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

Seeherenow,

Wow 27mm!!

The average eye axial length is approximately 23.30 mm. Assuming the central corneal power is the same for each eye at normal axial lengths, for every 1 mm of axial length difference you can anticipate a 3.0 D difference in the refractive error.

So you had lens replaced twice? What type of IOL do you have now?

What made you exchange?

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

Doc thinks wife will be able to see PC screen at 80cm.

What happens with paperwork though? She looks at paper work constantly and screen at the same time.

Does it mean normal reading glasses will help with that or do they need to be clear on top for PC and reading at the bottom? I find it all so confusing!

Hard to say really, but again, there is a reason why bifocal and trifocal iols have a focal point at around 3.0-3.5, because this is what is needed to give real reading vision.

The monovision gives about the same near as my Lara, so this is what I am comparing with.

It depends on how far away she holds the paperwork, if she has the paper at a distance of at least 60cm with good lighting, and she can still read it at this distance, she might be good, although it might not be fully comfortable.

But if she holds the paper at 40 cm, she will most likely need reading glasses to see it well. I guess the reading glasses could be +1.0 or +1,5 and this way she can probably still see the screen and the closer paperwork at the same time (she will then see the screen with the eye set for far), but it is something she needs to try after surgery, I think this part varies from person to person. Bifocal glasses might be more comfortable, but we are all different when it comes to this.

I think some sort of glasses will be needed for that type of work with monofocals, there is a big difference on people saying they can do it, and to do it for many hours each day, without getting tired.

But I am very sure, that it will be possible to get a pair of glasses that will do the job, as long a she is ready to use glasses, there will no doubt be a good solution.

hi seeherenow

what were your symptoms for doing YAG?

hi danish. on the symfony eye i need +2.5 glasses for dark clear reading at 8 to 12 inches. less than 8 and above 12 is blurry. so what reading do i need in an iol for reading? keep in mind that i an wearing +2.5 on the symfony eye.

Soks once your IOL situation is sorted then I don't think you need to worry too much about YAG. Get it done as soon as it interferes with your life.

I know you are waiting to turn 50 but that is just statistics. Stuff can happen even at 50+.

All surgeons I have met have said don't stress about YAG. I know easier said than done but just putting it out there 😃

when trying to see my pupil size on my pre-surgery reports to respond to you i noticed that my left eye has PVD. noone has ever pointed it out to me. not even the retina specialist. now does that make me more prone to RD? male, under 50, family history and PVD.

the way the opthalmologists are down playing my dysphotopsia complaint i am not going to trust them and be buyer beware. after 50 i will just retire and focus full time on recovery. until then i need my vision.

Hunh! Definitely not a 3D refractive error per mm in my case, was -10D. Oh, well, don't know how they come up with those statistics.:)

No, I didn't do a lens replacement, only cataract surgery in each eye. I did this combo for my cataracts:

monofocal IOL in dominant LE with "old school" surgeon. He was not on board with my overall plan but was closer, totally covered by insuranace, and had done 30k surgeries. He did an excellent job - I ended up at -0,25D in the dominant LE. Amazing clarity for distance.

I did the 2nd eye 4 months later with a younger, more open-minded surgeon who also had done 30k surgeries including lots with Symfony, my choice. He calculated the Symfony IOL power perfectly for my RE in relation to my then healed monofocal LE. I have awesome bifocal vision now, no glasses - except will get very low prescription (-0.5D) for driving on rainy nights in unfamiliar areas. So pretty much glasses free.

VERY happy and grateful!

PS - of course the reason for the mix/match of the IOL types was to mitigate the visual artifacts in the Symfony (non-dominant) Left Eye, (set for -1.2D, settled at -0.75D) by having the monofocal IOL in dominant Left Eye set for best distance. Very happy to have achieved that goal! Symfony artifacts are not noticeable at all in the day and only noticeable when driving at night if I look for them.:)

Yet I can see perfectly for reading, computer, and distance. So happy with this choice!

Oops! I meant the Symfony in the non-dominat RIGHT Eye.:)

Hi Soks,

As I wrote on a different thread, thePCO/( YAG) symptoms were like a thin film over the eye. Not as noticeable as the original cataract blur. More like a floater that is more or less stationary in the field of vision. As if you had a piece of plastic wrap over a bowl in the fridge and it eventually formed a thin film of condensed water on the plastic. You can see thru it, but you know it's not quite clear. Like fog, but not terribly dense.

In the YAG procedure, the surgeon aims four short laser bursts forming the 4 corners of a cross, which have the effect of "bursting the plastic wrap", i.e., the remaining central area of the capsule behind the IOL which has grown the cells which formed the PCO. My surgeon said they've been doing the YAG for 35 years now, so normally no worries for the patient. Quite amazing!

Opps! No, I wrote that wrong. The Symfony eye was set for -1.0D, settled at -0.75D.

how is your symfony eye, when using alone, for distance?

It will depend on her actual results - really hard to predict. If mini monovision strategy turns out well and she is going with target of -.25 and -1.00 there abouts she may only need glasses for close up vision / paperwork. But it coukd mean some sort of progressives.

That was my concern and one that eventually led me to choosing EDOF lens.

That's awesome. Great results and sometimes we need to push or keep looking for that open minded surgeon. I am guessing a201 may have influenced that decision? If memory serves me well I think he thought that set up would be the best one for seeing better range of vision taking full advantage of an EDOF lens but having monofocal in non dominant eye targeted for distance.

Hi Soks,

The Symfony eye is great for distance on its own,. If both eyes were at -0.75D I would probably feel the need for low glasses prescription more often for driving, but of course, I use both eyes together.:)

Before cataract, my vision was -8.5D, then went to -10D with the cataract. So as someone (Viking?) wrote above, seeing at -0.75D is winning the lottery for that eye, plus seeing well at all distances.

Thanks, SueAn!

Yes, someone on the forum here influenced my decision but when I tried to find it later, I couldn't. You're probably write about it being at201.

But I had also seen a YouTube somewhere by an optometrist who had tried mixing IOL types with good results. Don't think she was doing the mini-monovision as well, tho.

For me, it was only logical that the dominant eye would have the monofocal IOL for distance vision without distractions, since the visual artifacts seemed most bothersome to people when driving at night. So you would want the dominant eye to take over more responsibility for distance while driving. As I said, the artifacts are truly no problem for me when driving now.:)

hi seeherenow, what monofocal lens do you have?

I notice that almost all of the people here either wore glasses or had bad vision pre-cataract!

Seems like my wife is the only one here who went from excellent vision to her current cataract state, all in 3 months!!!!

I remember the surgeon saying when we were discussing AT LISA that it would definitely be improvement on her current dense cataract vision.

Thing is until 3 months ago wife had excellent vision so she knows what good vision is, unlike people who have not known good vision for many years.

I don't know what point I am making. Just putting it out there.

Surgeon/Dr Zeiss wrote to us again yesterday that we should let him know which combination we decided on. As they need to have spare of the IOL that we choose for operation. Otherwise operation may have to get postponed.

I replied that we go with the mini monovision combination that he recommended but I asked him one final time about AT LISA.

Thing is until 3 months ago wife had excellent vision so she knows what good vision is, unlike people who have not known good vision for many years.

I am quite sure, your wife has already forgotten, how vision really was before, even that she remember some things were better.

I have had cataracts for 45 years, and now 4 weeks after second eye was fixed, I am having a hard time really imagining how it was before, brain adapts really quick.

I remember some things that I could not see before, and when I look at it now, I am finding it difficult to understand, that I have not been able to see it before, and I find it difficult to imagine how it was.

And when I am outside, colors and details are almost overloading my brain, but still I can not really recreate in my mind, how vision was before.

It is like remembering pain, you know what pain is, you know it is not nice, but you can not recreate the feeling of pain.

So I am quite sure your wife will feel a big improvement not matter what lens she gets 😃

hi w-h

wills eye tried to say the same thing with me. they told me i had to decide fast because they had to order lenses 2 weeks in advance. i asked them that what if the iol required is different during surgery after ORA measurements. they fumbled for a response. most places have a "lens room". i asked the same question to my surgeons office and they said they will order adjoining powers and there will be more in the "lens room". even for them it was not a straight forward response. so on the day of surgery my surgeon came with 3 boxes and handed them to me. they were symfony 16, 16.5 and 17.

Soks, no it is different situation. He is not strong arming us or using it as some sort of pressure sale tactics.

The date was already booked with him, and we have already confirmed that he is the surgeon we have selected. He gave us till next week to decide, we can take longer but then there is "SOMETIMES" the risk of two of those IOLs not being available on that particular date.

Lot of the big surgeons here have their own clinic but the actual operation gets done in external facilities. So they need to forward those IOL requirements to them in advance.

Actually one of the reasons we liked this surgeon was that he never tried to oversell or make us pick him. He genuinely did not care which surgeon we went with.

He is in demand, his clinic is non stop full of young kids, middle aged and really old people.

None of the other surgeons had so much traffic. One facility was even bigger than his with multiple surgeons and even they were not that busy.

did he reply about lisa?

are you fixed with the surgery date then?

Sounds like your wife has a genuine interest in the Lisa lens. I can't help but think she should consider it if she doesn't drive at night. From your messages it seems she has a strong desire to be glasses independent as much as possible.

End of the month.

Sounds like your wife has a genuine interest in the Lisa lens. I can't help but think she should consider it if she doesn't drive at night. From your messages it seems she has a strong desire to be glasses independent as much as possible.

Yes but not at the expense of less clear vision and side effects. Who does not want to be glass free, although she has never used glasses ever. Her first priority is-

a) Not to be blind and

b) To have VERY CLEAR vision

...and only after that comes glass free.

Other thing is that as we age and other eye issues arise, multifocals might get tricky for the eye/brain to deal with.

As I think you know, I have monofocals myself and also prioritize very clear vision. Your wife's priorities are similar to mine, so I agree with her choice. I think we all have the same first priority 😃

I think we all have the same first priority 😃

😃

Ok guys. All set for end of this month OP with Dr Zeiss.

Doc emailed back again regarding my Lisa questions.

We going Zeiss monofocal way.

We really like this surgeon, glad we kept looking and found him.

Hope all goes well for near and distant future too.

And while I typed the above post, Dr Zeiss wrote one more time saying everything will be ok.

Date ? My right eye is scheduled for 9/27.

"Yes but not at the expense of less clear vision and side effects. Who does not want to be glass free, although she has never used glasses ever. Her first priority is-

a) Not to be blind and

b) To have VERY CLEAR vision

...and only after that comes glass free.

Other thing is that as we age and other eye issues arise, multifocals might get tricky for the eye/brain to deal with."

Worried - there shouldn't be any compromise in crisp vision between monofocal and premium lens. Normally compromise is night vision artifacts. Of course I am unable to compare crisp vision between 2 but I have no issues seeing anything near and far and everything in between during the day. Night time yes that was some getting used to but this was a trade off acceptable to me. I know everyone is different but being able to go through my day w/o glasses is wonderful - don't even bring a pair with me or have a pair at the office.

And I do drive st night without a second thought (first 6 months or so it was a bigger area of concern). Night driving is a part of life in Canada for 4 months of the year for those that drive even just to and from work.

As ling as your wife is confident and happy with her choice - all that matters.

Looking forward to those early reviews. Feel like we are all a part of her journey as well and routing for a great outcome!

Hi Sue,

The undisputed fact is that monofocal gives the best quality vision compared to multifocals at a given distance. It is an objective fact not subjective. I am not talking about spectacle independence but pure visual quality.

4 surgeons we met all suggested mini monovision. Two of them highly experienced said it is compromised quality at all distances. It is "basic" physics. Btw I was bad at physics so don't quote me 😃 lol.

Then Dr Zeiss who specializes in EDOF/Trifocals etc also recommended mini monovison based on my wife's lifestyle. He could have made straight $5k and more from us if he wanted to. He did not, he has no motive apart from what he thinks is best for my wife. I clearly told each surgeon that money was no barrier.

Multifocals are also not recommended when eye issues arise as we age. Who knows what is coming in the future. So based on all of that we came to the conclusion we did as the safest and most "sensible" long term option.

There is no decision that is 100% perfect, if it was this forum would not exist. Last 3 months I have spent every second pouring over this question and worrying about my wife who I so dearly love. It was our 20 years together anniversary when we got hit with this news.

Then I was super stressed in the first 2 weeks after the cataract diagnosis that we got hit by second bad news of fluid build up behind my retina, pushing my retina up.

Now in 2 weeks my 2 month waiting time will be up and I will know if I am normal or if it is start of my own chapter of severe eye problems 😦

All this IOL stuff was not easy decision to make as you yourself know.

Also I repeatedly asked Dr Zeiss about AT LISA and he says what we are doing is good way to go...he also suggested that in the future we could use multifocal contact lenses and we could also still implant add on multifocal lenses if we really wanted (something Viking had suggested in the past too).

I am not denying that your vision is good, but your good might equal bad for someone, or equal excellent for someone else. It is all too subjective.

The target numbers we are going with has also solid basis. We came to those number after lot of thinking and coincidentally Dr Zeiss emailed us those exact numbers too, and also gave his reasons.

Ideally no cataract coming at 42+ would have been ideal, we just have to play with the cards life dealt us 😦

Hopefully all goes well. Fingers crossed! Your support and everyone's support here has been HIGHLY VALUABLE!

Good luck to you and your wife. You did lots of research and got lots of great feedback from here.

Is that chart above only for night vision?

Do you have CSR?

My doctors think the same way, even until this day I wish I can go with a premium lens to achieve spectacle independence. Especially now that PanOptix just got approved for the US. However I do have a retina issue, I had what doctors think was an episode of CSR that went undetected in my left eye. My right eye was so dominant that I didn't even notice. With that on my record, my docs say I am not a candidate for premium lens.Monofocals, like you said, will be the "safest and most sensible long term". If you have CSR or any other retina issue, you will probably be the same as well but it's great that you prefer monofocals anyway. There's still a part of me that wishes I could do 20/25 at 3 distances (during the day) without the need to wear glasses. However I just have to think about the upside, like possibly getting better than 20/20 at once distance and better night vision. I am still in the middle of my cataract surgeries. I am 8 weeks post op left eye (Toric monofocal set for far). I am yet to schedule my right. I never wore glasses in my life, prior to knowing I have cataracts when I found out almost 2 years ago.I'm still having trouble getting used to wearing glasses for int/near and wearing bifocals, I misplace them EVERYWHERE, lol.

When is the big day for your wife? Wishing her the best surgrey and looking forward to her results!

Glad she has come to a definite decision - really does help as the surgery date approaches to know you've done your best to understand the options.

My distance vision was never as sharp as my husbands - going back even to my teen years. I developed a high fever when my MMR vaccine didn't work and came down with ref measles. Distance vision was affected soon afterwards and worn glasses for distance since age of 12. I do know I read the eye charts now better than when I wore glasses as my optometrist has my records. However I get what you are saying and likely my distance vision could have been better if I had gone with monofocals. I have no regrets as these have made my work life easier and I do like being glasses free after this many years of having them.

Sure hope your eye issue is resolved soon too. For both your sales hoping surgery date comes soon and all goes well.

Hi coppp - are you saying your dominant eye made up for whatever was lacking in other eye? What were symptoms of CSR?

Is that chart above only for night vision?

No, it applies generally. It also includes night vision comment as lower light creates bigger issues.

"Visual range with each lens type without glasses" does not say at night time or night time only.

Do you have CSR?

Technically yes although I have no vision issues now or ever before. I only found out around 1.5 months ago by chance. My wife in her early 40s got diagnosed with cataract 3 months ago. Couple of weeks later wife forced me to go and get my eyes checked too.

During that check up the eye doctor discovered slight fluid build up behind my retina literally next to the Macula. Eye doc thinks my wife's cataract related stress might have caused it. I have to say I truly was stressed out and felt extremely deeply for my wife's situation as she is my world. Since then I have calmed down and am more practical and concentrated on purely researching and supporting her as anything else won't help matters.

The eye doc showed my my eye scan images and said that all the retina layers are looking healthy, intact without any separation or breakage. She thinks it will be gone in two months but if not and if it moves towards Macula or gets bigger or breaks and leaks fluid into the eye chamber then...I guess I have full blown CSR.

Google image search of "central serous retinopathy" shows how bad things can get!!!

Coppp, do you have CSR too or were you just mentioning it?

I wonder if I had fluid build up in the past and just did not know. Although people notice clear symptoms most of the times.

I do LOT of sports and until 5 months ago I was also running 20-30-50km up and down mountains and in the woods for fun (till injuries started pilling up and I quit running).

Now I just do normal group fitness of around 12 hrs per week. Eye doc does not think my stress was from fitness and said I can continue doing fitness. Two more weeks and I go for my second eye scan!!!

I am same - don't train as much. Took a couple of falls while I had cataracts but didn't know it. Just thought I needed stronger glasses and was waiting for new vision care plan year to come to have exam and new glasses covered.

I could run now again but found it was taking me away more from family life so just exercise reasonable amounts of time for health benefits. Everyone has to find their own balance. Now my daughter is toying with a marathon so perhaps I will train again for 1 more.

Hi coppp - are you saying your dominant eye made up for whatever was lacking in other eye?

Yes.

It was my early 20's when I noticed my left eye was worse than my right. I'd say left eye was about 20/25 - 20/30 ish then, while my right was still 20/20. It wasn't until my mid 30's when I realized my sight was getting pretty bad, however since I work in IT I thought all along it was computer eye strain. Then DMV notified me that my driver's license is up for renewal but also required a vision test. That's when I panicked and self tested my eyes with a printable eye chart. As I test one eye at a time, my right eye was "ok", like 20/25-20/30 so enough to pass vision exam for that eye. However my left eye alone, was 20/50 and that was when I first noticed I had central vision distortion... My combined vision was like 20/30, distortion was hidden, but still general blue. So all these years I didn't realize until I tested one eye at a time. Finally went to eye clinic and found my left eye also had denser cortical cataract than my right.

What were symptoms of CSR?

Central vision loss, in my case (and usual case), central vision distortion. When I look at straight lines, it's warped /curved. Docs aren't 100% it was CSR but signs show it was. By the time they scanned my macula, fluid was already gone but apparently it was there for awhile and caused permanent swelling...

but still general blue

I meant general blur, not blue.

So annoying I can't edit, lol

Coppp, do you have CSR too or were you just mentioning it?

See my response to Sue. It is good you are catching this very early. Seems you're better now but please take care of yourself too so you can take care of your wife. I think my CSR episode/stress level may have started when my wife got pregnant. We were having twins but there was A LOT of worry. When they were first born I still worked full time while my wife stayed home, but I wanted her to rest as much as possible when I got home so it was usually me who stayed up all night while I watch over my boys. Then I relied on several cups of coffee to get through the work day. I put them first and didn't care for myself. It was not fun when I found out my eye condition/s. So my advice is please don't forget to take care of yourself as well. Good luck hope your next eye scan is clear and continue to exercise 😃

Glad things are better now. Twins - that is a lot to handle - especially energy wise those early years. Treasure those times / they grow so fast.

Jeez Coppp, that must have been tough! So you have CSR and cataract 😦

Do I remember correctly that you are in your 40s?

We are child free by choice and just the thought of having one kid gives me nightmares, with the current situation I would get a heart attack 😃 Hope your stress levels are under control. I wish you and your family the best!

I have done many work related late nights but that never stressed me like the first 2 weeks of my wife's cataract.

Central vision loss, in my case (and usual case), central vision distortion.

So both have stayed? I feel slight blur in both eyes but I think that is presbyopia kicking in as when I put my +1 reading glasses it becomes sharp.

Prognosis

Fortunately, with this disorder, spontaneous visual recovery generally occurs. The leak within the pigment epithelium usually closes by itself and the detachment resolves within weeks to months. Many patients have a vision of 20/30 or better in the affected eye. Although many patients may experience symptoms in the other eye, most do not. While vision is good, mild permanent visual abnormalities may develop including decreased contrast and night vision and distortion. It is possible that new detachments may develop weeks, months, or even years later. Each detachment can cause further damage to the retina and pigment epithelium and may require laser treatment.

Sue, apparently when fluid is there it does this to your vision. I am in a creative field where vision is important! I see all good and always have, I hope it stays that way 😃

Treatment

Most ophthalmologists recommend patients with the disorder change their behavioral patterns to become more mellow or relaxed in their daily life. The physicians of Vitreous-Retina-Macula Consultants have tried tranquilizers, antihistamines, non-steroid anti–inflammatory medications, and beta–blockers without success. If the detachment does not resolve on its own, or if it recurs hot or cold laser can be applied.

Now some things make sense when optometrist asks me if lines look straight or if vertical ones vs horizontal look bolder. I will pay attention more.

Hoping your next visit proves that things are back to normal. Amazing what stress can do.