Which IOL is right for you in 2024?
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- čas přidán 21. 07. 2024
- Cataract surgery today offers a wide range of intraocular lenses (IOLs), each with certain advantages and drawbacks. In this video I'll explore the four (or five) most popular IOL options so you can know what to expect to get your best vision possible!
timeline:
0:00 intro
1:51 monofocal IOL
3:45 toric IOL
5:27 extended depth-of-focus IOL
7:14 multifocal IOL
10:31 light-adjustable lens (LAL)
12:24 materials and design
13:08 general considerations
15:25 monovision / blended vision
16:07 prior surgery and other risks
17:45 summary and conclusion
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Disclaimer: This content is created for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Your viewing, commenting or subscribing to this CZcams channel does not create a physician-patient relationship. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of information presented on this channel. The statements made about specific products, conditions, or eye problems are not intended to diagnose, treat, cure or prevent disease.
Have you undergone cataract surgery? What IOL did you choose?
I answered this question in a reply to another viewer. Thanks for the very informative video! Oh! I have narrow angles and have had LPI’s in both eyes. The doctor says my surgery will be VERY difficult.
LAL. One reason was I could adjust to give decent mono vision and no glare or starburst. Unfortunately, I am seeing glare and starbursts and my doctor doesn’t know exactly why.
@@TonyPadgett thanks for sharing. do you have the LAL or LAL+? Do you have glare from both eyes or just the reading eye?
@@cohenlaservision As far as I know, only LAL (no discussion from my doctor about LAL+). Startbursts are in both eye at night or in dark room wherever there is a pinpoint light like traffic lights, car headlights, street lights, and even LED lights in my room off a printer or a camera phone light. I have glare (haze) in both eyes from canned lights in the ceiling. However, brimonidine has helped with the canned lights glare. But still have the starbursts.
@@TonyPadgett Gotcha. How far out from surgery are you? Are you locked in with your Rx? If not, ensuring you are as close to plano as possible is the first step. I don't have direct experience with LAL, but i generally understand the optics and think that this type of glare and starburst can happen with many types of IOLs and usually improves with time.
For those of us who can’t think as fast as this great doctor speaks in this video, you can change the playback speed by clicking the video to bring up (and click) the settings icon->playback speed-> [choose your speed]. Playback at 0.75 worked well for me.
My wife says I talk too fast, but I'm grateful you found the video helpful! 😂
I'm also happy to clarify anything if needed*
Thank you so much for sharing that info. Most of these very smart Doctors talk super fast and some with accents and I agree it's very challenging to keep up especially with so many medical terms to understand. I didn't know it was possible to slow down the speed. Too bad we can't do this in real life when in a conversation with a speed talker. Lol
Excellent, concise and unbiased review of most IOL options by Dr. Cohen. I really appreciate you taking time to answer all the questions which is very rare among surgeons. I feel better prepared going into an initial cataract surgery evaluation.
Thanks for the kind words! Glad you find the content helpful :)
I find this useful even as an optometrist! Thank you for sharing! 😊
Thanks so much, Dr Kusni!
Superb explanation by Dr. Josh Cohen. Easily the the most lucid and informative I've seen. I agree the casting director (her review below) it would be so good if he moved to Hollywood, CA. Thanks so much for your wonderful video Dr. Cohen.
Thanks for the kind words!
Excellent explanation ❤
Thank you
Thanks for the feedback!
Likely the best presentation on this topic here. And i've watched a lot. Much appreciated!
Wow thanks for the feedback!
Totally agree. I was very impressed with his presentation. He seemed to cover all the bases in a very honest and straightforward manner.
@@KarlBeeThree thanks so much!
Very well made video
Thank you!
@cohenlaservision Thank You So Very Much For Your Very Informative Video About The Various Lenses!!! I'm Going To Be Having Cataract Surgery Soon & You Gave Me A Lot To Think About Which Makes It Easier For Me To Speak With My Ophthalmologist!!! 👍👍👍
Glad you found it helpful, Eric! Best of luck :)
@@cohenlaservision Thank You So Much!!! I Really Hope Everything Goes Well!!! 🙏
Dr. Josh. It's Leslee Dennis your patient and former casting director for tv, film and stage, straight from Hollywood. I am soooo impressed with your presentation, so natural, professional and. informative. I'm taking you back to L. A. with me.
Omg that’s too funny! I had no idea you were a casting director. I just looked you up on IMDB ;)
Thanks for the support, Leslee!
@@cohenlaservision Also...You have STAR quality. See you on Thursday!!!
Very helpful video! I have to make my decision in 4 days. Thanks so much!
Good luck!!
What did you decide? I'm stuck between the Monofocal and the EDOF.....
@@missmonasuzette Hi! I decided on the monofocal. I was considering the trifocal, but the possibility of extra glare/halos with the trifocals in night driving was something I can’t possibly risk. I decided against the light adjustable lenses, because I figured I would ruin them by forgetting to wear my anti-uv glasses. I know I can’t be trusted to get that right. Also I don’t mind wearing glasses which have the added benefit of hiding the bags under my eyes. I look better wearing glasses than going without them! Then, of course, the lower cost cinched the deal! My surgeries are in mid April and mid May.
@@PrayNow4all Thanks for your quick reply and explaining your thought process. It's stressful picking the right lens! I thought, before I did the research, that I would go with the Panoptix multifocal so I could ditch the glasses. (which there's no guarantee). I was willing to pay the $$ but found too many scary testimonials, plus I did not realize there's a sacrifice of vision quality/rings/halos/contrast, etc... for focus range. Now I'm kinda stuck between standard monofocal and the extended range monofocal, such as the Tecnis Eyhance, which I am unsure is covered by insurance. (Medicare) I don't mind wearing reading glasses other than having to put them on in the grocery store to read labels. Good luck! My first one is 11 days from now and second, mid April.
@@PrayNow4allDid they offer you EDOF and if yes why you didn’t choose it? Hope everything is well with you.
I just had cataract surgery at the end of Feb and mid March. I did not care that I have to have glasses post op and the thing for me was to get rid of the cataracts as they were causing problems for me to driving at night and that is the one thing I wanted to be rid of was the glare. The surgeon did explain all the options but recommended that I just go with the standard IOL that was covered by Medicare. His reasoning is that I did not care if I still would have glasses. Well I was amazed at the clarity and extremely pleased by the incredible improvement I got mid to distance vision I have. I had extreme far sighted vision before with the right it was +6.00 and and the left +6.25. Now I have in the right 20/20 in mid to distance and the left +0.25 and then for the bifocal it is a +2.25 Oh my god I don't need glasses really at all but I still like to have the glasses for the simple reason of reading something quick without getting a pair of readers.
That’s amazing! Thanks for sharing. No doubt a huge improvement from +6.0!!
@@cohenlaservision The actual thing is I wish that insurance would have taken into consideration of allowing someone like me to have a clear lens replacement in my 40 's when I first started to wear bifocals. I am just so over the moon on how well it all came about to have the improved vision I have today
@@mikeske9777 so happy to hear that! The insurance thresholds for medical necessity currently don't include and pure refractive parameters, although the argument could be made for extreme hyperopes or myopes that surgery would be very beneficial earlier.
@@cohenlaservision I just wish there was a option for folks like me. Most likely I would have probably not done it until the cataracts first starting to show up in my early 50's. Insurance should take into consideration the cost of frames and thick heavy glasses. I know as I have a permanent mark on the bridge of my nose that the heavy glasses left after wearing those things for well over 60+ years
Did the standard IOL still give you a good intermediate vision like seeing computer or telly, chopping vegetables etc? From what distance up close do you wear glasses?
I'm having my first eye surgery in a few days. I have a lot of astigmatism and will be getting Toric lenses. I have been wearing contact lenses for 2 months to get used to having one eye for distance and the other for reading. I adapted well to the different monofocal points in each eye. My dominant (left) eye is first. I am looking forward to this.
Sounds like you’re on the right track! Best of luck
The surgeons don’t recommend wearing contact lenses prior surgery, you may damage your cornea and cause inflammation. And it’s not ideal before surgery.
After visiting a couple different eye surgeons in south Florida, this guy is by far the most professional.
thanks so much for the very kind words!
I got Clareon IOL yesterday per cataract surgery due to Retina detachment surgery back in march of 2023. I had my cataract in my eye for a while and had got use to it. The IOL is a bit strange but I can see clear. It's a strange feeling. Im in recovery mode.
Thanks for sharing your experience!
Got Clareon PanOptix UV IOL in my left eye on 3/26/2024 will get right eye done on 4/9/2024. Dr. Gary Chung in Washington State. In 2002 had LASIK and it also got rid of Astigmatism in right eye… NOW CATARACTS AND STILL WANT TO BE WITHOUT GLASSES.
Hope everything goes well!
Could you give an update? I have consulted with same doc and am curious about your experience. Thx!
My first lens was supposed to be a panoptix BUT my capsular bag broke sending lens fragments into my vitreous, emergency vitrectomy and 3 piece mono focal for distance placed in my sulcus instead. So for my second eye I am looking at the LAL with some intermediate and near vision dialed in. We shall see how it goes. Still getting 3rd and 4th opinions. I am a photographer, climber and youtuber that edits my videos at night off my ipad. I am picky and I lost a lot with my first surgery.
Sorry you experienced this, but it does happen from time-to-time. Sounds like an LAL is a great alternative for the second eye and should play well with the monofocal. Best of luck!
Didn't know there were that many choices.
…and counting!
For those who have the multifocal or monovision IOL installed and experience intolerable glare or other adverse perceptions, what is the time constraint for removal/replacement?
Does the IOL "scar" into position over time creating risk of removal/replacement?
Great question! In general, the optimal time for lens exchange (IOLX) is about 3-12 months, since the lens is settled, stable, but not fibrosed in the bag to the point where extraction is riskier. There certainly are risks to IOLX, and some manufacturers utilize coatings on the haptics that make extraction more challenging, but I've swapped lenses that are over 10 years old, so it's certainly possible, just not ideal...
Your thoughts on IC-8 for patients with keratoconus?
I don't have any personal experience implanting the IC-8, but it is useful for some patients with irregular astigmatisms like keratoconus or even post-RK, but the parameters are actually pretty restrictive to only about 1.5D I believe. However, even with standard torics I've had great outcomes in many of these patients. I usually don't implant EDOFs or MFIOLs in these patients as a general rule. I don't think the IC-8 IOL has gained much market share, but it's a great idea in theory.
May I choose Monofocus lenses one for reading another for middle-distance? While I can wear glasses for far distance because of my driving seldom.
Yes monofocal lenses targeted differently is an option, but this is not common. Keep in mind distance is what we use when we walk around, watch TV, etc. not just for driving.
I have nearsightedness since 2009...both eye now mins 1.5 recently my left eye diagnosed with cataract... I thought that with surgery left eye visio will be perfect but after seeing the type of lenses i'm affraid to have the multifocal lens... would you recommend to use the mono focal lens ? I was planning to have lasik surgery for the right eye if the left eye has perfect vision after the cataract surgery....so I can be free of glasses hehe but now I'm confused
Have you tried mono or blended vision? Perhaps try wearing a contact in only one eye and seeing if the -1.5 reading power in the other eye keeps you out of glasses and functional. If so, that might work as the target for cataract surgery as well. If that doesn’t work then a multifocal is still a good option if you just have reading without glasses. Talk to your doc and see what they recommend!
Hi Dr Cohen, I have high myopia, presbyopia with moderate astigmatism. If I choose the J&J Eyhance toric lenses set for distance what is the nearest distance I can see? Thanks!
thanks for the question! It's difficult to answer this, as in my experience people's near vision with Eyhance has been highly variable, with some patients experiencing minimal mid-range vision at 25-30 inches and others achieving relatively excellent near vision at 14-16 inches. Generally, most patients can see their computer screen, dashboard, but not their phones or small text. I'd still plan on needing reading glasses if you go with an Eyhance, unless you target one eye with monovision.
Thanks for the quick response!
Doctor, can you please tell me eyecril active from biotech qaulity and from which country please?
Can you clarify your question? If you’re asking about Alcon Acrylsof lenses, they are of great quality but have been largely replaced by the Clareon line. They are available worldwide
@@cohenlaservision my doctor Suggested Eyecril active iol lens for cataract surgery.. Is this lens good for quality and durability?
@@JFACTSJinujoseph Ah, the phakic IOL. thanks for clarifying. This isn't approved in the US so I'm not that familiar, however it seems very similar to the Staar EVO ICL in design, which is a fantastic option for younger patients who may not be ideal LASIK candidates.
I don’t mind wearing glasses for reading but not mid-distance like computer. What is better for clear vision: EDOF or Multifocal Lenses?
Does Monofocal Toric Lens differ from Toric EDOF and which is better? Would I be able to get used to Toric EDOF?
Depends on your measurements, but both monofocals and EDOFs generally come in toric models (currently the Rayner EMV is non-toric only in the US). If money is an issue, I'd go monofocal. If you want to "guarantee" functional computer/tablet reading at midrange I'd go with an EDOF. We price torics in-between monofocals and premium EDOFs (e.g. Vivity/Symfony).
@@cohenlaservision I hope in the UK they offer Rayner EMV Toric. I have astigmatism. But I will see what they will offer. Thank you so much for response.
What is your experience with young patients. I am 29. I am also active duty they will pay for which ever I want basically. Im a +6.00 in both eyes. This decision of going forward and which to choose is weighing on me. I'm not old. Will it be better than how I see now?
Hi Nick, you certainly have a tough decision to make regarding surgery at your age - but I have treated many patients with cataract surgery/lens replacement surgery in their 20s and 20s and they do quite well. Since you're young and can accommodate, I usually recommend a MFIOL to preserve the near distance as much as possible. Depending on your distance vision requirements in the military, a monofocal or EDOF could also be considered. LASIK is theoretially possible to cut down your hyperopia as well, but the quality of vision degrades quite a bit at that power, so lens replacement is what I'd recommend if contacts or glasses aren't working for you.
If I get monofocal lens 4 near how far will I be able to see without glasses I stay in the house most of the time will I be able to see everything in the house refrigerator the sink be able to do dishes watch TV my computer laptop and tablet and all that kind of stuff and will I have to have glasses and just as soon as I go out the door
Hi Ann, it depends on the target distance for near. We can calibrate the monofocal for any distance (e.g. 12 inches, 22 inches, etc.) and there is a bit of +/- in either direction, but generally the defocus curve is fairly tight. So if you have both eyes with monofocal lenses targeted for the same reading distance, then anything farther away will be blurry. So TV will be quite blurry, computer will be less blurry, etc. Will need glasses for driving as well. Fridge should be fine as anything inside is within arms length, so that's all considered "near or intermediate."
you left out the Lenstec Clearview 3
Yes, good call! The Lenstec was FDA approved at the end of 2022, but I personally don't have any experience with this lens. Thanks for the comment.
Hi, Have a question but no one seems to discuss this. Cost of the lens. What is the average cost or out of pocket for these lenses? I mean I have good insurance but they only cover the "standard" lens. It would really help to get an estimate on what my out of pocket would be. I'm currently leaning toward Monovision with the Eyehance lens, but not sure what it will cost.
Honestly, costs for upgrades (premium IOLs, toric, monovision, or femto) all depends on your particular surgeon’s or ASCs costs. Usually an Eyehance isn’t charged extra at our clinic, but we do charge a few hundred for monovision. Toric and multifocal lenses usually range from $1-4k per eye, but there is definitely variability. Local markets, doctor’s experience, included bundles for drops, etc all play a roll. Don’t be afraid to ask your doctor about pricing!
Insurance will usually cover a standard monofocal IOL, anesthesia, post op period etc. We charge a small fee for special testing and combination drops that are compounded for us as a convenience for patients who don’t want to fiddle with multiple bottles.
Do you have any experience or thoughts concerning Lenstec Clearview 3 IOLs. I am concerned about potential for glare and halos with multifocals and this lens claims to reduce these dysphotopsias.
I haven’t yet placed these lenses, but I hear good feedback from colleagues. some better glare performance, but mixed reviews regarding intermediate vision for some. I hope to implant some soon so I’ll prob make an updated video
@@cohenlaservision Looking forward to 2024 updates and beyond. Thanks and subscribed.
@@juicer52 Thanks for your support!
What if I choose multifocal but the result is not satisfactory, What's the policy if afterwards wanting to go to monofocal? Will the doctor offer discounts or give a replacement guarantee?
Generally most docs will perform an IOL exchange or offer additional refractive corneal surgery options if applicable, like PRK. Some include these services in their upfront costs, some charge extra or will bill insurance when able. Good questions to ask your surgeon beforehand to discuss any potentialities :)
Thanks for the great info, what a big rush though! Most audience looking for this type of info are elderly, they can't listen as fast as you speak, please give them time to digest. Not all CZcams players have the option to change the playback speed.
Thanks for the feedback!
There is the option to replay…
I'm 69 yo. I didn't have any problem listening.
How many years will IOLs last? Will they last for a lifetime for a senior in the 60s?
IOLs should last a lifetime, or longer ;) The materials are very stable and inert.
I had LAL surgery in each eye last month. My understanding is that these lenses will work well for people that want exceptional distance and night vision but don't mind wearing readers. For people that hope for great range of vision from near to far, these lenses will only work if you are well suited to mono-vision. My first adjustment was 2 days ago with a goal of mono-vision, (dominant eye = mid-far and non-dominant eye = near-mid). It's a bit early to know the final outcome but, so far, I am very pleased. I would warn against this procedure for people not suited to mono-vision, (a subject for the patient to discus with their dr.). Also, the entire process requires quite a commitment on the part of the patient. Plan on several visits and dilations. JMO as a patient.
thanks for sharing your experience, this is really helpful. In my discussions with colleagues, reading vision is variable with the LALs, but I agree that it's not designed for those who prioritize reading and can't tolerate some monovision.
@@cohenlaservision what are you referring to when you say that if patient can't tolerate monovision it's a bad idea to you 2 different lenses? I asked my doctor about this idea in terms of the panoptix and the Vivity iol and he said it's not a good idea. He didn't like the depth of focus implant for me either. He only wanted me to consider the Toric Panoptix if I wanted to go with a multifocal lens. What are the reasons a doctor would not consider any other option appropriate? Even with the Vivity lens he said he only uses it for patients who have eye disorders yet I read nothing about that on line. How many choices do you give your patients and do you leave the choice up to them or try to subtlety convince them that one lens over another is more suitable for them?
@@babybear4524 You pose some very thoughtful questions here! There are a lot of considerations based on patient's preferences, anatomy, lifestyle, and budget. Usually, I open the conversation with stating that there are many options available, and ask if the patient minds wearing glasses. If they don't mind, I say that there are some lenses available that can limit your dependence on glasses, but if that's not important that I almost always offer a standard lens as the recommended choice, for the reasons posted in this video. I only recently started offering EDOF and POX lenses in each eye, as I found that the mix can work quite well in some patients, but not in all. I've noticed through the years in my personal patients that the distance quality in the Panoptix cohort was quite as sharp as with other lenses, but offered the best near vision. Most were still quite "happy" at all distances, so it's still a preferred lens. Monovision is most appropriate for those who have tried it previously with contacts or LASIK and are happy with it. Those that aren't, I generally offer a Panoptix as first line option since it offers the best reading. I would of course go with your doctor's recommendations over mine, as he knows your eyes better than I do :)
I feel like others dont struggle with this decision as much as I am struggling. I currently am scared to drive at night but still must in order to go food shoppoing or go to the pharmacy.Even in the day my vision is not great while driving.But is this related to the cateracts only because my prescription has increased as well? I am waiting to get new glasses so I can see how much the new prescription helps but the issue of extreme glare and terrible low light vision will still exists unless I get the cateracts removed.Is this correct? So in that case if I were to get the toric monofocal with the correction made to my near,and not far vision,as one of the options which the doctor suggested,then what will my nighttime distance vision be like? He said it would be about the same maybe a little better.What would you expect my night vision to be after this choice of lens? Will I no longer have the astigmatism and so should I expect much clearer vision? Will the removal of the cateract itself greatly increase my vision? I am not clear,no pun intended,as to what this lens does in relation to my distance vision assuming I continue to wear glasses.Will I need a stronger optical prescription? I cant grasp the medical scientific aspect as to how these lenses affect my vision and so when people use terms like "better" or "will need glasses for" or "it may still be blurry" or any term which is subjective I find myself confused in trying to desipher exactly what they mean.I am obviously a very detail oriented person and maybe overanalyze everything but I cant feel comfortable in this decision to replace my vision and spend 8k unless I am confident that it wont make life even harder for me.The fear of not seeing at least as well as I am used to,after surgery,is a great one,and thats why he mentioned the near vision correction since I told him that I have never worn glasses for seeing up close but have worn them for distance so I am more used to that.Currently I am struggling but still able with the use of increasing the font on my pc,to read the computer and phone,but I feel too that I am straining more and more to do so and its hurting my eyes every day and making me tired.
I really appriciate your help.Thank you for your suggestions and insight.@@cohenlaservision
@@babybear4524 first of all, try not to worry too much. You almost can't go wrong with any of these lenses, just as long as you have your expectations in check. Once the cataract is removed, your visual quality (clarity, light sensitivity, contrast, and focus) will improve with any IOL. You should have much less glare, even with a MFIOL than you do now with cataracts. If you elect for a toric monofocal for near, then your distance won't be too great without glasses. This is a very rare option, since you'll be glasses free for near, but will need prescription glasses for everything else even for those who are nearsighted like you pre-op. Your Rx will change from what it is now, no matter what lens you choose. On our website we offer a "vision lifestyle questionnaire" to download that you might find helpful to inform your doctor what your priorities and concerns are. With all that said, I would try to sit down with your surgeon and ensure your concerns are addressed. Oftentimes, these decisions can be overwhelming and it's important you feel as comfortable as possible before your procedure. Good luck!
You said the only way toget good near vision is with a multifocal lens which confuses me bacause i thought that a monofocal lens to correct near and not far vision would achive that goal better.
Good question! You are correct that if you only want reading, and no distance, then we can target both eyes at near with monofocals. This is rarely done, since you’ll still be dependent on glasses for all other activities, and you’d need a prescription vs OTC readers. The only way to preserve distance and get reading vision is with a premium IOL or monovision, if tolerated.
@@cohenlaservision well after thinking about the option of the toric monofocal lens,I am troubled by the comment he made in reference to my distance vision if I did choose this option. He said it would remain the same as it is now but maybe just a little bit better. So if I am currently struggling to drive at night due to extreme glare of headlights along with terrible vision due to the cateracts making everything dim and cloudy other then the glaring headlights and this is with glasses on,then how I'd the option of the toric monofocal lens going to help me? I mean it's great that it would correct my near vision which currently isn't too bad but will it entirely remove the cloudy distance vision I have and will that be enough with a prescription glasses to see well? I will still have the astigmatism to deal with or will that be corrected for both near and far? I just want to know if I will ever see clearly again after this surgery even with glasses because weather its my near or distance vision that is corrected I can not function as I am now with my vision being so bad and having to strain and struggle just to go to the store and back to by food. Same question if I go with the multifocal. Will I ever regain my close up vision afterwards with glasses such that I can see as I do now which is according to my prescription (-2.25 OD sphere. Cyl -.50 Axis 117. Add +2.50). The measurements for OS are (-2.25 Cyl -0.75 Axis 007 Add +2.50). Sorry but I don't understand what all this means. I just know I am nearsighted and have astigmatism in both eyes but left eye is worse. I have dry eye condition Keratoconjunctivitis. I have pinguecula in both eyes. I currently only wear distance glasses. Please help me understand these issues so I can figure out what to do. Thank you so much.
You are nearsighted with a slight astigmatism going into surgery. This means that if you opt for a monofocal toric, your astigmatism will resolve which will sharpen vision at all distances, but if you target for reading (as you are now) then your distance won't improve much at all.
maybe try a contact lens in one eye targeting distance and leave the other eye as is for a trial of monovision. This will give you some insight into what a monofocal outcome will be with each eye, and you can see which eye you like better (distance vs near) and then make a decision. You could still elect for monovision as your final outcome or go with a multifocal if you can't tolerate it.
So as a surgeon would you choose the panoptix multifocal lens and would you feel confident that your near vision will be good enough to see precise detail up close? Or would you go in thinking that this is the best choice available on the market today and will give you the best all around visual corrections but you have accepted that you will need reading glasses for precise near vision tasks like performing surgery,assuming a magnified glass was not a factor to compensate while operating? Thanks so much for responding to my questions.❤
Dear sir, some studies claim that if the surgery of posterior polar cataract is done using FLACS, it creates a cleavage plane between posterior capsule and epinucleus which facilities safer removal of epinucleus without rupturing the posterior capsule. Is it true ?
Hi Vikram, yes! there are several studies including a few from India that suggest that FLACS, intraoperative OCT, and special hydrodilineation techniques can be safer than traditional phaco for posterior polar cataracts. There isn't any perfect solution, so if you've been diagnosed with one confer with your doctor and see after a thorough exam what approach might be best, and know that the chance for posterior capsular rupture is still relatively high.
@@cohenlaservision thank you sir
for some strange reason, my eyes are naturally monofocal. left is far, and right is near. My question is that also something they do with cataract surgery.
Yes, you can replicate natural monovision during cataract surgery to preserve near vision in one eye.
Hi doc,
I have cataract, glaucoma and until recently uveitis. Because of uveitis the cataract surgery was delayed for quite a while, while uveitis was treated with steroid tablets (prednisolone) and drops initially and then steroid drops for quite a long time. My doctor opined against any surgery before uveitis is controlled. Now uveitis is almost gone / quiet I'm told and that I should proceed with the surgery asap!
My current eye diagnosis is as follows:
1. S/P LPI (both eyes) -- [Status Post Laser Peripheral Iridotomy??],
2. 360 PS (right eye), -- [360-degree Peripheral Synechiae??]
3. Complicated Cataract (both eyes),
4. PACG (both eyes) . -- [Primary Angle-Closure Glaucoma??]
5. Arthritis
6. H/O CKD.
..........................
The "complaint" section says: Visual Acuity: Aided. Right Eye: 6/18 p +2.50. Left Eye: 6/9 Plano Add +2.50.
Anterior chamber: OD Quiet. OS: Quiet.
IOP: OD: 18 mm Hg (NCT). OS: 20 mm Hg (NCT).
Iris: OD: 350PS.
Lens: OD: lental opacity. OS: Early lental opacity.
Fundus: OD: Looks normal. OS: Looks normal.
---------------------------
"Surgery Order" says: "1. Phaco with PCIOL (right eye) local anesthesia with Synachiolysis+ iris hook under oral steroid coverage".
---------------------------
I was hoping to use "Clareon Vivity IOL" (EDOF) because I work with _computers and near and intermediate vision related work mostly,_ but my doctor says premium/multifocal IOLs are not advisable in my case since (to the best of my understanding of what he said!) if "Synachiolysis+ iris hook" unravels sometime after the surgery or in future, multifocal IOL will become totally useless, even detrimental. Which is a very undesirable situation. He recommends standard monofocal.
*MY QUESTIONS ARE:*
1. Is Alcon "Clareon Vivity IOL" a "multifocal" IOL really? My understanding was that it's something different due to new technologies although it covers some of the multifocussing benefits of a "multifocal" lens. Vivity/Clareon is VERY new in my country and I suspect my doctor may not be familiar with it and thinks it is "multifocal". I checked last year and it was not available in my country at that time, but it's now available (probably except Clareon though).
*_So my questions are again:_*
*1.* Is Alcon "Clareon Vivity IOL" a "multifocal" IOL ? Is it appropriate in my condition in your opinion, especially in case of ""Synachiolysis+ iris hook"? If you think it's okay, then what can I say to my doctor to explain / query this?
*2.* What would you recommend as safe & most suitable in my case from the following (available from my Eye hosp): Monofocal Aspheric (Zeiss/Alcon/J&J/Hoya) / Monofocal Plus (Alcon/J&J/BVI/RAYNER). Also: Alcon Vivity (it looks like Clareon Vivity may still not be available here, it's probablly mostly Vivity AcrySof IQ/Restor/SP/Toric/Sert).
*3.* What's your view on a Monofocal Plus or Enhanced in my condition if Clareon Vivity is not suitable or available?
Please help!
Hi Jomdoot, thanks for your detailed question. You certainly have a sincere interest and understanding of some fairly nuanced ocular pathology and lens design, so I commend you for taking the time to research your options.
First, I would certainly defer to your doctor for his recommendations, as he'll be doing the surgery and has examined you personally. He knows your eye best, his comfort level, and his experience will inform his advice. If he recommends a monofocal, I can't argue that's not the "safest" option given the complexity of your synechiae and potential for inflammatory complications.
Regarding the Vivity (both Acrylsof and Clareon), it's a hybrid diffractive IOL that functions more like a monofocal than the Panoptix. I would think that depending on your corneal measurements, a monofocal+ or EDOF could be suitable, as long as centration is easily achievable. I agree a "multifocal" is fairly risky, and I would not likely not recommend that if you were my patient. Given your history of iritis and synechiae, your pupil may be irregular so I would still be cautious with an EDOF.
In sum, yes, a monofocal is likely your safest and most predictable option, but if reading at the computer is an absolute priority, then a Rayner, Eyhance, Envista, or even Vivity may be suitable if your surgeon is comfortable. Even the Alcon Clareon monofocal offers some mild midrange comparable to the Eyhance in some studies, but certainly less than the Vivity.
Hope that helps!
Hi Dr Cohen, I have another question for you. If a patient has 20/20 vision and cataracts in both eyes and no presbyopia and this patient chooses the Eyhance monofocal IOL set to distance, will this patient lose the ability to see near like looking at a cellphone?
Are you asking what would happen if a patient elects to have lens replacement surgery with good preop vision and no presbyopia? This would almost never be recommended and would be a downgrade from physiologic vision in a patient without presbyopia, with any IOL and certainly an Eyhance. Anyone who has an Eyhance (or any IOL) will have fundamentally changed the optics of the eye and would be dependent on the properties of the new IOL.
Not sure if that answers your question…
Yes. What is recommended after the cataracts are removed from the patient in this scenario?
@@CC-uh8gl Any IOL can be used, but as a general rule cataract or lens removal is not performed without a replacement IOL unless under very unique circumstances.
I've seen many videos about those IOL's and they pretty much say the same thing, referring to seeing at "distance". What IS distance? 3 meters? 10 meters, 100 meters? Because glasses can only focus at a fixed distance, so what do we do? If we need to look at something that is at 50 cm from our eyes, do we use a pair of glasses, for things that are 1 meter from our eyes, a different pair of glasses, for 2 meters, another pair and so on, for each let's say 20 cm or so difference between 30 cm and 2 or 3 meters from our eyes or what? If we use monofocal IOL's, what is the minimum distance from where we don't require glasses? Sorry about metric units, I live in Europe.
Hi phaenius, really good question. Since you use the metric system, that works well because that's actually the system we use to classify refractive error. I have a video on refraction, so maybe check that out if you want more details, but generally we bend light with glasses and lenses using the principle of a DIOPTER, which is the amount of curvature needed to focus light 1m away. The focal length is 1/D, so if you are nearsighted with a -1.0 Rx, then your focusing distance is 1 meter in front of you. If you are a -5D, then you can see 20cm away. As you go farther out, the diopters decrease. For example, to focus 3m away, then you need a -0.33 lens, which is very weak. To see 5m away (16ft), you need a -0.2D lens, etc. As you can see, for distances over a few meters the refractive power decreases so slightly that the variation is small enough not to matter. That's why we generalize "distance" as anything over about 10 feet or so, but we formally measure distance at 20ft US or 6m in Europe, because that's the distance where we are less than 1/6 of a D of correction which is smaller than the eye can perceive. For these lenses, the depth of focus for distance is quite wide, so as long as you are targeted to neutral of "0.0" diopters, you should see clearly at all distances from a few meters away to infinity (stars, horizons, etc.) and don't need multiple glasses (or IOLs) for those ranges. It's only up close that the diopter effect is quite pronounced, which is why multifocal lenses are so important for near vision. In the video I list the precise distances, but I generally about 0.3m to 0.6m for close, intermediate.
Hope that helps!
@@cohenlaservisionThanks a lot for the detailed answer. I asked about what is generally understood by "distance" because I noticed that in USA there are certain terms used, like "distance", "computer", "fine print". But those are such relative terms. I think of a multifocal IOL, but I fear the distances between the three fixed points of focus will be somewhat blurred. EDOF I understand doesn't work so well at far distances. Again, thanks for your time.
@@phaenius Yes, these terms are certainly relative and imprecise. There are some slight "gaps" that some people notice with the MFIOL, but the brain usually doesn't notice them (from my experience with patients) and some MFIOLs like the J&J Synergy have an EDOF component that adds some gradual "blend" between the focusing elements. The EDOF is quite good at far distances and intermediate, but blurs at near (within 0.5m). If near vision is a high priority, I do believe the MFIOLs are your best bet of what's available today.
@@cohenlaservisionAgain, thanks for taking the time to reply. I don't mind using glasses for close distances, if I can see clearly anywhere beyond 50 cm. So, if that's the case, I understand EDOF is the way to go. Thanks again.
I did RK surgery in 1990s. My eyes have significant cataract and some astigmatism. My doctor said that I can use monofocal IOL lenses without mutifocal IOL for far vision correction, while wear glasses for reading. However, I most time use eyes for reading, computer, TV watching, and homework. I would like doing those without glasses! I don’t mind wear glasses for driving sometimes. Could you give me some suggestions for choose IOL lenses? Many thanks in advance!
RK can be challenging due to irregular astigmatism. Generally a monofocal or toric could be preferred over a multifocal, so I agree with your doctor. There’s a good chance you’ll need glasses for optimal vision, but I would defer to your doc’s recommendation :)
May I choose extended depth-of- focus IOL in my case? One for distance and another for reading-intermediate?
I hope I don’t use glasses in most time but don’t mind wear glasses when I am driving and watching movies just in cases. I was wondering?
@@lanxie4948 maybe, but it depends on your corneal topography. there aren't any hard-and-fast rules. each patient (eye) is different!
@@lanxie4948 Ask your doctor if he thinks there are any options that can reliably eliminate glasses most of the time. It might be possible, but might not.