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Should I risk for IOL after 24 yrs of Aphakia?
Hello all,
Let me describe my condition which is a little bit complicated: My cataract lenses was removed at the age of 6 months old but, they decided not to implant any IOL in my eyes and since then till now that I'm 24, I've been using glasses from when I wake up to when I go to bed and magnifiers for reading. Right now I'm using Windows magnifier 300x zoom. My glasses prescription is: R: +8.00 & L: +8.00 + 0.25x175. In addition, I have Amblyopia and Nystagmus (when the right eye is closed, the left one moves and can't concentrate, but when both are open, it is not that much visible). But, hopefully I am not diabetic and my eye pressure is normal. Up to now, I've visited 5 doctors who gave me somehow the same option: Monofocal IOL set for distance for both eyes + thin pair of glasses just for reading that I can get off the shelf or over the counter without prescription. Onc of them told me that after implanting the Monofocal IOL set for distance, I can then do the corneal inlay in 1 eye for my reading to completely eliminate the need for glasses. I have to mention that I don't like glasses and contacts and mono vision and thus, I don't like the idea of corneal inlay.
My questions are:
1- Do you think it worth going for the IOL after 24 yrs of using glasses? Right now, although I don't like glasses, but at least I can see with them well in near and intermediate. So want to go from the GOOD to the BEST, not from the BAD to the GOOD, which means I'm in a big dilemma.
2- Based on my eye condition, do you think there is any other way than monofocal IOL set for distance that could possibly completely eliminate the need for glasses?
3- Why my doctor did not gave me the option of Symfony? Is it RISKY in my case or completely IMPOSSIBLE? Because these two are completely different.
4- THIS QUESTION IS VERY IMPORTANT TO ME> For those of you who have implanted a Monofocal IOL set for distance, how is your near and intermediate vision? Do you need thin pair of glasses JUST FOR READING or for seeing ANY NEAR OBJECT? Do you see clearly without glasses, your face in the mirror, your watch or your cell phone to answer the calls? Do you see the edge of the lens or the holding gears or anything you haven't seen before? Do you feel it when you sleep? How does it perform in very hot weather like in sauna or very cold weather like -20c winter?
5- What do you think about corneal inlay?
Let me describe my condition which is a little bit complicated: My cataract lenses was removed at the age of 6 months old but, they decided not to implant any IOL in my eyes and since then till now that I'm 24, I've been using glasses from when I wake up to when I go to bed and magnifiers for reading. Right now I'm using Windows magnifier 300x zoom. My glasses prescription is: R: +8.00 & L: +8.00 + 0.25x175. In addition, I have Amblyopia and Nystagmus (when the right eye is closed, the left one moves and can't concentrate, but when both are open, it is not that much visible). But, hopefully I am not diabetic and my eye pressure is normal. Up to now, I've visited 5 doctors who gave me somehow the same option: Monofocal IOL set for distance for both eyes + thin pair of glasses just for reading that I can get off the shelf or over the counter without prescription. Onc of them told me that after implanting the Monofocal IOL set for distance, I can then do the corneal inlay in 1 eye for my reading to completely eliminate the need for glasses. I have to mention that I don't like glasses and contacts and mono vision and thus, I don't like the idea of corneal inlay.
My questions are:
1- Do you think it worth going for the IOL after 24 yrs of using glasses? Right now, although I don't like glasses, but at least I can see with them well in near and intermediate. So want to go from the GOOD to the BEST, not from the BAD to the GOOD, which means I'm in a big dilemma.
2- Based on my eye condition, do you think there is any other way than monofocal IOL set for distance that could possibly completely eliminate the need for glasses?
3- Why my doctor did not gave me the option of Symfony? Is it RISKY in my case or completely IMPOSSIBLE? Because these two are completely different.
4- THIS QUESTION IS VERY IMPORTANT TO ME> For those of you who have implanted a Monofocal IOL set for distance, how is your near and intermediate vision? Do you need thin pair of glasses JUST FOR READING or for seeing ANY NEAR OBJECT? Do you see clearly without glasses, your face in the mirror, your watch or your cell phone to answer the calls? Do you see the edge of the lens or the holding gears or anything you haven't seen before? Do you feel it when you sleep? How does it perform in very hot weather like in sauna or very cold weather like -20c winter?
5- What do you think about corneal inlay?
Best Answer
3 Comments
I also would not recommend corneal inlays or anything else newly available at this time. Try contacts and report back. If you can get a decent pair, your vision should be identical to what it will be after surgery. If you don't like it, you can try using a different prescription in each eye, but that's advanced. Try this first and report back. You will need a GOOD optometrist, not one of those cheap mass producing places, they won't devote the time you need. You can try calling doctors offices, and explaining your situation and see which doctor takes the time to talk to you and assure you he can help you. That's who you go see.
I like your last sentence! I am biting the internet right now! (:
First, Dr. Stein said that my vision will not become 20/20 after the surgery. Second, that's a charming thing of not needing any assistive device for reading if I wear reading glasses after surgery, but my far vision then, becomes blurry. It mean that I have to constantly put off and on my glasses, don't I? this is what makes me worried. I actually have persuaded myself to wear glasses till the last day my life and it's not a problem wearing reading glasses after surgery. Third, they told me it's gonna cost $400-500 for contacts. I actually had my first experience of contacts in the Bochner institute, but their sample lens was less than my eye's power, but it was a very brilliant experience. I felt like a free man for couple of mins. Forth, the other thing apart from all others that I have to be worried about is the determination of IOL power. I heard there is always a .05 D margin of error, even with IOL master.
First, Dr. Stein said that my vision will not become 20/20 after the surgery. Second, that's a charming thing of not needing any assistive device for reading if I wear reading glasses after surgery, but my far vision then, becomes blurry. It mean that I have to constantly put off and on my glasses, don't I? this is what makes me worried. I actually have persuaded myself to wear glasses till the last day my life and it's not a problem wearing reading glasses after surgery. Third, they told me it's gonna cost $400-500 for contacts. I actually had my first experience of contacts in the Bochner institute, but their sample lens was less than my eye's power, but it was a very brilliant experience. I felt like a free man for couple of mins. Forth, the other thing apart from all others that I have to be worried about is the determination of IOL power. I heard there is always a .05 D margin of error, even with IOL master.
oh and by the way, thanks for your time.
OK. I've made up my mind to go for it! I have 2 options from 2 different Drs.
1- Alcon anterior chamber, they also told me after op, I'll be using a pair of 2.75 reading glasses either off the shelf or RX made.
2- Opthec Artisan
I personally like AMO products, but it seems my doctors don't. So which one should I choose? I don't know their differences, so could you explain just a little bit about their difference?
tnx for your time.
1- Alcon anterior chamber, they also told me after op, I'll be using a pair of 2.75 reading glasses either off the shelf or RX made.
2- Opthec Artisan
I personally like AMO products, but it seems my doctors don't. So which one should I choose? I don't know their differences, so could you explain just a little bit about their difference?
tnx for your time.
Thank you. I got some of my answers. That's what I needed to know.
If I've understood it correctly, then the thin pair of glasses that my doctor said that I'll use for reading, is not just for reading, but for seeing near. If that's how a monofocal iol makes you see the world, then right now I think my vision, despite of being 20/50 in R and 20/60 in L, is far better than with an iol. At leas I have the quality of vision. And besides this, Dr. Stein, said that even now I can drive according to the rules of Ontario and that he will sign the documentations for me. I think I have to completely forget about divorcing my glasses ):
There is something called bioptic driving. Sadly, my optometrist did not know anything about it. (my optometrist, unlike Dr Stein, told me that I don't have the accuracy for driving and that he is not going to sign anything for me.) I guess I have to work on that. The requirement for driving a truck here in Ontario is 20/30 or less. I remember a low vision specialist told me that if implant an iol, I may even be able to drive a truck!
Just recently, I met a guy who operated his cataract in 1 eye and got blind due to the infection of the lens. He was so afraid that he decided not to operate the other eye.
Guys, is there any type of lenses for glasses that don't collect eye fat and get dirty?; that don't get foggy in the cold weather?; that don't get wet in rainy days? like being water resistant?
If I've understood it correctly, then the thin pair of glasses that my doctor said that I'll use for reading, is not just for reading, but for seeing near. If that's how a monofocal iol makes you see the world, then right now I think my vision, despite of being 20/50 in R and 20/60 in L, is far better than with an iol. At leas I have the quality of vision. And besides this, Dr. Stein, said that even now I can drive according to the rules of Ontario and that he will sign the documentations for me. I think I have to completely forget about divorcing my glasses ):
There is something called bioptic driving. Sadly, my optometrist did not know anything about it. (my optometrist, unlike Dr Stein, told me that I don't have the accuracy for driving and that he is not going to sign anything for me.) I guess I have to work on that. The requirement for driving a truck here in Ontario is 20/30 or less. I remember a low vision specialist told me that if implant an iol, I may even be able to drive a truck!
Just recently, I met a guy who operated his cataract in 1 eye and got blind due to the infection of the lens. He was so afraid that he decided not to operate the other eye.
Guys, is there any type of lenses for glasses that don't collect eye fat and get dirty?; that don't get foggy in the cold weather?; that don't get wet in rainy days? like being water resistant?
Many technologies start out poor and improve over time, so prior poor history says nothing about future success. Whether or not the current inlay technology is indeed useful seems to be under dispute among surgeons, there are prominent surgeons who have inlays in their own eyes. Fortunately since I have no need of an inlay I hadn't needed to decide if its a risk I'd take, but there are surgeons on each side of the issue so I figure its useful for people to be aware of that.
A premium IOL seems a better option than an inlay, but for those who already have monofocal IOLs (or presumably the Crystalens/Trulign), and really want more near vision, then an inlay might be an option to consider, though they should first understand the risks and be aware that some more conservative surgeons don't like them.
The explantation rate mentioned by the article on Dr. Hagan's page seems to be higher than it has gotten to with the latest techniques and a good surgeon:
http://crstodayeurope.com/pdfs/0715CRSTEuro_rs_tomita.pdf
"Advances in Corneal Inlay Implantation Over the Years
Changes in techniques have a direct correlation with decreases in a corneal inlay's removal rate
... my overall explanation rate is somewhere between 1% and 2% within 3 years of implantation"
That page indicates a surprisingly high explantation rate in the Kamra study for FDA approval however, so I would be cautious and check on whether thats due to surgeons using old techniques or perhaps not selecting patients well. Some other articles on the topic:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/intracorneal-inlays-correction-presbyopia-and-low-hyperopia
"In short: New alloplastic materials are being used as intracorneal inlays to offer predictable and safe refractive surgical correction of presbyopia and low hyperopia. The major problem with such inlays is the wound-healing response following their insertion; however, they can easily be removed."
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/corneal-inlays-still-altering-landscape-presbyopia?page=0,1
“More recently we have built upon the work of these pioneers and hopefully the new devices have solved the earlier issues,” Dr. Pepose said."
Some other articles on the topic and the choices available:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/presbyopia-therapy-comparison-corneal-versus-lens-based-options?page=0,0
"Presbyopia therapy: Comparison of corneal versus lens-based options"
http://www.medscape.com/viewarticle/843449
"Hydrogel Corneal Inlay Promising in Pseudophakic Presbyopia"
http://www.eyeworld.org/article.php?sid=8157
"Laser or inlay? Helping patients with a new decision"
http://www.eyeworld.org/article.php?sid=7713
"Correcting presbyopia: Monovision or corneal inlays?"
http://www.eyeworld.org/article.php?sid=8235
"Presbyopia inlays at the outset: Getting the near view"
A premium IOL seems a better option than an inlay, but for those who already have monofocal IOLs (or presumably the Crystalens/Trulign), and really want more near vision, then an inlay might be an option to consider, though they should first understand the risks and be aware that some more conservative surgeons don't like them.
The explantation rate mentioned by the article on Dr. Hagan's page seems to be higher than it has gotten to with the latest techniques and a good surgeon:
http://crstodayeurope.com/pdfs/0715CRSTEuro_rs_tomita.pdf
"Advances in Corneal Inlay Implantation Over the Years
Changes in techniques have a direct correlation with decreases in a corneal inlay's removal rate
... my overall explanation rate is somewhere between 1% and 2% within 3 years of implantation"
That page indicates a surprisingly high explantation rate in the Kamra study for FDA approval however, so I would be cautious and check on whether thats due to surgeons using old techniques or perhaps not selecting patients well. Some other articles on the topic:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/intracorneal-inlays-correction-presbyopia-and-low-hyperopia
"In short: New alloplastic materials are being used as intracorneal inlays to offer predictable and safe refractive surgical correction of presbyopia and low hyperopia. The major problem with such inlays is the wound-healing response following their insertion; however, they can easily be removed."
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/corneal-inlays-still-altering-landscape-presbyopia?page=0,1
“More recently we have built upon the work of these pioneers and hopefully the new devices have solved the earlier issues,” Dr. Pepose said."
Some other articles on the topic and the choices available:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/presbyopia-therapy-comparison-corneal-versus-lens-based-options?page=0,0
"Presbyopia therapy: Comparison of corneal versus lens-based options"
http://www.medscape.com/viewarticle/843449
"Hydrogel Corneal Inlay Promising in Pseudophakic Presbyopia"
http://www.eyeworld.org/article.php?sid=8157
"Laser or inlay? Helping patients with a new decision"
http://www.eyeworld.org/article.php?sid=7713
"Correcting presbyopia: Monovision or corneal inlays?"
http://www.eyeworld.org/article.php?sid=8235
"Presbyopia inlays at the outset: Getting the near view"
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If you have IOL's set for distance, and your distance vision is then 20/20, at intermediate, you'd require one and half diopters correction. If you chose not to use it, each half a diopter removes approximately one line of vision. So your vision should still be 20/50. To be safe, lets say 20/60. At near, you'd be off 2.5 diopters, or 20/70, lets say 20/80. Is your current near vision really that much better than 20/80 wearing only your distance glasses and no magnifier? There is a reason why everyone has an IOL implanted.
If there are no complications, I cannot imagine that you would be worse off than you are now at any distance, even assuming that you are in the group that has the worst vision at multiple distances after a successful cataract surgery. Medicine can't promise you no glasses, but they can promise much better vision than you have now. Given your history, I would recommend using regular monofocals, and not going to multifocals or anything else new fangled. You had congenital cataracts ,which means its possible that your visual system didn't develop normally because your brain wasn't receiving clear input. This slight disability could become a serious issue if you had to deal with the reduced contrast sensitivity and quality of vision you'd have with multifocal IOL's or current accommodating options.
Now, there is a way to run a test. Go find yourself a good, patient optometrist, and get yourself a pair of single vision contacts for distance. They do make brands for aphakic people, I think one is called silosoft if I remember correctly. You also have a fairly low prescription (if you didn't have cataracts ,you would have been extremely nearsighted and needed thick glasses anyway) so you may be able to use normal brands too but I am not sure. This should be approximately what your vision will be like with monofocal IOL's, except with IOL's you may occasionally catch a reflection around the edge, but your vision should be the same. If your distance vision is not 20/20 in contacts, it wont be with IOL's either. But your prescription is only a +8.00, so contacts should be really close (at all distances) to what you'd have after surgery. Try that, and then decide to keep wearing contacts, have the surgery with monofocals for distance, or if you're unhappy, then you can keep beating your head against the wall on internet forums looking for a better solution.