IOL and glaucoma

[Peggy333]

I deeply appreciate your recent suggestions regarding my situation. You may recall that I have the Alcon sn60wf in one eye and need an IOL in the other now. I was also recently DX'd with glaucoma and have had interocular high pressures for 20 yrs. The eye with the lens replacement is the one that took a big drop on the OCT and I was concerned that the test was not done well as they had  difficulty scanning that eye. I have adjusted to my crisp vision in the IOL eye but was researching IOLs and see several references to Glistening the type of material that the sn60wf is made of. They do not say that  glistening is a problem but it seems they are saying that t could be   with eyes that have glaucoma, due to a number of reasons, including the med's. Do you have any  thoughts about this? As long as I have a choice ahead of me - for the other eye - I want to consider my glaucoma, or at the least suspect situation, in the mix. If the lens I have now can hold more water - it seems not the best choice for the other eye - but I like the symmetry to keep both eyes the same.I wonder if you have any thoughts about this?

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

While I have seen many IOLs with "glistenings" I have never seen them cause any problems nor any patient that was aware of them. this is over a 1000 patients. You are over thinking the situation. If there was one "best" IOL we would all use them. Fact is most are extremely good and one is not way ahead of the others (think about it like automobiles you can buy)

JCH MD

[Peggy333]

Thank you. As an FYI - I was  researching the topic as I have  (if the test is correct) had over a 25% drop in optic nerve - since my  IOL 3 yrs ago-  and the other eye is stable with no change. I agree that this of course is not to be tied to the IOL. I have an outstanding proven product in my eye but I wondered if the aqua content of acrylic  IOL's may hold water and if so - was it possible that this material may not always be the best for someone with glaucoma.  I looked up articles about the acrylics and found several that mentioned glistening  - one is Glistening and Acrylic IOLs by Dr. Joseph Collin and  this topic is relative to a few other articles I read. None are proven I was just wondering if - based on your many yrs of experience with multiple brands of IOL's -  if you have a preference for your glaucoma patients. Just as in the choice of a vehicle - I assess my driving habits and safety concerns and narrow down my search. I never pick a vehicle because of popularity. I research safety tests and l determine what I want such as does it handle well in snow, rain, etc. &- I test drive it for visibility and handling. I am always pleased with my selection as I have made an educated choice based on my needs. With the IOL this is a lifetime decision thus I felt it was prudent to check. I did not check the1st time but if I did may have elected to have the lens I have. Many ophthalmologists only work with one mfg. so it seems that a patient may want to see  what is out there to better discuss their needs. I was assessing my needs as a glaucoma patient in case there is a lens that is best suited for that population..

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

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