How is your vision after Cataract Surgery?

[orbitnw]

How is your vision after Cataract Surgery?
Please specify whether you got a monofocal or multifocal/accommodative IOL.

I would like to know what distances you are able to see clearly. What distances are slightly blurry, but acceptable, and what distances are just unbearably blurry.

I am particularly interested in those who have received Monofocal IOL set to Distance but I would also really appreciate hearing those experiences with different IOLs. I have heard from several people that with a IOL Set to Distance, they are still able to use the Computer at about 18 inches. This has confused me since I had thought IOL set to distance makes intermediate distance blurry.

Thanks!

[SoftwareDeveloper]

The intraoperative measurements are an area which are still under debate among surgeons, just like with laser surgery.

http://bmctoday.net/crstodayeurope/2014/09/article.asp?f=pointcounterpoint-does-intraoperative
"POINT/COUNTERPOINT: DOES INTRAOPERATIVE ABERROMETRY MATTER?
Point: For those who consider themselves refractive cataract surgeons, this technology helps to nail the target refraction.
By Stephen G. Slade, MD; and Jonathan H. Talamo, MD
Counterpoint: Intraoperative aberrometry is not yet the best answer to guide the surgical refractive plan in cataract surgery. "

http://bmctoday.net/crstodayeurope/2013/03/article.asp?f=pointcounterpoint-is-intraoperative-aberrometry-worth-the-investment
"Point/Counterpoint: Is Intraoperative Aberrometry Worth the Investment?
Surgeons weigh in on the value of this technology in cataract surgery."

The issue is that the eye's state during surgery differs and the measurements some suspect are misleading. Since the results are based on statistical analysis of data (i.e. based on the out come they can compute what would have worked for a particular set of measurements) I would suspect that due to fewer highly myopic people that it might take longer before their results to be good (or perhaps not, if the glitches with myopic eyes turn out to be due to measurement errors which don't apply).

I don't know if the light adjustable lens might something to consider then since it provides extended depth of focus and astigmatism correction (though I don't know for sure if it'll do both at the same time), though its still in trials, there are some reports of patients on this site doing it.

[GreenBikeRider]

Thanks again, SD. Yes, i am very myopic. My surgeon uses a system called ORA that allows the surgeon to have a final check on calcs of power and sphere, during the procedure.

www.myalcon.com/products/surgical/ora-system/index.shtml

At least thats what Ive surmised. Reading is kinda tough just now.

[SoftwareDeveloper]

They are actually studying using an extended depth of focus pattern for the Light Adjustable Lens, an article from January mentions these are the results from Dr. Chayet, whose Mexican clinic   is walking distance from the US border in California:

http://reviewofophthalmology.com/content/i/3110/c/52313/
"In a study of binocular vision results in 20 ABV patients at Dr. Chayet’s practice, 75 percent could see 20/16 or better at distance after lock-in. Eighty-five percent now see 20/20 or better and 100 percent see 20/32 or better. In terms of binocular intermediate vision at 60 cm, 60 percent see J1+ versus zero patients preop, 75 percent see J1 versus 20 percent at this level preop and 100 percent see J2 or better compared to 45 percent preop. Ninety percent see J2 or better binocularly at near (40 cm) versus 15 percent preop. Fifty-five percent now see at least J1, compared to 5 percent who could see that well preop. "

[SoftwareDeveloper]

I'm guessing you mean the lens power is +5 (rather low) and a monofocal, rather than that being the add for a bifocal. Hopefully if you are that myopic they got the lens power right, since it isn't an exact formula but is instead based on statistics and for various reasons is more likely to be off for high myopes, as this page explains (somewhat technical):

http://www.doctor-hill.com/iol-main/extreme_axial_myopia.htm

That doctor apparently will consult for other surgeons on lens power choices in unusual cases.

Actually there is a toric version of the Symfony out now, with comparable results. Regardless the estimates I've seen suggest it won't be FDA approved until perhaps 2017, though as I said there are clinics in Canada that expect it to be available there within 1-2 months. Most multifocal lenses use diffractive optics, and many have toric versions.

btw, for those who are considering a monofocal, the Symfony is (or soon will be) in clinical trials in the US but it is randomized with a monofocal so you have a 50-50 shot. Unfortunately such trials usually exclude those with other eye conditions so that wouldn't be an option in your case, and I also don't know if it includes the toric version.

For those using a monofocal where it may be hard to get the lens power right, if the astigmatism is low, one option is the light adjustable lens (not yet available here either) which lets the fine tune the lens power after implantation (though the astigmatism has to be fairly low I seem to recall, but I hadn't checked lately).  The light adjustable lens is available from a prominent surgeon in Mexico, Dr. Chayet, who is just over the border from San Diego (I think there are posts on this site from at least one person who went there).

. Outside the US there are a number of other lens choices in addition to the Symfony like trifocals (which also have reduced halos&glare) and even lower add bifocals like Lentis +1.5D and +2D.

[GreenBikeRider]

You're right - I should mentally separate the Procedure from the IOL's themselves. The Symfony, however it works, would give me a grater "in-focus" range. I'm 6 days away from the having the first eye done with a +5 Tecnis Toric  and I don't think that a Toric Symfony is coming along anytime soon. In fact, if I understand the "diffractive" part of its function, I wonder if it's even a possibility.

I once considered having a non-FDA Approved Hip Resurfacing done in Belgium, back when I was in need of it. I ended up chickening out and limping around for another two yeas til the FDA approved the device here. If I thought that there was something better in the works in a matter of months, I would "limp along" for them as well.

My Cataracts are fairly mild. My biggest, most threatening t visual issue is my Macular Hole. I had an OCT scan done yesterday, and I was actually giddy to learn that it has not increased in size since October. Since the vitrectomy procedure for Macular Hole just about guarantees a cataract, and the surgeon's view is improved by having the clearest possible lens to see thru. I hate to remove my crystalline lens, just to prep for another, later Retinal surgery. But I see no way around it. Pun intended.

[SoftwareDeveloper]

re: "He suggested that I try to see a very good optician, who might be able to provide some color filtering that may improve my contrast,"

Also using higher abbe material might make a slight difference. I don't know how much of a difference customized wavefront lenses might make like the Zeiss iScription lenses.   (I wore contacts before my surgery so I decided it wasn't worth it for only rare backup use so I didn't research them in detail)

http://www.zeiss.com/vision-care/en_us/better-vision/products---technologies/i-scription-lenses.html
"i.Scription® lenses by ZEISS offer a new approach for better vision — enjoy clearer vision with better contrast"


re: "Consequently, I don't have much faith in the Snelling eye chart results because it's only measuring my visual acuity under certain contrast conditions,"

Many eye surgeons share that concern since they realize obviously vision can be impacted in ways that aren't tested by that. I don't have links handy, but I've seen a number of articles in the past talking about concerns about testing people for glare&contrast sensitivity issues, and about revising their approach as to how to advice people in terms of when they should get surgery. You might check for the articles and see if a local doctor does other tests, though of course the real concern is when you subjectively think your vision is reduced to the point where you think its worth the risk/benefit tradeoffs to   get the surgery done.

Obviously the longer you wait, the better the lens technology will become, and the more potential there is for say improved laser cataract technology to get to where it makes a demonstrable difference. The other concern is of course whether or not insurance will pay for the surgery since although some have been updating their approval criteria to make them more flexible, many rely  on the Snellen visual acuity test (I don't know how common each approach is now). Hopefully if they go by snellen acuity, then if your vision is fluctuating then if you keep getting tested perhaps on a bad day you'll meet their criteria and get approval.