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Medical Forum / General / Vision / May 2007advice on eyeglasses after cataract surgery/IOL implants
I had cataract surgery in both eyes over a month ago, and with the new IOLs, have gone from O.D.-12.75 O.S.-14.00 sph / 0.50 cyl / 068 axis to O.D.-3.00 sph / -0.75 cyl / 170 axis O.S. -0.50 sph / -1.25 cyl / 010 axis Needless to say this is a miraculous change, but not without complications. I can now see the alarm clock, even read both print and computer pretty well (right eye must be dominating), but I do need glasses for distance (reading headlines on the TV, road signs). The only suggestion my optometrist made concerning lens was to get polycarb. Having looked at the many informative exchanges on this group, I now wonder if I should be considering other issues, such as abbe values of lens materials, aspheric vs. spheric, etc. From previous discussions, I gather that anything higher than 1.60 index is probably not going to benefit my current Rx (I have had my fill with high-index lenses, colored halos, and peripheral distortion); also that a good anti- reflective coating and no polished edges are vital. I've picked Flexon 717 frames with a 47 eye size, so light, small, and also sitting close to the eyes. The optician is primarily hooked up with Essilor and was very unsure about being able to get Trilex, but thought that they could probably get Spectralite, possibly Sola and Hoya 1.60s, I didn't ask about others. Lastly I should add that I do experience noticeable glare and haloes with the IOLs, and that I already know that I will have to have follow- up surgery in a few months to zap the posterior capsular haze already developing in both eyes (vision has certainly begun to deteriorate post surgery). Hopefully the second set of surgeries will improve matters again, but I'll certainly still need glasses afterwards for distance. I'm in my late 30s, if that's relevant. Being able to read, write, and work on the computer without strain is my most important consideration. I understand that many factors are at issue in "without strain" - thickness, distortion, weight, shifting from near to far viewing distances (should I be thinking about progressives?) - but I would be most grateful for any and all suggestions/comments. Florence > Having looked at the many informative exchanges on this group, I now > wonder if I should be considering other issues, such as abbe values of [quoted text clipped - 8 lines] > thought that they could probably get Spectralite, possibly Sola and > Hoya 1.60s, I didn't ask about others. I'd go with regular CR39 lenses until things stabilize completely, as you might need to change them once or twice. I'd go with TRIVEX if you can, but the only come with a fairly glossy edge. Not bad, but if you must have the frosted, ground glass type edge, you probably need cr39 anyway. > Lastly I should add that I do experience noticeable glare and haloes > with the IOLs, and that I already know that I will have to have follow- [quoted text clipped - 10 lines] > progressives?) - but I would be most grateful for any and all > suggestions/comments. You could get progressives, but they are certainly not best for computer use. For that function, a single vision lens might be best, and switch to a regular bifocal, progressive, or a single vision distance lens for driving (you can always look under the lens to read something). w.stacy, o.d. > > Having looked at the many informative exchanges on this group, I now > > wonder if I should be considering other issues, such as abbe values of [quoted text clipped - 14 lines] > must have the frosted, ground glass type edge, you probably need cr39 > anyway. Thanks for this - I'm happy to pay now for any optical advantage, even if later changes are needed, since I've had so much down time already with eyestrain/headaches/unable to focus. Is Trilex preferable because of the abbe value-weight factors? > > Lastly I should add that I do experience noticeable glare and haloes > > with the IOLs, and that I already know that I will have to have follow- [quoted text clipped - 17 lines] > > w.stacy, o.d. Will do, and again, many thanks. > Thanks for this - I'm happy to pay now for any optical advantage, even > if later changes are needed, since I've had so much down time already > with eyestrain/headaches/unable to focus. Is Trilex preferable > because of the abbe value-weight factors? I wear Trivex (with a V, not an L) because it is very light, fairly thin, exceedingly strong, and optically very good. I like drilled rimless, so it is the best option for me, and due to the abbe value, much better than polycarb. However, if you are not having them drilled, ordinary CR39 plastic is really the best optically. Whatever you get, go for a high quality anti-reflection coating, one that comes with full anti-scratch protection and a warranty. >I wear Trivex (with a V, not an L) because it is very light, fairly >thin, exceedingly strong, and optically very good. I like drilled >rimless, so it is the best option for me, and due to the abbe value, >much better than polycarb. Not only that (better Abbe value), the rimless holes on Trivex doesn't spider crack like polycarb does, tints better and the hard coats lasts longer. I have told our office staff that when patients order any rimless or rimlon (especially for low power/thin lens edges) frames, the lenses must be made out of Trivex (if the power is low)/1.67 if the power is higher) or polycarbonate (if the style is not available in Trivex/1.67). If the patients refuse because of cost issues, they are instructed to pick a zyl or metal frame instead. The primary downside to Trivex is its relatively costly compared to CR-39/polycarbonate -- especially in single vision. I have been surprised that the cost difference between the same progressives in CR-39 and TRIVEX is minimal however. The absolute WORST material I have ever tried for rimless is the mid-index 1.56 photochromic plastic that is used for InstaShades. > > Thanks for this - I'm happy to pay now for any optical advantage, even > > if later changes are needed, since I've had so much down time already [quoted text clipped - 8 lines] > go for a high quality anti-reflection coating, one that comes with full > anti-scratch protection and a warranty. Just learned that my optician can get Trivex, so I'm going to go with that and will ask about the coatings they offer. Would an aspherical lens be of any benefit, do you think, at my Rx, or would it raise more problems? Sorry for the vagueness of the question, but I find the whole aspherical/spherical issue pretty confusing. With thanks in advance, Florence >Would an aspherical >lens be of any benefit, do you think, at my Rx, or would it raise more >problems? Sorry for the vagueness of the question, but I find the >whole aspherical/spherical issue pretty confusing. With thanks in >advance, > I never, ok almost never, recommend aspheric because like you I've not been convinced that they are better than spheroidal lenses for most Rxs. Of course if you decide on progressives, you're going to be getting aspheric surfaces anyway, like it or not. >Just learned that my optician can get Trivex, so I'm going to go with >that and will ask about the coatings they offer. Would an aspherical >lens be of any benefit, do you think, at my Rx, or would it raise more >problems? I recommend aspheric lenses for most plus prescriptions < +3.00 in the distance (IOW, not for +3.00 reading single vision lenses). I don't think aspheric lenses do much, if any, in high minus prescriptions but I recommend them anyways because it comes included with most hi-index plastics that I do recommend. > >Just learned that my optician can get Trivex, so I'm going to go with > >that and will ask about the coatings they offer. Would an aspherical [quoted text clipped - 7 lines] > prescriptions but I recommend them anyways because it comes included > with most hi-index plastics that I do recommend. Would you say the same for minus (I'm a minus) in that range? More generally, what are aspheric lenses good for and why are they recommended? Like you said, hi-index materials and aspheric designs seem to always go hand-in-hand, and certainly every pair of glasses I've had in recent memory before surgery was both hi-index and aspherical (I was always told that the chief benefit was further thinning the lens, which was certainly thick and heavy even with all the extras). But when I went to fill my new and considerably less strong Rx, they still said I should get aspheric lenses. If aspheric lenses are good no matter how strong or weak the Rx, then why aren't all lenses aspheric? And Dr. Stacy also expresses reservations about aspheric lenses. [snip] >> I recommend aspheric lenses for most plus prescriptions < +3.00 in the >> distance (IOW, not for +3.00 reading single vision lenses). [quoted text clipped - 4 lines] > >Would you say the same for minus (I'm a minus) in that range? No. In your power range, they make little, if any, difference. >More generally, what are aspheric lenses good for and why are they >recommended? <http://tinyurl.com/2agxs4> > Like you said, hi-index materials and aspheric designs seem to always > go hand-in-hand, and certainly every pair of glasses I've had in [quoted text clipped - 4 lines] > said I should get aspheric lenses. If aspheric lenses are good no > matter how strong or weak the Rx, then why aren't all lenses aspheric? The same reason all lenses aren't all high-index: primarily cost. Also, in the lower power ranges (-1.00 DS), you would be hard pressed to find any benefit. Doctors should recommend the best lenses for the patient. If two lenses are equally good and offer no real world benefits over each other, then why recommend the more expensive lens? >And Dr. Stacy also expresses reservations about aspheric lenses. They have some downsides -- beyond their higher cost -- just like high-index lenses do. Aspheric lenses are not always the best choice for every patient. Some patients who are used to spherical lenses have problems adapting to aspheric lenses -- especially those patients in higher power ranges. Florence You need your prescription run through the essilor computer program that minimizes anisometropia> You need an add in your prescription>| and you need to quit trying to tell the optician which lens you need> what was the cause of the cataracts at such an early age? diabetes? auto_immune disease? steroids? hereditary? congenital? trauma? this is probably a very important consideration also and hopefully is being addressed> rkautz to say this is a miraculous change, but not without >complications. I can now see the alarm clock, even read both print >and computer pretty well (right eye must be dominating), but I do need [quoted text clipped - 31 lines] > >Florence > Florence > You need your prescription run through the essilor computer program that [quoted text clipped - 5 lines] > important consideration also and hopefully is being addressed> > rkautz No diseases, no history in the family, no trauma, no steroids - I'll tell you exactly what the optometrist said about what was causing the rapid development of posterior capsular haze after my cataract operations: that "whatever etiology" was responsible for the early cataracts was probably also responsible for the rapid capsular hazing. So in short, no idea about the cause, and none of the opthamologists I saw for the cataract surgeries suggested a particular explanation ("it could be genetics, it could be UV rays..."). Thanks very much for the suggestions. Can I ask what does an "add" mean in this situation?. As for the lens issue, I guess I wouldn't have been tempted to investigate the options if the optician had talked with me in any detail about what lens I needed and why - if they'd said, for instance, "we're going to try to reduce the problems raised by the fact that your eyes have pretty different prescriptions, and here's how the lens we recommend addresses that issue". I'm not trying to second-guess the optician - it's their specialty, not mine - but I would like to have the sense that the recommendations they make are specific to my eyes, as opposed to "this is how we always do it", "we work exclusively with this brand", etc. Thanks again for your comments. |
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