Visitado al Cirujano N.º 3, el N.º 4 viene la próxima semana, luego decidimos.

Cuidado de los ojos
1

New thread to help me and any future cataract patients…

So we visited Dr. Rockstar (very experienced Surgeon) today. When we entered his room the other assistant surgeon from previous visit was there but she left straight away. She did not acknowledge us though. Maybe was in her thoughts or intentionally from us rejecting her.

He seemed more competent in his speaking and approach. Did not rush us in anyway. We feel he is the one that we might be going with. So if we go with him we will be doing left eye set to far and in the future right eye 1 Diopter closer. He thinks that will give us good quality of life with glasses mainly for reading.
He himself uses same setup for his glasses.

This surgeon was against Multifocal IOLs. He said if it was his own eyes, he would do what he suggested for us. He said Multifocals are a compromise in each distance range. He prefers older people getting it than younger ones as even though it is not super sharp in each range, it still ends up being an upgrade for older people (compared to their aging vision).

For younger patients he prefers super sharp focus via Monofocals. So if we go with him we would be using the Hoya lens, he offered Zeiss too but recommended the Hoya as it brings the far vision closest to plano for the left eye, based on my wife’s measurements.

Btw he prefers EDOF over Trifocals.

We said we are 99% going with him + mini monovision but that we are visiting another surgeon who prefers EDOF to get an opposing viewpoint just to cover all angles.

He was ok with that but you could see that he was hurt. I think some of these top surgeons are just used to peopel bowing to them. Kind of makes sense, our eye doc who did pursue surgery initially and felt it was not for her, had told us that eye surgeons can be bit of Divas, as they are held in high prestige.

P.S- I asked him about eye injection. He said that it is old skool and he would never inject the eye for cataract surgery. Why take such risks! Anyway we cancelled the OP with surgeon No.1.
Surgeon No.2 was basically No.3’s assistant who did all the measurements.

So next week we see surgeon No.4 and that would be it. Unless No.4 knocks our socks off with EDOF, we would be doing mini monovision with Surgeon No.3.

2

Best case scenario as taken from Zeiss promotion-

Monofocal

EDOF

Trifocal

3

Worried - just an opinion from what’s worth. I don’t think a surgeon should show emotion (hurt or otherwise). They should be giving unbiased information on the lens options and strategies. If they aren’t comfortable or doing many different IOLs all they need to tell the patient is lenses they focus on and encourage patient to seek another surgeon’s opinion for trifocals and EDOF lenses. To act hurt is unprofessional (again just my opinion).

If a surgeon is like this prior to surgery what would it be like for follow up visits if all isn’t going perfectly? Would he be insulted thinking you are questioning his skill and expertise?

Just my general thoughts on this clinic. Attitude of first surgeon might be an indication of general attitude of whole office. Again to me yellow flags of caution.

H’mmm not so sure I agree with his assessment of only older patients benefit from EDOF or trifocals and young people need sharp vision. I think that shows ageism on his part. Everyone wants good vision.

How did your wife feel after the appointment?

4

To act hurt is unprofessional (again just my opinion).

His actions or words did not directly show hurt feelings, he was trying to be neutral but both of us noticed a subtle change in his body language. Hard to describe what I mean.
Although he did clearly repeat that he would advice against multifocals even after we told him that we are visiting a pro EDOF surgeon.

H’mmm not so sure I agree with his assessment of only older patients benefit from EDOF or trifocals and young people need sharp vision. I think that shows ageism on his part. Everyone wants good vision.

Not sure he meant like that. It was more in the context of the sharpness/crispness of vision achieved by monofocals in comparison to multi. He did say that he does not have enough data on EDOF to promote it.

Wife did feel confident in his skills. He was friendly and seems competent. We felt the best with him so far. He is one of the best here and we have got that info from multiple sources. Sue all your points have merit though.

Sue do you see sharp with your EDOF? I think you are a best case scenario though?

5

Hi Worried
Thanks for sharing, we all learn something :slight_smile:
Off course non of us who reads yours posts have the full picture, only you and your wife have that, but I must say I have the exact same thoughts as Sue have described, I also hear an alarm bell in the background.

And beside that, I honestly think the point about the multifocals should make younger people see worse, and older people see better is rubbish - how should that be possible, if the iol makes the vision poorer at younger people, then it should surely make the vision even more poor for older people.
The lens only focus the light, and if the rest of the vision beside the natural lens is not in great shape, it demands an even better iol to make the best of it. That point makes no sense to me.
But I agree, that monofocal always have the most predictable outcome.

I have never had normal vision, so I know I really can not say if the edof gives good vision or not, but the other day I was comparing my vision with my friends vision.
He is 48 with normal good vision except presbyopia have set in, so he needs mild reading glasses.
We were standing side by side looking at stuff, he found some things that he could only just see with his far vision when he made a little effort to see it, and pointed them out to me, and I could see the same things with only one edof eye that he could see with both eyes. He actually became so impressed, that he started to talk about a clear lens exchange, to get rid of his reading glasses.
I would never suggest to anyone having a clear lens exchange, but it is widely used here in Denmark, even famous people are having it done and the eye clinics are using their names to promote their business. This would be a big change to take for the eye clinic, if they got an unhappy famous patient.
I would say clear lens exchange is a far way from your surgeons opinion :slight_smile:

Last thing I would like to share, is the point about reading glasses. I have met several eye doctors and eye clinic personal that have this opinion, that glasses are a total unimportant detail not even worth mentioning.
But here in Denmark people are paying close to 7000 Euro to get a clear lens exchange just to get rid of reading glasses, I thing this speaks for itself, glasses may be unimportant for some, but for others reading glasses are a very big deal.
I have one edof and one eye that really have no usable vision for details, so right now my main vision is one edof, which is about the same you will get from monofocals with monovision on two good eyes.
And I must admit, for each day that passes, I am getting more and more hooked to have the trifocal in the second eye to add near vision, it have been a very strange experience that everything gets blurry when it comes close.
Things like the food on your plate is not that clear, I can see it , but not that good unless lighting is really good, and when I lift something up to take a bite, it completely blurs out to the point that I can not see what I am biting into.
I did not have presbyopia before even that my general vision was much worse than now, but I have found out now, how many things I do at near range, that I really never have thought about before, it is not only reading we do at close up.
I know, I could wear reading glasses when I eat, and I could wear reading glasses in many other situations too, but I am not sure I want to.
If I get another edof, my near vision will improve too, it will probably be enough to satisfy me, but that will be more than you get with monofocals.

Good thing about monofocals is, that with monofocals you still have a lot of options, you can use glasses and you can also have a trifocal add on lens, that can be removed again with very low risk, if there comes a better option in xx years, I was actually advised to take this route by one surgeon (monofocals and add ons)

In any case, what is important is that your wife feels she makes the right decision, and I am sure she will do exactly that.

6

Not enough data???
The Symfony have been implanted probably in hundred of thousands eyes all over the world, there are LOTS of studies published with comparisons to other lenses…

7

Hi No Worries:)
(Just can’t address you as “worried”:slight_smile:
Great that you felt personally comfortable with Rockstar. And that then are seeing someone else with actual EDOF experience! As someone with a monofocal in LE and an EDOF in RE, i couldn’t disagree more with Rockstar. Surgeons are limited by their own experience with various IOL’s, or lack thereof, and their habitual ways of proceeding.

The difference for me is not in sharpness of vision, but rather in a very slight difference in subtle color of light perception through each IOL. This varies by specific IOL. My Technis monofocal has a very slight blueness, compared to the Symfony EDOF IOL.

Your doc seems to be prescribing the common “old age” solution of forcing your wife to need readers for anything close up - like her phone, menus, etc. - for the rest of her life. This has been the standard practice for decades among cataract surgeons. Doesn’t make sense now that there are so many better options available for clear vision in all ranges.

Docs and patients all display emotion, part of being human.:slight_smile: Can be tricky recognizing our own emotions as they pull on us to make decisions, sometimes overriding objective info. I agree with SueAn that doc’s emotional attitude is important predictor of aftercare satisfaction.

My first surgeon (LE monofocal IOL) displayed anger when I insisted on choosing my own course of action. My 2nd surgeon (RE EDOF Symfony) was totally cool with my choice, just wanted to be sure he calculated correctly between IOL power choices to give me the best result possible - which he did! I’m SO happy that I followed my heart and gut.:slight_smile:

Again, I emphasize knowing if your wife’s current cataract eye is the dominant eye would help in deciding. If it is dominant, then setting it to distance with the monofocal IOL should work perfectly for now. Only if/when her other eye (if non-dominant) needs cataract surgery would she have to make a final decision for that eye. By then there could be more/better choices and “more data”.

Good luck with the Doctor numero quatro.:slight_smile:

8

Thanks for sharing. If you go with this approach may I suggest -0.5D instead of plano in the plano eye and -1.0 in the other eye. That way the difference will be only -0.5 and even the -0.5D eye will be that much closer for near. Also I feel she may need to use mild glasses for surgery induced astigmatism for outdoor. Indoor vision would be great and near would be decent with one eye at -1.0. Did he say anything about the eyehance as an option at all?

9

also i saw a surgeon in India for positive dysphotopsia in January and she asked me why I got EDoF as younger people should get monofocals. so it seems some doctors do have that point of view and possibly because of the dysphotpsia complaints. their office was offering all lenses symfony, lara, lisa and monofocals.

10

PS - did a LOT of research on mini-monovision and mixed IOL types before making my choice, -THEN followed my heart & gut to get the result I wanted.:slight_smile:

11

hi seeherenow,
is it correct that you have great vision at all distances with monofocal lens? if i remember correctly it got better in 6 months time. would you recommend monfocal first and then depending on that result choosing premium or not?

12

Good let me know what happened to me because I just trusted the opinion of a family member who knew somewhat my first surgeon years ago…

Last January I had surgery in one eye and I saw graffiti when I tried to read, letters would appear, bunch up and disappear …Now my husband said when he takes his eyeglasses letters tend to bunch up, but his eyesight did not see graffiti when he tried to read traffic signs or the name of stores in the mall or for that matter see blurry so I kept insisting that something was wrong.I had the surgery on my other eye because it happened one month later and my surgeon insisted I was expecting healing too soon. But when the second eye was so much better in weeks while the first eye was still blurry and unable to read I became very concerned. So I returned to the surgeon and he said everything was perfect, I had done correctly and since I had macula that was my problem so I had to realize that in ten years my eyesight would be worse anyway. So I went to my retina doctor that indicated that although I have macular degeneration, my macula is healthy right now.

At that time I was very lucky because I read the posts Julielyn had written about a situation similar to mine but actually worse, the subject was IOL exchange and I that confirmed what I suspected, that something was wrong with that lens. At that time, seven months had gone by since I had surgery and I had started seeing double images that merged and separated. I could see people with two heads or two people speaking at a show…It was just awful. I could also see dark shadows on the side of the lens. Julielynn had gone to SightTrust and if you read her notes she had a wonderful recovery.

Well I went to see her doctor, Dr. Shatz and my experience has been great, to start my fist visit was about two hours, several tests and then 45 minutes with the doctor. He told me that he needed the records of the surgeon, the retina doctor and then an EKG and and a clearance from my internist. He also explained that in agreement with my retina doctor my vision after the surgery was 20/80 and that he would not want to do the procedure unless he could improve my vision to close to what it was before the surgery which was 20/35 . Well to make the story short. it has been 3 weeks and my eyesight was checked by my retina doctor and is between 20/35 and 20/40 and it is healing slowly. For an exchange it can take about three months to recover so I am very happy.

13

thanks for sharing Elizabeth - I am so happy your story has a wonderful ending. Hope things just continue improving. Keep us updated.

14

Was out fir a bit and just finished reading through all the replies which I think are all good considerations. As Danish mentioned we don’t see (pardon the pun) whole picture and take all our comments with a grain of salt. We do only wish the best for your wife. I think most of us when on this journey saw more than one surgeon and their willingness and/or unwillingness to explore IOL options and strategies played a role into our decisions.

Ultimately it’s what your wife feels comfortable with that counts most.

To answer your question I do feel I see sharp with Symfony. But I have 2 of them implanted and can make no other comparison. I wore glasses for distance since a child and to be able to see with them is remarkable! I also have good near vision with them - a surprise as I wasn’t expecting that. As one of the other posters said we use near vision much more than we realize - not just reading. IE bit vain of me but to be able to put on make-up or use tweezers on my eyebrows with use if a magnifying mirror is something I appreciated being able to do. I can honestly say I have no regrets choosing this lens despite the night concentric circles around certain lights. I do think if I’d gone with monofocals and even if I enjoyed great distance vision I would have wondered what if. Just my personal thoughts.
We live in an era of great advances that will only continue to improve. Your wife has many years ahead of her - I am glad you are at least consulting with a surgeon that is confident and knowledgeable about EDOF lenses. As Danish said they aren’t that new and it is a little surprising what Rockstar said about them - he at least should have been factual or said it wasn’t an area of expertise in his clinic.

And whoever said it - like calling you worries vs worried!!!

15

Hi Soks,
Yes, I have great vision at all ranges with the monofocal as well as the EDOF Symfony. But that is not necessarily common.

And yes, your memory is correct. We set it for -0.5 Dwhich it was at first. Then at about 6 months later it improved to -0.25D. I do have remaining minor astigmatism in that eye. Got the toric Symfony in the other, so no astigmatism there.

Yes, that sounds like a reasonable plan to me, but I’m no doctor so can’t recommend. People need to be comfortable with there own choices.:slight_smile:

16

Hi Viking:)
Totally agree with this:
And beside that, I honestly think the point about the multifocals should make younger people see worse, and older people see better is rubbish - how should that be possible, if the iol makes the vision poorer at younger people, then it should surely make the vision even more poor for older people.
The lens only focus the light, and if the rest of the vision beside the natural lens is not in great shape, it demands an even better iol to make the best of it. That point makes no sense to me.

17

Yes, happy for you, Elizabeth!
Another example of why aftercare is such an important part of the process.

18

Hi Sue.An2,
I hope you read about the results of my surgery, I did not have your email and I was hoping you now had the information of how wonderful the doctor, the staff , and the clinic were just wonderful. They would answer emails even on the weekend and I am happy mostly because I am recovering and doing so well. Thanks again for your kind emails, I will let you know how it goes later on.

19

hi elizabeth

what was wrong? incorrect lens calculation?

how long after original surgery did you do the exchange?

20

What was the issue? What IOL had you got and what was it replaced with?