Tive uma lente multifocal há 3 meses. Minha visão de longe não está tão boa. Foi-me fornecido um óculos que melhora bastante. Foi-me dito que com uma cirurgia de reforço com laser, essa é a visão que esperam alcançar para mim. Ao ir a uma consulta hoje, fui informado de que tenho acúmulo de proteínas e células em ambos os olhos. Isso PRECISA ser removido com uma cirurgia com laser YAG antes que qualquer reforço com laser possa ser feito. Bem, depois de ler sobre o YAG, percebi que, uma vez que a cirurgia YAG é realizada, não é possível facilmente substituir a lente novamente, caso seja necessário. Perguntei ao meu consultor óptico por que alguém desejaria fazer isso. Pensei que as lentes eram para a vida toda. Ela disse que, ocasionalmente, algumas pessoas podem não se adaptar à lente multifocal, por exemplo, a visão noturna pode ser prejudicada por halos, estrelas e cintilações. Bem, isso é exatamente o que eu tenho, muito severamente. Isso está afetando minha vida, pois evito dirigir no escuro a todo custo.
Fui aconselhado a considerar fazer novamente a substituição da lente e colocar uma lente monofocal, pois o risco de halos, cintilações, etc. é muito menor.
Estou aterrorizado só de pensar em submeter meus olhos preciosos a isso novamente e a todas as incertezas. Meu trabalho envolve dirigir à noite. Então isso está em risco. Tenho 45 anos. A ideia de o resto da minha vida ser tão limitado pela dificuldade de dirigir à noite é terrível. Isso derrubou minha confiança. Alguém já fez substituição de lente e depois fez novamente? Vale a pena fazer ou é muito arriscado? Minha recuperação da visão levou 3 meses dessa vez. Tenho uma consulta marcada com o cirurgião para discutir minhas opções. Qualquer conselho é bem-vindo. Estou com medo novamente.
Se você está tendo problemas com a lente e acha difícil dirigir à noite, pode considerar uma substituição da lente. Como você mencionou, isso traz riscos (como qualquer cirurgia), mas também tem o potencial de resolver os problemas que está enfrentando.
Uma lente monofocal é a solução tradicional e comprovada para a cirurgia de catarata. Ela tem a menor incidência de problemas desagradáveis, como baixa sensibilidade ao contraste (dificuldade para dirigir à noite), halos, brilho e outros. No entanto, você terá boa visão apenas em uma distância e precisará de óculos (ou lentes de contato) para as demais. Você também pode considerar uma lente como a Symfony, que é uma lente com profundidade de campo estendida, proporcionando visão intermediária muito melhor e, geralmente, visão próxima razoável, com os mesmos riscos de baixa sensibilidade ao contraste, halos e brilho que uma lente monofocal.
Wendy , check with your doctor to see if you are a candidate for monovision where one eye is set for distance and the other is set for reading and mud ground . No glare or halos . You might need a pair of driving glasses which sets your reading for distance like your distance eye . Your vision will then be very crisp and nice for either nighttime or daytime driving . No glares . No halos . Btw the lenses used to create monovision are monofocal lenses, just set at different strengths . Multifocal lenses are bad because they break the light spectrum into thirds for the three different focal lengths they offer . This is why they need a lot of light to work .
I am 60 and had monovision installed about 6 months and although it's not perfect I never wear glasses for anything unless I'm driving at night
Good luck to you and go monofocal , you'll be much happier and even happier if you try the monovision.
So sorry to read about your cartaract surgery results.
Many of us go in with the expectations that our surgeons tell us. Not always the results however. I understand how you would be a bit relunctant to try surger again.
I had a similar issue and have astigmatism lens a then laser. Nothing really improved my vision before cataract surgery.
After another opinion on my vision becoming worse it's been recommended to just leave the eye to rest in my case and try another lense later.
hope you decide to do what's best for you. It's always a challenge.
Wendy, I have an 80 year old friend who sustained an eye injury which required cataract lens replacement quite a lo g time after his initial cataract surgery. So it is possible and he's doing great.
The first question would be whether it improved your distance vision *enough*. If not, then a laser enhancement wouldn't improve your vision any more than glasses did. It wouldn't impact glare/halo/starburst issues (unless I guess there is reflection from glasses that didn't help). That would suggest considering a lens exchange to a monofocal or the Symfony which has fairly low risk of night vision issues. I do find it odd that someone whose job involves night driving wasn't given enough warning about potential night vision issues with multifocals (though most poeple don't have problems, enough do that its important to think the risks through).
Unfortunately a complicating factor is that often halo&glare issues can go away over time as people adapt to the lens, and such issues are much more common soon after surgery, even among those with monofocals. They usually only talk about statistics about halos and other artifacts only at the 3 month or 6 month postop point after most initial adaptation has occured.. but some people can take serveral months or even a year or more for the artifacts to go away, and of course some never see them go away. I'm not sure if the PCO might be contributing to the night vision issues, if so a YAG might help them, but there is no guarantee.
Although a lens exchange isn't as easy after a YAG, it can still be done and good results should still be expected. The issue is that after a YAG, when the lens is removed it is likely that the capsular bag the lens was in will tear and the replacement lens can't be placed in the bag. Although they prefer to places IOLs in the bag, if the bag is damaged they place the IOL outside the bag and suture it to other parts fo the eye. Most lenses now that go in the bag are 1 piece lenses, but outside the bag they need to use a less common 3 piece lens. That is the biggest difference since most premium lenses can't be used outside the bag, so after a YAG you wouldn't be able to use the Symfony for instance, and I don't think the Crystalens can be placed outside the bag either, so you'd presumably be using a monofocal lens.
re: "My recovery in vision took 3 months this time"
That sounds atypical. I don't know if that means it would take that long next time, or if you just had one time bad luck. Usually people's distance vision is good within a couple of days of surgery, with only issues like night vision artifacts taking longer to recover or with premium lenses their near vision may take some time to improve.
Desculpe ouvir isso, eu seria muito cuidadoso… o meu olho esquerdo está uma bagunça, fiz o procedimento em 27 de julho de 2016. Tenho tudo acontecendo no olho, desde flutuadores, piscadelas, coisas como pontos nas bordas dos olhos, coceira, além de um caso grave de ND. Me disseram que tudo isso iria desaparecer, mas não desapareceu. Além disso, perda de visão… antes tinha 20/25 nesse olho, agora tenho 20/40. O médico me disse para voltar e ele iria consertar! Hum, depois de ouvir todas as histórias de terror… não estou pronto para correr o risco de ficar cego.
Wendy, I'm sorry for all of your problems, I can relate to them. I too have had extreme halos on headlights, street lights, porch lights, any lights. I even have it in the day. When I go into large stores with a lot of fluorescent lighting I wear sun glasses. In the night they are a 15 on a scale of 1 to 10, really bad. I've discussed this with my surgeon and he is saying it is from the lens and an option is to have it removed and replaced. I also have Negative Dysphotopsia (a black arch shaped or moon shaped rim around the outer side of my eye in my peripheral vision).
My surgeon said that he wants me to wait at least six months to see if anything changes. I still have about three months to go to get there. I will say that I have had changes in my site and with flickers and floaters etc. since my surgery. As time passed things got better (it's been two months). I've thought a lot about this and at this time I don't think I will have it removed and changed because I've read up a lot about it and people have done that and things end up worse. I guess each of us have to decide what we think is best for ourselves.
As far as my vision, I paid extra for the better lens so that I could see far/intermediate and close. My vision is okay in all of those areas except for small print, I have to use a magnifying glass. At this point, I feel that I'm probably not going to get another surgery because then my sight may be worse and I won't be able to see as well. I'm figuring I'll just get used to things and keep the lens I have. I haven't driven in the night for over a year (before I got my Cataract surgery) so I'm figuring that I just won't ever drive in the night again. However, I am retired and 64 years old so I can do that unlike you since you said you drive in the evening for your work.
I just thought I'd share my story with you so you know that you're not alone. This forum is very helpful, I've read many stories and cases. I had extreme problems after my surgery and finding this forum really helped me understand that I wasn't alone and crazy. I thought Cataract surgery was a piece of cake and then I'd be able to see so well. That was not the case, it was a real nightmare. I had 12 appointments in less than two months. I hope things get better for you. All the people in this forum are in my prayers....we sure need it.
Olá. Obrigado pelo seu bom conselho. Um cirurgião oftalmologista fez um procedimento no meu olho esquerdo há 10 meses, implantando uma lente multifocal Abbot Toris Tecnis.
Após duas semanas, ele disse que havia implantado uma lente com potência errada, então a substituiu por uma nova lente multifocal Abbot Toris Tecnis com pontos de sutura. Mas agora, após vários meses, tenho sombras, visão turva, embaçada, anéis circulares e efeitos de estrelas, mesmo usando óculos para visão próxima e distante. Solicitei ao cirurgião oftalmologista que implantasse uma lente monofocal semelhante à do meu olho direito (que está bem), mas ele se recusou a fazer uma terceira substituição, dizendo que haveria complicações. Por favor, aconselhe-me sobre o que devo fazer e se alguém já passou por uma situação semelhante.
Uau, sinto muito em ouvir isso. Os sintomas estão melhorando um pouco? Embora a maioria das pessoas se recupere completamente e se neuroadaptar em alguns meses, pode levar mais tempo, especialmente após uma segunda cirurgia mais difícil.
Parece que valeria a pena consultar diferentes oftalmologistas (talvez mais experientes).
Bottom line if you have catarcats , Get the basic MONOFOCAL len's , perhaps try monovision with monofocals , but stay away from multifocal lens no matter what your doctor might say . Monofocal is covered with your insurance, The multifocal option is not because it presumably offers perfect vision at all distances. It simply does not ! In theory , it sounds great , but results are not so good . Doctors want you to choose this option because they make more money . You, the patient want to trust your doctor but beware . Stay MONOFOCAL and use glasses for up close work . You will be SOOOO happy if you do !!! it will be like your vision when you were 40 but needed reading glasses to see well up close. The evil Multifocal option is all about doctors and lens makers getting rich , but they dont work well for most because they are awful in low light and create halos and glare. DO NOT BUY THE HYPE . Stay strong . Stay MONOFOCAL, stay happy !!
The vast majority of people who get premium lenses are happy with them. Its mostly the minority of unhappy patients who post online so people get a skewed opinion of the results. It is true though that no lens provides perfect vision at all distances at the moment, though premium lenses can do a much better job of that than a monofocal. A minority do have problematic issues like halos so people do have to consider the risks before going that route. I went for the Symfony (extended depth of focus) rather than a multifocal due to the lower risk of things like halos, but I would have risked a multifocal if that hadn't become available since I'd had good luck with multifocal contacts and preferred those to monovision with contacts. I figured that it was worth the very tiny risk of needing a lens exchange if I had problematic halos in order to get the benefit of a wider range of vision for the rest of my life.
In terms of "vision when you were 40 but needed reading glasses to see well up close", I'd say that might be true of monofocals using monovision to get added near. Otherwise monofocals set for distance are more like someone's vision at 60 when they've lost all accommodation. A typical description I see is that on average people can expect things from 6 feet inward to be getting blurry with a monfocal set at distance. Full monovision has tradeoffs, like reduced stereopsis (3D perception) since you are using 1 eye for much of the visual range rather than 2. A small amount of monovision, micro-monovision, like might be used with the Symfony or Crystalens doesn't have much impact on stereopsis.
When I went to see my opthamologist about cataract suregery , I had done my research and was set for the multifocal lense. It was my doctor himself here in Los Angeles that talked me into monovision for a multitude of reasons. First and foremost, many of his patients are not happy with the final result of the multifocal lense. It's not just the unhappies on this forum. He doesn't believe MF manufacturers are here to stay or there would be a lot more compainies investing in the technology. That is not happening. He is a renowned and highly sought after opthamalogist . And remember , he could have made more money by putting me in what I wanted and that was the multifocal lense. I'm glad I listened to him.
Se você conversar com vários cirurgiões refrativos, receberá várias opiniões. Para mim, isso significa que não há evidência esmagadora para nenhuma visão específica, ou então praticamente todos os oftalmologistas a compartilhariam. (Por analogia, considere o debate entre sutura e grampos entre outros tipos de cirurgiões: muitos têm uma opinião forte, mas não há evidência esmagadora para nenhuma abordagem.) É verdade que os LIOs monofocais são o trabalho principal, com menor risco de efeitos colaterais, muitos anos de experiência, além de serem cobertos pelo seguro e pelo Medicare. No entanto, eles exigem o uso de óculos ou lentes de contato. Os multifocais têm um risco maior, e nem todos ficam satisfeitos com a visão resultante, mas muitos descrevem sua visão como excelente e ficam encantados por não precisarem mais de óculos ou lentes de contato. O Symfony parece (com base nos resultados clínicos) oferecer o melhor dos dois mundos, especialmente quando usado em uma abordagem de micro-monovisão (talvez 0,5 D de miopia em um olho).
All the studies I've ever found indicate most people are happy with premium lenses. Data collected in studies is a more reliable thing to look at than the anecdotal impression gotten by a doctor, even a good doctor. Unfortunately some doctors don't like dealing with any complaints, and therefore any issues may seem like "many" to them, they prefer the conservative "safe" approach. Its actually a good marketing strategy since if they are the "safe" doctor then they get patients referred there, and don't have problem patients scaring people off. That doesn't mean that their conservative approach is the best one for everyone.
Those with monofocal lenses may not express unhappiness the way a minority of those with premium lenses do, however they may not be as happy with their vision as they might have been with premium lenses. Most people are happy with whatever option they receive. Many folks are willing to have some risk of problems in exchange for a better result for the rest of their lives, but some doctors don't like seeing any problems and talk patients out of it. A problem patient scares off other prospective patients.
re: "doesn't believe MF manufacturers are here to stay or there would be a lot more companies investing in the technology"
That isn't a credible argument, I see a decent amount of activity in the sector and its not clear what sort of evidence and reasoning he could provide as to why it "should" or would be more. Doctors don't necessarly know much about business or the world of tech investing (I've been an entrepreneur, and networking with other entrepreneurs, in the software&net tech and startup world for decades, though not the medical device world).
There are many premium lenses available outside the US that aren't approved in the US, and the companies don't even bother trying to get them approved due to the high costs involved. Even the US company behind the Symfony didn't try for approval here until after it was approved elsewhere, and its likely if they didn't already have a big distribution network in the US they wouldn't have bothered. I haven't heard anything yet about US company Alcon trying for approval for the Panoptix trifocal it now has approved in Europe. The US in general tends to do a disproportionately large share of medical R&D, in addition to having one of the larger potential markets for premium lenses, so the problems with the US market likely reduces the R&D budget quite a bit. The FDA's problems likely have far more to do with the level of investment in new IOLs than anything to do with the technology itself.
There isn't infinite funding available for all the potential R&D projects that might lead to something useful in every potential niche in the world. Companies compete for R&D funding, including competing with other industries looking for investment. They need to factor in things like risk and the total budget required to get something to market. There is a huge cost to get a new medical device developed and approved, and risk that while all that is being spent a competitor might beat them to the punch, or some unforseen problem might arise.
Premium lenses currently have a fairly low market share, mostly due to not being covered by insurers or government payment programs, and partly since some doctors are cautious and there isn't yet a lens without some risks. Some think the lower risk profile of the Symfony might lead it to boost the market share of premium lenses, but its hard to say. Regardless the current limited market size limits the amount of R&D funding, even though people realize that in theory a "perfect" (or at least "near-perfect" IOL might have a huge payday by expanding the share of premium IOLs greatly. That near- perfect IOL doesn't exist, and any investment in a candidate path to get there has technical risk that it might not achieve its goals (or might not be approved) or risk it might have a limited time on the market before a better competitor arises, etc. Its not a sure thing that investors will necessarily pour money into, depending on whatever competing investment options there are.
Appreciate all the interest in my initial comment and my opinion. A bit surprised actually. In the end, wouldn't it be nice if we could try all these options before we buy. Bottom line is we can't. Glasses and contacts can mimick but are different from an implant. I believe each individual brain and it's communication with the eyes is beautifully unique. What works wonderfully for one person , might be a disaster for another . As it stands today, the outcome this surgical procedure, even with all of our science simply cannot be predicted, This is why I lean towards monovision. If your brain can and does adjust to this new visual system, you're golden. If a patient 's brain can't adjust to it after several months and doesn't like it, then with a little lasik, the reading eye can be set to the same as the distance eye and now the patient has traditional crisp monofocal vision but will now require glasses for up close activities. The nice thing here is no invasive surgery or removal of a lens further tramatizing the patient if the mono doesnt work.