Intraocular Lens-Cataracts with Perifoveal telangectasia (aka Macula Telangectasia)

[isbloomfield]

I am 69 years old and my cataracts have gotten bad enough to finally need operation and an artificial lens implant. I have had perifoveal telangectasia on my left eye retina for about 5 years - no worse and apparently now have it on my right eye as well although much less. They assure me my vision loss is mostly from the cataracts. From the retina only some wavy lines and an occasional dropped letter. Apparently not as bad as say macular edema.

The eye surgeon said he does not want to use the new panoptix multifocal lens that gives good far and near vision because of the retina issue. He only wants to use the basic monofocal lens as less likely to have problems.  At first he thought he could use the panoptix in my right eye but then changed his mind when he saw the OCT which showed some slight changes. I have seen opinions both ways about use of these lenses in people with retinal disease in my research from different eye surgeons.

I would love to no longer need glasses, if possible. I understand is conservative to go with monofocal but sometimes we can be too conservative and miss out on some great benefits of the newest technology.

I looking for any guidance one of the doctors on the board can speak to , or if anyone on this board has retinal issues and has had one of the newer multifocal lenses.

Also I have seen something about a new "light adjustable" lens. It is a monofocal but you can fine tune the focus after the surgery to really get the best vision. I'm thinking if I need a monofocal why not get really perfect far vision. It also is newer.. so looking for anyone who has experience with this lens or if it also would be a problem for someone with a retina concern.

Thanks much!!

[JohnHaganMD]

Your surgeon is making good recommendations.  Patients with macular pathology should generally avoid multifocial type IOLs.  The light adjustable IOL would not keep you out of glasses only allow adjustments to be made in the post operative period.

[isbloomfield]

Thanks Dr. Hagan. Do you have any general guidance ie the light adjustable vs the standard monofocal lens. I know would need glasses with either. Just trying to understand how much of an advance the light adjustable is... ie the company marketing vs reality/experience? Thanks much.

[JohnHaganMD]

Our practice at Discover Vision Centers in Kansas City, Missouri, USA was one of 3 sites testing the light adjustable in the USA.  The results are excellent but it is more expensive, many surgeons do not have experience with it.  Most surgeons can come within +/- 0.50 diopter of planned target in spherical eyes.   It is very helpful where the eye is abnormal and standard IOL formulas not as accurate: eyes with previous RK,  Keratoconus eyes, scarred corneas, previous corneal transplant or LASIK etc.

[JohnHaganMD]

Our practice at Discover Vision Centers in Kansas City, Missouri, USA was one of 3 sites testing the light adjustable in the USA.  The results are excellent but it is more expensive, many surgeons do not have experience with it.  Most surgeons can come within +/- 0.50 diopter of planned target in spherical eyes.   It is very helpful where the eye is abnormal and standard IOL formulas not as accurate: eyes with previous RK,  Keratoconus eyes, scarred corneas, previous corneal transplant or LASIK etc.

[isbloomfield]

Thanks Dr. Hagan. That was very helpful. One last question. I went to your practice website and I saw you all offer something called Full Focus Vision Correction. Can you please tell me which accommodating lens you all use for this procedure? I'm assuming this would work better to give me a wider range of vision without the problems of a multifocal because of my retina issue. Thanks much.

[isbloomfield]

Thanks Dr. Hagan. One last question. I see your practice offers - Full Focus Vision Correction. I'm assuming is an accommodating lens. Can you please tell me which lens or system you all use for this program? Thanks again.

[JohnHaganMD]

Our practice uses the crystalens accommodating IOL but with your macular problems would not put in.