Second eye operation
Posted , 4 users are following.
Hello. My name is Alex and I´m from Spain. My grandma is 82 and had a cataract surgery on her right eye around 14 years ago, and she got a monofocal IOL but she always said that she never reached a perfect vision with it (it was placed by a national health service, which only places monofocals). A few months ago we went to a private hospital and the doctor suggested the best option would be a trifocal IOL on the eye that still has the cataract and an Add-on lens in the cilliary sulcus on the previously operated eye, but they would operate the cataract first and see how she evolves, so the add-on may or might not be necessary depending on her binocular vision. I asked about IOL exchange but he said it is too dangerous because the capsule could break.
I have done a lot of research about IOLs, including reading her doctor´s Ph.D thesis and their latest papers, some of them published on Nature and other major scientific journals because I like making informed decisions, especially the ones that might not be reversible. In those papers they talk about EDOF lenses like symphony or miniwell and trifocals like LISA Tri, finevision or panoptix but synergy and symphony seem to offer the best results. The main difference seems to be that EDOF offer a continuous focus but lack of a good near vision, and trifocals offer good near and distance (and a decent intermediate) vision but only in specific focal points.
So I asked the doctor a lot of questions about the lens, and he said that she wouldn´t be a good candidate for EDOF for two reasons: the first one because she wants a good near vision and the second one because she has myopia and, since she is currently seeing better in near vision than she should (due to the myopia), an EDOF would give her a worse near vision than she already has, so he recommended Finevision IOL.
I also asked about synergy IOL which combines the best of both worlds (EDOF and trifocal) he said it is a good lens, but a hard one. The post-op is harder for patients because they see more distortion and halos, although after a month they see well, but he doesn´t like it much and recommends an easier lens for her , the finevision. She also has some astigmatism that he hopes to correct with the incision in the cornea.
What should I do? I said clearly that money was not an issue, that we want her to have the best vision she can get, and he still recommended the finevision. He answered all my questions very nicely and looked very trustworthy and experienced (does over 1000 cataracts a year) I really liked talking to him, but I still wonder why he doesn´t like synergy. From what i´ve read it is better than finevision... I don´t know, I´m just a biologist who reads papers about anything I´m interested in. Maybe I don´t know enough about this specific area and finevision really has advantages over synergy.
My grandma has put all her trust in me to decide for her what to do, and I don´t want to make a bad decision.
Would you get the finevision? Would you ask for a second opinion? Is there really any drawback to synergy? Maybe the decision is based on being able to "trifocalize" with the add-on the other eye (because there´s no synergy in add-on format)?
Thank you for reading it
Alex
0 likes, 10 replies
RonAKA Alexgdelcg
Edited
There are pros and cons to all the EDOF and MF lenses. The PanOptix and now Synergy are latest versions available in North America. Another option to consider is simply doing the second eye with a monofocal that undercorrects her vision by about -1.25 D, or in other words -1.25 myopic. This should allow good TV vision, computer monitors, and most reading. For the best reading vision, then readers could be added. Keep in mind that the best optical quality in IOLs is in the basic monofocal ones. They do not use optical tricks to allow you to see near and far.
Alexgdelcg RonAKA
Posted
thank you for your response. I don´t think she is interested in monovision because her sight with the far eye is already not so good and she would like to see near without glasses, but I appreciate your comment and it sure works for some people
RonAKA Alexgdelcg
Posted
Do you know what her issue is with the eye that is already been done? Her eyeglass prescription for that eye?
Alexgdelcg RonAKA
Posted
the doctor thinks she must have some degree of amblyopia in that eye. he said it must not be as dominant as it should and she also has some astigmatism in that eye
RonAKA Alexgdelcg
Edited
Yes, amblyopia cannot be corrected with an IOL. My wife is in that situation, and she will be going in for her cataract pre-op consult next week in the non amblyopia eye. I have suggested to her that going for a basic monofocal aspheric lens and using reading glasses would be the lowest risk option when you really only have one eye to work with.
Alexgdelcg RonAKA
Posted
what a difficult situation. I hope she is able to see well after the surgery. one question, why not try to use a MF on that eye so she doesn't need reading glasses anymore?
RonAKA Alexgdelcg
Edited
I thought about the Vivity lens as it seems to have a lower risk of dysphotopsia issues than a full EDOF or MF. We have a friend that has PanOptix in both eyes, and she is not happy with them, after spending about $4500 for them.
.
It seems to me that with only one eye to work with, one needs to be cautious and choose a very low risk option. I believe that is a monofocal aspheric for distance and reading glasses. She has needed reading glasses for many years now, so that will essentially a zero change for her. She has not really needed eyeglasses for distance, just readers for close up. She always has a pair or two of progressives as she has a very slight distance correction, but she does not like them. I suspect she will be very happy with full distance correction and still needing readers, but without a cataract to blur vision.
Alexgdelcg
Posted
up! let's see if someone else answers
Sue.An2 Alexgdelcg
Posted
Hi is there a particular reason your mom wants good close vision? Does she have a hobby or read a lot?
you mention the doctor said she would not be a good candidate for EDOF lenses because of her desire for close vision so I wondered why.
i had my surgeries in 2017 and opted for Synfony both eyes. They do provide seamless vision and for whatever reason I ended up with very good close vision - can read from 11 inches. I do have readers for when I do a lot of reading but for reading newspapers reports or anything on my iphone I don't use them. The info provided me at the time was that vision would be 18 to 22 inches out.
The disadvantage of MF lenses is night vision - I see multiple concentric circles around certain types of lights.
Sue.An2 Alexgdelcg
Posted
Hi is there a particular reason your mom wants good close vision? Does she have a hobby or read a lot?
you mention the doctor said she would not be a good candidate for EDOF lenses because of her desire for close vision so I wondered why.
i had my surgeries in 2017 and opted for Synfony both eyes. They do provide seamless vision and for whatever reason I ended up with very good close vision - can read from 11 inches. I do have readers for when I do a lot of reading but for reading newspapers reports or anything on my iphone I don't use them. The info provided me at the time was that vision would be 18 to 22 inches out.
The disadvantage of MF lenses is night vision - I see multiple concentric circles around certain types of lights.