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UPDATED: Dr's recommending EDoF/MF IOL I'm not yet convinced,

Posted , 4 users are following.

charles94562
charles94562

So Dr. 4's office closed on Friday 3/20 due to the COVID19 crisis, unfortunately my appointment was on the same day, and next available dates are in mid-May. In the meantime, Dr. 3 (Head of Ophthalmology at Kaiser) has scheduled my surgery for May 12th. We've settled on monofocal IOLs (Tecnis) set for distance in both eyes. At this point I'm hoping the dates hold and am moving forward with this plan. I have a couple of questions for Dr. 3 when I go in for pre-surgery on April 14th:

  1. As mentioned before, when I asked him what refractive target he would shoot for he said Plano, so little concerned that if we overshoot I'll be farsighted. Perhaps he target's something less than 0.0 as his standard to get to plano, but would like a little more assurance I won't end up +0.5.

  2. It appears I don't have enough astigmatism to go with toric IOLs. Dr. said when he plugged my numbers into the Tecnis toric calculator it came back with .61 residual astigmatism and recommended the regular Tecnis monofocal. We already discussed LRI and he did not recommend. So need to discuss what options I have to address the residual astigmatism if it prevents me from getting a good result. If anyone has experience with this or good research material I would be most grateful!

  3. Kaiser has largely switched to a simultaneous bi-lateral cataract surgery model (both eyes same day). In general I prefer the more conservative/traditional sequential approach, but at this point I kind of just want to get it over with, and am concerned about getting stuck with one eye done if things in the world get worse. Any thoughts?

I know people have bigger problems right now, so hope you won't mind me winging on. Hope you are all safe and healthy.

0 likes, 4 replies

4 Replies

  • Chris53317
    Chris53317 charles94562

    Posted

    Hi Charles, as you have selected monofocal for distance in both eyes the solution to your #2 question is simple. It will usually take 3-6 months for your eye to stabilize. During that time you will need readers for near vision, cheap drug store one should be adequate for this time period. At 3 months your vision should be tested to determine if any additional correction is needed, and if so the best solution would be progressive glasses that you wear all the time. This will fine tune your distance and intermediate vision, adjust for any astigmatism, and give you excellent near vision. These glasses can also incorporate transition tinting (automatic light sensitive adjustment) so that you will not need dark glasses. In the best case scenario, you may only need readers and no correction for distance or astigmatism.

    My operations were done two days apart, but same day would not have been a concern. The change to same day by Kaiser mwill likely have been based on years of experience, and providing the optimal results. Go for it.

    I wore progressive glasses for 20 years and was fine with them, but wanted to be glasses free so went with trifocal IOLs.

  • RonAKA
    RonAKA charles94562

    Posted

    My thoughts:

    .

    1. Your surgeon may be just talking generically about plano, or distance emmetropia. My understanding is that a surgeon will be very lucky to get perfect 0.0 D correction. The lenses themselves only come in 0.5 D steps in power. Also there is the error in measurement of your required power based on cornea topography. My understanding is that when they target perfect distance vision they shoot for -0.5 to 0.0. In other words when deciding between powers of 0.5 steps, they would go for the power that is an under correction, rather than one that would leave you in the + side.
    2. I did not research Tecnis as thoroughly as Alcon AcrySof lenses, but the minimum amount of astigmatism that would be corrected with an AcrySof Toric lens would be 0.7. That is probably determined by the minimum power of astigmatism correction that is available in the lens series. If they use the minimum then you would be over corrected and worse off than no correction. The other issue is likely economics. It would only be a small improvement, compared to the significant cost addition of using a toric lens. My surgeon also mentioned waiting and see how the eye turned out, and if necessary they could use LRI. I am adverse to that option also, and I think all considered I would prefer to correct it with prescription glasses. Eyeglass fitting is a trial and error, and the lenses come in 0.25 increments, so it can be more precise than a IOL. The other issue with astigmatism is that the IOL incision will cause some residual astigmatism addition or change. While they can estimate what it will do, the outcome can only be measured after the surgery is done and the incision is healed.
    3. In this COVID-19 crisis, you are fortunate to be able to get surgery. I have not had the call yet, but I am assuming my surgery which was slotted for August, will be set back, probably by months. I also would be inclined to have the eyes done sequentially. It seems that self care of one eye would be much easier than both eyes at the same time, unless you have someone that can do all the eye drop stuff for you. And since you are decided on distance monofocal for both eyes, there will be no decision to make after the first eye is done. It is common when doing monovision to defer the decision until after the first eye is done, and then do a trial first with a contact lens in the eye destined to be the closer vision eye.

      .

      Hope that helps some,

  • Sue.An2
    Sue.An2 charles94562

    Posted

    You have dome good replies so I won't repeat what others have said.

    I am amazed you are able to have surgery done in this COVID19 pandemic. I guess really up to you if you are fine with having both eyes operated on same day.

    Personally even in these times I would prefer a few weeks between surgeries. If going for monofocal lenses I would want the first eye to settle so as to make any adjustments needed to 2nd eye. As you can see from others responses lenses come in .50 increments and it is very hard to nail a target.

    Wish you well.

  • charles94562
    charles94562

    Posted

    May have spoken too soon. My pre-op got cancelled today. They're trying to keep the surgery dates and hope to reschedule the pre-op to beginning of May. Thanks to all of you that replied, it's very helpful.

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