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Are my eyes getting worse because of Cataracts?

Hi I am 25 and have been noticing my eyesight getting worse and worse it seems.The last check up I had 20/40 vision which I am not sure how bad that is or not.I was told i had cataracts around age 12 and was told they have to ripen I guess they said.I really want to get the cataracts removed but I am terrified of the surgery since I watched a video of what they did which freaked me out watching them do it.Also how much on average should it cost to get both removed.
14 Responses
10949559 tn?1414050805
Every cataract surgery cost depends on the procedure you are going to have, which depends on the severity of the condition. The average cost for a straightforward surgery would be $3,000 per eye and $4,350 for presbyopia-correcting intraocular lens procedure.

I think cataract surgery has an overall 98 percent or higher success rates. Most of its complications after a surgery is treatable with medication.

Avatar universal
I developed cataracts at 17 and by age 25 my vision was also around 20/40. I waited until I was 29 to have the surgery and am glad I did. If you have cataracts and you are 25 I would advise you to wait AS LONG AS YOU CAN BEAR IT before you have cataract surgery. Even in the highly likely event of a successfull cataract surgery, you will need glasses for a lot of things that you do not need them for now. You will lose the ability to focus your eyes save for one set distance that you have to choose. If you choose distance (driving) the computer that you are reading this on would be blurry, and everything closer would be very blurry. 20/40 means that if something is 20 feet away, you see as much detail as someone with perfect vision would if it was 40 feet away. If your vision is still 20/40 I don't think you're quite ready yet. After surgery your distance vision would be 20/20 but your near vision could drop from 20/40 to 20/100. Overall, you'd probably be much worse off than you are. When you start to have difficulty driving or start to get eyestrain from absolutely everything you may want to revisit on this.  
If you do need the surgery, it should be covered by insurance. If you don't have insurance, division of blind services in your state should pay for it for you. If you want to avoid needing reading glasses or bifocals/trifocals/progressives just like grandma after the surgery, you'll need to go with a multifocal lens. That is not covered by  insurance and could cost up to approximately $5000 per eye. Could  be less, but thats a worst case. It is highly likely you will have problems with strange effects around lights, and you will have difficulty seeing at night. You may not be able to drive at night. There is also a slight chance you will still end up needing reading glasses.
    Sorry to be the bearer of bad news, but as you get older, you lose the ability to focus your eyes anyway.  By age 40 your near vision starts to go. Because of this, most people who have cataracts have already lost the ability to focus due to age, so after surgery their vision is just as good as it was before they had cataracts. When you are in your 20's, thats just not the case. Your vision would be significantly worse than it was before cataracts. The eye doctors don't really warn you about this because all of their cataract patients are happy, (because they don't have any other 20 year old cataract patients who will lose most of their visual range with the surgery.)
      If you have questions, I am 30 post surgery with accomodating IOLs no longer available. I have a friend who is 27 post surgery with multifocals, and another friend who is around 29 post surgery with the normal monofocals that insurance would cover. I'm sure we'd all be willing ot talk about it, but I should warn you that none of us are completely happy with this and we all really wish we'd never gotten cataracts. (Although we will all say the surgery itself was no worse than a trip to the dentist.)
      On the  bright side, the surgery is really no big deal and very safe. The chances of losing your vision are almost nonexistent. Just understand that treating your cataracts will not restore the vision you had before you developed them, regardless of what the doctors advertisements on their webpages will tell you. This only applies to much older people, not to us.
Avatar universal
If you can...watch a few more videos of the surgery.  After a while you will become  desensitized to the blade insertion, and be able to observe the more interesting parts of the procedure.  
When you are on the table, you will be relaxed and calm (nice drugs) and your part will be "Look at the light, look up, look down."  
But, at your age and with your vision, waiting is your best bet.
Avatar universal
I assume you also talked with the doctor about whether you need glasses or contact lenses to help correct your vision until it's time to have your cataract procedure. If not, you should see an optometrist who can check your visual acuity.  

In case the cataract doctor did not mention it, sometimes as cataracts  develop they change the shape of the natural lens inside your eye. This can cause a person's visual acuity to change, either to get better or worse.  As an example, my dad's nearsightedness got much better during the time his cataract was 'ripening' before he had surgery  He had to have his glasses changed twice to maintain his visual acuity before he ultimately had cataract surgery.

Other patients' vision can get worse as their cataract gets more severe, both from the clouding of the cataract and because as the cataract worsens it can change the shape of the lens inside the eye and makes them more nearsighted.  

In your case, I'd check with a doctor to ask if there are any corrective lenses that would help you see better until you have the surgery.  Of course, all of the vision loss that is causing you to see 20/40 rather than 20/20 could be caused by the cataract, but you should still ask an optometrist to test your visual acuity and see if any lenses can improve your vision until you have surgery.

I agree that it's best to wait until the cataract significantly interferes with your vision to have the surgery.  There are newer IOLs that may be available by the time of your surgery that aren't available now, so you may have a greater range of choices for the replacement lens that's implanted.  But a KayakerNC says (who just had cataract surgery, I think) the procedure itself is extremely common, not difficult for the patient and has a very high success rate.  

Just be sure that when you do have the surgery, follow the surgeon's instructions EXACTLY in terms of how and when to use the medicated drops before and after surgery, how to protect your eye after surgery while it's healing and whatever other directions the surgeon gives you.  It can make a material difference in how good your outcome is and whether you end up with a complication (not likely at all, but less likely if you follow your doctor's instructions).  Good luck!
Avatar universal
You are awfully young to loose all your closeup reading ability, but if that is the situation you will have to live with it. If the cataract is not bothering you at the moment then leave it alone.

If the proper cataract surgeons start posting again here you should listen to their advise, until that happens treat all our posts with caution.

Go see a few consulatants and discuss what they can offer you.

The surgery is easy, but if watching the videos bothers you for goodness sake stop watching them.
Avatar universal
re: "your near vision could drop from 20/40 to 20/100. Overall, you'd probably be much worse off than you are. "

I will note that I'm guessing the initial post is referring to 20/40 as the best corrected acuity. That means no matter what glasses/contacts are used, that is the best vision gets. After cataract surgery with a monofocal someone's near vision might be 20/100 without correction, but the difference is that with correction they may likely be able to see 20/20 near, which is a big difference.

A common requirement for driving is  20/40 vision so someone who wants/needs to drive should strongly consider getting the surgery  when their eyes have gotten that bad to be sure its safe to drive. You may not realize if your eyes have gotten a bit worse if you haven't had them tested recently to realize you shouldn't be driving.

Unfortunately the problem is no replacement lens  solution is perfect now, which is one of the reasons many people like myself  try to wait as long as possible in hopes a better lens will be on the market. There are some new accommodating lenses   that are in clinical trials which may provide useful vision at most distances within a year or two in Europe or  a few years  in the US (they usually take a few years after Europe approves them, if ever).

One of the major issues in deciding what to do regarding a lens is simply how much it matters to you whether you need to wear correction afterwards. Progressive eyeglasses might work, though some wind up with   multiple pairs of single distance glasses for different distances. Multifocal contact lenses are another option.

Unfortunately someone younger   who wears correction now can't have a good sense of how different it might be to need correction to cope with the loss of accommodation. Many people adapt just fine to wearing progressive glasses, but not everyone, and  it just isn't as convenient as the sort of  single-distance prescription is that younger people are used to.

I had good luck with multi-focal contact lenses to deal with presbyopia, but not everyone does. Some   have complaints about visual side effects or don't adapt to them. One advantage of using a multi-focal contact lens rather than a multi-focal  implant is that if you discover you don't like them its easy to then   use glasses instead (unlike a lens implant that is risky to change). Contacts aren't  as convenient obviously since you need to take them out, and buy new ones (and the optical quality likely isn't quite as good as an implant, at least for soft contacts).

As others have noted, the surgery is covered by insurance, though a "premium" lens to deal with the loss of accommodation,  to be able to focus near, usually isn't.  Those who have high deductibles or want a premium lens not available here may consider traveling to another country where the costs can be far lower. It  can be cheaper to use a world class surgeon in say the Czech Republic, even including travel than it is to do it in the US (even with laster cataract surgery).

I hadn't checked into it in detail but  India appears  to be very low cost, e.g. one price  was   55,00RS= $976 for surgery with  a premium lens.   I hadn't evaluated the surgeon in that case to decide if they were one I'd be comfortable trusting,they appeared reputable at first glance at their website,  so I'm guessing that price isn't unusual there. I was just checking out of curiosity,  other factors led me to prefer to go elsewhere (e.g. need for visa, though thats likely not a big deal, especially  if you aren't in a hurry), so I didn't check further.

Avatar universal
Many people are happy with multifocal lens implants, although  a minority have   complaints and some  even have them removed. The newest lenses apparently are much better than the older ones, which has led some doctors who had given up on multifocals to use them  again.  You just need to balance which imperfect solution you prefer unfortunately.

Some doctors (especially if they aren't aware of the differences in the newer lenses) still  hesitate to use them due to the potential for visual side effects like halo and glare at night, and lower quality vision in lower light. A sharp eye surgeon (on my list to consider) discusses multifocals on his blog here:

http://eyesurgerysingapore.blogspot.com/2013/08/love-themor-hate-them.html

and has a sample image of the visual artifacts around a light that a patient described to him. If you hunt around the net there are other pages showing illustrations of what people mean by halos and glare. I'm considering the new Symfony lens (not available in the US yet) which has  the benefits of a multifocal, with side effects apparently reduced to the level of  a monofocal. It hasn't had widespread use yet to confirm the initial studies, but here are some articles on it:

http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/innovative-iol-breaks-new-ground-presbyopia-correcting-implant-technology?page=full
' “This extended range of vision IOL represents an entirely new design concept that allows for an extended range of crisp vision and a high rate of spectacle independence while minimizing photic issues, such as halos and glare, to levels similar to those occurring with a monofocal IOL,” he said[...]
Overall, more than 90% of patients achieved binocular UCVA of 20/25 or better for both far and intermediate, 99% had binocular UCVA of 20/40 or better at far and intermediate, and 88% of patients were seeing at least 20/40 uncorrected at near.'

https://theophthalmologist.com/issues/0914/is-better-the-enemy-of-good/
" Mean visual acuity was above 20/20 (decimal 1.0) for far and intermediate distances and 20/30 (decimal 0.67) for near distance, as seen in a recent clinical study (Figure 2)."

Manufacturer's description:
http://www.tecnisiol.com/eu/tecnis-symfony-iol.htm

PS on the price in the post above,  I should have clarified that the price in India was per eye, and a typo left off a 0, it was 55,000RS (non-toric lens). Prices in Europe  or Asia or New Zealand for instance can be anywhere from $1k-$6k per eye, they vary greatly. Obviously of course you want to find a reputable surgeon (which is what I was mostly looking for since my initial goal was a better lens not available in the US, it was just hard to find ones who had the new Symfony so I wound up scouting around a bit).


Avatar universal
I will note that I have been cautioned btw by an experienced US surgeon to be sure if I use a non-US doctor to be careful of the fact that in even in good  European clinics their standards may not be as high as US doctors in terms of things like complication rates and hitting the refractive target.

As with anything however, prices vary for many reasons between countries and there are good surgeons who are lower cost, but it is best to be cautious of course to ensure you are getting high quality treatment.
Avatar universal
Reading some of the posts I think there might be confusion about the Tecnis Symfony lens. The Symfony lens is not a multifocal or an accommodating lens.

My eye surgeon has recommended the ReSTOR 3.0 for me.  So let me state why am I interested in the Symfony Len. Even though clear vision is more than Defocus curves;  below are the Defocus curves for both the Symfony and ReSTOR Lenses.  

I have been looking for articles in comparing the two but have yet to find any so I have to do my own comparison.  

http://screencast.com/t/xewMvHgXL33

http://screencast.com/t/Wrsfn0weowA

In my case I do a lot of computer work so I want excellent distance and intermediate vision.  I would like close vision to be good enough for most task, but willing to accept reading glasses for some task.  I will give a real world example; I forget to bring my reading glasses everywhere I go so would be nice to be able to read the labels on cans at the grocery store without reading glasses.

So if you just purely look at the curves you might argue the reSTOR might be a better lens (assuming you ignore glistenings; http://www.iolsafety.com/issues-under-discussion/glistenings), but  with the Symfony about 90% of patients reporting experiencing no halos or starburst, and when they occurred, these symptoms were rarely severe.  

So if I can obtain great distance and intermediate vision and pretty good close vision with less risk of side effects that is the lens for me.

I will make one more note there definition of up close is not mine.  Maybe because my eyes are so bad, but up close to me is like 6”.

If anyone has seen articles by ophthalmologist who have implanted both of these lenses and compare the result Please let me know.
Avatar universal
Aside from the issue of haloes and glare being reportedly similar to a monofocal, the contrast sensitivity also seems to be similar. Many visual acuity tests are done with good lighting, in the real world indoor vision may often not have bright lights and the visual acuity may be reduced from what those defocus curves show. The results with the Symfony also show even slight monovision at a level unlikely to impact binocular tasks much shows some improvement in near, and of course if only one eye is done and the results allowed to settle you can decide if the other eye might be done with a different lens to compensate for any lacks in vision at any distance  with the first.


re: "look at the curves you might argue the reSTOR might be a better lens ("

Actually just from that it isn't clear in terms of the computer vision range of -1.5D to -2.0D (labelled on your one chart as being from 20 to 28 inches) since the curves for the two seem to be mirror images (with Restor going from about 20/30 up to about 20/20 moving closer in, and the Symfony going the other way). In addition the data is still coming in, that was one study.

I don't know what the intermediate point was but there are other studies that show it above or close to 20/20 for the Symfony:

https://theophthalmologist.com/issues/0914/is-better-the-enemy-of-good/
"Mean visual acuity was above 20/20 (decimal 1.0) for far and intermediate distances and 20/30 (decimal 0.67) for near distance, as seen in a recent clinical study (Figure 2)."

http://escrs.org/London2014/programme/posters-details.asp?id=21241
"However, binocular visual acuities were significantly better at intermediate (-0.031 vs. 0.171 LogMAR) and near (0.195 vs. 0.396 LogMAR)  "

http://escrs.org/London2014/programme/posters-details.asp?id=21271
"However, monocular visual acuities were significantly better at intermediate (0.09 vs. 0.32 LogMAR) and near (0.34 vs. 0.49 LogMAR)  "

Unfortunately many studies seem to be based on small numbers of patients, and it is hard to compare them since the measurement techniques  may cause some variation, as will the surgical techniques of the surgeons involved. There is a defocus curve for the Restor +3D on page 38 of this presentation:

http://www.slideshare.net/presmedaustralia/visual-acuity-and-patient-satisfaction-results-with-a

showing IQ Restor drops to to 20/40 at -1D, and since defocus curves are average some will be worse than that. That is a bit closer in than most driving needs, but it still leads to wonder if close in driving vision might also be suboptimal.  Due to the design of the Symfony it appears visual acuity would gradually decline from far to near so there shouldn't be any concerns I would guess with driving distance issues.

Many everyday home tasks, interactions with others, etc, are done at intermediate distance, and far and intermediate are important in driving.

If you read the descriptions of what it takes to see various print sizes, it is less than you'd expect. The odds seem to be the  Symfony seems to be good enough for most tasks for the occasional label reading or whatever, it seems more likely if reading glasses are needed (most don't need them) that it would be for very closer or extended use. Smartphones these days have magnifer apps for the occasional tiny print on a label that might be hard to see.
Avatar universal
re: "If anyone has seen articles by ophthalmologist who have implanted both of these lenses and compare the result"

It is unfortunately hard to find comparisons, even among lenses that have been out a couple of years, let alone  such a new lens. My concern had been whether the initial good studies would be confirmed and about the fact that the trifocals may give better near vision. I decided I'll plan on the Symfony but use a suregon who does a trifocal so I have more time to decide if new info appears.

The London Eye Hospital (one of those who first advertised and promoted the Symfony in the media in the UK) said in email that the AT Lisa trifocal and the Symfony are now  there two most popular choices, but the trifocal has more issues with glare and halos, while about 1 in 15 patients need reading glasses with the Symfony lens. (I'm hoping that being comparatively young for a cataract and not having other eye issues increase the odds of having better results).

The lens is fairly new so there is little experience with it. A surgeon  I was considering   has done 50 patients with the Symfony and has used a variety of lenses over the years (20,000 surgeries) from different companies and been involved with studies seemed to think it was the best fit for my needs.  

I'll note that in Europe they obviously have access to the Restor as well (and some promote it due to being FDA approved as an indication it is a safe choice), but the impression from reading various articles seems to indicate experienced surgeons who have tried various lenses are moving   towards the trifocals (though the Lentis lenses are somewhat popular also , I've read concerns including on this site). That was before the Symfony which hasn't had time for much reaction to be printed. The  article below from March is on "European Ophthalmologists See Promise in Trifocal IOLs" giving the  opinions from some European Ophthalmologists who are moving to the trifocals from bifocals, though the article was mostly comparing the 2 trifocals. Dr. Cochener seems to have been involved with studies on a variety of lenses but is moving towards trifocals:

http://www.gatinel.com/wp-content/uploads/2014/03/Outlook-2014_-European-Ophthalmologists-See-Promise-in-Trifocal-IOLs-1.pdf
' She has implanted more than 300 FineVision lenses and approximately 100 AT LISA trifocals. A trifocal lens now is her preferred choice for about two-thirds of cataract patients who ask for a multifocal IOL, she said. But neither lens is a perfect solution to presbyopia, she pointed out. ...

Iva Dekaris, MD, PhD, professor of ophthalmology at the University of Rijeka’s medical school in Zagreb, Croatia, said she, too, is shifting most of her multifocal patients to trifocals. ...
“It’s not that we’ve stopped doing Tecnis and Restor, but especially in younger patients, we prefer to use the trifocal lens. In my personal experience, there are only rare cases in which I would use something else,” she said.  [...]

As a co-designer of the FineVision IOL, Damien Gatinel, MD, assistant professor and head of anterior segment and refractive surgery at the Rothschild Ophthalmology Foundation in Paris, says the FineVision is the only multifocal lens he uses, with the exception of cases requiring toric correction. He retains a proprietary interest in the FineVision IOL, for which a toric version is awaiting marketing approval in Europe. ...
Intermediate acuity also is important for nonelectronic tasks like reading music, cooking and maintaining one’s balance outdoors, Dr. Dekaris said.
“An older patient who is coming for cataract surgery, this patient needs good intermediate vision for walking down the street,” she said.  '


I include the clip of Dr. Gatinel  because although it says he doesn't use other multifocals and pushes the trifocal he co-designed, his clinic is  apparently "about to start with the Symfony lens", though that means they have  no comparison comments on it other than what they know from other studies regarding the fact it may have lower quality near than a trifocal, but fewer halos, etc.

The Dr. Dekarvis mentioned in the article is at the Svjetlost clinic which was involved in the clinical trials of the Symfony and now offers it. They  apparently thought enough of the Symfony that a web search shows them as having demonstrated the implantation of the lens via video link to a conference in October (though it was other doctors there rather than Dr. Dekarvis).
Avatar universal
Sorry for the typo, that should have been Dr. Dekaris. I just thought I'd add that the Svjetlost clinic says Dr. Dekaris has done over 20,000 surgeries, though I don't know how many of those were with a premium lens to know how many bifocal vs. trifocal implants she is talking about. I know the other doctors in the article have published articles studying other lenses.

I don't know how many surgeries Dr. Cochener has done with bifocals, but she seems to pop up often in the literature on studies and on panels where they presumably choose surgeons who are respected in the field to ask questions of.  I'd be curious to hear more about what such surgeons think of the Symfony, but I don't see any sort of panel/round-table reporting on the net yet.


The lead investigator of the Symfony also seems to be very high profile and have been involved with studying many  lenses, Dr, Auffarth. here is a short video with his comments on earlier results.

http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7Ba932abdb-b127-4273-96a8-bd7b83b4f9c9%7D/early-results-show-new-iol-gives-good-visual-acuity-at-all-distances
Avatar universal
It seems like you have done your research.  I for one would be appreciative if you let us know which lens you decide on, where you go and tell us your experience.  

Robert
Avatar universal
Since you were considering the Restor, I ran into some more information on it including images from an optical bench comparing how the Restor +2.5 and Restor +3 lenses compare to the trifocals. Of course the human  visual system is more complicated than the optical bench,   with two eyes being combined in ways that can't be simulated that easily since it happens within our neural processing and isn't merely a matter of physics.


This summary links to the actual paper (free):

http://www.oteurope.com/ophthalmologytimeseurope/Latest+News/Trifocal-IOLs-useful-for-intermediate-vision/ArticleStandard/Article/detail/859971?contextCategoryId=40282
"Two trifocal IOLs (AT LISA tri, Carl Zeiss Meditec; FineVision, PhysIOL) enabled patients in whom they were used to have "a useful third focus for intermediate vision," but they also resulted in increased background halos and reduced distance visual quality for users compared with the vision experienced by recipients of two powers (+2.5 D and +3.0 D) of a multifocal IOL (ReSTOR, Alcon),  "

The summary notes that 3 of the for authors work for the  company that makes the Restor, which I don't tend to think is a concern, but in theory its possible they might be motivated (even unconsciously) to choose to include&highlight data which paints them in a better light.  A review article mentions  another paper I hadn't looked at which compares those two Restor lenses (+2.5D and +3D):

http://www.jcor.in/article.asp?issn=2320-3897;year=2014;volume=2;issue=3;spage=166;epage=170;aulast=Sinha
"Gundersen and Potvin (Clin Ophthalmol 2013;7:1979-85) studied comparative visual performance of ReSTOR +2.5 D apodized diffractive multifocal IOL, monofocal AcrySof IQ lens and the ReSTOR +3.0 D IOL.  ...
The data indicate that the ReSTOR +2.5 D IOL provided good intermediate and functional near vision for patients who did not want to accept a higher potential for visual disturbances associated with the ReSTOR +3.0 D IOL"

Since I'm concerned about computer distance more than occasionally needing reading glasses for near, If I were choosing between the Restor lenses I might be inclined to consider the +2.5D for better intermediate than the +3, though it has lower quality near, no solution is perfect yet.  In my case I'm still leaning towards the Symfony with a trifocal as the runner up. Although I gather adaptation happens faster if you implant both eyes, I   prefer the idea of getting a lens in one eye and taking time to adapt to it to see what makes the most sense for my other eye.
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