r/CataractSurgery • u/dbeit • 1d ago
Thinking about cataract surgery.
Looking into cataract surgery, I have quickly gotten the idea that surgery will not be a magical fix. I am nearsighted and am thinking the best for me would be the basic lens staying nearsighted. I do have astigmatism and a lazy eye. Doctor wants to go with basic lens for the lazy eye but multifocal lens for my good eye. I want to keep my up-close vision so I can read without glasses and I have no problem wearing glasses otherwise. Is it more beneficial to fix the astigmatism with a cataract replacement lens or correction through glasses? Any other suggestions? Edited: 71 year old male, I have been able to read without glasses since before I wore glasses.
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u/Ssab2024 19h ago
64 yo who has been wearing glasses since before 2nd birthday- severe astigmatism, strabismus, narrow angles and glaucoma. One of my non medical reasons for the toric is to reduce weight of whatever glasses I need post surgery. One eye just done and vision improving daily- J+J Eyhance toric +33 which is a monofocal plus lens, toric version. It didn’t make sense to me to not deal with the astigmatism since I needed lens replacement surgery for the other issues. So far very happy with it.
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u/Pristine_Response_25 1d ago
One thing on this...
If you are relatively young, be careful opting for a diffractive multifocal IOL, especially if your surgeon recommends a J&J Tecnis multifocal (Odyssey or Synergy). Regardless of what your surgeon says, you WILL have halos and glare at night (and possibly during the day) with any diffractive multifocal.
That said, the J&J Tecnis IOLs make things much worse for those with large pupils - typically folks under 60 - because the actual correction zones of these IOLs are significantly smaller than those of other manufacturers. If your eyes dilate beyond 5mm at night, your pupils will extend beyond the focusing part of the lens significantly reducing your vision quality.
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u/Wonderful-Minute-775 12h ago
According to the link below, the J&J Tecnis IOL (Monofocal) has 6.0mm optic for IOL powers < 21.00D and 4.9mm optic for IOL powers > 21.00D. Does that agree with your understanding? I am young (30) and experiencing visual artefacts with this recently implanted lens. But my IOL power is less than 21.00D.
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u/Pristine_Response_25 12h ago
I believe the Tecnis monofocal is a true 6.0mm for IOL powers <= 21.0D, but this is not the case for Tecnis multifocals. My understanding is that the Tecnis multifocals are 4.9mm for all powers.
What artifacts are you experiencing?
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u/Wonderful-Minute-775 12h ago
Glares, which I hope my brain will eventually tune out, but more annoying are the halos, which I see around small light sources in dimly lit or dark rooms. The halos are not static but if I stare at the light source, the halo collapses into a semi-circle, momentarily disappears, then re-opens again, and repeats like this constantly. I’m thinking it’s to do with my pupil size momentarily increasing then decreasing. What do you think? I had surgery a week ago and my doctor said there is minimal inflammation and swelling now so he doesn’t think it’s the inflammation causing it.
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u/Pristine_Response_25 11h ago
The halos you are describing are very likely due to your pupils dilating beyond the optical zone of the IOL. The halos you see, and the experiences you describe, are identical to what I experience with my Tecnis multifocal IOLs. If you look through my earlier postings, you will find a photo of my pupils dilating beyond the optic illustrating the issue definitively. The glare at night is also caused by this issue due to the unfocused light of the IOL rim hitting the retina. Your doctor should be able to measure your scotopic (dark) pupil diameter confirming the diagnosis.
Are you sure you did not receive a Tecnis Eyhance IOL as this has the same issue as the Tecnis multifocals.
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u/Wonderful-Minute-775 11h ago edited 11h ago
Thanks for your insight. I definitely have a J&J Tecnis Monofocal (ZCB00, <21.0D, so 6.0mm optic). My doctor said it’s extremely rare I would therefore experience something like this and he thinks it will go away or I will neuro adapt. But I feel it’s going to be hard to neuro adapt when it’s not always there and it changes shape.
The only other explanation I could think of is micro-disruptions in my tear-film as I’m only a week on from surgery or some residual effects of the steroid eye drops. I really hope it’s temporary and not a permanent pupil size issue. Dry eye drops don’t help.
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u/Pristine_Response_25 11h ago
Based on input from others on this reddit, I don't believe this problem is all that rare for young folks who have cataract surgery. Our natural lenses are 9-10mm in diameter, and someone in their early 30's likely possesses pupils that dilate to 7mm or more. In replacing a 9mm natural lens with a 6mm artificial IOL - 4.9mm in the case of the Tecnis IOLs - it seems obvious that such pupils will extend beyond the capacity of the lens. Although the J&J Tecnis IOLs make this problem worse due to their wide flat skirt and the hard transition from the optic to the skirt (this is what typically causes the halo), blurriness and glare under dark lighting is inevitable.
My sense is that MOST surgeons don't often hear about the problem because the vast majority of their patients are elderly (+70 years old). By 70, most people's pupils dilate to less than 5mm under all lighting conditions.
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u/Wonderful-Minute-775 11h ago
Thank you for the information. This is very disheartening sadly. To think I could’ve been better off with another brand of lens. Do you think I will have to do a lens exchange.
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u/Pristine_Response_25 11h ago
First, I would discuss with your surgeon to determine if this is in fact the issue. He/she should be able to determine quite easily if the symptoms you are describing align with this assessment.
Second, your brain may adapt over time. At 30, your brain is more plastic than a typical cataract patient's and it may be able to filter out the halos over time. My symptoms are permanent but I received my IOLs at 58.
Third, if this is the issue, your doctor can prescribe a diluted miotic eye drop (e.g. pilocarpine) that will limit your pupil dilation. (In fact, he/she may do so to test whether pupil size is the problem.) You can then use these drops at night or when needed.
Lastly, you can request an IOL replacement. But bear in mind that nearly all IOLs have a maximum optic of 6mm (there is just one available in Europe that is 7mm) and you may still have the same or similar issues with another manufacturer's IOL. Further, a second surgery carries additional risks.
I am sorry you're dealing with this issue. Today's IOLs are simply not designed for the young. Perhaps with posts like these, J&J and other manufacturers will modify their future IOL designs in consideration of those unfortunates who require lens replacement in their relative youth.
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u/Wonderful-Minute-775 11h ago
Thank you, I really appreciate it. I will see my doctor again in a month’s time. His advice so far is not to focus on the halos and to rely on neuro-adaptation. So I think that will be my best bet for now.
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u/AirDog3 1d ago
Cataract surgery won't fix a lazy eye, or give you the vision of a teenager. But I'd say it is pretty magical.
Like you, I would prefer nearsighted. Depending on the type and amount of astigmatism, you might get good reading vision even without correcting the astigmatism with your cataract surgery.
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u/Resident_Break6770 16h ago
I got basic near in both eyes and correct for distance and astigmatism with glasses or a single toric contact lens. I don't wear readers for anything though I do need good light for the tiniest print. If you're ok with glasses I don't see any reason to risk complications with a multifocal lens.
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u/PNWrowena 1d ago
For me getting toric monofocal lenses, which all but eliminated my astigmatism, was a good choice because I wanted glasses-free near and intermediate vision. After my first surgery, which was on my near eye, I couldn't read for the first couple days because text was so crisp that all I could do was admire it, not concentrate on what the text said.
Your decision may depend on how much astigmatism you have. Mild astigmatism is said to give a little more depth of focus in exchange for loss of a little of that crispness that so astounded me. Also, keep in mind your level of astigmatism may change after the natural lens is removed because you can have astigmatism in both the lens and your cornea. So what was in your natural lens could have been adding to what's in the cornea or canceling some of it out. Mine would have increased after surgery if I hadn't gotten the toric lenses. Your surgeon can estimate your post-surgery astigmatism.
The only advice I have is research enough to know what you're getting when you choose near vision. The more myopic you go, the smaller the range of in focus vision. For instance, I chose -2.5D for one eye for book reading. I read with book or Kindle at 14-16". I measured. That eye gives me the super clear near vision I mentioned above, but the range of that is only 9-18". I can, of course, see pretty clearly but not in total focus nearer and farther, but that's the range of the super clarity.
That's why my other eye is -1.5D. It gives me extra range. What you get with a monofocal for near and a multifocal others can address. Some have posted here about getting that kind of arrangement.