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Medical Forum / General / Vision / May 2007IOL
On May 3, 10:49 pm, "William Stacy, O.D." <wst...@obase.net> wrote: > By far most cataract patients are looking to rid themselves of the dim > fog of cataracts. Any IOL will help that. The fact remains that the > best post op vision comes with single vision lenses, prolate for most, > standard for some. Multifocal and 'focusing' IOLs are bad news for just > about everyone except the manufacturers. What you say so passionately agrees with almost everything I have read from patients, not from manufacturers or surgeons. My surgeon already resents me for not providing him additional income for his recommended Crystalens. Tough luck! But I still don't know what he is planning to give me, and find it hard to get any information from him. He is the second cat-doc with this attitude and I don't know how to deal with it. Fortunately, his resident-assistant is more forthcoming, but also pushing for the crystalens. William, you have mentioned the prolate IOL more than once before, but now you are saying that they are not the best for all and for some standard IOL works better. How can it be determined in advance what will be the best for me? And how are they different from the standard? Also, do the prolates cost more? Are they covered by insurance and/or medicare? Should I expect to pay extra for them? How much? >What you say so passionately agrees with almost everything I have read >from patients, not from manufacturers or surgeons. My surgeon already >resents me for not providing him additional income for his recommended >Crystalens. Tough luck! > I know the feeling. I'm still looking for a good local o.m.d. who will do what I want for my patients who are starting to back up wanting/needing the procedure. I try to avoid mentioning money... >William, you have mentioned the prolate IOL more than once before, but >now you are saying that they are not the best for all and for some [quoted text clipped - 5 lines] >medicare? Should I expect to pay extra for them? How much? > Prolate optics reduce spherical aberration, in some cases to near zero. But apparently in some eyes they are counter productive. I'm not sure how to determine who is, who isn't, and who it doesn't matter with, but I was a mild myope and they worked fabulous for me. I'm tying to nail this down, but I think the large majority of candidates will do best with prolate optics. Not sure how many $$ more, but I think it's one of those upgrades Medicare will allow the patient to pay for, and I would imagine it's something like 500 or 1000 additional per eye. YMMV. w.stacy,o.d. > >What you say so passionately agrees with almost everything I have read > >from patients, not from manufacturers or surgeons. My surgeon already [quoted text clipped - 24 lines] > > w.stacy,o.d. Which IOL's are prolate lenses? > Which IOL's are prolate lenses? Well, I don't know them all. Certainly the ones I got, Technis Z9000 by AMO optics are one, and I know for sure there are others. You have to ask. w.stacy, o.d. Technis, by amo for one; I think B&L also make one. >Which IOL's are prolate lenses? > > Another question: Is IOL spherical strength measured in diopters? Since there is a disparity between my eyes, and since at this stage I will have a cat removal and IOL implant only in the bad (right) eye, and since my vision in the bad eye cannot be corrected to 20/20 due to some retinal wrinkling or scar or pucker (who knows, nobody tells me exactly), should I insist on knowing in advance the Rx for the IOL? I have already decided to go with standard monofocal and intermediate distance, but my concerns and uncertainties are still many. Would I be correct assuming that intermediate Rx is roughly aimed to 20/40 acuity? And if so, since 20/40 is the best vision I can have anyway due to my wrinkle/scar/pucker, wouldn't it mean that I actually don't have a far distance choice and the only possible choice I have (in the bad eye)is intermediate? This means (if I am correct in my assumptions) that my IOL should be of maximum refractive correction for that eye, leaving the far vision for the left good eye? > Another question: Is IOL spherical strength measured in diopters? yes. > Since there is a disparity between my eyes, and since at this stage I > will have a cat removal and IOL implant only in the bad (right) eye, > and since my vision in the bad eye cannot be corrected to 20/20 due to > some retinal wrinkling or scar or pucker (who knows, nobody tells me > exactly), should I insist on knowing in advance the Rx for the IOL? I don't think that will help. What you need is some confidence in your surgeon. Hard to come by these days. You need to be bold and fearlessly ask the hard questions. > I have already decided to go with standard monofocal and intermediate > distance, but my concerns and uncertainties are still many. Would I > be correct assuming that intermediate Rx is roughly aimed to 20/40 > acuity? Not really. If the eye is only correctible to 20/40, then you will be 20/40 at intermediate, and with appropriate spectacle correction, will be 20/40 at any distance. Not really bad. Not perfect, but tolerable. And if so, since 20/40 is the best vision I can have anyway > due to my wrinkle/scar/pucker, wouldn't it mean that I actually don't > have a far distance choice and the only possible choice I have (in the > bad eye)is intermediate? NO. If 20/40 is your best possible vision, you just need to decide where you want that 20/40 to be. I mean where do you want your eyes to be focussed when you are not wearing any glasses? If that is at 40 inches, fine. If it's at optical infinity, fine. If it's at 12 inches, fine. All the other distances can EASILY be corrected for with glasses. This means (if I am correct in my > assumptions) that my IOL should be of maximum refractive correction > for that eye, leaving the far vision for the left good eye? This has gotten very complicated. Based on your last statement, which really doesn't make a lot of optical sense, I'd say have them shoot for best vision at 20 feet or so. If they hit that, at least you won't have a big disparity between your eyes and the other distances, as mentioned above, can easily be corrected for. w.stacy, o.d. > Prolate optics reduce spherical aberration, in some cases to near zero. What is spherical aberration? It is blur induced by the optics of a spherical lens, or one that uses a single, fixed curvature, esp. in high power lenses like IOLs. > > [quoted text clipped - 4 lines] > > Is this blur occurring only in the peripheral vision? If so, moving your head toward the viewed object may solve the problem. Eyeglasses wearers are used to it, thus it should be no problem. Am I correct? Obviously, I don't know what I am talking agout, but trying to collect all the info I can prior to having a permanent implant(s) in my eye(s). > It is blur induced by the optics of a spherical lens, or one that uses a > single, fixed curvature, esp. in high power lenses like IOLs. [quoted text clipped - 4 lines] > > - Show quoted text - No, it affects central vision more than peripheral, which is where we are most bothered by blur. Technically, it is off-center rays that are actually at fault, but these are rays coming from whatever your eyes are aimed at, and probably should not be called "peripheral" rays. w.stacy, o.d. >Is this blur occurring only in the peripheral vision? If so, moving >your head toward the viewed object may solve the problem. Eyeglasses [quoted text clipped - 22 lines] > > Ms. Brainy, I'm a patient who was in a situation similar to yours, and my experience and research might be helpful to you. I believe that the manufacturers of prolate optics (i.e., aspheric IOLs) recommend these lenses for just about everyone except formerly farsighted people who have had laser vision correction. However, it's questionable whether people with retinal pathology (like you and me) will see (literally) much benefit from a reduction in spherical aberration, at least in their affected eye. I chose to get aspheric IOLs anyway, and the cost was entirely covered by my Blue Cross. In my opinion, the Crystalens (or any of the multifocal IOLs) would be a bad choice for anyone with less than healthy eyes. There are many horror stories posted on other forums. You'll find that most cataract surgeons work with only a few different lenses, usually from the same manufacturer. I could find no research as to which aspheric lens is best. My best guess is that there's little difference among those available (although the manufacturers' hype would suggest otherwise). |
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