NEW CNOTO LENS FOR CATARACTS
Posted , 9 users are following.
Hi ,
I live in Manitoba, Canada.
My doctor has asked me if I want the new CNOTO lens from Clareon by Alcon for
my Cataract surgery. I couldn't find anything on this lens when I googled it. The
provincial government doesn't cover the cost of this lens. I would have to pay an extra $150.00
if I wanted it. Supposedly, it gives only slightly more clarity than the existing lens that is covered by the government.
this is all I know. Has anyone out there had these CNOTO lens placed in their eye?
0 likes, 15 replies
Guest rose61720
Posted
Pretty sure that is just the standard Alcon Clareon Monofocal. The funny model number sounds like it might be related to the delivery system (pre-loaded). In any case, very good lens and proven technology as it is the continuation of the Alcon Acrysof which has been implanted in probably millions of eyes. Maybe the extra fee is just to upgrade from an old inventory of Acrysof lenses to the latest and greatest Clareon version of the lens? Well worth the $150 I'd say.
RonAKA rose61720
Edited
I think you may mean CNA0T0? If so, that is the new Clareon lens from Alcon. The older version was called the AcrySof IQ Aspheric. I have one of each in my eyes. The Clareon lens has an improved material that is more resistant to glistenings in the lens. It also has an improved edge design which is supposed to make it more resistant to PCO. And yes I believe they claim an improved clarity of the lens.
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Do I see any difference between the two? Well with respect to glistening I think the risk even with the older material providing it was produced since 2017 is very low. The Clareon is even lower. I don't see glistenings in either lens, and my optometrist has not reported them either.
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With respect to the PCO (posterior capsule opacification) contrary to the claims by Alcon, I have some evidence of it in my Clareon eye after 13 months in the eye. The AcrySof lens has been implanted for 30 months now and there is no evidence of PCO. So, in my case the Clareon has not been more resistant to PCO. There are other factors in addition that may cause it of course.
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I notice no difference in clarity between the eyes. One would probably have to test the lens in a lab to measure a difference.
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In Alberta I paid $300 extra for the Clareon lens compared to the AcrySof as it was not approved by AHS for reimbursement at the time I got it. The hidden factor, which was what really motivated me to get it, was that because it was not fully covered I could get it in a private clinic with a wait time of 3 weeks instead of a year or so. So to be frank, I paid the $300 to jump the queue.
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This all said, I think it is a good lens. What is your alternative? My brother is in Manitoba and the lens he got at no extra cost is the B+L enVista. He got good results with it, with 20/20 vision. B+L claims no issue with glistenings. Not sure about resistance to PCO. The upside of the enVista is that it is an aspheric neutral lens and it is more tolerant to actual lens position in the eye, and more tolerant to less than perfect corneas. The ultimate vision if you have good eyes and the surgeon is very precise may be slightly higher with the Clareon. If not the enVista may be better.
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I suspect you cannot go wrong with either the Clareon or B+L enVista.
karin08666 RonAKA
Posted
My husband had cataract surgery 5 years ago with Acrysof put in both eyes. He has not had any problems, no glistening and to date no PCO. He has been very happy with them.
Who is your brother's doctor in Manitoba? I have not heard of a doctor in Manitoba who uses something other than Johnson & Johnson or Alcon.
RonAKA karin08666
Posted
His surgeon was Dr. Rocha. He is He is Medical Director of TLC Laser Eye Centre/LMD Winnipeg. Surgery is done out of the clinic. I see he gets a very good rating on Rate your MD. The B+L was his only fully covered cost option. I believe he had been given extra cost options like the Eyhance and some others. The Clareon or AcrySof IQ were not options. It must depend on the clinic what they offer as options. I suspect however that if the B+L enVista is fully covered by Manitoba health care it must be a commonly used lens there. It was not offered to me in Alberta, but I did not go shopping from clinic to clinic.
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My brother has only had one eye done and the second eye still has very good vision, so he is in no rush to do it. His issue now is that Dr. Rocha has apparently accepted a new position in Ontario so he will have to find a new surgeon.
julie66167 RonAKA
Posted
Hi Ron, I have been reading many posts. Still trying to understand and make a decision on what to do for cataract surgery. I have a long list of questions.
I just read about the PCO in the Clareon eye. I am so sorry. No one has contributed more and therefore helped so many people.
I also discovered your age and I am 73.
Appreciatively, Julie
RonAKA rose61720
Edited
The other thing to consider which is more important than the brand of the lens is the target diopter for each eye. If you want distance in both eyes it is best to target very slight myopia (-0.25 D) to minimize the chance of going positive (far sighted). When you go far sighted you start to lose near vision. My brother had his surgery with Dr. Rocha who lives in Brandon, but operates out of Winnipeg in a clinic. He likes to target plano (0.0 D). My brother got a plano outcome on a spherical equivalent basis, but with a + sphere and - cylinder. His near vision is not as good as what I got with a target of -0.25 D. It has now moved slightly to -0.375 D after 2.5 years. I can see fairly well down to about 20" with it.
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And if you want a full range of vision without eyeglasses you may want to think about mini-monovision. This is when you target -1.5 D of myopia in the non dominant eye to give you reading vision. I have about -1.625 in my near eye and can see down to about 8-10" without glasses. If that is of interest you should simulate it with contacts to see if you like it.
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Both the Clareon and the enVista should work well with mini-monovision, and possibly the enVista a bit better as it has a wider range of focus than the Clareon.
rose61720 RonAKA
Posted
Thank you for the very detailed reply. Based on your answer and others in community forum, I am leaning towards the Acrysof lens since you are experiencing PCO. Is your doctor planning to perform laser surgery to fix it?
Do you know what is involved in fixing PCO? My current prescription is -11 in both eyes.
My doctor is giving me -1 vision. I am not sure if this is in both eyes. After surgery, I will still need to wear glasses for making my distance vision crisper. For reading, I am suppose to use a magnifier.
RonAKA rose61720
Edited
Based on having one of each of the AcrySof IQ and the Clareon lenses, I would still select the Clareon over the AcrySof, despite the indication of PCO in the Clareon eye by my optometrist. I will see the ophthalmologist in October for a second opinion. To date I don't see the PCO myself. Here is the name of a study you can google for more information. In this study of 20 total eyes this was the outcome for PCO:
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"PCO
No patients were presented with PCO in the eye that received the Clareon® IOL within the3 years following surgery. Four patients (20%) were presented with posterior capsular fibrotic changes in the eye that received the AcrySof® IQ monofocal IOLs with 3 patients (15%) requiring Nd: YAG capsulotomy within three years following surgery."
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So my personal experience seems out of sync with the results of this study. The treatment for PCO is a YAG laser to cut a hole in the back of the capsule that holds the lens in the eye. I will decide in October whether or not I will go ahead with the YAG after I get a second opinion. This surgeon is a laser specialist and I suspect is going to be promoting the YAG. But I will wait and see. My person opinion is that YAG is sometimes over prescribed. In any case here is the name of the study:
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Comparison of Visual Outcomes and Patient Satisfaction Following Cataract Surgery with Two Monofocal Intraocular Lenses: Clareon® vs AcrySof® IQ Monofocal Smita Agarwal1, Erin Thornell2
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I would also encourage you to so some investigation of the enVista lens at the B+L site. Try googling this:
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bauschsurgical envista highlights
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I think it is a very credible lens also and should be fully covered (except for the post surgery eye drops in Manitoba. You can find a graph at this site which shows how the enVista compares to the the AcrySof IQ for depth of focus. The enVista is better. The Clareon will be essentially identical in this respect to the AcrySof.
RonAKA rose61720
Posted
"My doctor is giving me -1 vision. I am not sure if this is in both eyes. After surgery, I will still need to wear glasses for making my distance vision crisper. For reading, I am suppose to use a magnifier."
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I'm guessing the surgeon is saying they will leave you myopic with a required correction of -1.0 D. If they do that in both eyes you will not have great distance vision and will need prescription eyeglasses to be legal to drive. It will probably give you somewhat ok reading vision, but you will need readers to see well close up.
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Another option you could discuss with the surgeon is to give you full distance vision (target -0.25 D) in your dominant eye, and then target -1.5 D myopia in the non dominant eye. That will give you good reading vision. It is called mini-monovision and just uses standard monofocal lenses. You could do it with the AcrySof, Clareon or enVista lenses. Most who do this are pretty much eyeglasses free, but may need readers for very small print.
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If your vision is still reasonable with the cataracts you could simulate mini-monovision with contact lenses prior to surgery to do it with IOLs.
rose61720 RonAKA
Posted
Once again, you have given me great information. I will read up on the additional information you have given me. i will also ask my doctor about the -.25 and -1.5 D.
You seem to have a very good technical understanding of all of this. Do you mind me asking if you are a Doctor or have medical training? Thanks again for your help!!!
RonAKA rose61720
Posted
No, I am not a doctor, but have taken an interest in the cataract surgery as it seems to be a topic of interest to us older folk! I am a retired mechanical engineer, and don't shy away from the technical stuff. I find it very interesting.
jimluck rose61720
Edited
You might be okay to drive without glasses at -1 in both eyes. That's about 20/50 and that's the minimum in Canada I believe. But needing glasses to drive is no big problem, in my opinion, if that was the outcome.
I wear glasses that are -0.75 undercorrected and find that's my sweet spot for the most versatile vision -- I can read, drive, watch TV, use my phone and do the computer. I keep a pair of full distance-correcting glasses in the car and by the TV, and use them a few times a week. Usually, I don't bother and just drive or watch TV at -0.75. I also keep a pair of -2.0 reading glasses around, but go for weeks at a time without using them. I'm very myopic and just take the glasses off and get real close for tiny stuff, closing my right eye because the astigmatism in the right is real bad.
All that said, I'm leaning toward -2.0 in both eyes when I go for surgery. I don't want any degree of monovision, having tried it with contacts. I want full binocular summation. And, I don't want to carry around reading glasses for really close vision. I'll wear glasses to get to -0.75 for 99% of the day, and switch to distance glasses when I want that little bit of extra sharpness, keeping a pair by the TV and a pair in the car. Any time I need to see close I'll take the glasses off. The need for close vision arises in odd locations and odd times of the day, so it can't be anticipated and prepared for the way the need for full distance correction can be. So it makes sense to me to make close vision the one that is glasses-free.
RebDovid jimluck
Posted
Your reasoning is very thoughtful and, except for your decision to forego monovision, is similar to mine in prioritizing light myopia over the best possible uncorrected distance vision. I write because in thinking about monovision some readers may not appreciate the differences between the conditions of binocular summation, binocular inhibition, and having neither binocular summation nor inhibition.
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As explained by one leading expert, Dr. Jack T. Holladay, equal distance vision in both eyes slightly improves visual acuity. This is binocular summation: "Both eyes [working together] are better than one. If each eye is 20/20, the patient will have 20/16 binocular acuity (one line better than each eye alone) and 40% (2.3 dB) better binocular contrast sensitivity (CSF), and if each eye is 20/40 at near, the patient will have 20/30 binocular near vision and normal stereopsis, which is nine out of nine circles (40 arc seconds) on the Titmus stereo vision test."
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Discussing different types, or ranges, of monovision, Dr. Holladay says: "Traditional
monovision has a +1.50 D add in the nondominant eye and the dominant eye is targeted for distance. Mini-monovision is from +0.75 D to +1.25 D, micro-monovision is +0.50 D, and high monovision uses +2.50 D or above."
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Importantly, what Dr. Holladay calls traditional monovision produces neither binocular summation nor inhibition: "The binocular performance is equal to the better eye (acuities of 20/20 at distance and 20/25 at near), CSF is the same as monocularly, and three circles of stereopsis are lost (six out of nine, or 80 arc seconds)....This is why +1.50 D is commonly referred to as the 'sweet spot' for monovision because binocular inhibition begins with higher adds."
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Unfortunately, Dr. Holladay doesn't discuss the impact of mini-monovision, in particular, how moving along the spectrum from equal refractive results to mini-monovision affects binocular summation and stereopsis? Do they, for example, fall off a cliff or is there a steady, possibly predictable, decline?
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The article, published on August 2, 2017, at healio, is "Should I choose distance vision in both eyes, monovision, EDOFs or multifocals?"
jo61855 RebDovid
Posted
With monovision, there is a possible problem with depth perception. I didn't have a major problem with it years ago when using contacts, but did notice some and even more when wearing progressive eyeglasses later on. It affects judgment as in stepping off a curb, walking down stairs, clearance entering or leaving a parking space. As we age, this becomes more and more of a health and well-being issue.
RebDovid jo61855
Posted
I believe that Dr. Holladay addresses the concern about depth perception in his discussion of stereopsis. It's another reason why, when possible, it makes sense to trial monovision with contact lenses before deciding to implement it through cataract surgery. FWIW, my own such trial, with a refractive difference between my eyes significantly greater than that planned for my Eyhance IOLs, proved non-problematic.