OT- Cataract surgery - which lens option to choose?
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    Default OT- Cataract surgery - which lens option to choose?

    It's time, I no longer feel comfortable driving in the dark. I'm 75, near sighted, been wearing classes since I was 10 years old. Used to have great up-close vision w/o glasses, not so great anymore. Currently wearing progressive lenses.

    So the question is which lens option to go for. I do a fair amount of upclose work - inlay, engraving, carving - use Optivisors for that stuff.

    My doctor (great reputation) recommends correcting for distant vision, the opposite of what I've always had. He also suggests the multifocal lens with astigmatism correction if I can afford it. I asked and he said there is no downside to that choice, and would recommend it to everyone if insurance covered it. I'm not inclined to cheap out with my eyesight, but ONLY if it's really worthwhile.

    Wondering what people's experience has been?

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    Quote Originally Posted by richard newman View Post
    It's time, I no longer feel comfortable driving in the dark. I'm 75, near sighted, been wearing classes since I was 10 years old. Used to have great up-close vision w/o glasses, not so great anymore. Currently wearing progressive lenses.
    Also have required glasses since childhood.

    I had to bail out a few years earlier and get cataract surgery. Coming home on a highway in the dark in the rain was terrifying. Also got a newer, taller car.

    Never did progressive lenses - bifocals worked just fine.


    So the question is which lens option to go for. I do a fair amount of upclose work - inlay, engraving, carving - use Optivisors for that stuff.
    I decided to have the implanted lenses focus at about 10 inches, and not for distance, so I could work close up without glasses, including while using an Optivisor. So, I must wear glasses while driving, which is no change.

    I wear safety bifocals when working in the shop or at the computer. The top part of the bifocals are tuned for computer and machine-tool work, and the bottom part for reading (or the keyboard).


    My doctor (great reputation) recommends correcting for distant vision, the opposite of what I've always had. He also suggests the multifocal lens with astigmatism correction if I can afford it. I asked and he said there is no downside to that choice, and would recommend it to everyone if insurance covered it. I'm not inclined to cheap out with my eyesight, but ONLY if it's really worthwhile.
    Multi-focus is achieved by engraving a diffraction pattern on one surface of the lens, splitting the single focus into three foci, at varying distances. When this diffraction pattern is effaced by protein deposits over time, the multi-focus effect fades, and replacement is likely needed. This effacement also happens with plain lenses, but slower. Natural variation is large in either case.

    My wife got the multifocal lenses some years ago, and the problem she has is that at night, the three images are all simultaneously visible, making automobile head- and tail- lights (and reflections off shiny surfaces) of nearby traffic merge into a confused jumble, which obscures everything behind the jumble. She has sort of gotten used to it, and very much likes the fact that she does not need glasses at all. I chose to stick with traditional single-focus lenses.


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    I had -7.5 D glasses with trifocal lenses and enjoyed my microvision without glasses for most of my life. It was great for watch repair and coin collecting. I had cataract surgery in 2013. My doctor did not suggest extra cost lenses and my insurance paid the whole bill. He inserted Abbott ZCB00 intraocular lenses with +12.5 strength. I don't know how he figured the strength except that he had lots of experience. I have been OK with 20-20 distant vision for eight years now. I wear safety glasses all the time with plano and -.25 D distant correction and +3 progressive segments for reading and close work. There is no cylindrical correction (no astigmatism). I have to go to the microscope to read the numbers on little taps and use fine thread pitch gages. I can drive and watch movies without glasses. So I have to say I am happy with the results of the surgery.

    My eye doctors have mentioned that, with time, part of the eye will get cloudy and it can be easily fixed with a laser treatment. But insurance will not pay for the treatment until it gets to a certain point of impairing vision. Last year it was not to that point and my next exam is in December. I can see quite well.

    I did meet a man who had lost all vision in one eye because of his cataract surgery going wrong. He said his doctor messed up.

    Larry

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    I have had cataract surgery, with great success. I had a huge correction (10 diopters) with a mild astigmatism. Because of the big correction, the only lens option available to me was a single focal length one which has corrected my far vision to eagle-like. It is amazing. For near vision, I wear reading glasses on a cord around my neck. For very fine work I also wear an Optivisor.

    As someone who spent a long career designing and using optics, I would not even consider a multi-focal lens FOR ME. I am very sensitive to optical artifacts in my visual field, although I now have massive floaters which give me hell. The issue with the multi-focal approach is that you do not get something for nothing. My ophthalmologist discussed this option with me in detail, even though it was not available for my correction. One issue with it I was told is that there are artifacts around points of light in the dark. I doubt that you will have the sharpness of a single fixed focus lens either. Wearing reading glasses is something I have done since I was 40, and annoying as it can be sometimes, it works well.

    With respect to astigmatism, the surgeon who did the cataract surgery, performed a radial keratatomy to eliminate it. This worked very well! I suggest you discuss this option with your doctor. My astigmatism was about 0.75 diopters.In any case, PLEASE, PLEASE take your time and select your surgeon very carefully. I was lucky in that mine was the protege of the doctor primarily responsible for developing the modern cataract surgery technique. He was EXCELLENT!! This is a serious operation, even if a typical practice does many a day. It is your vision at stake here, and practically speaking, you do not get a do-over. So do your homework (as you seem to be doing). Rochester is a big optics center, so you may have many options for physicians who know their stuff.

    As far as the actual surgery, I was sedated and only semi-concious during the procedure (THANKFULLY). It was very fast, and there was no real discomfort afterwards. I could see pretty well on the drive home (my sweetie was driving!), and in a day or two I could see perfectly. They only did one eye at a time, with 3 to 4 weeks recommended between surgeries. Medicare paid for everything (with my supplemental insurance). You will not believe how wonderful it is to be able to wake up seeing well, and to be able to see in the dark. Everything is so BRIGHT!!! afterwards. Just be thorough about selecting the doctor and the type of lens they install. If you are a picky sort you might be happiest with a single focal length lens and reading glasses. Just bring a certain amount of skepticism to the discussion of what would be best for YOU.

    Best wishes!!!
    Michael

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    I agree with the above. I went with simple lenses, corrected for distance vision, because I didn't want any artifacts. My vision is fantastic compared to before. I wear bifocals with the lower section a bit stronger than most people would have, so I can do close-up work. One set for normal daily wear and one set for the computer, both with the same lower section. You have to be careful not to go too strong on the lower section. I did that once and had to have them redone because it turns out you rely on a slightly fuzzy image in the lower section at medium distances. Losing it completely was a problem. Same thing for the line height. Too high is no good and too low makes the lower section tough to use. Never tried progressives. I was extremely pleased with the work done here- Steve Park, M.D. - Brighton Surgery Center, LLC

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    I am to have implants done next month. Doctor recommended Vivity multiple focal length lenses. Said it would give minimal flares and halos with driving. Prescribing info said it would reduce night vision by 30 to 40%. That was unacceptable. I change sprinklers on the center pivot at night sometimes and being able to tell the difference between a snattlerake and a king snake under a partial moon is important to me. Will save about $8000 and can buy a lot of glasses with that. Already used to bifocals anyway so it is no big deal. The plan is now monofocal lenses set for distance.

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    This one came out some years ago. It's supposed to be variable focus using the same muscles that do the job in a natural eye. Last I checked, it is expensive and not covered by any insurance.
    Crystalens AO Lens : Bausch + Lomb

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    Been a few years, I nearsighted my whole life. I chose distance lenses, figuring I wear glasses in the shop regardless. It was the right choice for me. I wear cheapo Foster Grant reading glasses from Walgreens around my neck for closeup stuff, and kick them up a notch when welding.

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    Quote Originally Posted by richard newman View Post
    It's time, I no longer feel comfortable driving in the dark. I'm 75, near sighted, been wearing classes since I was 10 years old. Used to have great up-close vision w/o glasses, not so great anymore. Currently wearing progressive lenses.

    So the question is which lens option to go for. I do a fair amount of upclose work - inlay, engraving, carving - use Optivisors for that stuff.

    My doctor (great reputation) recommends correcting for distant vision, the opposite of what I've always had. He also suggests the multifocal lens with astigmatism correction if I can afford it. I asked and he said there is no downside to that choice, and would recommend it to everyone if insurance covered it. I'm not inclined to cheap out with my eyesight, but ONLY if it's really worthwhile.

    Wondering what people's experience has been?
    Folks have vastly different "systems".

    Not just the shape of the eyeball (not always the same left and right) the lense capsule in the eye nor the retinas. Also the specialized nervous-system signal pre-processor they feed into.

    Rare is the Doc who bothers to delve for the fine details, person A to person B of those bits.

    After a near-disaster, Reston, VA facility, I escaped, took my problem to Hong Kong, found that expertise.

    Dr. Dylan Chan did his part perfectly, no anaesthetics (DNA thing, plus it is HIS preference as well..) but still got a few surprises.

    - Zero scar by day three under 40X magnification (DNA thing).

    - Seems some folks can shift a rigid lense on the long axis with ease. "Ciliac muscles like an Olympic weight lifter!" he said. Dunno how. It just happened automagically.

    Result is 20/15, sub 1/4 Diopter LR/diff, annnd ability to read the fine print on a pill bottle or see individual leaves on a tree in the far distance without need of external lenses.

    It can take ten or so seconds for my eyes to MOVE that lense, "Zumar style", but it needs no glasses, any tasking, any distance.

    I wasn't sure if I'd take up flying again, but had him goal for starry, starry night, major metropolitan area ground lights.

    Works a treat for night driving and garish Hong Kong nights in a city of constant light-shows, too.

    Downside is need of at least mild sunglasses, outdoors, most days.

    UV thing, as there is no problem with high intensity light, indoors.

    Night driving and fog or snow driving is outright magical. No issue with oncoming headlamps, even if on high-beam, and I can still see colours in the grass at the verge, off side.

    Happy man! At 76 I see better than ever I did at 18/19, per USAF flight physical.... with one exception.

    Andrews AFB had re-run one test three times with re-calibration and added observers, each go. I was clocking the widest night-time COLOUR peripheral vision they had yet measured.

    No longer!

    Cataract lenses do NOT do peripheral vision nearly as well as natural vision can.

    BFD. I run better mirrors on the motor cars, and have re-trained - rigorously - to SWIVEL the head a LOT more.

    Howard Hughes to Noah Dietrich:

    "Find the experts, Noah. Find the experts."

    Dr. Dylan Chan has abnormally good natural vision, works FAST with no drugs. A bit of a legend, he had done over twelve thousand lenses before age forty and leaving Government Hospital to found his own clinic.

    He and his "girls" took three times as many test readings as is usual. Spread out over time of day and day of week before ever he selected the lenses.

    That's how he got that sub 1/4 Diopter Left/Right match.

    We also elected to NOT laser-away a window in the back of the capsule. He said the eye will try to place tissue on it.

    I said no, it will not. I'll order it not to do. It hasn't.

    Amazingly capable systems, humans are. No need to now HOW you command your staff. Only that you do.

    The rest is built-in. Thank God in her clever engineering.

    Does the USA have equally capable eye Surgeons? I'm sure we do.

    But have no idea whom. Dylan was already known to our family for no-drug rebuild (several hours of it) to my Mother in Law's cornea after serious tearing and impact damage in an accident. It went perfectly.

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    Had mine done a few years ago. Like you, I wore glasses most of my life and was very near sighted. Wore trifocals for the last 20 years. Cataract surgery will not give you 20 year old eyes again, but they will be so much better than they are now, it will be amazing. Unless things have changed, the lens will have a fixed focal lengths, it will not adjust like the original lens. The doctor can set the lens to focus at any distance you choose, but that will be the only length that is extremely clear. So you will need glasses to see well at the other distances, some people buy cheaters to read with. For me, he recommended getting the single vision lenses and continue to wear trifocals. It has worked out well. The hardest thing to get used to was not being able to remove my glasses and bring things up close enough to see clearly.

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    One of my closest friends is a cataract surgeon, he said the folks who complain the most about multi-vision lenses are teachers and engineers.

    I don't have cataracts at this time, if I were to need the procedure I would choose far distance. Brian's comments about the expectation of old eyes and elasticity make sense. Most folks after age 50 need some form of reading glasses because our focus becomes less responsive, yea there are exceptions Bill. He has been doing cataracts for about 35 years and I suspect he has done 15K plus cases.

    Personally wearing safety glasses with reader bifocals is preferred to having a lens that is a compromise in all focal planes. I know the technology is getting better all the time. The off chance that a fantastic new lens is not going to be the end all end is enough to error on the side of known expectations.

    My 2 cents,
    Steve

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    Good advice given by others in this thread. I finally had the surgery 4 years ago. I went to the State University because they have the best surgeons as teachers and are highly rated for their eye care dept! I was nearsighted and wore glasses since I was a teenager and as the years went by the glasses got thicker and I had severe astigmatism too! I am 70 now. The University gave me more information and more choices than any of my friends got from the private eye care places. I needed what they call Toric lenses (expensive, about $3k) because of the astigmatism, which in my case the insurance won't pay for. The head surgeon told me "Buy those and you can get rid of your glasses!" He left the room and the student intern came in and told me that if I allowed him to do the surgery the lens company would donate the lenses. The lens company wants the students to get used to their products so they will sell them when they get out of school! When the head surgeon returned I asked him what hazards there was in having the student do it and I was told the student had already done about a hundred other people and that he would be assisting through the whole operation. So that's what I did and it turned out fine and I wear cheap readers for up close work and passed my drivers licence exam for the first time ever with no glasses. No, the new lenses are not as good as what you were born with, and in some situations I need more light than others to see the same thing, and oncoming headlights still bother me at times and I still can't see distance as good as a young person, but I never could with glasses either! It worked out well for me and I would do the same thing again.

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    Thanks for the advice, much appreciated. I am confident in my surgeon, the head medical librarian for one of the large health care networks in Rochester is family and did the research.

    So the real question is what type of lens. The multifocal lens doesn't seem for me, I'd rather correct with glasses than have artifacts or less light entering. I'll probably adjust to whatever I pick, but after 65 years of being nearsighted, would be weird to have it reversed.

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    The head surgeon that I talked with at the university didn't advocate the multifocal lenses. He said in rare occasions you use them but it took a somewhat unique situation? Mine wasn't it. Do your own research and ask plenty of questions? I did that and when talking with other people I was amazed at the number of people who just trusted whatever they were told by the first person they talked with? If your doctor won't spend whatever amount of time you need to answer your questions find another doctor?
    I have also had detached retinas in both eyes so was somewhat experienced on eye surgeons.

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    Quote Originally Posted by richard newman View Post
    . . .So the real question is what type of lens. The multifocal lens doesn't seem for me, I'd rather correct with glasses than have artifacts or less light entering. I'll probably adjust to whatever I pick, but after 65 years of being nearsighted, would be weird to have it reversed.
    Did you ask about that Crystalens (post 7)? It isn't 'multi-focal', it actually changes focal length like a natural lens. I'm interested what its reputation is now that its been out a while.

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    Quote Originally Posted by Gordon Heaton View Post
    Did you ask about that Crystalens (post 7)? It isn't 'multi-focal', it actually changes focal length like a natural lens. I'm interested what its reputation is now that its been out a while.
    Just talked to the surgery coordinator and asked about the B&L Crystalens and she said that it was problematic and she has not heard of its use lately. Maybe they forgot to take the link down. Seems like the connections to attach to the muscles that normally control the lens shape would be very troublesome in practice.

    The doctor that will do the surgery recommended another lens for me Eyhance by J&J that is supposed to give medium and far sharp focus as well as 30% better dim light contrast over single focus lenses. Another thing requiring research.

    Please note this is a press release not an endorsement, I will be doing further research.
    Johnson & Johnson Vision Announces Availability in Europe of TECNIS Eyhance IOL, a Next-Generation Monofocal Intraocular Lens for Patients with Cataracts.

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    I had 10 diopters of correction for nearsightedness too. Could clearly see my own nose! I got my cataract surgery by an excellent doctor that teaches at Wills Eye. Despite lots of research there was something big I missed.

    I got varifocal lens, no magnification at the top and about 12” distance at the bottom. Was great, until I sat down in front of my two big monitors at work to look at a drawing. It was then I realized that the sharp clear area was only a spot on a huge complex drawing! I was horrified and called my optician who was a long time family friend. I had to get a second pair of progressive glasses for computer work. Focus range of only 12” to 36” but very wide. That worked well other than swapping glasses all the time. I have since worked from a small laptop and didn’t need the computer glasses often.

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    One option not mentioned yet is to not make a choice. What I mean is correct one close and one for distance. A small percent of people naturally has that setup and I’m one of them. I really like that because I can read the newspaper without glasses and don’t need glasses to drive etc. I do wear glasses as having both corrected optimally gives me the best near and far vision. But both eyes work together well for depth perception and and general vision. I know for sure that is what I’ll do when this Covid thing settles down and I get my cataracts fixed soon.

    Denis

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    Great info here...I will be needing this soonish. Night driving is terrifying.

    Happy Thanksgiving to all!

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    Quote Originally Posted by sandiapaul View Post
    Great info here...I will be needing this soonish. Night driving is terrifying.

    Happy Thanksgiving to all!
    You all have probably seen those aids for night driving and glare advertised. You are not supposed to use the dark one at night. I have been especially bothered by the new bluish white and blue super bulbs being sold today. Will give me a migraine with just seconds of exposure. Now the new projector lamps produce a very high intensity light from a very small source and are as bad. Several years ago my wife bought one for me but the amber shade did not do that much for me and the dark one was not supposed to be used at night, so I put it away. Got the idea of cutting the dark one at an angle and using it all the time. Pretty much works in a rural setting at night and city driving in the daytime also. the ones with polarizing filter for the dark ones will have the polarizing element as a film. If you try this be careful you do not tear the film as I did on the bottom. I do move my head around to keep in the dark and be able to see the road.
    With the recent cataracts I think I can tell when a driver has not dimmed his lights by the star bursts I see. Not perfect but does improve things. I need to put one in the fire truck as we had a call a week ago at night driving without one of these things was bad.
    Maybe a stop gap till you have your surgery. With my tendency for migraines these will be a permanent thing for me.
    drivinghelprs.jpg


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