Need help deciding type of lens
Posted , 6 users are following.
In September of 2019 i had surgery to remove an epiretinal membrane in my right eye. One side effect of this surgery is that you will develop a cataract in that eye within 2 years. My vision in that eye is blurry. Today i saw a doctor to see if a new eyeglass prescription would help. It wouldn't. He said my vision problem was due to a cataract, although its not too bad at this point. Since its inevitable, and only going to get worse, I think I'm going to get it done as soon as possible. I have an appointment with the cataract surgeon next month. The doctor i saw today said i will probably be given the option of getting a lens that will correct my nearsightedness, which ive had since i was a kid, or a plain lens, which would leave me nearsighted as i am now. In either case, i would need glasses for reading. The idea of clear vision is appealing, but i would still need glasses because of my left eye. Id end up with a prescription lens for my left eye, and a plain lens for my right. I currently have progressive lenses, although i usually take my glasses off when i read. If i get the corrective lens to replace the cataract, I would need a stronger correction in order to read with that eye. This would leave me with glasses with 2 wildly different prescriptions, both for distance and for reading. On the other hand, i do have a slight cataract in my "good" eye, so could conceivably get a lens to correct my distance vision at some point.
Of course i will discuss this with the cataract surgeon when i meet with him, but i'd like to go in there with as much information as possible. Any advice?
1 like, 26 replies
Chris53317 miscrap
Edited
Oh boy, there is so much that reading (just this site alone) and information gathering that you could do, but there are no quick answers. Years ago I was under the mistaken impression that cataract surgery would replace your lens with one that corrected your vision, leaving you glasses free. I had not appreciated that there is near, intermediate, and far vision. The young natural lens in your eye adjusts its shape to handle these distances. Presbyopia is the name of the condition when you eyes no longer adjust (old eyes), and progressive, bifocal or trifocal glasses are prescribed.
There are various types of IOLs and combinations deployed to try and give you the best possible vision for your situation. Each case is different and everyone has different priorities and preferences. There are also trade-off with each alternative, and there is no one perfect solution.
The popular type of lenses are:
o monofocal aspheric - you will normally need glasses, either reading, driving, or progressive
o extended depth of focus (EDOF) - you will usually need reading glasses
o trifocal - you may be glasses free
Often, these lenses are used in a configuration called monovision where one eye is adjusted for distance and the other for reading. This could reduce or eliminate the need for glasses.
Finally, there are side effects such as glare, halos, and starbursts. The extent of these side effects is different with everyone and is unpredictable. They occur most often with EDOF and trifocal lenses but can occur with monofocal.
As you will be having just one eye done at this time the best solution would seem to be a monofocal IOL adjusted for distance. You would then use glasses, your LE with the current progressive prescription, and the RE with a suitable progressive prescription. The latter would also make any fine adjustments for astigmatism and focal distance if the predetermined IOL strength was slightly off.
Enjoy the research and hope you find an optimal solution.
RonAKA miscrap
Edited
Chris, has pretty much covered the basic options and the issues. I noticed your one comment:
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My understanding is that both of these lenses will have refractive correction. I think what he is saying is that if you go for a monofocal lens (things are in focus at one distance) you can have it with a power that lets you read or lets you see in the distance. Should be the same cost. A monofocal IOL is a fixed power lens and does not have the ability to focus both near and far. There are some "premium" lens options which try to do that, but there are issues which you may or may not find tolerable. They cost significantly extra.
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One thing you should consider with a monofocal lens is correction for astigmatism (if you need it). Getting a lens that corrects for astigmatism would probably be worthwhile, especially if you are interested in a no glasses final solution. These toric lenses do cost extra though depending on your location and insurance.
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Without going into the multifocal options I see a couple of alternatives for you (as suggested by your doctor). If you get a focus for distance monofocal lens you will need a +3 or so eyeglass add to allow you to read. My experience with prescription glasses is that you pay for two lenses whether they have a prescription or if one lens is just plano. So, you could get progressive prescription glasses with a lens for both eyes, and you should see fine for both reading and distance, just as you do now with the other eye. When you take your glasses off you will see distance with the IOL eye, and depending on what your prescription is for the other eye, you may or may not be able to read as well as see in the distance, if your brain can make the switch from eye to eye. If your non IOL eye is only being corrected for -1.5 or so, this might work. If your correction is much more it probably won't be tolerable.
The second option is to get the IOL at a power that lets you read. Then without glasses you will not see at distance well with either eye. In this case you would need progressive lens eyeglasses in both eyes. With glasses on, that could be a very good solution as well. As Chris mentioned the eyeglasses can correct for any residual astigmatism or spherical correction needed. The only issue with this option is that you will have no distance with the glasses off. You may be able to read fine without glasses though.
So it kind of depends on your priorities and how much and when you want to be without glasses. Also as Chris mentions there is a final solution which would be where one eye is corrected for distance (usually the dominant eye), and the other eye is under corrected to about -1.5 D. The under corrected eye will give you better intermediate distance (like a computer screen), but you will probably still need reading glasses for small print. This option is called monovision or mini monovision. Other than close reading you can be glasses free. If you are interested in that, you may want to "test drive" that option by using a contact that under corrects the non IOL eye. You need to do that before you lose vision in the second eye to fairly evaluate it.
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Hope that helps some,
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EDIT: I noticed in your other post you do a lot of long distance driving. If it is at night, that could be a significant issue with multifocal type lenses. These lenses can cause halos around lights and flaring of the lights, which can make night driving difficult. Monofocal IOLs are less prone to this issue, but they can have issues too. I also noticed you expect 20/30 vision in the IOL eye. That may be another consideration in evaluating the monovision option, as to which eye should be the distance eye, and which is to be under corrected for reading.
ara21947 miscrap
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Another thought is, why do it sooner rather than later? Are you bothered by the cataract to the extent you cannot see? My cataracts came on quickly so I remember my past vision well. Although I kept my near vision and no longer have astigmatism, I do miss my former vision. I still use glasses for distance but a weaker prescription and dont use reading glasses but it continues to take time to adjust to the change. Plus knowing once you are in the cataract IOL world, you are in it for life-- with all the eventual changes and effects, such as PCO etc.
miscrap ara21947
Posted
The reason im thinking about doing it soon is that, due to the EM surgery i had, cataract surgery is inevitable. Right now the best they can correct the vision in that eye with glasses is to 20/50, and it will only get worse.
i agree that because of haloes and such during nighttime driving a mono lens would probably be best.
Ive just been thrust into all of this, so dont really understand all of the options you folks are giving me above, but i really appreciate the advice. There are a lot of knowledgeable people here. Here is my last eyeglass prescription. What would you guys do if you were me?
Right eye - EM surgical eye, soon to be IOL eye: -4.00 +1.00 175 +2.50
Left eye - dominant eye: -4.00 +0.75 180 +2.50
By the way, i cant wear contacts. I had hard contacts when i was in my 20s. Did great with them until i got poked hard in the eye. Cut my cornea. Couldnt wear them after that, so i was switched to soft ones. Those were great until i got kicked in the other eye. Major abrasion. Was told to not wear them for 2 weeks. When i went back to them they were fine until i removed them. Felt like i ripped my eye open. Doc said to wait a month before trying again. Same result. Waiting 6 months, then a year, didnt change anything. Was told to forget about contacts permanently.
Thanks again for any and all advice. I see my EM surgeon end of April, cataract doc early May. The more I know when i see them the better conversation i can have.
Chris53317 miscrap
Edited
The simple solution is aspherical monofocal IOLs in each eye adjusted for distance. Then combine this with reading glasses if the IOL correction in both eyes is spot on (plano), or progressive glasses. The latter will correct any minor distance vision along with any astigmatism, and provide correction for reading. Progressives would not be prescribed for 2-3 months after the last surgery to allow your eyes to recover fully. You can also get transition progressives so separate dark glasses will not be required.
The only minor downside is not being able to see up close without glasses, e.g., examining your eyes or face in a mirror, reading fine print, and maybe seeing text on your smartphone.
This is a great option for your situation.
miscrap Chris53317
Posted
Thank you, Chris!
Sue.An2 miscrap
Posted
Miscrap I had cataract surgery as you know then developed EM in left eye. If I end up with surgery for EM wondering how that impacts my IOL? And I have EDOF - extended depth of focus lens both eyes (don't need glasses except for tiny print)
Given you've already been through EM surgery I would discuss that with your cataract surgeon. Likely they will tell you to stick with a monofocal fixed for distance. However the choices may be wide open and EM has no impact on IOL and cataract surgery. Your surgeon should be able to best advise.
Thank you for sharing your experience - I know I will see a retina specialist who will tell me what my options are. Optometrist said it can correct itself but from what I read that would be unusual.
RonAKA miscrap
Edited
You have borderline astigmatism for correction with a toric IOL. Astigmatism can come from the cornea or the lens, or both. Until they measure the cornea you will not know for sure if a toric lens is indicated. In some cases the error in the lens offsets error in the cornea. So astigmatism can get worse when the lens is removed. I think it is best to get a toric lens if you do have significant astigmatism, which I believe is more than 0.7.
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Using contacts to try monovision is optional. Some cannot do it with their eyes because they just can't see well enough to evaluate. It is something to discuss with your surgeon. The backup plan to use monovision is to just get progressives to correct for the residual error.
miscrap Sue.An2
Edited
I have read that the tissue can fall off on its own, but i think thats pretty rare. I dont think your IOL would be a problem for EM surgery. They make 3 punctures into the white part of the eye and insert ports, and do all their work through the ports. Whether you have a natural lens or an IOL shouldnt make a difference.
miscrap RonAKA
Posted
Im willing to give contacts a try if the surgeon thinks it would be helpful to evaluate. My problems with contacts were a long time ago and they have more and better lenses now. Thanks for the info.
Sue.An2 miscrap
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Thanks good info to know.
RonAKA miscrap
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I have used contacts since about 1975. My first ones were soft and cost about $350 a pair, and many bought insurance in case they lost them. Now we get them cheap and flush them down the toilet daily. What I have found is that while they have become more comfortable to wear, they have also become much more difficult to put in. I'm sure in part that is due me being almost 50 years older and not having the same dexterity as I used to have.
Monovision is not for everyone. I think it is worth consideration though. At this point I would put my odds of going for monovision at about 50%. It will depend on the outcome of the first eye, and also on a contact lens trial.
Chris53317 RonAKA
Posted
Ron: you have communicated and displayed a wealth of interesting and useful information, and good guidance on this forum. However, I hope your comment about flushing them down the toilet is a literal rather than actual activity. Human produced waste and toilet paper are the only things that should be flushed.
RonAKA Chris53317
Posted
Yes, the trash would be better. I'm too cheap to dispose of them daily as well. I rinse them off with rinse/storage solution and keep them in my contact case for a week or more each.
henry1105 miscrap
Posted
I am planning for a cataract surgery on both eyes soon.
May I ask where I can find pictures showing the night vision effects (starbursts, halos, glares...) arising from EDoF lens vis-a-vis monofocal lens for a clear understanding of the extent of the issues that I’ll have to face with EDoF lens?
Thank you folks.
RonAKA henry1105
Edited
Here is an example I found. However, what you need is the subjective opinions of those that have the specific type of lens you are considering. i.e. how do they rate it compared to the photo. I do not have IOLs (yet) so can't help you with that.
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Chris53317 RonAKA
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My interpretation of that chart is Mild represents the Halo effect (concentric rings around the light), Moderate shows a combination of Halos and Glare, and Severe shows Glare at its worst with some Sratbursts (light beams). With Panoptix trifocal my category is Mild.
henry1105 RonAKA
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Thank you. That's informative.
henry1105 Chris53317
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Thank you.
Do I assume that there are differences only when looking at light sources? Otherwise, there are no glare, halo, starburst... effects?
What about tv/computer/handphone screens? Are there such effects on images on the screens?
Chris53317 henry1105
Posted
The halo effect is only with bright light sources, like street lights, car lights, etc. No issues for me with TV or laptop. Letters on my smartphone appear to have a fine shadow but it is not bothersome. I can read a document or book without thinking about this shadow. Examining text on the laptop seems to have the same thing, but I have to look hard to see it. This effect is from the trifocals presenting additional images.
henry1105 Chris53317
Posted
Am I correct to say that the fine shadow accompanying letters, etc on smartphone & laptop screens is more noticeable when the letters are small (which is the case with smartphone) & less so when they are bigger as on laptop screen?
Thank you.
Chris53317 henry1105
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No. It is more visible with white letters on a dark background. It is not a concern or bothersome. Perfect vision would be 100% and this effect makes it something less. You will get this effect with trifocals but not with monofocals adjusted for reading, or monofocals adjusted for distance along with reading glasses. It all comes down to your priorities and the compromises you are willing to accept.
henry1105 Chris53317
Posted
This has been valuable info.
Would love to hear first-hand experience from EDoF and monofocal (Tecnis Eyhence in particular) users as well next.
Have a great day!
RonAKA henry1105
Posted
You may want to start your own thread with your questions so they will get more attention. One strategy might be to get a monofocal in the dominant eye, and a somewhat under corrected Eyhance lens in the non-dominant eye. Not sure if anyone here has tried that combination.
henry1105 RonAKA
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Sure. Thanks for the cue.
melanie06783 Chris53317
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I agree. I have mild with Panoptix. Nowhere near the severe. I can easily drive at night.