Some cataract questions

Discussion in 'Optometry Archives' started by Roy Starrin, Sep 30, 2005.

  1. Roy Starrin

    Roy Starrin Guest

    I am 71 y.o. and have been, with my eyedoc, "watching" my cataracts
    develop in both eyes for some years. I am seen a couple of times a
    year for glaucoma, well controlled. At yesterday's exam, after some
    problems in seeing some of the blinking lights in a visual field, a
    "glare test" and others were done. It was determined that the RT eye
    met the criteria to have Medicare pay for part of it, and because of
    the difference that would exist, and the fact that my LT eye is on the
    threshold, both could/should be done---one week apart. Apart from the
    test, I have been able to detect over the past couple of months that
    something was going wrong with my visual acuity.
    I help edit an online newspaper. I need to go thru this with as much
    vision as possible.
    In my case, recommended are ReZoom multifocal IOLs. Would appreciate
    hearing fron anyone with any experience. I have pretty well scoured
    the internet, since internet research is what I do.
    In talking with friends my age who have had the surgery, night
    vision/driving, glare, and things of that sort seem to be one of the
    more consistent types of problems. Since we are going into the
    darkest part of the year, someone suggested waiting until about next
    May for the surgery, so that I would be able to adjust my evening
    schedule better thru the summer and hopefully be better able to adapt
    to the following winter.
    Am open to any thoughts/advice/experiences anyone wants to share on
    any aspect of this.
    Growing old is hell, but considering the alternative, entirely
    acceptable.
    TIA
    Roy

    Nothing is forever young and I'm not done---
    this train still runs

    Janis Ian
     
    Roy Starrin, Sep 30, 2005
    #1
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  2. Roy Starrin

    SiG Guest

    72 here with no glaucoma or other contras and ReSTORed in July and August. Went
    through the same preliminary exercises Googling and grouping. The best info I
    found was tech documentation from the FDA site itself that helped reconcile
    'discrepancies' between my experiences and anecdotal encomia.

    Although not optically equivalent, both ReZoom and ReSTOR share the common
    feature of distributing incoming light rays onto two image planes for distant
    and near objects and letting the brain pick that in sharper focus closest to the
    retina. The ReSTOR lens has a 4.0D internal add vs. 3.5D for ReZoom, putting
    the former's images a bit farther apart.

    This is most evident on a computer when your desktop is a star pattern - each
    bright star is surrounded by a halo ca. 10 pixels in diameter due to the out-of-
    focus distance image. White text on a black ground is quite readable down to
    the smallest fonts I can generate (#4) but the haloes can be initially a bit
    distracting. With black on white, the black halo is far less distracting but,
    in any case, there's a loss in contrast for near vision that is most apparent
    when trying to read yellowed paperbacks in dim light or maps intermingling
    multihued lines and text.

    What's rarely mentioned is the total loss of accomodation with such IOLs. The
    ReSTOR lenses come in 0.5D increments (internal). Playing with some lenses from
    the junk box, an 0.25D change from optimal distance refraction makes the
    dashboard odometer readable without bending forward while maintaining 20/20
    driving vision. To achieve 20/20 or better distance vision depends on some
    fortuitous parameters given the best optometry.

    Presently, my uncompensated refractions are 0.25/0.75 hyperopic and the useful
    binocular LCD monitor reading range is 30-55cm over which the pixel grid can be
    distinguished.

    The concentric glare circles from oncoming headlights is often raised as a
    critical issue. When a car first appears say 200 yds distant, these circles are
    larger than the car itself, but their angular dimension doesn't seem to change
    as the car approachs and, by the time it's almost parallel, the circles are no
    larger than the headlights themselves. Last night, I was out on an errand on a
    two-lane country road in deer country where the unwritten rule seemed to be
    high-beam, high-intensity SUVs only. No problem with eyes diverted towards the
    shoulder - the pre-IOL cataracts would have diffused a blinding light over the
    entire retinas forcing a pullover for dissipation.

    SiG
     
    SiG, Sep 30, 2005
    #2
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  3. I would stay away from multifocal IOLs. I had bilateral IOLs installed
    in Jan, 1 week apart and am loving my single vision Tecnis lenses. I
    don't have any of the glare, starbursts, blur and loss of contrast
    sensitivity that you WILL get with mf iols. I'm a 61 yo optometrist and
    went to one of the leading cataract surgeons in the U.S./world.
    Unless you just can't stand the idea of using glasses for near, do NOT
    do mf iols.

    w.stacy, o.d.
     
    William Stacy, Sep 30, 2005
    #3
  4. Roy Starrin

    Dan Abel Guest

    It seems to me that you have two issues to deal with here:

    1. Multifocal versus single-focus IOLs.

    2. Having the surgeries one week apart, or some other time separation.


    I think the issues might be somewhat related. I have had cataract
    surgery in both eyes. I wasn't given the option of MF IOLs, but
    probably wouldn't have gone with it, based on my personality. I was
    comfortable with reading glasses, and not comfortable with new things.
    Some people don't tolerate these MF IOLs, and I wasn't willing to risk
    the chance that I might be one of them. The single vision IOLs are
    tried and true.

    I would think that you could simulate the MF IOLs with MF contact
    lenses. I understand that they wouldn't be the same, but I thought that
    the concept of sending two images to the brain, and the brain selects
    the one in focus, would be similar. If the MF CLs don't work for you,
    perhaps that means that the MF IOLs wouldn't either.

    At 71, I'm guessing that you are already dealing with the problems of
    seeing both near and far in focus. What do you currently use, and are
    you happy with it? If it is working for you now, then single vision
    IOLs could replicate what you are currently doing, or you could have the
    surgeon set the IOLs to whatever you want. If you decide on monovision,
    I would again suggest that you simulate that with CLs and see if it
    works for you.

    If the MF IOLs don't work for you, after they are implanted, you have
    two choices: grin and bear it, or have the surgery redone. If you have
    both done a week apart, and the MF IOLs don't work for you, you face
    having two surgeries redone. You want to be real sure who will pay for
    this. If you space the surgeries farther apart, then you have a chance
    to see how things work. If the MF IOL just doesn't work for you, then
    you just have one surgery to redo. Of course, your vision will suffer
    significantly during this time.

    I would be reluctant to risk my vision by having both done a week apart,
    even with the standard single vision IOLs. Others are perfectly willing
    to risk this, and it's sure a lot more convenient.

    If you can easily put this off until there is more light, that might be
    a plan. If your cataracts are bad enough that they are significantly
    reducing your night vision right now, the surgery might possibly be
    enough benefit to counteract possible problems with glare, starbursts
    and such. I was already in the position that I had my wife or kids
    drive me at night, so putting it off didn't help any.
     
    Dan Abel, Sep 30, 2005
    #4
  5. I'm sure you considered all the accommodative options (Eyeonics et al)
    .... why did you elect to avoid them?

    Wayne
     
    Wayne Stidolph, Oct 1, 2005
    #5
  6. Roy Starrin

    Roy Starrin Guest

    First. Thanks for the reply (as well as a thank you to all who
    responded. Before reading any of these, however, I emailed myeyedoc
    this a.m., told him I couldn't clear my schedule and felt very rushed.
    To ld him we would do it after next Easter (as they days are getting
    longer), but that he would need to sit with me and discuss the
    pros/cons of all available options with me so that we could make a
    decision together.(I hate to say it, and I really trust this guy who
    helped me greatly in stopping glaucoma deterioration, but I'm
    suspicious by nature, and thru all of this all I could think of was
    the bigger the sale, the bigger the commission (aka kick-back).

    Have never worn contacts, but would be willing to see if this would
    work---if he is
    I have tri-focals, and would not mind a pair of glasses/bifocals for
    reading/computing, and/or a half pair for driving.
    Not sure I'm clear on this. DI I not
    I'm coming to this conclusion myself
    Not there yet. That's why I believe I can wait 'til spring. Readings
    were just above and just below whatever the threshold is.
    Again, thanks very much
    BTW, this is the clinic: http://www.beacheyecare.com/
    I came to it because my previous gent was running a factory and goofed
    once (which was too often when it comes to one's eyes)
     
    Roy Starrin, Oct 1, 2005
    #6
  7. Roy Starrin

    Dan Abel Guest


    I'm a lay person, and no vision expert. However, I don't believe that
    MF IOLs are the standard. They are for people who want them badly
    enough. If you are happy with what you have now, then I don't see any
    reason for you to go with MF IOLs.


    I'll make things really simple in this paragraph. Little kids can
    focus. They can see things up close, and they can see things far away,
    all without switching correction. As we get older, most of us lose that
    ability. This usually happens in the 40s. We then get reading glasses,
    bifocals, trifocals, progressives, half glasses, or else we just don't
    see very well. Most people accept this as a price of getting old. Some
    people really hate this and would do anything to be able to see both
    near and far without any of those aids I mentioned. These are the
    people who get MF IOLs. They will be able to see both near and far
    without switching lenses or any of those other things. Unfortunately, I
    understand that they don't always work very well.


    I couldn't recommend that you get MF IOLs unless you are really clear
    about all of the above. A lot of people don't want to become experts at
    this. Those people will let the doctor chose the power, but they will
    normally get single focus IOLs.


    If your doctor talks you into MF IOLs, and you find after the surgeries
    that they just don't work for you, you will have no choice but to have
    the surgeries redone.


    I would recommend that you continue doing internet research on this, and
    continue talking to others who have been through this. I also found
    that my OD was very helpful. Although he doesn't do surgery, he is very
    familiar with what is done and what the concepts are. I think that you
    are wise to put this surgery off, so you will have a chance to find out
    your options.


    A talked quite a bit with a lady at work, who had her cataract surgeries
    done about a year before mine. She wasn't interested in discussing the
    different options, and cut me off every time I tried to talk about them.
    She pointed to her trifocals, and said that she just loved them and was
    very happy with her vision. She was insistent on having those very same
    trifocals after the surgery. After the surgeries she did in fact have
    the very same trifocals, but with different lenses. The top section had
    no correction at all. When I tried to point out that it didn't make
    sense to me, she replied that she was very happy with them, and they
    were just what she wanted. I couldn't argue with that.
     
    Dan Abel, Oct 1, 2005
    #7
  8. As much as I'd like to go along with that idea, the problem is that he
    can't get a decent preview because not only are the optics different,
    he'd also be looking through his cataracts, which will make ANY contacts
    blurry.
    I think with modern small incision procedures, the healing time is so
    rapid that 1 week is plenty. I could tell the day after surgery that I
    wanted the same thing done in the other eye. My refraction has varied
    only slightly from day 1.

    I've been looking very critically at my night vision, and even with my
    prolate surface Tecnis lenses, I get minor starbursts around lights. I
    will not recommend multifocal IOLs to anyone until and unless they make
    a major breakthrough in the optics. They have not.

    w.stacy, o.d.
     
    William Stacy, Oct 2, 2005
    #8
  9. Because they don't work all that well (very low amounts of
    accommodations) plus they require larger incisions, and are optically
    not as good as the Tecnis. Plus, even though my surgeon is doing
    accommodating, he knew I wanted the crispest vision I could get, and
    recommended the Tecnis. It is what he would want for his own eyes, and
    he's world class.

    w.stacy, o.d.

    Wayne Stidolph wrote:
     
    William Stacy, Oct 2, 2005
    #9
  10. Roy Starrin

    Roy Starrin Guest

    In looking at IOL implants, I was also a bit concerned over the
    driving problem and other shifts in focus during the period between
    surgery on each eye and/or when wearing the "dark glasses" as well as
    "safety glasses" later. A woodworkers catalog fell out of the sky
    yesterday with a selection for stick-on magnifying lenses. A little
    research (GOOGLE "Stick-on" "magnifying lenses" ) revealed that they
    are available. Most appear to be made by an outfit called Optx20/20.
    Walgreens seems to carry them. So, I just pass the info along in case
    it might be of value to anyone
     
    Roy Starrin, Oct 2, 2005
    #10
  11. Roy Starrin

    Roy Starrin Guest

    the implications stated
    Gotcha!!!
    SNIP
    I sort of thought that with a plain IOL I would wind up like this
    lady, or with the needed close-correction set into bifocal half
    glasses; unless there was a single lens capable of of covering the
    entire spectrum from the end of my nose to where ever the IOL took
    over. As I said, I don't mind wearing glasses. I guess that meyedoc
    thought that my stated goal of the sharpest vision possible across the
    entire distance spectrum had to be done within the IOL world. It
    doesn't.
    Thanks again for the help, and I'd really like to hear from anyone
    else with an opinion on this. Certainly the five of us writing are not
    the only ones reading the thread who have had cataract surgery????
     
    Roy Starrin, Oct 2, 2005
    #11
  12. I'm the same. Ended up not really "needing" glasses for most things,
    but don't feel quite right without them (after 40 years of wearing
    them), so went back to progressives for most things, even though the
    tops are almost zero. It's nice to have the small print in focus without
    having to reach for the specs, since they're already there, where they
    belong, on my nose...

    w.stacy, o.d.

    Dan Abel wrote:
     
    William Stacy, Oct 2, 2005
    #12
  13. Roy Starrin wrote:

    Certainly the five of us writing are not
    Could be. I doubt that more than a couple hundred people total *ever*
    read any of s.m.v. Of course there's no way to know how many lurkers
    there are, but over the years, I'm still guessing about 200.

    w.stacy, o.d.
     
    William Stacy, Oct 2, 2005
    #13
  14. Roy Starrin

    Dana Guest

    What is a bilateral IOL? I'm not quite ready for an IOL yet, but will be
    within a few years, so would like to have as much knowledge as possible
    before. Thanks,
     
    Dana, Oct 2, 2005
    #14
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