Which IOL Is Best For Me?

I just found this group, and I'm sure your answers to my question will
help me in making an upcoming decision.

First, some background. I am 56 years old and one eye is very Myopic.
I wear a -12 contact lens, which is not a 100% prescritption. My other
eye is almost perfect. My eye refraction has been fairly stable over
the last three years; lens going from -11 to -12 two years ago. This
last year my good eye changed very slightly to a +.5, but I haven't
corrected it. I use reading glasses for almost 10 years, and they are
a now at +2. Recently, it has become difficult to wear the contact
lens. I even have trouble putting it in. Sometimes, I can wear it for
almost two weeks and then throw it away. Other times, one or two days
after putting it in, I get up in the middle of the night and my eye
feels like its in a vise. Today's Dr. told me the eye was rejecting
the lens, and it will become increasingly more difficult for me to waer
a lens (something that has become more apparant over the past few
years) So, the contact lens is no longer much of an option. If I could
continue using a contact lens, then peering over reading glasses or
taking them on and off, is not that much of an inconvenience. I am
very athletic and play softball every week from March to October, and
golf most weeks during the same time. I ride a bicycle. I spend a lot
of time in front of a computer, at work and at home.

So, while investigating possible solutions, it has been impressed upon
me by my regular Doctor, who does cataract operations, but not lasik,
and a Lasik/IOL doctor I went to today, that the best solution for me
is a Clear Lens Extraction. It appears that the implantable lenses
aren't optimized for those over 40-45 years old, and the CLE is very
effective. Also, I am likely to get a cataract in that eye anyway, as
I grow older. The Dr. took many measurements and pictures of my eye
today, and commented that I have a small pupil, which he said was good.
I have no idea why it is.

So, I'm trying to decide whether I want to go with a Restor, which the
Doctor today suggested, or a monovision implant, done by my regular
doctor. As the Dr. today told me, I have a unique situation in that I
have a very good dominant eye, and I have been, in effect, using this
eye primarily through the years, even while wearing a contact lens in
the other eye. I am concerned about the Halos and other drawbacks to
using the Restor, but I'm not sure it would affect me as I would still
be relying on my dominant eye. On the other hand, I would be okay with
a monovision lens and the continued use of reading glasses. Still, one
wants to get the best possible outcome, the first time with such an
operation, so I want to seriously consider all my options. The Dr. I
saw today seemed fairly confident that I would adjust well, in part due
to the Restor lens and in part due to having a good dominent eye. In
addition, as part of the contract, he would perform Lasik for free for
the next two years, if that would help adjust the vision in the lens
with the CLE.

Obviously, the most important things for me are that I can continue to
play ball without having any Depth of Field or peripheral vision
issues. I would not like it at all if halos became a big problem. I
would prefer the shortest period of adjustment, no matter which lens I
chose.

I hope I've given the experts in this group enough information for you
to help me make an informed decision. Thanks . . . Steven

 

We have a detailed article about Refractive Lens Exchange (RLE, aka
CLE) at http://www.usaeyes.org/lasik/faq/lasik-cle-iol-rle.htm that
you may find helpful. I'll add a few observations.

Myopia (nearsighted, shortsighted) vision is a risk factor for retinal
detachment because the eye is elongated and this will stretch the
retina. If your eye is more than 12.00 diopters myopic, then you are
undoubtedly at an elevated risk for retinal detachment. RLE is
relatively traumatic to the retina, even with today's advancements.
You absolutely should be evaluated by a retina specialist before
having elective surgery and discuss with that specialist retina issues
regarding RLE.

Before opting for a multifocal intraocular lens (IOL) implant, try a
multifocal contact lens. This will give you a simulation of the
effect.

Before opting for monovision, try it with contact lenses (although it
sounds like that is what you are doing now). Be sure to comprehend the
reality of monovision rather than the concept. We have a detailed
article about monovision surgery at
http://www.usaeyes.org/lasik/faq/lasik-monovision.htm

If considering a multifocal lens, understand your vision needs well.
The ReSTOR IOL puts more emphasis on near and distance vision at the
expense of mid-distance vision. The ReZoom more evenly distributes its
multifocal properties, but this can provide a general reduction in
vision quality. I recently made a detailed posting about this issue
that you can read at http://tinyurl.com/oenlr

Choose carefully based upon your needs, and be sure your surgeon has
extensive practical knowledge with both types of multifocal IOLs.

It sounds like you are wearing your contacts 24/7. Even if the
contacts are rated for this, giving your eyes a rest at night and even
wearing glasses on occasion may be enough of a respite that the
irritation you are suffering may be resolved. I'm sure the
optometrists who frequent this newsgroup will have ideas on that
issue.

Glenn Hagele
Executive Director
USAEyes.org
Patient Advocacy Surgeon Certification

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

 

"GovtLawyer" <> asked that, in message
A doctor who is recommending a multifocal IOL with repetitive lasik trims
would worry me (as a consumer of eyecare services).

Best advice I got for implants was "find a surgeon who does many of
them".

If he is doing them right, aftercare will not be a significant consideration.
Probably, also, he is not recommending multifocal IOLs, since his
considerable experience by now has probably suggested they are not
generally the best idea.

My guy, who, incidentally does also offer lasik, corrected much of my
astigmatism by knowing where and how to make the insertion opening.
Aftercare was some checking, and a refraction (by an OD in the
surgeon's office, the surgeon being too busy with surgery for that).

Lasik surgery success is not quite on a par with IOL-implant success,
as I understand it.

 

If distance vision is a priority, I would avoid a multifocal IOL. Most
of the optics for the distance vision is outside of the 3 mm central
zone. Not good for a small pupil.
Even though your other eye is dominant, this could break down under
certain situations.

DrG

 

Perhaps I misstated. He is not suggesting repetitive lasik. Rather,
he told me that IF NEEDED, as my eye might change, or I may have some
difficulty adjusting, he would fine tune it at no charge for two years.
The impression he gave me was that he expected the Restor to be a good
fit for me.

He IS recommending Multifocals, and he has done several thousand
cataract surgeries, and thus several thousand implants. His
credentials seem quite solid.

I cannot have just Lasik, as it would not improve my vision enough. I
am too far gone for Lasik.

 

The doctor told me I MUST have a consultation by a retina specialist
before the surgery, and he would set it up for me. So, apparantlty,
you're on the same page. He said I have a 1 in 4000 chance of RD just
with my Myopia and a 5 in 4000 or 1 in 800 with the surgery. So, he
made me aware that the risks are greater.

A good idea. I should try it.

Thank you, I'll most certainly read it.

Thank you, I'll read that as well. While I realize each lens has some
drawbacks, isn't my dominent and good eye going to compensate?

We didn't discuss the ReZoom. He used to do the Crystallens, but said
he no longer does as it loses its effectiveness.

I do give them a rest occassionally, not always by design. I
understand that glasses are out of the question. For one, they would
look odd, as one eye would be thick and the other plain glass. Also, I
understand the difference between the eyes is more disorienting with
glasses than contacts, etc.

Thanks for your help.

 

I think Mike and Dr Leukoma are both right on. The human lens is
typically about 13-14
Diopters of plus, and a clear lens extraction with no implant would
make you close to emmetropic. At that point your glasses or contacts
will be thin and much easier to wear in any case.

 

I'm not sure what you mean? Are you suggesting I not have a
replacment, just a Clear lens Extraction? Then, I can wear contacts or
thin glasses? If so, I do not intend to wear contacts again, as I
can't tolerate them anymore, and I will only wear reading glasses,
which is what I do now. Obviously, if I could get rid of them at the
same time, that would be good.

 

Yes, as the doctor explained, I have been favoring one eye for many
years, even when wearing the lens.

Not sure what you mean by this.

So, it seems the doctor is saying. Basically, as I understand it, he
is saying I'll avoid some of the usual multifocal RLE pitfalls because
my dominant eye will continue to remain dominant. What I don't
understand is the reading part of this. Even my dominane eye needs
reading glasses. So, if I get a multifocal, won't my uncorrected eye
still need reading glasses? Unless, the new implant takes over for
reading.

Definitely a choice, which is why I'm asking these questions. If I see
as well as now or better than I do now with a monofocal lens, I could
live with continued use of reading glasses.

 

When you go through your pre-operative examination for cataract
surgery, the doctor does a test called a B-scan that determines the
dioptric power of your human lens and helps him to determine what power
you would need in an implant to achieve clear vision. Yes, when you do
simple math in your head, a 12 Diopter myope is an excellent candidate
for clear lens extraction with no implant. Your doctor would be able
to do the actual math from that scan and determine if you would be a
mild myope or hyperope after extraction of your lens. In any case, you
would end up something between +/- 2.