Hi folks.
55 year old male, in the UK. Was first told I have cataracts just over two years ago. I’ve been myopic since my teens and current prescription is -4 in both eyes. No other issues except I had PVD in both eyes last year which has left me with floaters (I understand that this is a normal age related thing and is not concerning). Not diabetic, no other health problems.
I have seen two opthalmologists who have both advised me to wait as my corrected vision is still good. This is true when reading an illuminated black on white eye chart in “laboratory conditions” but my low light vision and contrast sensitivity have deteriorated. I still drive at night but am aware of needing to be more careful and get halos around lights at night and sometimes glare. Also I ski quite a lot in winter & have increasing difficulty in low light conditions (not being able to see the contrast of bumps and terrain on the snow unless it’s a sunny day).
I explained the above to the surgeons I have seen but didn’t think they really listened to me, just relying on the prescription and slit lamp exam. One of them said he would do it but call it “lens replacement” not “cataract surgery” (this would mean I would have to pay 100% out of pocket as my insurance company would only contribute if it was deemed necessary)
My vision is functional. I only have difficulties in low light or at night. I would quite like to ditch the spectacles (in so far as that might be possible) and now I know that I will require lens replacement surgery at some stage, I would quite like to do it before I start getting more serious visual problems.
So should I keep looking for a surgeon who will do this now or am I being a bit obsessive?
That is a hard call given that you are relatively young for cataract surgery. I would be tempted to put it off for as long as possible, while still seeing well. Where I am they will consider cataract surgery when vision can no longer be corrected to 20/20, or sometimes if the correction is changing so often, it is not practical to keep getting new lenses. I don't think it is a hard line that you have to cross, so you may have to keep looking for a cooperative surgeon. Do you have any other issues like double vision? That might help you plead your case.
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Another thing to consider is that IOLs are not a panacea either. Multifocal and even EDOF lenses can have issues with loss of contrast sensitivity and can have halos.
What do you see without correcting glasses/contacts when you look at a light source (especially circular ones like headlights, or illuminated power buttons)? Do you see multiple instances of this light in a circular pattern? You should keep a distance greater than 0.25m/10 inch (4 Dopters) from the light source.
Thanks for such a fast reply. I have had double vision very occasionally & briefly but I don't think that's been related to the cataracts.
I'm aware that there can be issues with MF and EDOF lenses & have done a fair bit of research & would prefer to avoid the "concentric circle" type lens (Panoptix, etc). I think I would rather accept readers than risk other issues.
One of the surgeons I saw has a preference for the Lentis Mplus by Teleon and a relative has had those implanted by the same man (as lens exchange, not cataract) and is delighted with them.
Hi. I see a blurry light source with a bit of halo around it, nothing as you describe.
I think you need to find out what the rules in the UK, whether through the NHS or private insurance. Here in the U.S., the surgeons I've seen basically have said it's time for cataract surgery when they degrade your vision more than you're willing to accept. I'm 73, so I think this advice is especially true for someone your age.
I'm the same age. I have one eye done and and the second one should be done soon. It's up to you. If the vision is impacting your life to a degree that isn't acceptable to you or impacting your ability to work or drive, then it's probably time. What is your best corrected distance vision? Mine was 20/40 in both eyes.
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Some of my issues before surgery were…
- couldn't read street signs until I was 20-30 feet away
- couldn't recognize someone I knew from across the street
- couldn't read subtitles on TV
- when running if I saw someone 100 feet away I couldn't tell if they are coming or going
- working on computer (even with a computer glasses prescription) was difficult (which is what I do for a living)
I have not heard of those lenses, but they sure sound like multifocal lenses. It is essentially impossible to do multifocal without creating multiple images which usually shows up as halos and more. Be very careful. In my view the lowest risk way to get the full range of vision without side effects is mini-monovision. Surgeons do not often promote it because there is no extra money in it. Most often monofocals are used which are fully covered by healthcare systems.
What stage are your cataracts? How dense are they? Mine were +4 and very dense. It made my surgeon's job more difficult.
I have tried monovision with contract lenses and didn't get on with it. Perhaps it's different with iols but I would be reluctant.
You might know them as Occulentis (company that used to make them), There was a recall a few years ago and company was subsequently sold to Teleon.
These https://www.teleon-surgical.com/en/international/products/lentis-iol/lentis-mplus/
Thanks. I don't think there are any rules in the UK relating to this.
The NHS won't provide cataract surgery until you are pretty far gone and then only
Insurance will pay, usually only for monofocal but you can top up for premium lenses. They do require a "procedure code" from the surgeon before they will process a claim and that is down to the surgeon.
Thanks. My corrected vision on a nice bright day or looking at an eye chart is fine (20/20 or better). It's in low light and at night when it's lacking.
Early stage. First mentioned during an eye exam two years ago. I hadn't really noticed at that stage (aside from noticing that my contrast when skiing wasn't as it was). Only in the last year that I've started noticing problems, and then mostly in low light.
Early stage. That's good
Anyway since you get your health care through the NHS, they will only do your cataracts when they want to.
True, but I won't be using the NHS. I have insurance and could pay out of pocket if needed.
If you have private insurance and it's up to the surgeon, then at whatever point you are experiencing unacceptable vision due to your cataracts I suggest finding a reputable surgeon who will give you the "procedure code". It may require multiple consults, but unless you're clearly premature in wanting the surgery, I should think you'll be able to find someone.
Not everyone adapts to Mini-monovision or are appropriate candidates. It simply is an alternative strategy that gives you a “blended” extended range through the sacrifice of distance vision in one eye for near sight. This can lead to stereo acuity, depth perception, and neuroadaptation issues. It is a compromise to highest quality vision possible. It’s essentially a “brain game” or trick, where two images from both eyes are integrated together to form a composite picture in the brain. It requires rivalry adaption by shutting off neurosensory processing of the blurry overlap images in the brain and the failure to do is what can contribute to dysphotopsias. Physicians don't promote it because of patient dissatisfaction and their belief in better in better options to achieve patient satisfaction.
Actually the brain is very good at selecting the best image from the best eye for the distance being used. We have evolved with two eyes that are not always in perfect identical correction. We have only had that since eyeglass correction started to get used. Many people have monovision and don't even know it.
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On the other hand it is much harder for the eye and brain to deal with multiple focus points in one eye after using a multifocal IOL. They are not at all the same as bifocal, trifocal, or progressive eyeglass lens. With those we learn to use different parts of the lens to get the best image. That is not possible with a MF IOL. You can't selectively look through different parts of the IOL lens. That is why optical side effects like loss of contrast sensitivity, halos, and flare are so common with MF IOLs.
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My ophthalmologist was fully supportive in getting mini-monovision and even recommended it. So was my optometrist. I saw another ophthalmologist looking for a Lasik adjustment and he said something like "I don't know if this (mini-monovision) was planned or you just got lucky, but you are very fortunate to have ended up this way ". Actually it was carefully planned.
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The real reason it does not get much attention is that there are no special lenses at premium prices marketed to do mini-monovision. I should not say "no" because Rayner markets the EMV (enhanced monovison) lens for that purpose. However in the scheme of things it does not offer much of an improvement over a plain Jane monofocal.
No two patients or eyes are the same and they may experience different visual image processing capabilities or sensitivities by their brains, thus surgical outcomes will vary from patient to patient. This is especially true since IOL implantation is not an exact science nor without risk in and of itself. Every procedure has its inherent trade-offs.
Every patient should consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment of a personalized nature due to the fact that non-clinical perspectives may not apply to every potential patient circumstance and can cause harm.
Surgeons will likely have an opinion on any approach based upon their own already established views and habits. If a surgeon is not convinced of the benefit risk ratio over other available options themselves, a patient will likely need to go somewhere else. Ophthalmologists/surgeons believe in the science of optics, visual system design/function, and doing no harm. Nothing beats natural visual design and function to date. Accommodating IOL's may offer the closest replication to that if and when approved.
Accommodating IOLs don't work any better than MF IOLs, which have all kinds of issues in themselves. That is why they are not being approved.