What is the best IOL to get?

[CherylLee76]

I have been reading about the different types of lens, it is quiet confusing. I had a vitrectomy which has caused a cataract in my left eye and it is now myopic. Prior to surgery it was +.75 as well as my right eye. The right eye now is +.25 since the vit.surgery for left eye in Dec. 2012. First, could the right eye now be forming a cataract that is why it has gone from a +.75 to a +.25? The diopter difference in both eyes now is larger than 2. I am wearing a contact in left eye of a -2.25 so I can see more balanced although it is still blurry. Dr. had me on a -3.5 which was too strong.

What is the best IOL implant. I don't want multifocal, but would like to see distance and intermediate. I don't mind wearing reading glasses as I had started when I was 45 anyways. How does the Dr. balance the eye's when determing the strength of the IOL? What is aspherical vs. spherical lens? I haven't heard good things about Restor, ReZoom or Crystalens..I don't want more glare or halo's.

What about the AcrylicIQ? or the Tecnis 1-Piece? Anyone have thoughts on this. I get lots of glare and lights are very bright right now, looking at the sun I will see spots, bright spots. I want to minimize the glare and halos at all cost and also what about blue blocking IOLS?

Thanks a lot to everyone.

[CherylLee76]

I went to the Dr. yesterday. I think the appointment went fine. He said he would use standard IOL, there was a couple he recommended. I asked him about glare and halos afterwards and he said most times that goes away although there could be a residual affect of flutter on the edges, like a shadow because the lens doesn't cover completely that area. It could be fixed with piggyback lens. He said the AcrySofIQ lens and then another one that is bigger that would cover the whole area although one would need to have strong zonales to hold the lens in place, that type of lens is either the EnVista or the Nanoflex. Down the road when I got older could be a problem? I cannot quite remember but if you have the answer let me know. I also have a small amount of astigmatism and he said that would be taken care of by opening the cornea in two areas so it would lay flat. What did your doctor do for your astigmatism? How bad was it.

He said he would bring the left eye to plano, it is a -3.5. How does that affect balance between the two eyes if my right eye is at +.50.

thanks for your comments. Craig and Doctors on this site.

[CherylLee76]

Thank you for taking the time to respond to all my questions. I will let you know how my Doctors appointment goes on Friday.

[Craig10x]

You will still see the floaters after you get the iols as they are on the back of the eyes...i have long had them too...I also get some starbust effects around lights at night...not everyone gets that, but i think it is fairly common...doesn't bother me though...kind of pretty, actually (lol)...I had my cataracts for about 2 years before i finally did it...then afterwards, wondered why i didn't do it much sooner!

Things would be out of balance, until you have your iols done...and i would schedule them pretty close together...once you have the first done you will be anxious to get the other one done quickly...

I was VERY nearsighted before i developed cataracts and had a high amount of astigmatism as well...

[CherylLee76]

Craig10x,
How long did you have your cataracts before doing the surgery? How bad had your eyes, My left eye is extremely blurry and even with a contact feels cloudy..although the strength is not balanced for the other eye because it seemed so far out of balance. My right eye has a haze of floaters and I get afterimages a lot in both eyes. Afterimages are when I look at something I get the same outline of the image again at a different spot I am looking at. Do you know of anyone who has had that problem? I mentioned it to my optometrist and was told it happens to many people but I am more aware of it. I have never had this issue until the floaters started in Oct. of 2011. It was around February of 2012 when this started happening. I am now seeing clear spots in my right eye, very similar to what happened to my left eye..both had floater like shadows, not just our regular floater. It is like looking through a haze or a dirty piece of glass all the time.
Looking forward to hearing your response.

[Craig10x]

You can test your dominant eye yourself...yahoo it and you will find simple ways to test for it but you should also have your eye surgeon check it out...

Also, best to discuss with him about 20/20 in both eyes vs doing mini monovision (remember...mini means targeted between -1.00 and -1.50 diopters in non dominant eye)...

Then make your decision based on his feedback...just remember 20/20 in both means a lot of dependence on readers...not trying to discourage you from doing that but just keep it in mind...

[CherylLee76]

How do you know which is your dominant eye? I don't think I would mind being 20/20 distance and only need glasses for three feet or less.Thanks for all the info. My eyes are already hard to adjust to one be far and the other near...I think 20/20 on both sounds good.

Again thank you for the time and information. So much appreciated.

[Craig10x]

I had the lasik touchup to go from monovision to mini monovision...
My left eye iol was set for -2.25 diopters and he moved me up to around -1.25 to -1.50 diopters...it's probably about in the middle...

You can't judge differences the way you are now because of the cataracts...only after both eyes are done would you know...

With both eyes corrected to 20/20 you probably would see sharp until something was 3 feet or less...which means you would need to carry reading glasses with you all the time...

You won't be able to read, do the computer, without them...that include things like reading labels in the supermarket, writing notes, etc...

But consult with your doctor that is going to do it, and see what he recommends in your particular situation...

My distance vision is very good...it's perhaps a tad less sharp then it would be if i went for 20/20 in both eyes...but i like having the flexibility of being able to do the computer and light reading without glasses...so, it's a personal decision...

Unless they get the dominant eye at the 20/20 target, you would not want to do any form of monovision...it's only worth considering if he does manage to accomplish that...

If he does, and agrees, you may want to try mini monovision first...you can always get a lasik to bring it up to 20/20...but doing the reverse, is not such a hot idea (20/20 and then have it reversed to mini monovision)..

[CherylLee76]

Hi Again,
Did you have lasik to adjust your vision? Or did you stay with the mini-monovision? I think I would rather just see one distance..far rather than both as I don't mind needing reading glasses.

I am myopic in my left eye after a vitrectomy and wearing a contact to balance out the eyes..it doesn't give me clear distance vision and the contact that is a -3.5 which brings my eyes equally 20/20 is also hard to adjust too. I feel like I am in a fish bowl with both the -2.25 and the -3.5. It could be the cataract that is causing this..but the optometrist said because of the diopter difference is the reason it is hard to adjust. I believe I am getting a small cataract in right eye as well (I also have floaters in right eye that are like shadows, so it is like looking through a screen anyways).

By getting distance IOL's would I be able to see comfortably 5 to 10 feet away as well? Or would this also be blurry?

Thanks for the info.

[Craig10x]

You are very welcome...glad to be of help..yes, as i was going home from the surgery, i was amazed but what i was seeing...be sure to follow the instructions on the after care (drops you use) and follow up visit schedule they give you...I had the dominant eye done and then he did the non dominant eye 4 days later...

Far less problems with monofocals as compared to the multifocals, so i think it's the better way to go...

Takes time to re-cover...varies person to person...usually a few months before things really settle in...First time i have been glasses free since i was 10 years old! (well mostly ...i do use my readers once in a while but not too often)...

The Acrysof is excellent...You can yahoo mini-monovision and you will find many articles about it...takes a while for the brain to adjust...you are still seeing out of BOTH eyes (not one at a time...lol) but your brain has to adjust to screening out the slightly fuzzy image from the nearsighted eye...

It gives you a wider range of vision though, and minimizes the readers...
If you should later decide you'd prefer to go full 20/20 in both eyes, you can also achieve that through a lasik touch up...but give it a few months!

Best of luck to you...

[CherylLee76]

Thank you for responding to my questions..so much appreciated! What was your recovery time, where you able to see immediately after the surgery? My father had both cataracts done at the same time (in Winnepeg, Canada) about 10 years ago and he drove home the same day..It seemed so easy for him. I am hearing so many horror stories on the ReStor, ReZoom and Crystalens..I think I will go with the same Brand you have as well as the blue blocker.

Any more info you can give me is so much appreciated!

[Craig10x]

Toric is if you have more than a very small amount of astigmatism...If you do and you don't get toric, you'll still need glasses for all distances...so ask your doctor is you need toric....

toric is considered to be a premium lens, most insurance companies don't cover the difference in price...they will pay for the basic lens, and the rest comes out of your pocket...my doctor charged $1600 per eye for the torics (the insurance company paid the rest)...

My doctor uses quite a few lenses but the Acrysof monofocal is probably the one he uses most...i like the uv filtering, as i never seem to need sunglasses outside...

Monovison is purposely leaving one of your eyes (the non dominant one0 slightly nearsighted, so that you will be able to see better close and well as in the distance...

If they make you 20/20 in both eyes, you will likely need readers for anything closer then about 2 1/2 feet or so...as that will be totally blurry...not the case with monovision...of course, you do give up a bit of that ultra sharp distance, to gain the advantage of minimizing your need for readers...

Initially, he did full monovision, it was too much difference for me to get use to..so, i had a lasik touchup to make it less (mini-monovision as i described above)...it pulled back my reading range...and i have to hold thing somewhat further away, but it's still useful for light reading...and it improved my distance and mid range sharpness, so i prefer it...

My doctor is excellent but i am in NYC (Manhattan) so too far for you to go to since you are in LA...

There's always a compromise, no matter which way you go...you just have to decide which one would work best for you...

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

All your questions have been answered before. use the search feature and archives to research the answers. The physicians here are all in practice and don't have time to do that amount of typing.
JCHMD

[CherylLee76]

Dr.,

Could you explain more about the Tecnis 1 piece? Why do you like the Tecnis brand. Does it come in asperical also.. I had read that it is harder to insert due to the device being used and could cause tears. How common is it to have the posterior sac cloud once a lens its put in? If they have to do more surgery after that by lasering a hole to let light in does that mean you are looking though a cloudy lens again? Thanks for answering and helping the eye community with your knowledge.

[CherylLee76]

Thank you for responding to my questions. What is a toric? How long did you have cataracts before you had surgery and what was your diopter difference in the eyes. Did you and your Dr. discuss other types of Lens and why did you choose the Acrysof IQ with the uv filtering. Are these considered premium lens and if so what is the difference between Standard IOL and the ones you had implanted? What was your dominant eye (myopic or far sighted and on the scale what was the range). How did he determine 20/20, which means you can see distance well? and mid? The left eye, why -2.25 and what is monovision? .What is mini-monivision?  What is the difference in the two eyes now as far as diopters. Was it hard to get used too?

I haven't had my surgery yet. I meet for consultation on May 3rd. I am wearing a -2.00 to a -2.25 in my vitrectomy/cataract eye, still blurry at distance. It is like looking through a window when looking at a distance, mid-range no so bad, up close is pretty good. I do feel like I am in a fish bowl some when I am out especially in a large room because it is very foggy and like looking through a misty piece of glass.

Thanks a for any more info you can give me prior to my appointment. Where was your surgrery done. I live in Los Angleles.

Thanks again

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

Almost all monofocal IOLS in North America/Europe and excellent quality. Our practice uses Tecnis IOLs.

JCH MD

[Craig10x]

I have the Acrysof IQ aspherical (with the uv filtering...filters the blue ultraviolet)...Mine are the toric version because i had a lot of astigmatism...
If you do, it's worth the additional cost if you want to be pretty glasses free...

My doctor did my dominant right eye for 20/20 (and he hit the target) and my non dominant left eye for -2.25 diopters originally for monovison...

I wasn't happy with it because my distance and mid range were compromised a bit too much...so i eventually has a lasik touchup on that left eye to bring it up to mini-monovison (target that at around -1.25 to -1.50) we hit the target on that also...

I am much happier now....my distance and mid range are much better, though it moved my reading range back a bit further, so i have to hold things a bit further away, but it's great for light reading....
I only put on my readers for long reading sessions, and never need to carry readers around with me outside...

No problem doing the computer either, with no glasses on....

If they make you 20/20 in both eyes, you will have ultra sharp distamce but need to use readers almost constantly for mid-to-close...

Mini monovision is also easier to adjust to the full monovison....
and multi focals often have a lot of problems, so better to go with the monofocal type lenses like i have...