Post-op eye disease after multifocal implant?
Posted , 7 users are following.
Hello Folks,
Above is not my problem, and hopefully never. But... it seems even healthy eyes can develop ERM, AMD, glaucoma, etc. Does anyone have thoughts or experiences about this?
Understand that low-light, low-contrast is worse with multifocal vs monofocal. And combined with eye disease, would the type of IOL be the difference between functional vision vs. not?
Playing "Google doctor" found some articles such as:
- Infuence of mild non‑foveal involving epiretinal membrane on eyes with multifocal intraocular lens
- Multifocal intraocular lenses and retinal diseases
- Visual outcomes of epiretinal membrane removal after diffractive-type multifocal intraocular lens implantation
- Short-term clinical outcomes after implantation of monofocal intraocular lens with enhanced intermediate function in eyes with epiretinal membrane
Expect to get IOLs for cataracts this year and just weighing the risks...
Thanks, Glen
0 likes, 12 replies
ka76787 glen9422
Posted
Multifocal IOLs do not give as good vision as monofocals but people are willing to put up with inferior vision for the sake of being "spectacle-free." If you are unlucky enough to develop another eye condition then yes your vision could be quite bad. Even droopy eyelids can affect the ability of someone to see properly with a multifocal IOL-- the fix for that is an eyelid lift. But if you have eye diseases that can not be fixed then you just have to live with the poor vision.
If you are willing to wear glasses and want the best possible vision then a monofocal or monofocal plus IOL is the best choice. Monofocal plus IOLs provide a slightly extended depth of focus without the visual compromise of a true EDOF lens.
Guest glen9422
Edited
Typically surgeons will only consider implanting multifocals in someone with no eye pathology at all… so that tells you something.
RonAKA glen9422
Posted
I do not think MF or EDOF lenses increase the risk for post cataract surgery conditions. There are some that may limit the ability to address post cataract surgery conditions. One I recall is the IC-8 lens because it has an opaque disk in the lens that may restrict laser treatment. Another is the RxSight LAL lens because it is made out of silicone. I can't remember exactly what the issue is but it seems to me there are some exclusions for using the lens.
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The main risk of MF and to a lesser degree EDOF lenses are optical side effects like positive dysphotopsia, halos, glare, and a combination of the two spiderwebs. Most reduce contrast sensitivity as well. In my view the best approach is to keep it simple. Use standard monofocals set for distance, or near, or in a mini-monovision configuration if being eyeglasses free is a priority. Monofocal lenses if there is a surprise in refraction, or simply to correct near or far set lenses is straightforward. If the plan is to wear prescription glasses there is no need to correct astigmatism. Glasses do that very well.
glen9422
Posted
Thanks for the thoughts so far. The referenced papers seem to indicate that outcomes with some forms of eye disease are not significantly worse by having multifocals. Am only considering the "usual suspects" of Synergy, Panoptix, and Vivity that have been in use for a while. I'm quite keen to be less glasses dependent, but understand that glasses might still be needed for close work, night driving, etc. since outcomes are not entirely predicatable. Seems in some cases folks even have pretty good near with just monofocals. So do want to tip the odds in favor of less glasses, but will accept the artifacts, loss of contrast, and possibility of a miss in refraction/acuity/etc. if I'm a little unlucky.
Yes, even if both eyes are healthy, it seems there are stats that maybe 10% develop ERM at some point, have not been able to find stats for AMD, glaucoma, etc. And of course there is family history, etc. Ultimately, given the many thousands of eyes that have been implanted with multifocal IOLs, seems there should be some understanding of the outcomes if eye disease does occur - but have only found the recent papers mentioned in the original post. And they are inconclusive and certainly not discouraging.
-- Glen
Guest glen9422
Edited
I might consider your age. I think most people getting implants are older. I guess the thing is, if you're 75 and don't have any signs of macular degeneration or glaucoma then you are probably in the clear. But if you are 40 you are going to be living with that implant for a long time and who knows what might happen in the next 40 years.
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Assuming you have a surgeon that is happy to use "premium" lenses in the first place (some never use them in any patients, it depends on the doctor) and given a choice between Vivity or a MF in a patient with borderline glaucoma or or pre-glaucoma, I think most surgeons would choose Vivity because it doesn't split the light.
glen9422 Guest
Posted
Thanks for the age angle. Still a decade-ish away from 75 so kinda a concern.
RonAKA glen9422
Posted
It came back to me what the issue is with silicone IOL lenses. There are some eye diseases which can develop which require the removal of the vitreous material the fills the eye. It is replaced with silicone, and that causes issues with a silicone IOL. If it becomes necessary to do a vitrectomy and you have a silicone IOL, it may be necessary to also exchange the lens for another material that is more resistant to silicone.
glen9422 RonAKA
Posted
Sure, only considering "standard" hydrophobic acrylic. And hopefully Clareon resolves the earlier glistenings concerns - which seemed to be better in later versions of Acrysof anyway.
RonAKA glen9422
Edited
I believe the AcrySof glistenings issue was resolved with increased quality control during manufacture, starting in about 2017. The Clareon is a further refinement in material. I have an AcrySof IQ in one eye and a Clareon in the other eye. No glistenings issue with either one. No perceptible difference in clarity of vision. I do have very minor indications of PCO in both eyes, but neither is at the point of needing YAG. The AcrySof IQ has been in over 3 years, and the Clareon over a year and a half. I do see some minor starburst effects at night with LED headlights, tail lights, and LED traffic lights. Both eyes are essentially the same in that respect, and have not changed over the time they have been implanted.
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The B+L enVista is another good monofocal lens worth consideration if you can find a surgeon that is using it. This is an older lens that was improved to the Enhanced version about 2018 so it unfolds faster, and has a harder surface to resist scratching during implantation. The optical advantage of it is that it more tolerant of being off center in the eye, and to tilting. It also provides an increased depth of focus. Here is the name of the promotion brochure from B+L to google for more information. My brother has this lens and is very happy with it.
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Bosch Surgical EU ENVISTA SIMPLIFEYE Brochure compressed pdf
glen9422 RonAKA
Posted
Thanks will look into it. Are these minor artifacts you describe happening with multifocal implants? Or Vivity? Regarding "better" monofocals, what do you think of Eyehance? Have not figured out what the extra cost for it is (if any) over standard monofocals.
I did try monovision using contact lens and 1.5D delta was fine, but 1D delta might be comfortable over a full day - hard to tell. Could see pretty good with 2D too, but eye strain was noticable. I would still need readers for extended close work, but casual use was definitely better with monovision. I realize contact lens simulations of monovision might not be accurate, and presumably there is still a little accommodation happening with my current natural eyes.
Still, having both eyes sharp (or pretty sharp?) is more appealing than monovision.
RonAKA glen9422
Posted
Here is a article to google about the comparison of halo effect of monofocal, Vivity, and PanOptix. Monofocal is the lowest risk, and PanOptix the highest. In this article there is a graphic which compares the lenses for optical side effects.
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Jimmy Hu, MD Blurry Vision after Cataract Surgery
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I prefer the Alcon Clareon and enVista Enhanced over the Eyhance. The Eyhance varies the power of the lens primarily near the middle of the lens to achieve the slight extra depth of focus. This makes the extra depth of focus pupil dependent. It also can make eyeglass correction more difficult to achieve as the eyeglass has to correct for a varying power IOL. Alcon produced a study that found the difference in depth of focus between the Clareon and Eyhance was clinically insignificant. It is small, in the order or 0.25 D extra. This said there are many that have the Eyhance and are happy with it. It is a lower risk than the Vivity or PanOptix, but also a lower benefit.
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Yes, the contact lens simulation with your natural eyes will give an optimistic view of near vision due to some residual accommodation. With contacts I found I preferred -1.25 D in my near eye and it worked. However, by using readers to simulate myopia after my first eye was done, confirmed I needed -1.50 D instead.
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After having mini-monovision for nearly 2 years now with -1.60 D SE in my near eye, the only limitation I have is in near vision in difficult circumstances of poor light. We went out for dinner last night and while it was near my limit, I could read the menu fairly easily without glasses. My wife who only has vision in one eye, and has a monofocal IOL set for distance has no hope of reading a menu. She has to carry readers or depend on me to read the menu. This said, I have been to restaurants where there is simply not enough light. In those I would use the light from my iPhone and then it would be easy.
glen9422 RonAKA
Posted
Thanks for the details on Eyehance vs Envista, and sharing your experience with monovision. Hope U had a nice dinner!