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Dr Hagan please advice. Age 42, out of the blue, Posterior Subcapsular Cataract :-(

Dr Hagan or anyone please. Kind of desperate and doing my best to research for my wife before making any wrong IOL decisons. Have initial appointment lined up with 2 different eye surgeons in next 2 weeks to get their opinion.

My wife is 42 and had good vision until 2 weeks ago (no glasses for near or far). 2 weeks ago, out of the blue she got blurry vision that lasted roughly from mornign till late afternoon. Now she is seeing ok again but if she covers the right eye she sees that left eye is slightly blurry.

We are located in Europe. We are struggling to decide what IOL to use. My wife is scared of making the wrong choice and of going from good normal eye sight to bad. She is a group fitness teacher 50% and works in office 50%.  

Group fitness = She is in front of around 40 people giving classes. Communicating constantly. Classes range from Yoga to strenous weight lifting type of group fitness classes.
Office Work = Usuall use of laptop/PC, mobile phone etc.

The idea of not seeing near/indermediate scares her and we really don't know what kind of IOL to go for :-(

I have included initial dignosis of the eye doctor.
___________________________________

DIAGNOSIS

OU Cataracta praesenilis (Cataract subcapsular posterior)

Mother of the patient also Cataracta presenile (Between age 40 and 45)

Dear Surgeon

I would like to assign you the above-mentioned patient for cataract surgery. On 25th June For the first time I saw the patient on an emergency basis after experiencing a massive loss of vision, left more than to the right, within the last week the view was clouded very quickly.

The uncorrected visual acuity is partial right 1,0 left 0,8 partial, but completely blurred in both eyes.

The visual acuity in both eyes corrected is very sharp, partially 1,0.

Subjective refractory values from the right +0.5 -0.25 103 °, left +0.5 -0.75 137 °.

Correspondingly, there is a clear clouding of the posterior shell, much more on the left than on the right.

The other findings on the anterior eye sections are inconspicuous.

The intraocular pressure was 12 mmHg on both sides.

The Fundus centrally reduced insight, especially on the left, the Papillae are unremarkable, physiologically excavated, the macula can not be reliably assessed, the retina is peripherally well visible on the right eye it is not visible everywhere on the left eye, where it can be seen, she is without pathology.
______________________________________

Any advice from anyone?

Thankful husband!
5 Responses
177275 tn?1511755244
Start by reading this carefully:  https://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You

Your wife does not have much astigmatism so a regular high quality, aspherical monofocal IOL should work nicely.   She needs a test called Macular OCT to view the macula or reading part since the doctor could not see it well.   There is considerable pressure in the USA and I'm assuming Europe to spend extra for toric IOLs, multifocal IOLs,  femtosecond laser, ORA real time IOL power verification.  None of these have been shown to be better or safer than  standard small incision phacoemulsification. In fact my wife had IOL surgery this year and we did not opt for any of these.  If she would like good vision without glasses  for distance  dominant eye targeting -0.25 and non-dominant eye -1.00 (minimonofocal distance bias works well) Glasses are still needed to make the eyes work together perfectly and especially for prolonged reading.   So called "Premium IOLs that are like bifocals in eye are:   1. Very expensive and most of cost out of pocket.  2. Have a higher incidence of disappointed patients.  3. Usually require glasses for many things   4. Provide inferior night vision.
7 Comments
"If she would like good vision without glasses  for distance  dominant eye targeting -0.25 and non-dominant eye -1.00 (minimonofocal distance bias works well) Glasses are still needed to make the eyes work together perfectly and especially for prolonged reading.   "

In your above example what will happen with near intermediate vision without glasses though? :-(

I am slightly confused with all the terms as none of us have ever worn glasses so what about EDOF IOLs? or Bifocal IOLs?  
Oh and thank you very much for your reply. Really appreciate it as we feel really alone.
There are over 4 million cataract/IOLs surgeries done each year in the USA alone, one of the most common operations done on adults so you certainly aren't alone.
Researching4Wife - Please know that you are not alone.  Thousands of people have had successful cataract surgery.  The fact that you are weighing all the pros and cons of choosing the right lens ahead of time improves your wife's odds of a successful outcome.   When you meet with the eye surgeons don't be surprised if you get two differing opinions.  I met with three and each had a different plan!  Trust Dr. Hagan here when he says to avoid premium lens pitches.  The surgeon I went with didn't offer any pitch and I was impressed with her credentials, confidence, experience, and listening skills.   Remind your wife that cataract surgery will actually save her sight and that she is going to be ok.   You are both doing all the right things by researching your options ahead of time.  But don't let all the information you're gathering overwhelm and worry you (like I did haha!).  See what her surgeons recommend.  Being involved in group fitness classes, it sounds like your wife is otherwise quite healthy.  She's going to come through this surgery perfectly!   Please keep us posted and remember that you are not alone.  Everyone in this forum is supporting you and appreciating the story you're sharing.  Keep us all posted!
Thanks for your comments.
MjCg thanks for your empathy and lovely post. Hearing opposing views from all directions is more than overwhelming! We don't know what to decide, anyway first let us see what the surgeons say.
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177275 tn?1511755244
The other thing is why would posterior subcapsular cataract develop suddenly in healthy young person:  Risk factors:  1. Heavy alcohol use.  2. Heavy nicotine/cannabis use.  3. Heavy body weight and diabetes   4. previous or current use of steroids  5. bad family history (seems to be the case).    Diabetes should be ruled out with a test called A1c.
1 Comments
Yes only No.5, bad family history applies.
Avatar universal
Saw first surgeon today.She reccomended doing MINI MONOVISION.
The IOL they use is Hoya-Vivinex. Anyone know if it is a good lens?
Avatar universal
I meant micro monovision. I think.
1 Comments
That IOL company doesn't market in USA. I looked on line, has been around since abut 1987 and seems to be one of the largest suppliers for Asia.   Mini-monovision is discussed in the link I sent you. It means the difference between the two eyes after surgery is not huge and can generally be corrected with glasses.   It would mean deciding on "distance bias"  dominant eye post op goal 0.00 and non-dominant eye about -1.00   or  "near bias"  non dominant eye about -2.00 and dominant -1.00.     Variations are common.  Full monofocal is hard to adjust to for many people and impossible to wear glasses comfortably for man. that would be 0.00 for distance and -2.50 for near.
Avatar universal
"dominant eye post op goal 0.00 and non-dominant eye about -1.00 "

Dear Dr Hagan,
She said that she would aim for 0.00 for the left eye (for far focus) and if I remember correctly .5 diopter difference for the right one. The cataract on left eye is quiet dense and covers most of the back part of the lens (around 40% vision). She said right eye has almost 100% vision and the cataract is very fine and not dense. She said we could even wait 1-2 years for the right eye, unless things change nnd replacement is required earlier.

She could not be sure about which eye is dominant though. She thinks that cataract on the left eye must have developed over many years and that my wife only noticed it 2 weeks ago the first time because that is when it reached a point that she truly noticed it.  She said currently right eye seems dominant but that could be becuase it has been pulling the slack for the left eye.
She said that she was able to see the macula etc and everythign looks healthy.
8 Comments
So you are saying the RE not need surgery now. What is the glasses prescription for the RE?   0.00 for LE distance and -0.50 for RE is not minimonofocal it's distance RX.  
Yes RE does not need surgery right now accordign to her.
0.00 for LE, could be she said 1.00 diopeter difference for RE, what would that be called?

Glass prescription for RE, I don't know. I mean currently she wears no glasses.
If RE is not beign operated right now then is it still relevant?
IMPORTANT- Spoke with wife and she translated some form text into English for me.

- The term used was MINI MONOVISON DEFINITELY
- For LE , Refraction aim- Normal far vision

Regarding  your RE questions, she has apparently 100% vision currently and she could read without any lense correction at the surgeon's place.
Okay,   so after surgery her glasses RX will be 0.00 at distance (6 meters/20 feet) if the surgeon hits the planned target. Because she is in her early 40's she will need reading glasses after surgery which she can take on and off.  As she ages over the next 5-10 years her ability to focus with the RE will fail due to age and she will either have to carry two pair of glasses one for reading one for shopping/computer or go to wearing no line multifocal glasses.
Dr Hagan,
That does not sound very promising.
Her RE won't last 5-10 years anyway as her cataract will probably take over her RE lens within 1-2 years. Do you have a better recommendation so she can live an activ normal life? :-(

I read your article twice and understood it very roughly but can't put it in context to my wife's situation!
Even if your wife did not have cataracts her vision will fail (without glasses) as she gets older. It' is called presbyopia.  It's why people start to need reading glasses, bifocal type glasses or if they are nearsighted to remove glasses during their 40's.   Suggest go ahead and do as you plan setting the LE for no help at distance (0.00) realizing it is not exact science and that may not be where she ends up. the error range is usaually plus/minus half diopter.  In 2-4 years when the other eye needs to be done you can go through the same process then.  I think when the second eye is done she will be happier with a -1.00 than 0.00 but you can wait and see.
Thanks Dr Hagan,

We visited a second surgeon. He is willing to do mini-monovision but his personal reccomendation was-

Left eye monofocal IOL set to far but instead of 0.00, set it to -1 or -.75 to take future ageing into account.
Right eye also set to far, he said mini-monoviison is bit of a compromise. As we age we all will need glasses/contacts anyway. So set both eyes for far and use glasses for near to get best quality vision possible.

The IOL he uses is made by NIDEK (Japanese firm). It is aspherical IOL, hydrophobic, UV/blue light cancelling etc.

Any views on all the above info please Dr Hagan?
I think that is a good choice and a good firm for IOL manufacturer.  
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