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
Another update after close to two weeks post op. My distance vision is not obviously improving, but I have an appointment next week to get vision checked to see for sure. What I have noticed more is that my close vision with the IOL eye seems to be improved quite a bit. I can read the computer screen print with it at about 20" away. I am surprised that I can read so close. The other thing I have noticed is that I sometimes see very tiny black floaters that appear and disappear quite quickly. It really does not interfere with vision and I only see it when looking at something white. Kind of hope that is not a bad sign.
My next step is to get some contacts for my non IOL eye that leave me slightly myopic at about -1.25 D, to simulate a mild monovision. That is the job for next week.
RonAKA
Posted
So I went for my 3 week checkup with my optometrist today. He said that everything look very good. My IOL eye vision tested at 20/20. He said I was left slightly myopic with about 0.25 astigmatism and 0.25 spherical, but it may not have settled yet from the surgery. He suggested coming back at the 8 week mark to get a final eyeglass prescription. I suspect I may get 20/15 with an eyeglass prescription for the IOL eye, but I am quite happy with what I see without any eyeglass prescription. In any case I need glasses for my other eye until it is done at some point, which does not appear to be within the next year. So, I will get progressive eyeglass lenses for both eyes at 8 weeks. My plan however is to continue trying monovision with a contact in my non IOL eye. I got a prescription for that eye today and hope to get some trial lenses tomorrow from Costco.
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All in all, I am happy with the outcome. Now, I just need to evaluate whether or not I am going to go with monovision.
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In our household the ball is now in my wife's court. She had her annual eye exam yesterday, and was confirmed to have a cataract severe enough to have surgery. So, now she has been referred to the same surgeon that did my eye. Her optometrist, which is not the same as mine, independently recommended him. She is probably going to have to wait a year+ though. Our COVID cases in Edmonton have gotten bad enough that it appears the cataract surgery has been shut down again...
RonAKA
Posted
I went for my final post op eye exam today to get my eyeglass prescription for both eyes. My IOL eye correction came out as:
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Spherical 0.00 D, Cylinder 0.75 D, @80 deg
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Pre OP I was:
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Spherical -2.75 D, Cylinder -2.75 D, @ 108 deg
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The surgeon obviously got my spherical power correction perfect. I did not get a toric lens, but now have a much smaller amount of astigmatism. The surgeon said I did not have sufficient corneal astigmatism to correct it with a toric lens, but said I could get it corrected with what I believe he called a LRI procedure. Has anyone had experience with doing that? Would it be of benefit to try to get astigmatism closer to zero?
stuart55yo RonAKA
Edited
LRI means Limbal Relaxaation Incision. they make a slit on your cornea to make your eye roundness affect the astigmatism approach zero (estimated).
RonAKA stuart55yo
Posted
As it turned out my surgeon does not do LRI because he says he cannot get predictable results with it. He told me I could get Lasik, but that turned out to be a dead end too as it would reduce my overall myopia and I would lose most of my reading ability.
Guest RonAKA
Posted
LRI can also be done with laser. Which is much more precise than by hand. In either case though I think your sphere has to be at or near 0. Which would be the case for many of us anyway.
RonAKA Guest
Posted
My sphere is somewhere between -1.0 and -1.25 D depending on the test day. That without the 0.75 D of cylinder is not enough for decent reading. If they were able to correct the cylinder to 0.0 D without impacting the sphere I would still be short. I thought Lasik could both correct the cylinder and increase the myopia. That turned out to not be the case.
claudiaRM RonAKA
Edited
Hello there, I've been following your posts and decision about your cataract surgery/lens. I wish I read this forum before doing mine. I am 60 year old and I had mine done 4 weeks ago in my left non dominant eye with Panoptix multifocal. I always been short-sited so it was promising to reduce the need of glasses. My expectations were realistic as I knew I might still need some readers. Well that is not what happened! Immediately I noticed I could read everything even the tiny print but to my disbelieve I could not see past the length of my arm. I was and still am myopic! During these 4 weeks the doctor patiently has been following me and started thinking what to do.I try to cooperate but I am complaining and I am very worry and she knows it! PCO is very very mild so not a concern for now. My vision is all together blurry ( true I can read my phone and pc but is kind of blurry too). The halos, starbursts and every other night disturbances are BIG and intrusive. I cannot drive at all. My other eye does have some cataract too and is far-sited, I cannot read anything with it but thankfully is helping the operated eye well enough, it is also cancelling the side effects like starbursts. Only if I cover the natural eye I see how wrong the operated eye is. I want to explant this so badly!! My doctor gave some contact lenses to see if correcting the far vision will help not only seeing better but also for the halos. Yes I can see further but not great ( lack of details, dull vision) glare and starburst still the same, these are so intense that some extension of the light ( like blades) are as wide as the highway. My husband was driving of course. What you read about this lenses is not always what you get. I would not recommend this lens. I want this out of my eye.
rwbil claudiaRM
Edited
If you can not see, "past the length of my arm", something is seriously off. Either that PanOptic IOl was defected or something else is going on like the power was way off.
My best advice is do some research on who is one of the Top Opthamologist in your area and get a 2nd opinion on what is going on.
Guest claudiaRM
Edited
One thing I suspect some people may not understand about trifocals is there are literally 3 points of focus. And there are dips between those points. So phone and computer will be good as will distance but the space BETWEEN computer and distance (i.e. beyond the length of your arm) will not be in focus. That's by design. Maybe that's what you're experiencing?
The new J&J Synergy lens attempts to smooth out those dips for a more continuous range of focus. The Vivity also has a smoother defocus curve (no dips) but it does not offer reading vision… just arms length / computer.
The other possibility is that the lens isn't perfectly centred. Centration is critical with multifocal IOLs. If they are not well centred it can throw things off. A monofocal (being a very simple optic) is much more tolerant of being slightly off.
RonAKA claudiaRM
Posted
Sorry to hear about your outcome. I don't know much about it, but I think I have read about the possibility of adding a piggyback lens or something like that. It seems your surgeon had a significant miss on the power needed.
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The other think to consider may be a monofocal lens for pure distance in the second eye.
claudiaRM Guest
Posted
I made a mistake in my post! I said I always been short-sited BUT IS WRONG...I ALWAYS BEEN FAR-SIGHTED how can I correct that? Now my eye cannot see far distance well. The Panoptix lens suppose to give clear distance, intermediate and near vision seamless. Said so it can happen some refractive error. It seems that for the near vision most people will need to use a low power pair of reading glasses for the small print especially in dim light. I think mine is undercorrected for the far vision resulting in myopia that aggravate the side effect well known with multifocals: low night vision and glare, starbursts. When I say I cannot see past my arm length I mean that past that distance things start to get blurry.
claudiaRM RonAKA
Posted
I don't think that adding a piggy back in my case will help. One of the reason I had a cataract was to make more space into my short eye with a mild glaucoma and high pressure controlled by medication. The artificial lens is smaller than the natural and makes more room plus I had an Istent implanted so now my eye is deeper now and pressure is good. I truly believe that there is a refractive error due to...who knows? I also noticed that all together my vision is blurred, nothing is crisp. I know that multifocals may take away some contrast, right now I am typing with my pc in a day bright light and the letters are blurry. I am not sure this is happenning because I have done only one eye for now. When I cover my natural eye and look only with the operated one the way I see my typing is better but with some glare and still not quite right. I will see my doctor today and will update. Is anyone had an explant? I know it can be done especially when power is wrong or lens is not well positioned and within 6 weeks. The sooner the better.
claudiaRM rwbil
Posted
what I meant saying I cannot see past the length of my arm is that things from that the distance get blurry and the further the blurrier. I agree, I think the power is off. My doctor is one of the top Ophthalmologist but It doesn't hurt to have a second opinion. Lately I also noticed that even reading on my pc or on a book is blurry. It takes effort to write and read here but I appreciate your answers. Thanks!
rwbil claudiaRM
Posted
I am not sure how blurry your eyesight is. But it sounds to me like your power is off 2 Diapoters or more. What correction is your Opthamalogist trying? Was your cataract so bad the Opthamologist could not get a stable reading for power selection. If that is the case then they should have used an Optiwave Refractive Analysis or something similiar or referred you to an Opthmalogist that has that equipment.
There are just so many possible issues like the centering of the IOL. I don't have as much faith in your Opthamalogist if he does not know what is causing the issue. He should be able to correct for power and see if that is the problem.
It is possible you are one of the people that just can not tolerate a MF IOL and it needs to be extracted, but I would pursue all options first including that 2nd opinion. Where do you live?
Keep us informed of your situation.
claudiaRM rwbil
Posted
my doctor said it is undercorrected, she gave me -1.25 contact lens and -0.75 glasses to see how I felt with those. She has all the equipment and she is the surgeon as well. She also told me I have short eye and with them people have sometime harder time to adjust. My cataract was not that bad ...I think. She said that most was hidden underneath the lens..I am not sure what she meant. She told me that she can fix probably with the laser, which one I don't know but they have all of the above. I see she is taking her time and giving me time because I really panicked with the outcome and the bad starbursts. I might be one of those people that cannot tolerate but better to say: I would consider to tolerate some MILD starbursts/halos night vision IF I could see normally for the rest of the day. I have a visit today and will update.
claudiaRM
Posted
I forgot to say that when I correct the far distance then I loose my near vision. I end up having bad vision at both distances. Sigh.
Guest claudiaRM
Edited
Okay if all distances beyond arms length are blurry (not just a "dip" in good vision between distance and intermediate, which is normal for a multifocal) then something is wrong or there is something else going on. Visit your eye doctor or seek second opinions.
claudiaRM Guest
Posted
I just came back from my doctor, we are going to explant . She explained that due to my short eyes ( I'll tell you short eyes are just nothing but problems) the Panoptix lens shift forward near my cornea? SO yes, one is not in the best position and two is opacified. I think is PCO? She said that is why all is blurred but did not proceed right away with yag suspecting the forward position. OH well....NOW I have to decide what lens I want again. She did an analysis of my eye and said that the best in her opinion is VIVIDY that I will do very well with it in both eyes. No halos, good distance vision and intermediate but need glasses for near. She also told me that most patients don't even need reading glass for majority of task unless is detail work. In Her opinion this lens will give me quality of vision and life. OR the monofocal for distance that is kind of a bummer ( her words) because it is really taking away the function of the eye. Glasses of course with it. I am leaning toward Vivity does anyone know something about this fairly new lens?
RonAKA claudiaRM
Edited
The AcrySof IQ Vivity lens is very new, especially in North America. If you want a presentation on the lens try googling this:
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"Clinical Outcomes of a Novel Non-Diffractive Extended Vision IOL CATHLEEN MCCABE, MD"
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The author is from Alcon and that needs to be considered. Another more detailed paper is available from Alcon if you google this.
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P930014 Package Insert AcrySof IQ Vivity
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I am looking at requesting this lens for my second eye. My first eye is corrected for distance with a AcrySof IQ Aspheric Monofocal lens. I will either go with another lens like this corrected for distance, and plan on using reading glasses for close up, or I will do some kind of monovision solution. If with a monofocal lens I will ask for a -1.25 D under correction for the second eye. That is what I am doing now with a contact lens monovision solution. I like it quite a bit, and almost never wear glasses for distance or reading. It works quite well at night too. No issue with flare or halos from lights. The third alternative is the Vivity lens. With it I would likely go with a little less under correction at -0.75 D.
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The Vivity lens compromises asphericity to give the extended depth of focus that allows good intermediate distance acuity. The down side of that should not be halos or flare, but it can compromise contrast sensitivity at night -- ability to distinguish between shades of grey. The Alcon story is that if both eyes are done with Vivity then it is not clinically significant. I am still thinking about whether or not I want to take that risk. Right now I am leaning toward two monofocal lenses with my upcoming one undercorrected by -1.25 which is a mini monovision solution.
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With respect to the explant that I understand is a fairly tricky procedure and it is usually done by a specialist. I don't know that much about it, but I believe you would not want to have the YAG done first. That cuts a hole in the bag that the lens is in and complicates things for the explant surgery.
Guest claudiaRM
Edited
Good news! Glad there is a path forward. Hope the IOL exchange goes well. I'll be VERY interested to hear how Vivity works out! Please followup! I haven't had surgery yet but I need to (soon) and I've spent the last month debating Vivity vs. Monofocal.
I know my Type A personality would not be able to deal with the Dysphotopsias of Multifocals.
I like the idea of the best quality vision with a Monofocal but I'm worried that the day-to-day quick little tasks of life (glancing at your watch, reading a label, looking at the car dashboard, reading a recipe while cooking) would be a pain. And I've been near sighted my whole life so the idea of completely losing all of my close up vision bothers me. Yes I could get Progressive glasses but I tried them once when I started getting Presbyopic and they drove me crazy. Plus it would seem unfortunate to have to always carry around glasses everywhere or wear Progressives full-time when your distance vision is perfect on it's own.
claudiaRM RonAKA
Posted
I am in North America, yes no YAG, she waited on that because I think she knew we would explant. Can be done safely in this case and within 6 weeks from surgery. The sooner the better. Finger crossed. I am going to do some research on Vivity but you know how it is, if you look at the company story they alway give you the best end. Look of how they describe Panoptix. then you hear people having issues that are not described or perhaps it is but in small print. The contras sensitivity might be a problem but she already told me would do both eyes with that. I have until Friday to think about it. She said that implanted this Vivity lens to many patients and they are all happy. Oh well many are happy with Panoptix too. Just my luck! I don't know how I would perform with my eyes having a different vision. I think symmetry or close to it is easier but some I know can cope well. You probably can.