Normal 42 year old one week to Posterior Subcapsular Cataract next week.

Hi seeherenow - i too am developing pco in LE (at least that is what I believe it is). Let me know how yours turns out. I see a bit blurry all ranges out of that eye but not noticeable with both eyes open. Is that how you'd describe it?

Some more questions 😃

8. Can you wear contact lenses instead of glasses? Is it not bad to use contact lenses on top of the IOL?
9. If say my wife get IOL to see far. That means she could wear glasses to see near. So if my understanding is correct then to see far she has to lift the glasses away? How does this scenario play if she wears contacts for near vision? What happens if she then looks up to see far? How will that work? I am confused.

Hi Worried Husband

8. Contact lenses can be a preferable option for many people, but there are some eye health issues and visual conditions that require certain precautions when wearing these lenses. Wearing contact lenses after you have had cataracts removed surgically is not an issue as long as the eyes have had enough time to heal. If your wife wears them now (and likely doc will mention this) have her remove them a couple of weeks before eye mapping is done as they can affect shape of your eye and power calculation may be off for IOL).

9. Yes contact lens can be worn over the IOL after healing.takes place and there are no complications. I was told to wait 6 weeks before going back to my optometrist for a new prescription. Often cataract surgery induces dry eye - for some people contacts wouldn't be comfortable.

Currently my wife wears no contacts or glasses. She had good vision until this issue appeared suddenly.

I was asking to understand future options, specially when doing sports. I wonder if there are glasses for sports!

if getting monofocals she can have dominant eye set for distance (plano) and other eye 1..0 diopter nearer - that way she can see well for computer to distance and need readers only for reading.

Alternatively she can chose a EDoF IOL like Symfony or atLARA or a trifocal after which she likely won't need glasses or contacts at all. As mentioned these ate gaining popularity and people are opting to have their natural lenses removed in their 40s to correct presbyopia. Not something I would do but if all goes perfectly your vision greatly improves.

Europe has many more options than USA or Canada for IOL selection. Typically people go with monofocals to lessen the chance of halos and glare at night but if your wife doesn't drive perhaps she'd prefer better vision at all distances than a monofocal will provide. Some people decide to mix IOLs and go with a trifocal in one eye (or EDoF) and monofocal in the other.

She should explore all options with the surgeon (and I'd suggest getting 2 or 3 consults) as most doctors have their go to solutions and IOL preferences. She will gain insight at each consult and assess who would be best for her. An IOL exchange is possible but is more trauma on the eye so it is best to get as much info as you can and get the result you want first time.

If she can get to an optometrist to experiment with contact lenses (to see if she tolerates them or can adjust well to a mini monovision arrangement) that would be a good experiment to try. My cataracts were bad enough I was not able to test that out.

9. if she gets IOL for far and wears reading glasses, you are correct that she has to lift them up for far.

if she has distance IOL and wears contacts for near then when she looks up the distance will be blurry and she will have to wear glasses for distance over the contact.

I sent you a private message with a link to an article about range of focus you get with a monofocal IOL and how mini mono vision can extend the range. I found it to be very beneficial. We can't post links here. If anyone else would like it, I'm happy to message it to you. As SueAn said, your wife should explore all options and decide what's best for her... multifocal, EDOF, tri-focal, monofocal set to distance, intermediate or near, monofocal with mini-monovision or monovision. I may have missed some.

As someone who has never worn glasses or contacts, is it same for non-cataract people who are near or far sighted?

Getting distance IOL for most people is like having good distance vision but presbyopia kicking in. So if you wear near contacts then you would have to wear distance glasses even though distance vision is good.

Once natural lens is removed all accommodation is lost and it is the IOL you choose and power calculation that will determine what glasses or contacts your wife needs. If going with atLARA (similar to my Symfony IOLs) or atLISA trifocals glasses or contacts likely not needed at all if power calculations are on target.

Hi SueAn!

Yes, the PCO began that way but now the left eye is very noticeable, almost like having the cataract all over again, including the dimming & slight darker tint. The right eye isn't too bad yet, so I'll wait another month or so for that one.

I'm grateful for the info you posted on another thread about YAG vs. lens opacification occurring with B&L IOL's. My doc checked for that and I was relieved to know it was just PCO! 😃

Yes, you can find prescription sports "goggles" for swimming and mountain climbing, presumably made of high impact polycarbonate plastic.

You can be sure I will be asking for verification of PCO vs lens opacification as well. That feels like a life sentence if it's not pco and they do the YAG. At that point one would prefer a lens e change. Wishing there was an update on that thread as I think there is a lawsuit pending. Perhaps another reason Canada and USA don't have as many IOL selections and take a long time getting FDA approval.

I too am waiting but think when I compare the eyes LE is starting to see a brownish tint again. Keep me updated on yours - and what you decide.

thats a great point to check for lens opacification. i wonder if they even check that in routine exam.

Not sure - but as a patient it's on my radar to ask.

The cases I read about were in UK where same clinic that did the implants also examined for pco when patient returned due to blurry vision. Did they know or did they misdiagnose? If properly diagnosed would they have had to do free lens exchange? One wonders if profit plays a part.

The IOLs that have this issue aren't available in Canada or US but still good to inquire.

So confusing!!! could someoen please check my understanding of IOLs?

1. Multifocal- I understand, so multiple rings with different focus areas/distances?

2. EDOF- I don't get this one fully, is it not just another name for a Multifocal IOL?

3. tri-focal- Means 3 distinct focus distances? How many does a multifocal IOL have then?

4. Bi-focal- Means 2 distinct focal distances?

5. monofocal set to distance, intermediate or near Standard IOL set to one fixed focus?

6. monofocal with mini-monovision or monovision. Don't fully understand this one either

Hi Worried - some info on IOLs (my understanding of them)

1. Multifocal - really are bifocals they provide 2 distant ranges and there could be a dip in vision bwtween 2 foxal points.

   Also from my understanding light is split between the focal ranges and there is loss of contrast sensitivity vs EDoF IOLs.

   One tends to see more halos vs a monofocal but the extent to which you see these or are bothered by them is very individualistic. Really important with all the premium lenses that power calculation is accurate. A person expects to wear glasses with monofocal and people's expectations generally not as demanding. People pay a price for premium lenses so expectations are high. Doctors should do better job and screening patients and not promising glasses free with premium lenses (although it can be the result). surgeons should stress you'll be less glasses or contacts dependent. Better to under promise and over deliver in my honest opinion.

2. EDoF (extended depth of focus). Think camera lens. You get continuous range of focus within that range - no dip in vision. These are newer on the market than multifocals. I have them - Technis Symfony) Zeiss atLARA are EDoF IOLs too and available outside of USA and Canada. Better contrast sensitivity - almost as good as a monofocal. Con: you do see multiple cinectric circles around certain light sources (red traffic lights) . These ate bigger the further away from target you are. Think spider web however they are very light - mine more vivid inner few circles and not very discernible the outer rings.if you drive for a living at night might not be choice for you. I found it harder in the beginning 6 months but had more glare that was bothersome till iol settled.

3. Trifocal like Zeiss atLISA are 3 focal points provide near intermediate and distance. If power target is achieved one can see all ranges well without glasses. Due light being distributed between 3 points there is a greater loss of contrast sensitivity from what I read. I believe there is a small halo around light sources with these as well at night. Many are mixing this lens with another to get that desired reading distance.

4. Bifocal are multifical lenses. Not sure why called multifocal when 2 zones.

5. Monofical lenses can be targeted to see one distance well. Distance (TV driving, etc) Intermediate is computer distance or seeing someone across the table) or Reading distance is self explanatory. Most surgeons assume distance - perhaps as one needs distance to drive. But you can choose a particular distance and a good doctor should ask where you spend your time and what you are used to. If one wears glasses for distance all their life perhaps they would prefer to stay that way after cataract surgery.

I should add here that some people getting monofocal lenses do actually see more than one focal point (ie if targeted for distance also see their computers. It depends on a variety of things (shape of cornea for one) but predicting this beforehand is hard so best go into it thinking i will need bifocals or 2 sets of glasses.

6. Mini or full monovision is a strategy used with monofical lenses. Mini would be anything from .25 to 1.25 diopter difference between eyes ad that gives someone ability to see 2 focal points. Mini is normally easier for a person to adapt yo without seeing double or different object size. Little loss of depth perception with this. Full monovision unless one is accustomed to that set up with contacts prior to cataract surgery not recommended. Harder to blend vision and much greater loss in depth perception.

Again I am so long winded but hope this helps. All these you can google to get fuller explanations. Important to discuss options with surgeons and get a sense how flexible they are and willing to explore with you.

To add to SueAnn's reply, it can be confusing.

I find that many (if not most) cataract surgery clinics use the term "multi-focal" generically to cover both traditional multi-focal, EDOF, and tri-focals.

The first "Multifocals" were really bifocals, give both a near and distance focal point. The downside was more effects like halos, and when the light is split into two focal points, some of the light is lost - this can lead to reduced contrast sensitivity.

EDOF, Sue-Anne explained. They provide extended depth of vision, aiming to cover from intermediate to far.

The latest generation is tri-focal (which is not available in the US yet, but has been used with great results in Europe for six years). The physics of vary with the each manufacturer, but the aim is to provide very good distance and intermediate (arm's length) vision, and good near vision. The physics have also been improved, so that less light is lost when splitting the light, so that the most recent tri-focals achieve 86% to 88% light yield, which is very good.

So US patients, when their clinic talks about multi-focals may be referring to the older bifocals (which will not be used in Europe anymore), or EDOF such as Symfony or AT LARA.

In Europe and much of the rest of the world, the premium lens choice is either tri-focal (PanOptix, FineVIsion, or AT LISA) or EDOF. Europe will not be offering the older "bi-focal" version of multi-focals anymore as tri-focals are better in every way than bi-focals ,and the experience has been very positive.

To learn more use the following search terms to find some good articles:

1. search "eyeworld" and "Trifocals outperforming other premium lenses"
2. For a company funded article that explains how one premium tri-focal works, search: "theophthalmologist" and "panoptix"

Your wife's doctor can advise which options might work for your wife based on her measurement and age.

Thank you SueAnn and Janus.

My wife is finding EDOF very attractive and the new trifocals but still scared about going for either over "safer" monofocal IOLs!

An eye surgeon replied to my question online-

Your wife does not have much astigmatism so a regular high quality, aspherical monofocal IOL should work nicely.

She needs a test called Macular OCT to view the macula or reading part since the doctor could not see it well.

There is considerable pressure in the USA and I'm assuming Europe to spend extra for toric IOLs, multifocal IOLs, femtosecond laser, ORA real time IOL power verification.

None of these have been shown to be better or safer than standard small incision phacoemulsification. In fact my wife had IOL surgery this year and we did not opt for any of these.

If she would like good vision without glasses for distance dominant eye targeting -0.25 and non-dominant eye -1.00 (minimonofocal distance bias works well)

Glasses are still needed to make the eyes work together perfectly and especially for prolonged reading.

So called "Premium IOLs that are like bifocals in eye are:

1. Very expensive and most of cost out of pocket.
2. Have a higher incidence of disappointed patients.
3. Usually require glasses for many things
4. Provide inferior night vision.

Agree one doesn't need cost of laser but ORA is a newer technology that allows surgeons in real time to check power calculation. I think if going with a premium lens - and paying the money that would be highly recommended and beneficial. Accuracy in the calculation of power is crucial to how well premium lenses work and patient satisfaction. I have a friend whose husband just had cataract surgery on both eyes one week apart with monofocal lenses and needs glasses initially for everything except distance. They were not keen on researching this. Also with having surgeries a week apart and now vision changing. Waiting gives a much better opportunity to make adjustments to 2nd eye.

My personal opinion - your wife should get several consults. This opinion is very conservative view and if going with this doctor I would not go outside what they recommend. Other surgeons will be open to more options and see pros and cons to both. The newer generation of EDoF and trifocals are much better.

I find it confusing as well, but all surgeons have their own opinion, based on their experience on what makes their customers happy.

You find this is in all sorts of trades. I am an educated mechanic, I like to fix brakes by my method, another mechanic like his own method better, but the car can probably stop in both cases 😃

Here in Denmark we also have eye surgeons that stay with monofocals, and they often do not think glasses after the operation is that big a deal, but we have also eye surgeons that make Zeiss Lisa trifocal lens implants on people that do not even have cataracts, just to eliminate presbyopia, which to me sounds a little crazy, but they have lots of satisfied customers, costumers often makes reviews on third party sites like Trustpilot.

I am going to have lenses soon from a mix and match strategy, time will tell, if it was the right decision for me.

I understand your wife have the opportunity of Zeiss lenses, I will be getting the AT Lara EDOF in my dominant eye, and the AT Lisa Tri in the fellow eye.

The Lisa Tri should give a little more reading vision and the rest of the way support the dominant eye, but at the same time Lisa Tri have more contrast loss and possibly more negative side effects than Lara, and monofocals.

Maybe this combination could be interesting to investigate for your wife as well.

Outcome is very different from person to person, but these mix and match strategys are made from the knowledge that the brain tends to take the best it can get from any eye and "only" take the best of the negative side effects as well.

Some people are happy with it, others are not, like with all types of lens choices.

But monofocals will always be the ones with less negative side effects, the more you want from the lens, the more you trade in possible negative side effects.

I have severe side effects now before the surgery, so I am not scared of side effects at all, I want all i can get from those lenses, and this my approach, each must make their own choice 😃

But for me it was also a matter of trusting the surgeon, who has done many thousands of these lens exchange, and has a solid knowledge that I can never get, no matter how many hours I spend on the internet 😃

I went to the clinic mostly interested in the trifocals, but he talked me in to choosing the Lara on the dominant eye, to boost the intermediate vision and have fewer side effects and lesser contrast loss than with two trifocals, and I am happy he did - i think - but we will see....

About laser lens exchange, they do have it where I am having my lens exchange, but the surgeon thinks it is a waste of money, and this is money he could have made, so I believe him 😃

Cheers

Christian

Oh, by the way, the surgeon have not promished me full independence of glasses with the mix of Lara and Lisa, he predicts that I should be able to do most of my daily activities without the need of glasses, but if I want to read a book or similar tasks with close up vision for extended time, I should use some mild reading glasses to not get tired from it.

Sounds like you have an honest surgeon with integrity. There are many variables in cataract surgery and although there is a strong probability you won't need correction with glasses afterwards a surgeon can't and should never guarantee that. Better to have a realistic expectation knowing possibility of needing glasses than expecting to be glasses free and disappointed with outcome.

Worried if I can piggyback on response to you, it is really just as important as lens selection (more do in my opinion) to find a good surgeon your wife is comfortable with, has the experience and skill and is also confident in his IOL selections. If you really like the surgeon who's go to lenses are monofocals stick with that. If you want to explore premium lenses find one that is the best in lenses she wants.

Hi Soks & SueAn:)

If you search "Lens opacification and Bausch & Lomb hydrophilic acrylic IOL", you can find some good articles. My LE has a B&L monofocal IOL of this type, implanted a year ago. Apparently the main difficulties with this type of IOL became known about 10 years ago, so companies have improved them. But one doc's article recommended "a careful eye slit exam" to look specifically for the lens opacification or PCO. I mentioned this to the Optometrist doing the YAG screening and she obliged, doing a 2nd exam to be sure. Only takes a minute.

This (2nd) surgeon (who did my Symfony RE IOL) is very open to answering my questions and so are his staff. They said that opacification of the lens is extremely rare, but easily spotted if you know what to look for. It has to do with the surface of the IOL being flat and the remaining capsule behind it not being flat. They also said that lens replacement is to be avoided if at all possible because it is more risky and traumatic for the eye. Don't think this had anything to do with financial motive on their part.

I was relieved to learn all this (along with the diagnosis of PCO) and am looking forward to the YAG in 2 weeks!

Eye Doctors professional opinion is very important. Get a second opinion to be sure.

The rest of us are not doctors, but can only share our experience and research.

The thing with premium vs mono is that your wife does not currently need glasses. So she is neither near-sighted, nor far-sighted.So premium multi-focal may not do as much for her and mini- mono (two mono-focals set to distance and intermediate) may be the best option.

Get another opinion, do your research, then you can make an informed decision.

i agree that lens is traumatic to the eye.

are you getting yag in both eyes?

BnL IOL is recommended for this with positive dysphoptsia risk.

That surgeon opinion that I posted above is a US surgeon who replied on an online eye forum.

We are seeing the first eye surgeon this Friday and a second eye surgeon 5 days later. We will see what they say and if we feel comfortable with them.

That was an online eye forum opinion of a surgeon.

We have not seen any eye surgeon yet. We have 2 different surgeon meetings lined up in next 10 days.

We won't get pushed or rushed into anything.

Janus -Right you are none of us are doctors s d like you think it is a goid idea to get a couple of professional opinions. Whether one has much near or far sightness prior to surgery matters only for power calculations. Once one's natural lens is removed all accommodation is lost and I do believe very much that the type of IOL will matter very much monofocal vs premium. She will notice and perhaps be bothered by monofocal lenses and havibg to wear glasses a lot more than current situation. Although no guarantees premium lenses are an opportunity to see at more if not all ranges.

yes there are 2 forums I am aware of online discussing IOLs and surgery. One in Singapore Dr Por Yong Ming and the other is Dr John Hagan

US Surgeons do not have access to the latest tri-focals. So the on-line response you got that seems to suggest don't bother with premium options, may not the appropriate answer for you as in Europe you have access to the latest tri-focals which have been getting very good reviews.

You are going to see two doctors in your country.. That's good. See what they say after considering your wife's measurements.

Tri-focal or EDOF may not be for everyone, but if your doctors suggest they may be appropriate for your wife, then I personally would strongly consider them.But most important is getting doctors tell you based on your wife's situation what the options are and what to expect.

Tomorrow is the day we see the first surgeon. I will be reading the whole thread again today and edit my "Questions for surgeon" list accordingly.

Thank you for being there, the support and empathy. We feel alone but bit less because of kind people like you.

Promised SueAn I would report , so here it is....

I went to Doc 1 again, even tho he hadn't done original surgery on that eye, because I felt most comfortable there. He explained how it works and that they've been doing this simple laser procedure for 35 years.

It's as if your posterior capsule were a taut piece of plastic wrap stretched over a bowl in your fridge and the PCO is like the plastic has condensed water on it producing the mild "film" of cells clouding your vision. The surgeon uses 4 laser pulses in a cross-like pattern which ore or less "pop" the tautness of the "plastic wrap" and it naturally falls away, eventually dissolving.

You can see the difference right away, They use anti-inflammatory eye drops to alleviate pain & you use them for a week. By then nearly all related floaters had dissolved and I was so grateful to have that perfect vision back in my left eye!

Of course, then I noticed the developing PCO in my right eye more, so I'll have YAG on that next month. Overall, living in MUCH GRATITUDE for perfect vision possibilities after cataract. We are so fortunate compared to patients 50 years ago!:)