Statistics on premium lenses

[ericscataract]

Hi,
I am 44 and I have congenital cataract. The one in my right eye has been getting worse recently and I have decided to get it done.
Currently my glasses are very mild: +0.5 on the left and +0.75 on the right. I also have very slight astigmatism.
I do a lot of reading on the computer, some book reading, TV watching and outside/driving.
Not too much night driving.
I am right-eye dominant.
I have found an excellent surgeon who has been recommended very highly in terms of the result of the surgery as my cataract has higher surgical complication risks. Due to those risks, crystalens is not an option for me. I am left with monofocal and multifocal.
As good as my surgeon is, he is not very patient discussing the different IOLs. Still, I would rather him due the surgery due to the complex surgery. So I am trying to do my homework.
It is really difficult to decide on the IOL. The idea of not wearing glasses is great. However, my surgeon initially recommended monofocals and only reluctantly accepted the multifocals. I read all the terrible stories (including here) which scares me. On the other hand, there were scientific studies showing high percentage receipients of the premium lenses were happy with the results.
I was wondering if there are statistics of side effects on the premium lenses.
Any other advice will be appreciated.

[Doreen Fazio, M.D.]

Multifocal intraocular implants split the incoming light between distance and near focal points.  As an inherent result of these optics, there is decreased contrast sensitivity, or the ability to see in dim environments, such as dusk or when driving in fog.  There is, unfortunately, no way to predict who will adapt to the multifocals and who will not.  There is a higher risk of glare/haloes with multifocal implants; these symptoms do seem to improve with time, as the brain neuroadapts to its new vision.  For people who cannot adapt and find the vision unsatisfactory, the multifocal implant needs to be removed (explanted) and replaced surgically.  This increases the risk to the eye.  It is true that multifocal implants are not covered by insurance, and the expense to the patient can be as high as $2500 per eye.  The Tecnis multifocal seems to have lower risk of glare/haloes, but you cannot go wrong with an aspheric monofocal lens, and wear glasses for the other distance.    

[FredZq]

Progressive "multifocal". Bifocal is two discrete focal lengths in one glass. Trifocal is three. Multifocal is continuous change from near to to far correction from bottom of the glass to the top. Google is your friend.

Determining the exact power of IOL lens to give you 20/20 distant is not guaranteed. If its off a little bit, you might see 20/25 or 20/30 distant and need glasses anyway, and for almost everything. It sure is nice for me to be able to read the alarm clock on the night stand without fumbling around for glasses. If you get 20/20 distant, you'll probably need glasses to read your watch, and the newspaper...Best of luck to you

[ericscataract]

Thanks for all the responses. I have decided to go with the monofocal. My surgeons recommendation is to set it for far vision. I understand I will need to use glasses for reading. What is not quite clear to me is what I will need to do for intermediate vision. Progressive glasses for near and intermediate? Use my left good eye for?

[TurtleJoe]

FredZq and I are in complete agreement. Had both my eyes done 2 weeks apart and monofocals were implanted. I have astigmatism so wore progressives before surgery and got new progressives afterwards. No halos to speak of but the Cat can now see better than me in the dark.
Regards

[FredZq]

I've worn glasses for years..48 to be exact, so I wasn't concerned about that. i decided that being able to see the clock on the nightstand or shave or read without glasses was more important than seeing distant without glasses like maybe a hunter or football player might need. So I asked the doc to set one of the eyes for close maybe 12" and the other for reading distance maybe 18" or so. The brain blends that little bit of difference in focus easily.

The process i not perfect so the left eye focuses about 11" and the right about 15". Result is I can read, use computer, work in the shop, kkitchen, bathroom, etc. without glasses. Need glasses to focus at other distances. I could drive safely w/o specs, but probably miss most of the exits cuz I couldn't read the signs until real close.

You could click on Dr. Hagans and read his posts re "premium" lenses and what he would do for himself, You'd could click back through many pages of his posts. here's a link you could read also

http://www.medhelp.org/user_journals/index/233488?page=2&personal_page_id=2095945&sort_by=date

Like I said, those premium lenses are a gamble...I didn't like the odds. Good Luck.

[ericscataract]

And BTW, since my left eye is still pretty good, would you recommend I try the "mono-vision" and "mini-mono vision"?
Like I said I have cataract in both eyes but the left one is VERY small and has been stable. So i am only doing the right eye right now.
But I am also right eye dominant.
I currently use glasses only for PROLONGED reading, +0.5 left and +0.75 right.
I have very slight astigmatism.
I don't mind wearing glasses for reading, as I am kind of doing it now and as I get older ill have to do it more often:-)
Im typing on an iPad right now. I just closed my eyes one by one and I think currently my left eye is doing most of the job! Probably due to the foggy vision
On the right. Does that mean I am already using mono vision?!!

[ericscataract]

Thanks so much for the responses. I think I am moving towards the monofocals as you are recommending here :-)
I am still learning about this but I guess the next question is: what power for the  and what brand?
Here is how I would prioritize MY vision distances:
Computer reading >iPad reading > driving > TV > book reading
I think most people get a monofocal for distance and use glasses for reading.
Here you mentioned you got both for near and intermediate. Does that mean you use glasses for distance?
Again, I really appreciate the help.

[FredZq]

Lissten to your Doc...He's trying to do you a big favor. He'd make more money with the "premium" the potential upside of premium is small; the potential downside big and bad. I made my decision on the basis of info I got here almost five years ago. Specifically Dr. Hagan's "what I'd do for my eyes" I got monofocal set for near and near-intermediate vision. Tecnis aspheric acrylic in both eyes. I was a military pilot and professional pilot for 30 years. I can see good enough now to do that. Most importantly...I can drive at night or be in a brightly-lit area or out in thye sun with no problems whatever.