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The most neutral monofocal iol
Hello,
I'm writing here because I'm really desperate and cannot find an answer. Almost one years ago had eye surgery and got two hydrophobic multi-focal intraocular len. I still had no cataract, I was starting losing my near vision and the surgeon suggested this operations. But at once the vision was a nightmare with huge halos, huge starburst, flickering light night & day, unstable vision. Nothing helped and 10 months later I was just exasperated. After trying to convince my surgeon, for months, that something went wrong (really?!) and the lens should be replaced, he decided to exchange the lens in the right eye only with a hydrophilic monofocal lens.
Many problems have solved but I can still see very annoying halos, flickering reflections 40 days from the operation. The surgeon told me just to wait but I have this sense that the problem won't solve very much. So for the left hand I'm still waiting because I don't want this same lent but something different and the most possible light phenomena-free ...
I have 2 questions please:
1) is that true that silicone-made, with rounded edges iols are more forgiving about annoyances?
2) how much the refractive index of the lens influences internal reflection? Human lens is 1.41, my lens is 1.47. Has that something to do with the disturbances I have?

Thank  you for your help!
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177275 tn?1438375244
To your first question the answer is NO. To your second question the refractive index of your IOL does not contribute to your problems.   Your problems are not uncommon and one of many reasons I don't recommend "refractive lens exchange" or "Clear lens extraction".  As you said you didn't have cataracts you just didn't want to wear glasses.  

Even for people with cataracts they are not uncommon problems and using the search feature and archives will show you. You have "dysphotopsia" or unwanted light reflexes.  I would suggest you get a 2nd and third opinion from different cataract/IOL/Cornea/refractive surgeons in your area. Glasses likely progressive multifocal are in your future.
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Thanks! Hypothetically what lens would you use in my case?
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177275 tn?1438375244
My wife just had cataract surgery on both eyes. We chose Tecnis Monofocal ZA9003   Its important to understand there is no best automobile but there are a lot of very good ones.  There is no "best" IOL.   There are a lot of very good IOLs.  Most monofocal give very good results.  As people start asking for more and more glasses independence then the IOLs become more complicated, the surgery much more expensive and the chance of complications more common.
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I see, yes. The Tecnis Monofocal ZA9003 has rounded optiedge, so probably a good choice. I read that most problems about iols are because the truncated edges.
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Here they say that refractive index can cause reflections.
https://www.amedeolucente.it/public/EW-December-supplement-2014.pdf
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177275 tn?1438375244
Those are all potential problems. But the 'experts" often disagree and each uses different IOLs.   There is no IOL that someone, somewhere has not had problems with.  I still say your best option is an independent 2n and 3rd consultation outside the office you go to.
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I had a Acrysof IQ monofocal IOL implanted in one eye only following cataract surgery, and have had no complaints.  Had no reason to go with a multifocal since at this time the other eye has needed nothing done other than wearing contacts.
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MrPresley, thats where I am at as well.
My right (dominant) eye has a significant cataract that now has best corrected vision of 20/50 or so. I've got a tentative surgery date of 10/24 for that eye, planning for a Tecnics Toric monofocal.
My left eye has a very early stage cataract, but probably won't affect my vision for several years yet - so I could just use an RGP contact in that eye after the right eye surgery.
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Usually a monofocal IOL is set to correct distance vision, however I did not go that route since it would have left a wide disparity in the uncorrected vision in both of my eyes, and I may very well never need to have cataract surgery in my other (right) eye.  As it is now, both of my eyes are at approximate parity and corrected with RGP contacts to 20/15.  
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By the way NightHawkGuy, best of luck in your cataract procedure next month.  It took about three months after the initial evaluation and measurements for me to get mine done, but that's to be expected I suppose when going to a reputable surgeon.
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Yep its taken several months for me as well.  I got cataract consulations with 3 different surgeons over the past 3 months. The 3rd one I liked the best, had to make the consultation appt with him nearly 2 months in advance! He offers both femtolaser and ORA as options, but I probably just go with manual blade surgery but with ORA. The femtolaser added cost ($1700) nearly doubles the price with a toric IOL, but the ORA added cost is reasonable ($300).
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The current plan is to target my right eye for just slightly nearsighted (-0.25D) to hopefully avoid getting overcorrected farsighted.  That eye I believe used to get 20/15 corrected with eyeglasses or contacts before the cataract affect its vision starting almost 4 years ago. So even with a little nearsighted could probably still get close to 20/20 if the astigmatism is corrected well by the toric IOL - I have nearly 3D cylinder in that eye. The surgeon told me he usually tries to leave a small amount of astigmatism (0.5D or less cylinder) since as the eye ages he told me the with the rule astigmatism can reduce slightly. That can also increase the depth of focus a bit.
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The best corrected vision in my left eye dropped to 20/70 before the cataract surgery. The nearsightedness in my right eye is currently -6.0D with a baby cataract, and with the IOL in my left eye it is at -4.5D.  
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My right eye also has glaucoma the past 4 years. I noticed in the results listed for my last cataract consultation, the eye surgeon listed that as "mild" glaucoma. I take two types of eyedrops a day in that eye to keep the IOP in that eye under control to normal levels and with that the eye's glaucoma has not gotten worse over the past nearly 4 years.

The eye surgeon also told me that after cataract surgery typically the IOP drops 4 points.  I hope that is the case for me, since then it might be enough to get me down to only one IOP eyedrop/day.

The surgeon also told me his results are that over 90% of his cases have resulted in achieving within 0.5D (power and cylinder) of the target.
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I found an online article that discussed how astigmatism is more common "with the rule" in younger people until age 60+ when "against the rule" becomes more common.

If someone had "with the rule" astigmatism up to age 60, expect this aging effect to become more "against the rule" to have a small cancelling effect causing a net less astigmatism as aging continues? If so, how far could it go into your 80s-90s?
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Can't answer regarding the astigmatism, but the IOP in my left eye did drop following cataract surgery in the manner you described.  Mine has never really been high to begin with however.
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MrPresley, did you get an IOP drop of 4points or more? How long has it been since your surgery?
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It was right at a drop of 4 the last time it was checked in June.  My cataract removal surgery was performed on March 20 of this year, and of course my IOP spiked the day immediately following surgery but even then still remained just below 20 or so.  Mine typically ran 12-14 before, and my left eye (on which the surgery was performed) was down at 8 in June.

Rx eye drops I used for the month following cataract surgery were Besivance, Diclofenac, and Prednisolone.
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Also I tried a "poor man's monovision" test earlier this year where I used a contact lens I had on hand in my right eye for distance correction and left my other eye uncorrected to use for close up.  I had not worn the pair of contacts that I had since fall of 2015.  Of course my close up vision in my left eye was being affected by the cataract, but it gave me enough of a feel to realize I still don't like monovision.  I tried it years ago with contacts in both eyes and did not like it much then either.
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The last set of RGP contacts I used up until about 4 years ago I had mini-monovision with the dominant right eye for good distance and the left eye less than -1D which at least gave me decent intermediate range and still good distance vision too.

Unfortunately the RGP contacts would warp the cornea a bit (goes back to normal if you stop wearing the contacts for a week or so) that makes it difficult to switch between the contacts and glasses that are setup with an Rx for when you haven't worn the contacts for weeks.

Good to hear you got a 4 point sustained reduction in IOP after the cataract surgery in one eye.  If I can get something similar, that would probably allow me to reduce down to only one glaucoma eyedrop per day (just before bedtime), which is much easier to cope with.
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Best of luck with your upcoming cataract procedure, and of course come back and post up your experiences with it.  It's good to have your dominant eye restored to dominance, which was the situation in my case.

One interesting point about cataract surgery is it's done with the patient more or less "awake".  It wasn't too bad in my case, and really not much  worse to me than having laser repair of a retinal tear in my ophthalmologist's office.  If you can get down to one eye drop per day all the better, that may seem positively easy after the post-op 4X daily drops that may be prescribed for the first month after cataract surgery.
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The eye surgeon I am going with does a new technique to significantly reduce or totally eliminate those post-op eyedrops by injecting one time into the eye at the time of surgery and it lasts for a few weeks!
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I remember that my optometrist mentioned that one-time injection when I went back after the cataract surgery to get new contacts.  Doesn't it eliminate the need for anti-inflammatory drops like prednisolone and/or  diclofenac?  The third drops I used were an antibiotic so something like that may still be necessary.
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As a caveat my optometrist was the one who originally referred me to the cataract surgeon.  I had asked him originally "Who would you see if it were you?" and he gave me the names of three specialists.  The one we settled on was great, and after the surgery and day-after follow-up were done I was released back to the optometrist about a week later to update my corrective lenses.  I remember telling then him that I was going to be using drops for several more weeks so we could wait until afterward to start back with contacts.  I was actually glad for the delay because that gave my operative eye time to settle into its final visual acuity.  It's soon going to be 6 months since I had it done and there's no indication yet that I will need a YAG procedure done.
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Today I finally got the entire sequence of appointments setup for my right eye cataract surgery!

The surgery date is 10/24 @11am and was told the surgery takes under 30min, and then rest for up to 60min before going home.

I have the cornea measurements pre-surgery office appointment a week before the surgery and a pre-op mini-physical exam by a nurse practioner next week which is under 30days before the surgery.

Only two post-op followup office checks scheduled, 1day after surgery and 2weeks after.

They are also sending a Rx to my local drugstore for the two non-generic eyedrops that only require 1drop each per day for the 4weeks after surgery. The reason the does is so low is the doctor also does a one-time eye injection at the time of surgery as well.

They told me if the copay total for the eyedrops is over $100 to cancel the Rx order and call them to get them at lower price.

The names of the Rx eyedrops are:  Durezol (steroid) and Ilevro (NSAID)
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Yours is moving along a little faster than mine did.  I went in for the pre-surgery measurements and consultation about 3 months before the actual surgery took place.  There was also no pre-op mini-physical, or a 2-week follow-up.  There was a one day-after follow-up, after which I was released back to the optometrist who originally referred me to the cataract specialist.  I did not use those specific eyedrops, rather a steroid, a NSAID, and a antibiotic.  I will soon be at 6-months post surgery and all is well.

Best of luck.
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One other comment, the day I had cataract surgery performed I noticed a reference on the pre-op paperwork to "floppy iris syndrome".  I asked about it and was informed that OTC supplements containing saw palmetto can cause this, and it's simply something the surgeon should know about as a precautionary measure beforehand.  So, the list of Rx meds and/or supplements you provide the facility beforehand during your initial evaluation should always be as complete as possible.
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177275 tn?1438375244
The primary cause of floppy iris syndrome is use of Flomax for prostatic hypertrophy
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Yesterday  I had the pre-op checkup to get cleared for the upcoming cataract eye surgery, scheduled for Oct 24.
All was normal intially except my BP is always very high only at the doctor's office - an hour before at home it was below normal as it usually is measured daily at home.

However at the end an EKG was done and it detected "right bundle branch block" but without any other symptoms, so that was considered benign - just something to monitor at annual physical exams.  Could have been that way for years or even decades since I never had an EKG before and the heart sounded normal with the stethoscope. So just something for the general doctor to monitor at annual physical exams in the future.

So I was cleared for the cataract surgery.
Next up is the cornea measurements in 3 weeks where the final choice of the IOL type will be made.  Also at that time I can get a $10 kit containing the eye shield, paper tape, and sunglasses.  Also will setup to pickup the two Rx eyedrops bottles for use 4 weeks after surgery, 1drop/day of a steroid and 1drop/day of a NSAID. Surgery date is one week after that.
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This week I had the appointment for biometry, cornea measurements.  The eye surgeon called me today and confirmed the measurements were as expected and my right eye had the expected 3D astigmatism and slight nearsightedness.

So he went over the IOL options and I selected for my right (dominant) eye the Tecnis Toric monofocal IOL to be targeted for good distance vision (0 to -0.5D) with elimination of the bulk of the astigmatism.  He will use ORA but not femtolaser for the surgery, scheduled for next week on Tuesday.

I have my two Rx eyedrops already, only will have to use one drop of each per day in the right eye for 4 weeks post-op. I hope everything goes well next week with no complications.

The doctor told me the top thing to avoid doing to reduce risk of toric rotation, etc is rubbing the eye.  He said the most common reported feeling in the eye after surgery is like feeling a foreign object in the eye.
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177275 tn?1438375244
Okay thanks for your post. These posts are helpful for people learning how different surgery is for different people.
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I made it a point to avoid rubbing my left eye both after a vitrectomy/ERM peel and subsequent cataract surgery, and have continued to avoid doing so to this day for both eyes.

Best of luck again on your outcome.
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