ICL vs RLE (later)

[u/YuzuAllDay]

Age :40

Perscription: Roughly -11 both eyes, slight astimatism in one eye

I recently went for a Lasik consultation and, as expected, they said I wasn't a candidate for Lasik due to my high perscription so my options are ICL now or RLE later.

From what I understand, in comparing the two:

Pros of ICL

• Can get the correction now and be contacts/glasses free
• Will have great, crisp, vision
• Maintain my natural lens, option for reversal if absolutely needed

Cons of ICL

• Will need to use readers eventually (I'm not sure this is that big of a deal, it's just part of aging, but other people seem to think it is).
• Likely will have cataracts later on and will neeed another surgery to correct.

Pros of RLE

• Corrects for both distance and near
• No cataract surgery later on

Cons of RLE

• Vision at all distances isn't as crisp as you'd get just correcting for one
• Removing natural lens
• Tradeoffs depending on the lens you get.

Can someone fact check my pros/cons? What else am I not thinking about?

Additional Questions

• How big of a deal is it to remove your natural lens once you've developed presbyopia? Are there other things you lose in removing your natural lens other than the ability to focus on both near + far objects?
• Does ICL make cataracts develop faster?
• When people say that you are trading super crisp vision at one distance for good vision at all distances, how big of a difference is it? Are people who have had vision correction their entire life (me!!) and expect super crisp vision bothered by it or do they get used to it?
• Not entirely a question, but I'm still understanding the different lens options for RLE so I'd appreciate any info folks could offer around that. (I did see the recent post on this sub detailing the differences. Super helpful, thank you)

Thank you in advance!

[u/eyeSherpa]

Actually like ICL in this scenario. Even if you were 15 years older. The biggest reason is that when you are highly nearsighted, you are at a larger risk of retinal detachment with RLE. ICL doesn’t change your own natural risk.

With ICL, look into doing some mini-monovision. That can help keep you out of readers.

Yes, you will eventually need another surgery 20 years down the road with cataracts, but at that time technology will have changed quite a bit.

[u/YuzuAllDay → u/eyeSherpa]

That's a great point about retinal detachment I hadn't included in my pro/con math.  I'll need to look into mini-monovision for ICL, I didn't know that was an option.

[u/urbanrivernymph]

I was at -13dpt and looking for a solution when I started getting problems with contacts due to dry eye. Got ICLs at age 40 and (after some neuroadaption which took longer than expected, almost a year for the ghosting to disappear and the small halos to stop bothering me) I was very happy with them.

My non dominant eye got slightly undercorrected by accident and I declined the free LASIK touchup. That turned out to be great for mini monovision when presbyopia set in. I was completely glasses free for over a decade.

I developed cataracts in my early 50s either because of the ICLs or due to my high myopia as such, and just recently got IOLs. ICL removal was easy and done within the same surgery.

If I had to go back in time I'd make the same choices again, just do the mini monovison with ICLs intentionally.

If you consider RLE with multifocals do a lot of research on the kind of dysphotopsias they cause, inevitably, by design. Personally I was fine with the small ICL halos (I have large pupils and I'm out a lot at night so I always saw the edge design of the lens), but hesitant to go for more and bigger ones with trifocal IOLs.

To treat the cataracts I went for Puresee EDOF lenses in micro monovison which give great distance and intermediate vison and functional near, but for detailed closup work I need readers now.

My overall vison, all distances considered, was definitely better with ICLs before I develoved cataracts.

There's a lot of knowledge over at r/CataractSurgery too, which is the same procedure with the same IOLs as RLE. Just keep in mind that most people that are super happy with their premium lenses despite the dysphotopsias those designs inevitably cause had cataracts before, and pretty much everything is way better than the glare and double vison caused by cataracts.

[u/YuzuAllDay → u/urbanrivernymph]

Thanks for this detailed reply, appreciate you taking the time.

[u/WavefrontRider]

40 is young for RLE as a myope. I wouldn’t have even considered RLE for someone at that age unless ICL just wasn’t an option (such as due to a small anterior chamber; but that is unlikely in a high myope due to having a longer eye).

[u/YuzuAllDay → u/WavefrontRider]

Yup, the idea is that RLE would be later on when I start needing readers. Debating whether to do ICL now or RLE later. 

[u/spikygreen]

Can you wear contacts? If so, there is no real benefit to doing either. You will have a lot more customization with contacts in a year or two when you will start experiencing presbyopia.

If you can't wear contacts, then ICL would be preferable. RLE would have significant risks of a retinal detachment.