Medical Forum / General / Vision / July 2006
Which IOL Is Best For Me?
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GovtLawyer - 28 Jul 2006 04:31 GMT I just found this group, and I'm sure your answers to my question will help me in making an upcoming decision.
First, some background. I am 56 years old and one eye is very Myopic. I wear a -12 contact lens, which is not a 100% prescritption. My other eye is almost perfect. My eye refraction has been fairly stable over the last three years; lens going from -11 to -12 two years ago. This last year my good eye changed very slightly to a +.5, but I haven't corrected it. I use reading glasses for almost 10 years, and they are a now at +2. Recently, it has become difficult to wear the contact lens. I even have trouble putting it in. Sometimes, I can wear it for almost two weeks and then throw it away. Other times, one or two days after putting it in, I get up in the middle of the night and my eye feels like its in a vise. Today's Dr. told me the eye was rejecting the lens, and it will become increasingly more difficult for me to waer a lens (something that has become more apparant over the past few years) So, the contact lens is no longer much of an option. If I could continue using a contact lens, then peering over reading glasses or taking them on and off, is not that much of an inconvenience. I am very athletic and play softball every week from March to October, and golf most weeks during the same time. I ride a bicycle. I spend a lot of time in front of a computer, at work and at home.
So, while investigating possible solutions, it has been impressed upon me by my regular Doctor, who does cataract operations, but not lasik, and a Lasik/IOL doctor I went to today, that the best solution for me is a Clear Lens Extraction. It appears that the implantable lenses aren't optimized for those over 40-45 years old, and the CLE is very effective. Also, I am likely to get a cataract in that eye anyway, as I grow older. The Dr. took many measurements and pictures of my eye today, and commented that I have a small pupil, which he said was good. I have no idea why it is.
So, I'm trying to decide whether I want to go with a Restor, which the Doctor today suggested, or a monovision implant, done by my regular doctor. As the Dr. today told me, I have a unique situation in that I have a very good dominant eye, and I have been, in effect, using this eye primarily through the years, even while wearing a contact lens in the other eye. I am concerned about the Halos and other drawbacks to using the Restor, but I'm not sure it would affect me as I would still be relying on my dominant eye. On the other hand, I would be okay with a monovision lens and the continued use of reading glasses. Still, one wants to get the best possible outcome, the first time with such an operation, so I want to seriously consider all my options. The Dr. I saw today seemed fairly confident that I would adjust well, in part due to the Restor lens and in part due to having a good dominent eye. In addition, as part of the contract, he would perform Lasik for free for the next two years, if that would help adjust the vision in the lens with the CLE.
Obviously, the most important things for me are that I can continue to play ball without having any Depth of Field or peripheral vision issues. I would not like it at all if halos became a big problem. I would prefer the shortest period of adjustment, no matter which lens I chose.
I hope I've given the experts in this group enough information for you to help me make an informed decision. Thanks . . . Steven
Glenn - USAEyes.org - 28 Jul 2006 04:52 GMT We have a detailed article about Refractive Lens Exchange (RLE, aka CLE) at http://www.usaeyes.org/lasik/faq/lasik-cle-iol-rle.htm that you may find helpful. I'll add a few observations.
Myopia (nearsighted, shortsighted) vision is a risk factor for retinal detachment because the eye is elongated and this will stretch the retina. If your eye is more than 12.00 diopters myopic, then you are undoubtedly at an elevated risk for retinal detachment. RLE is relatively traumatic to the retina, even with today's advancements. You absolutely should be evaluated by a retina specialist before having elective surgery and discuss with that specialist retina issues regarding RLE.
Before opting for a multifocal intraocular lens (IOL) implant, try a multifocal contact lens. This will give you a simulation of the effect.
Before opting for monovision, try it with contact lenses (although it sounds like that is what you are doing now). Be sure to comprehend the reality of monovision rather than the concept. We have a detailed article about monovision surgery at http://www.usaeyes.org/lasik/faq/lasik-monovision.htm
If considering a multifocal lens, understand your vision needs well. The ReSTOR IOL puts more emphasis on near and distance vision at the expense of mid-distance vision. The ReZoom more evenly distributes its multifocal properties, but this can provide a general reduction in vision quality. I recently made a detailed posting about this issue that you can read at http://tinyurl.com/oenlr
Choose carefully based upon your needs, and be sure your surgeon has extensive practical knowledge with both types of multifocal IOLs.
It sounds like you are wearing your contacts 24/7. Even if the contacts are rated for this, giving your eyes a rest at night and even wearing glasses on occasion may be enough of a respite that the irritation you are suffering may be resolved. I'm sure the optometrists who frequent this newsgroup will have ideas on that issue.
Glenn Hagele Executive Director USAEyes.org Patient Advocacy Surgeon Certification
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org http://www.ComplicatedEyes.org
I am not a doctor.
GovtLawyer - 28 Jul 2006 17:53 GMT > We have a detailed article about Refractive Lens Exchange (RLE, aka > CLE) at http://www.usaeyes.org/lasik/faq/lasik-cle-iol-rle.htm that [quoted text clipped - 49 lines] > > I am not a doctor. GovtLawyer - 28 Jul 2006 17:54 GMT > We have a detailed article about Refractive Lens Exchange (RLE, aka > CLE) at http://www.usaeyes.org/lasik/faq/lasik-cle-iol-rle.htm that [quoted text clipped - 8 lines] > having elective surgery and discuss with that specialist retina issues > regarding RLE. The doctor told me I MUST have a consultation by a retina specialist before the surgery, and he would set it up for me. So, apparantlty, you're on the same page. He said I have a 1 in 4000 chance of RD just with my Myopia and a 5 in 4000 or 1 in 800 with the surgery. So, he made me aware that the risks are greater.
> Before opting for a multifocal intraocular lens (IOL) implant, try a > multifocal contact lens. This will give you a simulation of the > effect. A good idea. I should try it.
> Before opting for monovision, try it with contact lenses (although it > sounds like that is what you are doing now). Be sure to comprehend the > reality of monovision rather than the concept. We have a detailed > article about monovision surgery at > http://www.usaeyes.org/lasik/faq/lasik-monovision.htm Thank you, I'll most certainly read it.
> If considering a multifocal lens, understand your vision needs well. > The ReSTOR IOL puts more emphasis on near and distance vision at the > expense of mid-distance vision. The ReZoom more evenly distributes its > multifocal properties, but this can provide a general reduction in > vision quality. I recently made a detailed posting about this issue > that you can read at http://tinyurl.com/oenlr Thank you, I'll read that as well. While I realize each lens has some drawbacks, isn't my dominent and good eye going to compensate?
> Choose carefully based upon your needs, and be sure your surgeon has > extensive practical knowledge with both types of multifocal IOLs. We didn't discuss the ReZoom. He used to do the Crystallens, but said he no longer does as it loses its effectiveness.
>It sounds like you are wearing your contacts 24/7. Even if the > contacts are rated for this, giving your eyes a rest at night and even > wearing glasses on occasion may be enough of a respite that the > irritation you are suffering may be resolved. I'm sure the > optometrists who frequent this newsgroup will have ideas on that > issue. I do give them a rest occassionally, not always by design. I understand that glasses are out of the question. For one, they would look odd, as one eye would be thick and the other plain glass. Also, I understand the difference between the eyes is more disorienting with glasses than contacts, etc.
> Glenn Hagele > Executive Director [quoted text clipped - 9 lines] > > I am not a doctor. Thanks for your help.
Mike Tyner - 28 Jul 2006 07:35 GMT > I hope I've given the experts in this group enough information for you > to help me make an informed decision. Thanks . . . Steven It sounds like you've been wearing monovision, essentially, since the -1200 contact was undercorrecting.
If you had to wear +2.00 over that, then your myopic eye doesn't contribute much (ie your other eye is strongly dominant.)
So it won't really matter which type of IOL you choose - you probably won't favor the IOL eye any more after surgery than before.
Clear lens extraction is still an excellent choice, but I'd consider using the simplest IOL, to match the fellow eye, and count on the same reading glasses after surgery. Not elegant, but very satisfactory vision and a safer procedure if the cornea isn't in peak condition.
-MT
GovtLawyer - 28 Jul 2006 22:44 GMT > > I hope I've given the experts in this group enough information for you > > to help me make an informed decision. Thanks . . . Steven > > It sounds like you've been wearing monovision, essentially, since the -1200 > contact was undercorrecting. Yes, as the doctor explained, I have been favoring one eye for many years, even when wearing the lens.
> If you had to wear +2.00 over that, then your myopic eye doesn't contribute > much (ie your other eye is strongly dominant.) Not sure what you mean by this.
> So it won't really matter which type of IOL you choose - you probably won't > favor the IOL eye any more after surgery than before. So, it seems the doctor is saying. Basically, as I understand it, he is saying I'll avoid some of the usual multifocal RLE pitfalls because my dominant eye will continue to remain dominant. What I don't understand is the reading part of this. Even my dominane eye needs reading glasses. So, if I get a multifocal, won't my uncorrected eye still need reading glasses? Unless, the new implant takes over for reading.
> Clear lens extraction is still an excellent choice, but I'd consider using > the simplest IOL, to match the fellow eye, and count on the same reading > glasses after surgery. Not elegant, but very satisfactory vision and a safer > procedure if the cornea isn't in peak condition. Definitely a choice, which is why I'm asking these questions. If I see as well as now or better than I do now with a monofocal lens, I could live with continued use of reading glasses.
Mike Tyner - 29 Jul 2006 01:21 GMT >> If you had to wear +2.00 over that, then your myopic eye doesn't >> contribute >> much (ie your other eye is strongly dominant.) >> > Not sure what you mean by this. It means if you occlude or blur the good eye, you find it very noticeable and probably unpleasant.
If you occlude or blur the myopic eye, you'll hardly notice the difference.
If your myopic eye were suddenly made perfect, you would still pay more attention to the other eye.
> So, it seems the doctor is saying. Basically, as I understand it, he > is saying I'll avoid some of the usual multifocal RLE pitfalls because [quoted text clipped - 3 lines] > still need reading glasses? Unless, the new implant takes over for > reading. You're approaching my point. I don't think the new implant will "take over" and even if it provides good near vision, you'll want reading glasses because you'll still pay more attention to the other eye.
-MT
Dick Adams - 28 Jul 2006 13:51 GMT A doctor who is recommending a multifocal IOL with repetitive lasik trims would worry me (as a consumer of eyecare services).
Best advice I got for implants was "find a surgeon who does many of them".
If he is doing them right, aftercare will not be a significant consideration. Probably, also, he is not recommending multifocal IOLs, since his considerable experience by now has probably suggested they are not generally the best idea.
My guy, who, incidentally does also offer lasik, corrected much of my astigmatism by knowing where and how to make the insertion opening. Aftercare was some checking, and a refraction (by an OD in the surgeon's office, the surgeon being too busy with surgery for that).
Lasik surgery success is not quite on a par with IOL-implant success, as I understand it.
-- Dicky (not professional)
GovtLawyer - 28 Jul 2006 17:44 GMT > A doctor who is recommending a multifocal IOL with repetitive lasik trims > would worry me (as a consumer of eyecare services). [quoted text clipped - 18 lines] > Dicky > (not professional) GovtLawyer - 28 Jul 2006 17:44 GMT > A doctor who is recommending a multifocal IOL with repetitive lasik trims > would worry me (as a consumer of eyecare services). [quoted text clipped - 18 lines] > Dicky > (not professional) GovtLawyer - 28 Jul 2006 17:44 GMT > A doctor who is recommending a multifocal IOL with repetitive lasik trims > would worry me (as a consumer of eyecare services). [quoted text clipped - 18 lines] > Dicky > (not professional) GovtLawyer - 28 Jul 2006 17:45 GMT > A doctor who is recommending a multifocal IOL with repetitive lasik trims > would worry me (as a consumer of eyecare services). > > Best advice I got for implants was "find a surgeon who does many of > them". Perhaps I misstated. He is not suggesting repetitive lasik. Rather, he told me that IF NEEDED, as my eye might change, or I may have some difficulty adjusting, he would fine tune it at no charge for two years. The impression he gave me was that he expected the Restor to be a good fit for me.
> If he is doing them right, aftercare will not be a significant consideration. > Probably, also, he is not recommending multifocal IOLs, since his > considerable experience by now has probably suggested they are not > generally the best idea. He IS recommending Multifocals, and he has done several thousand cataract surgeries, and thus several thousand implants. His credentials seem quite solid.
> My guy, who, incidentally does also offer lasik, corrected much of my > astigmatism by knowing where and how to make the insertion opening. [quoted text clipped - 5 lines] > > -- I cannot have just Lasik, as it would not improve my vision enough. I am too far gone for Lasik.
> Dicky > (not professional) Dr. Leukoma - 28 Jul 2006 14:09 GMT If distance vision is a priority, I would avoid a multifocal IOL. Most of the optics for the distance vision is outside of the 3 mm central zone. Not good for a small pupil. Even though your other eye is dominant, this could break down under certain situations.
DrG
> I just found this group, and I'm sure your answers to my question will > help me in making an upcoming decision. [quoted text clipped - 54 lines] > I hope I've given the experts in this group enough information for you > to help me make an informed decision. Thanks . . . Steven doctor_my_eye@msn.com - 28 Jul 2006 21:32 GMT I think Mike and Dr Leukoma are both right on. The human lens is typically about 13-14 Diopters of plus, and a clear lens extraction with no implant would make you close to emmetropic. At that point your glasses or contacts will be thin and much easier to wear in any case.
> If distance vision is a priority, I would avoid a multifocal IOL. Most > of the optics for the distance vision is outside of the 3 mm central [quoted text clipped - 62 lines] > > I hope I've given the experts in this group enough information for you > > to help me make an informed decision. Thanks . . . Steven GovtLawyer - 28 Jul 2006 22:27 GMT > I think Mike and Dr Leukoma are both right on. The human lens is > typically about 13-14 [quoted text clipped - 8 lines] > > > > DrG I'm not sure what you mean? Are you suggesting I not have a replacment, just a Clear lens Extraction? Then, I can wear contacts or thin glasses? If so, I do not intend to wear contacts again, as I can't tolerate them anymore, and I will only wear reading glasses, which is what I do now. Obviously, if I could get rid of them at the same time, that would be good.
doctor_my_eye@msn.com - 29 Jul 2006 16:34 GMT When you go through your pre-operative examination for cataract surgery, the doctor does a test called a B-scan that determines the dioptric power of your human lens and helps him to determine what power you would need in an implant to achieve clear vision. Yes, when you do simple math in your head, a 12 Diopter myope is an excellent candidate for clear lens extraction with no implant. Your doctor would be able to do the actual math from that scan and determine if you would be a mild myope or hyperope after extraction of your lens. In any case, you would end up something between +/- 2.
> > I think Mike and Dr Leukoma are both right on. The human lens is > > typically about 13-14 [quoted text clipped - 15 lines] > which is what I do now. Obviously, if I could get rid of them at the > same time, that would be good. GovtLawyer - 28 Jul 2006 22:47 GMT > If distance vision is a priority, I would avoid a multifocal IOL. Most > of the optics for the distance vision is outside of the 3 mm central [quoted text clipped - 5 lines] > >What do you mean by "break down?" My doctor seemed pleased that I had a small pupil.
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