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Avatar universal

Best IOL for night vision and Astronomy work?

I'm an avid, 49 year old, backyard Astronomer and I'm facing in the coming weeks my first of two cataract surgeries.   I've narrowed my IOL search to two lenses: Technis 1-Piece vs. Acrysof IQ lens implants.  I'm leaning toward the Technis lens because I value my night vision probably as much - or more - as my daylight vision.   I take night walks, in addition to my Astronomy activities, so the Technis seems to be the way to go.   My Dr. however want to use the Acrysof IQ lens due to a bit of astigmatism in both eyes.   He wants to correct to a nearsightedness similar to what I have now (approx. -2.00), with me wearing glasses to see far.   Since glasses are a part of the mix regardless, I think correcting to distance vision with the Technis lens is really the way I should insist on having it done, and correct for the astigmatism with the glasses that I will have to wear anyway.  It seems that most of the postings I've read were corrected for distance vision.   My Dr. explained that he prefers correcting to a nearsighted condition, since most of our world is interacted with at a closer range.   But I actually would prefer to wear glasses for the "close" interaction, and be corrected to distance vision.   Does this make sense, or should I just go with what the surgeon is wanting to do?   I understand that some of the astigmatism can be lessened simply by where the surgeon places the incision during implantation.   Is that true?
   Also, I have a problem with the Acrysof IQ having a "blue filter" (the IOL is slightly yellow) and would prefer to see ALL of the spectrum for my astronomy viewing.   I would like to know if the blue filter results in less night vision compared to the Technis?   How is the vision better at night with the Technis?      Are halos, or ghosting, when looking at point sources of lights (stars/headlights) at night a problem with either of these lenses?   The Acrysof IQ seems to suffer more from "glistenings" than does the Technis (if all of the Technis data on it's website is to be believed).   That is something of a concern for me as well.
   I would love to hear from anyone having had either a Technis, or an Acrysof IQ lens implant, and what has been your overall experience with either IOL?   Is the astigmatism correction really that overwhelming with the Acrysof IQ, or can I be happy with having the correction built into my glasses (and going with the Technis), as I've had for most of my life?
   I hope to hear from many of you, soon!
9 Responses
711220 tn?1251891127
MEDICAL PROFESSIONAL
Most studies indicate that patients are happiest with best uncorrected distance correction.  I share your concerns about the Acrosof.

You can google Oyakawa and Is an LRI needed in this eye?  This is how you determine the surigical location to minimize residual astigmatism or to do an LRI (also implant a toric iol).

Dr. O.
Avatar universal
I have AcrySof IQ lenses.  My personal research suggests that there is little (no?) evidence that blue-light blocking provides protection against macular degeneration.  The intensity of the yellow tint varies with the power of the lens.  Powers that correct very farsighted eyes have the strongest tint; powers to correct very nearsighted eyes have the least.  I was previously very nearsighted, and the yellow tint in my lenses seems to make no difference in my vision.  My night vision actually seems to have improved with the aspheric IOLs.  They do have a glistening effect (youthful glow?), though.

I had limbal relaxing incisions to reduce my astigmatism.  The results were great immediately after surgery, but four years later more than half of my astigmatism has returned.  If you have significant astigmatism, your vision will be blurred at all distances.  In your place, I'd choose AcrySof toric IOLs (despite the tint and the glistening) because they are reported to be the most reliable way to eliminate astigmatism.  If your lenses were set for mini-monovision (distance vision in one eye, intermediate in the other), with a little luck you would only need glasses for prolonged reading or seeing small print.

Few people would be happy with both lenses set for -2.  Since this is what you are used to, maybe it would work for you.  However, you might be happier with mini-monovision with a near bias (intermediate vision in one eye, near vision in the other).  You could read and use your computer without glasses, but you would need glasses to drive.

If you don't care about reducing your dependency on glasses, then go for the Tecnis lenses.  You should have excellent vision at all distances with progressive lenses.  
Avatar universal
Thank you Dr. Oyakawa for responding to my questions.  
Why do you think most people are happier with distance correction vs. near-sighted correction?   I was told I wouldn't be able to see anything at arms length if I got the distance correction, but I don't mind wearing glasses, having worn them most of my life.  I was also told that I have "moderate" astigmatism in each eye, so I hope that the LRI procedure will minimize this, with any remaining astigmatism being corrected in glasses.
What are your main concerns with the Acrysof Toric, and do you think that the Technis 1-piece is a superior lens?   Again, my primary concern is for the absolute best possible night-vision.   I want to be able to look up at the night sky and see the Milky Way without halos, ghosting, reflections, etc.   The same applies for any point source of light, such as oncoming headlights, and such.
Thanks again.
Avatar universal
Thank you for reponding to my questions, as well.
My main concerns with the Acrysof Toric ARE the blue-filter and the glistenings!   I need the best possible night-vision outcome, and losing a percentage of the blue spectrum, however imperceptable, would affect my Astronomy work - even though I know that at 49 years of age I have already lost it due to the yellowing of my natural lens.   I'm excited at the prospect of getting it back!   The glistenings are also troublesome, as they potentially could scatter feeble starlight entering my eyes.   You state that they give everything a "youthful glow".   Is that mostly a daylight phenomenom, or do you notice any effect on point sources of light at night, i.e. stars, oncoming headlights, streetlights, etc.?   In addition, do you have any "ghosting", or stary reflections,  in those situations?   I understand that the Tecnis 1-piece has an edge over every other IOL on the market when it comes to quality of night-vision.  It also is less prone to glistenings.
Why do you think that people are happier with being corrected for distance, as opposed to near-sighted vision?  My Dr. believes in the near-sighted correction because most of what we do on a daily basis is near, as opposed to far.   But since I actually prefer wearing glasses, I wouldn't mind having to wear any for my day-to-day activities.   I know that I wouldn't tolerate a mixed correction, though.   I either have to have both adjusted for distance, or near.   I am a -2.00 in my left eye, and a -4.50 in my right eye presently.   I used to be -1.75 in my right eye, but had a vitrectomy at the end of September, 2010 for a detached retina that was off of the macula.   So, after the vitrectomy, gas bubble, and scleral buckle, I am now at the -4.50 in that eye.  I was also told that my astigmatism is "moderate", so I hope that the LRI procedure can reduce, or eliminate, this.   Were you ever told why your astigmatism is starting to return 4 years later?   I was hoping that the LRI was a bit more permanent.
The cost of everything has been a bit shocking to me though.   I was told insurance doesn't cover the costs of either the Acysof Toric, or the Technis 1-piece lenses.   Nor does it cover the cost of the LRI procedure.   I have to pay up-front, out-of-pocket for these, before the surgeries can even be scheduled.   The Acrysof Toric is $1,050 per lens, and the Tecnis 1-piece is $2,200 per lens!   The LRI procedure that is needed if I go with the Tecnis is an additional $800 per eye.   So I am facing $2,100 vs. $6,000, depending on which way I end up.   I just love the insurance industry...
I'm willing to spend the extra for an edge to my night-vision though, as I would be miserable if I couldn't spend the night under the stars and enjoy the Milky Way in all of it's breathtaking beauty!
I look forward to your response, as well as any input from anyone else who has a Tecnis 1-piece or the Acrysof Toric lenses.
Avatar universal
If you don't mind wearing progressive glasses most/all the time, ANY aspheric monofocal IOL can provide your best possible night vision.  This is the case whether your IOLs are set for plano or -2, or whether or not your IOLs correct your astigmatism.

Cataract surgery provides a golden opportunity to reduce your dependency on glasses/contacts, which many people consider a big plus.  But keep in mind that your satisfaction with any IOL (including the Tecnis 1-piece and the Acrysof Toric) is highly dependent on the skills/experience of the surgeon implanting it.  Having a surgeon who is very experienced with a particular brand/model of IOL increases the odds of hitting your refractive target.  This is because the surgeon can factor his/her experience with that particular IOL into your IOL power predictions.  Successful correction of astigmatism (with either LRIs or a toric IOL) is even more dependent on the surgeon's skills.  So if you're counting on limbal relaxing incisions to eliminate/reduce your astigmatism, it's very important to have a surgeon with successful experience performing this procedure.  I suspect that most practioners are a lot less successful at this than Dr. Oyakawa.

It's possible for you to (almost) have it all--best night vision and reduced dependency on glasses  (see options described above).  But you might want to get another opinion from an experienced, board-certified cataract surgeon before proceeding.  Frankly, I would not choose a surgeon who corrects most of his patients to around -2.  I suspect that this is not a surgeon who is particularly skilled at hitting the refractive target.  (After all, it makes little difference whether vision ends up at -1.25 or -3, since his patients are probably going to be wearing glasses most of the time.)    



Avatar universal
Our responses crossed.  The "glistening" effect makes no difference whatsoever in your vision.  It is something noticed only by onlookers in some lighting situations--there is a subtle glistening from your IOLs.  No one has ever commented to me about this, but I've occasionally noticed it myself (in the mirror) in indoor situations with artificial lighting.  This might be a real problem for a few people (e.g., actors in the movies).

There's tons of marketing hype from the major IOL manufacturers about correcting spherical aberrations.  It's my personal opinion that there's no perceptible difference in vision between the aspheric IOLs from AMO and Alcon.  I also don't believe that the yellow tint makes a perceptible difference in vision for the great majority of people.  (And who knows, maybe it does actually help to prevent macular degeneration.  Anything's possible.)  I also needed cataract surgery as the result of a vitrectomy (right eye), and my left eye did not have a cataract at the time my AcrySof IQ was implanted.  I can honestly say that my vision with my left eye is at least as good as my best-corrected vision before cataract surgery (with slightly better night vision).

My vision in my right eye still has some mild distortion post-vitrectomy with epiretinal membrane peel.  Both my eyes are set for the same distance (plano), which allows my good eye to compensate for the distortion so that I'm almost never aware of it.  If you also have some distortion in your affected eye, then perhaps setting both your eyes to the same refractive target would also work best for you.  Your best target might be slight myopia (but not -2), but that's a personal decision.  Otherwise, a little mini-monovision would expand your range of focus.

After limbal relaxing incisions, there's been a progressive return of my astigmatism, with slightly more at each eye exam.  If you want LRIs, then find a surgeon who has lots of successful experience doing this.  By the way, I don't believe that the Tecnis 1-piece is a premium lens, so it might not be legal to charge an out-of-pocket fee to implant it.    
Avatar universal
I checked, and I don't believe that the Alcon toric IOL is availabe without a tint.  Given your strong concerns, I suggest that you find a surgeon who is experienced with the Tecnis 1-piece lens and LRIs.  Be sure to check out the legality of imposing a surcharge o the Tecnis lens before you pay it.  (The doctors on this forum would know.)
Avatar universal

I did a followup call to my Dr. after reading your belief that the Tecnis lens is not a premium lens and found that they had misquoted me on the Tecnis 1-Piece.   They thought that I was inquiring about the multi-focus version, not the monovision.   Turns out the monovision version is completely covered by my insurance, with no out-of-pocket expense up-front!   That's a nice $4,400 swing in my favor!   The LRI procedure is still $800 per eye, but that will be worth it when it's done.   He still strongly recommends that I be corrected nearsighted to roughly a -1.75 diopter in each eye, since that was what I had been most of my life and used to, and I am still working and would appreciate being able to see closer without glasses, than further.   I also found out that I am presently a -3.00 in my left eye, and a -4.50 in my right.   I was going off of an older script when I wrote my previous posting.  
Thanks again for responding to my posts!
Avatar universal
I am an amateur astronomer also.  I have multi focal IOLs in both eyes.  I could not recommend these to anyone serious about astronomy.  My doctor downplayed some of my concerns.  The end results are this.  My multi focal IOLs accomplish their ability to focus over a great range using a serious of halo like rings in the lens.  Not technical, I know.  These rings are always visible in car headlight and streetlights.  I have gotten used to it, but they are always there and often an anoyance.

For astronomy, any high power magnification of the moon or sun (through thousand oaks filter or baader film) makes these rings very apparent and anoying of which I have had no choice but to get use to.  They are not an issue with planets such as saturn or jupiter.

But you are looking at mono focal IOLs of which they all seem to create a high degree of corneal relection or eye glint.  A study in 2002 showed all IOLs increased corneal reflection from something like 30 to 1000 fold.  So, where I use to not experience corneal reflection when viewing Jupiter or Saturn, I now noticably do regardless of eyepiece whether it is a plossle, orthoscopic, kelner, RKE, or a wide field lens such as televue or baader.

The lenses don't seem to have any negative impact to deep sky or extended objects.  

The telescopes used are newtonian and SCT.  

If I was to redo this, I would give great concern to corneal reflections if planetary observing was important and if lunar or solar observing was important then definitely don't go with mult focal.
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