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Medical Forum / General / Vision / October 2005

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Some cataract questions

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Roy Starrin - 30 Sep 2005 09:46 GMT
I am 71 y.o. and have been, with my eyedoc, "watching" my cataracts
develop in both eyes for some years.  I am seen a couple of times a
year for glaucoma, well controlled.  At yesterday's exam, after some
problems in seeing some of the blinking lights in a visual field, a
"glare test" and others were done.  It was determined that the RT eye
met the criteria to have Medicare pay for part of it, and because of
the difference that would exist, and the fact that my LT eye is on the
threshold, both could/should be done---one week apart.  Apart from the
test, I have been able to detect over the past couple of months that
something was going wrong with my visual acuity.
I help edit an online newspaper.  I need to go thru this with as much
vision as possible.
In my case, recommended are ReZoom multifocal IOLs.  Would appreciate
hearing fron anyone with any experience.  I have pretty well scoured
the internet, since internet research is what I do.
In talking with friends my age who have had the surgery, night
vision/driving, glare, and things of that sort seem to be one of the
more consistent types of problems.  Since we are going into the
darkest part of the year, someone suggested waiting until about next
May  for the surgery, so that I would be able to adjust my evening
schedule better thru the summer and hopefully be better able to adapt
to the following winter.
Am open to any thoughts/advice/experiences anyone wants to share on
any aspect of this.
Growing old is hell, but considering the alternative, entirely
acceptable.
TIA
Roy

Nothing is forever young and I'm not done---
  this train still runs

                                   Janis Ian
SiG - 30 Sep 2005 14:44 GMT
> I am 71 y.o. and have been, with my eyedoc, "watching" my cataracts
> develop in both eyes for some years....
> In my case, recommended are ReZoom multifocal IOLs.  Would appreciate
> hearing fron anyone with any experience.  I have pretty well scoured
> the internet, since internet research is what I do....

72 here with no glaucoma or other contras and ReSTORed in July and August.  Went
through the same preliminary exercises Googling and grouping.  The best info I
found was tech documentation from the FDA site itself that helped reconcile
'discrepancies' between my experiences and anecdotal encomia.

Although not optically equivalent, both ReZoom and ReSTOR share the common
feature of distributing incoming light rays onto two image planes for distant
and near objects and letting the brain pick that in sharper focus closest to the
retina.  The ReSTOR lens has a 4.0D internal add vs. 3.5D for ReZoom, putting
the former's images a bit farther apart.

This is most evident on a computer when your desktop is a star pattern - each
bright star is surrounded by a halo ca. 10 pixels in diameter due to the out-of-
focus distance image.  White text on a black ground is quite readable down to
the smallest fonts I can generate (#4) but the haloes can be initially a bit
distracting.  With black on white, the black halo is far less distracting but,
in any case, there's a loss in contrast for near vision that is most apparent
when trying to read yellowed paperbacks in dim light or maps intermingling
multihued lines and text.

What's rarely mentioned is the total loss of accomodation with such IOLs.  The
ReSTOR lenses come in 0.5D increments (internal).  Playing with some lenses from
the junk box, an 0.25D change from optimal distance refraction makes the
dashboard odometer readable without bending forward while maintaining 20/20
driving vision.  To achieve 20/20 or better distance vision depends on some
fortuitous parameters given the best optometry.

Presently, my uncompensated refractions are 0.25/0.75 hyperopic and the useful
binocular LCD monitor reading range is 30-55cm over which the pixel grid can be
distinguished.

The concentric glare circles from oncoming headlights is often raised as a
critical issue.  When a car first appears say 200 yds distant, these circles are
larger than the car itself, but their angular dimension doesn't seem to change
as the car approachs and, by the time it's almost parallel, the circles are no
larger than the headlights themselves.  Last night, I was out on an errand on a
two-lane country road in deer country where the unwritten rule seemed to be
high-beam, high-intensity SUVs only.  No problem with eyes diverted towards the
shoulder - the pre-IOL cataracts would have diffused a blinding light over the
entire retinas forcing a pullover for dissipation.

SiG
William Stacy - 30 Sep 2005 16:33 GMT
> I help edit an online newspaper.  I need to go thru this with as much
> vision as possible.
> In my case, recommended are ReZoom multifocal IOLs.  Would appreciate
> hearing fron anyone with any experience.  I have pretty well scoured
> the internet, since internet research is what I do.

I would stay away from multifocal IOLs.  I had bilateral IOLs installed
in Jan, 1 week apart and am loving my single vision Tecnis lenses.  I
don't have any of the glare, starbursts, blur and loss of contrast
sensitivity that you WILL get with mf iols. I'm a 61 yo optometrist and
went to one of the leading cataract surgeons in the U.S./world.

> In talking with friends my age who have had the surgery, night
> vision/driving, glare, and things of that sort seem to be one of the
> more consistent types of problems.

Unless you just can't stand the idea of using glasses for near, do NOT
do mf iols.

w.stacy, o.d.
Wayne Stidolph - 01 Oct 2005 01:38 GMT
> I would stay away from multifocal IOLs.  I had bilateral IOLs installed
> in Jan, 1 week apart and am loving my single vision Tecnis lenses.  I
[quoted text clipped - 8 lines]
> Unless you just can't stand the idea of using glasses for near, do NOT
> do mf iols.

I'm sure you considered all the accommodative options (Eyeonics et al)
...  why did you elect to avoid them?

Wayne
William Stacy - 02 Oct 2005 15:28 GMT
Because they don't work all that well (very low amounts of
accommodations) plus they require larger incisions, and are optically
not as good as the Tecnis.  Plus, even though my surgeon is doing
accommodating, he knew I wanted the crispest vision I could get, and
recommended the Tecnis. It is what he would want for his own eyes, and
he's world class.

w.stacy, o.d.

> I'm sure you considered all the accommodative options (Eyeonics et al)
> ...  why did you elect to avoid them?
>
> Wayne
Dana - 02 Oct 2005 22:24 GMT
What is a bilateral IOL? I'm not quite ready for an IOL yet, but will be
within a few years, so would like to have as much knowledge as possible
before. Thanks,

>> I help edit an online newspaper.  I need to go thru this with as much
>> vision as possible.
[quoted text clipped - 16 lines]
>
> w.stacy, o.d.
Mike Tyner - 02 Oct 2005 22:33 GMT
> What is a bilateral IOL?

An IOL with two sides? <G>

No, it means cataract surgery in both eyes, eg bilaterally.

-MT
Dan Abel - 30 Sep 2005 19:17 GMT
> I am 71 y.o. and have been, with my eyedoc, "watching" my cataracts
> develop in both eyes for some years.  I am seen a couple of times a
[quoted text clipped - 4 lines]
> the difference that would exist, and the fact that my LT eye is on the
> threshold, both could/should be done---one week apart.

[snip]

> In my case, recommended are ReZoom multifocal IOLs.

It seems to me that you have two issues to deal with here:

1.  Multifocal versus single-focus IOLs.

2.  Having the surgeries one week apart, or some other time separation.

I think the issues might be somewhat related.  I have had cataract
surgery in both eyes.  I wasn't given the option of MF IOLs, but
probably wouldn't have gone with it, based on my personality.  I was
comfortable with reading glasses, and not comfortable with new things.  
Some people don't tolerate these MF IOLs, and I wasn't willing to risk
the chance that I might be one of them.  The single vision IOLs are
tried and true.

I would think that you could simulate the MF IOLs with MF contact
lenses.  I understand that they wouldn't be the same, but I thought that
the concept of sending two images to the brain, and the brain selects
the one in focus, would be similar.  If the MF CLs don't work for you,
perhaps that means that the MF IOLs wouldn't either.

At 71, I'm guessing that you are already dealing with the problems of
seeing both near and far in focus.  What do you currently use, and are
you happy with it?  If it is working for you now, then single vision
IOLs could replicate what you are currently doing, or you could have the
surgeon set the IOLs to whatever you want.  If you decide on monovision,
I would again suggest that you simulate that with CLs and see if it
works for you.

If the MF IOLs don't work for you, after they are implanted, you have
two choices:  grin and bear it, or have the surgery redone.  If you have
both done a week apart, and the MF IOLs don't work for you, you face
having two surgeries redone.  You want to be real sure who will pay for
this.  If you space the surgeries farther apart, then you have a chance
to see how things work.  If the MF IOL just doesn't work for you, then
you just have one surgery to redo.  Of course, your vision will suffer
significantly during this time.

I would be reluctant to risk my vision by having both done a week apart,
even with the standard single vision IOLs.  Others are perfectly willing
to risk this, and it's sure a lot more convenient.

If you can easily put this off until there is more light, that might be
a plan.  If your cataracts are bad enough that they are significantly
reducing your night vision right now, the surgery might possibly be
enough benefit to counteract possible problems with glare, starbursts
and such.  I was already in the position that I had my wife or kids
drive me at night, so putting it off didn't help any.
Roy Starrin - 01 Oct 2005 15:21 GMT
> I was
>comfortable with reading glasses, and not comfortable with new things.  
First. Thanks for the reply (as well as a thank you to all who
responded.  Before reading any of these, however, I emailed  myeyedoc
this a.m., told him I couldn't clear my schedule and felt very rushed.
To ld him we would do it after next  Easter (as they days are getting
longer), but that he would need to sit with me and discuss the
pros/cons of all available options with me so that we could make a
decision together.(I hate to say it, and I really trust this guy who
helped me greatly in stopping glaucoma deterioration, but I'm
suspicious by nature, and thru all of this all I could think of was
the bigger the sale, the bigger the commission (aka kick-back).

>I would think that you could simulate the MF IOLs with MF contact
>lenses.  I understand that they wouldn't be the same, but I thought that
>the concept of sending two images to the brain, and the brain selects
>the one in focus, would be similar.  If the MF CLs don't work for you,
>perhaps that means that the MF IOLs wouldn't either.
Have never worn contacts, but would be willing to see if this would
work---if he is

>At 71, I'm guessing that you are already dealing with the problems of
>seeing both near and far in focus.  What do you currently use, and are
>you happy with it?
I have tri-focals, and would not mind a pair of glasses/bifocals  for
reading/computing, and/or a half pair for driving.
> If it is working for you now, then single vision
>IOLs could replicate what you are currently doing, or you could have the
>surgeon set the IOLs to whatever you want.

Not sure I'm clear on this.  DI I not

> If you decide on monovision,
>I would again suggest that you simulate that with CLs and see if it
>works for you.
>>I would be reluctant to risk my vision by having both done a week apart,
>even with the standard single vision IOLs..
I'm coming to this conclusion myself

>If you can easily put this off until there is more light, that might be
>a plan.  If your cataracts are bad enough that they are significantly
>reducing your night vision right now, the surgery might possibly be
>enough benefit to counteract possible problems with glare, starbursts
>and such.  I was already in the position that I had my wife or kids
>drive me at night, so putting it off didn't help any.
Not there yet.  That's why I believe I can wait 'til spring.  Readings
were just above and just below whatever the threshold is.
Again, thanks very much
BTW, this is the clinic:  http://www.beacheyecare.com/
I came to it because my previous gent was running a factory and goofed
once (which was too often when it comes to one's eyes)
Dan Abel - 01 Oct 2005 18:04 GMT
> >At 71, I'm guessing that you are already dealing with the problems of
> >seeing both near and far in focus.  What do you currently use, and are
> >you happy with it?

> I have tri-focals, and would not mind a pair of glasses/bifocals  for
> reading/computing, and/or a half pair for driving.
[quoted text clipped - 3 lines]
>
> Not sure I'm clear on this.  DI I not

I'm a lay person, and no vision expert.  However, I don't believe that
MF IOLs are the standard.  They are for people who want them badly
enough.  If you are happy with what you have now, then I don't see any
reason for you to go with MF IOLs.

I'll make things really simple in this paragraph.  Little kids can
focus.  They can see things up close, and they can see things far away,
all without switching correction.  As we get older, most of us lose that
ability.  This usually happens in the 40s.  We then get reading glasses,
bifocals, trifocals, progressives, half glasses, or else we just don't
see very well.  Most people accept this as a price of getting old.  Some
people really hate this and would do anything to be able to see both
near and far without any of those aids I mentioned.  These are the
people who get MF IOLs.  They will be able to see both near and far
without switching lenses or any of those other things.  Unfortunately, I
understand that they don't always work very well.

I couldn't recommend that you get MF IOLs unless you are really clear
about all of the above.  A lot of people don't want to become experts at
this.  Those people will let the doctor chose the power, but they will
normally get single focus IOLs.

If your doctor talks you into MF IOLs, and you find after the surgeries
that they just don't work for you, you will have no choice but to have
the surgeries redone.

I would recommend that you continue doing internet research on this, and
continue talking to others who have been through this.  I also found
that my OD was very helpful.  Although he doesn't do surgery, he is very
familiar with what is done and what the concepts are.  I think that you
are wise to put this surgery off, so you will have a chance to find out
your options.  

A talked quite a bit with a lady at work, who had her cataract surgeries
done about a year before mine.  She wasn't interested in discussing the
different options, and cut me off every time I tried to talk about them.  
She pointed to her trifocals, and said that she just loved them and was
very happy with her vision.  She was insistent on having those very same
trifocals after the surgery.  After the surgeries she did in fact have
the very same trifocals, but with different lenses.  The top section had
no correction at all.  When I tried to point out that it didn't make
sense to me, she replied that she was very happy with them, and they
were just what she wanted.  I couldn't argue with that.
Roy Starrin - 02 Oct 2005 15:54 GMT
>I'm a lay person, and no vision expert.  However, I don't believe that
>MF IOLs are the standard.  They are for people who want them badly
>enough.  If you are happy with what you have now, then I don't see any
>reason for you to go with MF IOLs.
SNIP

>I couldn't recommend that you get MF IOLs unless you are really clear
>about all of ...
the implications stated
Gotcha!!!
SNIP
>After the surgeries she did in fact have
>the very same trifocals, but with different lenses.  The top section had
>no correction at all.  When I tried to point out that it didn't make
>sense to me, she replied that she was very happy with them, and they
>were just what she wanted.  
I sort of thought that with a plain IOL  I would wind up like this
lady, or with the needed close-correction set into bifocal half
glasses; unless there was a single lens capable of of covering the
entire spectrum from the end of my nose to where ever the IOL took
over.  As I said, I don't mind wearing glasses.  I guess that meyedoc
thought that my stated goal of the sharpest vision possible across the
entire distance spectrum had to be done within the IOL world.  It
doesn't.
Thanks again for the help, and I'd really like to hear from anyone
else with an opinion on this. Certainly the five of us writing are not
the only ones reading the thread who have had cataract surgery????
William Stacy - 02 Oct 2005 16:31 GMT
 Certainly the five of us writing are not
> the only ones reading the thread who have had cataract surgery????

Could be.  I doubt that more than a couple hundred people total *ever*
read any of s.m.v.  Of course there's no way to know how many lurkers
there are, but over the years, I'm still guessing about 200.

w.stacy, o.d.
William Stacy - 02 Oct 2005 16:25 GMT
I'm the same.  Ended up not really "needing" glasses for most things,
but don't feel quite right without them (after 40 years of wearing
them), so went back to progressives for most things, even though the
tops are almost zero. It's nice to have the small print in focus without
having to reach for the specs, since they're already there, where they
belong, on my nose...

w.stacy, o.d.

> A talked quite a bit with a lady at work, who had her cataract surgeries
> done about a year before mine.  She wasn't interested in discussing the
[quoted text clipped - 6 lines]
> sense to me, she replied that she was very happy with them, and they
> were just what she wanted.  I couldn't argue with that.
William Stacy - 02 Oct 2005 15:17 GMT
> I would think that you could simulate the MF IOLs with MF contact
> lenses.  I understand that they wouldn't be the same, but I thought that
> the concept of sending two images to the brain, and the brain selects
> the one in focus, would be similar.  If the MF CLs don't work for you,
> perhaps that means that the MF IOLs wouldn't either.

As much as I'd like to go along with that idea, the problem is that he
can't get a decent preview because not only are the optics different,
he'd also be looking through his cataracts, which will make ANY contacts
blurry.

> I would be reluctant to risk my vision by having both done a week apart,
> even with the standard single vision IOLs.  Others are perfectly willing
> to risk this, and it's sure a lot more convenient.

I think with modern small incision procedures, the healing time is so
rapid that 1 week is plenty. I could tell the day after surgery that I
wanted the same thing done in the other eye. My refraction has varied
only slightly from day 1.

I've been looking very critically at my night vision, and even with my
prolate surface Tecnis lenses, I get minor starbursts around lights. I
will not recommend multifocal IOLs to anyone until and unless they make
a major breakthrough in the optics. They have not.

w.stacy, o.d.
Roy Starrin - 02 Oct 2005 15:38 GMT
In looking at IOL implants, I was also a bit concerned over the
driving problem and other shifts in focus during the period between
surgery on each eye and/or when wearing the "dark glasses" as well as
"safety glasses" later. A woodworkers catalog fell out of the sky
yesterday with a  selection for stick-on magnifying lenses.  A little
research  (GOOGLE  "Stick-on" "magnifying lenses" ) revealed that they
are available.  Most appear to be made by an outfit called Optx20/20.
Walgreens seems to carry them.  So, I just pass the info along in case
it might be of value to anyone
 
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