Help needed in choosing an eye surgeon

I'm the 53 year old high myope(-9 contact prescription) male with a posterior subcapsular cataract in my right eye.

It's bothering me to the point that I need to get it taken care of.  I almost had surgery a year ago but canceled it a week before it was scheduled.  I had researched (probably to much) and discovered all kinds of information that did not give me warm fuzzy feelings. (increased risk of RD, etc.) I felt I could stand it indefinitely if it didn't get any worse, but it has (always in my field of vision, therefore on my mind too much, it's to the point of adversely affecting my mental attitude.  I own several businesses and require decent eyesight.

Can anyone relate to this?

So, here I am... I have scheduled surgery with a local MD on August 7...BUT...I'm not totally sold on this Doctor.
He's a solo practitioner, does surgeries on Mondays and Thursdays and has an Optometrist that works with him.

Their target for me is -1.5 using an alcon aspheric 1 piece monofocal lens.  They say I have about 1.25 diopters of astigmatism. I do not want to be corrected beyond plano where I would be farsighted.

I feel the decision (to have surgery) is important because it's permanent. Once it's done, it's done.  No turning back.

Here's my dilema..I got a second opinion...this morning...and I have an appointment with a renowned MD in Houston, TX on July 28.

The MD I saw this morning took my measurements (after my contact lens was out for 2 weeks) This is also a solo practitioner, about 40 years old, brand new office, all new equipment,etc.

He said...your target needs to be -.5.  He said if he aimed for -1.5 I may end up at -3 due to the astigmatism. Your IOL should be a 3 piece made by Alcon (not aspheric)  He said the 1 piece doesn't come in my prescription.  I told him I heard that aspheric is a good thing (Dr. Hagan's recommendation) He said it does help a little bit at night.

Then he said that Tecnis just came out with a 1 piece aspheric in April...They're checking to see if it comes in my prescription.  He said the Tecnis is a little harder to implant ( I have no clue why) but he could do it. He uses only alcon IOLs.

Which of these 2 doctors is correct?  How does one know?  I'm sick and tired of differing opinions from trained professionals. I just want to get this over with!  I wish I had done this last year before I learned so much.

I hope Dr. Hagan can help.  I've got my #s so maybe it can help.

AL: 29.17
K1: 43.89 D/7.69mm@178
K2: 45.42 D/7.43mm@88
SE: 44.66 D
Cyl: 1.53 D @ 88
R. 7.56mm (SD=0.01mm)

Target Ref.-0.5 D   opt. ACD 4.32mm
Visual acuity: 20/30
Refraction: -13.25 D +1.50 D x105


The 1st MD wants to put in a 1 piece Alcon with a power of 6 which he said would leave me about -1.5

The 2nd doctor would use a 3 piece Alcon (according to him the 1 piece doesn't come in my prescription)
The power would be a 4.5 leaving me at -.5

Can anyone out there offer any help, advice, suggestions?

Thank you very much.

[JodieJ]

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.    

[JodieJ]

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.

[John C Hagan III, MD, FACS, FAAO]

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

[Capes55]

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.

[Capes55]

Dr. Hagan,

Thank you again for your help.

[John C Hagan III, MD, FACS, FAAO]

Good luck
JCH MD

[JodieJ]

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.      

    

[John C Hagan III, MD, FACS, FAAO]

Thanks JodieJ

JCH MD

[JodieJ]

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.