UPDATE THREAD No. 3, July 25th (Wife's PSC)

Eye care
1

Today we met the very competent and empathetic eye doctor who had diagnosed my wife’s PSC. Let us call her Dr Angel. We just needed to talk to someone and wanted a neutral opinion of our meetings with the 2 surgeons so far. Dr Angel has some past operating experience too but she moved away from it as it is not her thing and instead opened her own non operating eye clinic.

Here is the conclusion of our meeting with Dr Angel…

Surgeon 1- Name- Miss Career (One of Mr Rockstar surgeon’s assistant surgeon)

Miss Career was supposed to take the measurements only and pass us on to Rockstar surgeon for further discussions. This meeting with the Rockstar surgeon part never happened as she actually took full control over all decision making and did not even ask what my wife does for living. She obfuscated the part about who would be actually operating. From her only assisting, it turned out that she would actually be operating (when we contacted reception to find out next day).

Dr Angel said no way should Miss Career operate, she might be good but still not as good or experienced as Mr Rockstar. For a young patient like my wife the risks are very high and an experienced surgeon is required. She said Miss Career can gain her experience with old patients.

Miss Angel was also not happy about Miss Career dismissing Multifocals so readily as Mr Rockstar does lots of Multifocal IOL operations too.

I think Miss Career is probably used to dealing with clueless old patients who go with whatever the doc says.

Surgeon 2- Mr Headstand

Apparently he is a very good surgeon but he seems too old school for me. He also dismissed Multifocals and on being pressed by me actually showed me some older bifocals which according to him are the latest and the best when it comes to Multifocal IOLs. Deal breaker for us was him saying that my wife can do headstand 1 day after surgery as the operation cut is tiny. Tiny or not why risk it???

Dr angel was not happy about him suggesting both eyes set to far. She said for a young person like my wife who had perfect, no glasses vision until few weeks ago, it would be very hard…not being able to put make up, cut nails etc.

So plan of action-

  • Make appointment with Surgeon 3 i.e. Mr Rockstar himself and discuss everything with him including Mulifocal IOLs even if we decide against them.

  • Miss Angel also refereed us to a place with the latest and the greatest eye measuring equipment to get all the measurements done perfectly to be super sure. She also said that they will help with identifying dominant eye as it is an important consideration for choosing which eye to set for far if going with monovision/mini monovision option. Miss Career was in such rush that she did not even care about dominant eye part until we brought it up.

Ok just needed to put today’s meeting in words to clear my mind!

2

I think you have come to the conclusion, that most of us agree to :slight_smile:

I went to 4 different private clinics before I found one that felt right, and when I did I had no doubt, you feel it immediately.

And the negative side effect issue with the premium lenses - most of the people who has the side effects, would chose the same lens again anyway, I would too, so I think in many cases it sounds worse than it is.
Some people see the glass as half empty, some see the glass as half full, we all chose how we see the world.
So you should definitely see a surgeon that are for premium lenses, as you say, to have a more full picture of the options, before you make a decision.

3

I like your plan and also agree with Christian that you should hear from a doctor the pros of multifocal iols. Hope my comments here won’t make your discussion go off topic, but my experience thus far has shown that monofocal iols can have the same problems. I’m now 2+ months after my 1st IOL and 1 month after 2nd IOL. Initially I had no positive dysphotopsia in the first eye. Things were looking good. Had the 2nd eye done and vision was 20/20 with no astigmatism 3 days post op (and still is). Then a few days later I drove at night. Clearly had positive dysphotopsia in 2nd eye. And recently (can’t say when) I discovered I now have positive dysphotopsia in my first eye. And both eyes have gotten worse. I have an appointment in 2 weeks with ophthalmologist (soonest I could get in since he is out of office). I have glare, halos, starbursts, and monocular diplopia from lights - traffic lights, car lights, street lights etc. I am hoping it’s something as simple as dry eyes, but my vision otherwise is excellent. Regardless of my cause, I have done a lot of research recently and positive dysphotopsia seems to occur quite a bit with monofocal IOLs also. It may well go away, but not in all cases. Acrylic IOLs with square edges and high refractive indexes are the worst (of course that’s what I have - Alcon Acrysof IQ SN60WF). Having said all this, I would still choose a monofocal IOL for myself. However, I’d definitely choose a different one.

4

So happy you have found a sense of relaxation about your process. And even a sense of humor - Mr. Headstand.:slight_smile: As Danish Viking said - we choose how we see our world. May your wife’s be perfectly beautiful!

5

Worried husband - I like Dr Angel’s consult and agree with fellow posters Christian, Deb03 and seeherenow.

Was concerned you’d dismissed EDOF and trifocals too quickly. Even if your wife still decides to go with monofocals I always thought you should make an appointment with someone who is comfortable, confident and competent with the latest IOLs (but not pushy about them) respecting patient preferences. Dominant eye is important - for a doc not to mention or dismiss it in conversation is something that would cause me to rethink selecting them as my surgeon.

Most of us here won’t push you one way or the other as we know too well how difficult a decision this is and no lens is perfect - each has its pros and cons and trade-offs.

I relate to Christian’s statement that a lot of us with premium lenses would still choose a premium lens if we had to do it over - the halos you can get use to and personally prefer that to wearing bifocal glasses (and if it works well no glasses at all). Key to satisfaction with premium lenses is power calculation being accurate, no significant astigmatism which takes a competent surgeon. The lenses work well. Especially important when you are you g with years ahead of you. It was my chance to see without depending in glasses daily (I wore glasses since childhood).

This is still all new for your wife. I had 7 or 8 months to wait for surgery. Don’t rush the decision and see as many surgeons till you find right one for her.

6

LOL I was told not to bend over first few days after surgery. The headstand I am sure would be a no go either!

7

Hi Deb - the square edge IOLs have a much lower incidence of PCO vs round edge so there is a compromise to make. Seems there is always a trade-off. My surgeon did tell me PD can also occur with monofocals but lower % experience that with monofocals. But to the 5% of people where that happens it’s 100% to them.

Hoping for your sake it dry eye. It took at least 6 months for some of my halos and glare to diminish so if it isn’t dry eye hopefully yours will subside too in coming months

8

**Best Trifocal lens currently- Alcon-Panoptix

**Best EDOF currently- Zeiss At Lara

Correct???

One thing I asked before but I am not still clear on!

As you get older and if more presbyopia, astigmatism etc develops. Then-
a) Won’t you need glasses anyway thus kind of lowering the reason for gettign multifocals in the first place?
b) Won’t it be complicated to measure for glasses required due to it having so many different zones.
c) Imagine later you need bifocal/progressive glasses, how will that work with these modern IOLs?

9

I guess you are right about what is the best right now, but again, best is relative.
Panoptix have distance, +2,25 and +3,2
Lisa tri have distance, +1,66 and +3,33
Depending on where you would like the focus points, i guess either can best, but I do think Panoptix is preferred by most, also because they allocate a little more light to the midrange than Lisa does, that allocate a little more light to distance instead.
And yes, At Lara is supposed to have a little wider range than Symfony.

In regards of what happens with aging, i think there is a difference on the edof and the trifocals.

The trifocals needs to be right on the money to work well, but that is exactly the same with a monofocal, I do not think that eye doctors see the trifocal as more difficult to deal with than monofocals, at least not the eye doctors that are using these lenses on a daily basis.
And you can correct with glasses the same way with trifocals as you can with monofocals, no change there.
Whether it will be nessacary to correct as you get older, i guess nobody knows, but if your eyes changes, there are other ways to correct astigmatism than glasses, depending on the situation.

You will never develop presbyopia when you have an iol, you could say that with the surgery you have 100% presbyopia, and that is why some of us go for the premium lens, with the monofocals you stay with 100% presbyopia.
But good thing is it does not change.

Edof lenses have a wide continuous range of vision, they are much different than trifocals, and they are much more forgiven than both monofocals and trifocals.
For the same reason a lot fewer are having corrections made after surgery with the edof, because even if the lens do not hit the target precisely, there is a good change you are still well within the range the lens offers and you have good vision anyway.
The edof are also more forgiving in regards of tilting and other stuff that can happen during surgery, so with the edof lens it is easier for the surgeon to make a good uncorrected result. For the same reason some surgeons are offering the edof at a lower price than trifocals, because they do not need to offer corrections as often.
And I guess the edof is also more forgiving to changes in the eye as time goes by, depending on what happens.
You can correct the exact same way with glasses or laser if you have edof lens as if you have monofocals, edof only have one focus point like the monofocals, but the focus point is stretched by clever lens engineering to add wider range of vision.
Because of the wide range from the edof, you can put on almost any + glasses for reading small stuff and they work, because you just need to hit somewhere within the wide range they have.
If I have to read small text I can put on +1,5 or +3, they both work fine with my Lara.
With +1,5 I even still have relative good distance vision, I found out the only place I really need glasses is when I am in my garage, where I work on motorcycles, and with the +1,5 I can keep the glasses on and see small stuff, but also have plenty of distance vision, so I do not need to take the glasses off for seeing longer distance, when I work in the garage, which I like.
At home and at the office I do not use glasses wiht the Lara.

10

What a NIGHTMARE!

So spoke with Dr Career on phone as she seems to be kind of gatekeeper and probably told off the receptionist.

  • They don’t do Multifocal IOLs. Dr Rockstar did some but the people were not happy with the results so they stopped doing them.

  • Similar view she gave about EDOF, they don’t do them. Plus she said that EDOF you need to do both eyes as soon as possible or the brain does not adapt good. Sounds like bull? She did recommend another clinic for EDOF

  • She said the operation slot in a month is her slot, if we want with Dr Rockstar then we will have to wait longer. Funnily I remember when we met her and were making operation appointment, the receptionist saying that there is free slot with Dr Rockstar alone, one week earlier.

  • She said she is part of Dr Rockstar’s team, he will be next to her so what is the big deal? Plus he will agree with all her findings and recommendations anyway.

  • She said young eye or old eye, the operation is exactly same so what is the big deal.

  • She said Dr Rockstar has longer waiting time, it won’t be fair on others if she lets him use her slot. If she has a patient before, then she will give them my wife’s slot!

  • We told her that our eye doctor sent us there for Dr Rockstar and not anyone else. We made the appointment because we were told she would take the measurements but the consultation and operation would be done by Dr Rockstar, she said we were given wrong information! Jeez that is hardly our fault!!! It’s their internal problem nothing to do with us!!!

  • She said count yourself lucky if my slot stays free and Dr Rockstar gets to operate so soon on you (calling a 42 year old newly diagnosed patient LUCKY!!!) lol

  • My wife asked her, would she be able to do her makeup etc with the mini monovision after losing all accommodation. Dr Career said she would not know as she has accommodation herself but her older clients don’t complain about it! Jeez!

  • On asking about setting left eye (the bad eye) for distance and if it really is the dominant eye. She said no one can be sure anymore as right eye could have taken over due to left being bad. She said she herself is left dominant and most people are too so my wife must be too!!! WTF! She said the fact that right took over shows that my wife’s brain is flexible. Umm what if my wife’s right eye was always dominant???

This is so depressing!!! As if the stress of cataract was not enough!

11

Oh my. I really have a problem with Dr. Career. I am angry just reading your message! Did you/can you make an appointment for a consult with Dr. Rockstar? I don’t think it’s a problem to wait. I’m no expert but question whether +.5 diopters would give most people enough close up vision to do things like makeup, and trimming fingernails. Also, is there a 3rd place you can go for a consult?

12

Regarding your question about glasses, your vision may or may not change as you age. But it is my understanding that the monofocal IOLs are the only IOLs that you can correct the vision with progressive glasses. Of course, many people don’t need glasses with premium IOLs and therefore don’t have the need for progressive lenses. :slight_smile:

13

Sorry for your troubles in finding the right doctor/clinic. But keep looking until you are comfortable!

For premium lens, for EDOF, AT LARA is clearly the latest and greatest.
For tri-focals, I think the main thing is tri-focals are better than bi-focals, and while the Alcon PanOptix being the latest, is somewhat better than the AT LISA but I don’t think the difference would be that major.

  • I also get the sense that doctors get used to certain brands. So if a doctor is used to using Carl Zeiss lens, they aren’t going to go out of their way to order an Alcon PanOptix, if the Zeiss AT LISA is roughly comparable.I expect that clincs are used to ordering from certain manufacturers, and in Europe Zeiss is the biggest player; a clinic may not have a relationship with Alcon.

Surprised first two clinics are so anti-premium lens.maybe they had poor experience before, but still the latest premium lens have been available in Europe for many years and feedback from many surgeons in Europe has been very positive. I mentioned in my case in Toronto, my doctor used to “discourage” (but probably not forcefully discourage) multi-focals; but she has been very happy with results from tri-focals in her practice the last 2 years.If your wife is hearing very negative views about premium lens options from the doctors she is seeing, then it is completely understand she would be very fearful of the premium options.

I agree with what you have said before, that it’s probably easier for those of us who are older (not that much older!) in that anything is an improvement over what we have currently. In any case, I think the key is to understand what the negatives may be, and to go in with realistic expectations. Then you are more likely to be happy with the results.

14

I always find when faced with sarcasm and pushy people it’s always best to take step back and take time to reassess.

Although your wife is wanting this behind her I honestly in her shoes walk away from this clinic altogether. Yes it may mean a delay but the decision is far too important and has a great impact on quality of life after surgery.

Just reading your account of what was said you can google any number of reputable sites and see the error and inaccuracy of what was said.

Please do yourselves a big favour and seek out another place for consultation.

Ask yourself this. If this is how they deal with patients prior to surgery what will the after care be like?

15

Wow! Lots of misinformation there.
With EDOF (Symfony) in my non-dominant eye, I can do makeup but don’t have the intense “microscopic” closeup vision I had with extreme myopia, so need a magnifying make-up mirror for things like tweezing eyebrows. (Some people with normal vision use those anyway, so it’s not really a big deal.:slight_smile:

Re dominance - most people are RIGHT eye dominant, corresponding with right-handedness. In my case, I’m ambidextrous with Left eye dominant, unusual. My brain is very flexible as a result and had no trouble adapting to micro-monovision with mixed lens types, mono and EDOF. But I made a point of setting the dominant Left eye for distance and the right eye for slightly less distance.

My right eye did take over somewhat when the cataract was getting bad, but the Left eye dominance was still obvious to my optometrist when he tested pre-surgery.

Astigmatism is generally considered to be caused by the shape of the eye or the cornea. It is not something that develops with age. The cataract can cause a temporary distortion of vision that has a similar effect as astigmatism. And the cornea can be very slightly changed by surgery, causing a mild increase or decrease in astigmatism that was present pre-surgery.

I agree with SueAn - a consult with a different surgeon experienced and comfortable with EDOF and multifocal IOL’s (remember, they are not the same!) would be very beneficial. Why limit yourself based on Rockstar’s reputation? Why not explore all options to retain/regain as much flexibility in vision as possible?

And as many of us have stated elsewhere, the more comfortable you are going into surgery, the more likely your eyes will heal superbly and give you the best result. Based on your description of interaction with Ms. Career, and the lack of accommodation in her schedule & attitude, she wouldn’t seem to be a good choice for your wife.
Wishing you the best.

16

Just piggy backing on what Janus has said it is very true doctors have a comfort level with a few lenses and will not usually go out of their way to get another. They also get kick backs and incentives for working with a particular manufacturer.

If they were at least being honest they’d just say upfront they work and offer just these certain lenses. To trash and outright day premium lenses make patients unhappy is simply not true.

My own doctor didn’t lean one way or the other on monofocal vs premium lens. Told me the compromises and trade-offs of them both. And I outright asked him what he’d do in my shoes or which he thought would be better for me. After both my surgeries after my near vision test he did say he was my age and if it were him he’d have gone with EDOF lens I chose. Whether he was reassuring me I don’t know. Perhaps if my vision was rubbish he’d not said anything but point is a doctor should provide the info to help you decide what’s best.

17

** Did you/can you make an appointment for a consult with Dr. Rockstar? **

Deb, that is what we were trying to but looks like the secretary was told that we have to speak with Dr Career first. Wife said to the receptionist that she is not interested in speaking with Dr Career and that she wants to be operated by Dr Rockstar PERIOD and that is the only reason we came to your clinic. Also have a consultation with him!

She said that she understand but we have to speak with Dr Career first (I think she was forced to say that). So above was the result of that conversation!!!

Now is weekend so on Monday we call and tell receptionist we want appointment with Dr Rockstar alone and want him to operate. Either give or bye!

18

I am flabbergasted at the attitude of this clinic and cannot get over outright misinformation given like you sereherenow.

Honestly Worried it really isn’t a big deal to delay surgery and make appointments with other surgeons/clinics.

19

Honestly, I think both clinics you have visited have made your choice very easy.
I would never in a million years use any of them, and I really mean that, so for me it would be a very easy choice, I would not use as much as one minute more on any of them.

There are very skilled eye surgeons all over the world.
My surgeon here in Denmark is actually a guy from Sweden, half of the time he also works in China. He is very skilled with more than 20.000 surgeries, very pleasant and helpful, and that shows even in China you can find a surgeon like him.
There will be at least one in your country as well.

Cataracts is not life threatening, I have lived with it for 45 years, take your time, find the right clinic, where you feel safe.

Please do not take it the wrong way, I feel your frustration, and I understand how this affects your wife.

Take your wife out to dinner, do not talk about cataracts and do something that makes you happy, try to forget it for a short while, it will make you see things clearer.
I wish the best for both of you :slight_smile:

20

Sue,

I am not sure if I should blame the clinic or her? The receptionist was actually very nice but probably got told off by Dr Career. Dr Career’s was not angry or aynthign on the phone but was acting as if she was doing us a favour! Her ego was probably bruised!

Dr Angel has given us details of another place but they are fully booked until October! :frowning: