Cataract lens choice?

[Mike Islander]

Finalizing lens choice for cataracts. My surgeon is suggesting perfect long distance in right (dominant) eye and closer (but not reading close) in the other. He says I'll see well from computer distance to infinity. I understand that I will likely need readers for small print..

He says I won't notice any difference between eyes at distance unless I cover the longer distance eye.

Any thoughts on this choice as a hunter?

 

[Poltax]

I had this same surgery a year ago. Went really well. My Dr was really pushing the mono vision set up. I know several people that have that with just contacts. For me I felt this would not work. I do a lot of driving for my work and need the long distance in both eyes. I also help teach shooting classes and felt that the longer distance was more important then the Mono vision set up. Plus I did not want to have reading glasses, or glasses to enhance long distance. I ended up going with the combo permanent lenses for both eyes that will do long distance and up close reading. Going with that set up, you do lose a slight bit on the close up and a slight bit on the long distance. However, my vision is 20/20 in both eyes. For me, this has been the best set up. Everyone's situation is different. I know the eye profession is really pushing the mono vision with contacts or with permanent implants. The other thing I would add is that if you ever have to shoot for hunting or defensive with your non dominant eye you may not have the clear vision you have with your longer distance set up in your dominant eye.

When they did the surgery, the right eye was done first and then 2 weeks later the left eye was done. I could not believe how much the cataracts had changed the colors to more tans, browns, and was blocking clarity. Especially at night. With the 2 week separation I was able to see the difference in the color changes and how much I had lost in the brighter colors.

For recovery after surgery, you will have some halos for awhile at night. I still have some of that going on but it is getting better over time. It is pretty normal from what I have learned from others. The surgery itself was a breeze. Do not even be nervous. I was rolled in to the pre-op, they put in 18-20 drops in my eyes to numb them up. I got an IV for knock out juice. They rolled me into the operating room, put in the juice. I do not remember much about the surgery except one time when the Dr asked me to follow the red dot. Then I woke up in recovery and was able to go back to the hotel. You will not be able to drive home due to the drugs. My sight was a bit blurry the first few hours but got better by the next morning. I was tired and took a couple of naps. Two days afterwards I drove 300 miles to get back home.

Good luck on your surgery. Your going to like it.

 

[CoStick]

I believe I am going panopix multi focal. Family members is an eye surgeon and just got these as well. Seems to cover much of what I want.

 

[fwafwow]

Not the same as cataract surgery, but I have a similar set up with my contacts. Distance in my right and dominant eye, corrected for reading glasses in my left. It’s been great for hunting, including reading a distance dial on my bow that previously required readers. Also great for general living. I tried multi focal contacts and hated them, and monovision contacts took two tries to work in general.

Good luck with your surgery.

 

[CoStick]

Not the same as cataract surgery, but I have a similar set up with my contacts. Distance in my right and dominant eye, corrected for reading glasses in my left. It’s been great for hunting, including reading a distance dial on my bow that previously required readers. Also great for general living. I tried multi focal contacts and hated them, and monovision contacts took two tries to work in general.

Good luck with your surgery.

My surgeon mentioned multi focal contact lenses aren’t the same as the newer cataract, much different experiences.

 

[MTWop]

Cataract surgeon here. The Alcon Panoptix is a great multifocal lens implant (the only type of multifocal I will use), but you have to understand that there’s no free lunch in optics. Multifocal lenses give a larger range of vision but come at the cost of reduced contrast sensitivity, increased haloes and glare at night compared to a mono focal lens. The panoptix lens is a series of concentric rings with different focal lengths that allows for the increased range. The technology has progressively gotten better over the years, but at the end of the day we’re replacing your natural lens with a fancy piece of acrylic. We can’t replace the same quality of vision you had in your 20’s.

I archery and rifle hunt a fair bit - definitely too much if you ask my wife Personally I would lean towards the J&J Eyehance with mini mono vision (distance in my dominant eye and slight myopia in the fellow eye. This allows for binocularity while giving a larger range of vision. However, the majority of my patients are very happy with their panoptix. Most of what you’ll read online will have significant bias from the company promising everything. Here’s a fairly neutral review from Dr. Devgan at UCLA. He has numerous other reviews of different intraocular lens implants. Best of luck with your surgery and next season.

Initial Review of the Alcon PanOptix IOL

The Alcon PanOptix IOL has been available in the USA for about three months. What are our initial impressions? How does this lens perform? Are patients happy with the results? My artistic represent…

cataractcoach.com

 

[Mike Islander]

Cataract surgeon here. The Alcon Panoptix is a great multifocal lens implant (the only type of multifocal I will use), but you have to understand that there’s no free lunch in optics. Multifocal lenses give a larger range of vision but come at the cost of reduced contrast sensitivity, increased haloes and glare at night compared to a mono focal lens. The panoptix lens is a series of concentric rings with different focal lengths that allows for the increased range. The technology has progressively gotten better over the years, but at the end of the day we’re replacing your natural lens with a fancy piece of acrylic. We can’t replace the same quality of vision you had in your 20’s.

I archery and rifle hunt a fair bit - definitely too much if you ask my wife Personally I would lean towards the J&J Eyehance with mini mono vision (distance in my dominant eye and slight myopia in the fellow eye. This allows for binocularity while giving a larger range of vision. However, the majority of my patients are very happy with their panoptix. Most of what you’ll read online will have significant bias from the company promising everything. Here’s a fairly neutral review from Dr. Devgan at UCLA. He has numerous other reviews of different intraocular lens implants. Best of luck with your surgery and next season.

Initial Review of the Alcon PanOptix IOL

The Alcon PanOptix IOL has been available in the USA for about three months. What are our initial impressions? How does this lens perform? Are patients happy with the results? My artistic represent…

cataractcoach.com

Doc, many thanks for your expertise. I believe what I am getting is what you described. It is not mono vision. It is long distance dominant eye and fairly close to fairly long in left eye. My doctor said I wouldn't likely notice unless I covered my right eye, and my left would not quite be as clear to infinity.

I live in Charleston, SC and my doctor is near by and well known in this state. He treats many golfers, hunters, and other sportsmen. He advised against the freznell style lens, as he understands I want maximum contrast over distance and am fine with reading glasses for fine print.

I have an appointment Monday and will try and get the exact lens names and types at that meeting. Surgery is in late May.

 

[Poltax]

I checked my cards and Panoptix is what I had implanted.

 

[Mike Islander]

Cataract surgeon here. The Alcon Panoptix is a great multifocal lens implant (the only type of multifocal I will use), but you have to understand that there’s no free lunch in optics. Multifocal lenses give a larger range of vision but come at the cost of reduced contrast sensitivity, increased haloes and glare at night compared to a mono focal lens. The panoptix lens is a series of concentric rings with different focal lengths that allows for the increased range. The technology has progressively gotten better over the years, but at the end of the day we’re replacing your natural lens with a fancy piece of acrylic. We can’t replace the same quality of vision you had in your 20’s.

I archery and rifle hunt a fair bit - definitely too much if you ask my wife Personally I would lean towards the J&J Eyehance with mini mono vision (distance in my dominant eye and slight myopia in the fellow eye. This allows for binocularity while giving a larger range of vision. However, the majority of my patients are very happy with their panoptix. Most of what you’ll read online will have significant bias from the company promising everything. Here’s a fairly neutral review from Dr. Devgan at UCLA. He has numerous other reviews of different intraocular lens implants. Best of luck with your surgery and next season.

Initial Review of the Alcon PanOptix IOL

The Alcon PanOptix IOL has been available in the USA for about three months. What are our initial impressions? How does this lens perform? Are patients happy with the results? My artistic represent…

cataractcoach.com

Doc, not sure if you can respond to this here, but for the group, I am going with Vivity EDOF lenses. The dominant eye will be optimized for distance and the other eye will be "bumped up" slightly to allow me to see from computer distance out. I asked my "councilor" for a more technical description, but she said "bumped up closer" would be enough of a description that any cataract experts would know exactly what she was talking about.

Any thoughts on this lens choice? To me it sounds exactly as you said you would go, with the exception of brand.

 

[Texasbuckeye]

Another cataract surgeon here and I have lots of very happy hunters under my care, and several who are not as happy because they wanted it all and would not get out of their own way to have a good outcome...I digress.

My recommendation would be against the Vivity, mainly for the possible low light aberration you can experience with it. The lens advertising says there should be no low light distortion, but my patients state otherwise.

This is also the same reason I recommend against any multifocal lens in hunters, the low light aberration can be a bear to deal with and ruin a hunt. The panoptix is the best of the multifocal lenses out there but it still has a relatively high (20+%) chance of having significant aberrations in low light, but nearly everyone will have some aberration with that lens in low light.

The concept of monovision of "mini-monovision" can work if someone has a very dominant eye and doesn't have co-dominant eyes, but for someone used to using both eyes together I rarely try this approach as the brain can reject the split in the vision and make life not so fun for the patient. For someone who has done monovision in contacts I am happy to continue this approach.

For the vast majority of y hunters, shooters, and avid outdoors people, sticking with best distance vision is my go-to and I can achieve that with a combination of just standard distance correction lenses and/or astigmatism correcting lenses.

This is definitely an area where weighing how much you value your low light vision comes into play. The more you value low light vision, the less fancy you want to get. If hunting is just a once a year not super important part of your life, then no big deal. But for dedicated game hunters, simple is better in my opinion.

It is also my opinion that lens discussions should be had with the surgeon and not some counselor, as most of the time these counselors are paid a spiff or get bonuses based on the number of premium lenses they upsell, and they are not subject to malpractice if something goes wrong. Hearing it from the doctors mouth is golden. At least in my neck of the woods, the counselor is usually nothing more than an automotive extended warranty sales person, selling something they know isn't worth it

 

[MTWop]

Doc, not sure if you can respond to this here, but for the group, I am going with Vivity EDOF lenses. The dominant eye will be optimized for distance and the other eye will be "bumped up" slightly to allow me to see from computer distance out. I asked my "councilor" for a more technical description, but she said "bumped up closer" would be enough of a description that any cataract experts would know exactly what she was talking about.

Any thoughts on this lens choice? To me it sounds exactly as you said you would go, with the exception of brand.

Agree that I would not recommend the vivity in your situation. Texas Buckeye and I have similar approaches/recs. We both agree with monofocal lenses with distance targets. I mentioned minimonovision as above - Plano in the dominant eye and slight myopia, approx -0.5 in the dominant eye for Texas buckeye. This preserves binocularity while giving a slightly larger extended range of vision. Expectations are everything in cataract surgery. Ask questions about what you can expect. If the surgeon dismisses your questions, time to find another surgeon

 

[Mike Islander]

Agree that I would not recommend the vivity in your situation. Texas Buckeye and I have similar approaches/recs. We both agree with monofocal lenses with distance targets. I mentioned minimonovision as above - Plano in the dominant eye and slight myopia, approx -0.5 in the dominant eye for Texas buckeye. This preserves binocularity while giving a slightly larger extended range of vision. Expectations are everything in cataract surgery. Ask questions about what you can expect. If the surgeon dismisses your questions, time to find another surgeon

So thankful for you and TexasBuckeye's feedback. If I go Plano/ - 0.5, how will my near vision be? Do you think I could use my computer without readers? In other words, what range would require readers?

 

[CoStick]

If you stick with distance vision, are you pretty much all set except for needing readers up close? Or would you still need them for mid ranges?

 

[MTWop]

If you stick with distance vision, are you pretty much all set except for needing readers up close? Or would you still need them for mid ranges?

Sorry to clarify, I would personally target Plano in the dominant eye and -0.5 in the non-dominant eye. Again, this is a very personal decision and not a one size fits all. I’m a stranger on the internet and not the person doing your surgery I also primary use the J&J eyehance that has a slightly larger range of vision than traditional lenses but is still a monofocal. MOST patients (not all) are able to read the desktop computer, dash board, etc, but need readers or progressives lenses are still needed for other near tasks (anything closer than about extended arms length).

 

[CoStick]

Sorry to clarify, I would personally target Plano in the dominant eye and -0.5 in the non-dominant eye. Again, this is a very personal decision and not a one size fits all. I’m a stranger on the internet and not the person doing your surgery I also primary use the J&J eyehance that has a slightly larger range of vision than traditional lenses but is still a monofocal. MOST patients (not all) are able to read the desktop computer, dash board, etc, but need readers or progressives lenses are still needed for other near tasks (anything closer than about extended arms length).

Thank you, I am just trying to make sure I know enough to ask good questions and appreciate your insights. I am 50 with cataract based on a large steroid dose for a different reason. So trying to make sure I don’t miss anything. Ideally I am using them for a long time!

 

[Texasbuckeye]

Yeah, i tell my distance focused patients that if we hit the target on both eyes then arms length and beyond will be very good and things get progressively blurrier as you move up close to the point you will need readers for close things and small print.
Computer should be fine, reading paper work in front of the computer will require readers. Car dash board should he fine. Reading maps (does anyone do that anymore?) will require readers.

Giving a tad bit of near with the non-dominant eye like MTWop suggests will give an extra couple inches but bot negate the need for readers, but might get you into the range where cell phone is mostly
comfortable to read texts (but prob not make it super easy to surf the web on it). Again, as he suggests, that option isnt for everyone tho.

 

[Mike Islander]

Agree that I would not recommend the vivity in your situation. Texas Buckeye and I have similar approaches/recs. We both agree with monofocal lenses with distance targets. I mentioned minimonovision as above - Plano in the dominant eye and slight myopia, approx -0.5 in the dominant eye for Texas buckeye. This preserves binocularity while giving a slightly larger extended range of vision. Expectations are everything in cataract surgery. Ask questions about what you can expect. If the surgeon dismisses your questions, time to find another surgeon

Had my pre-op today. Told my surgeon my expectations/requirements. He was very open about the loss of contrast sensitivity with Vivity and without any prompting from me quickly said "We're swapping lense choice. We're going to use Eyhance with a bit of myopia (mini monovision) in the non-dominant eye."

I very much appreciate you and Texasbuckeye sharing your experience. I definitely feel more peace with this choice. Not only do I hunt but I night hike and do a ton of camping in winter after work. That means hiking in and camping in the dark. Also a huge fan of avoiding my headlamp in camp if there is any moonlight.

 

[Mike Islander]

Now the big question. No reading glasses from computer distance out with Eyhance mini monovision?

 

[Laelkhunter]

Cataract surgeon here. The Alcon Panoptix is a great multifocal lens implant (the only type of multifocal I will use), but you have to understand that there’s no free lunch in optics. Multifocal lenses give a larger range of vision but come at the cost of reduced contrast sensitivity, increased haloes and glare at night compared to a mono focal lens. The panoptix lens is a series of concentric rings with different focal lengths that allows for the increased range. The technology has progressively gotten better over the years, but at the end of the day we’re replacing your natural lens with a fancy piece of acrylic. We can’t replace the same quality of vision you had in your 20’s.

I archery and rifle hunt a fair bit - definitely too much if you ask my wife Personally I would lean towards the J&J Eyehance with mini mono vision (distance in my dominant eye and slight myopia in the fellow eye. This allows for binocularity while giving a larger range of vision. However, the majority of my patients are very happy with their panoptix. Most of what you’ll read online will have significant bias from the company promising everything. Here’s a fairly neutral review from Dr. Devgan at UCLA. He has numerous other reviews of different intraocular lens implants. Best of luck with your surgery and next season.

Initial Review of the Alcon PanOptix IOL

The Alcon PanOptix IOL has been available in the USA for about three months. What are our initial impressions? How does this lens perform? Are patients happy with the results? My artistic represent…

cataractcoach.com

Thank you Doc for your input. I have 2 questions. #1 I had RK surgery back in 1986, by Dr. Stephen Brent in New Orleans, who was a pioneer in the field of RK. Results were 20/15 vision, which lasted about 25 years. Now I need reading glasses, and glasses for distance, so I wear bi focals. Which lens combo would you recommend?
#2, I suffer from motion sickness, so I was wondering if I would get one lens for close up and one for distance, would that create a situation where I would get motion sickness? Once about 7 years ago, I got the no line tri focals. Had trouble wearing them s seems they gave me motion sickness. I had to go back to bi focals .

 

[MTWop]

Unfortunately none of these questions can be answered by somebody on the internet without physically looking at the eye, the biometry (measurements used to determine lens calculations, corneal topography looking at astigmatism, OCT looking for any subtle macula pathology, etc). These are questions only your surgeon can answer, as the answers to all of these questions is “it depends.” Additionally, statistics mean nothing when we’re applying them to an n of 1. The last thing I want to do is to set incorrect expectations because I lack the proper information to set them in the first place. My advice would be to reach out to your surgeons with as they will be be able to give you the most accurate information. Best of luck!