Need advice on IOL selection process...
Posted , 20 users are following.
I am 70 years old and was diagnosed with a cataract in my right eye (non dominant) nearly a year ago. My vision in my left dominant eye is still excellent, but my optometrist says I can expect to get a cataract in it too at some point. I am moderately myopic and have had a +2.5 add for reading for a long time. Long wait in my area of Canada (Alberta) to get an appointment with a surgeon, but I will have my first pre-op consultation a week from now. I did a bunch of research into my options when first diagnosed and then let it slide. Now push is coming to shove, and I will have to make a decision. For those who have been through this I would be interested in getting some advice as to whether I am thinking this through properly and if there are options I should be considering that I am not. Although I will have to pay for anything over the cost of a basic lens out of pocket, cost is not an issue I worry about.
For needs, I drive, some sports. I use contacts for snorkeling. I do some shooting and target shooting with my right eye (which now has the cataract), and really want excellent distance vision. With age I have found driving at night more and more difficult, and I also want excellent night vision for driving. I have tried monovision with contacts, but gave up on it. Partly it was because I really don't like contacts, even though I have been wearing them on and off since 1975. But the main reason was I did not at all like the night vision and flaring of light I was getting from it. I was afraid to drive with my contacts at night, even though my day vision was excellent. While it would be nice to be glasses free, to me excellent vision is a higher priority. I use the computer a lot, and my progressive eyeglasses work very well for me to do that.
So, what do I do? I have a friend who went the multifocal route and she likes it. She says she can do most things without glasses except for reading small print on OTC drug labels and the like. She uses readers for that. She is also adverse to wearing glasses. My thoughts are that this is not me. While I would like to be glasses free, I also want as perfect vision as possible for both reading and distance. This has lead me to think a lens that corrects for distance only is the best route for me. I have some astigmatism and I expect I would also benefit from a toric lens to correct for astigmatism. My research to date has indicated the most popular choice for this type of lens is the AcrySoft IQ Toric IOL. It is claimed to be the most stable in position and easiest to locate correctly. The negatives I have seen on it is the issue of glistenings. But, that seems to have been addressed with improved manufacturing quality control -- or at least the mfg claims that.
So, for those that have been through this, what do you think? Is this thinking sound? Alternative that I have overlooked? Other factors I should consider?
1 like, 106 replies
RonAKA
Posted
I mentioned in an earlier post that I have concluded one can roughly convert a eyeglass correction for astigmatism to one for non toric contacts by adding the sphere and cyl together. It turns out that is not quite right. I found a CooperVision web calculator that does this kind of conversion and at least for lower amounts of cyl it recommends both toric and non toric options. It also presents a calculated number.
Since I can't post a link here, you could try the following search terms if you want to find it. You may have to hunt around a bit for it though.
coopervision optiexpert spectacle conversion calculator
RonAKA
Posted
Have run into a slight hiccup with my cataract surgery scheduled for Oct 7. Three staff at the hospital where it will be done tested positive for COVID on September 22. Just found out about it yesterday. But I also got a call from the hospital a couple of days ago with them looking for more personal information for their records. So, at this point I assume it is still on. I can't say I am real worried about getting COVID, but I do worry that they will shut down all elective surgeries again. That would not be good. It will be two weeks from the time the infections were discovered until my surgery time, so it should be resolved by then, unless there is further undetected spread.
Chris53317 RonAKA
Posted
Fingers crossed for you. Although treatment options for COVID are much better than at the start, everyone should be concerned about getting it as it will affect a small number of people quite badly.
RonAKA
Edited
Well after about 18 months wait, I had my 10 minute IOL cataract surgery done this AM. Arrived at hospital at 6:00 AM, and got screened for COVID about 4 times, (but they never took my temperature once). Went into the OR at about 7:50, was out at 8:00, and home by 9:00. I did have the sedation which was a one shot injection through a IV shunt. Made my arm feel cold as it went in, but I really did not notice much of an effect from it. I was fully aware what was going on through the 10 minute operation, and there seemed to be no after effects from it. Most of the time was consumed before the OR with screening questions, BG test, BP test, and about 12 different sets of drops. As others has said, a pretty minor surgery, and in my opinion way less painless and more comfortable than getting your teeth cleaned.
Chris53317 RonAKA
Posted
Yes!!!!
But you did not say how the eye is feeling. It should be usable, maybe a bit blurry, with very bright colours. Lots of eye drops to take and a patch over the eye at night.
RonAKA Chris53317
Posted
They gave me a goofy clear bubble shaped eye cover with ventilation holes in it. I guess the basic purpose is to keep you from rubbing your eye without thinking about it. If I peek around it, I can see pretty good. Looking through this bubble is somewhat cloudy. Not sure if it is the shape or if it is just dirty, or it is the lens still settling in. Will know more tomorrow when I take this eye bubble cover off.
I think the pupil dilation drops have pretty much worn off. Yes, there is now a big difference between my two eyes. The IOL eye is brighter and whites are much whiter to the point of looking blueish compared to the now yellow looking image with my remaining natural eye. Prior to the surgery I used to think my left eye (right eye now has IOL) was pretty good. Not so at all when it comes to colour. The image is still fairly sharp and I don't see double, but the colour is certainly off. I suspect I won't qualify for an IOL until the vision starts to deteriorate more than it has so far.
I am wearing a contact in my left eye, which was prescribed for distance vision, and reading has now become an issue. The IOL is much worse for reading than the contact over the natural lens.. I can't read a computer screen at all with the IOL. I have also tried a contact that has less power and somewhat simulates monovision, and it is actually quite a bit better. It was prescribed for closer vision in my right eye (contact monovision), and I will probably go with those until I can get some contacts with the correct power for monovision.
I am scheduled to go for the 24 hour exam tomorrow morning, and after that I will start the drops. Not looking forward to that...
As far as the feel goes, it is pretty good. When the freezing wore off I started to feel something like having something in my eye, but so far it comes and goes, and is quite minor. Nothing like having an eyelash under your contact!
soks RonAKA
Posted
hi ron
how is your near vision with the iol eye? good luck with continued healing.
RonAKA soks
Edited
Vision close up is essentially terrible in the IOL eye. There is no distance that I can read normal sized text on my computer. It has been just over 24 hours and my distance vision is not crisp either. Had my 24 hour exam by the surgeon this morning and my IOL eye tested at 20/30. The surgeon says that is very good and it should improve as it heals.... I sure hope so. Right now my jerry rigged monovision contact in my other eye is giving me slightly better distance vision, that I would estimate at 20/25, and it is good enough to let me read normal text on my computer. It is not the ideal power for monovision but is the closest I had in my home inventory of contacts.
Just as an update I got a bit of a surprise this AM when I got up to go for my appointment. I slept well overnight and had zero pain. However, when I turned the lights on in my room I thought my eye was going to explode. I was not prepared for that. The pain was by far the most intense of the whole cataract process so far. There was no pain yesterday, but I think the dilation drops were still keeping my iris in an open and fixed position. Today the iris is reacting to light changes and the pain seems linked to changes in the pupil size. Not sure how the iris changes but there must be some muscles in the eye somewhere that are not happy with the lens removal and insertion process. The surgeon just said that my eye has not recovered from the sharp instruments that it was subjected to yesterday. In any case I was wondering yesterday what the dark glasses in my kit were for. Today, I found out, and could not get them on fast enough!
soks RonAKA
Posted
i was 20/30 the day after and always after that because of surgery induced astigmatism.
RonAKA soks
Posted
Unfortunately that seems to be a risk. My understanding is that a skilled surgeon can make the incision in a location such that it can actually reduce existing astigmatism. I have an optometrist appointment in a couple of weeks and I will find out more then as to what I got out of this... But I will wait until 6 weeks before I proceed with new eyeglasses.
soks RonAKA
Posted
my astigmatism is only -0.5 but makes a huge difference.
RonAKA soks
Posted
Have you considered a Lasik correction for the astigmatism? My surgeon says it is an option for residual error after an IOL surgery.
soks RonAKA
Posted
no coz correcting astigmatism makes near worse so i will just wear mild glasses when driving or going outside. also i may exchange so not doing anything till then.
Chris53317 RonAKA
Posted
Great report, and everything seems normal. I had to wear the eye patch at night for a week, a good precaution.
Prior to the surgery I had been using eye drops twice per day as a preventative measure for glaucoma, so using the drops after the surgery was no issue. I am now doing the preventative drops once per day, and Systane Complete three or for times per day to prevent dry eyes. All easy. Just wash your hands before using the drops.
RonAKA
Posted
50 hours post op, I am seeing improvement in my distance vision. While I reported that my IOL distance was not quite as good as my monovision jerry rigged contact eye, the IOL is now better. Guessing somewhere between 20/25 and 20/20. The pain issues associated with pupil dilation and contraction have gone away.
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I am feeling better about the IOL solution at this point, but am now starting to worry about what my close vision will be like with an IOL in both eyes. However, that is probably at least a year away, and perhaps two years with the waiting time added in. Lots of time to consider alternatives. I am now thinking that a monovision solution using the Vivity lens in my second eye may be a good solution if it is available by the time I need it. Hoping my surgeon will be a little more positive about the Vivity than he is about the PanOptix by then. Or I also have time to switch surgeons...
soks RonAKA
Posted
thanks for the update. great to hear the vision doing well. maybe you should consider panoptix. the near with panoptix will be hard to beat. i dont think the side effects will bother you even with type a personality. and the monofocal will really dumb them down. just my 2 cents.
RonAKA soks
Edited
I've got a long time to think about it. However, I am currently thinking just another SN60WF but with -1.25 D monofocal under correction, or the Vivity with 0.75 to 1.0 D under correction. I am afraid of the starburst, halo, aberrations with the PanOptix. If one believes what is being reported about the Vivity, it would seem the only downside of it vs the standard monofocal aspheric would be the cost. Next step is to get a proper power contact in my left eye, so I can evaluate my tolerance/preference for monovision.
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My unprofessional calculation of an ideal power for a contact would be one of these two options:
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Toric - Sph -0.25, Cyl -0.75 @ 80
Non Toric - Sph -0.75
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The lens I have in right now is working pretty good, but is well off the ideal. It is:
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Toric - Sph -0.75, Cyl -1.25 @ 110
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It is too strong, and I should get better reading with a little loss of distance with a more suitable lens power and correct angle for the cylinder.