Which IOL should I get in cataract surgery?

I have a minus 9 correction in hard contact lens for myopia (near sighted).  I began wearing bifocals in junior high, and could not get a tennis ball across the net until I got hard contact lens at age 22.   I need cataract surgery, but am very concerned about which intraocular lens I should get.  I prefer not to have glare, and would not be adverse to glasses since I have worn them since second grade.  I need to read books, read music, sew, knit, garden, and drive.   Has anyone had experience with IOLs as a fairly high myopic person?   My contact lens now give me a lot of glare and loss of contrast.  I see better with glasses at close range now, but have to use contacts to drive.   Surery is forthcoming.  Help!

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

Use the search feature and read the many many posts on this subject. This is the short summary and general consensus.

Have a monofical aspheric IOL like tecnis, Alcon or B&L by a experienced, ethical surgeon.

Don't be talked into multifocal IOLs.

If you want best distance vision without glasses aim for post op refractive errors of -0.25 in distant eye and -1.25 in the intermediate/near eye.

If you want to be able to read without glasses. aim for -2.50 in reading eye and -1.00 in intermediate eye.

Plan on wearing progressive bifocals for your best binocular vision.

JCH MD

[battleax]

Thank you very much for your advice.  I have been looking at the many comments, but this surgery for a myopic person is scary.  I forgot to mention that I have astigmatism in my left eye, not bad, but noticeable to me.    I am not sure about what you mean about having different prescriptions in each eye.  I do know someone who uses that method for her contact lens, but it did not appeal to me.   I'm sorry, but I need more details to feel comfortable with your advice.

I also forgot to mention needing to use the computer and reading grocery store signs in the store which I cannot do presently.  

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

I am not advising you what to do with your surgery. I'm only telling you what options others have done.  You and your surgeons make the decision.

JCH MD

[2ndsight]

What Dr Hagan is talking about is to get a slightly different degree of near and far vision in the two eyes to get more independence from glasses, in other words, target better near vision in one eye, better distance vision in the other.

If you are not averse to glasses though you might not want this, and especially if you do sports, a lot of driving, other outdoor activity, you might want to try to achieve good distance vision in both eyes and then use glasses for closer-up activities.

lots of people with myopia have posted on this board and have achieved good vision with both mono and multifocal IOLS. I have a Crystalens which I am happy with,  but my vision was -7.00 before my surgery, and I have read in one article that it corrects myopia reliably only up to around -9.00.

Crystalens also does not correct astigmatism and I felt my slight astigmatism was even exaggerated after surgery.

as far as the side effects from mutlfocal IOLs, it seems from reading many posts on this board that possibly some surgeons are not taking the care and attention to make sure the multifocal lens is really suited for the patient. Also possibly that the surgeon is not fully experienced with every kind of IOL. I would recommend having an in-depth discussion with your surgeon about the kind of vision you have now, and what  outcome you would like to achieve and ask him to explain the pros and cons of each IOL in view of this.

I would also ask him which lens he implants most regularly, and what percentage of patients have had any side effects or complications.

Another question you might ask him since you wear hard lenses is about the accuracy of the measurements he will be taking. Most surgeons recommend some time off from wearing lenses, especially hard lenses, to get accurate measurements of the cornea. If he hasn't discussed this with you, consider getting another opinion.

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

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[FredZq]

You don't want any glare and you like to read.

What the Doc advises -2.50 and -1.00 is what you want. You will be able to read and sew comfortably without glasses. The slight mismatch in focus distance is easily compensated for by the brain. You will need glasses for driving. That ain't bad considering the alternative of just a few years ago.

I told my Doc thats what I was leaning toward, with a Tecnis aspheric lens; on our first consultation. He gave me the standard caveats about any surgery, never even mentioned the multifocals,  and said thats what he did for his mom.

I'm happy with the one in my left eye and probably next month will have the other one done. I would not even consider any of the multifocals lenses.

[battleax]

Thank you for your comments.  It is great to get information.  It appears that you both have had reasonably positive experiences with your surgerys and lens results.  I 'm glad to know as much as I can because I live in a small town and have to drive 50 to 200 miles round-trip to see medical specialists.   I was not impressed with the opthamologist I saw in the nearest medical facility of 15 miles away.  

I have corrected 20/40 in my right eye and 20/50 in my left eye (with astigmativm) at the present time, and unless surgery is done, I will probably fail my next driving license eye exam.  My actual correction seems to vary between -10 to - 11, and since the images seen are so small, there is a +2.25 added back in (my intrepretation).   I really hate to give up my near vision.

Can cataract patients wear soft lens to correct distance vision after the surgery has healed?

Visual acuity is a major concern for me.   The higher the correction, the more distortion occurs in seeing distant objects as in passing cars and reading street signs.   Does anyone know what the actual strength of an IOL implanted into an eye?   For example, -2.50 is a result, not the actual prescription strength of the lense.

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

A IOL of say + 19.50 diopters will give different post op refrctive errors depending on the axial length of the eye and the radius of curvature of the cornea.

All IOLs are positive power.  Myopes require lower powers of IOLs than hyperopes.

Yes soft CTL can sometimes be worn after surgery but what would you want to do that for? If you wear them for distance you will need glasses for reading. You could try monovision.

JCH MD

[2ndsight]

several patients on this board have said they wear contacts after surgery, maybe not
immediately though while your eyes are still healing


another solution as Dr Hagan has suggested to many others is progressive no-line glasses. This way for example if your corrected vision is good for close-up, you can leave the lower or reading part of the glasses clear, and just correct distance and intermediate if need be. You can also get the glasses corrected for your astigmatism, this is what I did

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

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[armand74]

I've decided to have crystalens implants at my cataract surgery.  Is $2,000 per eye beyond the cost of a monofocal lens the going rate?  It sounds ourageous to me.

[peakhope]

Based on what little information I have, $2000 per eye for a premium IOL would not be outside of my range of expectations.

[ace399]

I live in West Chester, PA (a suburb of Philadelphia) and I paid $2200 per IOL.  The reason for the extra cost is because there is a lot of follow up and adjusting that may need to be done with premium IOL's and the insurance companies do not pay for this.

Two weeks ago I had a Crystalens HD520 implanted in my right eye.  Although it is still early yet, nevertheless, my near vision (computer screen and closer) is not clear.  My Dr. recommended implanting a Restor lens in my left eye.  He says he his patients who are like me and have this combination are very happy.

I went and got a 2nd opinion on this from another Dr. and he says this is good approach to getting near vision, while keeping distance.  He has also done this with his patients.  He said that the patient's happiness depends on the patient.  "bstaggs" has been ecstatic about this combo.  I decided to go with the Restor in my left eye.

It seems to me that the most critical thing is to make sure your surgeon is really really good at implanting premium IOL's.  Make sure you are getting the latest Crystalens, the HD.  Good luck and visualize success!

[mmrudy]

Cost of a premium IOL varies by location. The additional cost of a Crystalens HD runs $2500, a ReStor or ReZoom about $2000, a Toric about $1000 in New Mexico. Hope this gives you the range of information you need. For myself, good vision and an excellent surgeon are worth the cost.