Cataracts

Hi liz,

I've been researching the topic since my last checkup.

Here's my story - I had PRK mono-vision 16 years ago - it was wonderful - I was better than 20/20 in my far eye and J1 in my near eye. About two years ago my optometrist noticed the beginnings of observation - just a bit. My last checkup he said it was time for cataract surgery - the average age of cataracts is 69 - I am 69. My family has always had cataract surgery at about this point. My near eye was rated 2+ for cataracts and my far eye 1+.

The topic can get quite complicated, but the basics are that Medicare/Insurance will cover basic replacement IntraOcular Lenses. These simply replace you current organics lens in a very common, high success rate, usually painless and very success operation. The surgeon will use some basic refraction information to choose a lens for your eyes that could even improve your vision. Most folks will continue to need to wear glasses for near vision, however.

There are MANY different lenses available from several companies that can improve vision like a basic lens, but they may also provide some extended depth of field (EDOF) capability, or even multi-focal capability - usually with some side effects to vision like increased halo effects, clarity at distance, etc. These lenses are called "premium lenses" because you will pay an additional $2000-$5000 (varies based on area and surgeon) per eye.

The very latest in developments is by a company RXSight, that makes a lens from a different material (silicon) - that always a few modifications following implantation. This is called a Light Adjustable Lens (LAL).

Most moderate sized cities and large towns will have surgeon who can implant basic lenses and most types of premium lenses. LAL is not as common, but the number of surgeons doing this is increasing.

Thank you so much for taking the time to reply. Very helpful.

I'm definitely ready for cataract removal. I was reading about LAL, but I guess I'm not ready, since very few people have had this and wonder what is complication rate. I'm a high myope, so I might not be eligible. My cousin had bifocal lens implants and is not happy. I do a lot of close work, so I'm considering having lens to help with close vision and I will continue to wear glasses for distance. I've heard about having one eye with close lens and one eye with distance, has anyone had an experience with this option?

I have the basic lens from cataract surgery and am quite happy with them. I have "mono" vision of closeup and far vision and it works great--no problems getting my brain to manage the difference. For reading, I can see, but it seems easier with 150 lenses. Question your doc about the distance from nose to book; my clearest vision is beyond my finger tips! I do wonder with the new trifocals, whether the acuity is as good as you age and refocusing is slower. (My sister priced out the newer versions and it would cost her more than $7K for both eyes. I had no cost with the basic and all seems good 7 years on)

1995,

LAL has been around for tens of thousands, perhaps more, in the US, and many, many more than that in Europe where they have been implanted for about 15 years. Did you read somewhere that very few people had these implanted?

I've not read much about bifocal IOLs, but many, many multifocal have been implanted - maybe millions? They have their own issues - lots of online reading is available.

Monovision - millions have this, both with IOLs and from LASIK and PRK. Again, millions of folks have this construct. Lots of reading available online.

Try a search like - "study analysis 2023 interocular lens results monofocal multifocal light adjustable lal edof extended depth of focus"

With eye glass prescriptions you can easily just change the prescription and / or lens styles (single, bifocal, progressive etc), but with cataract surgery your committing to a lens change to your eyes which you cannot try and test in advance before you decide which to choose. Also your eyes may change as you age. In my opinion the risk of a sophisticated lens not working for you is too high and as some observers have commented, the basic simple no cost lens used most commonly in cataract surgery may be the safest option that can later be complemented with eye glasses.

about LAL, I read only 50,000 here in US in 2022, and like 25.000 in 2020......so ?????
And it seems that people who have had LASIK or RC can have more issues when going for cataract removal
I guess I try to stick with Mayo, Hopkins, Leahy, the big places.....

yes, I've been wearing glasses since I was 9 yo.....so I don't mind glasses

Yep - I hear ya!

Except - at the time of cataracts most folks' eyes have changed almost as much as they are going to - I look at this as the last chance for the best vision possible ((to me this is vision from close up to far out - without glasses) - the same way I did when I had PRK in 2007. I want and am willing to pay for the best vision possible. And, LAL is not really sophisticated, as much as it is a monofocal IOL that can be modified after implantation.

I have read a LOT on this topic, but still don't fully grasp the physics - the scariest IOLs are the ones that promise EDOF, but also have significant likelihood of dysphotopsias which impact nighttime driving, in particular.