Aa
Cataract IOL Questions
I have myopia and astigmatism as well as blepharitis. My question was whether the monofocal lens would REQUIRE one to wear glasses for one focus since the lens can only focus you at near or distance. A distance IOL monofocal lens would that mean my near vision would be worse than prior to surgery and that I would lose my ability to see near or would it keep my current nearsightedness and only correct my distance? Also why do doctors recommend you to choose to focus for distance rather than near? Is it because the possibility of future presbyopia and that your near vision will get worse?
What IOL lens would you recommend? I would hate to sacrifice my near vision to be fixed as distance, I want both without having the need to wear glasses as well as my astigmatism fixed, is this a possibility? Also is there a risk if I was to wait to get my cataracts fixed since I don't want to have to choose to be either near or farsighted this early? Doctors say my vision would get "better"; however, my vision as of now isn't that bad. How clear and unclear would my vision be based on the focus I choose being either (near or distance)?
How do the toric IOLs compare to monofocal IOL in terms of how clear it provides in vision? Would you say it's better to get toric toi fix my astigmatism instead of fixing it with glasses? Also would the multifocal IOLs be an option for me even though it doesn't fix astigmatism? I can possibly get it fixed with laser surgery in the future if I were to choose the multifocals can't I? What are the differences between the regular toric lens, Tecnis toric lens, and the Trulign toric lens? Are these available in the U.S?
What IOL lens would you recommend? I would hate to sacrifice my near vision to be fixed as distance, I want both without having the need to wear glasses as well as my astigmatism fixed, is this a possibility? Also is there a risk if I was to wait to get my cataracts fixed since I don't want to have to choose to be either near or farsighted this early? Doctors say my vision would get "better"; however, my vision as of now isn't that bad. How clear and unclear would my vision be based on the focus I choose being either (near or distance)?
How do the toric IOLs compare to monofocal IOL in terms of how clear it provides in vision? Would you say it's better to get toric toi fix my astigmatism instead of fixing it with glasses? Also would the multifocal IOLs be an option for me even though it doesn't fix astigmatism? I can possibly get it fixed with laser surgery in the future if I were to choose the multifocals can't I? What are the differences between the regular toric lens, Tecnis toric lens, and the Trulign toric lens? Are these available in the U.S?
When you stated "To me the issue is whether a very slight risk of a lens exchange is worth taking to have better vision for the rest of your life, or whether you prefer the risk of an accommodating lens not accommodating but being less likely to have halo issues."
I'm assuming the first option you were referring to the multifocal. I'm not quite sure of the complications that follows with a lens exchange so I may have to do more research. Could you expand on the risk of an accommodating lens not accommodating? Not quite sure what that means. As for other accommodating lenses, they don't seem to be available in my state (Kentucky) and since most are out of the U.S. my options are limited. I'll be moving overseas to South Korea during the end of the year, so I may have to research if there are other lens options that may be available there. Will have to find out if they import premium lenses from outside the U.S that might be worth the wait.
I'm assuming the first option you were referring to the multifocal. I'm not quite sure of the complications that follows with a lens exchange so I may have to do more research. Could you expand on the risk of an accommodating lens not accommodating? Not quite sure what that means. As for other accommodating lenses, they don't seem to be available in my state (Kentucky) and since most are out of the U.S. my options are limited. I'll be moving overseas to South Korea during the end of the year, so I may have to research if there are other lens options that may be available there. Will have to find out if they import premium lenses from outside the U.S that might be worth the wait.
2 Comments
Yup, for the first part of that I was referring to whether the slight risk of a lens exchange due to complications from a multifocal are worth the potential for better vision the rest of your life.
The other comment was referring to the issue that a minority of people with the Crystalens/Trulign seem to have no better near vision than they would have had with a monofocal. There are also some slight increased risks of complications with the Crystalens, e.g. z-syndrome, which use to be more common with older versions and might not be as much of an issue with the latest, I hadn't seen much on the topic.
I suspect South Korea is likely going to have options that aren't available here, most other countries seem to have access to the Symfony and trifocals by now.
The other comment was referring to the issue that a minority of people with the Crystalens/Trulign seem to have no better near vision than they would have had with a monofocal. There are also some slight increased risks of complications with the Crystalens, e.g. z-syndrome, which use to be more common with older versions and might not be as much of an issue with the latest, I hadn't seen much on the topic.
I suspect South Korea is likely going to have options that aren't available here, most other countries seem to have access to the Symfony and trifocals by now.
I'd also like to add that they diagnosed me with astigmatism when I was a child but in the past few years astigmatism was never mentioned from my optometrist so I'm not even sure of the degree of astigmatism that I have in my eye and whether it is a big enough concern for me to consider an astigmatism-correcting lens like the torics or whether I can correct it with glasses as I have done for the past 30 years. I'll be returning to my optometrist to find out more info regarding my current vision and the degree of my astigmatism (which was not noted in my optometrist eye exam). It's unfortunate that the ophthalmologists didn't really give me a detailed overview of my current cataract condition, yes the basics of "you don't have to have cataract surgery now but it won't be fixhttp://www.medhelp.org/posts/Eye-Care/Cataract-IOL-Questions/show/2873229#ed without surgery" was mentioned, they also mentioned I had healthy eyes overall, but I am pre-diabetic so that's always a concern.
1 Comments
Unfortunately most optometrists don't have the appropriate scanning equipment to determine total corneal astigmatism. The astigmatism in your prescription includes astigmatism from the lens, which goes away when the natural lens is removed so the only relevant astigmatism is what is from the cornea. Even some surgeons don't have the latest equipment that measures both anterior and posterior corneal astigmatism since they didn't realize until the last few years that posterior corneal astigmatism is often enough to make a noticeable difference (they used to think it was always very small).
If one of the opthalmologists did scans to determine astigmatism, you should be able to ask their office to tell you what it was, or worst case to give you a copy of your medical records and you can try to interpret it yourself or ask your optometrist to look.
Again, the studies show the vast majority of people with either a multifocal or accommodating lens are happy with the result. The issue is whether you wish to risk night driving issues which only happen with a minority, and the possibility you'd want a lens exchange. To me the issue is whether a very slight risk of a lens exchange is worth taking to have better vision for the rest of your life, or whether you prefer the risk of an accommodating lens not accommodating but being less likely to have halo issues.
If one of the opthalmologists did scans to determine astigmatism, you should be able to ask their office to tell you what it was, or worst case to give you a copy of your medical records and you can try to interpret it yourself or ask your optometrist to look.
Again, the studies show the vast majority of people with either a multifocal or accommodating lens are happy with the result. The issue is whether you wish to risk night driving issues which only happen with a minority, and the possibility you'd want a lens exchange. To me the issue is whether a very slight risk of a lens exchange is worth taking to have better vision for the rest of your life, or whether you prefer the risk of an accommodating lens not accommodating but being less likely to have halo issues.
I liked to share my experience regarding my ophthalmologist visit. I met two different surgeons, the one I had an original referral to was unavailable that day so instead I met a different surgeon. He was very honest and detailed and walked me through what he thinks would be the best option for me. However, he was not able to diagnosis my astigmatism well (said one eye had minor astigmatism and the other eye did not, however he wanted me to return to get a more detailed exam next time) But only to find out that he only had 2 years of experience, I decided to change surgeons. The next surgeon was in the same hospital and he had the most experience, however, he seemed rushed and would only answer my questions if asked, he told me to think about my options and to return to the lady who sets up my paperwork regarding the different lens options. (I had returned to the second surgeon for the astigmatism test to find out that I had astigmatism in both eyes, but he did not tell me the degree).
I told both surgeons my concern that I could not drive at night. I guess I forgot to mention my concern that I wanted to keep my accomodation of having good near vision while correcting my far vision. Both surgeons disagreed with the multifocals and said it was kind of "meh and that I would not be happy about it". They both recommended having a monofocal set for distance, the second surgeon said I would be a candidate for the toric lenses and that it was the best option for having a sharp distant vision (yet I suppose both recommendations were made as if they thought that I only wanted to correct my distant vision while wearing glasses for near, which was not discussed). Honestly, I do not drive much, I'm 54 and I do more work at home, and I enjoy watching the tv, cooking etc, so I guess this falls under the intermediate category? I'd still like to be able to correct my driving for night and I would really hate to wear glasses for reading because right now I can read just fine.
Both surgeons said laser surgery wouldn't benefit me much and did not discuss any other options for correcting my astigmatism (if it needs to be corrected). I turned down the first surgeon due to lack of experience, and I am hesitating on the second surgeon due to his lack of care. Monovision was not mentioned once and both seemed to disregard the fact that I want to keep my near vision while having the best possible correction for distant and intermediate while addressing my astigmatism. Multifocals were just mentioned as a "meh" to be because of my astigmatism and because I have dry eyes, and I'm not really confident in going into surgery since I'm not even sure what I'd benefit more from (in terms of the Toric vs monofocal and whether to set them for distant and how much intermediate vision I'd end up still having..). The lady doing the paperwork said that I'd have better vision than what I have now, but that's not really what I want to hear since she's just trying to make business, my biggest concern is that even with my two visits, I'm still left in a world of questions and now I am just in doubt of whether to have my cataract surgery or not because both ophthalmologists were unable to advise on the best lens options and guide me through choosing the right option for having the best vision I can possible have (they only have monofocal, multifocal, and torics). The hospital seemed to have a mindset of correcting cataract via the easiest possible way and assumed that patients wanted to have distant correction without putting much thought and care into my astigmatism and concerns. Any advice would be appreciated.
I told both surgeons my concern that I could not drive at night. I guess I forgot to mention my concern that I wanted to keep my accomodation of having good near vision while correcting my far vision. Both surgeons disagreed with the multifocals and said it was kind of "meh and that I would not be happy about it". They both recommended having a monofocal set for distance, the second surgeon said I would be a candidate for the toric lenses and that it was the best option for having a sharp distant vision (yet I suppose both recommendations were made as if they thought that I only wanted to correct my distant vision while wearing glasses for near, which was not discussed). Honestly, I do not drive much, I'm 54 and I do more work at home, and I enjoy watching the tv, cooking etc, so I guess this falls under the intermediate category? I'd still like to be able to correct my driving for night and I would really hate to wear glasses for reading because right now I can read just fine.
Both surgeons said laser surgery wouldn't benefit me much and did not discuss any other options for correcting my astigmatism (if it needs to be corrected). I turned down the first surgeon due to lack of experience, and I am hesitating on the second surgeon due to his lack of care. Monovision was not mentioned once and both seemed to disregard the fact that I want to keep my near vision while having the best possible correction for distant and intermediate while addressing my astigmatism. Multifocals were just mentioned as a "meh" to be because of my astigmatism and because I have dry eyes, and I'm not really confident in going into surgery since I'm not even sure what I'd benefit more from (in terms of the Toric vs monofocal and whether to set them for distant and how much intermediate vision I'd end up still having..). The lady doing the paperwork said that I'd have better vision than what I have now, but that's not really what I want to hear since she's just trying to make business, my biggest concern is that even with my two visits, I'm still left in a world of questions and now I am just in doubt of whether to have my cataract surgery or not because both ophthalmologists were unable to advise on the best lens options and guide me through choosing the right option for having the best vision I can possible have (they only have monofocal, multifocal, and torics). The hospital seemed to have a mindset of correcting cataract via the easiest possible way and assumed that patients wanted to have distant correction without putting much thought and care into my astigmatism and concerns. Any advice would be appreciated.
Wasn't the Symfony that you had a type of presbyopia-correcting lens?
Also I believe I mentioned this to you via message but I will repost it here to share with others:
I asked the individual about the Tecnis multifocal surgery that you mentioned and received some feedback. Do you happen to know why the Tecnis is better than the Restor? Also could you please explain to me the differences of what the terms "low add" and "high add" mean. The individual mentioned that the doctor said he would not recommend the "low add" Restor. Also the individual said that they said it might be better to wait for the Tecnis Symfony to be approved in the U.S. What do you think?
Also do monofocals have less risks of glares and halos compared to multifocals? If so do you know why premium lenses and multifocals have higher complications in regards to these aspects?
Also I believe I mentioned this to you via message but I will repost it here to share with others:
I asked the individual about the Tecnis multifocal surgery that you mentioned and received some feedback. Do you happen to know why the Tecnis is better than the Restor? Also could you please explain to me the differences of what the terms "low add" and "high add" mean. The individual mentioned that the doctor said he would not recommend the "low add" Restor. Also the individual said that they said it might be better to wait for the Tecnis Symfony to be approved in the U.S. What do you think?
Also do monofocals have less risks of glares and halos compared to multifocals? If so do you know why premium lenses and multifocals have higher complications in regards to these aspects?
1 Comments
The Symfony is a premium presbyopia-correcting lens which is referred to as an "extended depth of focus" lens. It uses a different optical method than mulitfocals to give a broader range of vision with a lower risk of side effects than multifocals.
Surgeons do vary in their preferences, some prefer the Alcon by default, but I've seen more comments from knowledgeable surgeons indicating they prefer Tecnis by default (though which is best varies depending on the patients needs). There are a few reasons that some surgeons think the Tecnis lenses on average are better than the Alcon lenses like the Restor. One reason is that the material has a higher Abbe number, which results in less "chromatic aberration" (a particular type of optical distortion that lenses cause that reduces visual quality). This trade publication has an article on chromatic aberration and mentions:
http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
" Cataract surgery with an IOL with an Abbe number greater than that of the natural lens (47) can improve CA, so that our cataract patients could actually experience better vision quality than they did as young adults. "
It shows a table with Abbe numbers of various materials, and Tecnis is 55 (above the natural lens) and Alcon is 37 (below the natural lens). There are articles around the net that talk about choosing eyeglass lens material that discuss the issue of chromatic aberration as well. In my case the Symfony has special optics designed to not merely reduce chromatic aberration, but get rid of it.
The Alcon lenses are "blue blocking" lenses which not only block UV (ultraviolet) light, but also block a bit of the visible blue light spectrum compared to other IOLs. Many surgeons consider that a marketing gimmick, and that it is better to just wear sunglasses to block UV light, and if you wish to go further there are also blue blocking sunglasses. I prefer to see the whole spectrum of light, and wear sunglasses if I need to.
The Alcon lenses are also subject to a side effect called "glistenings", little bubbles that can appear over time, though there is debate over whether they have any noticeable impact on visual acuity.
The "low add" and "high add" phrases refer to the fact that these are bifocal lenses. I don't know how old you are, if you have dealt with presbyopia and the need for reading glasses or bifocals/progressive glasses yet. If you buy reading glasses in a store they will have powers on them like "+1.5" which indicate how strong the "add" is, the higher the add the closer in the glasses are focused at. People who get bifocals (or progressive glasses) that are prescription have the lens power they need for distance, then a separate number that gives the "add" for the lens that is focused close up. The prescriptions for those have an "add", e.g. +1.5D.
Lens powers are given in diopters. To determine were a reading glass is focused, there is a formula: distance_in_centimeters = (100 / lens_power). So a lens of +1 is focused at 100 centimeters(=1 meter), a lens of +2D is focused at 50 centimeters, a +3D lens focused at 33.3 centimeters, etc. So a high add lens is focused closer in.
If you have a high add IOL, the near point is focused in fairly near, and a lower add is focused further out. The high add bifocals may leave people without very good intermediate vision, they may need glasses to see a computer screen better. The new lower add IOLs have better intermediate vision, but not as good really near.
How much add you want partly depends on what distance is most important to you, close up or intermediate. These days many people prefer intermediate since they read computers, tablets and smartphones from further out than they usually would have held a book.
A multifocal lens has a higher risk of halos&glare as a side effect of the optics that gives the 2 different focal points. On average, the larger the "add" for a multifocal' the larger the halos are and the more risk they will cause problems. Most people don't have problems with halos with the new low add lenses (even if the person who posted about them on Medhelp, rwbil, was one of the unlucky ones), but it is a risk. A very tiny percentage of people find them enough of a problem that they get a lens exchange for a monofocal lens. Many people think that is worth the risk, since if they aren't bothered by halos then they have a wider range of vision.
The Symfony reportedly has a risk of halos&glare that is about the same as a monofocal. Whether its worth waiting for partly depends on whether you wish to have lower quality vision while waiting for it, in hopes of having better vision for a long time after. When I had a problem cataract I waited 2.5 years in hopes the US would approve a better lens like a trifocal. I finally had to give up waiting when my cataract got too bad and went to Europe, and decided that the new Symfony was a better match for my needs than a trifocal.
I'd looked at the data submitted to the FDA for approval of the Tecnis and Restor lenses, and the Tecnis seems to have a lower risk of halos than the Restor. I say "seems to" because the problem is they may have asked different survey questions. How you ask people something changes how they answer, so the data may not be directly comparable.
Its likely too technical for most people, but here is the link to the data they submitted to the FDA for the Tecnis lens (many people won't understand the tecnical jargon, but might understand some of it):
http://www.accessdata.fda.gov/cdrh_docs/pdf/P980040S049d.pdf
and the FDA data for the Restor multifocal (it has links on the page to the PDF files):
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfTopic/pma/pma.cfm?num=p040020s050
Surgeons do vary in their preferences, some prefer the Alcon by default, but I've seen more comments from knowledgeable surgeons indicating they prefer Tecnis by default (though which is best varies depending on the patients needs). There are a few reasons that some surgeons think the Tecnis lenses on average are better than the Alcon lenses like the Restor. One reason is that the material has a higher Abbe number, which results in less "chromatic aberration" (a particular type of optical distortion that lenses cause that reduces visual quality). This trade publication has an article on chromatic aberration and mentions:
http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
" Cataract surgery with an IOL with an Abbe number greater than that of the natural lens (47) can improve CA, so that our cataract patients could actually experience better vision quality than they did as young adults. "
It shows a table with Abbe numbers of various materials, and Tecnis is 55 (above the natural lens) and Alcon is 37 (below the natural lens). There are articles around the net that talk about choosing eyeglass lens material that discuss the issue of chromatic aberration as well. In my case the Symfony has special optics designed to not merely reduce chromatic aberration, but get rid of it.
The Alcon lenses are "blue blocking" lenses which not only block UV (ultraviolet) light, but also block a bit of the visible blue light spectrum compared to other IOLs. Many surgeons consider that a marketing gimmick, and that it is better to just wear sunglasses to block UV light, and if you wish to go further there are also blue blocking sunglasses. I prefer to see the whole spectrum of light, and wear sunglasses if I need to.
The Alcon lenses are also subject to a side effect called "glistenings", little bubbles that can appear over time, though there is debate over whether they have any noticeable impact on visual acuity.
The "low add" and "high add" phrases refer to the fact that these are bifocal lenses. I don't know how old you are, if you have dealt with presbyopia and the need for reading glasses or bifocals/progressive glasses yet. If you buy reading glasses in a store they will have powers on them like "+1.5" which indicate how strong the "add" is, the higher the add the closer in the glasses are focused at. People who get bifocals (or progressive glasses) that are prescription have the lens power they need for distance, then a separate number that gives the "add" for the lens that is focused close up. The prescriptions for those have an "add", e.g. +1.5D.
Lens powers are given in diopters. To determine were a reading glass is focused, there is a formula: distance_in_centimeters = (100 / lens_power). So a lens of +1 is focused at 100 centimeters(=1 meter), a lens of +2D is focused at 50 centimeters, a +3D lens focused at 33.3 centimeters, etc. So a high add lens is focused closer in.
If you have a high add IOL, the near point is focused in fairly near, and a lower add is focused further out. The high add bifocals may leave people without very good intermediate vision, they may need glasses to see a computer screen better. The new lower add IOLs have better intermediate vision, but not as good really near.
How much add you want partly depends on what distance is most important to you, close up or intermediate. These days many people prefer intermediate since they read computers, tablets and smartphones from further out than they usually would have held a book.
A multifocal lens has a higher risk of halos&glare as a side effect of the optics that gives the 2 different focal points. On average, the larger the "add" for a multifocal' the larger the halos are and the more risk they will cause problems. Most people don't have problems with halos with the new low add lenses (even if the person who posted about them on Medhelp, rwbil, was one of the unlucky ones), but it is a risk. A very tiny percentage of people find them enough of a problem that they get a lens exchange for a monofocal lens. Many people think that is worth the risk, since if they aren't bothered by halos then they have a wider range of vision.
The Symfony reportedly has a risk of halos&glare that is about the same as a monofocal. Whether its worth waiting for partly depends on whether you wish to have lower quality vision while waiting for it, in hopes of having better vision for a long time after. When I had a problem cataract I waited 2.5 years in hopes the US would approve a better lens like a trifocal. I finally had to give up waiting when my cataract got too bad and went to Europe, and decided that the new Symfony was a better match for my needs than a trifocal.
I'd looked at the data submitted to the FDA for approval of the Tecnis and Restor lenses, and the Tecnis seems to have a lower risk of halos than the Restor. I say "seems to" because the problem is they may have asked different survey questions. How you ask people something changes how they answer, so the data may not be directly comparable.
Its likely too technical for most people, but here is the link to the data they submitted to the FDA for the Tecnis lens (many people won't understand the tecnical jargon, but might understand some of it):
http://www.accessdata.fda.gov/cdrh_docs/pdf/P980040S049d.pdf
and the FDA data for the Restor multifocal (it has links on the page to the PDF files):
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfTopic/pma/pma.cfm?num=p040020s050
An individual stated "Presbyopia happens when the lens inside your eye gets too stiff to change focus. That lens is removed in surgery so how stiff it was before surgery is irrelevant after surgery."
This information seems a bit misleading as it sounds like it's saying that presbyopia can be corrected by any lens replacement, but if so why are there different presbyopia-corrected lenses. Please advise.
This information seems a bit misleading as it sounds like it's saying that presbyopia can be corrected by any lens replacement, but if so why are there different presbyopia-corrected lenses. Please advise.
1 Comments
In young eyes the natural lens will change its shape to change focal distances in response to eye muscles. In presbyopes the lens is no longer able to change shape as much to change focus. The problem is that most artificially lenses don't change shape at all so they don't change focus at all. There are attempts at making accommodating lenses that will change shape and shift focus, but the one in use now, the Crystalens (and its toric version the Trulign) doesn't provide much accommodation, in a minority its no different than a monofocal. There is actually some debate over whether the lens actually changes shape the way the natural lens does, or whether there is some other reason it provides a little more range of focus than a monfocal.
There are better accommodating lenses in development but it will be a few years before they are available in the US. I saw a recent report that one of them is applying for approval in Europe, but I don't know how long it'll be before its approved (and even then it'd likely take a few years to be approved in the US, if they even bother trying for approval here), and I haven't seen enough data to be sure how it compares to existing premium lenses.
Multifocal and extended depth of focus lenses don't change shape so they use other methods to achieve a wide range of useful vision.
There are better accommodating lenses in development but it will be a few years before they are available in the US. I saw a recent report that one of them is applying for approval in Europe, but I don't know how long it'll be before its approved (and even then it'd likely take a few years to be approved in the US, if they even bother trying for approval here), and I haven't seen enough data to be sure how it compares to existing premium lenses.
Multifocal and extended depth of focus lenses don't change shape so they use other methods to achieve a wide range of useful vision.
Can you tell me more about the surgery with the Tecnis multifocal and how his/her outcome was? Why did the individual also get a laser done instead of an LRI to fix the astigmatism as well?
Also I'm assuming none of that was covered by insurance just as in most cases premium lenses and LASIK aren't.
I'm also wondering about the out of pocket costs that you had to pay for your entire cataract surgery with the Symfony that you did outside the U.S. Thanks.
Also I'm assuming none of that was covered by insurance just as in most cases premium lenses and LASIK aren't.
I'm also wondering about the out of pocket costs that you had to pay for your entire cataract surgery with the Symfony that you did outside the U.S. Thanks.
1 Comments
Someone has posted on this site about their experience with the +2.75 Tecnis multifocal here, and would likely answer questions:
http://www.medhelp.org/posts/Eye-Care/Tecnis-275D-MF-IOL-Experience/show/2597910
I suggested the person who just got the +3.25 post about it, the surgery was just this week so its early yet. The laser was used to do the LRI incision since its more accurate than a blade.
In general insurers consider only the basics of surgery with a monofocal to be covered. Anything to correct astigmatism, and premium lenses, are considered optional so they don't cover it since people can wear glasses afterwards and cope without them.
Someone posted about getting the Symfony from a reputable surgeon in Mexico (walking distance from the San Diego border where you can stay) and mentioned his costs:
http://www.medhelp.org/posts/Eye-Care/Symfony-IOL-at-Codet-in-Tijuana/show/2853291
Someone had asked about costs on the Symfony thread recently. I had a special introductory price that others won't get. The poster was from Europe, so I replied with costs in euros that quotes were given in when I did my research. I hadn't converted my comment there from euros to $ (google will convert currencies if you search for say "123 euro to dollars"). I wrote: If I recall correctly, at least a year or so ago you could get the Symfony from reputable surgeons elsewhere in western Europe for perhaps 2500-3500 euros, though that only covered the initial postop the day after surgery, not the 6 month followup that you refer to.. and well under 2000 euros in the Czech Republic (depending on whether you have laser surgery), and somewhere in between in Croatia (perhaps around 2000- 2100 euros). A quick check shows one site listing 1300 euros and another 1670 euros for a premium lens in the Czech Republic.
http://www.medhelp.org/posts/Eye-Care/Tecnis-275D-MF-IOL-Experience/show/2597910
I suggested the person who just got the +3.25 post about it, the surgery was just this week so its early yet. The laser was used to do the LRI incision since its more accurate than a blade.
In general insurers consider only the basics of surgery with a monofocal to be covered. Anything to correct astigmatism, and premium lenses, are considered optional so they don't cover it since people can wear glasses afterwards and cope without them.
Someone posted about getting the Symfony from a reputable surgeon in Mexico (walking distance from the San Diego border where you can stay) and mentioned his costs:
http://www.medhelp.org/posts/Eye-Care/Symfony-IOL-at-Codet-in-Tijuana/show/2853291
Someone had asked about costs on the Symfony thread recently. I had a special introductory price that others won't get. The poster was from Europe, so I replied with costs in euros that quotes were given in when I did my research. I hadn't converted my comment there from euros to $ (google will convert currencies if you search for say "123 euro to dollars"). I wrote: If I recall correctly, at least a year or so ago you could get the Symfony from reputable surgeons elsewhere in western Europe for perhaps 2500-3500 euros, though that only covered the initial postop the day after surgery, not the 6 month followup that you refer to.. and well under 2000 euros in the Czech Republic (depending on whether you have laser surgery), and somewhere in between in Croatia (perhaps around 2000- 2100 euros). A quick check shows one site listing 1300 euros and another 1670 euros for a premium lens in the Czech Republic.
So I've read articles that say it's usually better not to wait to have your cataract surgery done but many say there aren't complications in waiting. Going blind makes it sound a bit scary I am assuming that's a possible risk for waiting too long, but it seems difficult to determine when too long is and how fast the cataract will progress. I can see well using my eyes now, but as you said, one eye is bad and I'm using the power of both eyes to see as much as I can now, so I'm sure there's a lot of strains and it's probably hurting my other good eye too. Like you mentioned before, it's a bit hard to lose the accommodation of what we have now as in my case would be being nearsighted to compensate for having good distant vision now and reading glasses later which is the opposite of what I'd be doing now.
I have an appointment next week so I am going to ask some more indepth questions as to how much I can delay my surgery and the specifications of my vision and astigmatism to reach a final decision.
I have an appointment next week so I am going to ask some more indepth questions as to how much I can delay my surgery and the specifications of my vision and astigmatism to reach a final decision.
1 Comments
Someone I've been in touch with just had cataract surgery this week with a Tecnis multifocal, and the surgeon used a laser to correct a small amount of astigmatism.
If your vision is mostly using your good eye, that doesn't damage it, its merely in a sense like monovision where your brain is mostly using that eye and tuning out the other. I postponed surgery for 2.5 years after my eye had a problem cataract that could have been operated on, in hopes of a better lens being approved. My other eye retained good vision so I just tuned out the bad eye. Eventually I had trouble tuning it out when it got too bad, I'd see blur at times and get headaches, so I went for surgery outside the US (which was a hassle, but I figured I'd live with the result a few decades perhaps).
A cataract can always be removed no matter how long you wait, even if someone waits until they are blind the natural lens can still be replaced. At some point the risks start to rise, but not until it gets fairly bad. If the cataract gets bad enough that your best corrected vision is worse than 20/100 or so then it gets harder for the surgeon to see in to check your retina before surgery (since it impedes vision in both directions), but thats usually well past the time anyone in a modern country would choose to have surgery (unless the cataract is developing far faster than usual). Usually of course seeing the retina isn't a big deal if you don't have problems, they just prefer to be able to check on it. The other slight risk is that if you wait even longer than that the cataract will make the lens hard, a mature cataract requires more effort to break apart (increasing slightly the risk of complications, but its still very safe) and there is more of a risk that removing it will damage the capsular bag so the replacement lens needs to go outside the bag (which still leads to good results, but most premium lenses are meant to be placed inside the bag and don't work outside it).
If your vision is mostly using your good eye, that doesn't damage it, its merely in a sense like monovision where your brain is mostly using that eye and tuning out the other. I postponed surgery for 2.5 years after my eye had a problem cataract that could have been operated on, in hopes of a better lens being approved. My other eye retained good vision so I just tuned out the bad eye. Eventually I had trouble tuning it out when it got too bad, I'd see blur at times and get headaches, so I went for surgery outside the US (which was a hassle, but I figured I'd live with the result a few decades perhaps).
A cataract can always be removed no matter how long you wait, even if someone waits until they are blind the natural lens can still be replaced. At some point the risks start to rise, but not until it gets fairly bad. If the cataract gets bad enough that your best corrected vision is worse than 20/100 or so then it gets harder for the surgeon to see in to check your retina before surgery (since it impedes vision in both directions), but thats usually well past the time anyone in a modern country would choose to have surgery (unless the cataract is developing far faster than usual). Usually of course seeing the retina isn't a big deal if you don't have problems, they just prefer to be able to check on it. The other slight risk is that if you wait even longer than that the cataract will make the lens hard, a mature cataract requires more effort to break apart (increasing slightly the risk of complications, but its still very safe) and there is more of a risk that removing it will damage the capsular bag so the replacement lens needs to go outside the bag (which still leads to good results, but most premium lenses are meant to be placed inside the bag and don't work outside it).
I'm a bit afraid of having monovision because I don't think I'd be able to adapt to it, as in being able to see near in one eye and distant in the other eye. I also heard that there were more complications in the process of adapting to it. Some also said that monovision makes people have soso vision for the different focuses compared to a monofocal which would provide at least clear vision for one focus. As much as I do not want to lose my accommodation for my near vision in the process of getting cataract surgery I think it's important for me to consider the pros and cons of each lens and to hopefully find the best suited lens for me (whichever that may be..). It seems difficult to locate a lens that would be ideal for me in the U.S as my hopes are to be the closest to being independent from glasses for my near, far, and intermediate vision while finding a lens or using a procedure that will fix my astigmatism and of course removing the cataract. The last thing I would want is to fix my cataract only to lose the near vision that I have now to compensate for a different focus.
1 Comments
re: "The last thing I would want is to fix my cataract only to lose the near vision "
Unfortunately medicine isn't yet perfect and so after the bad luck of having a problem like a cataract arise there may be negative consequences you'll have to live with. A cataract will cause you to go blind unless its treated so you are stuck with imperfect options to prevent that. The odds are that whatever option you go with you will be able to get used to, but will be imperfect compared to a young natural lens. Unfortunately there is no perfect lens out there, and the options aren't as good in the US. They are next generation accommodating lenses in the research stage that may be an improvement, and reportedly one is seeking approval in Europe now (though I don't know how the data look, how good a bet it is compared to existing lenses), but I don't know how soon that will come and its likely it would then be a number of years before its available in the US even if it is approved there.
Most people adapt to a small bit of monovision without a problem, the issue is usually only larger amounts. Although in theory your vision isn't as good when its mostly 1 eye doing the work, most people with monovision have good enough vision that way and are happy with the results. I was happy with contact lens monovision when I tried it for early presbyopia, though I preferred multifocal contacts when I later tried those (and early presbyopia only required a small difference between the eyes).
Ideally they should have people do a contact lens trial of monovision before a cataract impacts their vision too much. If they are young enough to have some accommodation then that won't be a completely accurate test for near (though it would be fairly accurate for distance), but it may give them some idea of whether they can adapt.
Unfortunately medicine isn't yet perfect and so after the bad luck of having a problem like a cataract arise there may be negative consequences you'll have to live with. A cataract will cause you to go blind unless its treated so you are stuck with imperfect options to prevent that. The odds are that whatever option you go with you will be able to get used to, but will be imperfect compared to a young natural lens. Unfortunately there is no perfect lens out there, and the options aren't as good in the US. They are next generation accommodating lenses in the research stage that may be an improvement, and reportedly one is seeking approval in Europe now (though I don't know how the data look, how good a bet it is compared to existing lenses), but I don't know how soon that will come and its likely it would then be a number of years before its available in the US even if it is approved there.
Most people adapt to a small bit of monovision without a problem, the issue is usually only larger amounts. Although in theory your vision isn't as good when its mostly 1 eye doing the work, most people with monovision have good enough vision that way and are happy with the results. I was happy with contact lens monovision when I tried it for early presbyopia, though I preferred multifocal contacts when I later tried those (and early presbyopia only required a small difference between the eyes).
Ideally they should have people do a contact lens trial of monovision before a cataract impacts their vision too much. If they are young enough to have some accommodation then that won't be a completely accurate test for near (though it would be fairly accurate for distance), but it may give them some idea of whether they can adapt.
Honestly the monovision sounds pretty scary to me. I don't think I could get used to the fact that if I were to close one eye I'd see far and near for the other eye but not both. I also read it takes a lot of time to get used to and it may not yield the best results when it comes to a single focus. As in the vision would all be soso and it may not guarentee being free from glasses so as much I do not want to lose my accomodation for my near vision I may need to put some more thought into the monovision. In the end I am looking for the best results for an eye that I will live with. And with it being a one time surgery I want to consider all my options and choose the best lens suited for me (whichever that may be..) to hopefully find the balance of near and far vision while getting my astigmatism taken care of.
Also which leads to better results for intermediate vision for being set to distant vs near in a monofocal?
I also read if most of your astigmatism is lenticular, it will all be gone after the surgery regardless of an astigmatism-correcting lens. "Sometimes the incision made in the cornea greatly reduces corneal astigmatism also." I'm assuming this statement is talking about the limbal incision mentioned before. Is this information correct?
I also read if most of your astigmatism is lenticular, it will all be gone after the surgery regardless of an astigmatism-correcting lens. "Sometimes the incision made in the cornea greatly reduces corneal astigmatism also." I'm assuming this statement is talking about the limbal incision mentioned before. Is this information correct?
1 Comments
If you want good intermediate vision it is possible to use monovision where the nearer eye is set to intermediate rather than set too near.
Most astigmatism is corneal usually, lenticular astigmatism is usually small, so its unlikely that removing the natural lens will get rid of all of it. (though in some cases a cataract can cause a lens to have more astigmatism, and if the astigmatism you have is fairly new it could be that its from the cataract and will go away, though that isn't too common I gather). Its actually possible to have lenticular astigmatism which is in the opposite direction from corneal astigmatism and counterbalances some of it, so that when the lens is removed the astigmatism would increase.
Doctors will do scans of the cornea to determine how much of the astigmatism comes from that source, they don't rely on your prescription since as you note some of it is lenticular. It used to be they only relied on scans of the front of the cornea to measure anterior astigmatism, since that is where most corneal astigmatism lies and that is what the scans they use for other purposes measure. However they've determined that although posterior corneal astigmatism is usually minor, it can sometimes be enough to make a difference, so its important to be sure the doctor has the latest equipment to determine total corneal astigmatism, including posterior astigmatism, to get the most accurate result.
Often what they do to reduce astigmatism is something called an LRI (limbal relaxing incision), though there are other places on the eye besides the limbus they sometimes put the incision. The incision used to remove&replace the lens can impact astigmatism, so they can try to plan that so it counteracts any astigmatism you have. These days they use micro-incision surgery which doesn't impact astigmatism much, in the old days the incisions were larger and there was more concern over "surgically induced astigmatism".
Most astigmatism is corneal usually, lenticular astigmatism is usually small, so its unlikely that removing the natural lens will get rid of all of it. (though in some cases a cataract can cause a lens to have more astigmatism, and if the astigmatism you have is fairly new it could be that its from the cataract and will go away, though that isn't too common I gather). Its actually possible to have lenticular astigmatism which is in the opposite direction from corneal astigmatism and counterbalances some of it, so that when the lens is removed the astigmatism would increase.
Doctors will do scans of the cornea to determine how much of the astigmatism comes from that source, they don't rely on your prescription since as you note some of it is lenticular. It used to be they only relied on scans of the front of the cornea to measure anterior astigmatism, since that is where most corneal astigmatism lies and that is what the scans they use for other purposes measure. However they've determined that although posterior corneal astigmatism is usually minor, it can sometimes be enough to make a difference, so its important to be sure the doctor has the latest equipment to determine total corneal astigmatism, including posterior astigmatism, to get the most accurate result.
Often what they do to reduce astigmatism is something called an LRI (limbal relaxing incision), though there are other places on the eye besides the limbus they sometimes put the incision. The incision used to remove&replace the lens can impact astigmatism, so they can try to plan that so it counteracts any astigmatism you have. These days they use micro-incision surgery which doesn't impact astigmatism much, in the old days the incisions were larger and there was more concern over "surgically induced astigmatism".
One question that I still have unanswered from research relates to the monofocal lens. How come one would need to wear glasses for all distances even if the surgeon had set your focus to distance? Wouldn't a monofocal set for distance free one from glasses for distance, same for someone set for near vision it would free them from glasses up close?
1 Comments
If both eyes are set for distance then you shouldn't need glasses for that distance. The odds are if you have monovision with one eye set for distance that you also won't need glasses for distance. It is true however that vision is better with 2 eyes than one, so although you might not need glasses for distance, you might see an improvement if you wear glasses that correct the near eye for distance so both are being used for distance (or use a contact lens on the near eye to adjust it for distance). That usually won't be an issue, unless you have some need for the very best distance vision possible for some task.
If you have monovision with one eye set for near, you can likely get away without glasses for near. The one caveat is that near tasks like reading are more demanding than distance tasks, so it may be more comfortable if you are engaged in prolonged near work to wear glasses that correct the distance eye to also be focused at near.
If you have monovision with one eye set for near, you can likely get away without glasses for near. The one caveat is that near tasks like reading are more demanding than distance tasks, so it may be more comfortable if you are engaged in prolonged near work to wear glasses that correct the distance eye to also be focused at near.
I'm going to go back tomorrow to get some accurate measurements for my vision and my astigmatism. The surgeons did not recommend a multifocal for me although that was my original hope so I don't have to lose my near vision. Seems to me that I'll need multiple procedures since I have presbyopia and astigmatism so catching everything with one lens will be hard.
What are your thoughts on the multifocals such as the Restor lens. Do you think I would be a candidate for this? I know multifocals would lead to better vision for all ranges; however, since it doesn't correct astigmatism I'm still left with a problem.
What are your thoughts on the multifocals such as the Restor lens. Do you think I would be a candidate for this? I know multifocals would lead to better vision for all ranges; however, since it doesn't correct astigmatism I'm still left with a problem.
2 Comments
As noted in clips above, they can likely correct the astigmatism with an incision to let you get a multifocal. It is done as part of cataract surgery, not a separate procedure, they just make different incisions. I've read better things about Tecnis lenses in general than Restor lenses, but the newest low add Restor reportedly has a different design than the older ones so I don't know how they compare. It seems likely you'd be a candidate, the only issue is that you just need to ready to risk the potential for side effects like halos. The vast majority of patients are happy with the results, a minuscule fraction are unhappy enough to get a lens exchange to a monofocal. So there is some risk, In my case I figured that since I'd live with the results a few decades that it would be worth it, though I decided to go for the Symfony which I viewed as a better bet (just more time consuming to get since I had to travel for it).
As noted in clips above, they can likely correct the astigmatism with an incision to let you get a multifocal. It is done as part of cataract surgery, not a separate procedure, they just make different incisions. I've read better things about Tecnis lenses in general than Restor lenses, but the newest low add Restor reportedly has a different design than the older ones so I don't know how they compare. It seems likely you'd be a candidate, the only issue is that you just need to ready to risk the potential for side effects like halos. The vast majority of patients are happy with the results, a minuscule fraction are unhappy enough to get a lens exchange to a monofocal. So there is some risk, In my case I figured that since I'd live with the results a few decades that it would be worth it, though I decided to go for the Symfony which I viewed as a better bet (just more time consuming to get since I had to travel for it).
Whoops, and adding to my question in #2. What is the range of astigmatism (in numbers) that would qualify me for a better candidate for the toric monofocals versus a LRI to fix my astigmatism
1 Comments
The range of astigmatism where surgeons recommend toric IOLs varies with the surgeon, and whether or not they are doing laser incisions which can be more precise. While some surgeons prefer toric lenses even for fairly low amounts of astigmatism, some will correct even large amounts via incision. A few sample articles mentions of the issue of doing even large amounts via incision, with the first article giving a more typical range if toric or incisions are both options:
http://crstoday.com/2014/08/how-to-decide-between-laser-ak-and-a-toric-iol
"When the astigmatism is greater than 2.00 D, I use a toric lens. When it is less than 0.75 D, I plan to use a laser-created arcuate incision. When the degree of astigmatism is between 0.75 and 2.00 D, I may use either technology depending on other factors such as posterior corneal cylinder, refraction, topography and pachymetry readings, and the type of IOL."
http://crstoday.com/2015/05/managing-astigmatism-during-the-cataract-procedure
"Laser arcuate incisions and limbal relaxing incisions (LRIs) can correct approximately 1.00 to 1.25 D of cylinder or less very well. Toric IOLs and LRIs are both acceptable choices to address higher amounts of astigmatism. For each patient, the best treatment takes into account risk, benefit, and cost. Because I can successfully correct up to 4.00 D of astigmatism with an LRI at a significantly lower cost than for a toric IOL, many of my patients choose the former treatment option. The predictability of LRIs decreases from the usual 95% to approximately 80% to 85% when treating astigmatism ranging from 3.00 to 4.00 D. It is important to inform patients of this difference when they cannot afford a toric IOL.
When patients want to be rid of their bifocal glasses after cataract surgery, I find that performing an LRI to correct astigmatism allows me also to implant a multifocal IOL such as the Tecnis Multifocal (Abbott Medical Optics). In my experience, this lens provides patients with clear UCVA at distance and near. I do not think it is reasonable to tell patients that they cannot have the desired multifocal lens simply because they have 2.00 to 3.00 D of astigmatism."
http://crstodayeurope.com/2013/01/state-of-the-premium-iol-market-in-europe/europe/2016/03/a-clear-improvement-in-pediatric-cataract-surgery
"Response to Question No. 2: For up to 2.00 D of cylinder, I enlarge the incision on the steep meridian. From 2.00 to 5.00 D of corneal cylinder, I prefer laser arcuate incisions (Figure 7) provided there are no signs of keratoconus or dry eye. Because laser relaxing incisions are easy to open (Figure 8) and precise in location, shape, length, and depth, we use toric IOLs in less than 3% of cases. "
http://crstoday.com/2014/08/how-to-decide-between-laser-ak-and-a-toric-iol
"When the astigmatism is greater than 2.00 D, I use a toric lens. When it is less than 0.75 D, I plan to use a laser-created arcuate incision. When the degree of astigmatism is between 0.75 and 2.00 D, I may use either technology depending on other factors such as posterior corneal cylinder, refraction, topography and pachymetry readings, and the type of IOL."
http://crstoday.com/2015/05/managing-astigmatism-during-the-cataract-procedure
"Laser arcuate incisions and limbal relaxing incisions (LRIs) can correct approximately 1.00 to 1.25 D of cylinder or less very well. Toric IOLs and LRIs are both acceptable choices to address higher amounts of astigmatism. For each patient, the best treatment takes into account risk, benefit, and cost. Because I can successfully correct up to 4.00 D of astigmatism with an LRI at a significantly lower cost than for a toric IOL, many of my patients choose the former treatment option. The predictability of LRIs decreases from the usual 95% to approximately 80% to 85% when treating astigmatism ranging from 3.00 to 4.00 D. It is important to inform patients of this difference when they cannot afford a toric IOL.
When patients want to be rid of their bifocal glasses after cataract surgery, I find that performing an LRI to correct astigmatism allows me also to implant a multifocal IOL such as the Tecnis Multifocal (Abbott Medical Optics). In my experience, this lens provides patients with clear UCVA at distance and near. I do not think it is reasonable to tell patients that they cannot have the desired multifocal lens simply because they have 2.00 to 3.00 D of astigmatism."
http://crstodayeurope.com/2013/01/state-of-the-premium-iol-market-in-europe/europe/2016/03/a-clear-improvement-in-pediatric-cataract-surgery
"Response to Question No. 2: For up to 2.00 D of cylinder, I enlarge the incision on the steep meridian. From 2.00 to 5.00 D of corneal cylinder, I prefer laser arcuate incisions (Figure 7) provided there are no signs of keratoconus or dry eye. Because laser relaxing incisions are easy to open (Figure 8) and precise in location, shape, length, and depth, we use toric IOLs in less than 3% of cases. "
Whoops, also adding on to point #2. What is the range of astigmatism (in numbers) that would qualify me for a toric monofocal rather than a LRI for my astigmatism?
Thanks for your reply once again. I just had some final questions that I needed some clarity on.
1) Being realistic with the options I have available to me, how would the monofocal vs the toric monofocals compare with my vision in all distances? I was told that I would need to wear glasses for a non toric monofocals even if I were set to focus on distant because my astigmatism?
2) What would be the deciding factor of whether to get a monofocal with a limbal relaxing incision versus a toric monofocal lens?
3) I'm assuming the LRI and torix monofocals are not covered by insurance (Tricare)?
1) Being realistic with the options I have available to me, how would the monofocal vs the toric monofocals compare with my vision in all distances? I was told that I would need to wear glasses for a non toric monofocals even if I were set to focus on distant because my astigmatism?
2) What would be the deciding factor of whether to get a monofocal with a limbal relaxing incision versus a toric monofocal lens?
3) I'm assuming the LRI and torix monofocals are not covered by insurance (Tricare)?
2 Comments
You hadn't mentioned what your astigmatism is, if it were small enough some people get way without correction. Since they are talking about toric lenses being an option however, the odds are its high enough that if you don't get it corrected via incision or a toric lens that you will need to wear correction for all distances.
I recall seeing people mentioning that toric monofocals and LRIs aren't covered, but you should check to be sure. Usually just the basics of cataract surgery are paid for since its required to get rid of the cataract, but they don't pay for extras to reduce the need for visual correction.
Whether to go with a toric lens or an incision is largely based on how large the astigmatism is, surgeon preference, and cost differences if that is a factor. The availability of a toric option is obviously the other issue, if you wish to get a multifocal lens in the US then an incision is the only option.
I recall seeing people mentioning that toric monofocals and LRIs aren't covered, but you should check to be sure. Usually just the basics of cataract surgery are paid for since its required to get rid of the cataract, but they don't pay for extras to reduce the need for visual correction.
Whether to go with a toric lens or an incision is largely based on how large the astigmatism is, surgeon preference, and cost differences if that is a factor. The availability of a toric option is obviously the other issue, if you wish to get a multifocal lens in the US then an incision is the only option.
You hadn't mentioned what your astigmatism is, if it were small enough some people get way without correction. Since they are talking about toric lenses being an option however, the odds are its high enough that if you don't get it corrected via incision or a toric lens that you will need to wear correction for all distances.
I recall seeing people mentioning that toric monofocals and LRIs aren't covered, but you should check to be sure. Usually just the basics of cataract surgery are paid for since its required to get rid of the cataract, but they don't pay for extras to reduce the need for visual correction.
Whether to go with a toric lens or an incision is largely based on how large the astigmatism is, surgeon preference, and cost differences if that is a factor. The availability of a toric option is obviously the other issue, if you wish to get a multifocal lens in the US then an incision is the only option.
I recall seeing people mentioning that toric monofocals and LRIs aren't covered, but you should check to be sure. Usually just the basics of cataract surgery are paid for since its required to get rid of the cataract, but they don't pay for extras to reduce the need for visual correction.
Whether to go with a toric lens or an incision is largely based on how large the astigmatism is, surgeon preference, and cost differences if that is a factor. The availability of a toric option is obviously the other issue, if you wish to get a multifocal lens in the US then an incision is the only option.
How is your vision now after getting the Symfony lens? I read it was a presbyopia correcting lens except it acts as a multifocal and not a monofocal where your vision is set to one focus? Is this true? How is your vision across all ranges?
I'm in the U.S now and the only options they seem to have in my region are monofocals, torics, multifocals, or monovision. Since I have astigmatism the surgeons did not recommend multifocals. In all honesty, it's the one I would want to do to not lose my nearsighted accomodation from myopia. The toric was a consideration; however, there are regular torics like the monofocals they only focus in one distance so I'd be needing glasses either ways was what I was told. If I were to wear monofocals and set it for distant, I would still need glasses because my astigmatism is what I had read. I'm in that hesitant situation of where I need to have my cataract removed but do not want to lose my vision accomodations that I have now from my myopia.
My ideal IOL lens would be something that gave me a broad range of vision while correcting astigmatism, something like the Trulign toric but I also read those weren't available in the U,S? Although someone else posted in their thread that it was. So I don't think I'm left with too many options, I could either go for the regular torics set for distant and wear glasses for near or go for the monofocals for distant and wear glasses for all, which isn't really appealing. I do a lot of work intermediate and neither would accomodate that vision either, so my concern is that I don't think my vision would improve (yes I'm sure my distant will) but I would lose my accomodation of nearsight and intermediate that I have now.
I'm in the U.S now and the only options they seem to have in my region are monofocals, torics, multifocals, or monovision. Since I have astigmatism the surgeons did not recommend multifocals. In all honesty, it's the one I would want to do to not lose my nearsighted accomodation from myopia. The toric was a consideration; however, there are regular torics like the monofocals they only focus in one distance so I'd be needing glasses either ways was what I was told. If I were to wear monofocals and set it for distant, I would still need glasses because my astigmatism is what I had read. I'm in that hesitant situation of where I need to have my cataract removed but do not want to lose my vision accomodations that I have now from my myopia.
My ideal IOL lens would be something that gave me a broad range of vision while correcting astigmatism, something like the Trulign toric but I also read those weren't available in the U,S? Although someone else posted in their thread that it was. So I don't think I'm left with too many options, I could either go for the regular torics set for distant and wear glasses for near or go for the monofocals for distant and wear glasses for all, which isn't really appealing. I do a lot of work intermediate and neither would accomodate that vision either, so my concern is that I don't think my vision would improve (yes I'm sure my distant will) but I would lose my accomodation of nearsight and intermediate that I have now.
2 Comments
Again as I wrote above, it depends on your level of astigmatism whether a surgeon will correct it surgically, you might consider getting another opinion if this one doesn't. Do you know how much astigmatism your prescription says you have, or better yet from any scans?
The Trulign toric has been approved by the US, it is a toric version of the Crystalens. Most people seem to get decent intermediate with the Crystalens/Trulign, though I gather a small percentage don't seem to see any better than with a monofocal which is the major reason I decided to pursue other options. It also has a higher risk of some complications than other lenses, like something called z-syndrome, but it sounds like that may not be as much of an issue with the latest generation lens. I don't have a link handy, but I've seen some surgeons suggest that perhaps half of patients need readers with that, which is much higher than with a multifocal or the Symfony. Of course you can always use a bit of monovision with the Trulign/Crystalens to get more near vision, especially in case it doesn't accommodate. A tiny bit of monovision is easier to adapt to and doesn't reduce steropsis (3D perception) as much since you are using both eyes for more of the range.
Someone who lives here wroteup his experience with the Crystalens in detail a few years ago:
http://www.komar.org/faq/colorado-cataract-surgery-crystalens/
I haven't seen studies to know for sure, but I suspect the Symfony may have better contrast sensitivity than the Crystalens since we compared near vision after a lecture we met at in a well lit auditorium. He showed me that even holding a file folder over the near vision chart to cast a shadow over it caused his near vision to be reduced, but it didn't impact mine at all. It may just be personal differences in our vision, we are about the same age so that wasn't the factor (contrast sensitivity goes down as we age).
The Symfony is considered a new category of lens, an "extended depth of focus" lens, rather than a multifocal, which is one of the reasons it isn't clear how long approval will take since they needed to decided on standards to approve extended depth of focus lenses. The optical method it uses to get a wider range of vision is different than a multifocal which leads to a lower risk of visual artifacts like halos, more comparable to the risks of a monofocal, and better contrast sensitivity (low light vision) than multifocals. Some doctors lump it in with multifocals since it isn't a monofocal.
My visual acuity is great, I am almost 20/15 at distance and I can't remember my distance vision being corrected this well with contacts/glasses. I have 20/25 at near at my best distance where I hold the near chart, and I can use a smartphone with no issues and read the fine print on eye drop bottles, though admittedly I need to find the right distance to hold it to do so. My intermediate seems comparable to distance, so likely at least 20/20 even though it hadn't been tested and also seems at least as good as it ever was with contacts.
The Trulign toric has been approved by the US, it is a toric version of the Crystalens. Most people seem to get decent intermediate with the Crystalens/Trulign, though I gather a small percentage don't seem to see any better than with a monofocal which is the major reason I decided to pursue other options. It also has a higher risk of some complications than other lenses, like something called z-syndrome, but it sounds like that may not be as much of an issue with the latest generation lens. I don't have a link handy, but I've seen some surgeons suggest that perhaps half of patients need readers with that, which is much higher than with a multifocal or the Symfony. Of course you can always use a bit of monovision with the Trulign/Crystalens to get more near vision, especially in case it doesn't accommodate. A tiny bit of monovision is easier to adapt to and doesn't reduce steropsis (3D perception) as much since you are using both eyes for more of the range.
Someone who lives here wroteup his experience with the Crystalens in detail a few years ago:
http://www.komar.org/faq/colorado-cataract-surgery-crystalens/
I haven't seen studies to know for sure, but I suspect the Symfony may have better contrast sensitivity than the Crystalens since we compared near vision after a lecture we met at in a well lit auditorium. He showed me that even holding a file folder over the near vision chart to cast a shadow over it caused his near vision to be reduced, but it didn't impact mine at all. It may just be personal differences in our vision, we are about the same age so that wasn't the factor (contrast sensitivity goes down as we age).
The Symfony is considered a new category of lens, an "extended depth of focus" lens, rather than a multifocal, which is one of the reasons it isn't clear how long approval will take since they needed to decided on standards to approve extended depth of focus lenses. The optical method it uses to get a wider range of vision is different than a multifocal which leads to a lower risk of visual artifacts like halos, more comparable to the risks of a monofocal, and better contrast sensitivity (low light vision) than multifocals. Some doctors lump it in with multifocals since it isn't a monofocal.
My visual acuity is great, I am almost 20/15 at distance and I can't remember my distance vision being corrected this well with contacts/glasses. I have 20/25 at near at my best distance where I hold the near chart, and I can use a smartphone with no issues and read the fine print on eye drop bottles, though admittedly I need to find the right distance to hold it to do so. My intermediate seems comparable to distance, so likely at least 20/20 even though it hadn't been tested and also seems at least as good as it ever was with contacts.
Hi there,
Thanks for your reply, is the Symfony lens available in the U.S? Also what eye conditions did you have as in were you nearsighted or farsighted, astigmatism or presbyopia etc? Which Symfony lens did you use? Looking forward to your reply.
Thanks for your reply, is the Symfony lens available in the U.S? Also what eye conditions did you have as in were you nearsighted or farsighted, astigmatism or presbyopia etc? Which Symfony lens did you use? Looking forward to your reply.
2 Comments
The Symfony isn't approved yet in the US, I went to Europe for it (though you'll see a recent thread on this site from someone who went to a prominent surgeon in Mexico for it recently since its now approved there, and also in Canada). I read they submitted data to the FDA, and some people guess it might be available within a year but the FDA isn't predictable, it could be longer or surprise us and be soon (unlikely).
I was very myopic (around -9.5D and -6D, before the cataract shifted that) but didn't have much astigmatism so I didn't need the toric Symfony, just the regular Symfony. When a problem cataract was first diagnosed at age 49 I was old enough to have some presbyopia, which I'd initially dealt with using contact lenses in monovision. I liked that, but then when given the option of multifocal contacts I discovered I liked those better. I'd never noticed a loss of stereopsis, 3D perception, when wearing monovision contacts, but when I switched to multifocal contacts I realized that the near world seemed subtly more 3D. I didn't mind it, but I didn't have quite as good vision in low light with the multifocal contacts, I see noticeably better with the Symfony in low light.
When I discovered I'd need cataract surgery, I didn't like the idea of losing all my near vision accommodation, even a smaller loss of it due to early presbyopia was inconvenient. Since I liked multifocal contacts, I liked the idea of trying a multifocal IOL, but I discovered at the time that in the US they only had high add bifocals, which were focused at near and distance vision, with not quite as good intermediate. I spend a lot of time at a desktop computer so intermediate was important to me for that (as well as for social distance, household tasks, even finding footing when hiking/running on trails). If I were going to risk needing to wear glasses for anything, I preferred it to be for near vision rather than intermediate. There were trifocals available outside the US I discovered which were a better bet for good intermediate than the high add bifocals (though there are now low add bifocals in the US, non-toric, that are decent for intermediate). So I tried to wait for those to be approved, and then when my cataract got too bad I gave up waiting, and then discovered the Symfony had been recently released and might be a better bet for my needs than a trifocal and went with that.
I got the 1st lens due to a cataract, not just to correct refractive error. I did get the 2nd eye done despite not having a problem cataract yet, to prevent the need for another trip when the cataract advanced in the other eye and due to a sense of imbalance when the first was done ( though I'd likely have adapted to the difference, I only had an hour or so after the patch came off the 1st eye to decide whether to do the 2nd eye before returning to the US).
I was very myopic (around -9.5D and -6D, before the cataract shifted that) but didn't have much astigmatism so I didn't need the toric Symfony, just the regular Symfony. When a problem cataract was first diagnosed at age 49 I was old enough to have some presbyopia, which I'd initially dealt with using contact lenses in monovision. I liked that, but then when given the option of multifocal contacts I discovered I liked those better. I'd never noticed a loss of stereopsis, 3D perception, when wearing monovision contacts, but when I switched to multifocal contacts I realized that the near world seemed subtly more 3D. I didn't mind it, but I didn't have quite as good vision in low light with the multifocal contacts, I see noticeably better with the Symfony in low light.
When I discovered I'd need cataract surgery, I didn't like the idea of losing all my near vision accommodation, even a smaller loss of it due to early presbyopia was inconvenient. Since I liked multifocal contacts, I liked the idea of trying a multifocal IOL, but I discovered at the time that in the US they only had high add bifocals, which were focused at near and distance vision, with not quite as good intermediate. I spend a lot of time at a desktop computer so intermediate was important to me for that (as well as for social distance, household tasks, even finding footing when hiking/running on trails). If I were going to risk needing to wear glasses for anything, I preferred it to be for near vision rather than intermediate. There were trifocals available outside the US I discovered which were a better bet for good intermediate than the high add bifocals (though there are now low add bifocals in the US, non-toric, that are decent for intermediate). So I tried to wait for those to be approved, and then when my cataract got too bad I gave up waiting, and then discovered the Symfony had been recently released and might be a better bet for my needs than a trifocal and went with that.
I got the 1st lens due to a cataract, not just to correct refractive error. I did get the 2nd eye done despite not having a problem cataract yet, to prevent the need for another trip when the cataract advanced in the other eye and due to a sense of imbalance when the first was done ( though I'd likely have adapted to the difference, I only had an hour or so after the patch came off the 1st eye to decide whether to do the 2nd eye before returning to the US).
Thank you for the reply
Are toric-multifocals available in the U.S? All the clinics I've been to did not have them. My main concern with me is that I have myopia, blepharitis, and astigmatism and if I were to choose to wear monofocal lens, not only would the lens only be able to focus in one distant making me have to choose whether to stay nearsighted or become farsighted I was told that since it does not cure astigmatism I would still have to wear glasses for ALL distances even if I were to choose to correct my distant vision. Is this true?
This is why I think the ophthalmologist recommend toric lenses, but even so I would still have to give up my other focus points since they are single focus as well. Reading the link you provided you noted that premium lenses were not much better either and since I'm in the process of developing presbyopia and even though I have myopia, eventually, I would lose my near vision, so which is why they recommend to fix it per distant. What do you think is the best option for me? (Note that I only have cataract in one of my eyes, but the surgeon still wants to eventually do both).
Are toric-multifocals available in the U.S? All the clinics I've been to did not have them. My main concern with me is that I have myopia, blepharitis, and astigmatism and if I were to choose to wear monofocal lens, not only would the lens only be able to focus in one distant making me have to choose whether to stay nearsighted or become farsighted I was told that since it does not cure astigmatism I would still have to wear glasses for ALL distances even if I were to choose to correct my distant vision. Is this true?
This is why I think the ophthalmologist recommend toric lenses, but even so I would still have to give up my other focus points since they are single focus as well. Reading the link you provided you noted that premium lenses were not much better either and since I'm in the process of developing presbyopia and even though I have myopia, eventually, I would lose my near vision, so which is why they recommend to fix it per distant. What do you think is the best option for me? (Note that I only have cataract in one of my eyes, but the surgeon still wants to eventually do both).
2 Comments
Toric multifocals aren't yet approved in the US. If your vision isn't a that bad as you say, then usually there is no problem in waiting to get surgery for a better lens to be approved, other than the fact that you are living with poor vision from a cataract in the meantime. I waited 2.5 years with a cataract in one eye that was best corrected 20/60 or worse since my other eye was still good and I was hoping they'd approve a better IOL. At first I seemed to tune out the bad eye, but eventually the eye was bad enough to distract me and I had to get the surgery.
The only concern i've read is that its better to get the operation before the cataract gets too mature and hard (or too opaque to for them to see through well, like 20/100 or worse). That won't be anytime soon unless the cataract is developing very rapidly (as it sometimes does in people atypically young for them). You'd decide it was worth getting surgery I'm sure well before that point. The issue is like getting a new computer or cell phone, the longer you wait the better options you'll have, but in the meantime you have to live with an option that isn't as good as getting something today.
Doctors often correct low levels of astigmatism during cataract surgery using incisions which cause the eye to reshape. Doctors tend to think toric lenses do better for higher levels of astigmatism, the results are more predictable, but they vary in where they draw the dividing line. If your astigmatism isn't too bad, even if they'd prefer a toric lens, it may be they'd still correct your astigmatism surgically so you could use a non-toric lens since the toric multifocal isn't available. Do you know how much corneal astigmatism you have, or at least what your prescription for astigmatism has if you don't know how much is from the cornea (some can be from the natural lens)? Some prefer to correct even fairly high levels of astigmatism using a laser to more accurately make the incisions rather than using a toric lens.
Many surgeons are cautious about multifocals, even though the vast majority of patients are happy with them since there is a small risk you may not like the side effects and wish to get a lens exchange. However If you are just developing presbyopia now then you are young enough you'll live with the results for a few decades. In my case even at age 52 when I got the surgery I figured it was worth the risk to get a premium lens (I went outside the US to get the Symfony lens), even if there was a tiny chance I might need a lens exchange, since I'd benefit from better vision the rest of my life.
The only concern i've read is that its better to get the operation before the cataract gets too mature and hard (or too opaque to for them to see through well, like 20/100 or worse). That won't be anytime soon unless the cataract is developing very rapidly (as it sometimes does in people atypically young for them). You'd decide it was worth getting surgery I'm sure well before that point. The issue is like getting a new computer or cell phone, the longer you wait the better options you'll have, but in the meantime you have to live with an option that isn't as good as getting something today.
Doctors often correct low levels of astigmatism during cataract surgery using incisions which cause the eye to reshape. Doctors tend to think toric lenses do better for higher levels of astigmatism, the results are more predictable, but they vary in where they draw the dividing line. If your astigmatism isn't too bad, even if they'd prefer a toric lens, it may be they'd still correct your astigmatism surgically so you could use a non-toric lens since the toric multifocal isn't available. Do you know how much corneal astigmatism you have, or at least what your prescription for astigmatism has if you don't know how much is from the cornea (some can be from the natural lens)? Some prefer to correct even fairly high levels of astigmatism using a laser to more accurately make the incisions rather than using a toric lens.
Many surgeons are cautious about multifocals, even though the vast majority of patients are happy with them since there is a small risk you may not like the side effects and wish to get a lens exchange. However If you are just developing presbyopia now then you are young enough you'll live with the results for a few decades. In my case even at age 52 when I got the surgery I figured it was worth the risk to get a premium lens (I went outside the US to get the Symfony lens), even if there was a tiny chance I might need a lens exchange, since I'd benefit from better vision the rest of my life.
Read this carefully then let me know what questions remain unanswered: http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You
Have an Answer?
You are reading content posted in the Eye Care Community
Top General Health Answerers
Kansas City, MO
Grand Prairie, TX
San Diego, CA
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.
