Avatar universal

Cataract surgery and the kind of lenses I can have implanted

My optometrist, who I've been going to for several years, told me recently that I should look into getting cataract surgery, so I have started looking around. I've gone to a couple of ophthalmologists, and I've gotten conflicting recommendations.

I need to mention that I have a macular pucker in both eyes. I am slated to meet with a retina specialist to learn more about that. I have also been told that I have a slight unevenness in my corneas. I apparently don’t have astigmatism.

For some time now, my sight has been getting worse. My distance vision is blurry, but I can still see well enough to drive without glasses. I can no longer read or view my computer screen (which is how I spend a significant part of my day) without reading glasses. My optometrist hasn't had me get prescription glasses. Instead, he has encouraged me to get by with my drugstore reading glasses.

Finally, I am 73 years old.

My questions have to do with what is possible for someone in my situation.

One surgeon told me that he could install Symfony lenses and that the macular puckers, which he looked at, would not present a problem. Another surgeon told me that given those very conditions, he would only install mono-focal lenses focused on distance. He ruled out multi-focal lenses. I have read about a "mono-vision" solution using one mono-focal lens focused on distance and the other focused on close up, but he ruled out even that.

I, of course, would like a solution that would enable me to see well across all ranges (preferably even without glasses). Failing that, I'd probably rather see better close up and middle distances than far.

How do I decide which surgeon to believe and go with?

Also, I don't fully understand how these complicating conditions (the macular puckers and the unevenness in my cornea) affect which kind of lens I can use.
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233488 tn?1310693103
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Avatar universal
Hi. I appreciate it that you have responded to my request, At the same time, I knew that if you responded, you would tell me to read that post. so I did. I had already read it maybe three times in full and parts of it more than that.. I had trouble with some of the terminology that is fairly technical like refractive error, phaecoemulsification, and diopters, but I think I got the gist of what you wrote, and I posted my questions hoping that you wold be able to provide some direction.

Here is a second attempt at asking my question. How much of a factor are my macular puckers in the decision about what lens I can use or, more generally, the kind of solution that I can expect from the surgery? In effect, I have two opinions from opthalmologists in my area. What advice can you give me about what to do with these apparently conflicting opinions? Also, and this is probably behind all my thinking about this, how can I come through this with the best possible eyesight?
Helpful - 0
Our practice is NOT to  any mulitfocal type IOLs in patients with macular pathology. The most common problems of the macula are age related macular degeneration, diabetic macular edema and macular membranes.  In special cases we might do a toric IOL but generally will do only high quality monofocal IOLs.   I would give up on the idea that you will not need glasses for anything after surgery. I have done 2nd opinions on people spending as much as $6000/eye out of pocket for "not needing glasses for anything after surgery" who did need glasses and were much the poorer for it.   If you read my article then the option that often works well is dominant set for distance (20 ft or further) and non-dominant about -1.00. This is referred to as mini-monofocal distance bias. I have found it works better than setting both eyes for distance (target refractive error (glasses prescription for distance)  0.00   It seems the surgeon that recommended monofocal IOL is closest to generally recommended norms. (recall ERMs often get worse).
Avatar universal
Thank you for this clear and to-the-point response.

I have read about the "mini-monovision" solution both in your post and in other places and will discuss it with my surgeon.
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177275 tn?1511755244
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