What is an IOL "Platform"?
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Hi All,
My mind is reeling a bit due to possibly overthinking things. A few weeks ago in person and in subsequent email correspondence with my doctor I asked him about having my existing iol implanted left eye (which as set for distance 4 years ago) paired with an EDOF lens set "near"-er (say +.75D) for "mini-monovision" in my right eye surgery yet to be done. It seemed to me I could have something akin to the best of both worlds. I could (in theory, I think) get reasonable reading and good intermediate vision in my right eye with the EDOF lens whilst still maintaining my good distance (and intermediate actually) vision in my left with my existing monofocal plus maintain stereo vision more than I might obtain with, say, a monofocal lens set near at +1.50D in the right eye.
But somehow my doctor was opposed so that and steered me towards a monofocal for the right eye and have it set at +1.50. He didn't think mixing two different "optical platforms" or "optical systems" would be a good thing by introducing, say, a Symphony, Eyhance, or Vivity lens. So I'm trying to understand what he means by "optical platforms" or "optical systems". Does anyone know? Is he referring to mixing a monofocal with an EDOF? Or is he talking about different manufacturers, materials, or some other thing?Any why would mixing platforms or systems necessarily be a bad or risky thing?I've read about a study that resulted in quite high satisfaction rates for participants who paired a monofocal lense with an EDOF lens. Thanks for listening.
IndyG
0 likes, 4 replies
RonAKA indygeo
Edited
It is hard to say what your surgeon is thinking. I would suggest that a "platform" is sales talk. Kind of like we have the basic lenses (free in many locations), and if you are willing to pay more then you can "step up" to the "Premium Level" lenses. This is kind of akin to eyeglasses for presbyopia. You can get a basic bifocal with the line in the middle, or you can "step up" to get a progressive, and they in turn can have different quality levels and associated pricing. In other words is is a vocabulary used to upsell the customer. The problem of course is that the basic monofocal IOL is the highest optic quality lens, and the so called "Premium" lenses compromise the optical quality to get an extended depth of focus. And, the premium term really applies to the price not the quality of vision.
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I think the second issue is that many cataract surgeons are doing the cookie cutter monofocaL lens targeted for distance in both eyes. Asking them to do any different is asking them to step out of their comfort zone. Sometimes they will refer you to another surgeon that specializes in "premium" lenses. And when you go to them, that is really all they are interested in, and I think in no small part the extra profitability they provide.
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So when you ask for monovision, that pushes the cookie cutter surgeons out of their comfort zone. And, they worry if you don't like the outcome it will hurt their reputation. And, on top of that there is no extra profit in monovision. All that changes is the power of the monofocal lenses used, with no associated extra price and profit.
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My thoughts are that your surgeon is trying to avoid a more complicated out of the box approach to your vision. If you want to go glasses free they really want you to buy an expensive "premium" lens for both eyes, not just one. They want to prescribe the lens by the book which is written by J&J or Alcon. Alcon says for example that you should put Vivity in both eyes as that will reduce the loss in contrast sensitivity. They conveniently don't mention that a monofocal in one eye and a Vivity in the other will result in better overall contrast sensitivity. They would much rather sell you two Vivity lenses.
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I guess to draw some comparisons to prescription medications there is prescribing by the book or the label. But, there are some doctors which will deviate from that and prescribe "off label". Some will do it, and some will not.
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But I think to answer your question more directly there is no reason you can't mix brands and so called platforms between the eyes. It does however require a skilled confident surgeon that is willing to do it. I recall one study where they put blue light filtering IOLs in one eye, and clear ones in the other. Nobody in the study was bothered by it.
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Just my thoughts. If you want to mix lenses you may have to seek out another surgeon that is more confident in what they are doing. I may have read the same study as you where a clinic in Japan uses what the call a hybrid monovision approach where they use a monofocal in one eye and an EDOF in the other. The study found a high satisfaction rate.
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I think many patients fall into this trap of the same lens in both eyes. They want a one size fits all cure all to their vision. There can be better options. My surgeon was quite willing to put a monofocal in one eye and a PanOptix in the other eye. I wasn't game for the PanOptix because of the undesirable optical side effects, but he was game to do it. It all depends on your surgeon....
Reader's Digest version of my answer? There is no such thing as a standard platform that needs to be adhered to.
indygeo RonAKA
Edited
Thank you again Ron. I think you're right about my surgeon not wanting to go out of his comfort zone by not wanting to mix and match.At the same time however, when I suggested a mono-vision approach to him he jumped on the idea of a 2.0D difference in eyes which I (as well as my original doc for my distance eye) thought was on the extreme side. So he seems to be, at some level, willing to step outside the safety net... or maybe he just doesn't know what he's doing. Hard to tell.
I'm really torn. My logical mind says that the best theoretical option is to pair my exisiting monofocal distance eye with an EDOF lens set "in" around 0.75D.But as you have had (as well as many others have had) such great success with your mono-focal monovision set-up perhaps I should go with a similar strategy. My only concern is the degree of loss of stereopsis and the degree of loss of the distance vision in the "near" eye.
Yes, I think the article I read involving the EDOF lens paired with a Monfocal lens was in Japan.
Update: I've sent an email cancelling my surgery for 3rd June for a monofocal lens at 1.50D because I'm so on the fence now. I need a bit more time and investigation. Ughh... why am I so analytical about this?!
IndyG
RonAKA indygeo
Posted
The practice of doing monovision with the full -2.5 D that you would get with bifocals or a progressive eyeglass is falling out of favour. The more recent trend is to mini-monovision in the -1.5 D range for the close eye. So perhaps your surgeon is not keeping up with the latest trend in monovision. My surgeon seemed a bit surprised that I was asking for -1.5 D, and said that he has done as much as -3.0 D!
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But on the other hand he was willing to put a PanOptix in my close eye until I told him flat out that I was not willing to take the risk of the optical issues associated with a MF lens. So, it seems a bit strange what they are comfortable with and not comfortable with.
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I have no regrets with doing -1.5 D with a monofocal (compensating for the 0.75 D of astigmatsim), but I would much rather have gotten it without the astigmatism complication. From what I am seeing now, I think an eye ending up at -1.5 D and 0.25 D or less of cylinder would be perfect.
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The advantage of an EDOF is that a little more of the distance vision would be preserved. I think I could have gotten equivalent close vision with a Vivity at -1.0 D, and that would have compromised my distance vision by 0.5 D less. But on the other hand, I really do not miss the perfect distance vision with my closer eye as the other eye which is 0.0 D makes up for it.
Guest indygeo
Edited
Platform refers to a manufacturer suite of lenses that use the same materials, haptics design, injector system, etc. That's not necessarily what the surgeon meant though. They may have meant mixing and matching in general (i.e. a mono and edof even if they're of the same "platform" like tecnis 1 + tecnis synergy). Some surgeons just don't like to "mix and match". Some do it all the time. Depends on the surgeon. Typically a public health surgeon will not "get fancy". Or they don't even really have that option since public health doesn't stock premium lenses. You'd have to go a private clinic for that.