I have another alternative for you, although I hate adding to your decision-making burden. The aspheric SofPort IOL by Bausch & Lomb is available in a power range from 0 to 30 D. I believe that this is the IOL preferred by Dr. Kutryb of this forum. It is a silicone IOL, but many retinal specialists don't see this as a problem.
I believe that all the modern IOLs used to be 3-piece. Alcon introduced a 1-piece IOL several years ago. Surgeons liked it, reportedly because it was easier to implant. Apparently, it's not profitable for the manufacturers to make their newer aspheric IOLs in sizes that are rarely used. So if someone needs a rarely used power, they must get an older IOL model.
There is one published study comparing the performance of one of Alcon's older conventional IOLs with their newest aspheric model, the AcySof IQ. Subjects had a conventional lens in one eye and an aspheric lens in the other. Most subjects couldn't tell the difference in their vision. Of those who could perceive a difference, the majority preferred their vision with the conventional lens! (An aspheric IOL is reported to provide sharper distance vision; a conventional IOL reportedly provides sharper near vision.) So you shouldn't feel that you're missing out on something great if you do opt for the older 3-piece lens. A +4.5 IOL would probably give you much better uncorrected vision than a +6 Acrysof IQ.
Dr. Hagan,
Thank you again for your help.
Thank you very much for your help. You have been very kind and generous. I really appreciate it. You seem very knowledgeable about eye issues.
This morning, a technician from MD #2's office called to let me know the tecnis 1 piece they heard about doesn't come in my prescription.
Question...do you know the purpose and benefit of 3 piece IOLs? Is it necessary because of the low power needed to correct high myopes?
I got the impression from the tech that she couldn't remember any of their patients in recent years being implanted with a 3 piece IOL. Is my prescription really that rare?
If I were to decide right now, I think I'd play it safe and go with MD #1..(the 1 piece alcon IOL)
Thank you again for your help. Your information on the various power availabilities was very helpful. It cleared some things up for me.
It is not at all unusual for professionals (MDs, lawyers, dentists, etc) to have different opinions about diagnosis and treatment.
Both of these would be acceptable. Many Eye MDs feel the perfect uncorrected post op refractive error is -0.50 for distance and -1.25 in the other for intermediate and near in good light.
Just as there is no single best automobile there is no single best IOL.
Go with the eye MD you feel most comfortable with.
JCH MD
Addendum to above: I think both doctors are correct. If you're planning to wear glasses/contacts all the time (or spending $2000+ on PRK), then getting the +6 Alcon AcrySof (or 1-piece Tecnis) makes sense. On the other hand, Doc #2's option would probably give you much better uncorrected vision. Please let us know what you decide and how it goes.
IMO, the aspheric monofocal IOL is currently the state-of-the-art implant, providing the sharpest distance vision and the best contrast sensitivity. (There is research data to back this up.) I looked up the available size ranges for the AcrySof IQ and the 3 Tecnis aspheric models. (A lower number corrects more myopia.)
Alcon AcrySof IQ (acrylic) +6 to +30
Tecnis 1-piece (acrylic) +6 to +30
Tecnis 3-piece (acrylic) +10 to +30
Tecnis (silicone) +5 to +30
Based on the IOL Master output I've seen, there is a slight variation in the predicted power for different IOL models in order to achieve the same target. The predicted power may also differ slightly depending on which surgeon is operating.
The available formulas for predicting power are much less reliable for high myopes. But let's suppose that your calculations were perfect. Post-surgery with Doc #1, you would be -1.5 D with 1.25 D of astigmatism, for a spherical equivalent of about -2 D. This should give you pretty good uncorrected near vision. Post-surgery with Doc #2, you would be -.5 D with 1.25 D of astigmatism, for a spherical equivalent of about -1 D (pretty good uncorrected intermediate/computer vision).
Based on the available power ranges, the silicone Tecnis IOL looks like a good option. Some (but certainly not all) retinal specialists are opposed to having a silicone IOL implanted in their patients. (The material might cause problems should retinal surgery become necessary.) So you might want to run this choice past your retinal specialist before proceeding.
Remember that glasses/contacts can correct residual refractive error post-surgery.