Cataract surgery options in 2014

[RolfRivello]

For JodieJ: Your advice is always measured and sound, and it's well appreciated.

I have a dense nuclear cataract in my right (dominant) eye.

Although there are signs of cataract in my left, I don't care because I get  very good corrected vision with specs or contacts.

I have been trying to live with and adapt to the condition for two years now.

But now the cataract in the bad eye is very troublesome - best attempts to correct are a -11.5 contact lens, but now this only improves things a little.

I am 49 and have been myopic (-7.0 both eyes) all my life. Needless to say, I am well conditioned to the world of correcting vision.

I am at the stage of being saturated with information.

I am a scientist and engineer and understand optics, but have yet to be convinced about "multifocal" IOLs - the physics isn't sound in my opinion. Splitting the light into two or even three focal zones and asking the brain to "ignore" parts seems odd to me. If the brain could ignore out of focus stuff, then why can't it "neuroadapt" to astigmatisms, for example? And why would precision optics manufacturers not employ this idea instead of using moving lenses to get focus? Also, if a "multifocal" has two focal points (then it's actually a bifocal), near and far, then what does the brain do with the intermediate light rays? Intermediate vision is also important in day to day life and is often neglected.

Accommodating lenses make physics sense if they actually work. But do they work when put in the eye?

Personally, I am fastidious and love detail and color and contrast and clarity. Is it worth compromising this to try getting dubious mutlifocality? At least focality can easlily be corrected with contacts or spectacles.

I can't seem to get unbiased or measured advice from my "professionals", which disturbs me as I view the eye as a true wonder of the universe and it should be treated with the utmost seriousness.

I have now really got three main questions:

1. Cataract surgery - bladeless by laser OR manual phakoemulsification?
2. Consider trying an accomodating lens (still new technology I think) or abandon my eye's focussing muscles forever and insert a simple monofocal (aspheric or non aspheric?)?
3. Acrylic or silicone?

I see that a lot of issues with multifocal lenses is now over 5 years old. Have things changed now in 2014?

I am in Europe, and note that there is a big range of IOLs, including various accommodating designs (which is not the case in the US).

There may be an accommodating lens in the future that truly works. Or there may be a cure for cataract by somehow bleaching the lens to restore clarity (research into this area seems to be minimal - a disgrace). Who knows.

Comments would be most welcome.

My advice to anyone with eye issues is to be sceptical, first and foremost, and if possible gradually build up knowledge before deciding anything.

And do not have anyone perform surgery on your eye unless it is necessary.

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

I have just returned from a surgical meeting where the results of the femtosecond laser were reviewed. It is a remarkable system and an exponential improvement on an already excellent procedure.  That  technology will be used more and more. When coupled with astigmatism reducing surgery via the laser and intraoperative aberrometry represents the state of the art. It should be noted these are value added services and you can expect to pay more out of pocket costs than the standard phacoemulsification procedure.

JCHMD

[RolfRivello]

Thank you - it's a very informative, valuable and refreshing article.

(I am aware of image size imbalance when only one eye is selected for surgery, plus the issues that arise being myopic at -7.0.)

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

http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You


Please read the above article carefully.


JCH MD