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Cataract surgery - how to decide on an IOL?
At the ripe old (!) age of 65, I need cataract surgery. I need guidance on how to choose a lens. I did have Lasik surgery nearly 20 years ago, and, as a result, my opthamologist has recommended again multi-focal lenses. I also have rather severe astigmatism in my left eye. He has recommended that I either: (1) get a toric lense for my left eye, and a standard lens for my right eye (with some kind of surgical loosening, the name of which I can't recall, to help with right eye astigmatism); or (2) get crystalenses in both eyes. He states that either way, I'll require glasses; with option 1, I'll likely need glasses for close and intermediate; with option 2, I'll likely need glasses only for close work.
I'm a good internet searcher, and am frighted by negative comments on crystalens. But I haven't figured out which option would be best for reducing glare in night vision. I don't object to glasses. I do - strongly - object to glare and halos. Suggestions?
I'm a good internet searcher, and am frighted by negative comments on crystalens. But I haven't figured out which option would be best for reducing glare in night vision. I don't object to glasses. I do - strongly - object to glare and halos. Suggestions?
I feel compelled to add to the discussion about Crystalens.
About a month ago I had to get my "Surgery Clearance Form" for cataract eye surgery validated by my general practitioner MD at a local clinic. It turns out that my physician himself had bilateral cataract surgery within the last few years using the Crystalens IOL.
Unfortunately after several days post-op, the "haptic" in the IOL disintegrated and left him essentially blind in one eye. His local ophthalmologist, who had performed the original surgery, then sent my physician to an well-known "expert" (located about 85 miles away) who was able to replace the Crystalens with a monofocal IOL after a very arduous surgery. In other words, my physician now has one Crystalens IOL and one monofocal IOL.
I have always wondered about the intrinsic mechanical integrity of Crystalens owing to the accommodating function. Of course, some error by the original ophthalmologist during surgery cannot be discounted either. Still, it was a scary story told to me first-hand by my own MD...
About a month ago I had to get my "Surgery Clearance Form" for cataract eye surgery validated by my general practitioner MD at a local clinic. It turns out that my physician himself had bilateral cataract surgery within the last few years using the Crystalens IOL.
Unfortunately after several days post-op, the "haptic" in the IOL disintegrated and left him essentially blind in one eye. His local ophthalmologist, who had performed the original surgery, then sent my physician to an well-known "expert" (located about 85 miles away) who was able to replace the Crystalens with a monofocal IOL after a very arduous surgery. In other words, my physician now has one Crystalens IOL and one monofocal IOL.
I have always wondered about the intrinsic mechanical integrity of Crystalens owing to the accommodating function. Of course, some error by the original ophthalmologist during surgery cannot be discounted either. Still, it was a scary story told to me first-hand by my own MD...
3 Comments
That story is grossly over-simplified. The material that IOLs are made out of does not "disintegrate" IOLs are one of the most successfully implanted foreign material into the human body and billions of them are well tolerated. When IOLs are removed they are usually sent to specialized pathology laboratories like at U of SC and U of Utah. None of these studies that are published in medical journals show "disintegration". So what happened. No way to tell for sure but this is the usual story. The Crystalens requires extra care and precision because it has to be inserted "just so" within the capsular bag. The chances are 99+% that at the time of surgery the Crystalens was not inserted correctly into the capsular bag or the capsule was torn or the capsular bag zonules torn. In any case no one should have an idea that IOLs disintegrate in the eye. The material they are made out of don't do that. I'm glad the story had a happy ending.
I'm wondering if this might be a case of someone along the way perhaps mishearing "dislocated" as "disintegrated", perhaps an unclear cell phone connection. Its odd that this unlikely claim comes just after another post yesterday further above on this page where someone says they needed 4 YAG procedures for 1 eye for a Trulign, and the data I linked to suggested that would seem rather unlikely (unless there is some issue I missed), it seems incredibly rare based on the data I saw if it were for PCO, unless the YAG were say used for floaters rather than PCO.
Of course I agree with your points, though one minor nitpick irrelevant to the argument is that its likely "hundreds of millions" of IOLs of some type rather than billions. Not that it changes anything at all about your point, I was just curious when I saw that if it really was in the billions and I'm guessing it isn't quite yet.
Without checking for even earlier cataract surgery rates, I see rates quoted of perhaps 6 million worldwide surgeries in 1995 and 7-12 million by 2000, and over 20 million by 2015, which suggests likely less than a billion total over time. And if the issue is IOLs made of silicone, it wasn't used until:
https://theophthalmologist.com/issues/sinister-eclipse/a-brief-history-of-iol-materials/
1978 and only some lenses are silicone. Its also some huge, but still much smaller figure for lenses using the exact silicone elastomer used in the Crystalens of course.
Of course I agree with your points, though one minor nitpick irrelevant to the argument is that its likely "hundreds of millions" of IOLs of some type rather than billions. Not that it changes anything at all about your point, I was just curious when I saw that if it really was in the billions and I'm guessing it isn't quite yet.
Without checking for even earlier cataract surgery rates, I see rates quoted of perhaps 6 million worldwide surgeries in 1995 and 7-12 million by 2000, and over 20 million by 2015, which suggests likely less than a billion total over time. And if the issue is IOLs made of silicone, it wasn't used until:
https://theophthalmologist.com/issues/sinister-eclipse/a-brief-history-of-iol-materials/
1978 and only some lenses are silicone. Its also some huge, but still much smaller figure for lenses using the exact silicone elastomer used in the Crystalens of course.
The yag figure is certainly "off" if its being done for a posterior capsular opacity. I have only had to do one Yag a second time and that was one with a history of retinal detachment and we made as small as possible telling the patient if she saw the edges I would enlarge. I've also done 2-3 cases done elsewhere. So 4 is not likely at all.
This, too, is pretty amazing. http://www.nature.com/news/sci-fi-eye-experiments-improve-vision-in-children-and-rabbits-1.19535. It's a really tough decision to think about delay because of advancements coming down the pike (I get the cell phone & computer analogy).
1 Comments
oops, I meant to say the Symfony is available in Mexico&Canada now (It wasn't when I got my surgery, I had to go to Europe since I couldn't wait any longer to get the surgery).
1 Comments
I should note that many people do have good results with the Crystalens, someone I know wrote up their overall positive experience getting the Crystalens in detail here:
http://www.komar.org/faq/colorado-cataract-surgery-crystalens/
re: "I also had a friend who had monofocal torics done for his cataracts, and he only needs glasses for very small print. "
You don't mention whether he has monovision, and to what degree. How much near vision people get when they have monofocals set for distance varies greatly depending on each person's natural depth of focus with that eye. A tiny minority of lucky people with monofocals set for distance can do some reading with them, but that isn't typical and shouldn't be planned for. I'd heard a common vague description is that from 6 feet or a couple of meters in that things get blurry in more typical cases. Its best to expect your results to be average and explore options like monovision or premium lenses if you want more near vision, and them hope that you are lucky enough to get even more near vision than you expected.
I went outside the US for the new Symfony lens which isn't approved here, which has reportedly risks of visual artifacts similar to a good monofocal, but its up for FDA approval now and there is a chance it might be available within a year, so some folks might consider waiting for it if their cataract isn't interfering too much with their vision yet (though of course after that there may be some other new lens just on the horizon, as with computer&cell phones waiting always gets you something better, but you are stuck with something less in the meantime). Since you are comfortable with glasses I suspect you aren't the sort to bother traveling to get it, its available now in Mexico&Europe. As with any lens, there is a risk of halos, though those that do see them often don't consider them a problem since they are light and translucent, people can see through/past them.
http://www.komar.org/faq/colorado-cataract-surgery-crystalens/
re: "I also had a friend who had monofocal torics done for his cataracts, and he only needs glasses for very small print. "
You don't mention whether he has monovision, and to what degree. How much near vision people get when they have monofocals set for distance varies greatly depending on each person's natural depth of focus with that eye. A tiny minority of lucky people with monofocals set for distance can do some reading with them, but that isn't typical and shouldn't be planned for. I'd heard a common vague description is that from 6 feet or a couple of meters in that things get blurry in more typical cases. Its best to expect your results to be average and explore options like monovision or premium lenses if you want more near vision, and them hope that you are lucky enough to get even more near vision than you expected.
I went outside the US for the new Symfony lens which isn't approved here, which has reportedly risks of visual artifacts similar to a good monofocal, but its up for FDA approval now and there is a chance it might be available within a year, so some folks might consider waiting for it if their cataract isn't interfering too much with their vision yet (though of course after that there may be some other new lens just on the horizon, as with computer&cell phones waiting always gets you something better, but you are stuck with something less in the meantime). Since you are comfortable with glasses I suspect you aren't the sort to bother traveling to get it, its available now in Mexico&Europe. As with any lens, there is a risk of halos, though those that do see them often don't consider them a problem since they are light and translucent, people can see through/past them.
1 Comments
Wow - all of this information is so valuable! My take-aways: I need to figure out the prescription and other information about my own eyes. I truly appreciate all of the information. I'll let you know more information as I obtain it, and decisions as I make them. I'm a 1.5 hour drive from any ophthalmologist, so it's a bit of an effort, but given the life-long ramifications, it's worth it. Again, my thanks.
I had the Trulign lenses done 1 1/2 years ago for my cataracts and I am totally happy with my vision. Especially the no glasses part!
My brother-in-law had had the Crystalens, and his praises for his own glasses free outcome was a big motivator for me.
My astigmatism and farsightedness were in the moderate range, so I can only speak to that.
I also had a friend who had monofocal torics done for his cataracts, and he only needs glasses for very small print.
Medicare and most private insurance plans will cover 2nd, 3rd (whatever you need) appointments before this kind of surgery, so take advantage and visit the best ophthalmologists in your area, until you are totally comfortable in your own decision.
Accommodating lenses (Trulign) work for me with no halos or any other visual problems. Good luck with your journey.
My brother-in-law had had the Crystalens, and his praises for his own glasses free outcome was a big motivator for me.
My astigmatism and farsightedness were in the moderate range, so I can only speak to that.
I also had a friend who had monofocal torics done for his cataracts, and he only needs glasses for very small print.
Medicare and most private insurance plans will cover 2nd, 3rd (whatever you need) appointments before this kind of surgery, so take advantage and visit the best ophthalmologists in your area, until you are totally comfortable in your own decision.
Accommodating lenses (Trulign) work for me with no halos or any other visual problems. Good luck with your journey.
Oops, of course I meant the benefit of the Crystalens is better intermediate and near vision (I see I typed "better intermediate and distance"). I wish they'd let you edit to fix typos.
Do you have a good relationship with your ophthalmologist or eye surgeon?
Having never had any eye serious problems before, I was very apprehensive about cataract surgery. Using the internet, I read and read and read about my options (mostly scholarly sources, including the estimable Dr. Hagan), and I had three--three!--separate appointments with my very patient surgeon to voice my concerns. I figured it was worth my while to devote as much effort to this project as I would to buying a new TV.
The upshot was a pretty complete understanding of what I wanted vs what I could expect, and the outcome was excellent.
Having never had any eye serious problems before, I was very apprehensive about cataract surgery. Using the internet, I read and read and read about my options (mostly scholarly sources, including the estimable Dr. Hagan), and I had three--three!--separate appointments with my very patient surgeon to voice my concerns. I figured it was worth my while to devote as much effort to this project as I would to buying a new TV.
The upshot was a pretty complete understanding of what I wanted vs what I could expect, and the outcome was excellent.
Unlike some young patients you are old enough to be used to having lost lots of near vision from presbyopia and if you are comfortable dealing with wearing glasses now for that, then it seems you probably don't need to worry about a premium lens. You might consider some level of monovision. I'll note further below however that monofocals aren't all created equal.
I did want to emphasize first, mostly for the benefit of others that the net can give a flawed perception of the risks. If you read many posts online you'll also see negative comments from patients even after they have had monofocal lenses, unfortunately there is no perfect lens yet even though the vast majority of patients are happy with the results regardless of lens choice.
Unfortunately most people don't post if they have a positive result with a lens, so its only the minority with a problem that usually post, which leads to a skewed perspective of the level of risk involved compared to what a clinical study would say. Studies are the best guide to the risks and benefits of a particular lens. That said, the negative patient comments are a reminder that *someone* winds up being the "statistic" and people need to be prepared for the risk. Life is full of risks unfortunately, for some its worth it.
Obviously the benefit of the Crystalens compared to a monofocal is better intermediate and distance vision. Unfortunately I haven't seen direct comparisons of the Crystalens to good monofocals to know how the quality of distance vision compares, for those most concerned about having the best quality possible, and I don't see good figures for the newest models on glare&halos.
It may not have features that some good monofocals have that improve their visual acuity by dealing better with like spherical aberration and chromatic aberration as discussed in this trade journal which lists values for some common lenses, where you'll also note indications that the Tecnis monofocals are better than the Alcon Acrysof lenses, though I hadn't seen a direct head to head comparison:
http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
One new study about to be reported at a conference that doesn't report details yet has a worrisome comment regarding the Acrysof monofocal:
https://ascrs.confex.com/ascrs/16am/meetingapp.cgi/Paper/23813
"Preliminary data found no complaints of glare and halo symptoms in the enVista eye but >80% rate of such symptoms in the AcrySof eyes."
I hadn't hunted for the FDA filings for the monofocal lenses, but I'd looked at the filings for recently approved multifocals from Alcon and Tecnis and they include monofocal lenses for comparison. Unfortunately it may be that their survey methods are different and that the questions regarding halo&glare aren't directly comparable, but they suggest a risk of halo&glare issues with Alcon monofocals that may even be larger than the multifocals from Tecnis.
This FDA information on the Alcon +2.5 multifocal includes data on an Alcon monofocal for comparison, and indicates that 6 months after surgery 53% of monofocal patients reported glare and 39% reported halos:
http://www.accessdata.fda.gov/cdrh_docs/pdf4/P040020S050c.pdf
This FDA information on the Tecnis +2.75 and +3.24 multifocals includes data on a Tecnis monofocal for comparison. It reports only 4.1% of those with monofocals report halos and 1.4% report night glare issues:
http://www.accessdata.fda.gov/cdrh_docs/pdf/P980040S049d.pdf
Unfortunately I don't seem to see the data for the most recent Crystalens AO model, this FDA document on the Trulign has a vague "visual disturbance" question regarding that lens, but nothing calling out glare&halos. It has archived results for an older model Crystalens which may not be comparable to the new models, the AT-45
http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/medicaldevices/medicaldevicesadvisorycommittee/ophthalmicdevicespanel/ucm346390.pdf
in Table 22 it reported that 43.1% have night time glare/flare and 38.5% have halos. Again, the design has changed. I'm not sure why I don't seem to see the approval for the Crystalens AO, it may be someplace different than other approvals because it is merely considered a variant of the initial AT-45, I'd be curious if anyone else can find glare data on the AO or Trulign. I'm not curious enough to hunt further for it since I've already had my surgery, even though I'm somewhat curious since I get asked about IOL issues since I researched them before my own surgery.
I did want to emphasize first, mostly for the benefit of others that the net can give a flawed perception of the risks. If you read many posts online you'll also see negative comments from patients even after they have had monofocal lenses, unfortunately there is no perfect lens yet even though the vast majority of patients are happy with the results regardless of lens choice.
Unfortunately most people don't post if they have a positive result with a lens, so its only the minority with a problem that usually post, which leads to a skewed perspective of the level of risk involved compared to what a clinical study would say. Studies are the best guide to the risks and benefits of a particular lens. That said, the negative patient comments are a reminder that *someone* winds up being the "statistic" and people need to be prepared for the risk. Life is full of risks unfortunately, for some its worth it.
Obviously the benefit of the Crystalens compared to a monofocal is better intermediate and distance vision. Unfortunately I haven't seen direct comparisons of the Crystalens to good monofocals to know how the quality of distance vision compares, for those most concerned about having the best quality possible, and I don't see good figures for the newest models on glare&halos.
It may not have features that some good monofocals have that improve their visual acuity by dealing better with like spherical aberration and chromatic aberration as discussed in this trade journal which lists values for some common lenses, where you'll also note indications that the Tecnis monofocals are better than the Alcon Acrysof lenses, though I hadn't seen a direct head to head comparison:
http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
One new study about to be reported at a conference that doesn't report details yet has a worrisome comment regarding the Acrysof monofocal:
https://ascrs.confex.com/ascrs/16am/meetingapp.cgi/Paper/23813
"Preliminary data found no complaints of glare and halo symptoms in the enVista eye but >80% rate of such symptoms in the AcrySof eyes."
I hadn't hunted for the FDA filings for the monofocal lenses, but I'd looked at the filings for recently approved multifocals from Alcon and Tecnis and they include monofocal lenses for comparison. Unfortunately it may be that their survey methods are different and that the questions regarding halo&glare aren't directly comparable, but they suggest a risk of halo&glare issues with Alcon monofocals that may even be larger than the multifocals from Tecnis.
This FDA information on the Alcon +2.5 multifocal includes data on an Alcon monofocal for comparison, and indicates that 6 months after surgery 53% of monofocal patients reported glare and 39% reported halos:
http://www.accessdata.fda.gov/cdrh_docs/pdf4/P040020S050c.pdf
This FDA information on the Tecnis +2.75 and +3.24 multifocals includes data on a Tecnis monofocal for comparison. It reports only 4.1% of those with monofocals report halos and 1.4% report night glare issues:
http://www.accessdata.fda.gov/cdrh_docs/pdf/P980040S049d.pdf
Unfortunately I don't seem to see the data for the most recent Crystalens AO model, this FDA document on the Trulign has a vague "visual disturbance" question regarding that lens, but nothing calling out glare&halos. It has archived results for an older model Crystalens which may not be comparable to the new models, the AT-45
http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/medicaldevices/medicaldevicesadvisorycommittee/ophthalmicdevicespanel/ucm346390.pdf
in Table 22 it reported that 43.1% have night time glare/flare and 38.5% have halos. Again, the design has changed. I'm not sure why I don't seem to see the approval for the Crystalens AO, it may be someplace different than other approvals because it is merely considered a variant of the initial AT-45, I'd be curious if anyone else can find glare data on the AO or Trulign. I'm not curious enough to hunt further for it since I've already had my surgery, even though I'm somewhat curious since I get asked about IOL issues since I researched them before my own surgery.
Begin by reading this very very carefully:
http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You
As good as it is the crystalens even when implanted by a skilled surgery and a perfect operation does not give as good of night vision and is more prone to glare and halos (dysphotopsia) than high quality spherical monofocal IOLs. If you have less than 1 diopter of astigmatism you likely don't need corneal surgery or toric IOL. If greater than 1 diopter toric IOLs are more predictable than corneal incisions in reducing astigmatism. Toric IOLs give good night vision. Since you don't object to glasses and you don't want glare and halos you are not ideal for multifocal and accommodating IOLs. Get a second or third opinion as some offices and surgeons exert very strong pressure to upgrade everything about cataract surgery. multifocal IOLs, femtosecond lasers and ORA technology. Other offices do not pressure their patients to "upgrade"
http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You
As good as it is the crystalens even when implanted by a skilled surgery and a perfect operation does not give as good of night vision and is more prone to glare and halos (dysphotopsia) than high quality spherical monofocal IOLs. If you have less than 1 diopter of astigmatism you likely don't need corneal surgery or toric IOL. If greater than 1 diopter toric IOLs are more predictable than corneal incisions in reducing astigmatism. Toric IOLs give good night vision. Since you don't object to glasses and you don't want glare and halos you are not ideal for multifocal and accommodating IOLs. Get a second or third opinion as some offices and surgeons exert very strong pressure to upgrade everything about cataract surgery. multifocal IOLs, femtosecond lasers and ORA technology. Other offices do not pressure their patients to "upgrade"
4 Comments
I'm VERY sorry I went for the "upgrade" to Trulign Toric lens in one eye. My vision is now far worse than with my cataract. I have had 4 YAG capsulotomies, a PRK procedure that left corneal scarring, a retinal tear and hemmorrage (supposedly unrelated). I had Lasik 12 years prior to my cataract surgery and used one of the "best" eye surgeons around. 3 years later, I am wearing glasses for both distance and near with lots of glare and haze (corneal scarring). Lots of procedures to try to correct a refractive error. When I need cataract surgery in my other eye, I most certainly will be conservative and go with a monofocal IOL. I have spent over 8K on procedures and am not a happy patient. I wish my surgeon had not recommended the Trulign- I trusted him and took a risk with my eye. I am 60 yrs old and very upset that I will have compromised vision for the rest of my life-- no night driving, etc.
Thanks for sharing your experience, it helps balance the too optimistic too pessimistic posts that are here. Please get a couple of other opinions. In all large communities there are ophthalmologists that specialize in post cataract surgery complications, IOL exchange, cornea refractive surgery, etc. Find one that you can get reasonably easy and see someone else to see what can be done.
I will note that it seems the complaints listed could have happened with any IOL. The risk of PCO does vary between lenses, but most people don't get it anymore with modern IOLs, though some get it with any lens. Usually 1 YAG resolves the problem. Having more than 1 YAG for an eye is unusual, let alone 4, which seems rather strange, it isn't clear why that would happen.
I see one informal guess at the frequency of multiple YAGS being needed:
https://www.aao.org/eye-health/ask-ophthalmologist-q/does-yag-laser-cure-posterior-capsulotomy-good
"These events are not common, and in my practice at least 99% of the time one posterior capsulotomy is all that is ever required. "
That is just a rough guess. I would think the need for repeats would have gone down as technology/techniques improved, and I see one actual study from 2005 mentioning a repeat rate of YAG's of 0.31%
http://onlinelibrary.wiley.com/store/10.1111/j.1600-0420.2005.00405.x/asset/j.1600-0420.2005.00405.x.pdf?v=1&t=j034a702&s=1e15b438d5ab3b4884bd3978ab2677bcd4af9ac5&systemMessage=Pay+per+view+article+purchase%28PPV%29+on+Wiley+Online+Library+will+be+unavailable+on+Saturday+11th+March+from+05%3A00-14%3A00+GMT+%2F+12%3A00-09%3A00+EST+%2F+13%3A00-22%3A00+SGT+for+essential+maintenance.++Apologies+for+the+inconvenience.
If the same repeat rate applies each time, that would indicate 1 out of 34 million would need a 4th YAG (but then with 20 million cataract surgeries a year globally, it seems the odds are that eventually such a person would consider posting about all their bad luck). I don't know if there is something about the Crystalens increasing the odd of needing a repeat YAG, or its about this patient rather than the IOL, or if there is some other explanation.
I'm wondering if they were using the YAG for treating floaters or something else unrelated to the IOL.
Correcting the refractive error is something that can be needed with any lens, including a monofocal if you wish to not need correction for some distance. Its true that people need to be aware there is a risk of problems, but they also need to keep the risks in perspective, there can be problems even with a monofocal.
Unfortunately it is true that anyone can wind up being the "statistic" even if a problem is rare so they do need to be prepared. In my case I went for a premium lens being willing to take the tiny risk I'd need a lens exchange.
I see one informal guess at the frequency of multiple YAGS being needed:
https://www.aao.org/eye-health/ask-ophthalmologist-q/does-yag-laser-cure-posterior-capsulotomy-good
"These events are not common, and in my practice at least 99% of the time one posterior capsulotomy is all that is ever required. "
That is just a rough guess. I would think the need for repeats would have gone down as technology/techniques improved, and I see one actual study from 2005 mentioning a repeat rate of YAG's of 0.31%
http://onlinelibrary.wiley.com/store/10.1111/j.1600-0420.2005.00405.x/asset/j.1600-0420.2005.00405.x.pdf?v=1&t=j034a702&s=1e15b438d5ab3b4884bd3978ab2677bcd4af9ac5&systemMessage=Pay+per+view+article+purchase%28PPV%29+on+Wiley+Online+Library+will+be+unavailable+on+Saturday+11th+March+from+05%3A00-14%3A00+GMT+%2F+12%3A00-09%3A00+EST+%2F+13%3A00-22%3A00+SGT+for+essential+maintenance.++Apologies+for+the+inconvenience.
If the same repeat rate applies each time, that would indicate 1 out of 34 million would need a 4th YAG (but then with 20 million cataract surgeries a year globally, it seems the odds are that eventually such a person would consider posting about all their bad luck). I don't know if there is something about the Crystalens increasing the odd of needing a repeat YAG, or its about this patient rather than the IOL, or if there is some other explanation.
I'm wondering if they were using the YAG for treating floaters or something else unrelated to the IOL.
Correcting the refractive error is something that can be needed with any lens, including a monofocal if you wish to not need correction for some distance. Its true that people need to be aware there is a risk of problems, but they also need to keep the risks in perspective, there can be problems even with a monofocal.
Unfortunately it is true that anyone can wind up being the "statistic" even if a problem is rare so they do need to be prepared. In my case I went for a premium lens being willing to take the tiny risk I'd need a lens exchange.
I should note that there may be some reason that someone is more prone to recurrent PCO so the odds of each extra YAG being needed wouldn't compound that much, but it still would be rare.
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