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HamiltonGuy Cataract Surgery Update
I have posted before under "Restor/ReZoom/Monofocal" I'm 45, cataracts in both eyes - the left non-dominant eye was worse. For those wrestling with the decision of what Type of IOL, I'll offer you my experience with my decision to go monofocal. I had the left-eye cataract surgery yesterday, and met with the doctor this morning. I finally chose the monofocal over the rezoom / restor options. My doctor went with the AMO Tecnis foldable acrylic IOL ZA9003. Diopter 17.5.
Day 1: When they took that bandage off my left eye, I was amazed at the colors. There is great contrast between objects
Day 1: When they took that bandage off my left eye, I was amazed at the colors. There is great contrast between objects
Day 14: Distance Vision: Although my distance vision is 20/20 in the left eye, there is still a slight ghosting. My Doc thinks it's a slight refractive error - but very minor. It only bothers me low light. Still better than the cataract though. I am much more confident driving. Contrast is very good.
Intermediate vision: It's slightly out of focus out to 8 feet, then it gets better. Best at 12-18 feet,at that point the clarity is stunning. Afer that, the slight ghosting takes over. Seems to change all the time though. The computer is a bit of a struggle. I strive to find the optimal distance from the monitor with the right reading glasses...
Near Vision: This keeps changing as well. I alternate between 1.50-2.00 readers. reading 14 pt text or smaller without the readers is not possible.
Aberrations: Slight shimmering from the left if: A) I exert myself; B) if certain bright lights hit my eye at just the right angle from the far left. But it's nothing to write home about. No night problems at all. No halos.
The other eye is scheduled for the first week of March. At that point I will lose my "perfect" focus of my right eye, but will also lose the cloudy haze that I am looking through. It's the lesser of two evils though. Since I see through a corrected eye and one that has a cataract, I have the advantage of comparing the the two. The cataract has to go. Then, I guess it's Bifocals. I've never needed glasses before, so this is a little tough - but I'll deal with it. I can see colors now. I wonder how long I've been wearing navy blue socks that I thought were black......
Intermediate vision: It's slightly out of focus out to 8 feet, then it gets better. Best at 12-18 feet,at that point the clarity is stunning. Afer that, the slight ghosting takes over. Seems to change all the time though. The computer is a bit of a struggle. I strive to find the optimal distance from the monitor with the right reading glasses...
Near Vision: This keeps changing as well. I alternate between 1.50-2.00 readers. reading 14 pt text or smaller without the readers is not possible.
Aberrations: Slight shimmering from the left if: A) I exert myself; B) if certain bright lights hit my eye at just the right angle from the far left. But it's nothing to write home about. No night problems at all. No halos.
The other eye is scheduled for the first week of March. At that point I will lose my "perfect" focus of my right eye, but will also lose the cloudy haze that I am looking through. It's the lesser of two evils though. Since I see through a corrected eye and one that has a cataract, I have the advantage of comparing the the two. The cataract has to go. Then, I guess it's Bifocals. I've never needed glasses before, so this is a little tough - but I'll deal with it. I can see colors now. I wonder how long I've been wearing navy blue socks that I thought were black......
You certainly have my sympathy for what must have been an extremely frustrating and draining experience with your IOL. It sounds like your aspheric lens was the right power but may somehow have gotten repositioned post-surgery. But having 20/60 vision is not a catastrophe. If your second eye were corrected to 20/20, you'd have a very nice range of focus with both eyes. (Having 20/20 distance vision in both eyes means poor near and intermediate vision.)
I tried sample bifocal disposal contacts, but my distance vision was better without them and my near/intermediate vision was mediocre at best. So I was eager to pay the $300 for Triton soft bifocals by Gelflex Labs. The top part of these contacts is for distance and the bottom is for near/intermediate vision. I had no problem using the computer with these lenses, and I was able to read the smallest print. Unfortunately, I've already managed to lose a lens, which apparently managed to fall out of my eye (and with a plano distance portion the loss went unnoticed.) So it'll be $150 and about two weeks before I have a replacement. If you're interested in the contacts, try one of the search engines and/or call the toll free number 866-GELFLEX for names of providers.
Castle-Connolly (www.castleconnolly.com) has a whole book listing "best doctors" in Chicago. Doctors are included based on peer nominations, among other criteria. Last year a friend of mine was horrified to learn that I intended to have eye muscle surgery with a doctor whose name I had found in a Castle-Connolly book at the library. So he offered to get recommendations for eye muscle surgeons from a "big-name" ophthalmologist he knew personally. The three docs recommended (which included my surgeon) were all listed in Castle-Connolly. For a reasonable fee, you can access their entire data base at their website. I've always had excellent results with Castle-Connolly doctors, and using the listing gives me the sense of having the same info as medical "insiders."
I tried sample bifocal disposal contacts, but my distance vision was better without them and my near/intermediate vision was mediocre at best. So I was eager to pay the $300 for Triton soft bifocals by Gelflex Labs. The top part of these contacts is for distance and the bottom is for near/intermediate vision. I had no problem using the computer with these lenses, and I was able to read the smallest print. Unfortunately, I've already managed to lose a lens, which apparently managed to fall out of my eye (and with a plano distance portion the loss went unnoticed.) So it'll be $150 and about two weeks before I have a replacement. If you're interested in the contacts, try one of the search engines and/or call the toll free number 866-GELFLEX for names of providers.
Castle-Connolly (www.castleconnolly.com) has a whole book listing "best doctors" in Chicago. Doctors are included based on peer nominations, among other criteria. Last year a friend of mine was horrified to learn that I intended to have eye muscle surgery with a doctor whose name I had found in a Castle-Connolly book at the library. So he offered to get recommendations for eye muscle surgeons from a "big-name" ophthalmologist he knew personally. The three docs recommended (which included my surgeon) were all listed in Castle-Connolly. For a reasonable fee, you can access their entire data base at their website. I've always had excellent results with Castle-Connolly doctors, and using the listing gives me the sense of having the same info as medical "insiders."
I had surgery with monofocal aspheric IOLs (mine are by Alcon)last September. My recovery was very rapid (as predicted by my surgeon)--I had no problem driving the next day. I've never experienced visual aberrations (halos, arcs, dark crescents, etc.) However, I was uncomfortable enough with my near and intermediate vision to get bifocal contacts, which I wear much of the time. (My distance vision is excellent.)
I'll be curious to know whether you notice any improvement in your night vision as a result of your aspheric IOLs after your second eye is done.
I'll be curious to know whether you notice any improvement in your night vision as a result of your aspheric IOLs after your second eye is done.
thanks for the input
I believe that your crossed eyes (and double vision) could be a complication of your cataract surgery. I suspect that the problem involves your eye muscles. I think you need to be evaluated by an ophthalmologist who specializes in strabismus.
I'm not an eye care professional, but I know a little about eye muscle problems from personal experience. I hope that Dr. Prince finds your question on this thread, so that you can get a professional opinion. If not, please re-post it as a new thread.
I'm not an eye care professional, but I know a little about eye muscle problems from personal experience. I hope that Dr. Prince finds your question on this thread, so that you can get a professional opinion. If not, please re-post it as a new thread.
calz, put your question in a new thread so people can see it. On the Eye Care Forum page, click on "Post a Question". Most threads don't stay active for that long, so if you post a comment in an old thread, few people will see your question.
just found this site, looks like there might be some answers available to anyone that has had cataract surgery and Intraocular Lens implants.
Last November a Restor was placed in my right eye, and a Rezoom in the left eye.
I still need to use the old 2.75 reader glasses to read the paper. Have noticed last couple of weeks while watching TV that vision would split into two images..
Today during followup exam at the Eye Center.... they discovered I am becoming cross-eyed....! In all of my 68 years of life todate I have never been cross eyed!
When they were checking my ability to read small type.... it became obvious that when I was looking thru both eyes, the frames of the letters began to seperate..and the one on the right was moving to the right and down lower than the block of letters on the left.
Is it possible that a misplacement of one of the lenses or some other surgical procedure could have caused this?
Last November a Restor was placed in my right eye, and a Rezoom in the left eye.
I still need to use the old 2.75 reader glasses to read the paper. Have noticed last couple of weeks while watching TV that vision would split into two images..
Today during followup exam at the Eye Center.... they discovered I am becoming cross-eyed....! In all of my 68 years of life todate I have never been cross eyed!
When they were checking my ability to read small type.... it became obvious that when I was looking thru both eyes, the frames of the letters began to seperate..and the one on the right was moving to the right and down lower than the block of letters on the left.
Is it possible that a misplacement of one of the lenses or some other surgical procedure could have caused this?
The great majority of people who choose monofocal IOLs prefer to correct their vision for distance viewing, and then wear readers for near/intermediate tasks. But this is a personal choice. Astigmatism can be reduced or eliminated at the time of surgery with limbal relaxing incisions. I'd suggest that you consult two or three cataract surgeons who will make recommendations about what would work best for you. There are also a number of web sites which explain what cataract surgery involves and what types of implants are available.
I plan on having my cataract surgery this March. Currently I am a college student and after graduation I will need to see up close for my job. Should I get my vision corrected to see up close? Another question is would I have to get bifocal contacts or can I just where a normal -# prescription contacts. Right now I have a +4.75 prescription in both eyes. The type of contacts I wear are hard to find in toric. I seems they make many options for -# prescriptions. I would like monovision but I tried this with my glasses and it made my number of migranes increase plus my depth perception was way off. Any suggestions?
P.S. I was told toric IOL's where not an option.
P.S. I was told toric IOL's where not an option.
"Since I see through a corrected eye and one that has a cataract, I have the advantage of comparing the the two. The cataract has to go."
Hamilton Guy, this is where it seems to me that you were a good cataract candidate. I see virtually no distinction between my two eyes; therefore, I think I was a premature cataract candidate. As I have a monovision contact in my non-surgical eye, it is essentially the same vision as my surgical eye. Your report is interesting to me for insight as to how it is to actually be corrected for distance. Thanks!
Jodie, thanks for the optometry advice about a ray of hope for my BCVA, the referral, and the sympathy.
I have felt very powerless as a dissatisfied cataract patient, as if my opinions and questions about my treatment are irrelevant, or at least treated by the doctors I've encountered as irrelevant. One doctor told me that my problem is that I know too much, as if that is a a bad thing.
Any bit of info we can share helps.
Hamilton Guy, this is where it seems to me that you were a good cataract candidate. I see virtually no distinction between my two eyes; therefore, I think I was a premature cataract candidate. As I have a monovision contact in my non-surgical eye, it is essentially the same vision as my surgical eye. Your report is interesting to me for insight as to how it is to actually be corrected for distance. Thanks!
Jodie, thanks for the optometry advice about a ray of hope for my BCVA, the referral, and the sympathy.
I have felt very powerless as a dissatisfied cataract patient, as if my opinions and questions about my treatment are irrelevant, or at least treated by the doctors I've encountered as irrelevant. One doctor told me that my problem is that I know too much, as if that is a a bad thing.
Any bit of info we can share helps.
The fact that you "know too much" might indeed be a bad thing...for your doctor, if s/he's not being straightforward with you. What a ludicrous comment! I wouldn't be eager to see that doctor again.
My gut tells me that once it became apparent to my doc that I had been reading and researching (I asked questions about types of IOLs, how power cacls were done, etc), I may have branded myself as "hard to please" or "difficult patient"; now no one seems to be in a particular hurry to recommend the cataract procedure. In fact, at my last check-up, the cataracts seemed not to have changed significantly from the year before, even though they are the PSC type, which I understand is highly variable, and could be rapidly progressing.
I'm grateful to have bought more time, and I shudder to think what my situation would be had I blithely gone ahead with the procedure when it was first suggested.
For anyone out there considering this procedure, I would suggest that you wait good and long, until your vision cannot be assited by any other means. I cannot imagine contemplating lens exchange in the absence of cataract, just as a means to (hopefully!) rid oneself of glasses/contacts. Spending any time at all at this forum should tell you that good results are by no means guaranteed.
It boils down to the question of will you be better off after the surgery than before. If you delay surgery until such time as your vision is significantly bothersome and cannot be corrected any other way, I feel you stand a greater chance of being happy with the outcome, even if it is less than perfect. Sure, I have ghost images now, and night driving problems with glare/scatter/halo effects, but given the state of the industry, I'm happy to wait as long as I can.
I'm grateful to have bought more time, and I shudder to think what my situation would be had I blithely gone ahead with the procedure when it was first suggested.
For anyone out there considering this procedure, I would suggest that you wait good and long, until your vision cannot be assited by any other means. I cannot imagine contemplating lens exchange in the absence of cataract, just as a means to (hopefully!) rid oneself of glasses/contacts. Spending any time at all at this forum should tell you that good results are by no means guaranteed.
It boils down to the question of will you be better off after the surgery than before. If you delay surgery until such time as your vision is significantly bothersome and cannot be corrected any other way, I feel you stand a greater chance of being happy with the outcome, even if it is less than perfect. Sure, I have ghost images now, and night driving problems with glare/scatter/halo effects, but given the state of the industry, I'm happy to wait as long as I can.
Your experience truly is nightmarish, beginning with the doctor who made inflated promises to you and then f'd up the surgery. I did experience a little improvement in my vision after 4 weeks post-surgery. Your eye might take longer to heal after having had two invasive procedures within a short time. And it might be a stretch (and no offense intended to ophthalmologists reading this forum), but who told you that your BCVA was 20/25 or 20/30? In the past, I was told the same thing by an ophthalmologist, but later discovered that I could easily read the 20/20 line when an optometrist added more astigmatism correction and changed the axis on my prescription. Obviously, individuals in both professions differ in their abilities, but it's been my experience that optometrists are generally better at prescribing glasses and contacts.
I don't know where in the Chicago area you live, or whether you want/need the name of a good optometrist. Mine is really first-rate. His name is Michael Zost, and he's located in NW suburban Glenview (847-657-8787). He's great with contact lenses, including the Triton soft bifocals.
I don't know where in the Chicago area you live, or whether you want/need the name of a good optometrist. Mine is really first-rate. His name is Michael Zost, and he's located in NW suburban Glenview (847-657-8787). He's great with contact lenses, including the Triton soft bifocals.
I'm one of the lucky majority of cataract patients who is much better off post-surgery than before. I only had one cataract, which developed as the result of a vitrectomy in January '06. My vision in that eye was still correctable to 20/20 prior to my cataract surgery last September, but my prescription seemed to become stronger every week in the cataract eye. (It went from -5.50 to -7.50.) I hadn't had glasses in my correct prescription for months, and I was dependent on the samples of disposable contact lenses my optometrist donated (which weren't always quite the right power). Three of the cataract surgeons I initially consulted ultimately declined to do the surgery until my cataract became so bad that the DMV could revoke my driver's license--the vitrectomy had increased my risk of retinal detachment with surgery. Finally, I found a good surgeon who believed that performing cataract surgery early (in higher risk patients like me, anyway) was preferable, since it's safer than operating on a very dense cataract.
So I went from being a high myope with astigmatism to having 20/20 distance vision without correction. I was so undecided about what to do with my "good" eye that I insisted on getting measurements for both an IOL and for laser vision correction. But once I saw the good results of my first eye, I knew I wanted an aspheric IOL for my second eye, too. I really had no problems post-surgery, and my recovery was very rapid. The only thing I don't like is the amber glow I sometimes get from the acrylic IOLs. (Has anyone else experienced this?) But with all the emphasis today on getting that "youthful glow" from makeup and skin care products, maybe this is actually an asset.
My advise to anyone considering cataract surgery is to find an experienced doctor with an excellent reputation. For best results, I'd suggest a surgeon who specializes in both cataract and refractive surgery (i.e., laser vision correction). Other ophthalmologists and optometrists often have a very good about who's good and who's not. If you're considering multifocal IOLs, delaying surgery whenever possible makes sense, since there are so many new innovations on the horizon.
So I went from being a high myope with astigmatism to having 20/20 distance vision without correction. I was so undecided about what to do with my "good" eye that I insisted on getting measurements for both an IOL and for laser vision correction. But once I saw the good results of my first eye, I knew I wanted an aspheric IOL for my second eye, too. I really had no problems post-surgery, and my recovery was very rapid. The only thing I don't like is the amber glow I sometimes get from the acrylic IOLs. (Has anyone else experienced this?) But with all the emphasis today on getting that "youthful glow" from makeup and skin care products, maybe this is actually an asset.
My advise to anyone considering cataract surgery is to find an experienced doctor with an excellent reputation. For best results, I'd suggest a surgeon who specializes in both cataract and refractive surgery (i.e., laser vision correction). Other ophthalmologists and optometrists often have a very good about who's good and who's not. If you're considering multifocal IOLs, delaying surgery whenever possible makes sense, since there are so many new innovations on the horizon.
bbd, the part of your post that jumped out at me is that you said you are still correctable to 20/20. Prior to my cataract surgery, I was also correctable to 20/20. After surgery, I may no longer have BCVA of 20/20; I may now only be correctable to 20/25 or 20/30, as I'm just 4 weeks out now. I wish my doctor would have told me that it was too early to have cataract surgery instead of telling me I needed it. I also think I had better contrast sensitivity and night vision pre-surgery than with my aspheric and miss the accommodation of my natural lens.
bbd. I heartily AMEN your post. My experience has been nightmarish. Living with my incipient cataract was vastly preferable to sitting in an ophthamology office crying over the quality of vision that I have lost and having my life totally disrupted by unnecessary surgery.
I was limited in my IOL choices by past eye problems. Monovision (which I loved) eventually gave me double vision that had to be surgically corrected. Plus my right retina (which is still healing from a vitrectomy to remove a layer of scar tissue) will probably always have some residual damage. This didn't make me a great candidate for multifocals, which I might have considered otherwise.
If you're planning to get monofocal lenses, I'd definitely recommend aspheric IOLs over traditional ones. Both the Tecnis and Alcon IQ lenses are probably excellent. (The Tecnis IOL theoretically corrects more higher order aberrations than the IQ, but who knows whether this translates into a meaningful difference between the two.) I hope to be driving at night 15-20 years from now, so I view anything that might help me in that regard as being positive. I'd recommend going for plano in one eye and making the second eye a little nearsighted, but that's a personal preference. (Having both eyes plano means poor near and intermediate vision.)
You'd definitely want to correct astigmatism, if you have any. My surgeon didn't charge extra to do limbal relaxing incisions. The new Alcon toric IOL is probably an excellent way to correct moderate astigmatism.
If you want to get multifocals, find a surgeon who has lots of experience working with these lenses. If you can delay surgery until the Tecnis multifocal is approved (probably in '07), this might be a good move. One of my biggest reservations about the multifocals is the loss of contrast sensitivity involved, so an aspheric multifocal like the Tecnis has a lot going for it. (I've read that Alcon is currently working on an aspheric version of ReStor.)
IMO, the Triton soft bifocal contacts are absolutely superior to the disposable bifocals with concentric circles. Triton lenses can be made in different materials--I'd recommend the version with the highest water content. Distance and near vision are excellent; computer vision is satisfactory. (The power of the near vision portion of one of the lenses can be reduced to improve intermediate vision.)
If you're planning to get monofocal lenses, I'd definitely recommend aspheric IOLs over traditional ones. Both the Tecnis and Alcon IQ lenses are probably excellent. (The Tecnis IOL theoretically corrects more higher order aberrations than the IQ, but who knows whether this translates into a meaningful difference between the two.) I hope to be driving at night 15-20 years from now, so I view anything that might help me in that regard as being positive. I'd recommend going for plano in one eye and making the second eye a little nearsighted, but that's a personal preference. (Having both eyes plano means poor near and intermediate vision.)
You'd definitely want to correct astigmatism, if you have any. My surgeon didn't charge extra to do limbal relaxing incisions. The new Alcon toric IOL is probably an excellent way to correct moderate astigmatism.
If you want to get multifocals, find a surgeon who has lots of experience working with these lenses. If you can delay surgery until the Tecnis multifocal is approved (probably in '07), this might be a good move. One of my biggest reservations about the multifocals is the loss of contrast sensitivity involved, so an aspheric multifocal like the Tecnis has a lot going for it. (I've read that Alcon is currently working on an aspheric version of ReStor.)
IMO, the Triton soft bifocal contacts are absolutely superior to the disposable bifocals with concentric circles. Triton lenses can be made in different materials--I'd recommend the version with the highest water content. Distance and near vision are excellent; computer vision is satisfactory. (The power of the near vision portion of one of the lenses can be reduced to improve intermediate vision.)
I have noticed your name come up in more than one thread within this forum; please forgive me if I'm asking something that you have answered elsewhere. I appreciate your extremely thoughtful comments on your own experiences, as well as those of others. It is apparent that you have spent much time researching these incredibly complex issues.
I'm 52 and have bilateral PSC cataracts, and was told a little over a year ago that I could elect the surgical removal and implantation of an IOL pretty much at any time. I was still correctable to 20/20 distance, though, so I'm not in any great hurry even now. I have worn all manner of contact lenses for 35+ years for moderate myopia (-4.75). Of course, I now have normal age-related presbyopia as well.
Until several months ago, I had been wearing, and LOVING, RGP multi-focal contacts. They were good enough that I rarely had to pop on a pair of readers (low-light restaraunts, mainly). My distance vision was wonderful: crisp and clear. I decided to ditch my RGPs though, with the thought that were I to pull the trigger on the cataract surgery, I wanted my corneas to be in the most "normalized" state they could achieve (figuring that there likely was some corneal moulding going on with the RGPs, and that that might screw up the power calcs). So, several months ago, I began trialing different soft multi-focal contacts. (I know I'd have to be out of even soft lenses for a period of weeks prior to IOL power calcs, but I figured this would buy me a little more time without glasses.)
After switching around a bit to find the best fit, I wore for several months B & L SofLens Multi-Focal (-4.75) with HIGH ADD. My distance vision with these was crumby, but I was told that in switching from RGPs to soft contacts, I would never be able to achieve the crispness in distance, so I just hung in there and tolerated it with those SofLenses. As with the RGP multi-focals, I rarely had to wear readers.
The approach of winter brings two major dilemmas for me, though, one being the increase in DARK, and with it, night driving problems, and the other being my involvement in skiing, and the necessity to "read" the snow, not to mention, see the skiers downhill of me. With the lenses above, I was really concerned that I would not be able to ski safely, and I knew that my night driving was already compromised (actually, night reading of road signs was the pits...I was ok if I didn't also have to read road signs). I finally decided to bag the HIGH ADD SofLenses and am now in the same B & L SofLens, only in a LOW ADD. Distance is now significantly better, in fact, back to 20/20 (don't know how bad it was with the HIGH ADDs), but of course, I wear readers for close work (+1.5). Intermediate, eg dashboard and computer screen, are pretty workable without glasses. I am so glad that I "complained" yet again to my contact lens tech who's been working with me lo these many months.
So it is with great interest that I read in your post about your experience with an aspheric IOL combined with the Gelflex Triton bifocal contacts. After all the reading I've done about the restor, rezoom, and crystalens, not to mention aspherics such as Tecnis, I'm leaning at this point to an aspheric monofocal IOL plus a contact lens for reading, if I were to do the surgery any time soon. I've looked at the Gelflex website and read a little about the Triton, and they do seem to make the distinction between its technology, and that of most multi-focals that rely on concentric rings of correction. It is that "concentricity" (?) which my lens tech guy tells me is responsible for the ultimate degradation of distance vision. It sounds like the Triton does not have the reading add "bleed" into the distance correction. I wonder what your experience has been regarding intermediate vision with these? Also, do you find the "break" line in the two corrections to be disconcerting? Do you get that "old bifocal spectacle" feeling of definite distance area vs. definite reading area?
Like you, I have some astigmatism (don't know how it's quantified, though), and my doc had mentioned LRIs at the time of IOL surgery to deal with that. I suppose I could also have LASIK for any residual astigmatism or distance correction (aim for plano distance).
It just seems that the more I read, the less excited I am about the multi-focal IOLs. I have night abberations now; why would I want to go with an IOL that makes them perhaps a permanent part of my visual picture? Further, it seems that an aspheric IOL can be particularly beneficial to those of us, like you and me, on the "young" end of catarct lens replacement, as our eyes still have enough receptors to benefit from the increased contrast sensitivity afforded by the aspherics. I'm not sure I have a clear preference between one or another aspheric; I understand that pupil size may be a determinant of what's the most appropriate selection and I don't have any idea what my pupil size is. I've also read (in a journal?) about using aspheric IOLs to achieve, I think it was, "continuous vision"? It sounded to me like the writer was describing monovision, where one eye would be under-corrected for distance using a monofocal aspheric, and the other eye corrected for full distance, also using a monofocal aspheric. However, I've had people tell me that if you are into any sports, then monovision is NOT the way to go (it decreases your depth perception?). Before the RGP multi-focal contacts many years ago, I did try monovision, and found it unsatisfactory. I'm very attached to both eyes seeing the same for distance and constantly found myself at red traffic lights covering one eye, and then the other, and grousing about how poor the vision was in the undercorrected eye).
Another development within the last year is the diagnosis of bilateral normal-tension glaucoma, for which I had SLT laser therapy, plus now use tension-lowering drops. I've read that there is a surgical procedure for glaucoma which is done in conjunction with IOL surgery, so the thought has crossed my mind more than once that I could kill two birds with one very precisely chosen stone here. In theory, anyway! It's choosing the best stone that's the devil, though!
Any thoughts from JodieJ or anyone else out there are always much appreciated.
I'm 52 and have bilateral PSC cataracts, and was told a little over a year ago that I could elect the surgical removal and implantation of an IOL pretty much at any time. I was still correctable to 20/20 distance, though, so I'm not in any great hurry even now. I have worn all manner of contact lenses for 35+ years for moderate myopia (-4.75). Of course, I now have normal age-related presbyopia as well.
Until several months ago, I had been wearing, and LOVING, RGP multi-focal contacts. They were good enough that I rarely had to pop on a pair of readers (low-light restaraunts, mainly). My distance vision was wonderful: crisp and clear. I decided to ditch my RGPs though, with the thought that were I to pull the trigger on the cataract surgery, I wanted my corneas to be in the most "normalized" state they could achieve (figuring that there likely was some corneal moulding going on with the RGPs, and that that might screw up the power calcs). So, several months ago, I began trialing different soft multi-focal contacts. (I know I'd have to be out of even soft lenses for a period of weeks prior to IOL power calcs, but I figured this would buy me a little more time without glasses.)
After switching around a bit to find the best fit, I wore for several months B & L SofLens Multi-Focal (-4.75) with HIGH ADD. My distance vision with these was crumby, but I was told that in switching from RGPs to soft contacts, I would never be able to achieve the crispness in distance, so I just hung in there and tolerated it with those SofLenses. As with the RGP multi-focals, I rarely had to wear readers.
The approach of winter brings two major dilemmas for me, though, one being the increase in DARK, and with it, night driving problems, and the other being my involvement in skiing, and the necessity to "read" the snow, not to mention, see the skiers downhill of me. With the lenses above, I was really concerned that I would not be able to ski safely, and I knew that my night driving was already compromised (actually, night reading of road signs was the pits...I was ok if I didn't also have to read road signs). I finally decided to bag the HIGH ADD SofLenses and am now in the same B & L SofLens, only in a LOW ADD. Distance is now significantly better, in fact, back to 20/20 (don't know how bad it was with the HIGH ADDs), but of course, I wear readers for close work (+1.5). Intermediate, eg dashboard and computer screen, are pretty workable without glasses. I am so glad that I "complained" yet again to my contact lens tech who's been working with me lo these many months.
So it is with great interest that I read in your post about your experience with an aspheric IOL combined with the Gelflex Triton bifocal contacts. After all the reading I've done about the restor, rezoom, and crystalens, not to mention aspherics such as Tecnis, I'm leaning at this point to an aspheric monofocal IOL plus a contact lens for reading, if I were to do the surgery any time soon. I've looked at the Gelflex website and read a little about the Triton, and they do seem to make the distinction between its technology, and that of most multi-focals that rely on concentric rings of correction. It is that "concentricity" (?) which my lens tech guy tells me is responsible for the ultimate degradation of distance vision. It sounds like the Triton does not have the reading add "bleed" into the distance correction. I wonder what your experience has been regarding intermediate vision with these? Also, do you find the "break" line in the two corrections to be disconcerting? Do you get that "old bifocal spectacle" feeling of definite distance area vs. definite reading area?
Like you, I have some astigmatism (don't know how it's quantified, though), and my doc had mentioned LRIs at the time of IOL surgery to deal with that. I suppose I could also have LASIK for any residual astigmatism or distance correction (aim for plano distance).
It just seems that the more I read, the less excited I am about the multi-focal IOLs. I have night abberations now; why would I want to go with an IOL that makes them perhaps a permanent part of my visual picture? Further, it seems that an aspheric IOL can be particularly beneficial to those of us, like you and me, on the "young" end of catarct lens replacement, as our eyes still have enough receptors to benefit from the increased contrast sensitivity afforded by the aspherics. I'm not sure I have a clear preference between one or another aspheric; I understand that pupil size may be a determinant of what's the most appropriate selection and I don't have any idea what my pupil size is. I've also read (in a journal?) about using aspheric IOLs to achieve, I think it was, "continuous vision"? It sounded to me like the writer was describing monovision, where one eye would be under-corrected for distance using a monofocal aspheric, and the other eye corrected for full distance, also using a monofocal aspheric. However, I've had people tell me that if you are into any sports, then monovision is NOT the way to go (it decreases your depth perception?). Before the RGP multi-focal contacts many years ago, I did try monovision, and found it unsatisfactory. I'm very attached to both eyes seeing the same for distance and constantly found myself at red traffic lights covering one eye, and then the other, and grousing about how poor the vision was in the undercorrected eye).
Another development within the last year is the diagnosis of bilateral normal-tension glaucoma, for which I had SLT laser therapy, plus now use tension-lowering drops. I've read that there is a surgical procedure for glaucoma which is done in conjunction with IOL surgery, so the thought has crossed my mind more than once that I could kill two birds with one very precisely chosen stone here. In theory, anyway! It's choosing the best stone that's the devil, though!
Any thoughts from JodieJ or anyone else out there are always much appreciated.
Jodie, thanks for some innovative thoughts on my visual correction options as I could use some brainstorming ideas. Here is a new e-mail addy I've created so you can contact me: ***@****. If you still have problems reaching me, please let me know here.
Based on some piggyback complications that I have read about, lasik is starting to look like a more viable alternative, and I could certainly use a local referral. The vision I have now is much preferable to where I was before the exchange, but I know more acuity is achievable. I just have to find the best route to it.
Based on some piggyback complications that I have read about, lasik is starting to look like a more viable alternative, and I could certainly use a local referral. The vision I have now is much preferable to where I was before the exchange, but I know more acuity is achievable. I just have to find the best route to it.
Thanks for the doctor info, JodieJ!
I want to pick up on the point made by K-D above, about cataract surgery only being simple in terms of time in the OR. I would think long and hard before going through it. I miss my natural lens and just having "normal" eye problems.
I'm in a strange situation now because my non-surgical eye is -5.0 and the surgical eye is now -1.0. I've tried glasses and they cause double vision because of the Rx disparity. It's a sorry solution to have to wear a contact in one eye and then glasses over the contact. Amazingly, my original doctor told me that I would likely no longer need glasses or contacts; now I need both when before I could wear either. It would be a last resort to go through another cataract surgery just so I can wear a pair of glasses over unassisted eyes.
I want to pick up on the point made by K-D above, about cataract surgery only being simple in terms of time in the OR. I would think long and hard before going through it. I miss my natural lens and just having "normal" eye problems.
I'm in a strange situation now because my non-surgical eye is -5.0 and the surgical eye is now -1.0. I've tried glasses and they cause double vision because of the Rx disparity. It's a sorry solution to have to wear a contact in one eye and then glasses over the contact. Amazingly, my original doctor told me that I would likely no longer need glasses or contacts; now I need both when before I could wear either. It would be a last resort to go through another cataract surgery just so I can wear a pair of glasses over unassisted eyes.
You're right, glasses won't work in your situation. But there are several ways that you could lose the glasses. (1) You could wear contact lenses in both eyes, undercorrecting your left eye for monovision. (2) You could wear a contact only in your left eye with full distance correction, giving you a form of modified monovision. (I'm right-eye dominant, too, but was able to use either eye for distance vision when I had monovision. I've read that many monovision users are also equally comfortable with either eye corrected for distance.) (3) You could wear bifocal contacts in both eyes. (4) If you really want to keep the glasses, you could correct both eyes for distance with contacts and wear readers over them only when you need them.
If you're truly unhappy with your 20/60 vision, I'm guessing that a small laser vision correction might be safer than getting a piggyback IOL, which would involve a third invasive procedure on your eye. My cataract surgeon also specializes in laser vision correction if you want another opinion, but I have a sense that he might not like having his name posted on this forum. I'd be happy to email this info to you, though. You could easily get an email address at yahoo or hotmail for this purpose.
If you're truly unhappy with your 20/60 vision, I'm guessing that a small laser vision correction might be safer than getting a piggyback IOL, which would involve a third invasive procedure on your eye. My cataract surgeon also specializes in laser vision correction if you want another opinion, but I have a sense that he might not like having his name posted on this forum. I'd be happy to email this info to you, though. You could easily get an email address at yahoo or hotmail for this purpose.
I waited for 3 months for my distance vision. It then became perfect. But with only one eye corrected, it is my experience that things constantly change as the eyes compete.
I also have just one eye implant.(multifocal) Initally my near and intermediate were very clear and distance blurry. That changed to perfect distance and reading good only in dim light, good intermediate. Now after 8 months my halos are decreasing daily. But I notice that my dominate eye changes constantly depending upon the lightening. Outside, left eye dominate. Inside or lower lightening, right eye dominate. That may be why my halos are dimishing. So, now I am wondering if the halos will return when I have the second eye implant.
When you hear people say that cataract surgery is simple, they must be referring to the time in the OR. It has been far from simple for me.
I also have just one eye implant.(multifocal) Initally my near and intermediate were very clear and distance blurry. That changed to perfect distance and reading good only in dim light, good intermediate. Now after 8 months my halos are decreasing daily. But I notice that my dominate eye changes constantly depending upon the lightening. Outside, left eye dominate. Inside or lower lightening, right eye dominate. That may be why my halos are dimishing. So, now I am wondering if the halos will return when I have the second eye implant.
When you hear people say that cataract surgery is simple, they must be referring to the time in the OR. It has been far from simple for me.
I used the Castle-Connolly listings for ophthalmologists, and I narrowed my choices to those who specialized in both cataract surgery and laser vision correction. (You could pay $20 to get this info online or get it free from the "Best Doctors in Chicago" book available at most public libraries.) My surgeon only used Alcon IOLs, as do many surgeons in the Chicago area. He did do a lot of ReStor surgery, but I think that any perspective multifocal patient should only see a practioner who works with all the multifocals.
In your situation, I'd generate a list of possibilities and make a lot a phone calls, asking for referrals from contacts who don't do all the multifocal lenses. Jonathan Rubenstein and Thomas Deutsch at Rush St. Luke's (312-942-2734) are reputed to be excellent surgeons and advertise ReStor and ReZoom on their website. Robert Feder at Northwestern (312-695-8150) uses AMO's Tecnis lens--I don't know about multifocals. It would probably be important to find a surgeon who offers a good "package" to his multifocal patients or you might end up paying several thousand dollars beyond the cost of the multifocals for laser vision enhancement. Eyecu, who sometimes posts at this site, could probably give you some names.
In your situation, I'd generate a list of possibilities and make a lot a phone calls, asking for referrals from contacts who don't do all the multifocal lenses. Jonathan Rubenstein and Thomas Deutsch at Rush St. Luke's (312-942-2734) are reputed to be excellent surgeons and advertise ReStor and ReZoom on their website. Robert Feder at Northwestern (312-695-8150) uses AMO's Tecnis lens--I don't know about multifocals. It would probably be important to find a surgeon who offers a good "package" to his multifocal patients or you might end up paying several thousand dollars beyond the cost of the multifocals for laser vision enhancement. Eyecu, who sometimes posts at this site, could probably give you some names.
With Alcon's aspheric IOLs I experienced little significant change in vision after 2-3 days. (I got an eye chart from the Internet and marked off the feet, so I had a pretty good idea of what I could see.) I had limbal relaxing incisions to correct astigmatism, which blurred my vision at all distances for the first day or so. I'm 54 and needed a +2.00 correction for near vision before surgery. After surgery I needed +2.25. I didn't experience ghosting, which will probably be temporary for you. Did you have astigmatism pre-surgery?
I wanted aspheric IOLs (rather than conventional ones) because I had read that they produced fewer glare issues. (And I have not had any problems with glare.) I would have preferred the Tecnis acrylic lenses that you'll have, but it seems that Alcon has corned the IOL market here in Chicago. There is one weird thing about my acrylic lenses--they tend to glisten/glow in certain lighting situations. With Alcon's blue-blocking feature, the glow sometimes has an amber cast. Maybe I'm the only one to notice this (no one has commented), but I occasionally feel like a character from the horror flick "Village of the Damned."
I wanted aspheric IOLs (rather than conventional ones) because I had read that they produced fewer glare issues. (And I have not had any problems with glare.) I would have preferred the Tecnis acrylic lenses that you'll have, but it seems that Alcon has corned the IOL market here in Chicago. There is one weird thing about my acrylic lenses--they tend to glisten/glow in certain lighting situations. With Alcon's blue-blocking feature, the glow sometimes has an amber cast. Maybe I'm the only one to notice this (no one has commented), but I occasionally feel like a character from the horror flick "Village of the Damned."
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