Some of you may have helped me previously here: Dr's recommending EDoF/MF IOL.I'm not yet convinced, I'm still waiting for elective surgeries to be rescheduled due to COVID-19. In the meantime I've settled on monofocal IOLs for distance, or possibly mini-mono vision. I've ruled out Acrysof lenses because of their propensity to develop glistenings. I'm aware that it hasn't been conclusively proven that glistenings affect vision, but why take the chance. Additionally, it has been shown that glistenings hinder an ophthalmologist view into the eye. So there's that. As I'm in the US, my choices are somewhat limited, and it seems the best options are the Tecnis ZC800 and the Bausch & Lomb enVista MX60E. I have my own pros and cons list for theses lenses, but I'm interested in other patients experiences and/or perspectives on these two IOLs, or any others you think I should consider. Thank you!
I have forgotten. Will it be a toric IOL or not?
Not toric. Thanks Ron!
You are in a similar situation to me. My first eye will not be toric as the required cylindrical correction is not high enough. My second eye is more of a question, so it remains to be seen if I need a toric or not. . In my pre-operative consultation we discussed the lens options. The Acrysof IQ Aspheric is the one recommended by my surgeon. However, when I raised the issue of glistenings he said if I insisted he would use the Tecnis lens instead. His opinion on glistenings is that yes, they do exist, but he has never seen them to the extent they were an issue with the lens. He also added that the issue was more prevalent in the past before Alcon improved their manufacturing quality control. He never offered me the B+L option, and I have not done any research into that lens, and can't comment on it. . As it stands I have the choice of the AcrySof or Tecnis, and my decision at this point is to go with the AcrySof lens. I have looked that the pros and cons of each, and concluded that glistenings are a factor, but potentially not the most significant one. There are all these theoretical pros and cons of each lens, but there is also the practical matter that at the time of the surgery, the surgeon has to "get it right". There is a lot of skill and expertise that surgeons develop to get good outcomes. For that reason I am very reluctant to push the surgeon into using a lens that he may not have as much experience and skill with. Before COVID they were doing this work day after day, and one has to respect that they have much more experience than I do, in just looking at the theory of it all. . On a the technical pros and cons front, I think the main advantage of the Tecnis is the lack of glistenings. The pros for the AcrySof is the material seems to bond better to the eye and as a result is more stable in the eye, and less susceptible to PCO. I think the blue light filtering that the AcrySof uses is an advantage. It provide a colour rendition that is more like the natural lens. It also seems to give better night vision. I can't say I am a believe in the benefits of improving sleep, etc. Last the AcrySof uses a 0.2 aspheric under correction compared to the 0.27 with the Tecnis. The theory is that it provides better visual acuity than the perfect 0.27 correction. . Here is an article that may be of interest to you. It is very bias toward AcrySoft and was written by a paid consultant. However, it does explain why they are doing what the do with the lens. CRST Today Why My Choice Is the AcrySof IQ IOL Anna F. Fakadej, MD . Next is a link about glistenings. Note that this is two articles, Point, and Counterpoint. The first is a pro B+L article, and the second is a pro Acrysof. CRST Today How Serious a Problem Are Glistenings? . Here is another article based on a survey of surgeons on what lenses they actually use and why. It found it informative as to what the popular lenses are. Review of Ophthalmology Surgeons Share Their Views on IOLs . Hope that helps some. I guess we all have to weigh it all and make our decisions.
Thanks RonAKA. I've read all the same articles :-). To date I've been basing my decision on specs, but was hoping to get some stories of personal experience with either of these IOLs. A good friend of mine has the previous generation B & L lens and has 20/15 distance vision and can read the small print on a bottle of water at 30". My mom has the Acrysof Natural (BL filtering) in her eyes and has similar vision. However, she's in her mid 80s and likely won't experience any long term affects from glistenings. Your point is well taken regarding which lens your surgeon is most comfortable/experienced with. My Dr. doesn't seem to concerned about using a different lens than he usually implants, and has said to me that he's not as conservative as some of his peers in what he will and will not do including explanting lenses well after the fact. I do plan to ask him point blank if he has concerns about this during my preop appointment.
Finally got new surgery dates. I'll be undergoing simultaneous bilateral cataract surgery on June 22 at the Kaiser Surgical Center. I had my pre-op appointment yesterday and after much discussion with my surgeon decided to stick with a monofocal B&L enVista IOL in both eyes set for distance. I do wish the new B&L trifocal was available, but... it's not. Also asked about the new Symfony Plus and apparently it's not being marketed yet. My surgeon was not to complimentary of the original Symfony,but was pretty positive about Panoptix. No pre-op eye drops were prescribed and only one formula of drops for post-op (Sandoz Didofenac Sodium). I was told that recovery should be quick and easy and I should expect to see pretty well the day after surgery. Regardless, my surgery is on a Monday and I've planned to take the week off from work (I've been working from home since 3/20). I'll update this with my surgery experience after the fact. Thanks again to all the folks on here who have contributed their experience and wisdom to help me get to this point!
Good luck with it Charles, and would expect it to go well. That lens selection should be just fine so do not worry about second guessing if you made the right choice.
If the clinic has a viewing area then get the person who is taking you to the appointment to video the procedure. One video can be of the room in general with the surgeon working on one eye, and the second can be of the TV that displays what is seen with the microscope. Pretty cool to have this as a record of the event.
Thanks Chris. I'm content with my decisions. It took me a long time to get here and agree that second guessing choices at this point will only add anxiety to the process. I will check into the video options, that would be pretty cool to watch after the fact.
If I were you, I'd choose Alcon Clareon lens, not Acrysof.
However, one more thing from my experience. I recommend you to stop trying to prove that one lens is somehow better than other. I did it myself and really regret it. The final outcome is more related to your pure luck than anything else. I know you're trying to para-scientifcally prove it, but it won't work that way. Why? Because I did it. Then it turned out that I was wrong. And now I keep blaming myself.
Thanks ad12345 for sharing your experience.
Successful surgery yesterday on both eyes. Had my post-op today and am at 20/15 UCDV in both eyes. 1.5 - 1.75 readers for close work and reading, but otherwise pretty functional intermediate and close vision (I would have no problem cooking a dinner or such without readers). I'm not sure I've ever had vision this good, it's like a hidden world no one told me about. I feel so blessed and lucky to have something like this happen for me. I can only wish a similar outcome for all the folks out there waiting for their surgery. Thank you so much everyone. I will update later this week as things settle down.
Congrats Charles, seems like you are over the moon with the results. Take care of them now and they should last a lifetime.
that is good news. congrats on a successful surgery. enjoy your new vision.
Not much new to report. Vision is stable and I've gotten into a routine around when I really need to use readers or not. I have an Optometrist appt. on 7/23 and will report back with my final readings and prescription.
Hi, Charles,
First of all, congratulations on such successful surgery. It sounds almost too good to be true that you have such great intermediate/near vision with monofocal IOL.
I am in the similar situation. After visiting several prominent ophthalmologist in the area, Acrysof and Tecnis are typical recommended lens. I got introduced to enVista lens recently and was very intrigued to use it for my own cataract surgery.
How is your experiences so far on enVista? Did you go for distance for both of your eyes? I am considering a mini-monovision setup. Was this also in your consideration as well?
One thing that concerns me about enVista is its relatively small market share so it is not as widely tested as Tecnis or Acrysoft. Another concern is its Axial Compression and Corresponding Dioptric Shift comparing to Tecnis and Acrysoft. DId your ophthalmologist discuss this with you?
Again, sorry about all these questions. I am really nervous about this operation. Any of your answer will be deeply appreciated here.
What are you concerns about axial compression? The main issue with IOL's from my investigation is that they use a higher refractive index than the natural lens (about 1.4 RI), and as a result are thinner. This can mean they sit further back in the eye and that can result in optical artifacts like dysphotopsia. Silicone lenses have a lower RI (about 1.41) and are close to the natural lens and said to be less susceptible to these issues. I see that the enVista material has a RI of 1.53, which is between the Acrysof 1.55 and Tecnis 1.47. Seems insignificantly different than the Acrysof material. The advantage of a high RI is that that a thinner lens can be folded up smaller and requires a smaller incision to put it in the eye. What is a bit concerning about the enVista material is that it claimed to be 25X harder than the other hydraphobic acrylic lenses. Harder usually means less flexible. Does that mean it cannot be folded up as tightly and requires a larger incision? The incision in the eye can induce astigmatsim that was not there before the IOL surgery. Some things to consider.
Thank you very much, RonAKA.
My concern is from the following plot on Acrysof website, which could be a marketing play but I am not sure how much this Dioptric shift will negatively impact vision outcome.
As for enVista, it seems like it has some unique aberration-free optic design which offers impressive image quality even when pupil size increases at low light condition. But again, I am not sure how much of that will be translate into real life vision outcome or it is just another marketing play.
At this point, I am tilting towards Tecnis monofocal ZCB00 because of its less chance of glistening (something enVista does the best) and overall good quality vision it can provide. Acrysof yellow-tint design and blue-light blocking are interesting and does a good job to cut down the glare. But that is not my top priority now.
I found one report on the issue, but some caution needs to be considered as it was done in an Alcon laboratory. You should find it by searching for the following. . Evaluation of intraocular lens mechanical stability journal of cataract & refractive surgery . I have not seen this issue raised as a concern in any of my readings. Perhaps it becomes more significant in people with smaller eyeballs? . The issue of large pupil sizes is more of a concern for younger people. Unfortunately as we age our maximum pupil size decreases. This is generally bad, but it does have some advantages. First it can avoid some of the optical artifacts which occur with more open pupils. The other benefit is that it has a bit of a pinhole camera effect that increases our depth of focus. An older person may adapt better than a younger person to the monofocal strategy as they can focus closer especially in lower light. . I have dismissed the issue of glistenings. It seems that it is mainly an issue with quality control that has been addressed by Alcon. Again, it may be more of a concern for a younger person that has to live with their lens for a much longer time. . If you are getting a toric lens for astigmatism the Tecnis may not be the best choice. They have more of a tendency to rotate in the eye after surgery than the Acrysof. A toric lens has to be aligned with an error of less than 3 deg. to be most effective. Probably less of an issue with non toric lenses.
Thank you, RonAKA.
I agree on the glistening part. It seems after Alcon improved its QC (back in 2012?), the issue of glistening has been well under control (well at least based on Alcon's own claim).
As for toric lens, my LE is borderline requiring astigmatism correction (around 1.0). However what puzzled me is that from three cataract surgeon places I went to, the astigmatism measurement are just all over the place while rest of numbers like eyeball length/pupil size are more or less inline with each other.
e,g. my left eye astigmatism measurement is around 1D at 90 degree but another place gets 0.5D at around 70 degree. Then one ophthalmologist gave me more than 1D where he definitely recommend Toric lens but other two think it is not necessary. especially for my case it is on vertical direction.
My logic is if the astigmatism measurement is so inconsistent, how does toric lens work eventually?