Two Differing Opinions on Multifocal Lens, not sure if I should get a third?

They may not get kickbacks like car dealers do based on volume of sales, but according to my ophthalmologist preferred surgeons can get their clinic outfitted with all the fancy and expensive instruments needed to measure the eyes by the IOL company. This is worth quite a bit especially to a surgeon early in their career.

You might be interested in checking out a US government website called Open Payments Data CMS. It seems to track funding that individuals get from private companies in the US. I found it when checking out Dr. Uday Devgan who is one of the rockstar ophthalmologists that is located in LA. I didn't check into all of the years, but he seemed to hit a peak of about $30,000 in payments in 2019, and has gone down to much lower levels in the years since. Most of them seem to be drug reps buying him lunch. Most payments came from Novartis and in 2019 it seems he was on a paid speaking tour for Novartis. Bausch and Lomb and Alcon come in with lower amounts. To my knowledge Novartis does not make IOLs, but they do make the name brand Vigamox and Durezol eye drops that are expensive and commonly prescribed for the cataract surgery recovery period.

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To Sandy, Dr. Devgan may be someone that would use B+L lenses (based on the lunches they have bought him!). Their enVista lens is one I would consider if doing monovision with a monofocal lens. They can be harder to find than the more commonly available J&J or Alcon lenses.

Oh yes, I'm well aware that doctors and drug companies, device manufacturers, etc. often have too-cozy relationships. I was simply responding to the idea that an eye surgeon might be getting more money for prescribing a certain type of lens rather than another: they do, but in any particular case that extra money is from what the patient is paying out of pocket for, say, a multifocal rather than a monofocal, even by the same manufacturer.

There's a reason that multifocals are pushed so hard by certain docs, and while their underlying choice of which multifocal can certainly be influenced by what you describe, the pressure to use one over a monofocal comes down to wanting the patient to pay more out of pocket.

Thank you for all your replies. It's very helpful since this is a big decision. I think my first doctor is still old school about his choices because he said he's had less problems with the older IOLs in terms of halos and other issues and he said it would give me the best reading, mid, and long distance vision and thought I would be happiest with them. The second doctor just insisted on the PanOptix and wasn't much concerned with the side affects saying that those would clear up several months later. The first doctor also said he goes back two weeks after surgery and cleans things up with his laser. I have no idea what that means. He said he does it for all his patients. His price was $2900 per eye and the PanOptix doctor was $3500 per eye. I'm in California, so we pay a "premium" no matter what. Unless, of course I go with monofocal lenses. Then it's all covered. Thank you again for all your feedback.

I am not sure about the doctor's conclusion that the older multifocals being better. The majority of surgeons are abandoning the use of those lenses. There are two possibilities with respect to the statement that he "cleans things up with his laser". One is that he is cutting a hole in the capsule that holds the lens and that will reduce the side effects. That is called a YAG laser process. It can be needed but only in about 15% of cases where there is posterior capsule opacification (PCO), and doing it before it is needed is not responsible. And YAG is sometimes used to pacify the patient that complains about the other optical side effects like flare, glare, halos and spider webs. But YAG will not fix those issues because they originate in the lens itself. And if you ever need a lens exchange it becomes very difficult after a hole is cut in the capsule. The other possibility is that he anticipates missing the power selection and goes back to do a Lasik correction to your cornea to correct for the miss on the lens power selection. That also is not a good prospect. You really want the surgeon to do everything possible to hit the correct power and not leave you with a surprise.

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If your objective is to be eyeglasses free after surgery, I would not discount the option of doing mini-monovsion. It uses standard monofocal lenses so would be fully covered in your case. The best way of evaluating it is to use contact lenses to simulate what it would be like after surgery. An optometrist and contact lens fitter would be the best to choose contacts to do the simulation. Just say you want to be corrected to plano (0.00 D) in your dominant eye and to -1.50 D in the non-dominant eye. Wearing the contacts will give you a good idea what monovision is like.

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From what you say, I do not get a good feeling about either of these choices for a surgeon. I would suggest finding another couple that will at least consider mini-monovision and work with you to evaluate if that solution is right for you or not. To be fair it does not work for everyone, but neither do multifocal lenses. It is what is a best fit for you and your priorities. The nice thing with monovision with monofocal lenses is that you always have a plan B which is to use prescription glasses. Prescription glasses do not always work to correct the issues with multifocal lenses. You are kind of stuck with them unless you get them removed, and some do that.