High myopia and iol

[Dovekin]

I am a 55 year old diabetic male with high myopia, -12.5 os, -10 od.

And now cataracts. My doctor computes the replacement should be +4, +5 for distance, but they don't come in those powers. So I am getting +6 lenses.

Why don't they make lower powers? Is there a better solution?

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

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[Fleetfoot197]

I am a very high myope who had cataract surgery one year ago.  I had a 3+ mono focal acrylic sensor (amo) spherical lense implanted in the left eye and a 4.0 acrylic Hoya monfocal aspherical lense in the right eye.  I now see 20/25 for distance and am able to go without glasses except to read fine print.  For fine print I use dimestore reading glasses.

I suggest that you find a surgeon who has experience with refractive surgery.  They tend to be more in toon with trying to correct vision.  My surgeon was very comfortable mixing lenses (brands and spherical with aspherical) and did not try to push premium lenses.  In fact, he chose the lenses and I became confident that he was making the right choices.  In fact, he even corrected my nondominant eye first because the cataract on the left had progressed further than the right.

There are no guarantees.  I know that I could have a r.d. tomorrow.  The best you can do is listen to your doctor and weigh the pros and cons.  IDr. Hagan, who appears to have no agenda, is a good resource.  So take his advice and get a second or third opinion until you find a surgeon with whom you are comfortable.  For example, a doctor who operates on other doctors is always a good choice in my view.

Good luck

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

There is not a lot of difference between the modern 3 piece and one pice IOLs. The one piece has theoretically less chance of structural problems. (no failure at haptic-optic junctions) and less potential of irritation/abberation from construction. A one piece is carved-lathed with no assembly. A 3 piece is carved-lathed plus assembled. Again with moder IOLs the lens material, edge design and proprietary design and cost are more important factors.

JCH MD

[JodieJ]

The Tecnis one-piece IOL was introduced within the past couple of years.  Previously, I think that Tecnis IOLs were 3-piece lenses, and they were considered to be among the best IOLs on the market.  I read somewhere that a one-piece IOL is easier for the surgeon to implant but not necessarily a better product.  I don't know whether this is true.  Maybe Dr. Hagan can comment.

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

One thing that I've done is get a second opinion and a second set of measurements done at another office of an ophthalmologist I respect and who does meticulous IOL measurements. I don't know where you live THE world expert on IOL power is Warren Hill MD of Mesa Arizona.

JCH MD

[cwatt1]

If you are comfortable with your opththalmologist, I would be inclined to stay with the same type of lens as you have in your right eye since you will require eyeglasses anyway, especially since your eye surgeon is apparently not as familiar with the older miniscus lenses.  Additionally, the difference in optics might or might not be bothersome to you.

The choice between the +6 and +7 is, of course, yours, but if you have the opportunity to be glasses free at certain times (i.e., intermediate vision such as computer work), that might be a good option for you.

[Dovekin]

My apologies if my last note was unclear; with one cataract removed, Half of everythib is unclear to me.
My dr convinced me I should correct my vision for distance when I have my other cataract removed. After measurement/calculations, he said I would need +4 iol for distance, or +7 iol for intermediate. But the lowest power available was +6 iol, which we would use since that was as close to +4 as hr could get.
So I am trying to decide if I should insist on a +4 iol, even though it is a 3 piece meniscus lens instead of the standard single piece biconvex. (is any of that significant?);
OR get a +6 iol because the calculations are inaccurate at this axial length anyway;
OR get a +7 iol for intermediate since i will need glasses for distance in my other eye.
Thanks for your help, and for allowing me to clarify my thinking on this.

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

Even if the formula showed you needed no IOL power 0.00 you should have an IOL with that power. The reason is that studies have shown it supports and stabalizes the vitreous and reduces the risk of a retinal detachment.

The power of the IOL is not the power you are left needing after surgery. Short eyes (farsighted) need larger IOL powers and myopic eyes need lower powers. Leaving a person myopic after surgery is not all bad since at certain distances vision is good without glasses, farsighted is a total bummer as there are no distances that are clear without glasses.

JCH MD

[Dovekin]

Thanks for the responses.
I  am still not sure if getting the lower power lens is worth it. The lens Jodie (thank you) found is meniscus, rather than biconvex, so I am assuming the 6 diopter strength limit has something to do with optics, not demand. But I do not know.

The other part is that I had my right eye done, and then found out about the power discrepancy. Vision is ~20/50, so I will still need glasses, which I do not mind. (after 50 years, it would be strange to go without)
I need the left eye done soon, and don't know if I should insist on the +4 lens, or just go with +6

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

These answers are spot on correct.

JCH MD

[JodieJ]

Addendum to above:  I tried googling "Alcon IOL models power range" to see what one manufacturer (Alcon) could offer you.  It seems that model MN60MA comes in powers between -5 and +5.  There are also PMMA IOLs in the powers you need.

[JodieJ]

I believe that there are IOLs that come in the power you need.  Maybe they're not the newest aspheric models--it might not be profitable for the manufacturers to produce powers that are rarely used.  But I think that getting the right power is more important than getting an aspheric lens.  You might consider getting a second opinion from a surgeon who has been practicing for awhile.

[cwatt1]

The axial length of an eye with extreme myopia is quite long, and It is more difficult to compute the correct IOL power.  A +6 lens might get you closer to plano than you think.

A surgical solution to get rid of residual myopia could be LASIK or a piggyback IOL.  However, a simpler solution, If you don't mind wearing glasses, would simply be progressive lenses.  Talk to your eye surgeon about your various options.