Questions about Toric Lenses, Monofocals and Dry Eye suggestions
Posted , 9 users are following.
Hello,
My name is Jorge. I am 61 and other than the cataract, I have no health issues that I know about and am on no meds. I stay away from fluoridated and chlorinated water by distilling my water and take whole food based supplements/vitamins. I eat organic almost exclusively whenever possible.
I have been following some of the threads on here for years and have gotten to the point where I need to act. I don’t think I have written before (and if I did, it was not extensive) because everyone here seems to have done much more research than I had/have and I felt that I could not add much to the conversations. I was frankly embarrassed (and still am) for not having done more research on my own. To be honest, I don’t know what I don’t know and need guidance regarding what I should consider important and or relevant to my case.
I have been told by my soon to be ex—prospective surgeon (more on that later) that the panoptix topic lens that was just approved is not recommended for photographers and those who work with subtle color changes and detailed work with subtle contrast differences. I have therefore decided to go with monofocals and deal with glasses for very short distances.
I would like to ask and hope that some of you long-term users of both monofocals and multifocals can weigh in on your experiences regarding glare from the concentric rings and the color aspects.
My vision has been deteriorating for about 6-7 years and I now find it difficult to read small print and I am sure that since this has been a gradual decline over years, that my vision in an absolute sense, is much worse than I realize. I am therefore wondering if since i have come to tolerate and deal with my vision up to this point, if the comparative differences between how it is today and how much better it will be with ANY lens, should be a factor in considering a toric lens. (I tend not to like any compromise and think that i would prefer no concentric ring glare from toric lenses with occasional glasses use to constant glare from point sources of light and hoping that my brain will learn to ignore them over time with only slightly less need for glasses along with the possibility of the reduced contrast and color differences).
Dry eyes: Did any of you have your doctor test for dry eye? Did your doctor try to remedy that and tell you what was wrong?
I went to a doctor who explained to me that my dry eye was being caused by MGD (Meibomian Gland Dysfunction). She then charged me an eye and a leg to get a heated eye massage as well as using a laser to help tread the MGD. Here are links to articles that discuss approaches:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298157/
I cannot find a reference to the laser she used but I am continuing to do the heated eye treatments with mask that heats uo the eyes and then I express the glands by gently rolling my fingers up to the eyelids.
Why I am seeking another doctor to do my surgery:
This doctor though seemingly experienced and competent/knowledgeable about the surgery, never once brought up dry eyes and when I brought it up, he told me that what he was going to be doing dealt with the inside of the eye so that dry eye would not affect it. While I can see how that might be accurate, I would think that a doctor should still try to get the eyes to be as healthy as possible before surgery and that was what another doctor (who I also let go) was trying to push prior to surgery. Your thoughts?
My date for surgery was set when I remembered that as a former Lasik patient, I had read that there were some adjustments that were sometimes needed for cataract surgery patients who had had Lasik. When I brought this up with the gal who scheduled my surgery, she looked in my notes and confirmed that Lasik though noted, was never discussed with respect to surgery. She spoke to the doctor who said that he remembered seeing that I had had Lasik and “thought” he had gone over it with me. She informed him that according to the notes and myself, that he had not and had to reschedule surgery to a facility that had the newer lasers that could perform those procedures (I believe she called it ORB or something like that).
So, the fact this doctor has overlooked things that I think are important, is prompting me to look for someone else.
Can anyone who has had the Lasik and the subsequent adjustments to further accommodate for that, tell me what their experience was and if they would recommend it. I recall reading that some were actually against doing it for one reason or another.
I am in Los Angeles, just in case some of you have a recommendation for a great doctor. Family is referring to a doctor in NY.
Thank you very much,
Jorge
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0 likes, 17 replies
soks banterer
Posted
i did not have lasik but still got ORA which is intraoperative measurements and it was accurate. i did travel to new york for surgeon of choice. Los Angeles doctor i considered was Rex Hamilton out of UCLA but did not proceed as teaching hospitals have tendency to use residents for surgery. i have Symfony non-toric so not much insight on your other questions. good luck.
banterer soks
Posted
Hi Soks,
I will assume that you were happy with your NY doctor. How did you find him/her? My brother-in-law says that his ophthalmologist has consistently appeared in the New Yorker's (magazine) list of best doctors for the past few years.
Thanks,
Jorge
ara21947 banterer
Posted
hi Jorge
while there are always good doctors on the best list in New York magazine or that of any other city , there are varying criteria to get your name there some of it financial . it is advertising
select your surgeon by the number of surgeries hes done and go on the Medical Quality Assurance page of your state to check his license status and other information and ofcourse if he remembers you and spells your name right and all the other things that might make you uncomfortable. That said, it still can go not perfectly well but youve done your part
soks banterer
Posted
i am not happy with my NY surgeon and will not be going to him for the 2nd eye. he had great reviews, teaches at premier university and charges a premium. he was very responsive used the latest technology and allowed me a lot of choice given all that, i had PCO in 3 weeks and suffer from positive dysphotopsia. now i can blame myself for my troubles but i will at least save a premium. one often meets their destiny on the road they take to avoid it! we can talk in pm if you want.
ara21947 banterer
Posted
you are correct to seek another surgeon who is less cavalier. Dry eyes and cataracts are a big deal. Most surgeons will put you on a regime to lessen any dry eye syndrome should time allow.. It affects the outcome.
Just today for check up on my monofocal toric lens the dr asked if im using restasis to increase tear production. I said I was using moisture drops He shrugged saying thats all fine but final results are assisted by increasing inner eye moisture
Guest banterer
Posted
Hi
For sure it is confusing, we all have plenty of doubts, both before and after surgery.
I have a mix of two premium lenses, one edof and one trifocal.
I am happy with my vision, but yes, these lenses do have side effects.
For sure, if you want the highest quality of vision with least risk of side effects, quality monofocals are the way to go. An yes, then you will need glasses for close up vision.
About dry eyes, when the surgery is done, it will affect dry eyes as well, dry eyes in the weeks or month after surgery is normal. I don´t think many surgeons do much to treat dry eyes before surgery, whether it is wrong or right I don´t know.
About Lasik and cataracts surgery, it is true that Lasik makes the measurements for the new lenses more difficult. I think the system that was mentioned to you is called ORA, it is a clever system, that makes new measurements during the surgery, and gives the surgeon the choice of making more precise measurements when the old lens is removed, that is if the surgeon have different lenses on hand at the surgery.
With premium lenses, the lenses are often made to order, so ORA is often not possible with premium lenses. If I was going for monofocals, I would choose a clinic with ORA for sure.
Mutti3 banterer
Posted
will keep my comments brief. Did seek a second opinion, and very happy i did. Monofocal was chosen for me because i have ABMD of my cornea. The colors and tones i see now are just fabulous! My left is set for intermediate, right
eye distance. i can see perfect at night while driving with no glasses. i wear +1.25 reader because my house is dim!
Dry eye, use eye drops occasionally. Maybe once daily.
cataract surgery was a real game changer for me.
banterer
Posted
Thanks to you all for your responses, they are truly helping me with my decisions.
I tried mono-vision when I first got Lasik and I hated it. I went back and had the surgeon redo it and he still scared me into doing mini-mono where my dominant eye was a set for perfect vision and the other to a little farther distance. I tolerated it but this time will get both eyes the same (if I can).
Thank you for your comments about dry eye, I have been using the heated eye mask now for about two months or so and only feel slight discomfort if I don't get a full night's sleep. I confirmed that my oily tear production has improved by asking the technician who was doing the measuring for the lenses, if she could actually see any increased wetness on the surface of the eye after she told me "blink, blink, blink". She told me that she did. So I will continue with the heat and expressing the glands as I actually do feel increased moisture between my lashes when I explicitly pay attention on conscious blinks.
mjcg banterer
Posted
When it came time to get cataract surgery after a successful RD repair (vitrectomy), I sought opinions from three top area cataract surgeons. Each one provided a different recommendation! So it is definitely not an easy decision for anyone.
In my case, I went the conservative route and received a near distance lens (the majority of people go for distance or multi-focal lenses). I've been near sighted all my life and at my age, I'm ok with wearing glasses. The surgery went well and the first thing I noticed that wasn't apparent before was how clear my vision was - meaning I had been seeing the world through a slightly yellow/orange tint! Colors appeared brighter (blues more blue, greens more green!). It was an easy surgery compared to a vitrectomy!
I was also diagnosed with dry eyes about two years ago and was given a popular prescription eye drop that starts with an R. It seems to help, along with regular eye drops as needed.
So... I've been trying to offer advice but I'm using the "I" and "me" word a lot and making this all about me (ha ha). But this is about YOU and you need to ask for recommendations from the top lasik/cataract surgeons in your area. Go see another two. Then choose the surgeon you have the most trust in.Follow the pre- and post-op instructions carefully and all will go well. Please keep us posted! Your journey will help others who come to this forum.
banterer mjcg
Posted
How does one go about finding/determining the "top" or best cataract surgeons in one's area?
ara21947 banterer
Posted
Just a suggestion that might have gotten lost in above. Look for length of practice and number of surgeries, then look at what type of surgery and what specialty. Then look up license . Just because a dr has a lawsuit doesnt always mean squat since people are litigious and sometimes a case is simply settled -- its the number of lawsuits that might show a pattern. This site will also show education and sometimes continued ed courses. Those best dr lists in magazines often are paid advertising or gifts for those who have advertised preciously in the magazine or who have political connections etc. Check also the facility.
I 100% understand your stress since this whole thing is not fun and is so crucial to well being.
Bookwoman banterer
Posted
One route is to look for doctors in the ophthalmology dept. at the best teaching hospital in your area, or at a dedicated eye hospital. Then, as ara says, length of practice and number of times they've done the procedure are crucial.
Mutti3 Bookwoman
Posted
banterer
i went to a dedicated eye center that specialized in diseases of the eye. No optical store, no vision testing for glasses. i learned this from my first encounter, almost ran out of there!
mjcg banterer
Posted
Good suggestions from my fellow posters. I'm fortunate enough to live in a city with one of the top ranked eye clinics in the U.S., and it is connected with a university hospital. I also sought opinions from two additional surgeons outside this particular clinic just to "be sure"... lol You should do a simple internet search for top cataract surgeons in the LA area. My guess is there are many qualified and excellent surgeons there. You can call these offices and ask them if they have any surgeons who have performed cataract surgery on patients who have had lasik surgery. Ask how much it costs for an evaluation (hopefully your insurance will cover any costs, mine did). Also, ask around (your optician, general practitioner, friends, family, neighbors...).
One thing I was told by a friend who is a pediatric eye surgeon is that the best way to insure a successful eye surgery is to strictly follow the pre- and post-op instructions. So, one you've decided on the surgeon and type of lens you want to have, then follow those instructions.
soks banterer
Posted
"How does one go about finding/determining the "top" or best cataract surgeons in one's area?" - i had asked this to 3 of my doctor friends and these were the responses.
ask your local optometrist who the local superstar is. u will be surprised at this approach.
go to surgeons from good universities through their private practice. if you go through the university a resident may do the surgery under their supervision.
make sure the doctor is an in network provider for your insurance.
i wanted catalys and ORA so selected doctors who had and used both of these. btw rex hamilton does not have catalys he uses lensx laser system. in case you are considering laser capsulotomy.
another friend said when it comes to cataract surgery volume is the key. on healthgrades you are able to check the surgeon volume for cataract as compared to their peers. large number of reviews on google, healthgrades and vitals also help with this,
look for someone with 10+ years of experience and in their mid 40s and early 50s. rationale being they have enough experience but are also not using out of date techniques.
Meet the surgeons and ask for the visit report and compare them. ask questions post visit and see how responsive the office is.
banterer soks
Posted
Thanks Soks,
I looked up healthgrades and got mixed results. Some doctors had good reviews but when I searched for cataract specifically, the site said only a few listed it as something they treated, yet they were the ones that came up as a result of my search for cataract surgery.
I tried looking for docs in the 41-50 bracket but the two that came up only had 2 reviews. The one that I eventually ended up sending a request for an appointment had over 400 reviews but he is in his 60s. I however, am not sure if you meant that I should be able to look up the number of cataract surgeries they have done specifically on healthgrades. If that is what you meant, I was unable to locate that utility/functionality.
So, we will see what happens.
I'm also looking at Vitals.
Thanks for the various methods.
Jorge
soks banterer
Posted
hi banterer
healthgrades has replaced the section i was referring to with experience section. i used healthgrades to look up individual doctors after i had searched them elsewhere.