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  1. #1
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    Default Cataract surgery; which IOL?

    I’ve had myopia for 40 years; presbyopia for 5 and have started to develop neovascularisation from 30+ years of wearing contact lenses. On top of that now I have cataracts developing, although currently they are on the mild side they are only going to get worse. I’ve been referred to a ophthalmic surgeon who is recommending I have cataract surgery now and have IOL’s fitted; what I’m stuck on is which one to pick. My main priority is to have clear far and intermediate vision; I can live with glasses for reading etc but not for general looking. My visual acuity through glasses is atrocious and frankly quite hazardous to both myself and anybody within flailing distance.

    At the moment I’m hanging off making the decision for a few more months until they release the Vivity in my size (apparently I have larger than normal eyes ) as that one is a refractive EDOF lens and most multi-focals including the Panoptic are diffractive. I have tried diffractive multifocal contact lenses and didn’t really get on so well; all improvement in near vision was offset by an equal reduction in far vision so although I could read I ended up squinting at the tv...

    So; has anybody here been fitted with either “Panoptic” or “Vivity” lenses? Or any other type of IOL other than monofocal? I’m interested in hearing peoples stories and results.
    Nothing succeeds like a budgie without a beak.

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  3. #2
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    Just wishing you all the best; sorry I can't help.

  4. #3
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    Sorry to hear this CT - hope something works out for you.

  5. #4
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    I have had both cataracts replaced most probably about a decade apart IIRC. I was extremely short sighted and diagnosed as needing glasses at about 10 years of age and by the time I had the first surgery I was close to being legally blind and had been using contact lenses because the weight of glasses was distorting my face. The doctor suggested a two stage approach to see if I could use mono vision and it was a revelation for me. Some people can't get along with mono vision but I took to it straight away and never had any issues at all. I used mono vision for the whole time between surgeries but it sounds like you might not have that extended period though you will know pretty quickly if it is for you or not.

    He did the first surgery correcting one eye to near perfect long sight and gave me a lens in the other to read with and I now never need glasses but it does take away some depth of field making very fine work such a soldering thin wires a bit difficult, then I put a long vision lens in the reading eye and use reading glasses. This happens about once a year. If I was to do it again I would seriously consider restoring both eyes to full sight and using a lens in one to achieve mono vision but it would be a close call as never having to worry about lenses makes life easy. To give you an idea of how bad my sight was I literally could not walk out of the house with lenses or glasses and only had vague definition of people, objects etc.

    Moving along a few years I wondered about driving and one thing I had noticed was that if the sun was in my long sight eye my vision was pulled back to my reading eye and as I habitually wear sun glasses it seemed a good thing to put a lens in them for my reading eye and correct the vision for long distance. This had two problems, I found that the instruments were a bit difficult to read but more importantly it caused a horizontal split vision for some reason. I saw a number of doctors and that resulted in a decrease in my bank balance and no answers so I went to the Universty in Sydney where they train optometrists and after a long four hour session the best suggestion was my brain had changed the way it treats sight caused by the monovision. I am not buying it because I can put a lens in and the vision is perfect but I simply can't be bothered chasing the issue at this time.

    I don't know if this addresses your concerns but my experience might help others if it doesn't.
    CHRIS

  6. #5
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    Chief,

    Not sure if this will help, but here is my experience.

    Myopic from age 8, deteriorating to -12 both eyes by the time I developed cataracts. I asked the eye surgeon about mulitifocal intraocular lenses - he did not recommend, saying they had not been as successful as some people expected. This was 10 years ago.

    I went with his recommendation - correct long distance vision both eyes and use glasses for shorter distances. My distance vision is now extremely good unaided, e.g. driving. Mid-distance e.g. TV also OK unaided. Closer distances (computer monitor, reading) definitely require glasses.

    i’ve had a lifetime of wearing glasses so I’m used to them. I choose to wear multifocal glasses all the time (clear at the top) so I don’t have to keep putting specs on and taking them off again.

    Good luck with the surgery.

    Brian

  7. #6
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    Quote Originally Posted by homey View Post
    Chief,

    i’ve had a lifetime of wearing glasses so I’m used to them. I choose to wear multifocal glasses all the time (cleae at the top) so I don’t have to keep putting specs on and taking them off again.

    Brian
    That sounds like an excellent idea, for the short time I have to wear reading glasses due to astygmitism pre surgery they drove me mad never being where I needed them. To add a bit more to my post above I would not recommend mono vision without an experimental period but I doubt any doctor would do it without a learning period though it could be nullified by wearing a lens in the reading eye. BTW I have just been diagnosed with the very first stages on Malacular Degeneration in one eye during a routine check up, just what I needed but it is so early that my vision has suffered yet.
    CHRIS

  8. #7
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    One of the things you can discuss with the surgeon is to have a different degree of correction for each eye. Partial correction for your dominant eye and full correction for the other eye. In this way, you will see both far and near objects but with a slightly comprised sight.

  9. #8
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    Thanks for all your kind words and especially to Chris and Brian for sharing your stories. My issues aren’t anywhere near as bad as what you two had to suffer; the presbyopia is the normal age-related kind and the cataracts as yet aren’t causing me any issue other than I really hate places with “mood lighting” coz I can’t see stuff all! My beloved would happily live in perpetual twilight; she refers to my preferred level of lighting as “Blackpool Illuminations”. If I didn’t have the myopia I doubt any surgeon would recommend surgery for at least another 5-10 years.

    No, my main issue is the myopia and how to correct it. I always struggled with glasses and at 19 I commenced wearing contacts. Unfortunately the 30 and a bit years of wearing them is now causing neo-vascularisation. I’m good for maybe 6 months to a year and then I have to permanently stop, and even during this period I have to reduce the hours where I can. Glasses distort my vision hugely as my eyes and brain cannot cope with the focal differences between a lens sitting on the cornea and non-concentric one sitting 1/2” in front of it. It takes me nearly a week before I dare drive a car and I have terrible depth perception along with no peripheral vision worth seeing.

    Plus in the immortal words of Troy McClure: “You wouldn’t ask a handsome man like me to wear glasses? It'd be a crime against nature!”

    We’ve discussed having asymmetrical lenses fitted where one is biased for long distance and the other slightly more close but to be frank I’m not that keen. I have tried mixing contact strengths & types to duplicate that but it just feels weird; apparently it can take up to 6 months for the brain to get used to it. I would try each combo for about a week but it just didn’t click for me; I just really dislike losing far vision. So I’m 99% certain I’ll be keeping both eyes the same. I wear glasses for reading and working with computers so I don’t have an issue with keeping that going permanently.

    Diffractive multifocal lenses like the Panoptic were being spruiked as being the dog’s pods but now that they’ve been put into enough people to get a realistic range of feedback they may not be quite the cure-all they try to represent; I can (and already do) live with glare and light halos at night but it’s the loss of sharpness that concerns me. I can’t trust online reviews to be unbiased; especially when the host sites are the manufacturers or the surgery’s... which is why I’m seeking feedback from people I “know”!

    My elderly neighbour had monofocals put in a few years ago; he too chooses to permanently wear multifocal glasses. Sometimes when we’re working together he’ll be laughing at me while I’m moving my head around trying to see through the magnifying bit of my bifocal safety specs or searching for where the hell I’d put my glasses down last; he’s got 30 years on me but half my vision issues!
    Nothing succeeds like a budgie without a beak.

  10. #9
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    I have never asked but apart from the expense involved I wonder if the lens correction could be changed if you did not like the result, does anyone know if this is possible? During one conversation I was told the the vision still deteriorates even with implanted lens's but mine hasn't done that to any measurable degree yet.
    CHRIS

  11. #10
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    Hello Chief,

    I'm 56 and have been very shortsighted since I was about 14. It got to the point where if I didn't put my glasses in their usual place I had no chance of finding them. Used to have to wait for my wife to come home and look for them. About 2 years ago I went for my normal new eyeglasses test and the optometrist recommended I go and see an eye specialist. It took about 4 months to get an appointment. When the lady at his office was doing the pre inspection tests on one of the machines she said "can you actually see out of that eye?". Lol. Turned out I had a very rare form of cataracts that progress at a fiendish rate. The doctor said I would have been totally blind within 6 months.

    Anyway when he was telling me what he'd like to do he said that I could get one eye corrected for distance vision and the other for closeup. I thought he was mad to be honest. It sounded crazy to me. I opted to have both eyes set to distance. I had the first one done and to be able to see perfectly into the distance without specs for the first time in 40 years was simply amazing. During the 8 weeks between operations I got to experience what it was like to be able to see closeup and into the distance at the same time and I really liked it. I rang the surgeon and changed my request to get the second eye set for closeup vision. Ive been living with the dual setup now for more than a year and I LOVE it. NO SPECS!

    Just my experience and good luck with your operations matey.

    Mick.

  12. #11
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    Quote Originally Posted by ARealBoy View Post
    Hello Chief,

    I'm 56 and have been very shortsighted since I was about 14. It got to the point where if I didn't put my glasses in their usual place I had no chance of finding them. Used to have to wait for my wife to come home and look for them. About 2 years ago I went for my normal new eyeglasses test and the optometrist recommended I go and see an eye specialist. It took about 4 months to get an appointment. When the lady at his office was doing the pre inspection tests on one of the machines she said "can you actually see out of that eye?". Lol. Turned out I had a very rare form of cataracts that progress at a fiendish rate. The doctor said I would have been totally blind within 6 months.

    Anyway when he was telling me what he'd like to do he said that I could get one eye corrected for distance vision and the other for closeup. I thought he was mad to be honest. It sounded crazy to me. I opted to have both eyes set to distance. I had the first one done and to be able to see perfectly into the distance without specs for the first time in 40 years was simply amazing. During the 8 weeks between operations I got to experience what it was like to be able to see closeup and into the distance at the same time and I really liked it. I rang the surgeon and changed my request to get the second eye set for closeup vision. Ive been living with the dual setup now for more than a year and I LOVE it. NO SPECS!

    Just my experience and good luck with your operations matey.

    Mick.
    Another mono vision convert. I too couldn't find my glasses if I put them somewhere different, one night I came home after a few sherbets and the glasses got put somewhere they did not belong and I had to ring a mate to come over and find them for me!
    CHRIS

  13. #12
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    Quote Originally Posted by Chris Parks View Post
    I have never asked but apart from the expense involved I wonder if the lens correction could be changed if you did not like the result, does anyone know if this is possible? During one conversation I was told the the vision still deteriorates even with implanted lens's but mine hasn't done that to any measurable degree yet.
    Hi Chris;
    Yes IOL’s can be removed and replaced; there are a few videos online with it. There is a US surgeon called Dr Shannon Wong who has produced some really interesting videos; including having a multifocal IOL inserted himself.

    The potential for future deterioration of my sight was one of the BIG questions I had; my sight has never been stable for more than 12 months and I have no wish to get an IOL installed that would only reset my uncorrected vision back to being an 11 YO again. It was explained that myopia is caused by three things; the length of the eyeball, the shape of the cornea and the action of the lens; the last part being responsible for about 70%. Surgeons normally won’t install them into people under 40 because it’s only around that age that the eye has definitely stopped growing. The IOL totally replaces the lens and is dimensioned to suit the eyeball, leaving only changes in the cornea as a potential cause. This can only cause minor loss of focus; and the good thing is that it can be rectified using quite mild Lazik or similar. My sight is too far gone for Lazik; at best if I’d had it done 20 years ago I would have had dry eyes ever since; would have been back on glasses after about 3 years anyway and would still have started developing cataracts.

    I am enjoying the “before” tales of putting down glasses and essentially being lost! Whereas I can quite believe those episodes were at the time extremely frustrating and probably somewhat worrying it’s good that now they can be recalled with a bit of humour! I have my own peculiar problem when I don’t have lenses in or glasses on; I go partially deaf when listening to someone talking... Many years of working in noisy environments like engine rooms and wearing full on hearing protection teaches you basic lip reading, and I find I subconsciously partially rely on it normal conversation. There’s nothing wrong with my hearing; screaming gas turbines and naval gunfire assisted in developing a habit of always having earduffs on hand and I have slightly better than average hearing for my age group; but my beloved is adamant that the audio booths are either wrong or I cheat somehow. I have pointed out to her that perhaps if she spoke to me rather than mumbling in an opposite direction while walking away I might have a slight chance of understanding whatever it is causing her angst...
    Nothing succeeds like a budgie without a beak.

  14. #13
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    When the doctor said to me he could correct my vision with implants I asked him if he could do it before I left the surgery and he laughed and declined to do it. I recall when I first got glasses, I walked out of the building at night in Sydney and for the first time could see all the pretty bright lights of the buildings and advertising clearly and it is something I will never forget. It seemed a whole new world had opened up for me and when I went to school I could see what was written on the blackboard for the first time in a long while. Why the teacher never said anything when I used to leave my desk only he knows. I was most probably Myopic for my entire life up until someone worked out that I had a vision problem.
    CHRIS

  15. #14
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    I had my cataracts done about two years ago. At that time my guy recommended very strongly not to go with multi focals as he said studies showed about 80% had problems, one example being star bursts at night. He said future developments would probably solve the problems but on my yearly checkup lsst week he still wasn’t recommending them.

    I have worn glasses for long vision eg driving for 30 odd years but had great close up vision.

    I went for one long vision and one for mid range. I need glasses for reading and one of the new problems that appeared during testing for glasses was split horizontal vision which had to be corrected with the glasses lenses. I don’t think my close up, even with glasses, is as good as it was before the surgery.

    Whats good about the combo though is I don’t need glasses when driving but a can also see the vehicle display, sat navigation etc clearly with the mid range eye.

  16. #15
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    This is a very interesting thread, as 18 months ago I got my annual checkup and be said that I have the first stage of Cataracts. Minor changes last Christmas and I expect to have a new prescription this Christmas. He said that it should be another 5 year's before I need to have lenses fitted, so all this has given me food for thought.
    One thing he did say was that I had to consider that seeing I have worn glasses all my life, after lens replacement my eyeballs will no longer be protected by glasses.
    Rgds,
    Crocy.

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