues, specially night Vision issues associated with multifocal lenses and Symhony lenses. (don't buy into all the advertisements about those lenses)

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    • Posted

      Andrew - you will not find many of us on the cataract forum that would recommend exchanging your natural lens for any IOL.  Always better to wear glasses or contact lenses until you have cataracts bad enough that vision can no longer be corrected.  Probably not what you want to hear but there are trade-offs with any lens you choose and due to the IOL being 1mm vs 4mm of the eyes natural lens no target can be guaranteed by any surgeon.  The IOL moves till it settles and there could be as much as .50 diopter either way.   Many patients find themselves having to wear glasses anyways.   The surgery itself can cause astigmatism.   

      For those with cataracts and cannot see well and have glare anyways these IOLs mean generally better eyesight than what they had and some willing to accept the trade-off of halos at night with multifocal lenses. But NOTHING is as good as the eyes natural lens without cataracts.  These private clinics make thousands of dollars with the promise of vision restored at all distances.  Once you have cataracts this surgery is free of charge on the NHS.   At 53 I was diagnosed with cataracts both eyes - best corrected vision was 20/60 and 20/50 with glasses.  Could no longer read road signs and driving st night a nightmare due to halos and glare.  When you have no option - then this surgery is a must but only then in my opinion.

      If you have time, read through some posts here - some had the clear lens exchange that you are contemplating.  They wish they hadn’t done it - and there is no going back once done.  

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  • Posted

    The surgeon who refused me did offer me phakic lens IOL.

    Tht would seem the better option then as my natural lens would not be removed and if I had issues then I could reverse the procedure.

     

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    • Posted

      Yes. That will be a better option.

      However, you may want to consider other options such as LASIK. If you do, make sure that the surgeon provides you with a detailed record of the cornea measurements before LASIK, as those will be needed by your cataract surgeon down the road for an accurate lens calculaion.

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  • Posted

    Andrew,

    I'm going to guess that the surgeon's reasoning for waiting for the vitreous gel to deteriorate is probably related to the risk of retinal detachment or similar issues.

    I'm 51 and going to give you the same advice as the orhers. Don't get this surgery unless you have cateracts. If you tolerate contacts, try every type of multifocal contact first and don't give up on it easily. If that doesn't or can't work for you and you REALLY hate glasses then the phakic IOL might work. Your surgeon sounds very ethical.

    Most iol patients are satisfied and that's what every study will tell you, but I think that is skewed because most people getting iol's have cataracts and are elderly so they are very tolerant of the potential problems and side effects with the surgery.

    I have a multifocal iol in one eye and despite some issues I'd consider myself very satisfied. However, the cataract in my other eye doesn't yet affect my vision so I cancelled that surgery and wear a multifocal contact. There's just no comparison between the two, the eye with the natural lens is much better. My satisfaction would not have been high if I had done a clear lens exchange and I'm one of the lucky ones who've avoided many of the debilitating side effects you'll read about on this forum.

    Please let us know what you decide.

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  • Posted

    Hi Andrew

    I'm 49 years old and I had lens exchange in Jan and Feb this year (I had Tecnics toric monofocals in both eyes).  I had around -5.5 in both eyes with astigmatism of around -1.  I now have monovision of -2.25 in the right eye and 0 in the left eye.  Still adjusting to the monovision (close up mainly) but for the most part my vision is fantastic.

    I'm very happy that I went ahead with it (in spite of the well-meaning warnings I got from some people on this site).  It's the best thing I ever did as I was sick of wearing progressive glasses that gave me sub-standard distance vision and I found contact lenses very uncomfortable (due to mild keratoconus in both eyes).  Now I won't have to worry about glasses for the rest of my life (except intermediate/computer vision glasses) and I don't have to worry about getting cataracts.  Yes, my risk for retinal detachment is slightly increased and I may have to have YAG in the future, but it was a risk I was willing to take.

    Everyone has to make their own decisions about this especially as obviously for you it is elective surgery and not an essential operation.  I personally wouldn't go to one of those big national companies that are in it just for the money.  My sister had lens exchange done in London a few years ago and she went with a doctor at Moorfields.  I can find out the surgeons name if you want it.

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    • Posted

      Hi CaroZim, thanks, the surgeons name woud be useful but I don't know how I would get to see him, maybe bengreferd by my doctor.

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    • Posted

      Hi Andrew

      Her name is Valerie Saw and you can easily Google her.  She wasn't cheap - my sister paid about GBP12,000 or thereabouts for both eyes.  But you don't want to be messing with your eyes and doing anything on the cheap - go for a good surgeon then you'll be less likely to have problems.  

      I totally get where you're at with not wanting to wear glasses anymore.  I've been wanting to get my eyes fixed for about 20 years: first I tried ortho-K but they said my eyes weren't suitable, then I couldn't afford lasik, then when I could afford it I saw a doctor in Cape Town who said I had keratoconus and so lasik was a definite no no. I then checked out PRK and that just seemed like it would be too painful so I left it.  I tried for a few years to find a doctor in Singapore where I currently live willing to do lens replacement on me but they weren't keen as I was too young (around 46 at that time).  Finally I found someone here willing to do it (although he did try to get me to go with special contact lenses first but when he realised I was determined to have the surgery he agreed to do it.

      Good luck in your decision making process.

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  • Posted

    Thanks for all the advice which will help me make an informed decision.

    I had been wearing contact lenses for around 25 years and glasses the last 15 years, I really wanted to be free of glasses and my eyes have become dry and sensitive the last few years so I looked at other options.

    I always dismissed laser eye surgery as I didn't want my eyes to become any more dryer so I checked out ICL in 2012 at a private clinic and was suitable but I never went ahead then a few months ago I was talking to a woman who told me about lens replacement which she had had last year and she said it was the best thing she had done.

    She said she had it at Optical Express and very happy, I researched Optical Express and wasn't 100% happy with the reviews so I went back to the private clinic and saw Mr Sheraz Daya who said he would rather me wait another 3 years but offered the phakic lens.

    I would still like some sort of procedure as for numerous reasons I'd like to be free of glasses at least for long distance.

    I've dismissed Optical Express as an option, I do have two other companies being Optimax and Optegra, and Optrgra looks like the better option as they use hospitals to perform the surgery and they look more professional.

    I will also go back and see Mr Daya about a phakic lens procedure before I make any decision.

    If I could wear contact lenses for longer than 4 hours I'd stick with them but I've tried almost every brand.

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    • Posted

      It is hard I know for you to make this decision - and it is a big one.   I wore contacts too for many many years but after birth of my daughter found my eyes would no longer tolerate them.  I have lived with glasses for last 15 years not wanting lasik for same reason you stated.   I know the clear lens exchange is fairly new and before I even knew that existed was diagnosed with cataracts both eyes that necessitated cataract surgery.  

      Cataract surgery is paid for on NHS.  If you develop cataracts in coming years this surgery won’t cost you anything unless you have it privately.

      As a few have said the lens options today - particularly the premium lenses all have night time halos or concentric circles.  Added to that is the measurements taken will provide surgeon with a good target but the lenses only come in increments of .50 diopters so they cannot guarantee you will be glasses free.  If you oct for monofocal lenses - yes you can do monovision to get better useable vision but some people don’t tolerate it well - little loss of depth perception which as you age can become an issue (falls, etc).  And with monofocals there is still the chance night vision issues will be present.  Lastly when we are younger our eyes dialate more and the IOLs are 6mm in diameter.  Many see glare or an arc (edge of IOL).

      Yes you will find good testimonials but there are people so sorry they ever opted for this.  With cataracts there is no other solution than surgery.   

      Only you will be able to decide if you can live with that decision should it not go as planned and you need glasses anyways.

      Really not trying to scare you - but want you to consider things thoughtfully.  

      If you do go ahead with it please post your thoughts on it and outcomes.  This forum is so useful to many people facing these decisions.

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  • Posted

    So, with an implantable lens like the phakic lens where I keep my natural lens would the halo's and night time problems still be an issue or that only with lens replacement?

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    • Posted

      You can find people’s experiences on the internet.  From my search - yes it is possible that there will be halos and night vision issues.  I will try and paste the link here but moderator may have it removed as some links they don’t allow.  To my surprise even with the implantable lenses lasik enhancement is sometimes needed.  This person has an interesting story.  She had this done 3 years ago so I am not sure if lenses have improved.  Her story was a. Interesting read.
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