Lens for 35 year old female, no astigmatism

[shirdisai]

Hello

I have no astigmatism ..Was diagnosed with Posterior subcapsular cataracts 2 years ago. Right eye is at a stage for surgery now.

Left eye is also affected though to a lesser extent.

What would be a  good lens for me, considering my age and eye condition?

I am wary of the multifocals.

Thanks for your opinions.

[SoftwareDeveloper]

re: "options for changing lenses once they go in"

That is true of anyone even if the capsule doesn't rupture in the initial surgery. Although in bad cases they will exchange lenses, they try to avoid it if at all possible since the procedure is riskier. The natural lens can be easily broken up using current technology and the pieces extracted, but artificial lenses need to be made sturdy enough to last, which means they aren't designed to be easily extracted at the moment (though I think there is some research into that for future lenses, current lenses aren't designed to be extracted). That means its best to assume you are stuck with the lens choice for life.

Overall between accommodating and monofocal lenses, I'd personally probably have bet on an accommodating lens since there would be a good chance of not needing glasses/contacts as much.  The risk is that if the lens doesn't accommodate, that the Crystalens then becomes a monofocal lens with perhaps not quite as good image quality as the better monofocal lenses. Some people don't mind wearing glasses all the time and would shoot for the highest quality image. It is unfortunately hard to get a sense of how much difference in image quality there might be.

Overall a main concern  is mostly how much you wish to avoid the need to wear correction, which I'm guessing is harder for you to guess at since you hadn't gotten to the age where you needed to deal with reading correction. In my case I went outside the US partly since it seemed I could get a lens that would have a good chance of giving me comparable  image quality to a monofocal (and perhaps better) as well as giving me a good shot at rarely needing to wear glasses.

In terms of which monofocal to go with, it may be make sense to research the issue as much as you can and then grill the doctor or get multiple doctor opinions if your first doctor doesn't seem to have good answers. At least around here many eye surgery clinics have free initial consults for those thinking about using them, so I suspect in any urban areas where there is competition that some will have that same policy.

This Eyeworld publication talks about chromatic and other aberrations and the various lenses:

http://eyeworld.org/supplements/EW-December-supplement-2014.pdf

It seems the STAAR and Tecnis materials offer the least chromatic aberration, and overall I seem to see good things about Tecnis (the Symfony lens I received is from that company as well), however I don't know the details of other aspects of monofocals (e.g. their spherical abberation)  to know how they'd compare, I haven't had reason to research them in depth. The article seems to indicate one Hoya material doesn't have as good an Abbe number as the Tecnis, but I don't know if the benefits of "extended depth of focus" of that new Hoya lens mentioned above outweigh the lower Abbe number.

[shirdisai]

I do not have a prescription. I have posterior cataracts and the doctor told me that the spectacles will not work. So I was using my left eye to see/work while my right eye kept deteriorating.

My dad has monofocals (he gor them at age 42) and is happy with them...

With the risk of capsular rupture with PSC, I do not think I have any options for changing lenses once they go in...So it has to be one shot

Which monofocal/accomodating lenses would be best? with the least abberation?

[SoftwareDeveloper]

oops, I just realized that I'd ignored a major issue when suggesting a monovision trial, sorry. Most people needing cataract surgery already have lost some accommodation. At your age it seems likely your good left eye can accommodate for near so you can't easily test monovision productively since that eye sees at all distances. Except that I seem to recall cataracts can reduce accommodation, have you needed a reading correction already despite being only 35? A multifocal contact trial is also not as useful either if you cans still see near, however I presume it would at least let you see if the side effects are bothersome and if you adapt to it.

One unfortunate aspect of having a cataract at your age is that you hadn't experienced presbyopia yet to see how much the loss of accommodation bothers you. In my case at 52 I had fighting it off with multifocal contact lenses and knew I wanted something better than a monofocal lens, and figured I'll hopefully be using the lenses another few decades so it was worth a bit of effort to get a better one.

What sort of prescription does your left eye have now? If it is high,  do you have any trouble wearing a contact lens on it if you only get surgery in your right eye?  (when prescriptions are very different they are harder to correct with eyeglasses, though there are methods to try).

re: "accommodating lens - since it depends on the eye muscles"

I hadn't looked into that issue so I'm unsure, I had decided I didn't want to risk an accommodating lens since it might not accommodate. Your situation is different though since it would at least be better than a monofocal. I do know that some elderly people who hadn't accommodated for a long time have managed to recover accommodation, but I don't know anything about the statistics or the likelihood of losing accommodation in the future for those who still have some now.  There is also some concern I'd read (I don't know how likely i tis) that the eye healing around the lens over the years may reduce its movement, but they haven't had accommodating lenses for decades to know for sure. I figure that worst cast an accommodating lens turns out to be like a monofocal, but it at least gives a chance of having some accommodation.


In terms of monofocals, here is a blog post from last year that talks about issues regarding IOL choice:
http://eyesurgerysingapore.blogspot.com/2013/08/an-overview-of-cataract-surgery-lens.html

Even with monofocal IOLs the link above regarding chromatic abberation is useful since some lenses use better materials for that than others.

[shirdisai]

My right eye is pretty bad..I work on the computer all day as business analyst for an insurance company in wisconsin and I cannot see the screen with my right eye..can I try the monovision after surgery in one eye? The left eye still has 20-20 vision but is showing signs of deterioration...

I will check with my doctor on the hoya..

accomodating lens - since it depends on the eye muscles, does it affect the way the lens works after a few decades?

[SoftwareDeveloper]

oops, one minor correction. The Symfony is from an American company, but   I shouldn't have said "American made" since I'm fairly sure the lenses I got were  manufactured in Germany. Likely most people don't care about the distinction, it doesn't matter to me, but some folks are sticklers about where a product is made. I just find it unfortunate that the latest technology from American companies isn't always available in the US.

[etrader]

By all means read on the internet about IOLs but at the end of the day you have to take your surgeons advice - he is doing the surgery and has the knowledge of your eyes and your medical notes.

[SoftwareDeveloper]

PS, I should clarify that I *think* Barrett's papers are about the Hoya lens rather than another brand,  but I'm not positive at the moment, I can't remember what source indicated that. If not the Hoya its about a similar lens.  I should add that if you go with a monofocal, they aren't all created equal, but I don't have info off hand about those since I never seriously considered that.

[SoftwareDeveloper]

Had you ever done a contact lens trial of monovision to see how well you adapt to it? If you are ready for surgery then unfortunately your vision may be too poor to be able to do a good test of it now, but you might check into it if you hadn't since most other options tend to potentially benefit from a bit of monovision (which risks reducing some stereo-vision, like depth perception, depending on how much the difference is between the eyes).

Along the same lines, you mention being wary of multifocals. Obviously there are risks so your wariness suggests staying away from them (since you can't easily replace them if you don't like them) but have you ever tried a multifocal contact lens to see if they work for you?  The optics isn't quite the same, an IOL would be better, but it might give you some clue about how well you'd adapt.

If you don't want a multifocal, the other general  options now are: accommodating (Crystalens), monofocal, or a new category of "extended depth of field".  Which one in part depends on what your preferences are regarding the risk of needing to wear correction afterwards (glasses or contacts)  not merely your age and eye condition. How important are distance, intermediate (computer&social) and near vision without correction  to you, which would you prefer to risk wearing correction for?

Another question is whether you are concerned enough about what lens to get to consider going outside the US to get a better lens, since the slow  FDA approval process tends to keep the US a number of years behind the rest of the world. Last month I went to Europe to get an American made lens implanted that I couldn't get in America (search for my posts about the Symfony).

For a non-multifocal in the US I would think the Crystalens is a better bet than a monofocal since it has a chance of accommodating and worst case it winds up being like a monofocal.

Although the Symfony isn't available yet in the US, I was surprised to discover that there does appear to be an "extended depth of focus" lens from Hoya  approved by the FDA since it is  a modification of an existing monofocal lens. It doesn't appear to be as good as the Symfony, but is likely better than a standard monofocal. There seems to be very little information on the net, but it sounds like it probably isn't as good as the Crystalens *if* the Crystalens does accommodate  (which is a risk, though it sounds like it usually does). This article refers to the lens model:

http://bmctoday.net/crstodayeurope/2014/12/article.asp?f=trends-in-refractive-surgery-and-in-presbyopia-correction
"The IC-8 and other EDOF IOLs will likely gain popularity next year as well. Few visual disturbances are expected with the Symfony or the iSert 751 Gemetric lens (Hoya). "

I was curious about it and found this description:

http://hoyasurgicaloptics.com/eu/event/escrs-2014-in-london/
"HOYA Surgical Optics will announce iSert Gemetric 751 in Europe , new optic design with positive spherical aberration; this is the first monofocal lens with  positive aspheric optic available on  the market providing an Extended  Depth of Focus for better intermediate vision . "

which led me out of curiosity to discover that the FDA seems to have approved it already, viewing it just as  a modification of a monofocal IOL that was already approved:

http://www.massdevice.com/news/medtech-approvals-fda-releases-june-2014-pmas?page=11
"The U.S. Food & Drug Administration releases a list of pre-market approvals granted in June 2014.
The device, as modified, will be marketed under the trade name iSert® Gemetric™ Model 751 and is indicated for implantation after extracapsular cataract extraction or phacoemulsification of cataracts in adults. "

I don't know if they are actively marketing it here yet, but I would guess that since  its approved that any doctor could get it if they wanted. A search for Graham Barrett and "extended depth of focus" should lead to more info on it, it often doesn't mention the actual name of the lens in his papers. I didn't look much but it turns up what I suspect is a paper on that lens:

https://ascrs.confex.com/ascrs/14am/webprogram/Paper6552.html
"Extended Depth of Focus IOL and Modest Monovision"

Here is a podcast with him:

http://www.ascrs.org/sites/default/files/resources/Barrett.mp3

and another surgeon mentions it briefly, while noting the better Symfony lens not available in the US:

http://www.medscape.com/viewarticle/833838
"The first of these IOLs may be the lens from Hoya (Hoya Surgical Optics, Singapore). They are introducing an extended depth-of-focus lens that is based on spherical aberration to give some increased depth of field. "