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Medical Forum / General / Vision / January 2006Quick Survey on "Accommodating" IOLs
Has anyone reading sci.med.vision ever seen any of the accommodating or multifocal IOLs in practice? If you have, please tell us which ones and any info you've learned about them. If you have not, please tell us that, too, as this input may be more important than the above. Thanks a lot. w.stacy, o.d. (I'll start, to break the ice): I've seen one case of Crystalens, implanted monocularly, which I observed 2 weeks after implantation. The vision was good, 20/25 unaided in that eye, correctable to 20/20 with -.50. There was zero measureable accommodative amplitude. No other problems, and no advantages noticed. "If you have not, please tell us that, too, as this input may be more important than the above." unless you count the few ive seen online. There has been limited success with accomodative IOLs but its drawbacks make regular IOLs preferred. Many people choose monovision or undercorrect both eyes. One guy with regular IOLs chose to be -1.5 in each eye and now he only needs reading glasses for fine print. His distance vision was decent actually and needed glasses for little more than driving. "The vision was good, 20/25 unaided in that eye, correctable to 20/20 with -.50" aha! Diopters to 20/something revealed! This confirms that -.5 diopters indeed does only cost one line of vision and is such a low refractive error its not really myopia in the sense that its a problem, per see. I consider low myopia -.75 to -2.75 and many agree with this. "There was zero measureable accommodative amplitude." This happens for some. The ciliary muscles become too weak from age and nonuse and cant push the lens to accomodate. Others retain a very limited accomodative amplitude. The best solution is readers or undercorrection. Shut the f.ck up you moron.You can't quote anecdotes when William asked for experience. For christ sake, bugger off you fuckwit. dr grant > "If you have not, please tell us that, too, as this input may be more > important than the above." > > unless you count the few ive seen online. Ace--he's perfectly capable of doing his own online work. He wanted to hear people's DIRECT experiences, of which you have none since you sit in your room in front of your computer all day when you're not doing magic mushrooms, and even then you're in front of your computer telling the world about it. Why don't you go outside and play? The weather's nice where you are.  Signature~RT > This happens for some. The ciliary muscles become too weak from age and > nonuse Isn't it nice when you can cite your own imagination as an authoritative source? -MT > Isn't it nice when you can cite your own imagination as an authoritative > source? come on dude, psychotropic drugs allow a totally untrained, inexperienced and phakic person to get the "feel" of what its like to have an IOL. right aceman? Billy boy, lots of experience with MF IOL's. They can be great when subject selected appropriately. Interestingly, patients who had diffractive IOL's (Allergan echelon) 15-20 years ago and complained at the time are now unaware of the haze and can do everything with no additional correction. Newer MF IOL's are great and most of my patients are ecstatic and spectacle free. A good surgeon, and amenable patient are required. grant > Newer MF IOL's are great and most of my patients are ecstatic and > spectacle free. That's quite a testamonial. Have you done any careful monocular refractions with near point best add testing of any specific lenses, or are you doing like the surgeons are told (and like we were when the reps were pushing bifocal soft lenses): don't test monocularly, and don't add any plus unless absolutely necessary. Also, I don't want to hear about people who can "do everything" without glasses. That is about as unscientific an analysis as I can think of. (There are plenty of single vision iol patients who can do that too). I'm most interested in the actual performance of the lenses, monocularly, which is the only way to do it, IMO. How am I supposed to compare the level of ecstacy between a MF and a SV IOL recipient? w.stacy, o.d. We used to offer the ARRAY (no longer on the market) multifocal implant to a few select patients ( they had to meet certain criteria). Many had good central vision, 20/20 - 20/30 range, near vision they have to "learn" to use the lens to see through the outer rings for near vision - so it got better depending on the patient. The biggest complaint - halos around lights. The newer lenses are supposed to have fewer side effects. But the newer lenses have a mark-up cost to the patient. The practice I work at has changed ownership, so while in the transition period we haven't started offering multifocal implants - I don't know if we will offer the new ones. > Has anyone reading sci.med.vision ever seen any of the accommodating or > multifocal IOLs in practice? If you have, please tell us which ones and [quoted text clipped - 12 lines] > with -.50. There was zero measureable accommodative amplitude. No other > problems, and no advantages noticed. > We used to offer the ARRAY (no longer on the market) multifocal implant to a > few select patients ( they had to meet certain criteria). Many had good > central vision, 20/20 - 20/30 range, near vision they have to "learn" to use > the lens to see through the outer rings for near vision - so it got better > depending on the patient. The biggest complaint - halos around lights. My biggest concern with any of the MF lenses, like the Array, is that less than half the ambient light actually has a chance of being in focus at a particular viewing distance. This has GOT to cost some acuity and some contrast sensitivity. There is no way it can't. Worse yet, it's not something that we can completely fix with glasses, ever. And the focusing lenses don't seem to focus much at all, although at least we can fix that with glasses. w.stacy, o.d. I can do some further digging to get more stats if you'd like. We didn't use it in too many, as they had to be screened and meet the criteria. Besides, some patients weren't all that motivated to "give up" glasses. >> We used to offer the ARRAY (no longer on the market) multifocal implant >> to a few select patients ( they had to meet certain criteria). Many had [quoted text clipped - 12 lines] > > w.stacy, o.d. my experience has not been positive with multifocal IOLs. i find that MOST patients acknowledge blur and haloes to at least some degree. i have two patients who are Crystalens patients. my experience is that very little accommodation is recovered. perhaps there is some small measurable amount, but in my 2 rat study i am not impressed. BTW, the company line is, it takes 1-2 months to develop accommodation with these lenses. the patient is encouraged to do accommodative exercises (pencil push-ups, etc.) and avoid using readers. > i have two patients who are Crystalens patients. > [quoted text clipped - 5 lines] > with these lenses. the patient is encouraged to do accommodative > exercises (pencil push-ups, etc.) and avoid using readers. Thanks; you're confirming my sense about it and I've got a perfect test case. A person with one crystalens and the other eye is phakic with a distance contact lens, so she's pushing it to the max every time she trys to read. We shall see... w.stacy, o.d. Have scientists never compared the corrected visual acuity of a random sample of monofocal patients with that of a like sample of multifocal patients? Perhaps a comparison of their driving (accident) records would reveal a difference? -Gordon > Have scientists never compared the corrected visual acuity > of a random sample of monofocal patients with that of a like > sample of multifocal patients? Perhaps a comparison of their > driving (accident) records would reveal a difference? > -Gordon I don't think so. Might be informative, as would be simple polling IOL wearers as to how they feel about driving at night. When we screen for multifocal implants, we highly recommend AGAINST multifocal if the patient drives much (or very far) at night. I have never seen a study on accidents of patients with multifocal IOL's. We have practically every ophthalmology journal printed sent to our office. >> Have scientists never compared the corrected visual acuity >> of a random sample of monofocal patients with that of a like [quoted text clipped - 3 lines] > I don't think so. Might be informative, as would be simple polling IOL > wearers as to how they feel about driving at night. |
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