Cataract - School me on IOL ?

[GoldMember]

It’s only their vision, no big deal


Sent from my iPhone using TGR Forums

I have a couple of friends who went through this last year. Both skied with good goggles that had the necessary UV protection and wore the funny glasses in the lodge. They were fine. I wouldn't do it, I'd wait until ski season was over.

[EWG]

I have a couple of friends who went through this last year. Both skied with good goggles that had the necessary UV protection and wore the funny glasses in the lodge. They were fine. I wouldn't do it, I'd wait until ski season was over.

Any idea what goggles they used?

[detrusor]

Yeah, postpone the ski trip for fucks sake. First world problem

[EWG]

You guys are kinda missing the point. Doc is telling them it’s fine to go. They want to go. I ain’t changing any of that whether I want to or not. I already brought that up. Now just trying to help out with logistics and insert extra caution and get thoughts from people that have knowledge on the specifics. Sounds like at least a couple people have skied on trips successfully in the same situation.

[Bosco]

I had LAL's put in last March. After laying low for a couple of weeks, I did end up getting a couple of spring skiing days in.

[EWG]

I had LAL's put in last March. After laying low for a couple of weeks, I did end up getting a couple of spring skiing days in.

Did you just wear goggles or did you find goggles to wear over the UV blocking glasses?

[old goat]

Not worth fucking up your vision for one ski trip. Cancel trip or cancel surgery.

[Bosco]

It was spring skiing so I wore the glasses they gave me and didn't need goggles. I know I asked the doc about wearing goggles, and I think he said it was OK, but I can't remember for sure. However, if their doc said it was OK to go, I'd go.

[powdrhound]

Timely thread revival.
I am scheduled for the 10th and the 31st this month. They tell me I should be good to ski after a week.

3 years ago I was told that the air bubble inserted into my eye during the Vitrectomy, to repair the macular hole, would guarantee that I would develop a cataract that required repair within the next 6-12 months. Ok. I check in with the doctor that will do that procedure, he starts checking me every 6 months. Not bad enough yet, 6 more months.
Finally tells me - it’s time. And, by the way your other eye is bad now and you need to do both eyes.
Then, for the first time, tells me about the options in lenses. The standard lens that Medicare covers, that will require me to continue to wear glasses.
Or the magic Vivity lenses. Only $4,200 extra out of pocket!

Of course I have to go with the modern lenses. But damn, I really wish that he had told me about this years ago, I would’ve been planning on the expense. I very clearly let the office manager/salesperson know about how I felt about the sudden hard sell. Maybe it’s my fault for not doing adequate research during that time period. But that’s why I was seeing that Doctor.
I will admit that I am looking forward to regular sunglasses.

[Duffman]

Eye Dentist here. Somehow missed this topic before but was checking on here for some knee info for the wife and saw it....

Powdrhound- As far as the decision for a Extended Depth of Focus lens like the Vivity vs a standard monofocal lens, it really depends on how you feel about wearing glasses for near activities. The Vivity and similar lenses will give you better intermediate (computer ,dashboard, etc) range vision , and some level of near reading vision without glasses compared to a standard lens. As far as distance vision, there is no benefit whatsoever, and actually there is a slight theoretical contrast loss compared to a standard monofocal. This is imperceptible to most people, but could be an issue in the eye that has the Mac Hole repair if there are any lingering retinal issues.

So it's really a personal preference / lifestyle lens. The cost is getting you good computer and phone vision and say some improvement in reading vision without glasses. Since reading glasses are annoying, there is definitely value in this for some people. But it's not simply a case of the "Medicare " lens vs the better lens.

EWG- I would be careful with UV exposure with the LAL. The LAL is not cheap (and we really don't use them much as the value is really in an eye where the calculations are tricky , in a straightforward eye without a lot of astigmatism or weird measurements it's usually fairly easy to hit the target with a standard lens ) and it would be pretty dumb to go through all that extra cost and adjustment time to potentially screw it up.

The large majority of cataract surgeries are done without a LAL, so when people are describing their post op glasses or care, 99 times out of 100 they didn't have to worry about a LAL and UV exposure.

Hope this helps!

[GoldMember]

Any idea what goggles they used?

Smith. But from what I understand, any good brand will be 100% UV protective so just about anything should be okay.

[powdrhound]

Duffman, thank you for your knowledgeable input. (How can you not love this community?)
My vision on the repaired eye continues to improve. The vertical squigglies are nearly gone. I can almost read with that eye now. I certainly can’t see that I have the cataracts… they must be there, though. I choose to believe him.
According to my doc, the only reason to not get the Vivity is if you can’t afford them. Do you know people who have regretted their choice?

[billyk]

The Vivity lenses are extended depth of field (EDOF) lenses, like the Symfony lenses I got. I don’t regret going that route at all, other than the extra cost.

[EWG]

Eye Dentist here. Somehow missed this topic before but was checking on here for some knee info for the wife and saw it....

Powdrhound- As far as the decision for a Extended Depth of Focus lens like the Vivity vs a standard monofocal lens, it really depends on how you feel about wearing glasses for near activities. The Vivity and similar lenses will give you better intermediate (computer ,dashboard, etc) range vision , and some level of near reading vision without glasses compared to a standard lens. As far as distance vision, there is no benefit whatsoever, and actually there is a slight theoretical contrast loss compared to a standard monofocal. This is imperceptible to most people, but could be an issue in the eye that has the Mac Hole repair if there are any lingering retinal issues.

So it's really a personal preference / lifestyle lens. The cost is getting you good computer and phone vision and say some improvement in reading vision without glasses. Since reading glasses are annoying, there is definitely value in this for some people. But it's not simply a case of the "Medicare " lens vs the better lens.

EWG- I would be careful with UV exposure with the LAL. The LAL is not cheap (and we really don't use them much as the value is really in an eye where the calculations are tricky , in a straightforward eye without a lot of astigmatism or weird measurements it's usually fairly easy to hit the target with a standard lens ) and it would be pretty dumb to go through all that extra cost and adjustment time to potentially screw it up.

The large majority of cataract surgeries are done without a LAL, so when people are describing their post op glasses or care, 99 times out of 100 they didn't have to worry about a LAL and UV exposure.

Hope this helps!

This is awesome. Thanks Eye Dentist Duffman!

So here's the million dollar question. If it was you, and you were a big skier/mtn biker/tennis player in your mid 50s, and you had developed cataracts (and had terrible vision along with astigmatism all your life), what lenses would you choose if price and time were no object? And how would you focus them?

[Bosco]

I went the LAL route and I'm happy with my choice. During the adjustments I favored reading over distance vision as I do programming for a living. As a result my reading vision is off the charts, I can easily read the smallest print on the test card they gave me. My distance vision is close to, buy not quite 20/20. When playing golf I notice that some of my partners can see the ball a better at a distance. However, no more glasses for me.

As for the RxSight (LAL) sunglasses. They also propose to have a special coating on top of them having UV protection. I don't know if this is true or just marketing. They have clear lenses they want you to use when your indoors.

[Duffman]

This is awesome. Thanks Eye Dentist Duffman!

So here's the million dollar question. If it was you, and you were a big skier/mtn biker/tennis player in your mid 50s, and you had developed cataracts (and had terrible vision along with astigmatism all your life), what lenses would you choose if price and time were no object? And how would you focus them?

Lens choice really is a personal preference in many cases, there really is no one best lens. Given the parameters above and assuming fairly normal measurement (no super high astigmatism or anything like that) I would likely want some sort of monofocal lens targeted at distance in my dominant eye with a very slight near defocus in the non dominant eye , like -0.50 to -0.75.

Jury is still out on the LAL, it's been in trials for years and years, but really didn't reach any significant adoption numbers by surgeons until this year. The technology is very cool ,but whether the significant cost and hassle factor are really worth it really depends on how the measurements of the eye look and how much of a layup it would be to hit those numbers with a standard multifocal or a lens with a very slightly elongated focus curve like a J&J Eyehance.

The LAL requires a fairly significant cost in the equipment needed to adjust and lock it in , so I can see where surgeons who have recently procured that have a pretty strong incentive to push it. It also requires a significant increase in post op visits and time, so the additional cost is justified. And unlike some other gimmicks that the refractive cataract mills were pushing hard before (like laser assisted cataract surgery which is a pointless expense that never showed superior outcomes even independent of cost) , there is definitely value in the adjustability of the LAL, especially in hitting more difficult refractive outcomes .

[EWG]

Lens choice really is a personal preference in many cases, there really is no one best lens. Given the parameters above and assuming fairly normal measurement (no super high astigmatism or anything like that) I would likely want some sort of monofocal lens targeted at distance in my dominant eye with a very slight near defocus in the non dominant eye , like -0.50 to -0.75.

Jury is still out on the LAL, it's been in trials for years and years, but really didn't reach any significant adoption numbers by surgeons until this year. The technology is very cool ,but whether the significant cost and hassle factor are really worth it really depends on how the measurements of the eye look and how much of a layup it would be to hit those numbers with a standard multifocal or a lens with a very slightly elongated focus curve like a J&J Eyehance.

The LAL requires a fairly significant cost in the equipment needed to adjust and lock it in , so I can see where surgeons who have recently procured that have a pretty strong incentive to push it. It also requires a significant increase in post op visits and time, so the additional cost is justified. And unlike some other gimmicks that the refractive cataract mills were pushing hard before (like laser assisted cataract surgery which is a pointless expense that never showed superior outcomes even independent of cost) , there is definitely value in the adjustability of the LAL, especially in hitting more difficult refractive outcomes .

Super helpful, and thank you.

[powdrhound]

One done.
Damn, that light is intense. The most painful part of the process.
I’m not going to try to grade it yet. The mesh of the guard, and all. Looking forward to tomorrow, after a bit of healing time.

[Duffman]

Even with the shield off (I only have my post ops wear them while sleeping ) things will likely be bright and not super sharp due to dilation, some people can stay dilated for 24-48hrs post op , and some corneal swelling is normal also.

Sent from my Pixel 7 using Tapatalk

[Duffman]

Even with the shield off (I only have my post ops wear them while sleeping ) things will likely be bright and not super sharp due to dilation, some people can stay dilated for 24-48hrs post op , and some corneal swelling is normal also.

Sent from my Pixel 7 using Tapatalk

Never mind ,I'm an idiot. Just realized you had the adjustment done, not the operation. Disregard above

Sent from my Pixel 7 using Tapatalk

[powdrhound]

It was me being unclear.
Vivity #1 inserted today.
#2 will be on the 31st.

I do see a different blue, brighter hues.

[Duffman]

It was me being unclear.
Vivity #1 inserted today.
#2 will be on the 31st.

I do see a different blue, brighter hues.

Gotcha. So my tips above apply. Yep the blue shift is really noticable at first, like when taking off tinted goggles. You are actually seeing the color spectrum properly now, even a mild cataract has a significant color shift that you are accustomed to now.. After you get used to it you will find the non operated eye to look ruddy and colors washed out .
One of the main reasons people with a cataract way worse in one eye end up wanting the surgery in the second eye quicker than they may have thought originally

[GoldMember]

Well, I took the plunge and am in the midst of cataract surgery. I was torn between going Toric to help the astigmatism correction or LAL due to my wanting to maintain monovision correction. I've had monovision contacts for over 20 years with great success, until this past couple of years. My distance vision wasn't up to par and my near vision still required cheaters for some activities like reading the paper or books.

On my last contact script, I had them change it after the fact to lesser reading and greater distance vision. She changed it and my distance was better but still wasn't up to snuff. Additionally, over the past ten months or so, I was having significant occlusion by way of blotchy vision that weren't like floaters; more filmy. cloudy but not over the entire eye. It was getting annoying so made the call for surgery and LAL. The deciding factor was that I had changed my last script to better suit my wants (somewhat unsuccessfully) and could dial it in after the procedure.

My left eye was done Tuesday with my right this coming Tuesday. Amazing clarity! In the follow-up on Wednesday, it was 20/20. The right eye will also be set to distance initially with it adjusted back to accomodate monovision. In the meantime, it's the funny glasses for UV shielding but they're not a big deal. First adjustment will be early June and I should be wrapped up no later than the end of June. I'll report back as this goes along but, so far, I'm pretty happy ( except for not being able to work out for two weeks...).

[old goat]

I would want an IOL that I could ski with and drive with and wear glasses for reading and computer (and TV watching hockey).

I'm not at that point of surgery yet. Right now the best tool to improve my vision is a headlamp--in the woodshop for example.

[GoldMember]

I would want an IOL that I could ski with and drive with and wear glasses for reading and computer (and TV watching hockey).

I'm not at that point of surgery yet. Right now the best tool to improve my vision is a headlamp--in the woodshop for example.

Yeah, I would think if you've not done monovision before and are happy with glasses around the house for reading, etc., monofocals are probably a solid choice (but I'm no eye dentist...). It really is a personal choice. For me, with success with monovision for 20+ years, keeping on works for me. And with the LAL, I can get set up to my happy place with all distances. I think...