Cataract lens choice?

[ChrisAU]

Man, I went for an evaluation 7 years ago and was told that surgery would not improve my vision. I have a small cataract dead in the center of my right eye that makes my right eye only correctable to 20/25 (left corrects to 20/15) with contacts - it is so incredibly noticeable when using optics. It has made me become left eye dominant, and I now shoot a bow left handed because of it. I often wonder if there have been changes between 2015 and now. I wouldn't want my left eye messed with. My right eye is so bad looking through a scope hunting that usually when its the first 30 minutes of legal light or last 30 minutes of legal light I will swap to being ready to shoot left handed.

 

[Mike Islander]

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!

Based on all my metrics, my doc predicts that I will be able to read my computer without glasses. That is good enough for me. I don't mind using reading glasses to read books or paperwork. I actually wouldn't be heartbroken if I need them for the PC, but it would be nice if not. I want excellent distance vision and dim light vision. Things I really love to do, like hunting, camping,, night hiking, surfing, dirtbike, etc., all require distance vision.

I have very good eyes for my age, with the highest level of contrast sensitivity on the tests, etc. I can focus 2.0 reading glasses from 10" to infinity without discomfort. As an engineer, I completely agree with your stance on statistics. Group results don't apply to the individual, but the odds are definitely in my favor.

 

[grapo13]

Man, I went for an evaluation 7 years ago and was told that surgery would not improve my vision. I have a small cataract dead in the center of my right eye that makes my right eye only correctable to 20/25 (left corrects to 20/15) with contacts - it is so incredibly noticeable when using optics. It has made me become left eye dominant, and I now shoot a bow left handed because of it. I often wonder if there have been changes between 2015 and now. I wouldn't want my left eye messed with. My right eye is so bad looking through a scope hunting that usually when its the first 30 minutes of legal light or last 30 minutes of legal light I will swap to being ready to shoot left handed.

Man, I went for an evaluation 7 years ago and was told that surgery would not improve my vision. I have a small cataract dead in the center of my right eye that makes my right eye only correctable to 20/25 (left corrects to 20/15) with contacts - it is so incredibly noticeable when using optics. It has made me become left eye dominant, and I now shoot a bow left handed because of it. I often wonder if there have been changes between 2015 and now. I wouldn't want my left eye messed with. My right eye is so bad looking through a scope hunting that usually when its the first 30 minutes of legal light or last 30 minutes of legal light I will swap to being ready to shoot left handed.

It might be worth your time to check in with your doc again, a lot can change in a cataract over 7 years. The surgery has gotten to the point where if your vision is impacting your lifestyle, which yours from your post indicates it is, most surgeons are comfortable operating. Great thread and really valuable info from the doc.

 

[Mike Islander]

It might be worth your time to check in with your doc again, a lot can change in a cataract over 7 years. The surgery has gotten to the point where if your vision is impacting your lifestyle, which yours from your post indicates it is, most surgeons are comfortable operating. Great thread and really valuable info from the doc.

A couple of awesome docs willing to at least address this in a public forum. Can't express how much I appreciate them both. Most importantly, they stressed making your expectations very clear to your actual doctor. I did that, and like magic, suddenly he agreed with the two docs here who are serving people with similar requirements. I never mentioned any of the viewpoints of the docs here, just what I wanted to happen.

 

[Texasbuckeye]

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 .

I wlll say the history of RK really hinders the ability of the eye to do well woth a multifocal lens such as the panoptix. I generally shy away from any advanced technology lenses (multifocal, edof, or toric/astigmatism) in a patient with RK just due to the variable (sometimes daily variable) vision RK patients can experience.

Likewise, in someone with severe motion sickness, vertigo, falling episodes, or anything else that could similarly make a patient more probe to fall or become nauseated, i do not recommend mono-vision (one eye for near and one for distance). As i mentioned i am a little more of a conservative person when it comes to lens choices as the last thing i want to do is harm someone by putting the wrong lens choice in their eye. Ultimately this should be part of the discussion between the patient and the surgeon, not a counsellor who gets paid based on how many premium lenses they upsell to people.

I hope this helps. As always, medical advice is near impossible over the internet because every person and their experiences are different. So much goes into the medical decision making between the surgeon and the patient, it is amazing sometimes it can he a very quick process and sometimes it takes several discussions.

 

[Mike Islander]

RESULTS!

7 hours since my right eye was done. Holy Mother of God, I am truly amazed with the result. I'm a relatively tough guy, work a tough job, and play tough sports (dirt bikes on hard trails in grueling heat, heavy pack hunts, surf big waves, etc.). But I cried like a baby when I realized just how well my right eye now works.

Essentially I can see clearly from about arms length to infinity, with sharpest from about 4 feet out. What shocked me was the increase in contrast, brightness, and color pallet. In comparison, my left eye now looks like it has green sunglasses on, with yellow green in the places I'm seeing whites with the right eye. And it's less than 8 hours out of surgery! Drops help immensely. I had some halos for the first few hours and was very worried, but I think my eye was just dry. My wife went and got me preservative-free drops and within an hour the halos were gone.

Left eye in two weeks. Doc is going to add a little myopia, which will improve my close vision. I can't wait.

I can't thank the docs and all you folks enough who shared your experiences in this thread.

 

[Mike Islander]

RESULTS 2nd Edition!!!

Tuesday had my left eye done. By that evening I was reading my tablet without glasses. I haven't used them since, even for my phone! My expectations were basically to be able to see from my computer screen out, but I can see the hairs on my arm clearly at about 12". May need to use readers in dim light for reading a book (bedtime), but I wouldn't know. I haven't touched those infernal glasses in three days. 100% satisfied.

LENS = J&J Tecnis Eyhance
RIGHT EYE = Now 20/20 (or better, we stopped there) set for distance (was 20/30 the day after surgery)
LEFT EYE = Set for reading. Not sure what the actual myopia is set at, but my guess would be -1 diopter or slightly more. Next morning it was 20/25 at reading distance. Need to check it again, as it gets better daily.

I'll get the full report and post eye measurements in about a month. They'll do the full mapping and all that with dilated eyes, etc. As an engineers, I'm anxious to get the numbers.

 

[Wellingtontx]

Just went today for a consult for IOL and the Panoptix was recommended. Would love to be seen by an surgeon that actually hunts and understands the concerns. Was quoted $14,000 for both eyes. Seems a little higher than I anticipated, but definitely need some help in the eye department and vision.

 

[MTWop]

This video outlines a lot of options and limitations of each. As a cataract surgeon, I would personally go with the tecnis eyehance rather than the panoptix, but you’ll get different opinions. Neither is wrong. Both have their advantages and disadvantages. All eyes are unique and there is no one best answer for everyone. Only you and your surgeon can make the best decision for you and your goals with surgery. Good luck!

 

[Texasbuckeye]

Just went today for a consult for IOL and the Panoptix was recommended. Would love to be seen by an surgeon that actually hunts and understands the concerns. Was quoted $14,000 for both eyes. Seems a little higher than I anticipated, but definitely need some help in the eye department and vision.

I am a cataract surgeon who does a lot of surgery. I put a lot of different lenses in peoples eyes and they all boil down to 3 choices:

1. Monofocal/single focal lens. This is covered by inaurance but it can be a great option for people who do not have much astigmatism, and dont mind readers. I place this lens (or option 2 below if desired and needed) in anyone who uses their eyes for a living at night such as pilots, truck drivers, or in people who are into best low light vision such as serious hunters.

2. Astigmatism correcting/toric lens. This is also a single focus lens same as above but for people with astigmatism. There are lots of reasons why i do not use these in some people with astigmatism but those are individual reasons and too much to get into on here in a general manner. These are not covered by insurance so there is out of pocket expense for these.

3. Multifocal/bifocal/extended depth of focus lenses. These are the most expensive and give a range of vision with certain compromises inherent in them. Almost every one of these will give some low light and night time aberrations such as rings around lights, halos, blurred focus or other visual phenomenon that are less than desirable but the compromise for increased range of vision. These are the most expensive but also should not cost 14,000 for both eyes. The lenses are considerably less than that fron a cost perspective and the professional fees for dealing with these is the remainder of the fee, and 14,000 is high. I have seen many sirgeons bot even bill the cataract surgery to insurance when doing these lenses and just upcharge the cost of surgery to the lens to make their office work less and get more money. In my opinion, 14,000 for both eyes is a very steep price, about 2-3,000 more than it should be for a cash paying surgery and for an insurance covered surgery the 14,000 is about double what it should be.


For the record, rifle scopes, shotgun/handgun sights, bow sights and spotting scopes/binos are all considered distance vision when i counsel patients (and i do all my patient lens counselling, not some salesperson). The worry that a rifle scope is near and therefore needs to be for near vision is just not true, and i tell my patients distance vision starts around arms length and goes out. With a single vision lens, vision is really good at arms length and the vision progressively gets blurrier the closer you get to reading distance to where you need readers.

I have found hardcore hunters are bothered by the visual acuity loss with multifocal lenses in low light when a lot of animals are moving.
But for periodic hunters, they are many times willing to deal with less than ideal low light vision the few times they go out for the better near vision without readers

Having said all that, as was mentioned these discussions need to he had between your surgeon and you, after a thorough examination of your eyes. I can not stress enough if you are being seen by someone other than the surgeon and or being talked to about the lenses by someone other than the surgeon, you probably need to find another practice to have surgery with. Those types of practices will have you never see the surgeon again after the surgery and problems that arise will be difficult to get fixed and or diagnosed. I see it nearly dIly from the big name high dollar advertised practices in my area and patients suffer for the cattle call mentality of pumping out lots of surgery.

There are niches practices out there that cater to the patient…find one and do yourself a favor.

 

[Wellingtontx]

Thank you, thank you so much for the response and advice. I too thought the price quoted was way over priced. They quoted me $4,000 per eye - just for the lenses regardless of whether they are the Panoptix or vivity.

I am also very concerned about giving up long distance clarity and low light vision.

I travel all over Texas and would love to come see you for a consult if you are comfortable PM me as not seen an ophthalmologist who deals with hunters. Thanks

 

[Hunter53]

? for the Doc's as I am starting to get cataracts. If a person is most concerned with distance vision and depth perception and doesn't care if they have to wear readers; what would be the best choice?

I know when my eye doc talked about using 2 different contacts so I could read up close as well as see distance; as soon as I mentioned I didn't want to lose any depth perception he immediately said I need to just stay with distance in both contacts.

 

[MTWop]

? for the Doc's as I am starting to get cataracts. If a person is most concerned with distance vision and depth perception and doesn't care if they have to wear readers; what would be the best choice?

I know when my eye doc talked about using 2 different contacts so I could read up close as well as see distance; as soon as I mentioned I didn't want to lose any depth perception he immediately said I need to just stay with distance in both contacts.

Monofocal distance in both eyes. The tecnis eyehance is still a monofocal but has a slightly improved range at intermediate (think computer distance)

 

[parshal]

I'm dealing with this right now. Back in late May I had lasik in both eyes. Right eye for distance and left eye for reading. I specifically did this so I could see my turrets. I'd used contacts for a few years mimicking this.

My right eye turned out perfect but my left eye is bionic at 2.75. Way too strong. Apparently, I'm one of the 2% that doesn't heal correctly. I'm getting the left eye done again on November 3. I'll still have to use readers for up close stuff which I'm fine with but being able to see turrets, my dashboard and computer screen without readers is what I'm after.

I'd investigated paying for a lens in the left eye rather than lasik which would be exactly what you're doing. I kinda wish I did that.

Short answer to your main question, if you play around with contacts before the lens surgery you'll mimic the end result. Your brain will figure out the different eye powers as long as they're not too far apart.

 

[Hunter53]

Monofocal distance in both eyes. The tecnis eyehance is still a monofocal but has a slightly improved range at intermediate (think computer distance)

Thank you!!

 

[Texasbuckeye]

Monofocal distance in both eyes. The tecnis eyehance is still a monofocal but has a slightly improved range at intermediate (think computer distance)

I second that emotion 100%. The typical monofocal lenses made by alcon and J&J and some others do a great job of giving computer distance as well as distance vision, but some monofocals don’t have the same effect.

Monovision, where one eye is set for dostance and one set for near can be tolerated in about 50% of the population but about 50% will not adapt to it and dislike it. For those that can do it, it gives a good blend of near and distance, but, like everything, has its compromise as the decrease in depth perception (technically it reduces stereopsis which is one of many components in depth perception) and makes wearing readers tough and using binos difficult if they dont have separate eye diopter power adjustment (high end ones should, but no cheaper pair has that i have seen).

 

[Jclink]

This is for the doctors that replied earlier.

Man I wish I’d have found this thread sooner! I am early 50’s and had my first cataract lens surgery yesterday in my right eye, and I’m right eye dominant. My vision is really bad, I am very nearsighted. I have a very slight astigmatism in my right eye and a very large astigmatism in my left eye. My right lens was really bad. So cloudy I couldn’t identify a person sitting 6’ away from me. Also from the cloudiness of the lens the layer below it was cloudy and would need some laser work to clean up the cloudiness after the lens was changed.

When I went for my surgical consult my surgeon suggested 3 options. He could set one for near and one for far, both for far or the panoptix lens which “does it all”. Said my eyes would tolerate all options. I am an active hunter, shooter, carpenter and cabinet maker so tape measures are part of my life and I work outside almost every day summer and winter. Also went over costs. Insurance only covers the standard lens, if I went with the toric it would cost me $1,600 per eye and if I did the toric panoptix it was going to be $3,000 per eye.

I did a bunch of research (what I could find online) and spoke to the surgeon again and decided on the panoptix. It’s the newest one that has the clareon lens. I asked specific questions about using optics such as scopes (especially about being able to see the crosshairs as I could not see them at all in my current state), binos and spotters and even asked about how the focal length of the tubes would react with each lens. I am pretty sure the surgeon is not a hunter, but said any of them should work. He also mentioned he had just did another fellow about my age that went with the panoptic and was very pleased with them. I asked what his real world experience was with the panoptix lens and severe halos and such and he said that was actually pretty low but assured me there would be some and that some people deal with it better then others. He did explain that they all came with trade offs.

My surgery was less than 24 hours ago and I can see again out of that eye! It’s not perfect yet, but I can see. Noticed within a few hours how much brighter and more vivid colors were. Our leaves are in almost peak fall colors right now and man I didn’t know what I was missing! I can read the words on the tv now from across the room, they aren’t perfectly clear, but I can read them now which is something I couldn’t do since I was a very young kid. Will this continue to get clearer as the eye heals from the surgery?

The surgeon said he was able to clean up the layer below the lens with the laser but I might need some more laser work on it when the lens settles next week or so. Other eye has a cataract as well but not nearly as bad as the first eye. (The surgery for my second eye is about 3 weeks from now.) My eye is still very dilated and I am seeing halos around point source lights at night. I also noticed it was pretty hard to see last night with the lights off when I was heading to bed. I experimented with covering each eye as I went to bed.

I did not even think to ask about low light performance of each lens when I had my page full of questions before picking which lens to go with. Did I mess up by choosing the multifocal lens? If so should I go with the eyehance for my left eye? Or is it just better to stay with the same panoptix I have in my right? He said my eyes were healthy otherwise.

The difference I noticed after dark last night heading to bed, could that just have been because my eye is so dilated? It was a pretty significant difference between the new lens eye and the old lens eye as to navigating through the house with no lights on except for a few nightlights here and there.

I was the youngest person in his office by a long shot. So naturally one of my questions was why was this happening so early in my life. He asked if I was a welder, and I am not but I have done quite a bit (keeping my snow removal equipment working) and in my younger years was a welders helper on the pipeline. Said the type of cataracts I had were typical of welders. So being a jack of all trades and doing whatever you have to do to make ends meet can hurt you later in life. As young men we don’t take the precautions or worry about what is this going to do to me when I’m 50+. Moral of the story is wear your safety glasses, welding helmets, shields, sunglasses, etc!

Thanks for taking the time to read this and any opinions or suggestions you can offer. Sorry for the epic post.

Jim

 

[Texasbuckeye]

Jim,
You didn’t mess up, so don’t worry about that. There are lots of visual phenomena you will experience in the first couple weeks that will get better as time goes on. The rings around lights will get better, but you might not notice a big improvement in them till you get the second eye done.
The panoptix is a good lens, not my ideal choice for a hunter, but its a good choice regardless.
As time goes on and the eye heals, make sure the surgeon is comfortable to make adjustments via lasik or prk to treat any residual astigmatism or nearsightedness.

Hope that helps some. These early days are tough to gauge how things will be ling term, so stick with it and don’t get too worried about small things. Big things to watch for are a severe deceease in vision, worsening pain, increasing redness around the white of the eye. Very rare infections happen in the first week (and all that is a sign of infection) but also need to he aware of retinal detachment given your gery near sighted eyes…lots of floaters, or a curtain or veil effect from peripheral vision are signs to watch for retinal detachment. While cataract surgery doesnt normally increase risk for that, it doesnt get rid of the risk either.

 

[Jclink]

Thank you for that. I really appreciate all the folks that put out great information on here, seems like there’s always someone willing to chime in with something relevant.

I had my one day follow up appointment (less then 24 hours post op) and that eye is 20/20 now and can make out a few letters on the 20/15 line. The edges were a little fuzzy but I could make them out. Even before I had cataracts I could only make out maybe the first big E or maybe the SL of the second line. With the cataract I could not make out any of the letters.
The Dr was very pleased with how everything looks and I was very thankful for what he has done for me.
Looked through one of my FFP scopes and I can see the crosshairs on the lowest setting! Remarkable and life changing are the words that come to mind.