Looking for recommendations regarding monovision and Apthera ic-8
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I am a 52 year old with a strong correction in both eyes (-4.5 D spherical, -3.5 D cylinder). I tried to contact a surgeon regarding getting lasik because my right dominate eye was experiencing worsening vision and I was hoping to get my eyes corrected to moderately myopic (-2.0 D) without astigmatism. Unfortunately, my doctor informed me that I was not a good candidate because I had a cataract forming in the center of my right eye as well as cortical cataracts forming on my left and right. Thus they recommended that I have a IOL implanted. The first doctor recommends two fixed focus toric lenses and the use of glasses for intermediate and near. But when I researched more I found there were options that were not discussed with me so I got a second opinion and did further research. To add to the issue, when I met with my optomitrist, she tested me and discovered that I had nearly 1D of preexisting monovision. Because my dominate eye is weaker than my left, and I had refused upping my prescription in my left so many times my visional range was now separate with my right eye only in focus for 1m to infinity and my left used almost exclusively from 30 cm to 60 cm (though it does have 20/35 at infinity current due to larger accommodation range than right).
I got a second opinion regarding surgery and this time brought a plan which best meets a computer jockey who spend 8 hours reading and 8 hours on computer regularly (and will do so for next 10 years). The new surgeon was happy with the plan of using a Synergy TECNIS in my right eye and a Apthera IC-8 in my left with a range set for monovision. However, he wanted me to wait a year to see if a toric version of the Apthera IC-8 was released.
Thus my question, the manufacture's recommendation for the Apthera IC-8 is for a target of -0.75 D which is micro monovision, but has anyone had experience using this for full monovision (-2.0D)?
Given my current level of monovision (~1D) and the use of a trifocal which gives adequate near, it would seem that something in the range of -1.25 to -2D would be better than a -0.75 D which is mainly for far to intermediate range. Given the extended range of the Apthera IC-8 a -1.5 D would leave me with 20/45 at distance which I find tolerable when mixing lens from different glasses and at the same time decent vision at 30 cm. Does anyone have an opinion as to whether using the Apthera off label would be a bad idea?
0 likes, 24 replies
Lynda111 karl04879
Posted
karl04879 Lynda111
Edited
Thanks for the reply. My first surgeon wouldn't meet with me for a follow up prior to surgery so that is why I went with to the second. The second has been conducting cataract surgery since 1994 and had experience in using mixed lens to meet patient needs including mixing of biofocal/trifocal lenses with monofocal.
I am interested as to why you think a monofocal is best for my right eye. I would be fine with a monofocal on the left as so long as it can be correctable with lens to different distances I can function. But what reason for using the same on my right?
Lynda111 karl04879
Posted
Part of my earlier message got cut off. Ron explained why a monofocal would probably work best for you better that I can. I will add that monofocals are less like likely to cause issues. Some like the Acysof, the enVista, or the Tecnis 1 have a long track record. I think it's best to keep it simple. I work in health care and I know a number of physicians who also feel that way.
RonAKA Lynda111
Edited
Here is your post that got cut off. The trick seems to be to highlight and copy it. Then paste it like I have in this post. The text seems to be there but is not visible due to formatting issues with this forum software.
"Stay with a monofocal. If your cataract surgeon doesn't use the enVista or the Clareon, you can go with the Johnson and Johnson Tecnis1 or the Eyhance. Get at least two opinions. Try to find a cataract surgeon who is fellowship trained in Cornea/Anterior Segment surgery. They specialize in cataract surgery. Find someone who will listen to you, take time with you, and you feel comfortable with."
Lynda111 RonAKA
Posted
Thanks, Ron. It has only gotten cut off 2 or 3 times over the past year or so.
jimluck karl04879
Edited
I suggest getting the IC-8 and plan on wearing glasses with it for additional astigmatism correction. The IC-8 will give you the best depth of focus. For me, wearing glasses is not a big drawback as long as I don't have to use multifocals or 2 or 3 different pairs of glasses. Maybe you feel differently.
I'm not necessarily suggesting bilateral use of the IC-8 but there are plenty reports of successful bilateral use. And there aren't reports, that I am aware of (and I have read everything I could find on this lens) of people who have it saying it is too dim.
Some with big pupils complain of photic phenomena.
In one study, 50% of those that got the IC-8 bilaterally achieved vision of 20-16 whereas none of the unilaterally implanted achieved this result.
Google "Small Aperture IC-8 Extended-Depth-of-Focus Intraocular Lens in Cataract Surgery: A Systematic Review." This is an overview of many studies.
There is a lot of misinformation and uninformed opinion about the IC-8. Something about the pinhole makes people think they are an instant expert on it without having to do read the actual research. So if you're interested in it, go right to the scientific sources.
I agree about monofocal for you over trifocal. With your array of eye problems I would run screaming from anyone who suggested the trifocal. In contrast, the IC-8 has been very helpful in treating problematic eyes. In an article in CRST by H. Burkard Dick the author reports on implanting the IC-8 in a patient severe eye trauma resulting in 20/100 vision and achieving 20/25. Dr. Dick has extensive experience with the IC-8. He writes:
"Patients who receive the IC-8 IOL in one eye and a standard aspheric lens in the other have achieved an average UNVA of J1, along with 20/20 for both UIVA and UDVA.1 In another study, the small-aperture IOL did not decrease binocular contrast sensitivity, even under mesopic conditions.2
Unlike other premium lenses that require specific parameters to maximize their attributes, the IC-8 is an incredibly forgiving lens."
karl04879 jimluck
Edited
Thanks for the reply. I am very much in agreement that the depth of field for the IC-8 is impressive and if a bilateral implantation with a toric correction were available then it would be my first choice. The ability to deal with up to 1 D of residual astigmatism would make it the most forgiving option.
I also found the articles regarding the night vision. Your view is supported. In terms of total light one would assume there would be a loss in night vision, but all studies I can find show it not to be the case. Only by comparing the monofocal eye was it at all measurable and far less than the physics model suggested.
I discussed whether IC-8 with lasik was an option with the surgeon. He recommended waiting the year to see if a toric was available. I can certainly manage that long by swapping between glasses. Given my right eye is the worst, I have considered reversed monovision. But given I am already adapted to near on my left, I would have to test with contacts and glasses to see if I can tolerate it.
Thus far I have yet to find any studies on IC-8 plus lasik nor IC-8 being tested with a toric option. Many articles mention pinholes as being the solution for irregular astigmatism, but I haven't been able to find a product that matched. Hence reaching out here.
I put in a call to the makers of the IC-8 to see if there will be such an option.
Regarding trifocal there appear to be a fair number of differences in the level of forgivingness between products. Synergy seems to be one of the least forgiving. I still have more research to do on that front.