If you are avoiding LRI and going with a standard monofocal IOL, then ORA is an advantage.
And I may be confused here, but is this going to be a Toric lens, which is, again, an extra out-of-pocket cost?
If the IOL is a Toric, then the ORA is definitely an advantage.
Dr. Hagan,
I got a second opinion regarding the cataract surgery for my RE and have decided to go with him since he seems to have a lot of experience with cataract patients who have had previous refractive surgery.
His recommendation was conservative, to go with a monofocal lens and steer away from premium IOLs due to the shape and thinness of my right cornea, and to also steer clear from limbal relaxing incisions for my asigmatism.
He will use ORA, which he's experienced in using.
The last decision I need to make is whether or not to pay $1200 extra out of pocket for him to use LenSX laser to do the surgery. He wasn't really trying to up-sell me on it, but he said he felt the outcome might be a little more accurate and lessen the risk of infection slightly.
I've tried to read up on this and the only downside seems to be the added cost. The $1200 would be a sacrifice but I'm willing to pay it if it's worth it. Some things I read make me hesitate, that there is no real evidence that visual outcome would be better, especially given that I am going with a standard IOL. I am leaning toward using laser to give myself every advantage of best visual outcome since I'll be living with this a long time, but the cost makes me hesitate.
Any thoughts on whether using LenSX laser would be worth it?
Thank you all for your suggestions regarding finding a qualified surgeon for a 2nd opinion. Interesting..... I went to the Trulign surgeon locator at http://trulign.com/en-us/surgeonlocator.aspx and low and behold, there is only one surgeon listed in a 100 mile radius of my zip code.... and that is the surgeon I went to last week! That was a good sign... I will take your suggestions and get a second opinion for my peace of mind.
I managed to dump my wife this summer "launching" her so now she insists I not touch her kayak launching or docking. We decoded to go with SOTs after seeing several deep well kayaks wrapped around trees and underwater in Colorado and Wyoming.
SOTs are my favorite.
Easy on, easy off. You can launch them anywhere you can walk to the water. Grounded on a sandbar? No problem.
Sit sideways dangling your legs in the water? Go for it!
Comfort and ease of use makes the SOT my kayak of choice.
Got a kayak thing going here. My wife kayaks and since she has two I sometimes go with her. We now us the sit on top and not the "real" kayaks.
Yes do get several opinions. Go with the one you feel most comfortable with and who has the best reputation. Often this is NOT the one your optometrist sends you to whom the optom often has an undisclosed to you "co-management" kick-back/fee splitting arrangement.
JCH MD
My brother in law had recently had cataract surgery and was glasses free, which leaned me towards the Crystalens/Trulign IOLs for my cataracts. My optometrist recommended the 1st surgeon I consulted.
For 2nd and even 3rd opinions, I looked at the "Surgeon Locator" link at the Crystalens website.
http://crystalens.com/en-us/surgeonlocator.aspx
Check the websites and see which surgeons offer different lenses, to avoid a one lens fits all type of practice. When you get that 2nd opinion, ask LOTS of questions.
Try contacting a local university opthamology program. They may be able to offer some names.
SoftwareDeveloper and Dr. Hagan, thank you so much for your responses. You have addressed all the various concerns I have and you have pointed me to some very good information, including studies on Trulign lenses as well as other posts on this forum. I am feeling more confident as I go forward in making an informed decision.
The only piece that is still missing is knowing the best way to find a surgeon in the Dallas area with lots of experience with cataract surgery on eyes that have had refractive surgery in the past, preferably with ORA experience as well. I have consulted with one such doctor who will probably do a great job but would feel better about seeking a second opinion from another qualified doctor - for my peace of mind if nothing else.
If you have any advice please let me know. I called Alcon today to ask them what doctors they might recommend who use the ORA system, but they referred me to reclaimyourvision.com which didn't really help because there was no way to filter all the results with doctors using ORA - in fact that wasn't even one of the search criteria.
So other than googling "ORA", "Cataracts", and "Dallas", do you have any advice as I seek a second opinion? Thanks so much for all your time!!!!
Thank you for your information on RD. I was getting the responses mixed up and I didn't acknowledge your input in addition to Dr. Hagan's. . I appreciate it very much! It is very reassuring to hear from others who have had experience with what I"m going through. Please, if you have any advice for me with regards to the questions I just posted regarding how to find data on effectiveness of Trulign lenses, whether to only go with a surgeon who uses ORA, please let me know. In the meantime I'll surf the other threads to see what else I can find.
Many people successfully get an IOL in only one eye and wear a contact lens in the other with no trouble, however not all do. I'd suggest the thing to do is to hope for the best, that you can adapt well to having an IOL in only one eye (which is likely), but prepare for the worst in advance, i.e. the possibility you might need to get the other eye operated on even though its still clear (i.e. seeing if the doctor is comfortable with that and checking on whether insurance will cover it).
One potential problem area is when there is a large difference in refraction between the two eyes after one has an IOL implanted for good distance vision (plano, no distance correction required), and the other eye needs a strong prescription.
I checked to see if you'd posted more info about your situation, and see that your profile indicates that your eyes have fairly different prescriptions now and that you "had to wear" contacts after the PRK that left them that way. That suggests you might be familiar with the reason for concerns, that if you wear glasses when the eyes have fairly different prescriptions the image size in each eye may be different and your brain may not be able to merge them easily. The issue is anisometropia (the prescriptions being different in each eye) leading to aneisokonia (perceiving different image sizes). Usually in such cases when you wear contact lenses the difference in image size is less than in glasses, small enough not to be a problem. Everyone's tolerance to prescription differences between their eye's is different, but since you are coping with a fairly large difference now, hopefully that means you can cope with a bit larger one if your IOL eye is set for good distance vision. There isn't that much difference between correcting vision at the IOL plane and at the corneal plane with a contact lens, so the image size is likely not enough to be a concern if you wear a contact lens in the other eye, but there is no guarantee since some people are more sensitive to differences.
Image size isn't the only issue. I don't know if you are as young as the first poster on this page who hadn't yet hit presbyopia, if so it might be hard to adapt to having a lot of accommodation (ability to focus to see near) in your natural eye and not in the IOL eye. Again, I think most adapt to it, though I recall young adult posting here who had a great deal of difficulty adapting to an IOL in only one eye and that seems like it may have been the reason.
Even if you have presbyopia already, an IOL is different from a natural lens in other ways, especially a multifocal, so although most people with a IOL in one eye have no trouble adapting, some people do have issues with the difference in optics between the eyes feeling odd. In my case I had a bad cataract in only one eye when I had my first surgery, the other was still 20/20 correctible with about a -6D contact lens. Once the bandage came off the first eye, I felt a weird sense of imbalance between the two eyes that is hard to describe, I'm not sure if it was the difference in prescription or the difference in optics with the IOL (especially since my other eye had a multifocal contact lens). I may well have been able to adapt to it quickly if I'd given it a chance, but because I'd traveled to Europe to get my surgery I decided to go ahead and get the 2nd eye done to avoid needing to travel back if I didn't adapt quickly. As soon as the bandage came off the 2nd eye, the feeling of imbalance was gone.
No posts since 2011 Not likely to get a reply
I'm just wondering if you ever got the cataract surgery, or if you are still waiting? I am in a similar situation in that I have one cataract with the other eye still clear. I'd love to hear how your situation turned out and if you are happy with the result.
Thank you all for the comments.
@walkietalkie - We tried glasses/contact in the bad eye. It did not clear the blurriness enough to be worth the cost and trouble of them.
@Ray T Oyakawa, MD - Do you know any experienced doctors in the North NJ area. The person I'm seeing was recommended by my Primary care doctor, while I trust his judgement I'm not tied to him in anyway. I don't have diabetes, as that was one of the first things I asked my doctor about, since I read it can cause them.
Now that I've read abit more about the technologies and such, I think I'm going to try to hold off as long as I can. Hopefully in the next year a new lens or technology will come out that makes it even better. Of course I say this now, a week from now it could be driving me nuts..
Is your blurry vision correctable by glasses? If cataract is still early perhaps you want to wait. I had lasik about 12 yrs ago and now have early cataract. I read that doing cataract surgery for post lasik patients is a bit tricky. I am waiting till science is more exact or when the surgeons can gurantee the results to 0.5% error ( similar to insurance NAV)
I had an experience similar to yours recently. First I must say that you should discuss with your doctor the best lens option. Once he discards the options you just can not choose, there is no right or wrong answer.
In my case, my choice was a monofocal lens just on the right eye and I am very happy with the choice, of course I need reading glasses, but its ok, I would need it anyway.
I learned that there are many people that can not adapt to multifocal, so I was afraid to try.
I had a small annoying problem Due to the big power difference (3.75 on LE and now "0" on RE), I can`t use glasses to correct LE, but a contact lens on LE solved this problem very well.
I have seen patients about your age for cataracts due to diabetes. I have implanted Crystalens with good results. HOWEVER, you must find an experienced Crystalens surgeon.
Both eyes will work better together since you still have accommodation in the good eye. A multifocal IOL does not stimulate accommodation.
There are a number of programs to calculate IOL power for post LASIK patients. However, the targets results are not as good as a virgin cornea. This can touched up with a PRK on your flat if needed.
Dr. O.
Dr. O.