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Your Post Lasik Cataract Surgery Results (Trifocals, EDOFs, Multifolcals and Halos—oh my!)

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banterer
banterer

I posted this on the 7th of August but it has been in moderation and it is now the 10th so I am posting it again. If it gets posted twice, I will attempt to remove the duplicate...

My name is Jorge. I am in the US. I had Lasik in 2004 and vision was great until about 3-4 years ago. I initially saw an opthalmologist who told me that I had a cataract forming in my left eye and another just starting in my right.

I was also told that they were not "ripe" and that I should wait about a year before looking into surgery. It has been about 3 yrs now and the vision in my left eye is really annoying me. I have been trying to drink water and carrot juice and all sorts of other things but the vision continues to worsen. I have done a lot of research on IOLs and it seems clear that in the US our IOL options are very limited compared to what is available in Mexico, Germany, Turkey, Greece and Belgium (probably many other places too).

I was seriously considering traveling to another country to have the surgery done because of the options (trifocals such as the Reviol Tri-ED or the LIght Adjustable Lens. The LAL was developed here in the California yet is still not yet approved by the FDA but I believe it has been available elsewhere since 2009. I hear they are "close" to approving it here).

I am now thinking that I should maybe NOT go elsewhere because if there are any complications or adjustments that need to be done, they would not have any experience with those lenses here and because I had chosen to go around them, may be all too pleased to tell me that I would have to fly back there for them to deal with me.

I would like to ask people who have had Trifocals, multifocals and EDOFs what results they have had. I have been told that none are perfect and that I will have to compromise on one of the following:

• near vision

• intermediate vision

• long distance vision

• night or driving vision (halos and glare)

• low light vision (the ability to see properly in low light situations)

I was told that almost all lenses other than monofocals will produce halos/glare but that after about 3-6 months my brain would adjust and I would not notice them.

I have been dealing with the cataract getting worse and worse for 3 years now, I am wondering if the halows I would see after the surgery could possibly be any worse than how I am seeing now. Maybe it would be a marked improvement!

One doctor told me that that I should try the "small aperture" IOL because by using a small aperture it extends the depth of field. That made sense so I then followed up with a question about low light sensitivity (since just like a camera, you can get almost infinite DOF if you stop the lens down but you then you can almost not see anything unless it is bright daylight), he never responded.

There was another lens, the Reviol Tri-ED. I contacted the author of an article: "The Lens: Reviol Tri-ED” (/). The article made the lens sound great because it had great light distribution. He sent me a research article: 

RESEARCH ARTICLE Open Access

Clinical outcomes of a new diffractive

trifocal intraocular lens with Enhanced

Depth of Focus (EDOF)

Banu Torun Acar1*, Erkan Duman2 and Saban Simsek1

Everything sounds great until I ask him:

Besides the Reviol, are there any other IOLs that you recommend to eliminate halos as well as providing continuous focus from close to far?

His response: In Reviol and Zeiss, there are complaints about halo glare. Alcon Panoptics gives us better results.

Keep in mind that this was the doctor who penned the research article that stated: 

"All our patients achieved spectacle independence without an incidence of photic phenomena, such as halos and glare at 6 month-follow up."

I cannot ask any of the local doctors what their opinion is on these other lenses because they will only recommend what THEY can do and claim that the FDA only approves the latest and greatest and if they have not approved it, then they are "obviously not having good results overseas".

So at this point, I am completely confused.

1) I can get the surgery done here in the US knowing that there are more advanced and probably better lenses with possibly fewer post surgery abberations and side effects.

2) Go to another country where I will have to stay 1-3 weeks and then hope that when I come home nothing needs anymore work

3) I can go to Mexico and get the LAL but I do not really know how competent they are there. The LAL is adjusted post-op and after your eye has healed (about 2 weeks). Up until your eyes heal, you must wear a pair of UV blocking sunglasses for those 2 weeks so as not to inadvertently expose and thus alter the lenses. After 2 weeks you go back, to the office, they measure your eyes as they are now healed and then adjust the lenses and then once it is dialed in, lock the lens in with another Laser that then prevents any further changes to the lens. The thing about the LAL is that they change shape and can get bigger than when first implanted and if they need to be removed (I don't know under what circumstances you would need them removed) it can be a chalenge since they will be bigger than when they went in.

4) Go to Canada and see what options they have there

5) Go to Greece to visit a doctor who practices both in NY and Greece. If I had to make any changes I would only have to go to New York but that might also be a PITA if I had to do it more than once.

6) Go to New Zealand. There is a doctor there who is one of the few in the world who has worked with the Harmoni lens and I do plan on moving to NZ within 2-3 yrs but that is a much bigger hassle if I have to go there because of the long flight times and their expense.

So, in closing, I would like to hear from people who have had Lasik. I would like to know what type of lens you opted opted for (multifocals or mono) and why. I would like to know if you are happy with them and if you would recommend them.

Thanks in advance and sorry for the long post but I wanted to give as much background as possible.

Sincerely,

Jorge

 

2 likes, 30 replies

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  • soks
    soks banterer

    Posted

    This is a great post given the issues reported with symfony for night time especially with driving. 

    What's next after symfony? LAL?

    Symfony sounds tempting with near and dish vision but night issues could be bothersome. 

    • Sue.An
      Sue.An soks

      Posted

      Just to clarify - only a small percentage of people will consider the night vision issues bothersome.  You can read the studies on those.  Personal it would be great if there were none however don't consider them to limit my life.  I have been driving around the city with no difficulty.  The worst is when I face bright headlights from newer cars that have LED headlights but my husband who doesn't have cataracts find them bothersome too.

      It really comes down to what compromise you want to make (and there is that no

      matter which lens you choose).  Monofocals also can cause night issues (I am actually wondering if that comes down to pupil size).  Also funding as premium lenses are out of pocket expenses.  How I

      Wish there were ma Hines that would mimic the view you'd get prior to implanting lenses but currently there are not.

    • banterer
      banterer soks

      Posted

      I believe I spoke to someone who said that the LAL finished its last FDA trials at the end of 2015 and that they now had to submit their 12 month follow up results so it seems as though the LAL will be approved here sometime soon.
  • banterer
    banterer

    Posted

    Is anyone familiar with the Haromi lens? Since I cannot post links on posts, I willl paste what I found from one site:

    The Lens: Harmoni Modular

    Robert Edward Ang, MD

     

     

     

     

     

    Despite multiple advances in IOLs and the tools we use to implant them, the basic design of IOLs has remained essentially unchanged for 50 years: an optic with two or more haptics affixed. Enter the Harmoni Modular IOL (ClarVista Medical). With this two-component design, the haptics—the base of the lens—can serve as a stable platform in the capsular bag, and the optic component can be exchanged or adjusted to accommodate each patient’s changing visual needs.

    AT A GLANCE

    • The two-component Harmoni Modular IOL allows surgeons to address the changing needs of patients over time.

    • With the base simulating a capsular tension ring and holding the capsular bag securely, the optic can be safely decoupled and removed, and a new optic can be inserted....

    ...CONCLUSION

    The standard IOL design is no longer capable of meeting the demands of many of today’s active seniors, who may well have decades of life ahead of them when they undergo cataract surgery in their 60s. The modular design of the Harmoni IOL allows us to address the changing needs of our patients over time. 

    With this lens, surgeons can have peace of mind that they have given their patients multiple options for the future. [author]

    This lens is available in New Zealand and only a handful of doctors have worked with it so I am concerned about any possible follow ups, if I were to get it.

    In addition, they say that the premium IOL choices are limited for post-lasik patients since the lasik further compicates the calculations needed to come up with the right power lens.

    Of course, no one can be sure what lens they are going to recommend until after they test you and I would be displeased to fly to NZ only to be told that they suggest using a lens that I could have gotten at home.

  • Siempre
    Siempre banterer

    Posted

    I had Symfony Toric lenses implanted in both eyes about 6 months ago - ZXT375 in the right eye and ZXT450 in the left eye. These operations were carried out in the UK (where I live) and about four weeks apart. Having started with glasses and a prescription of -12.50 (right) and -11.00 (left) for myopia and -6 (right) and -4 (left) for astigmatism, I am now glasses free except when trying to read newsprint in low light. There are some (for me) minor drawbacks - such as halos around bright lights and some spiderweb effect. However, these may be the consequence of slight capsular opacification (PCO) which will need treating eventually. Currently my vision is excellent.
    • banterer
      banterer Siempre

      Posted

      That sounds very encouraging. My surgeon (the one who did the Lasik) was gun ho on the Symphoni lenses until I started asking him about the lenses available elsewhere and to my total shock, he agreed that there were more (better) choices outside of the US but that the FDA (Federal Deception Agency) liked to be very careful and that was why it took so long to approve lenses here. He could not account for why LAL has been available in Europe since 2009 and it was just getting out of trials here in 2015.

      My thought regarding halos, is that these cataracts (I know they are all different but obviously all of them deter and hinder proper vision to some extent or else we would not know we had them) mess with our vision so badly already with respect to glare that halos may actually be an improvement.

      By the time we are told that the cataract is "ripe" or ready to be removed, we have already been suffering the slow degradation of our clear vision. I can tell you that for me, my vision is quite discouraging. I almost don't remember how wonderful it is to see clearly again. At night, headlights have tremendous glare and during the day, if the light is too bright, I need to shade my eyes to get enough contrast to see properly. If I put my glasses on, the images do get clearer but it is not always better if it is not fairly dark because I am seeing multiple images so with glasses I see multiple clearer images which in a way is much worse. So my choices are no glasses and see not that clearly but see one main good image with several fuzzy ones or many sharper images.

      So by the time you get ANY lens, I think that as long as you start seeing one image, you might just be happy as pie.

      My cataract seem to be forming in the center of the lens which is the worst place (I'm told).

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