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To IOL or really give hard contact lenses a try?
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To IOL or really give hard contact lenses a try?

Dear Doctors,

I have relatively severe Myopia in my right eye (contact lense -9.50) and myopia and astigmatism in my left (-8.50; 2.25)  so it's no surprise that Lasik examinations have found I am ineligible for laser treatment.  

I'm only 27 years old, but have been eying IOLs for quite some time.  I've read in some places that you generally have to be over 40 to ensure eye growth does not stress the IOL -- is this a fixed rule?  How about this dream of adaptive IOLs -- would their implantation likely improve or worsen my vision?   I know there's a lack of long term studies, but is this likely to in the long run reduce my vision more than it is now.  

I'm so sick of contact lenses and glasses -- and doctors tell me it's just a matter of time before I get a serious problem wearing my contacts all day long, every day (I've had them for around 15 years, and only had the occasional infection..)

Alternatively, though it seems really unpleasant, expensive, and impractical for me (I swim a lot and travel throughout Africa and South America), I suppose I could suck it up and try hard lenses -- but I've always thought soft contact lenses would be my bridge until I was ready for IOLs at around the age of 30...  Is this a pipe dream to imagine I might get a decade or so of good vision, and then wear reading glasses for far-sightedness?

should I resign myself to hard lenses, and forget about IOLs until I need cataract surgery?  All I've ever wanted is to wake up and be able to see.,,  Your thoughts are much appreciated,



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Dear Teebs,

I would recommend that you seek the  care of an eyeMD who performs refractive surgery including the Visian ICL [implantable collamer lens], PRK [photorefractive keratectomy] as well as LASIK.  They should be able to assist in determining which procedure is best for you.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California
Who says that "it's just a matter of time" until you can no longer wear contacts?  I know people over 70 who are still comfortable wearing contacts all day every day.  As long as you can wear contacts comfortably, my advice would be to continue wearing them.

I can think of a couple of good reasons not to get IOLs now.  For one, having cataract surgery increases your risk for retinal detachment, and you are already at a higher than average risk because of your high myopia.  (You would probably also need a YAG, which adds to the RD risk.)  Furthermore, none of the currently available "premium" IOLs are all that great, and you won't get the same crisp vision at all distances that you have now with your contact lenses.  There will definitely be better "premium" IOLs available in the future, including some that correct astigmatism.  If you got monofocal IOLs now, you'd need glasses for all near and intermediate vision tasks (i.e., most of the time.)

"Pipe Dream" is a good description. I was just like you, wishing for great vision without glasses or contacts. I was very  nearsighted and needing reading addition in my 40's,.. really,really hating monovision contacts or bifocal glasses. I was lured by the promises of accommodating IOLs. Today, I would give anything to go back and have the vision I had before. First of all, accommodating or multifocal IOL's rarely give you great vision at all distances. There is a compromise somewhere. You can read this forum and see that most patients are dissatisfied about some aspect. Secondly, the risks of surgery are very real. The more myopic you are, the greater your risk of retina complications as a result of the disruptive effects of the surgery on the vitreous attachment to the retina. The vision loss and distortion from the retina damage I now have three years after lens replacement surgery is directly related to this and it appears to be something I'll be living with the rest of my life.
Hard contact lenses are not so bad once you give yourself plenty of time and build up to being able to wear them. And, even if you are not a LASIK candidate, there are  other options to consider such as implanted contact lenses. Any surgery to the anterior part of the eye will not carry the risks of the more invasive IOL surgery, which I really think you should avoid at all costs.
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John C Hagan III, MD, FACS, FAAOBlank
Discover Vision Centers of Kansas City
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