lens replacement for patient who has other complications

I am 70 and a UK resident. When young, my eyesight passed the RAF aircrew pre-selection examination. However, I now have cataracts in both eyes. I am now considering having intra-ocular lenses fitted, but there are complications so I need advice.

The cataract in my left eye has been there for years but is no trouble and seems to be growing very slowly. The cataract in my right eye, however, has ‘come from nowhere’ in the last year or so and the vision through that eye is now blurred.

There is glaucoma in my family, so I have my eye pressures tested annually. My current pressures are at the top end of the ‘normal’ range. I also have Fuch’s Endothelial Dystrophy, so whatever choice I make in regard to intra-ocular lenses needs to be the final one as secondary surgery may well be inadvisable.

I feel tempted by premium lenses, such as Synchrony or Tetraflex, however I hear that premium lenses generally are more likely to yield an unsatisfactory result and have to be removed. Am I wise to confine myself to monocular lens types?

I also wonder if it is advisable to have a new lens only in my left eye, which needs it, and delay having one in my right eye for as long as possible?

[Ray T Oyakawa, MD]

You are providing too little details.  What is your refraction, vision, the endothelial cell count (Fuch's), etc.    The best thing for you is to find the right surgeon.  The Synchrony and Tetraflex are not yet approved in the U.S.  I understand that the Synchrony requires a large incision and a "perfect" capsulorhexis.  The results with the Tetraflex seems similar to the Crystalens.

Dr. O.

[SkyArrow650TC]

Hi Doctor Oyakawa,

Thank you so much for your reply.

I regret I have only limited information, but such as I have is given below.

I have had only preliminary consultations with two surgeons and no biometric measurements of endothelial cell count have so far been made. The difference in the advice given by the two surgeons is, however, stark. So I am considering consulting a third surgeon and then following the majority view!

The surgeon who examined me under the British National Health Service (NHS) advised me that my vision was as yet not sufficiently bad to meet the criteria for surgery under the NHS. He advised me in any case to delay surgery until my vision was so bad as to make life difficult as surgery can go wrong and leave me in a worse situation than I am in now.

The other surgeon I consulted was private surgeon who, (because I hold a [currently expired] flying licence,) recommended the Synchrony lens. This is a young surgeon out to make a name for himself and struck me as being just a little bit too 'gung-ho' for my liking, so I have not so far followed his advice.

Last August my visual accuity was recorded by the private surgeon at 5/36 in the right eye and 5/24 in the left. My best corrected vision was 5/5 part in the right and 5/9-1 in the left. Intra-ocular pressures were 21 mmHg in each eye. I am moderately hypermetropic but my anterior chambers are deep and my cup disc ratio was 0.5 with a healthy neuroretinal rim. The macula appearance was normal.

I should be grateful to receive any comments you feel able to make.

Kindest regards,

SkyArrow.