Cataract Surgery--Did You Get Light Adjusting Lenses or Premium Trifocals Lenses?

[Qs Laptop]

I bet one needs to not get greedy (wow, it's pretty good but) and wonder if they can make it "just a little bit better". Can they undo something if it makes it worse?

Yes, until the lenses are locked in changes can be made. Typically, you get 3 to 5 tweaks included in the price. Not sure if more than 5 are possible if you pay more.

 

[zinger1457]

I'm confused on what Medicare reimburses. I understand they will only cover the cost of the basic lens but do you still get reimbursed for that amount if you select one of the higher cost premium lenses?

 

[Qs Laptop]

I'm confused on what Medicare reimburses. I understand they will only cover the cost of the basic lens but do you still get reimbursed for that amount if you select one of the higher cost premium lenses?

No, the Medicare amount of payment is applied to the entire procedure and you pay out of pocket for anything other than the basic lenses included with Medicare.

 

[Qs Laptop]

There is a great series of YouTube videos about the light adjustable lenses made by a 60 something year old woman. She's a pretty good presenter. Here is the first one in the series.

As she says a couple of times: "The great thing about the light adjustable lens is that you get to decide what you want our of your lens. The bad thing about the light adjustable lens is that you have to decide."

 

[JBTX]

I went through a lot of hand wringing about 18 months ago but ended up using a toric distance lens in my right eye, which had poor vision and a rapidly advancing cataract. Corrected to 20/20 and I’d consider it a success. I still wear glasses, my left eye, with a cataract, still corrects to 20/20 and has a progressive lens. I put just a plano lens in the right. Both eyes see distance 20/20, and I read out of my left I only with glasses

I finally went to optimistist to get progressive for right eye, and I hated it. I had wore progressives for a couple of decades, and still do in the left. But in my newly corrected right eye I found the progressive glasses made my vision worse. With the glasses you only had clear vision through the correct spot, meaning you had to turn your head to look sideways or up and down. I had been fine with that for 20 years but after having 20/20 vision and moving to a progressive to get the close vision I hated it so bad I returned the glasses.

This has got me wondering whenever I get my left eye done for its cataract, do I want to use the standard and use readers, or should I get a multifocal for that I so I can read with the one eye?

Not a decision I need to make right away but will eventually. The Panoptix pro sounds promising

Speaking of white vs yellow, there is a marked difference between my two eyes, with my surgery eye being much whiter. I only notice it if I think about it.

 

[jazz4cash]

Yes, until the lenses are locked in changes can be made. Typically, you get 3 to 5 tweaks included in the price. Not sure if more than 5 are possible if you pay more.

Let's say you go from a level 2 to level 3 via the targeted UV exposure described above but for some reason you want to go back to level 2. How is that achieved ?

 

[Qs Laptop]

Let's say you go from a level 2 to level 3 via the targeted UV exposure described above but for some reason you want to go back to level 2. How is that achieved ?

I presume they program the UV equipment that changes the calibration of the LAL lens to the previous specifications you had in level 2. As far as I know the LAL lens is malleable up to 5 times and can be programmed to any spec (within the capabilities of the lens.)

 

[jazz4cash]

I'm not gonna presume anything here. I keep thinking it's like ordering a steak. It can't go from medium well back to medium.

 

[Texas Proud]

I find it interesting that so many talk about the color changes... that is one thing that my sister talked about that was a surprise to her..

She said she did not know how 'bad' it was.. her comment was fixed eye=white, old eye= yellow..

I have heard from others how bright things were after surgery...

I'm not gonna presume anything here. I keep thinking it's like ordering a steak. It can't go from medium well back to medium.

Or it could be like a tire.. put air in it to blow it up, take air out to deflate it...

I cannot see them making something that needs adjusting to only adjust one way...

 

[5Miler]

I find it interesting that so many talk about the color changes... that is one thing that my sister talked about that was a surprise to her..

She said she did not know how 'bad' it was.. her comment was fixed eye=white, old eye= yellow..

I have heard from others how bright things were after surgery...

I had the same experience with color between eye surgeries. After the first surgery I was surprised to note how yellow things like my laptop background appeared compared to my eye with the replacement lens.

As for brightness, even after 6 months I can easily be overwhelmed in brightly lit areas although it is getting better. Sometimes going to the grocery store can have that effect on me due to the bright overhead lights.

I just returned yesterday from a 5 week scuba diving vacation and sunglasses were a requirement when outside especially when on the dive boat on open water. The good part is I can now wear cheap Amazon sunglasses I get for $12 or so a pair and leave them all over the place.

I also can now use a scuba mask without having to have expensive optical lenses installed. The savings keep adding up.

 

[zinger1457]

I just returned yesterday from a 5 week scuba diving vacation and sunglasses were a requirement when outside especially when on the dive boat on open water. The good part is I can now wear cheap Amazon sunglasses I get for $12 or so a pair and leave them all over the place.

Do you trust the cheap Amazon sunglasses to live up to all of their claims, especially UV protection? I'd be very skeptical and not something I would want to roll the dice with.

 

[Mulligan]

I had the same experience with color between eye surgeries. After the first surgery I was surprised to note how yellow things like my laptop background appeared compared to my eye with the replacement lens.

As for brightness, even after 6 months I can easily be overwhelmed in brightly lit areas although it is getting better. Sometimes going to the grocery store can have that effect on me due to the bright overhead lights.

I just returned yesterday from a 5 week scuba diving vacation and sunglasses were a requirement when outside especially when on the dive boat on open water. The good part is I can now wear cheap Amazon sunglasses I get for $12 or so a pair and leave them all over the place.

I also can now use a scuba mask without having to have expensive optical lenses installed. The savings keep adding up.

Whats funny for me as I have always been a sunglasses guy…When my eyes were good I wore them all the time outside, and when they went bad I had my script sunglasses on all the time. Only for reason of comfort and later seeing better. Now, post lens replacement surgery, I dont particularly like to wear them and even forget about them. Friday I was golfing and put them on my hat before I started the round, and forgot to ever put them on.

 

[AudiDudi]

I find it interesting that so many talk about the color changes... that is one thing that my sister talked about that was a surprise to her..

My grandfather had lens replacement in the 80's - his comment was from the one eye, everything white looked like it was weak coffee colored while the other eye was bright white. I noticed the brighter colors and seem to be a little more sensitive to bright light, and I always wear sunglasses outdoors.

 

[FD1000]

I've had one cataract surgery consultation and I've got two more scheduled. My goal is to ditch wearing glasses forever.

From what I've learned the best way to get rid of glasses forever is to get a premium trifocal interocular lens implanted. Some of the brand names are Johnson & Johnson's Tecnis Odyssey lens, Alcon's PanOptix lens, and Basch & Lomb's Envista Envy lens.

Another option is the light adjustable lens (LAL) pioneered by RxSight, though success rate of never wearing glasses is not as high as with trifocal lenses.

If you have had cataract surgery, or lens replacement surgery, and you've gotten the Odyssey lens, the PanOptix lens, or the Envista Envy lens I'd like to hear about your experience and your review of how your eyesight is after surgery.

I'd also like to hear from those that got light adjustable lenses (LAL).

Both premium trifocal lenses and light adjustable lenses require out-of-pocket payments above and beyond the Medicare paid benefit amount.

I DO NOT want to hear about the standard monofocal lens that is used to correct vision at a specific distance, usually distance. People that get this lens are fully covered by Medicare and they typically need glasses to see intermediate and close up.

Some get the standard lenses and set one lens for distance vision and one lens for close up. This is called monovision and the person that gets this set up relies on their brain adapting to the mismatched lenses. This is of some interest to me as the light adjustable lens set up is somewhat similar to this setup.

I had LASIK monovision done more than 15 years ago, and it’s been fantastic. I always hated glasses because I’ve been active in sports my entire life. Before the procedure, I wore contact lenses configured for monovision, and within a few days my brain adjusted naturally. My prescription was extremely strong, over -10 in both eyes.
I’ve also discussed cataract surgery options with three hiking buddies who are eye surgeons and have performed many of these procedures. All of them told me to stick with monovision because it’s the simplest option with the best long-term success rate. This is what I'm going to do when I need cataract surgery.
The sad thing is that monovision is rarely discussed, and most people, along with many eye doctors, don’t give it enough time before deciding against it. As usual, I always take the time to research and try to work it out.

They also mentioned newer premium lens implants, although we didn’t go into much detail since the technology keeps evolving and every case is different:

• Bifocal IOLs — Designed to provide clear near and distance vision.
• Multifocal IOLs — Expand vision range to include intermediate tasks like computer work or cooking.
• Trifocal IOLs — Provide even more precise vision across near, intermediate, and distance ranges.

 

[Mulligan]

I had LASIK monovision done more than 15 years ago, and it’s been fantastic. I always hated glasses because I’ve been active in sports my entire life. Before the procedure, I wore contact lenses configured for monovision, and within a few days my brain adjusted naturally. My prescription was extremely strong, over -10 in both eyes.
I’ve also discussed cataract surgery options with three hiking buddies who are eye surgeons and have performed many of these procedures. All of them told me to stick with monovision because it’s the simplest option with the best long-term success rate. This is what I'm going to do when I need cataract surgery.
The sad thing is that monovision is rarely discussed, and most people, along with many eye doctors, don’t give it enough time before deciding against it. As usual, I always take the time to research and try to work it out.

They also mentioned newer premium lens implants, although we didn’t go into much detail since the technology keeps evolving and every case is different:

• Bifocal IOLs — Designed to provide clear near and distance vision.
• Multifocal IOLs — Expand vision range to include intermediate tasks like computer work or cooking.
• Trifocal IOLs — Provide even more precise vision across near, intermediate, and distance ranges.

There is also the inbetween version which I did. One eye distance and one eye multifocal which is considered “hybrid monovision”. For my eye situation, I followed the doctor’s suggestion after consultation and questionnaire, etc. It worked out great to be able to read without any assistance and also have 20/12.5 vision. That is why I always preach for newbees to research like you said and make sure your doctor understands your specific eye problem(s) and your hopeful outcomes. Eyes arent like slapping new tires on a car.
As my doctor said, the actual surgeries he performs has been perfected. What is the X factor is how each persons body reacts to the specific type surgery.

 

[Mulligan]

Another thing people should be aware of after lens replacement is the possible need for a YAG laser capsulotomy. Cells can accumulate on the back of the new lens making vision eventually a little more cloudy. My doctor said this can occur between 3 months and 33 years past initial surgery. The YAG procedure I have been told by Doc is easy and effective. Hopefully I’m at more the “33 year end” and be likely dead before procedure is needed so I dont have to pay the ~$700 cost to do it.

 

[pb4uski]

Actually they use ultraviolet light.

Let's say you get light adjustable lenses implanted. After the surgery you go about your usual daily routines for a week then go see your opthalmologist for an evaluation. (And yes, you have to wear special glasses that block UV light during this time.)

You like your vision but you'd like to see a bit better in the intermediate/near range. The LAL lenses are made of a special material that reacts with UV light. Ultraviolet light is shined at a particular wavelength of UV at a particular region of the lens for a specific amount of time. This will slightly alter the shape of the lens to fine tune your vision so the intermediate/close vision is stronger in that eye.

Again, you try out this new "setting" on your light adjustable lenses and after a week go back to the eye doc. Maybe you want to tweak the distance vision just as bit. The UV light treatment is applied again with different parameters for distance vision.

You can continue this process until you are completely satisfied with your vision. Then there is one more UV light treatment that is your final tweaking. This is what they call "locking in" your LAD lenses. Once this is locked in the lenses cannot be altered any more.

This is the appeal of LAL. You're not stuck with the original outcome of your vision after the surgery. You can actually change it.

I meant UV, wrote it wrong but at least I was consistent. Didn't bother to look it up since my files are all packed for our trip north.

 

[6miths]

I had both eyes done last summer at age 64. Had mini-monovision with Alcon's Vivity extended depth of field lenses (EDOF), one of the lenses was the toric version. My major concern was to not have any night-time flaring effects that are much more common with tri-focals. I strongly considered just going with the standard aspheric mono-focal lenses as this likely results in the 'best' vision and I would often need protective glasses for near work anyway. The EDOF lenses were an excellent compromise. I saw the ophthamologist last week for an eye check up and they were very impressed with the results from a visual acuity point of view. I don't need glasses for any distance and can read very small label print and licence plates while driving. I have considered getting glasses to 'correct' the near eye to distance for naked eye star gazing but a very minor thing. The night sky, which had dimmed, is now stunning again. I able to see very dim objects and able to appreciate star colours again. Am very, very satisfied with the results. All in cost for both eyes was 3,200.00 USD.

 

[5Miler]

Do you trust the cheap Amazon sunglasses to live up to all of their claims, especially UV protection? I'd be very skeptical and not something I would want to roll the dice with.

They are advertised as UV400 with polarized lenses. Throwing additional money at an issue doesn't necessarily guarantee a superior outcome. I leave multiple pairs all over the place so they are always available to me which meets my need.

 

[Qs Laptop]

Let's say you go from a level 2 to level 3 via the targeted UV exposure described above but for some reason you want to go back to level 2. How is that achieved ?

I presume they program the UV equipment that changes the calibration of the LAL lens to the previous specifications you had in level 2. As far as I know the LAL lens is malleable up to 5 times and can be programmed to any spec (within the capabilities of the lens.)

I'm not gonna presume anything here. I keep thinking it's like ordering a steak. It can't go from medium well back to medium.

I did some more research on LAL's yesterday. The technique they use to 'dial in' and 'lock' your lenses is to set both your eyes at plano, meaning no correction at all. Then you try out this setting for a week or two. If you want more near vision they will adjust the non-dominant eye towards near-sightedness by setting the lens to -.25 diopters.

You try this out for a week or two, go back and tell the doctor if you want any more adjustments. If you want more near vision they can set the non-dominant eye another -.25 diopters and also the dominant eye -.25 diopters.

They never explicitly said you couldn't go backwards on the adjustments but it seemed to me they were always incrementally moving the lenses from plano to near-sightedness.

 

[Teacher Terry]

It terrifies me to think of this as I have 3 very unique eye issues and corneal scarring . . . so I try not to.

I can't help but wonder what happens if you lose one eye due to accident or illness and you have one near/one far lens. Can they just give you glasses to fix the remaining eye? Is this even a thing? IDK.

That’s one of the reasons that I chose to get both eyes done for distance. I think this is a valid concern.

 

[6miths]

Apologies if this has been clearly stated upthread but by way of clarification and not to actually address the question but to comment that 'premium' lenses are premium in price to consumer and payday for doctor. They do not result in the 'best' optical outcome. That being the most crisp focus with least light loss and best contrast sensitivity at the desired focal length. 'Premium' lenses will reduce the need for glasses subsequently but have issues with flaring/starburst effects, especially at nighttime, and light loss and decreased contrast sensitivity. Like many areas of life, there are no free lunches in optics and one should consider all of the trade offs/compromises/costs when considering intraocular lenses.

 

[Teacher Terry]

I had LASIK monovision done more than 15 years ago, and it’s been fantastic. I always hated glasses because I’ve been active in sports my entire life. Before the procedure, I wore contact lenses configured for monovision, and within a few days my brain adjusted naturally. My prescription was extremely strong, over -10 in both eyes.
I’ve also discussed cataract surgery options with three hiking buddies who are eye surgeons and have performed many of these procedures. All of them told me to stick with monovision because it’s the simplest option with the best long-term success rate. This is what I'm going to do when I need cataract surgery.
The sad thing is that monovision is rarely discussed, and most people, along with many eye doctors, don’t give it enough time before deciding against it. As usual, I always take the time to research and try to work it out.

They also mentioned newer premium lens implants, although we didn’t go into much detail since the technology keeps evolving and every case is different:

• Bifocal IOLs — Designed to provide clear near and distance vision.
• Multifocal IOLs — Expand vision range to include intermediate tasks like computer work or cooking.
• Trifocal IOLs — Provide even more precise vision across near, intermediate, and distance ranges.

I did a lot of research before I had my cataract surgery 10 years ago and I chose mono vision. The first surgeon that I saw was insisting that I get one done for reading and one for distance. He kept arguing with me and in the end I didn’t trust him to do what I wanted so I asked my family doctor for a referral to a different surgeon. The next surgeon was fine with doing what I wanted.

Also, I’ve known two people where the cataract surgery went wrong and their vision was worse off than before. That’s the other reason that I put six months between having my eyes done.

Locally many of the doctors push for you have your eyes done a week apart. I don’t think that gives you enough time to determine if you are satisfied with the results.

 

[Qs Laptop]

Apologies if this has been clearly stated upthread but by way of clarification and not to actually address the question but to comment that 'premium' lenses are premium in price to consumer and payday for doctor. They do not result in the 'best' optical outcome. That being the most crisp focus with least light loss and best contrast sensitivity at the desired focal length. 'Premium' lenses will reduce the need for glasses subsequently but have issues with flaring/starburst effects, especially at nighttime, and light loss and decreased contrast sensitivity. Like many areas of life, there are no free lunches in optics and one should consider all of the trade offs/compromises/costs when considering intraocular lenses.

Yes, the monovision lenses you get under Medicare coverage will give you the best contrast sensitivity and crispest vision at a specified focal point, usually distance. You will still need to wear glasses for intermediate and close up vision. This means you might need to wear glasses for driving if you want to see your dashboard clearly.

You could roll the dice and get one eye set for distance and one eye set for intermediate/close and if your brain adapts properly you are golden, but you likely will still need to use reading glasses for reading.

Contrast sensitivity is the ability do discern similar colored things in low light, say for example, a gray cat lying on a gray rug in dim light. The quantitative loss of contrast sensitivity using the premium lenses is somewhere between 5% to 20% depending on the lens with 10% to 15% about average. Sounds like a lot, but when you compare your vision with the premium lenses to your current vision with cataracts, even with the 15% loss in contrast sensitivity it will look like a brand new world.

The haloing effect at night is a real concern. I rarely drive at night, maybe 400-500 miles per year. Plus, most people can adapt and their brain learns to not recognize the halos. If your brain does not adapt to the halos, it could be a big problem if you drive at night.

Bottom line--if you don't want to wear glasses, it's got to be something other than standard lenses provided by Medicare, but your very best overall vision is with the standard lenses and glasses for intermediate and close vision.

 

[Teacher Terry]

I don’t need glasses for intermediate vision or to drive. I just need glasses to read close up and I needed them before I had the cataract surgery so it’s no big deal.

A friend of mine got contacts first to see if her brain could adapt to having one eye for distance and one eye to read. It worked well for her so she had her cataract surgery done that way and she’s been reading without glasses for 20 years with no problems.