IOL Sizes...I size fits all?

I'm the 53 year old male high myope that needs cataract surgery for my right eye.  My axial length is 29.1mm.  One Doctor wants to use a 1 piece alcon acrysof IOL.  He said 1 size fits all.  Does anyone know if that's true?  I have big eyes.

Another doctor I saw recently measured my eyes with a brand new IOL Master with all the bells and whistles.  I believe this machine tells the Doctor which lens is best for the patient.  The lens that was suggested was what I believe was a rather unusual a 3 piece Alcon.  How in the world does someone know which one is best?  There just happened to be some Alcon reps present when I did the IOL Master test.  I remember hearing the surgeon ask the reps if that particular IOL was "injectable" and they said "yes".  Should I be concerned if the Doctor doesn't have much experience with a particular IOL?

I recently read an article by an experienced eye surgeon from California.  It was about surgery on High Myopes.  I remember him saying that he prefers using a 3 piece foldable IOL  on high myopes  because it "fits their large eyes quite well"

I also read recently in a book about Cataracts that High Myopes are more likely to develop early cataracts, often in their 40's and 50's.  They are called "oil droplet cataracts"  Does anyone know if this is true and are these the same as Posterior Subcapsular Cataracts?

I also read that high Myopes, particularly younger Males, are at increased risk for RD, around 5%. Does anyone know if that's true?

Even with the risks,  we're still fortunate to live at a time in history when these problems can be solved with surgery.
I guess throughout history, people just went blind.

I've been considering surgery for about a year now.  I've done alot of research on my own.  Sometimes I wish I hadn't learned so much.  Most people I know who have had cataract surgery are in their 70's and they all said "there was nothing to it" and all their surgeries were uneventful and successful.

Because I'm younger, Male, and a High Myope, the whole thing is a little different for me.  I'm trying to put this off as long as possible, but my symptoms and quality of life are such that I'm probably going forward..soon.  
1 more question...Do we know...absolutely for sure...if someone gets an IOL implant....will it last in perfect condition for 30-40 years?  I don't know if any of these IOLs have been around that long, so how do we know?

Thank you all in advance for any comments, suggestions, etc.

[JodieJ]

In response to your final question, several months ago I read an article suggesting that the newer acrylic IOLs appear to degrade from exposure to presciption and nonprescription eye drops.  When I raised this issue with my cataract surgeon, he just rolled his eyes and shook his head.  Maybe the more relevant question is whether WE are going to be around in 30-40 years.

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

1. Just as there is no "best automobile" and many brands of cars are used throughoout the world so too it is with IOLs. There is no best IOL and many work just fine. If I were having surgery on me I would want a tecnis aspheric IOL, Alcon makes find implants. I would avoid multifocal IOLs especially the problem prone ReZoom.

2. "injectable" just means it's soft and can be folded like a taco, put in a "shooter" and put into the eye through an incision that will only need to be half the size as if it were not folded.

3. The IOL Master does not tell the surgeon which implant to use.

4. An oil drop cataract is not the same as a posterior subcapsular cataract.

5. Using different types of monofocal IOLs are not that much different and I would not be concerned if an good surgeon was using his first IOL if monofocal. I would not want to be any surgeons' first, second, third, ....... up to about 20 cases of multifocal IOL like crystalens or ReStor. Forget the ReZoom.

6. You absolutely will be at very high risk (5-8%) of RD after successfull IOL surgery and much higher if complication occur like capsular tear/vitreous loss. You absolutely don't want to have surgery until your vision is a BIG problem. Your demographics are the highest of any for RD after cataract surgery.



5. One diameter will fit all because the flexible parts (haptics) will expand or compress depending on the diameter of the capsular bag where its put. The POWER however is different for different people and the reason why all the tests are done before surgery.

6. You are not the typical case. you are high risk.

JCH III MD

[JodieJ]

The IOL Master output can provide power predictions for different IOLs given the patient's eye measurements and the surgeon's results (if available) with a particular IOL.  I suspect that the Alcon reps programmed your surgeon's IOL Master to provide output for most of Alcon's lenses, including models rarely used today.  Yes, opinions vary, but I do think that an aspheric monofocal lens is currently considered state-of-the-art.  It's reported to provider sharper distance vision, less glare, and improved contrast sensitivity/night vision relative to a spherical (conventional) IOL.  AMO, Alcon, and Bausch & Lomb all make aspherical IOLs.

Yes, your axial length shows that you do have long eyes.  But an IOL is implanted near the front of the eye, and its size relates to width (rather than length) of the eye.  So one size can fit all.

The way I see it, just about everyone is high risk for something bad.  I don't want to minimize your risk, but it appears that you have about a 92 to 95 percent chance of NOT experiencing RD (which can usually be surgically repaired).  

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

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[Capes55]

Thank you both very much for your responses.  Dr. Hagan, I really appreciate your help.

And also you JodieJ

Thank you again

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

You're welcome

JCH III MD