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Should I risk for IOL after 24 yrs of Aphakia?
Hello all,
Let me describe my condition which is a little bit complicated: My cataract lenses was removed at the age of 6 months old but, they decided not to implant any IOL in my eyes and since then till now that I'm 24, I've been using glasses from when I wake up to when I go to bed and magnifiers for reading. Right now I'm using Windows magnifier 300x zoom. My glasses prescription is: R: +8.00 & L: +8.00 + 0.25x175. In addition, I have Amblyopia and Nystagmus (when the right eye is closed, the left one moves and can't concentrate, but when both are open, it is not that much visible). But, hopefully I am not diabetic and my eye pressure is normal. Up to now, I've visited 5 doctors who gave me somehow the same option: Monofocal IOL set for distance for both eyes + thin pair of glasses just for reading that I can get off the shelf or over the counter without prescription. Onc of them told me that after implanting the Monofocal IOL set for distance, I can then do the corneal inlay in 1 eye for my reading to completely eliminate the need for glasses. I have to mention that I don't like glasses and contacts and mono vision and thus, I don't like the idea of corneal inlay.
My questions are:
1- Do you think it worth going for the IOL after 24 yrs of using glasses? Right now, although I don't like glasses, but at least I can see with them well in near and intermediate. So want to go from the GOOD to the BEST, not from the BAD to the GOOD, which means I'm in a big dilemma.
2- Based on my eye condition, do you think there is any other way than monofocal IOL set for distance that could possibly completely eliminate the need for glasses?
3- Why my doctor did not gave me the option of Symfony? Is it RISKY in my case or completely IMPOSSIBLE? Because these two are completely different.
4- THIS QUESTION IS VERY IMPORTANT TO ME> For those of you who have implanted a Monofocal IOL set for distance, how is your near and intermediate vision? Do you need thin pair of glasses JUST FOR READING or for seeing ANY NEAR OBJECT? Do you see clearly without glasses, your face in the mirror, your watch or your cell phone to answer the calls? Do you see the edge of the lens or the holding gears or anything you haven't seen before? Do you feel it when you sleep? How does it perform in very hot weather like in sauna or very cold weather like -20c winter?
5- What do you think about corneal inlay?
Let me describe my condition which is a little bit complicated: My cataract lenses was removed at the age of 6 months old but, they decided not to implant any IOL in my eyes and since then till now that I'm 24, I've been using glasses from when I wake up to when I go to bed and magnifiers for reading. Right now I'm using Windows magnifier 300x zoom. My glasses prescription is: R: +8.00 & L: +8.00 + 0.25x175. In addition, I have Amblyopia and Nystagmus (when the right eye is closed, the left one moves and can't concentrate, but when both are open, it is not that much visible). But, hopefully I am not diabetic and my eye pressure is normal. Up to now, I've visited 5 doctors who gave me somehow the same option: Monofocal IOL set for distance for both eyes + thin pair of glasses just for reading that I can get off the shelf or over the counter without prescription. Onc of them told me that after implanting the Monofocal IOL set for distance, I can then do the corneal inlay in 1 eye for my reading to completely eliminate the need for glasses. I have to mention that I don't like glasses and contacts and mono vision and thus, I don't like the idea of corneal inlay.
My questions are:
1- Do you think it worth going for the IOL after 24 yrs of using glasses? Right now, although I don't like glasses, but at least I can see with them well in near and intermediate. So want to go from the GOOD to the BEST, not from the BAD to the GOOD, which means I'm in a big dilemma.
2- Based on my eye condition, do you think there is any other way than monofocal IOL set for distance that could possibly completely eliminate the need for glasses?
3- Why my doctor did not gave me the option of Symfony? Is it RISKY in my case or completely IMPOSSIBLE? Because these two are completely different.
4- THIS QUESTION IS VERY IMPORTANT TO ME> For those of you who have implanted a Monofocal IOL set for distance, how is your near and intermediate vision? Do you need thin pair of glasses JUST FOR READING or for seeing ANY NEAR OBJECT? Do you see clearly without glasses, your face in the mirror, your watch or your cell phone to answer the calls? Do you see the edge of the lens or the holding gears or anything you haven't seen before? Do you feel it when you sleep? How does it perform in very hot weather like in sauna or very cold weather like -20c winter?
5- What do you think about corneal inlay?
Best Answer
3 Comments
I also would not recommend corneal inlays or anything else newly available at this time. Try contacts and report back. If you can get a decent pair, your vision should be identical to what it will be after surgery. If you don't like it, you can try using a different prescription in each eye, but that's advanced. Try this first and report back. You will need a GOOD optometrist, not one of those cheap mass producing places, they won't devote the time you need. You can try calling doctors offices, and explaining your situation and see which doctor takes the time to talk to you and assure you he can help you. That's who you go see.
I like your last sentence! I am biting the internet right now! (:
First, Dr. Stein said that my vision will not become 20/20 after the surgery. Second, that's a charming thing of not needing any assistive device for reading if I wear reading glasses after surgery, but my far vision then, becomes blurry. It mean that I have to constantly put off and on my glasses, don't I? this is what makes me worried. I actually have persuaded myself to wear glasses till the last day my life and it's not a problem wearing reading glasses after surgery. Third, they told me it's gonna cost $400-500 for contacts. I actually had my first experience of contacts in the Bochner institute, but their sample lens was less than my eye's power, but it was a very brilliant experience. I felt like a free man for couple of mins. Forth, the other thing apart from all others that I have to be worried about is the determination of IOL power. I heard there is always a .05 D margin of error, even with IOL master.
First, Dr. Stein said that my vision will not become 20/20 after the surgery. Second, that's a charming thing of not needing any assistive device for reading if I wear reading glasses after surgery, but my far vision then, becomes blurry. It mean that I have to constantly put off and on my glasses, don't I? this is what makes me worried. I actually have persuaded myself to wear glasses till the last day my life and it's not a problem wearing reading glasses after surgery. Third, they told me it's gonna cost $400-500 for contacts. I actually had my first experience of contacts in the Bochner institute, but their sample lens was less than my eye's power, but it was a very brilliant experience. I felt like a free man for couple of mins. Forth, the other thing apart from all others that I have to be worried about is the determination of IOL power. I heard there is always a .05 D margin of error, even with IOL master.
oh and by the way, thanks for your time.
Software developer thanks for telling me about magnification. Also my computer crashed this week and I'm working off an iphone and laptop I don't usually use. IT tech coming tomorrow PM.
2 Comments
I'm guessing you checked if you were are on Windows rather than Mac, but for anyone else who hasn't seen it, its control + or control - to change sizes under windows. Or in some browsers you can right click an image. I suspect most know you can use your finger gestures to zoom on a smartphone, pinching reduces size and the opposite motion increases.
I'm PC all my kids MAC.
Now I want to update my topic a little bit. Just recently I visited Dr. Ike Ahmed, a well known complex surgeon in Canada. Actually, he is the last one and I will not going to see anybody else.
His opinion for me was Artisan and a back up lens, if I've understood correctly, in case any thing happens in the OR, otherwise, if the first lens is OK, the backup is useless. I guess he mentioned pediatric Artisan because my eyes are small. He said I have to consider all the risks including infection and endothelial cell loss, which the latter occurs for sure, as far as I know. i.e after 20 years, I will experience a 50% endothelial cell loss. This is just my guess based on what I've read. He also said that I certainly will be wearing glasses for every day use, but they'll gonna be very thinner and lighter than what I wear right now. Something interesting was that he said my left eye is 20/200 and right is 20/60, but Dr. Stein had told me my L is 20/200 and R is 20/50 which is enough for driving here in Ontario and that even now, he signs the paper for me to get the license if I want.
So I'm thinking why should I put my life in danger when I can reach 1 of my 2 goals (1- driving and 2-getting rid of glasses) right now before the operation? Realistically, If I can get the vision I have currently with my glasses, then the surgery becomes rational, even with its risks, but what if I lose?
Believe it or not, deciding is very hard for me because as our friends here on medhelp have mentioned, there should be something positive that every one has a lens in their eyes, right? And actually, that is what tempts me to do the surgery.
I will appreciate any opinion on this matter. I don't know how efficient Artisan is. So please if you have any experience, or you know anyone who has, share it with me. I am in need. Thank you.
His opinion for me was Artisan and a back up lens, if I've understood correctly, in case any thing happens in the OR, otherwise, if the first lens is OK, the backup is useless. I guess he mentioned pediatric Artisan because my eyes are small. He said I have to consider all the risks including infection and endothelial cell loss, which the latter occurs for sure, as far as I know. i.e after 20 years, I will experience a 50% endothelial cell loss. This is just my guess based on what I've read. He also said that I certainly will be wearing glasses for every day use, but they'll gonna be very thinner and lighter than what I wear right now. Something interesting was that he said my left eye is 20/200 and right is 20/60, but Dr. Stein had told me my L is 20/200 and R is 20/50 which is enough for driving here in Ontario and that even now, he signs the paper for me to get the license if I want.
So I'm thinking why should I put my life in danger when I can reach 1 of my 2 goals (1- driving and 2-getting rid of glasses) right now before the operation? Realistically, If I can get the vision I have currently with my glasses, then the surgery becomes rational, even with its risks, but what if I lose?
Believe it or not, deciding is very hard for me because as our friends here on medhelp have mentioned, there should be something positive that every one has a lens in their eyes, right? And actually, that is what tempts me to do the surgery.
I will appreciate any opinion on this matter. I don't know how efficient Artisan is. So please if you have any experience, or you know anyone who has, share it with me. I am in need. Thank you.
3 Comments
Dr. Ahmed is world known, respected and a nice man. Most of the posts in this forum are people having problems not coming her to post how happy they are.
yes Dr. Hagan. I agree with you 100% about him. He was really nice, talked to me for more than 20 mins!!!! (damn me with my poor English, he talked very fast, although I understood him, but there are things I have to see his lady assistants to ask. Plus, I made a mistake: he first tries the amo, if not works, then artisan) but his decision is a little bit strange. He wants to first use the amo tecnis za9003 and if it dose not fit, he takes it out and puts artisan instead. something very strange because as far as I know, I don't have capsular bag support. the amo tecnis za9003 goes to capsular bag.
I don't know. What I can do is just trust him and hope to see the future. He knows better than me.
I don't know. What I can do is just trust him and hope to see the future. He knows better than me.
I think his reputation is well deserved and well earned.
I cant advise on those types of lenses. I can however say that since your case seems to a little bit more complicated, go with the one that your surgeon recommends, as that is what he personally has had the best results with, and he will be the one who needs to get you through the operation without complications.
7 Comments
tnx. I've asked my doctor to postpone the surgery and have gotten appointments with 2 other doctors to get their opinion.
I also have to admit that because I don't have capsular bag support, my options are limited. Anyway, I hope I can find and IOL which is made of a soft material like acrylic and thus is foldable requiring only 2 mm incision, is aspheric and probably, intended for anterior chamber. I guess PMMA is old and will cause me troubles in long term. Unfortunately, both Artisan and Alcon AC are from PMMA that are rigid and require 6 mm incision that will increase the risk of after-op astigmatism. Plus, they are both spheric.
I also have to admit that because I don't have capsular bag support, my options are limited. Anyway, I hope I can find and IOL which is made of a soft material like acrylic and thus is foldable requiring only 2 mm incision, is aspheric and probably, intended for anterior chamber. I guess PMMA is old and will cause me troubles in long term. Unfortunately, both Artisan and Alcon AC are from PMMA that are rigid and require 6 mm incision that will increase the risk of after-op astigmatism. Plus, they are both spheric.
Keep us updated.
Off course man, I know how difficult it is to start and end this journy, because as softweredeveloper says, thoese who had good results usually don't visit here to explain their outcome, but I want to open another topic after op to explain everything I can.
oh I forgot to mention something: they actually confirmed what Anomalychick has said to me, that my eyes already have lost the ability to accommodate and there is no reason to fear about setting the iol for distance. They told me that it will be like my current vision or even better. I have to mention that I think both of these lenses require suturing which is another concern.
oh I forgot to mention something: they actually confirmed what Anomalychick has said to me, that my eyes already have lost the ability to accommodate and there is no reason to fear about setting the iol for distance. They told me that it will be like my current vision or even better. I have to mention that I think both of these lenses require suturing which is another concern.
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If you have IOL's set for distance, and your distance vision is then 20/20, at intermediate, you'd require one and half diopters correction. If you chose not to use it, each half a diopter removes approximately one line of vision. So your vision should still be 20/50. To be safe, lets say 20/60. At near, you'd be off 2.5 diopters, or 20/70, lets say 20/80. Is your current near vision really that much better than 20/80 wearing only your distance glasses and no magnifier? There is a reason why everyone has an IOL implanted.
If there are no complications, I cannot imagine that you would be worse off than you are now at any distance, even assuming that you are in the group that has the worst vision at multiple distances after a successful cataract surgery. Medicine can't promise you no glasses, but they can promise much better vision than you have now. Given your history, I would recommend using regular monofocals, and not going to multifocals or anything else new fangled. You had congenital cataracts ,which means its possible that your visual system didn't develop normally because your brain wasn't receiving clear input. This slight disability could become a serious issue if you had to deal with the reduced contrast sensitivity and quality of vision you'd have with multifocal IOL's or current accommodating options.
Now, there is a way to run a test. Go find yourself a good, patient optometrist, and get yourself a pair of single vision contacts for distance. They do make brands for aphakic people, I think one is called silosoft if I remember correctly. You also have a fairly low prescription (if you didn't have cataracts ,you would have been extremely nearsighted and needed thick glasses anyway) so you may be able to use normal brands too but I am not sure. This should be approximately what your vision will be like with monofocal IOL's, except with IOL's you may occasionally catch a reflection around the edge, but your vision should be the same. If your distance vision is not 20/20 in contacts, it wont be with IOL's either. But your prescription is only a +8.00, so contacts should be really close (at all distances) to what you'd have after surgery. Try that, and then decide to keep wearing contacts, have the surgery with monofocals for distance, or if you're unhappy, then you can keep beating your head against the wall on internet forums looking for a better solution.