What would you do?

adam did not exchange the lens. he got the yag.

you dont have to get aspira for high myopia, only if you have large pupils.

if u choose monofocals u should choose a target between -1 and -2.

At what stage of your cataract process are you at? Have you had the detailed measurements taken to determine how long your eyes are? What was your eyeglass prescription prior to cataracts? The biggest issue with high myopia is the accuracy of the required power calculation formulas. See this abstract of an article on the accuracy of formulas based on the axial length of the eyes.

.

https://journals.healio.com/doi/abs/10.3928/1081597X-20230831-03

.

Alcon makes an EXpand series of IOLs that go from -5.0 D to +5.0 D that should be available in the US - MN60MA, MA60MA, if that low of a power is needed.

.

As far as targets go, one does want to be negative, but I see no reason for targeting higher amounts of myopia. I used to be in the -2.0 to -2.5 D range and do not miss being that myopic at all. I currently have mini-monovision with nominal targets of -0.25 D and -1.5 D. I am quite happy with the outcome. But the accuracy of power prediction has to be considered and the factor of safety against going positive has to be considered.

.

The most important aspect of your plan would be to find a surgeon experienced with high myopic eyes and the use of meniscus style IOLs, if they are necessary. Perhaps Alcon would assist in finding a surgeon in the US. Also if you google "cataract surgery extreme myopia cataract coach" you will find the name of a surgeon in Los Angeles that seems to specialize in it.

thank you for your reply!

my eyes measure 31-32mm in axial length and using my optical biometry i need a spherical power of approximately +3.0D (OD) and +4.5D(OS) to get a refractive target of -1D of residual myopia. i think maybe a staphyloma is affecting my axial length measurement because my right eye was always my better eye-- when I was 35 my contact lens prescription was -13.0(OD) and -13.5(OS). So it seems weird that my right eye is measuring longer now.

i do not want the Alcon Acrysof MA60MA iol because it has inferior optics with possible glistenings, surface haze, and spherical aberrations. It also requires a relatively large 3.2mm incision that may require a suture to close. My other two options in the US are the J&J AR40E and the new Zeiss CT LUCIA 621P that was FDA approved in April of 2023.

The J&J AR40E is a glistening free 3-piece iol that requires a 2.8mm incision, but I'm not sure how good the optics are.

The Zeiss CT LUCIA 621P is a 1 piece iol that has excellent optics and a small 2.2mm incision. It is so new that only a handful of doctors are using it on the East Coast.

the reason I'm considering going to Europe is because the Aspira has a larger optic that is good for avoiding dysphotopsias and is supposed to be good for patients with retinal pathologies since it is easier to see the peripheral retina through the larger optic. (I have central vision loss in my left eye due to retinal scarring and myopic macular degeneration)

what I'm wondering though is after PCO inevitably forms, and YAG capsulotomy is performed, isn't the usable area of the optic only as large as the capsulotomy? so it wouldn't matter if the optic was 6mm or 7mm if the capsulotomy is 5mm in diameter, right?

How would you know if you have large pupils?? I don't think my opthalmologists have ever measured mine.

You have obviously done a lot of research into your condition and what the options are for high myopia IOLs. That is good. One needs to go into this with "eyes wide open" so to speak.

.

In the context of the article link I posted you would fit into the extreme myopia Group 1 category, which found that the Hill-RBF 3.0 and EVO 2.0 giving the most accurate results. Your would want to be sure both formulas are used before making a decision on power.

.

What I find is that many getting into the IOL decision process get hooked into the technology and can overlook the "process" of cataract surgery which at the end of the day can be much more important. By this I mean that some get consumed in deciding between Tecnis 1 and AcrySof, or Eyhance or Vivity, or PanOptix or Synergy. In your case you are looking at options for low powered IOLs but the same trap can creep in. You have obviously looked at your options carefully and this is not a category I have done much research into. I will comment that the AcrySoft glistenings and surface haze, and spherical aberrations is a red herring. Alcon has significantly improved their manufacturing process some years ago and glistenings have been essentially eliminated. However other manufacturers continue to push the issue to try and make AcrySoft appear inferior. I have an AcrySof IQ in one eye and the "new and improved" Clareon in the other eye. There is no detectable difference in clarity or any other aspect of the lens. I am sure the main reason Alcon came out with the Clareon material is to try and shake the misinformation that continues to be claimed about the AcrySof material.

.

The elephant in the room is not the technology of the lens, but the fact you will have a significant risk of a miss in the power calculation. This is what I would call "process". You will want to consider all potential methods to reduce that risk. The prime one would be to use the very best of formulas, and also the very best biometry instruments like the IOLMaster 700, and Lenstar LS-900 and ideally both, as well as the best topography instruments like the Pentacam HR. You may also want to consider using the Alcon ORA system during the surgery.

.

And the very basics can also be overlooked. Ideally you want to do one eye first, wait 5-6 weeks and get an accurate refraction before deciding on the final power for the second eye. Good surgeons will use the outcome of the first surgery to determine what adjustment may be needed to the formula for a more accurate outcome on the second eye. It may make some sense to go for a more conservative mild myopia target for the first eye like -1.0 D, but the second eye with the learning from the first eye, could be targeted closer to plano, assuming distance 20/20 vision is considered desirable. All of this becomes much more difficult and expensive if you travel half way around the world for the surgery.

.

On the IOL diameter make sure you consider the actual optical diameter of the lens. Some of the J&J lenses have a non optical ring around the outside. Reflections can be created by the design of the edges as well as the diameter. Pupil diameter is primarily determined by age. Reflections off the edge are more common in younger people. I do have reflections in odd situations with my lenses, but I do not consider it an issue, and is more a curiosity than a problem. I am 74, so probably have smaller maximum pupils.

.

Just my thoughts. Don't get fixated on the technology of the IOLs and overlook the basic process.

"Just my thoughts. Don't get fixated on the technology of the IOLs and overlook the basic process." That was well-said.