accommodative vs. monofocal IOLs after cataracts

Discussion in 'Optometry Archives' started by Liz, Jul 11, 2009.

  1. Liz

    Liz Guest

    O:

    I personally think the "accommodative" lens is more "hype" than
    anything else.


    L:

    Some others seem to think so too, including some of the people I asked
    who got them.

    I read a few articles about the Crystalens, in which it appears that
    there have been problems with other aspects of vision, which new
    iterations of the product design have improved - *maybe*.
    I'm gonna go with monofocal. I'm not a beta tester!



    ---------------------------

    D:

    Talk to your surgeon and OD. The OD doesn't do the surgery, but
    they ... deal with it afterwards....


    L:

    Maybe I need a different one. The same guy (or his office staff) does
    the refraction as does the surgery. I think he's a good surgeon, but
    we've had communication problems a lot already.

    ---------------------------


    Myopia sounds really awful.


    D:

    Hyperopia isn't that great, either. At least I could take off my
    glasses and see *really* close. I could focus on the end of my nose.
    It didn't look pretty.


    L:

    !!! :)
    A myopic friend says she can "see microbes walk".

    cheers,
    Liz
     
    Liz, Aug 16, 2009
    #41
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  2. Liz

    Liz Guest

    Mike, Dan, Otis,


    Thank you for your input so far. Many aspects of this surgery make
    more sense now!
    One thing still puzzles me...


    L:

    It seems my astigmatism keeps changing. [Maybe it's] better not to
    insert something permanent for this... safer to just deal with those
    changes with changing glasses scrips. ?


    M:

    Nonono. The only thing changing is the lens. Remove the lens and the
    changes
    stop. After surgery, the only astigmatism is corneal and it's
    generally very
    stable.


    L:

    Wait... You mean, when someone develops astigmatism in middle age,
    this is NOT
    caused by any change in corneal shape? ALWAYS/ONLY by a change in
    the
    lens?


    M:

    Geez.. always? only? There is no "always".



    Of course not... but I'm still confused on how it works.

    On the web I find assertions that astigmatism both does and doesn't
    continue to change with age. And they always mention the cornea, but
    seldom the lens; dunno why not.


    I'm trying to picture the physical process that would cause
    astigmatism in the lens in my own case. Not that I can do anything,
    just am curious.
    From my records...


    Before age 43, no vision problems. Age 44, first saw presbyopia and
    slight astigmatism. 44.5, presbyopia much worse, astigmatism no
    change. Age 47-48, presbyopia even worse; cataract became visible to
    me in left eye. Age 49, left eye totally clouded; right eye now w.
    cataract easily visible to both me and doc; right eye now w. minor
    astigmatism also.

    i.e., vision went from perfect to three kinds of lousy within five
    years.



    Does this sound to you like the kind of astigmatism typically caused
    by a change in the lens, in the cornea, or both? I can't picture
    what's going on.



    thanks,

    Liz

    Indianapolis, USA

    (I presume the city is still there despite its vague appearance :)
     
    Liz, Aug 16, 2009
    #42
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  3. Liz

    Otis Guest

    Myopia sounds really awful.



    Dear Liz,

    Subject: The eye has refractive STATES.

    Re: "Myopia" and "Hyperopia".

    The ophthalmologist truly "nailed" my refractive STATE correctly. The
    eye has a power of about 60 diopters. Getting EXACTLY ZERO, is
    virtually impossible. Getting to 1 percent 0.6 diopters in
    incredible.

    In order for my distant vision to be CLEAR, it was essential that my
    refractive STATE be positive (called, variousy, Hyperopia, Ametropia,
    and other "bad" sounding descriptions.)

    So, having SLIGHT hyperopia is not "terrible" -- like "myopia" -- is
    it in fact necessary for both a CLEAR Snellen at distance and good
    night vision (because of a "tonic accommodation" effect.)

    Getting stair-case myopia from a consistently over-prescribed minus --
    is indeed bad idea. This is how you have people getting "down to" -6,
    -9, and even -11 diopters.

    Second-opinion best,





    D:


    Hyperopia isn't that great, either. At least I could take off my
    glasses and see *really* close. I could focus on the end of my nose.
    It didn't look pretty.


    L:


    !!! :)
    A myopic friend says she can "see microbes walk".
     
    Otis, Aug 16, 2009
    #43
  4. Liz

    Dan Abel Guest

    I did things differently. I'm not sure I know enough to give advice. I
    really valued the advice I got from my independent OD. Still, after my
    surgery, I saw an OD who worked in the same office as the surgeon that I
    saw next. That worked too.

    Communication is key. If it isn't working, then, yeah, maybe it is time
    for a change.
     
    Dan Abel, Aug 16, 2009
    #44
  5. Liz

    Liz Guest

    Maybe "hype" isn't the right word. I think they're a useful product.
    However, nearly all the information I've found on them seems less than
    upfront about the possible visual tradeoffs, and I think that some of
    the doctors who suggest them are less than upfront about what results
    to expect. (I say this based on friends' descriptions; I was not
    there listening to the docs.)

    When I can't easily get the unvarnished, unspinned facts about
    something, that drains my confidence in it.

    Liz
    Indianapolis
     
    Liz, Aug 17, 2009
    #45
  6. Liz

    Dan Abel Guest

    At some point in life (like yours and mine) people lose some of their
    vision. They want it back. I can understand that. There are a whole
    lot of ways to get it back. None of them are perfect, you just get part
    back, and there are a lot of trade offs.

    Then again, medicine works slowly. Things work a little, and people try
    it, and the medical people make it better. Maybe this will turn out to
    be a good thing. Maybe it will get dumped.
     
    Dan Abel, Aug 17, 2009
    #46
  7. Liz

    Liz Guest

    Maybe "hype" isn't the right word.  I think they're a useful product.
    Your point is my same point. There DO seem (so far as I can tell!?)
    to be visual tradeoffs between accommodative vs. monofocal. And if
    someone wants to sacrifice some peripheral focus, or whatever, to
    enjoy the enormous pragmatic gain of not needing glasses in more
    situations, as opposed to their having sharper vision in some
    situations but no accommodation, then go for it.

    I only wish that doctors etc. would talk more bluntly about these
    tradeoffs, so the patient can more easily decide which way they want
    to go. I don't like having to dig for this info; doing so makes me
    impatient and paranoid. But that's just how I am; probably other
    patients would just as soon not be confused by these details.

    cheers,
    Liz
    Indy (wherever it is)
     
    Liz, Aug 19, 2009
    #47
  8. Liz

    Otis Guest

    Dear Liz,

    I knew "going in" that I wanted the mono-focal.

    BUT -- the ophthalmologist was very good a playing a "video" that
    described the "pros" and "cons" of this type of choice.

    The value of sci.med.vision and the "pro" and "con" (private opinion)
    here -- is that you get general information for your choice.

    I was also told that the potential "problem" of the operation was:

    1. Detached retina.
    2. Blindness.
    3. Other problems (un-specified).

    His video (and my undersanding) were very clear on those points.

    All operations are "risks" -- and you have to choose. The more
    education you have -- the better your choice.

    Good luck,

    Otis
     
    Otis, Aug 19, 2009
    #48
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