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Multifocal vs Monofocal Near vs Far Laser vs Conventional

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primeland
primeland

I am told I need to get cataract surgery on both my eyes,.  My left has a fairly dense nuclear cataract and my right  eye not as bad.  I have the following decisions to make and I would love to hear from anyone who has gone thru what i am about to go thru who can help me with my decision and lessen my anxiety.

1.  I am told I could wait if it is not interfering with my quality of life, but that if I wait too long, the longer I wait the harder the cataract will become and if it becomes too hard and/or brittle, it could make the procedure more difficult and hence more risky.

2.  I am near sighted., I wear progressive glasses.  Nothing is sharp anymore because of my cataracts, even with glasses but I can see my computer and my smartphone without glasses.  If I go with monofocal, which one?  Distance, intermediate or near?  Anyone who had this surgery and chose one or the other, would love to hear how you are dealing with being able to see only one out of those 3 choices and whether you are happy with your decision..

3.  Multi focal vs Mono focal:  I am told multi focal has not been perfected yet and there is a loss of contrast you don't have with mono focal.  Also there is a problem with glare and/or halos.  Some people are so unhappy with multi focal that they have another operatnion to switch to monofocal.  Would love to be able to see at all distances but want to know what people think who have gotten the multi focal. Also there is a new multi focal for the past few years called TRI focal instead of BI focal.  Supposed to let you see at intermediate which the bi focals did not do. 

4.  Most people say laser is better but I have a doctor from bascom palmer who is telling me that she is more comfortable with conventional and that she gets better results with conventional.  Yeah but what about scarring, healing, no stitches, less energy required to break up the cataract and less stress on the eye that I heard about benefits of laser.

5.,  Anestheisa:  I am VERY squeamish about anything touching my eye. I cannot imagine a blade or even a laser, cutting into my eye. One doctor wants to put my eye totally to sleep so I won't be able to see for hours after my operation. wow, that's scary. want to ask about what the procedure is like, what you see and what you feel.

Thanks guys..  Any help would be greatly appreciated. 

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  • softwaredev
    softwaredev primeland

    Posted

    re: " that if I wait too long, the longer I wait the harder the cataract will become and if it becomes too hard and/or brittle, it could make the procedure more difficult and hence more risky"

    The guidelines vary, but I think I'd commonly seen concerns start to be raised if the visual acuity is worse than a best corrected 20/100 in the eye since then they start having trouble seeing in to check out the rest of the eye before surgery. The odds are your vision isn't yet that bad.  It has to get even worse than that however for it to be hard enough to impact the surgery itself, though I don't think I've seen what visual acuity might go along with that.  As I mentioned in another post, if the cataract is very mature and hard, then there are apparently advantages to laser surgery, I know someone who had a very rapidly developing cataract that became hard within a few months (very rare) who decided on the laser surgery for that reason. 

     

    • primeland
      primeland softwaredev

      Posted

      yeah I heard that the laser surgery softens it.  I think I am around 20/60 in my left eye (my dominant eye) I think the right eye is 20/40.  I was told i need cateract surgery if it is worse than 20 50.  youare telling me 20 100?  wow.  where did you hear that?   I had one doctor tell me I didn't need it yet and 3 other doctors told me I did.  I had one doctor who wants to do the surgery on my right eye first (the better eye) for the onyl reason being that it is the non dominant eye. The other two doctors say to operate on the worst eye first.  Every doctor has a different opinion.  unbelievable.    thanks
    • softwaredev
      softwaredev primeland

      Posted

      When you need cataract surgery is up to you, when it impacts your vision enough for you to decide it is worth the risk/hassle/time/money. Some people may prefer to get it when their best corrected vision is down to 20/30, though at that level it likely isn't covered by insurance. Usually in the US at least it is covered if best corrected vision is 20/40 or worse. I wasn't saying that you need to wait until it is 20/100, I was saying that  I'd read it is best to get the surgery before it is much worse than 20/100, that when its worse than that they have a hard time seeing the rest of your eye to make sure it is ok before surgery. (since if the lens is clouded that effects them seeing in, just like it effects you seeing out). It'd need to be worse than 20/100 before the cataract is actually hard enough to benefit from using a laser, though I don't know what a typical value would be. Few people in modern countries wait until their cataract is that bad, unless it developed incredibly rapidly as it did for someone I heard from where it only took a matter of weeks before it was mature.

      In my case I only had a problem cataract in one eye,  my good eye remained 20/20 correctible up until surgery on the bad one. Since I could see well enough it wasn't a concern to rush. I actually didn't the problem eye done until it was about 20/100, but that wasn't enough to cause any issues with the surgery and there was no benefit to using the laser.

    • softwaredev
      softwaredev primeland

      Posted

      Also, in terms of the laser, as I just posted on another page here, there is a good ebook that gives an overview of cataract surgery, including issues like whether to get laser cataract surgery.  Unfortunately on this site they send the message to a moderator if you include a link, so to avoid delay I'll say that the PDF file of the book should be the first link, or close to it, if you Google for this line:

      "David Richardson, MD"  "what you need to know about cataract surgery" pdf

      The surgeon author of that  comes down on the side that for most people laser surgery isn't worth the cost yet, though it depends on each person since some people may have complicating factors that makes a laser better in their case. Also lasers for surgery are improving all the time so eventually it may get there, the benefit just hasn't yet been proven in the view of many surgeons. I don't think anything has really changed since that ebook came out based on what I'd read. As I mentioned above, I didn't choose to get laser cataract surgery.

       

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