Yo yo land. Final thread about choosing surgeon (promise)

You seem slightly confused on the -0.5D stuff. Surgeons give themselves a range of -0,5D because the lens can fluctuate 0.25D either way (+/-) on average. I agree with SueAn, at least aim for -0.25D in distance eye, never plano. (Tho your doc may assume that when he says "plano".)

I wish it was like that. I asked Dr. Rockstar that I find plano(+0.06) too risky and would prefer -0,25 as we don't want to risk ending up at +0.25 or more...

He said that he can do that too (-0.25) but we need to be aware that if we aim for -0.25, it could also be that we finally get -0.75.

This kind of confuses me from the point of view that if he thinks there could be error of upto .50 then why was he recommending plano when it could very well have ended up at +.50. Unless his SRK/T formula calculation always ends up going under rather than over.

Either way that made me gravitate bit more towards Dr Zeiss as he recommended -0.25 and he uses Haigis formula. Fact is both surgeons have 10,000+ operations in the bag so know more about these formuals etc than me, a Google Dr!!!

Soks did say that Barretts formula is most accurate etc. We most likely are using Zeiss lens, I got this from Zeiss website, I think for my wife's eyes Haigis will be good too.

In conclusion, calculation of the IOL power can be performed using a great variety of formulas. According to clinical studies, the SRK-T formula is recommended for rather long eyes whereas the Hoffer Q formula is recommended for rather short eyes. The Holladay 1 and Hoffer Q formulas are equally good for eyes with an AL between 21.00 mm and 21.49 mm and the Holladay 1 formula seems to perform better than the Hoffer Q formula for eyes between 23.50 mm and 25.99 mm. Fourth generation formulas, like the Barrett, Haigis or Holladay 2 formula, have the advantage of including the non-proportional relationship between the ACD and AL and therefore should provide the highest accuracy over the full range of ALs.

At the top it shows which type of eye shape type... Short/Normal/Long. My wife's eye falls in normal to slightly short category.

Zeiss website-

W-H

this is what Uday Devgan from UCLA says "Small eyes have anatomic features that can complicate cataract surgery. These eyes have a shorter axial length, often associated with a shallower anterior chamber. In addition, the corneal diameter may be less and the effective lens position of an IOL more difficult to calculate. But there is one great upside: These are hyperopic eyes, often highly hyperopic, and they are dependent on glasses for all activities. When successfully performed, cataract surgery can provide these patients with the best vision of their lives."

So she may get great results with the monofocals. So please go with the plano or -0.5 eye first. if that gives her near too then why bother with -1 or -1.5. Sue.An do you have a short eye?

So she may get great results with the monofocals. So please go with the plano or -0.5 eye first. if that gives her near too then why bother with -1 or -1.5.

Why do you say my wife has small eyes? Based on the reading I had posted? Is it the one that says AXIAL in mm?

I don't think my wife has small or hyperopic eyes. I am no specialist though.

coz her axial length is close 22. and she also needs a + prescription so she is hyperopic.

So my wife has axial length of 22.45mm and 22.35mm.

Btw we met Dr Zeiss today again and he threw in an interesting option of - 1. 0 in both eyes. I don't know what to make of it. He did it for an eye doctor's wife and she is very happy. Functional vision in all ranges and eye glass dependence is lower.

He also thinks wife is perfect candidate for Zeiss Lisa.

He also said that wife's eye measurements are very close to each other, which is a good thing.

As things stand he will operate left bad eye first but won't set it for far because based on my wife's eye shape combined with her being right handed, he predicts she is right eye dominant.

Cataract in both eyes is very bad he said. So no postponing "better" right eye for months option.

We could not decide what to choose.

So we have to send him a detailed email explaining what vision range is most important to us and why so he reads it relaxed with no next patient pressure to give some of his final recommendations.

"Small eyes have a shorter axial length, typically less than 22 mm, and accompanying hyperopia of +3 D or more."

Small eyes have a shorter axial length, typically less than 22 mm, and accompanying hyperopia of +3 D or more."

Ok but 3 months ago she needed 0.5 correction only and "technically" she is not under 22mm.

Any opinion on my above post of - 1.0 in both eyes?

I may have - would need to see my file. I always wondered why I see such a great range with Symfony and if I would have gotten same result with monofocals.

Would you know if small eyes are related to ones frame? I am only 5ft 2" tall snd have small frame. But maybe no co-relation?

Any real consideration being given to atLISA? Great that he thinks she's a good candidate as sometimes depending on eye condition that is off the table as an option.

I believe you said your wife doesn't drive. My positive dysphotopsia only bothers me when I drive. Since I don't have premium lenses I can't speak to what starbursts, halos, etc others see with them, but I would expect it is similar to me in that it is most bothersome with driving. Something to consider since you mentioned the Zeiss Lisa. I have my lens exchange next week. Targeting -.4 I think. I will let you know how I see, but I do think my eyes have a very limited range of vision.

do you know what your IOL diopter was? higher 20s seems to indicate shorter eye.

"Any opinion on my above post of - 1.0 in both eyes?" - that has the potential of disappointment with no distance and no near without glasses.

deb. do you know what diopter of the softport lens are you getting?

I can't recall that number - but now curious to find put.

21.5. what does that tell you about my eyes?

21.5. what does that tell you about my eyes?

Deb, That is your axial length I assume and not IOL strength? If Axial length then short eyes apparently. What is your second eye's axial length?

Looks like 21.5 is your softport IOL strength. In that case I don't know.

What kind of lens is your replacement lens? Monofocol too?

Wife is bit more open to Lisa now!

Btw Soks, Surgeon wants right eye set for distance. Right eye's biometry gives only the following options-

+0.12

-0.25

-0.62

-1

Left eye options:

-1.26

-1.65

-2.04

So you would have done -0.62 and -1.65 I assume?

Going with plano good vision lottery thing would mean operating on "good" eye first.

Although both are bad now, left just bit more badder!

My wife is NOT "short eyes with high hyperopia". Yes shortish eyes but not high hyperopia atleast.

COPY PASTE-

Noted by Dr. Ken Hoffer some 30 years ago, short eyes with high hyperopia continue to present a special challenge with regard to biometry and IOL calculation, said Wolfgang Haigis, MS, PhD, at the 2013 Congress of the European Society of Cataract and Refractive Surgeons. “The short eye is a very unforgiving eye,” Dr. Haigis said.

Measurement errors, IOL manufacturing tolerances and uncertainties regarding effective lens position all affect short eyes much more than medium or long eyes. But Dr. Haigis has a few recommendations to help.

Ultrasound axial length determination is frequently more difficult compared to normal eyes because these eyes have distorted geometries which make it difficult to get a good-quality A-scan. As a result, Dr. Haigis recommends optical biometry.

Another way short eyes are penalized is that they are much more sensitive to minor displacements. While a change of 1 mm in a long eye will cause a change of only 0.6 D in refraction, a 1 mm shift will translate into 1.9 D of refraction in a short eye.

Selection of a suitable IOL calculation formula is critical in these eyes. Dr. Haigis recommends the following formulae: Haigis, HofferQ and Holladay-2 with optimized IOL constants.

In cases of extreme hyperopia, a custom-made IOL may be the best option, Dr. Haigis said. The typical upper limits of available IOL powers end typically around 30 to 35 D. While creating a higher power can be achieved through piggy back lenses, Dr. Haigis notes that some German manufacturers will custom-make lenses with refractive powers as high as 75 D (Morcher, Carl Zeiss, HumanOptics).

Lastly, when performing refractive surgery in short eyes with high hyperopia, Dr. Haigis recommends use of large optical zones, don’t correct more than 4 D of refractive error and avoid creating too much change in corneal asphericity.

Graham Barrett, clinical professor, Lions Eye Institute and Sir Charles Gardner Hospital, Perth, Australia, adds that refractive lens exchange is a good option in high hyperopes aged 40 and older, while LASIK may be better for patients in their 20s.

Dr. Barrett says the risk of retinal detachment from refractive lens exchange in these patients is lower compared with high myopes undergoing the same procedure. Additionally, lens exchange can also lower the risk of angle closure, and it’s a relatively predictable procedure compared with LASIK.

He offers a few surgical tips in these challenging eyes: Use Healon 5 to maintain the chamber, a needle rhexis, and maintain perfect fluidics to avoid leakage. He also uses a coaxial I/A.

For two weeks postop, he prescribes oral steroids and cyclopligia to reduce the risk of choroidal infusion or possibly malignant glaucoma.

Stressing again the importance of proper IOL calculations, he said that 85 percent of his patients are within .5 D of expected outcome after surgery and had deeper anterior chambers with IOP under control.

“If you are aware of complications, you can achieve excellent outcomes with refractive lens exchange in high hyperopes,” Dr. Barrett said.

Hi Worried - if both eyes need doing surgeon will usually operate on whichever eye you prefer first. If thinking is she is TE dominant I would likely tend to want that one operated on first - particularly if going with monofocals and best corrected distance is desired.

So she she might be swaying towards the dark side and considering atLISA! If that is her end decision won't matter which eye is operated on first.

W-H:

On eye dominance, I agree with Dr. Zeiss, just assume that the right eye is the dominant eye (not just because left eye is currently worse -- but your wife was probably right eye dominant years ago before cataracts had any impact on her sight, and right handed people are highly likely to be right eye dominant). Even if brain can adapt can change eye dominance, no need to add another variable particularly since both eyes will be operated on within a short-time frame.

Interesting Dr. Zeiss says your wife would be perfect candidate for tri-focals.Did this come up in earlier discussions with Dr. Zeiss (I think asked about that in an old post, as despite his reputation for being pro-EDOF, he prefers tri-focals for premium and another patient coming out of his office had tri-focals).Unfortunately, we can't test out each option beforehand! I'm sure your wife is getting tired or considering all the options, but you might as well explore that option fully, and once you reach a decision, don't second guess it. I'm sure both mini-monovision and tri-focals are good options.

Interesting Dr. Zeiss says your wife would be perfect candidate for tri-focals. Did this come up in earlier discussions with Dr. Zeiss (I think asked about that in an old post, as despite his reputation for being pro-EDOF, he prefers tri-focals for premium and another patient coming out of his office had tri-focals).

In the first meeting he said mini monovision is a good way to go. Trifocal is good too but we will have to make some more measurements if going AtLisa way. He said think about it all before making a decision.

Btw yesterday my 80 year old neighbour said go for cheap IOL and not expensive ones. She sees all ranges without glasses. Only sometimes for reading small stuff she uses readers. Although she does not have smart phone internet etc. so does not understand this IOL stuff. She was repeating what her friends and doc said to her.

Sometimes the " cheap iol" is the only option, because of expense, or cornea issues. I doubt if a 80 years can see all ranges without glasses. Missing pieces to that story!

Choosing IOL is a big deal, but a bigger choice with problem free eyes!

"Choosing IOL is a big deal, but a bigger choice with problem free eyes!"

That's correct. my sister has never wore glasses. claims to have excellent vision. so i asked her to read the fine print on back of ipad box and could not read it. and she is 47. u should get a vision test of your neighbor. ha ha.

worried husband those were my exact questions i asked myself when i was diagnosed at 53. someone at 80 (even if that's the new 70) is still vastly different. I was going to be working for another 10 years. My interests and hobbies are different. Someone at 80 had also bpt had good eyesight in over 20 years so anything is an improvement! Even my surgeon acknowledge this during my consults. He told me someone older is gaining something whereas someone younger has to decide what to lose and that's why the whole IOL selection and strategy process is just painful. An 80 year won the lottery.

Speaking with others your wife's age far more helpful in this process. Would her surgeon be able to put her in tough with anyone ?

Missing pieces to that story!

Yes I agree. I tried to get more info from her but she is clueless so I gave up.

Yes it is all so subjective.

u should get a vision test of your neighbor. ha ha.

No chance of that happening buy that would have been really funny.

I guess most people with monofocals would suggest monofocals to others, and us with premium lenses would suggest premium lenses to others 😃

Off course I discussed monofocals with my surgeon as well, he said, well your are in your forties, you will benefit from the premium lenses for many years to come, why not have it all.

And for me that is the essence, as one of my friends said before the surgery, for what reason should you choose not to be free of glasses for the next maybe 30-40 years, why would you choose to get only half of the package, when the full package is offered to you.

Unless something else happens off course, but we never know that.

I talked to a guy, that is in his sixties, he have had monofocals, and he felt that I was almost stupid because I have payed for the premium lenses, he said he have very good vision, and could not ask for more, and first off this sounds really great.

But when I talked a little more with him, he said that he had worn glasses all his life because of nearsightedness, and now he only needed to use reading glasses for using his smartphone, or seeing small things, and surgery didn´t cost him a dime! 😃

I guess this shows that it is a matter of what we think is a good result, I would hate it, if I had to bring reading glasses with me, for using my smartphone.

I talked to another guy, that also was very happy with his monofocals, he said he had good all round vision, and was free of glasses most of the time. I asked about use of smartphone, he said no problem at all, I can read it just fine, when I hold it out in straight arm 😃

That said, I also know a guy with monofocals, who can read quite well with monofocals, so as always, outcomes vary a lot.

Sue, with patient confidentiality etc I don't see it happening plus even in the same age group there are so many variables.

We just sent our surgeon the email he had asked us to write. About our feelings, thoughts, daily life activities etc. 70% work in front of PC... also included photos of my wife giving group fitness classes to give him better idea of her activities.

We wrote that we are open to both Mini-monovision and also Zeiss Lisa!!!!

Now we wait for his reply.

Viking,

We have left the decision to Dr Zeiss now.

Let us see which IOL he picks.

Btw I am typing this from my dentist's office. Just got my yearly cleaning done. Hygienist said that she wishes more people were clean like me and it was like a holiday for her lol

Waiting for wife to come out now. Will tell her that the eye OP will be less painful 😃

I am sure Dr. Zeiss will give a very good advice, he is the expert that have seen your wifes eyes.

And yes, dentist is far worse than iol implant in my opinion 😃

Ok so Dr Zeiss replied already (within couple of hours). He picked:

RE: - 0.25 and LE: - 1.26 (Difference 1.01 D)

He said her brain may also be able to manage

RE: - 0.25 and LE: - 1.65 (Difference 1.4D) but the computer screen might need to be closer than she would like and the eye will disturb her more when she looks in the distance.

These were the options, and we explained what she does. From that he concluded that far vision is important for her.

1. RE: - 1.0and LE: - 0.88
2. RE: - 0.25 and LE: - 1.65 (Difference 1.4D)
3. RE: - 0.25 and LE: - 1.26 (Difference 1.01 D)
4. RE: -0.62 and LE: -1.65 (Difference 1.03 D)
5. RE: -0.62 and LE: -2.04 (Difference 1.42 D)

He did not mention Lisa, I had that as an option!

No.3, that was basically what me and wife were thinking is the safest option.

So two surgeons recommended something similar. One recommended both eyes for plano/far.

And now Dr Zeiss has spoken!

I might still shoot him a mail saying...."So definitely no AT LISA???"

I think we should all vote! 😃

If your wife does not mind reading glasses, I think Dr. Zeiss is right.

I posted this on the PanOptix thread. The aspheric monofocol (yellow line) does come closest to perfect "quality" vision.

Yes, no question about that, you will always get the most crisp vision with a good monofocal, and glasses for near. An risk of visual side effects are much smaller with monofocals, although not zero.

And in theory, when you move the monofocal to -1.25 you move about 1 ft nearer, and then you have usable vision within reaching distance.

But then again, when both eyes see the same object clearly at the same time, you get a binocular "bonus" of 25%, and you lose some of that bonus with monovision.

I fully get the arguments for monofocals, and most people are very happy with their outcome with monofocals.

But still I would chose the trifocal for myself 😃

Honestly so true! Getting your teeth cleaned (and I have a good set that get cleaned every 6 months at dentist) hurts worse than cataract surgery!

If I hadn't been just plain nervous would have been fascinated by whole process.

I think you are right Danish in that we'd all vote for what we chose for ourselves. Provided we are happy with how that turned out. Remember the movie Sliding Doors - it always made an impression on me. What would life be like if at a crossroad we went the other way. And if we did would it have really mattered!

I won't vote - lol. But whatever you wife chooses Worried I hope and pray she gets good results. One she is happy to live with and back to enjoying life again. It sure is nice to get to a point (big relief too) when vision and your eyes aren't the first thing you think of upon waking and last thought before drifting off to sleep.

BUT do keep us on the loop. We will be looking to see what final decision is and those early first impressions after surgery. I could not believe I was able to see the clock upon waking. Think I auto reached for glasses!

Watching "Sliding Doors" right now thanks to you lol

is it on netflix?

Not sure, I just searched for it using DuckDuckGo.

I felt sleepy after 30mins though 😃 The concept is good but...

it's a classic fav of mine. Enjoy.

But then again, when both eyes see the same object clearly at the same time, you get a binocular "bonus" of 25%,

Won't there be any binocular bonus if there is only 1D difference between the eyes?

Worried I hope and pray she gets good results. One she is happy to live with and back to enjoying life again. It sure is nice to get to a point (big relief too) when vision and your eyes aren't the first thing you think of upon waking and last thought before drifting off to sleep.

BUT do keep us on the loop.

Thanks Sue. Hopefully this nightmare ends soon!!!

Offcourse I will keep posting. You guys gave us more support than any of our acquaintances/friends. That part of the experience was the hardest for me to digest. Even at my age people still surprise me!!!

Yes, there will be some binocular bonus with minimonovision, but not as much as if both eyes are in focus.