Can somebody help with lense selection?

[pvbarri]

I am 66, have cataracts in both eyes and, therefore, need to have the 2 x lenses replaced.

My vision is important to me (as, of course, it is to all) so I am a little neurotic about getting it right.

I have stated, to Optegra, that the most important thing for me is clear distance vision, preferably without halos etc. and I really would like to be able to drive, at night, without glasses. This has led me to cross-off the multi-focal option they put to me.

I have been doing some on-line research but, to be honest, I am finding many of the 'technical terms' very difficult to understand.

Essentially, my choices are either to have TECNIS monofocal 1-piece IOL (ZCB00) on the NHS or TECNIS Eyhance ICB00 (ICB-IOL) done privately.

I understand the Eyhance would (might?) give improved intermediate vision over the ZCB00 - so helping me at the computer, reading and DIY/hobby type pastimes - but have no idea as to how much. E.g. would I need glasses to see, up to around 1 metre with the former but only to 50 cm for the latter?

I just wondered if anybody could compare/summarise the two lenses (given the distance/no halo/hobbies criteria above), in a fairly non-technical way, with the bottom-line being a, non-attributable, (but informed) opinion as to whether the Eyhance might be worth the £5,000 expense of going private? Or are they pretty much the same?

Apart from the cataracts, my eyes and general health are good and I have not had any eye surgery etc. before.

Many thanks in advance.

[John C Hagan III, MD, FACS, FAAO]

You are wise to do your homework before surgery as my office and this forum are filled with people who did not do theirs and after spending much time and money were very very disappointed. You will need to read these two articles:

By me and still very valid:  https://www.medhelp.org/user_journals/index/177275?personal_page_id=67912  ;

And a recent "optimistic-industry paid for symposium" (consider an advertisement rather than objective data. Companies sponsor these seminars and many of the speakers, perhaps most of them get money from the companies and never really say anything bad about the IOL)  LINK  https://theophthalmologist.com/fileadmin/top/subspecialties/2019_April/0419-900_J_J_Supplement___1_.pdf

There is a  saying that appears in the second article  "Premium lens surgeons should under promise and over deliver"  My experience it is the opposite they over-promise and under delivery.   Most people that fork a lot of money out of pocket do so on the idea that they will not have to wear glasses at all or only a little bit and that their night vision without glasses will be good.    That is not the case all or perhaps even most of the time.   Ophthalmic surgeons in the US and other countries are under intense  economic  pressure because payments from insurance companies and federal/government systems are going down.  Thus many offices (not the one I work for) start pressure from the time you call to 'upgrade" to premium lens, ORA technology,  femtosecond laser, etc.   Recently I saw a patient paid $16,000 US out of pocket with the 'guarentee' that he would not need glasses for anything. He needed for most things and even with glasses his night vision was terrible. I can't give the name of the surgeon or practice but it would be nationally/internationally known.

When My wife opted for surgery she chose a monofocal IOL and expected to wear glasses most of the time.  She does well at distance without glasses but needs them for computer and read.  When a friend of mine with astigmatism wanted good distance vision but had  2.5 diopter of astigmatism I suggested he get a toric IOL from one of our experienced surgeons.  I am very reluctant to ever suggest to my patients they spend a ton of money out of pocket and think they will be glasses free.

Read the two articles and if you have further questions post. No one can or will tell you what IOL to get.  There are more complications and more dissatisfied patients with premium IOLs and 'big pay' out of pocket than standard IOLs.