Yellow filter IOL or Clear UV-only?

[mlsline]

65-year-old working in a visual field with a cataract in one eye only and, while I think he may be overly optimistic, my truly outstanding ophthalmologist and surgeon says I may never need surgery in my other eye. I recently tried a Farnsworth-Munsell 100 test and scored zero on the first try using my non-cataract 20/20 or better 'good' eye. (A zero is a perfect score and means completely neutral color hue acuity. 16 % score 0-4 errors; Average or Normal, 68% of pop., score 16 -100; and 16% score worse than 100.) My currently blended sight is still overall clear thanks to my brain working to override 20/200 cataract vision in the one cataract eye. I can see what each eye's vision is by closing the other eye and can see that my blended vision is slightly (although increasingly) negatively affected by my cataract eye IE: not quite as clear and very slightly more yellow. (The cataract eye is now so cloudy that using it alone, most print is almost completely illegible and has a rather unattractive murky yellow color cast.) My question is whether to use a yellow Alcon Natural filter IOL or choose Alcon's clear UV filtering only IOL. I have no other vision or health issues. Will a yellow IOL, possibly more yellow than my 'good' eye, or a clear IOL, almost certainly less yellow than my 'good' eye (with perhaps lower-than-normal age-related yellowing of the human lens) blend better and work better for years to come?

[Ron_AKA]

Blue light filtering IOLs are often misunderstood. Despite being tinted yellow, they do not produce a colour rendition that is more yellow than a young person's natural eye. They are in fact designed to replicate the colour spectrum of a young natural eye as closely as possible. Clear UV only IOLs transmit much more blue light than a natural eye. So when choosing a blue light filtering lens vs a clear lens one has to decide whether you want a more blue than normal outcome or if you want to match that of the natural eye. If you are doing digital darkroom work you may want to choose the blue light filtering lens so what you see will be the same as another person with natural eyes will see. See this link to see how the colour spectrum transmission of a clear lens and blue light filtering lens compares to a young natural lens. It is also claimed that blue light filtering improves contrast sensitivity in dimmer light. FWIW I selected blue light filtering lenses for both of my eyes. Despite being tinted yellow they gave me an immediate shift toward blue compared to a cataract eye. A cataract eye is typically very yellow to almost orange if they are bad.

https://www.researchgate.net/figure/Transmission-spectra-of-the-natural-crystalline-lens-and-of-the-intraocular-lens-models_fig1_49714701

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

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

If your bad eye cataract is not due to trauma or sugery, then I would not be so confident that the 'good eye' will not surgery 'someday' since they both are obviously the same age.  Our practice has not used any yellow lens. You can do your own research but the most imporatnt thing is uV blocking. Most people if they had an otherwise normal eye would not be able to tell color differences in a clear implant or a yellow implant. Almost everyone remarks on the improvement in color vision post cataract surgery with the fomeraly 'best eye, best vision, best color' switching to the eye with the cataract after surgery. I have been doing this forum for over a decade. We get far more complaints about post operative refractive error, trouble with the eyes working together, need glasses more than expected.  You can discuss with your sugeon. This is especially important if you wear glasses now, or can read without glasses now. Our practice has moved to Light Adjusted Lens for our 'best' premium lens (IOL) and you should discuss that with your surgeon also as it allows adjustments in vision without glasses after surgery.

[mlsline]

Thanks!

At least in part, the cataract is likely from injury.

My only point regarding my other eye is that as of yet there's no apparent reason or intent to change its lens so what's there--likely at least slightly yellowed with age--will be there for a while, how long is unknown. The difference between my eyes after cataract removal is anticipated to be none or slight. I use relatively weak readers much of the time when I'm reading or working on something detailed, typically 8 hours+/day, most of which is on a screen, but can see and read at just about any distance with no correction.

Regarding color, my point is that I am very color sensitive and use my color perception in much that I do. A zero score on FM-100 would seem to indicate my vision is not biased toward blue, yellow, or any other wavelength. I'd like to keep it that way!

My ophthalmologist and I discussed various tech developments including light-adjustable lenses and I'm relying primarily on his expertise, but I like hearing from as many points of view as possible.

[Ron_AKA]

My experience with having cataract surgery with one eye for about 18 months before the second eye done was that the colour from each eye blends to somewhere between the two. When the first eye with the more advanced cataract was done with a blue light filter lens I noticed an immediate step change in colour from yellow to blue. I noticed it most on the whites on HDTV and in the skin tones of people on TV. The contrast also took a big step change up. I actually turned the contrast down on the TV to something that looked more natural. The whites did not turn blue, they just got more white.

When I switched between the two eyes my second eye was not as badly yellowed, but there was a noticeable difference. With both eyes open I got a blend of the colours, but overall much whiter and brighter. When the second eye was done, also with a blue light filtering lens, the change was not as dramatic, as the cataract was not as bad.

I would expect at age 65 if you look at the colour spectrum graphs your vision will be on the yellow side just due to age. A blue light filtering lens is likely to give you a much whiter image than your natural eyes. Still it will be closer to your natural eye than a totally clear lens. A totally clear, UV only, lens will cause a much larger shift to the blues, beyond just whiter.

Regardless we adapt to different colour spectrums just as we adapt to fluorescent lights even they they are all over the map with colour balance.

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

One thing to ask your potential surgeon "do you do LAL. As a matter of informed conscent some surgeons mention, but they don't do it, and stear the patient towards an IOL they do use