IOL EXPLANT AFTER 2 YEARS POSSIBLE?

Eye care
1

Age 26

In both eyes have been implanted a Acrysof IQ Vivity IOL Femtolaser assisted

Surgery is about 2 years ago

Perfect daylight vision, need reading glasses to see food sharp or read comfortably

Unhappy night vision + Contrast Sensitivity

Glare, Starburst, Halos, blurry vision in dim light,

Lightstreaks from street lights going from top to bottom

Tried Pilocarpine drops - No Effect

PCO forming on both eyes - Right eye(Dominant eye) very developed strong Glare+Starburst) Left eye about 30%.

No YAG Laser used yet - since I’m thinking about explant and don’t want additional risk

I had another post about me being unhappy with the night vision and I think I will not be able to enjoy night driving ever again, if I don’t get an explant with a monofocal lense. Since the night vision gives me terrible depression I think it’s the best option to get an explant in my dominant right eye.

Is an explant possible after such a long time?

How would my vision quality be with 1 monofocal set for distance and the other an EDOF VIVITY?

Would I encounter peripheral vision problems?

Can 1 monofocal make up for the lost contrast sensitivity and glare from the EDOF?

Would I start to squint since one eye has a better quality?

Could I read the speedometer with a monofocal?

How much would an explant cost and where could I ask around? I’m in Germany and couldn’t find anything online.

2

Yes it’s possible but not all surgeons will do it. They have to have experience with it and have to be convinced that there is no other way to make the patient happy. It carries more risk and can be more difficult since the capsular bag may have formed scar tissue around your implant (fibrosis)
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No one can say how your vision would be afterwards but supposedly if Vivity is the source of your issues then removing one in exchange for a simpler lens with fewer image quality issues (like a monofocal) would presumably improve matters including your issues of glare, contrast, etc. But there are no guarantees.
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Peripheral vision issues and squinting? Umm. No. I don’t think so.
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For great quality overall vision while still seeing the dashboard the Eyhance would probably be the best choice HOWEVER with such a long time since your first surgery your choice of new implants might be limited. A simple 1 piece IOL may no longer be an option. That’s because if the capsular bag has too much fibrosis or tears during the surgery they have have to place the new lens in the sulcus instead. That requires a 3 piece IOL like the Sofport. If you keep one Vivity though that may give you the dashboard vision you need.
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I DID see a YouTube awhile ago from a German doctor that did an IOL exchange years later but I can’t find it now. Also there is a thread on here where someone was looking to do an exchange 12 years later. It mentions a surgeon from Nee Jersey that apparently specializes is doing IOL exchanges years after the initial surgery.
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And people also have IOL dislocations sometimes decades later and yes there are ways to get a new lens in place in those cases (probably involving placement in the sulcus and/or Vitrectomy). So yes there are solutions. It’s just that doctors have to “first do no harm” so they have to be sure there’s really no other option for you first (assuming they even have the skill and experience to do it).

3

I have no personal experience other than I have one IOL (AcrySof IQ Aspheric monofocal) set for distance and have considered the Vivity for the second eye. If the explant can be done successfully, and I have no idea of the odds of that, my opinion is that overall vision may improve with a monofocal in place of the Vivity, in the dominant eye. The Vivity should act as a form of hybrid monovision. On the basis that the brain selects the best image of the two choices I would expect contrast sensitivity to improve as well, especially at intermediate and further distances. Closer up the Vivity has higher contrast sensitivity than the monofocal. The question as to whether your brain could ignore the glare is harder to guess about. I would not expect any peripheral vision problems. With my monofocal eye, I can see my dash instruments on my truck, car, and motorcycle perfectly, day or night.

4

How would my vision quality be with 1 monofocal set for distance and the other an EDOF VIVITY?

  • very good

Would I encounter peripheral vision problems?

  • yes. they are because you are 26. large pupil. sorry u have to go through this at 26. i am 45.

Can 1 monofocal make up for the lost contrast sensitivity and glare from the EDOF?

  • yep.

How much would an explant cost and where could I ask around? I’m in Germany and couldn’t find anything

  • if you are in Germany get the Human Optics Aspira XL. it is 7mm iol and can help with the edge glare.

good luck.

5

If you have perfect daytime vision I personally would not do an exchange. It is riskier than cataract surgery and may not help your vision or worse you lose perfect day vision. I am cautious though by nature.

I also have also developed another condition after cataract surgery called epiretinal membrane. Surgery to correct is risky. Thankfully right eye compensates so I was told to hold off from having the procedure until my vision all round with both eyes open compromised vision. That was told to me by my optometrist and a retina specialist. It is good advice that I am following.