Visited Surgeon No.3, No 4 coming up next week, then we decide!
Posted , 9 users are following.
New thread to help me and any future cataract patients...
So we visited Dr. Rockstar (very experienced Surgeon) today. When we entered his room the other assistant surgeon from previous visit was there but she left straight away. She did not acknowledge us though. Maybe was in her thoughts or intentionally from us rejecting her.
He seemed more competent in his speaking and approach. Did not rush us in anyway. We feel he is the one that we might be going with. So if we go with him we will be doing left eye set to far and in the future right eye 1 Diopter closer. He thinks that will give us good quality of life with glasses mainly for reading.
He himself uses same setup for his glasses.
This surgeon was against Multifocal IOLs. He said if it was his own eyes, he would do what he suggested for us. He said Multifocals are a compromise in each distance range. He prefers older people getting it than younger ones as even though it is not super sharp in each range, it still ends up being an upgrade for older people (compared to their aging vision).
For younger patients he prefers super sharp focus via Monofocals. So if we go with him we would be using the Hoya lens, he offered Zeiss too but recommended the Hoya as it brings the far vision closest to plano for the left eye, based on my wife's measurements.
Btw he prefers EDOF over Trifocals.
We said we are 99% going with him + mini monovision but that we are visiting another surgeon who prefers EDOF to get an opposing viewpoint just to cover all angles.
He was ok with that but you could see that he was hurt. I think some of these top surgeons are just used to peopel bowing to them. Kind of makes sense, our eye doc who did pursue surgery initially and felt it was not for her, had told us that eye surgeons can be bit of Divas, as they are held in high prestige.
P.S- I asked him about eye injection. He said that it is old skool and he would never inject the eye for cataract surgery. Why take such risks! Anyway we cancelled the OP with surgeon No.1.
Surgeon No.2 was basically No.3's assistant who did all the measurements.
So next week we see surgeon No.4 and that would be it. Unless No.4 knocks our socks off with EDOF, we would be doing mini monovision with Surgeon No.3.
2 likes, 76 replies
janus381 W-H
Posted
WH:
It is a not easy to decide what is the best option, I think mini-monovision and premium lens are both reasonable ways to potentially reduce or eliminate need for glasses.
I'm sure you've read this article already, because I recall you posted one table that I know came from this article.But the only one that compares mini-monovision to the next premium lens (tri-focals) is "Comparing Trifocal IOL’s and Mini-Monovision Principles, Planning and Outcomes: A South African Private Practice Study"it a slightly old study, so the tri-focal in the comparison is the Fine Vision Tri-focal, which seems to have been surpassed by the PanOptix now.
I guess the good news is that this study and most studies show the vast majority of patients are happy with either approach.
In my view, one difference is expectations.
People who decide to go for mini-monovision go in expecting that they will likely need glasses for near, and many are pleasantly surprised that they don't need glasses as frequently as they thought they would.
On the other hand, those opting for premium lens may have higher expectations, with many expecting to not need glasses at all, and some are disappointed that they may still need glasses.
Therefore from clinic's perspective, mini-monovision is less likely to produce an unhappy patient, and of course there is a lower risk of effects like halos and starbursts. Rockstar has had bad experiences in the past with older multi-focals, and he himself has mini-monovision. So he truly believes mini-monovision is the best. He has less personal experience with premium lens, because he tends to discourage them. He makes less money with mini-monovision but he is giving you the advice he think is right.
From patient's perspective, premium IOLs cost a lot more than mini-monovision, and cost is an important consideration for many. So mini-monovision tends to underpromise, and hopefully overdeliver (don't promise freedom from glasses, and lower cost), whereas premium IOLs patients have higher expectations (higher cost, and are thinking freedome from glasses).
Still more and more surgeons are going with the latest premium lens, either EDOF or tri-focals. I mentioned in my post about my experience, that my surgeon also used to discourage multi-focals, but has been very happy with the PanOptix. I also mentioned in Toronto at least, most of the eye surgeons prefer the PanOptix now as the premium lens of choice (backed up by Alcon reports of very strong demand in Canada).
I think both are reasonable choices, and it's hard to tell what is the best. Those of us who have done it already and are satisfied with our results like to think we made the best choice for ourselves.
Sue.An2 janus381
Posted
Hi Janus wish they had the trifocal had been available in New Brunswick - may have opted for that. But I think you hit on an important aspect of patient expectations and satisfaction. Reminds me of my economics course in university of Loblaws. His principle in developing Presidents Choice products (rather a formula) was Expectations divided by reality equals happiness.
My initial and 2nd consult with surgeon mentioned I would need glasses for near vision. When that didn't end up my day to day reality I was very pleased.
seeherenow49806 W-H
Posted
Yes, No Worries, Janus analysis makes snes. Definitely take your time until you feel more certain.:)
Regarding doc-patient interactions, here's my example. I consulted 3 docs, one of them twice.
Doc 1 (an hour away) was referred by a friend and has done this surgery on hundreds of eye docs, 30,000 patients. So he might be comparable to your Rockstar guy, except he has humility and is down to earth. But my friend had misinformed me about cost so I was very surprised when his "closer"/scheduler told me it would cost $8000 for recommended EDOF Symfony in both eyes. When I said I couldn't do that, she began to act like a car salesman and I was totally turned off.
So I went to Doc 2 , very nearby. But when he told me "it usually takes 3 surgeries to get it right" - cataract, laser touchup, and YAG - I freaked and decided I was in the wrong place.
So I went to Doc 3, also nearby. He was also very experienced, recommended monofocal or Crystalens, assumed "Old person" strategy but was open to opposite - needing glasses for distance instead, and was completely covered by insurance.
Wow! so what to do? Research here on this forum and elsewhere!! Eventually I found the mixed IOL type solution and the mini-monovision solution. Didn't see much about anyone mixing these 2 strategies, but knowing the high adaptability of my brain, I decided that's what I wanted to do. This all took about 2 months and my first cataract was getting worse.
So I went back to Doc 3. Meantime, his scheduler told me that "no one is using Crystalens anymore" because of an issue with the haptics, so this doc had switched over to Symfony. When I told him I wanted to do mix/match IOL with mini-monovision, he was definitely NOT on board!! What to do?
I decided to let him do the first (dominant, left) eye with the monofocal at -0.5D and see what happened. He demanded that I sign something saying that I was doing this against his recommendation! Surgery was easy and comfortable, no laser btw, When I went to my trusted optometrist afterward, he said the surgery looked perfect. But when I went back to Doc 3, the aftercare was very uncomfortable and I saw this was why he could charge less than other surgeons. Very untrained techs doing tests, etc. Oh, well. The eye healed well and my vision was better than he would have dreamed possible.
Meantime my friend who recommended Doc 1 was very satisfied, and my 2nd eye was getting worse, so I decided to go for a 2nd consult there. As I mentioned in earlier post, he was totally okay with my plan and had much more experience with Symfony. Maybe his being younger had something to do with being more open-minded, don't know. Luckily, his previous "closer"/scheduler had quit and he had a new woman who was awesome, so I felt comfortable at $3500 for this eye. He took great care with the IOL power calculation and gave me a choice between 2 powers based on the probable outcomes. I actually didn't make that final decision till a week before surgery, haha! But everything went perfectly and I'm so happy with the outcome!
Moral of this long story - taking the time to study all your options and compare them with your lifestyle, overall adaptability and risk tolerance, and finding a respected, experienced surgeon you're comfortable is well worth the effort and patience, and will likely bring your best possible outcome, whatever choice you make! Confidence and peace of mind going into surgery go a long way.:)
Wishing you the best!:)
seeherenow49806
Posted
PS - I did end up needing YAG in left eye and had it last month. So simple it's crazy!
Promised SueAn I would report , so here it is.... I went to Doc 1 again, even tho he hadn't done original surgery on that eye, because I felt most comfortable there. He explained how it works and that they've been doing this simple laser procedure for 35 years. It's as if your posterior capsule were a taut piece of plastic wrap stretched over a bowl in your fridge and the PCO is like the plastic has condensed water on it producing the mild "film" of cells clouding your vision. The surgeon uses 4 laser pulses in a cross-like pattern which ore or less "pop" the tautness of the "plastic wrap" and it naturally falls away, eventually dissolving.
You can see the difference right away, They use anti-inflammatory eye drops to alleviate pain & you use them for a week. By then nearly all related floaters had dissolved and I was so grateful to have that perfect vision back in my left eye!
Of course, then I noticed the developing PCO in my right eye more, so I'll have YAG on that next month. Overall, living in MUCH GRATITUDE for perfect vision possibilities after cataract. We are so fortunate compared to patients 50 years ago!:)
Sue.An2 seeherenow49806
Posted
Seeherenow thanks for update on YAG. Happy it brought back your clear vision.
Was it the anti inflammatory cream that helped with floaters? This is first I hear of prep work for YAG. Seems many on forums report worse vision after YAG so it is great to hear a good outcome.
soks seeherenow49806
Posted
what were the symptoms of PCO for you?
Sue.An2
Posted
Yes would like to know symptoms you experienced for pco as well. I am wondering if astigmatism can account for my blurriness.
seeherenow49806
Posted
Hi Soks and SueAn,
As I mentioned, the PCO was like a slight film over the vision. Not as severe as cataract, but slight yellow discoloration like cataract. Not super severe, but enough that I noticed I wasn't seeing as well in all ranges due to blur. I could easily test the difference between eyes simply by closing them alternately. The retina specialist said he could see the left eye "splotches of PCO" easily. with slit eye exam.
The anti-inflammatory eye drops are thick but not a cream. The nurse put them in before the YAG and then I used them once a day for a week. They are for pain and prevention of inflammation, don't think they have much to do with floaters. I actually saw the main part of the capsule peel away to the left side of the eye about 2 hours after the YAG. The rest of floaters were barely noticeable and dissolved relatively quickly.
My guess is that unsatisfactory YAG recipients are being treated incorrectly, i.e., the condition isn't PCO.Seems like some docs jump to a YAG very quickly after the original cataract surgery, when the problem might be an incorrect IOL power or placement (for astigmatism/toric IOL) or something else. But I don't know...:)
SueAn, seems like your surgeon or optometrist could easily ascertain if you have astigmatism.:)
W-H
Posted
Our appointment with Dr Zeiss was brought forward, we are seeing him tomorrow.
Very interested to hear his POV!
Guest W-H
Posted
I guess you already know, what he will say 😃
Guest W-H
Posted
By the way - try to google "Acriva Trinova"
I think you will find it interesting 😃
soks W-H
Posted
stepless zones!!!! holy cow, i am getting an exchange!
Sue.An2 soks
Posted
we were cheated soks - the future looks better than ever! Holding off on yag!
soks Sue.An2
Posted
there are still steps though just more smoother it seems.
Sue.An2 soks
Posted
Wish they'd come up with a drop that prevents or dissolves cataracts.
seeherenow49806 Guest
Posted
Yes, this is fascinating, Acriva Trinova lens! Seamless vision in all ranges - awesome!
Proof that those with one good eye should have faith that the future will provide them better options without the halos, etc. The reactions in this small thread make me even more grateful for the phenomenal results i got with the mix/match IOL plan, minimizing Symfony spiderweb effect.
Wonder how many years it will take for this to be approved in the US? And how many more years for insurance companies to cover it. If it does what it claims, this should become the norm for all future cataract surgeries.
Thanks for sharing, Viking!
W-H Guest
Posted
Very interesting. What is this company? Never heard of them.
Sounds promising. The design must have some cons? How come the big firms did not think about this?
Will rings (spyder web) still be visible or will they appears like blurred rings?
Viking you still going ahead with your operation? 😃
W-H Sue.An2
Posted
Apparently not happening anytime soon!
Cut and paste-
Is progress being made in developing eye drops to treat cataracts, thus making surgery no longer necessary?
Por Yong Ming, Eye surgeon | Cataract, Cornea and Refractive Surgery Specialist
Answered May 8
One big misconception that needs to be addressed first off is that-cataracts are not a single thing or condition.
Just like, glaucoma is not a single condition, and neither is cancer.
Cataracts just mean that the lens of the eye becomes increasingly opaque. As such, there are many types and causes of cataract.
Yes, there are studies which show that a certain type of cataract in babies and animals can be reduced by using lanosterol. But this will generally only work if lanosterol (or something it interacts with) were somehow involved in the pathogenesis of all cataracts, and there is no evidence that this is the case.
In fact, most cataracts develop for no obvious reason than age.
That generally means many factors and pathways degenerating and breaking down, and means that it is unlikely there will be a magic eyedrop or tablet that will make the cataract disappear.
In assessing these types of news/news articles, we should also be mindful that it is in the interest of these companies to exaggerate and generate as much hubris as they can, the better to increase readership.
I don’t think there are any ophthalmic professionals who would believe that surgery will be made obsolete in the forseeable future.
Guest W-H
Posted
The Trinova lens looks very interesting indeed, it might be the best one out there, it surely looks that way.
I believe the rings will still be visible, but I guess it will be better than traditional trifocals.
My Lara edof also have the rings, and starbursts and stuff, but it have never really been bothersome, and it have fainted a lot in these 5 weeks I have had it, on some outdoor lamps where I live it has even disappeared, so I believe the side effects will be more or less gone as time goes by.
I will go ahead with my surgery, that decision was taken 6 weeks ago.
About 25 years ago, when I was about 20, my eye doctor, that I saw each year for many years for regular checks, said to me that he understood why I was holding back on surgery, but I should also keep in mind that it is like buying a pc.
There will always come a pc on the marked next year that is a little bit better, so if you always wait for the best, you will never have a pc.
And now I have simply come to the point, where I am tired of waiting, tired of not being able to see well, and tired of all the road blocks my bad vision have set up for me all my life.
Sometimes I actually do regret I did not have it fixed with monofocals 30 years back, when monofocal iols like we know them today became available, especially now where I see the difference with the Lara in just one eye, for me it is like I have landed on a new planet I have never seen before.
6 weeks ago I made the promise to myself to take what I can get now, with no regrets.
And that is what I will do, in two days my other eye will be fixed, and I am so excited, I almost count the minutes 😃
soks Guest
Posted
did u decide on lara or lisa? if u go lisa route i am interested in how you compare the two.
soks Sue.An2
Posted
there was someone at MIT working on the drops and was doing trials on animals back in 2015. since there is no news about it may still be under research. whoever cracks that code will be a billionaire.
until then the liquid filled accommodating lens sounds very promising for the future. unfortunately our ship has already sailed.
Guest soks
Posted
I really have not decided yet, I think both Lisa and Lara will have very satisfying outcome.
But I am leaning against Lisa, the Lara I have now works great, so why not try to add something else, instead of more of the same 😃
soks W-H
Posted
they are advertising near vision as up to 80 cm which is higher than what Symfony / LARA advertise at 60 cm.
Sue.An2 W-H
Posted
yes i had read that too - followed Dr Por Yong Ming's blog on Symfony prior to my surgeries.
Think too there is so much money invested in this (like cancer) there is no motivation to find a cure.
Sue.An2 Guest
Posted
Not to change your thoughts on these 2 lenses but there may be added benefits to going with what you know and have with lara. I am sure your surgeon can better tell you which would be beneficial to you. Hope all goes well - it really is life changing for you and I am happy you are able to see well
Guest Sue.An2
Posted
I agree, Lara do feel like the safe choice, and I change my mind about 10 times each day.
But in reality maybe difference is not that big, beside that Lisa have a bigger range, and maybe small soft spots between the ranges, and the Lara uses light more efficient.
The Lara edof is a manipulated multifocal built on the same platform as the Lisa tri, that dates back from the Lisa bifocal.
And the lenses are the same material, same color and so on.
I think my brain will blend it easily if lenses are different, the eye that is not done yet have very poor vision, I can not read pc screen, phone, or any other details at all, the eye test I have at home only go down to 20/40 and it is a lot worse than this. But still, even that the eye can not see letters on the screen, reading becomes a little better with both eyes, compared to only the Lara eye - I find this very strange, but I guess it shows what the brain is capable of.
But I will tell the surgeon about my experience so far, and let him decide lens, then I have someone to blame, if I am not satisfied 😃
W-H Guest
Posted
Wish you all the best Viking! You have a good attitude!
W-H
Posted
Did this company exist before or brand new?
Guest W-H
Posted
I have not come across a clinic here in Denmark that mention them, so I don´t know their history.
But I can see they also make monofocals and bifocals, and I can find videos from 2012 where their bifocal is being implanted.
And the news about their trifocal was released late 2017, so all in all I believe the company have been on the marked for some time.
janus381 Guest
Posted
The four largest companies in the IOL market (Alcon 31%, J&J 22%, B&L 6%, Zeiss 4%) account for about 63% of the 2017 global iol market.There are many with small segments of the market.
VSY has "biotech" in its name. I think if one of the small companies has something really innovative that cannot be duplicated, they will end up getting acquired by one of the four largest companies.
Also found that Zeiss won a patent infringement case against VSY in 2017 in a German court (patent seems to be related to manufacturing process rather than IOL design).Zeiss bought the patent from a Japanese company. VSY is appealing the ruling.
On eye drops, it's interesting that there are companies that make Lanosterol eye drops for cataracts for pets, and one in particular seems to make no effort to discourage use by humans eventhough studies have shown these drops don't work in human eyes. They get around this because it's technically for animals only, so outside scope of FDA in the US. For example take a look at Lanomax website.Almost implies it works in humans, plus in FAQ about side effects, they say: "Lanomax™ eye drops are safe for both animals and humans. Lanosterol, the active ingredient of Lanomax™, is a natural compound which is naturally occurring in the body tissue and blood of both animals and humans."
janus381
Posted
Follow-up Zeiss and VSY settled their dispute out of court earlier this year.
Guest janus381
Posted
Funny, I did notice to myself, that the VSY lenses looked very similar to Zeiss lenses, and I guess Zeiss felt the same way 😃