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Cataract Surgery-Multi focal lens
Old 02-06-2008, 12:35 PM   #1
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Cataract Surgery-Multi focal lens

Just got back from visit with Optomermist who told me forget a new contract prescription (wear bifocal hard lens). I need cataract surgery on one eye for sure and she told me that I might as well do both since the second eye is well on its way.
The literature all says the procedure is quick and painless (except to the pocketbook). I guess insurance will cover the basic lens replacement but not the new technologies like multi-focal lens and astygmatism correction.
So, given the collective wisdom of the Board, I would appreciate insight and experiences regarding: Two eyes now versus waiting until necessary for the second; experience with multi-focal lens replacement versu single vision (would have to have bifocals glasses), and any and all "watch outs" for managing the overall cataract removal and lens replacement experience.
Many thanks in advance for all input.
Nwsteve
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Old 02-06-2008, 12:49 PM   #2
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Quote:
Originally Posted by nwsteve View Post
Two eyes now versus waiting until necessary for the second
Is there any possible "good" reason for doing both at the same time that could outweigh any of the "other" reasons not to do so?

Better still, what does the person who's going to be responsible for your care think about that proposal?

As far as the lens goes, do you have any links we can look at? Spouse is considering bifocal contacts (she's worn contacts for over 20 years) but I can live with reading glasses for a long time. If I have to deal with cataracts someday I'd rather have a replacement lens that can do it all...
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Old 02-06-2008, 03:33 PM   #3
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I don't have cataracts, but do have presbyopia, and really hate my eyeglasses. Last year while I was at an aviation fly-in I attended a lecture about multi-focal lenses and other refractive surgery given by a pilot and ophthalmologist who specializes in these surgeries (and had a financial interest in enticing pilots to get the surgery). Several fellow pilots who had gotten multifocal lens replacements were there, too, and were uniformly pretty happy with their results.

The surgery is done one eye at a time with a fairly low risk of complications resulting in loss of vision, but it's fairly common to need a second surgery to fine-tune the refractive correction. Once the first, more severely affected eye has been stabilized, they do surgery on the second eye.

The current crop of multifocal implants work by having different focal lengths ground into the lenses at different diameters, allowing your eyes to focus by varying the diameter of your eye's iris, something that takes a little bit of time for your brain to learn, but it learns this new trick pretty quickly.

The ophthalmologist giving the talk liked to use different brands of implants in each eye, and did this because the two brands he used (ReZoom and ReStor) approached the focal lengths they use differently, allowing one eye to have better vision at distances the other lens was not quite so good at. This approach, the doctor reasoned, allows for better vision in a wider range of situations, and (once again) the brain adapts and learns how to use each eye and lens to its best advantage over time, and once learned, the user isn't even aware the brain is making decisions about which eye works best when.

The pilots who have had this surgery -- not all of them had cataracts beforehand -- were very impressed with their results, some claiming their eyesight was never this good when they were young, even. Those with cataracts were also delighted that their color vision had come back with the new lenses, and the colors they see now were bright and clear again.

Based on their comments and some other research I've done, I'd get these implants in a flash if I had cataracts that were impairing my ability to see well, but I've also learned a few things that tend to make me want to wait on getting my focally challenged, but otherwise healthy eyes fixed.

The first is some concern that most of the current lenses may cause an elevated risk of macular degeneration. The concern is that our eye's natural lenses have a slight amber-yellow tinge to them that filters higher-energy ultraviolet and violet light down to manageable levels and improves the eye's focus by reducing the harder-to-focus high-violet light. In other words, they work something like "amber vision" sun and driving glasses. The lenses I mentioned here don't have this yellow-amber tinge, and allow more UV and high-violet light to hit the retina, and that may accelerate macular degeneration. Some of the newer lenses that are working their way through the R&D and approval processes have yellow-amber tinting to address this concern.

Next in my list of reservations is that a new lens that focuses more like a natural lens has just come out. The new lens has the tinting I just mentioned, but operates differently from the multi-focal implants in that it is "hinged" and flexes as the muscles around the edge of the lens move, somewhat duplicating the function of a young eye's lens. I don't know if this truly works well or is just so much marketing hype, but am happily willing to wait until enough people have gotten this type of implant to develop some health data points on the procedure.

And that's what I know . . . hope it helps.
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Old 02-06-2008, 03:52 PM   #4
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Quote:
Originally Posted by Nords View Post
As far as the lens goes, do you have any links we can look at? Spouse is considering bifocal contacts (she's worn contacts for over 20 years) but I can live with reading glasses for a long time. If I have to deal with cataracts someday I'd rather have a replacement lens that can do it all...
Nords
Want to be sure that I did not give the impression that the cataract came using a bifocal contact---there is NO Connection. More a heridity and age thing. Something like 75% of people over 75 have them and nearly 50% over 65
I have found the bifocal contacts great but the fitting is key--my previous doc did it well. My wife who also has them had to finally see my doc to get a prescription that worked--she had seen two other practioners in the same office with no success. I only needed to use reading glasses in low light or late in the day.
The recovery from surgery varies but is rarely longer than a day except for taking some anti-inflammantory medication for awhile. I still need to have my formal eval by the surgeon but wanted to get a bit more informed before that meeting later this month.
Here are a couple of links:
Patient satisfaction high for cataract patients receiving multifocal lens - Ophthalmology Times
What type of lens is best after cataract surgery multifocal or monofocal? It depends, study says

nwsteve
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Old 02-06-2008, 06:13 PM   #5
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Don't know much about the multifocal lens which was just starting to be talked about right after I had my cataract operations. If you do opt for the old type lens, you could
"tune" it for whatever you do most frequently.....short for reading, or long for driving.
Then your giasses could be made to compensate so you would wear the glasses or not but wouldn't need bifocals.

I had the operations sequentially , not simultaneously, in the 2 eyes.....maybe a month apart. Wasn't sure I wanted to take the risk simultaneously of a new doctor w/both eyes at once. In my case, because I was under anesthesia, the experience of the
first operation was helpful in the second as they got to adjust either the dose or the type so I didn't get sick from the anesthesia like i did in the first. I think most operations are w/o anesthesia. In my case the doctor wanted to do it that way because my eyeballs are very elongated and she thought it would be better.

Don't whether the doctor mentioned that often/sometimes the capsule gets cloudy
after the operation (like a yr or so after) and they have to fix that w/ making a hole
in the capsule w/ a laser. Painless/quick/outpatient procedure.
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Rezoom results
Old 02-06-2008, 06:58 PM   #6
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Rezoom results

I just had both eyes done with the Rezoon lenseswithin the last few months . I was told that it was a 90% odds that I would not require any glasses at all. So I opted for the high-buck lenses.
When it was all said and done, I fell in to the 10% catagory. So I have now gone back to the Costco $7 "cheater" for reading.
My right eye was really bad when I had the surgery. I couldn't even read a stop sign out of my right eye.
Given the same situation today, I'd take the risk and hope for the best with the Rezoom lenses. 90% odds is pretty good, but there is no sure thing.
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Old 02-06-2008, 07:20 PM   #7
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I had cataract surgery on both eyes 4 years ago. One of them was very bad, the other one was not bad enough to be covered by Medicare if I had been eligible, which I, of course, wasn't. In addition to my cataracts, the vision between my two eyes was so far apart that I had to go ahead and do the second in order for them to set my two lens so that I could see again. I had them done about three weeks apart. First one was a breeze, the second one had some swelling and pain for the first night, and then it was fine.

I did some research before I had my surgeries, and I also talked to my optician and opthalmologist, and based on what I learned, I decided against the multi focal lens. I read several discussion forums and there seemed to be a lot of problems with dry eyes and glare with the multi focal.

I have never had one problem with my eyes or lens. I have great distance vision for the first time in forty years; I play golf without my glasses and I can see the ball better than anyone I play with. Unfortunately, I have NO close up vision, so I wear glasses most of the time.
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Old 02-06-2008, 11:13 PM   #8
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I have bad eyesight.. in the +8 to +9 range... and am tired of glasses..

Went to try and let laser.. but could not because my eyes open up to much at night... but they said I could have 'clear lens replacement'... now, I had been asking about the procedure where you put in a 'contact' inside the eye, which can be reversed if you have problems... so I was thinking this is what they were talking about...

But even then, they did not want to do anything because of my eyes 'size'.. but I read about the lens... and it did not seem like a 'contact'... so they came out with the new ones that 'flex' and can 'fix' a lot of problems.. but then when I found out what 'clear lens replacement' really meant... well, I am still wearing glasses...

I will get the operation done when I do get the cataracts.. which the doc said I will get 'young' with my eyes... and I will go with the flex lens then.
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Old 02-07-2008, 08:21 AM   #9
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I had cataract surgery two years ago at 58 . The rezoom lens were just being perfected then so the surgeon did not recommend it plus it was an extra $1900 per eye .I opted for monovision ( one eye is for close and one eye is for distance ) .I have great vision . The surgery was simple and recovery time was two days . I had the surgery with numbing drops and a little sedative . The one thing no one mentions is while they are doing your surgery you'll see flashes of light .
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Old 02-08-2008, 11:34 PM   #10
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I had cataracts and had the surgery 2 1/2 yrs ago. Only had one cat, but doc said best to do both eyes. Good thing I did, I couldnt balance my vision between surgery on the first and second eye...only a couple days apart, so it wasn't too bad. I had my eyes on the Crystalens (the style the emulates the natural lens)...doc had experience with that one as well as ReStor and told me ReStor was better. I am, overall, happy with the results and would do it again. Only a couple of issues: mid-range vision isn't great, and dim light reading is impossible due to how the pupil reacts to low lighting and due to the design of the lens to take advantage of light entering the eye from different angles.

The long and short of it is that I have progressive lens glasses I need to use for low-light reading (menu in a dim restaurant), using the navigator in my car, and some shopping.

I checked out ReZoom on the net just now, and it looks like it solves (at least partially) the mid-range problem. I can't tell if it helps for dim light reading or not.

I would do it again in a flash, but if ReZoom was available, I might have gone with either both eyes ReZoom, or one ReZoom and one ReStor It is better than having to wear glasses ALL the time, and certainly better than cataracts. The $7 readers from costco do fine for menu reading.

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Old 10-06-2008, 09:27 PM   #11
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Here is an update on my cataract surgery and lens replacement. Had cataracts removed in both eyes in June and July. Replaced the natural lens with a multi-focal lens--Restor in one ReZoom in the dominant eye.
Both lens have there strenghts and weakeness--combining allows you to get the best of the two when used bifocally.
I now have better vision than anytime since I was 12/13. Until the surgery, I was very near sighted and had been using bifocal contacts for at least the last 8 years. Cataracts required lens replacement. The standard choice covered by insurance and medicare is replace the natural lens with a distance focused natural lens. In this treatment, you will have to wear glasses to see anything near.
I am glasses free for 90% of the time. For low light and very small type, I will use a reader but even then I can often "work it out" if I have the time or no options.
Good news, great vision, near and far. No problem with night vison for me.
Bad news--multi-focal lens required a $2k investment for each eye. Since I get the benefit every day, and is a permanent fix, my personal ROI is pretty high.
Note, physician skill and perscription determination is critical to having success with this option.
I am happy to share more specifics if anyone needs more info
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Old 10-06-2008, 10:27 PM   #12
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Originally Posted by nwsteve View Post
Here is an update on my cataract surgery and lens replacement. Had cataracts removed in both eyes in June and July. Replaced the natural lens with a multi-focal lens--Restor in one ReZoom in the dominant eye.
Both lens have there strenghts and weakeness--combining allows you to get the best of the two when used bifocally.
I now have better vision than anytime since I was 12/13. Until the surgery, I was very near sighted and had been using bifocal contacts for at least the last 8 years. Cataracts required lens replacement. The standard choice covered by insurance and medicare is replace the natural lens with a distance focused natural lens. In this treatment, you will have to wear glasses to see anything near.
I am glasses free for 90% of the time. For low light and very small type, I will use a reader but even then I can often "work it out" if I have the time or no options.
Good news, great vision, near and far. No problem with night vison for me.
Bad news--multi-focal lens required a $2k investment for each eye. Since I get the benefit every day, and is a permanent fix, my personal ROI is pretty high.
Note, physician skill and perscription determination is critical to having success with this option.
I am happy to share more specifics if anyone needs more info
Nwsteve
nwsteve,

Sometimes, as people develop presbyopia, they go with monovision correction = distance vision in one eye and near vision in the other.

I'm trying to interpret your comments, above. Is this what you have achieved or is your correction something different? And if so, why?

Thanks,

omni
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Old 10-06-2008, 10:37 PM   #13
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Sorry for any confusion.
Before the cataract surgery, I was nearsighted 20/275 and presbyopia.
Cataract surgery removes the natural lens. They insert surgerically an artificial lens to replace the lens damaged by the cataract. Most folks just get correction to give distance vision. They then have to wear corrective lens to read and see mid-range.
I opted for a multi-focal inplant--Interocular lens implant which replaces the natural lens. Since it is a multi-focal lens, I can see near and far without any other corrective device.
Hope this clarifies
Nwsteve
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Old 10-07-2008, 08:54 AM   #14
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Steve, how did the midrange turn out (not that I can change anything now, but curious if the Rezoom Restor combo does the trick?).

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Old 10-07-2008, 10:40 AM   #15
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Mid-range is great. Only area where I notice any difficulty is close and small type. Took about 3 months for both eyes to work well with each other. When I first started, the computer could be a bit ragged on the edge but no longer.
If close in gets tough, I can usually get what I need by closing the Rezoon eye and use only the Restor.
Have to give the entire process high marks overall. Really weird not to be fooling with contacts and squinting when the wind blows to keep the crud out.
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Multi-focal lens
Old 10-07-2008, 10:46 AM   #16
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Multi-focal lens

It was a "no-brainer" for me. 90% odds of no glasses required forever more. That ain't bad odds. Unfortunatly the insurance wouldn't pick up the $8000 for the multi-focal.
When it was all said and done, I didn't get lucky. I still need cheaters for newspapers and phone books. Anything larger than a newspaper I can handle. If I had it to do over again I would still go with the odds and pay the $8000.
Someone named Steve tried to send me a message. I can't open it due to a pop-up blocker. Try something else, Steve.
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