Choosing the Right Intraocular Lens for Cataract Surgery: A Patient's Journey

Q: Choosing the Right Intraocular Lens for Cataract Surgery: A Patient's Journey

Hello Jane,<br>I believe this is a great approach： using single-vision lenses for distance without glasses and wearing reading glasses for close-up work. <br>This may provide better quality vision. <br>If you prefer not to constantly take glasses on and off, you might consider mu

Selection of Intraocular Lenses (IOLs)

Dear Dr.
Gao,
Hello! About 18 years ago, I underwent laser surgery for my myopia (1200 degrees).
From 2017, my vision gradually worsened, and by 2020, my eyesight had been dim for three years.
I initially thought it was due to regression of my prescription, but at the end of 2020, after a frighteningly high prescription check at an optical store, the optometrist advised me to see an ophthalmologist for a thorough examination, which revealed that I actually had cataracts.
I never expected to develop cataracts, especially at a young age.

Due to my high myopia and previous laser surgery, I consulted with four clinics and three hospitals regarding my cataract condition.
I do not have any issues with my macula.
The combination of my deep myopia and the blurred vision from cataracts significantly affected my daily life and work.
After gathering advice from doctors and information online, I underwent cataract surgery on my right eye on March 4, using the Alcon model SN60WF monofocal lens.
I chose this lens because I was focused on one main issue: my high myopia and the complications from my previous laser surgery.
I realized that expensive, high-quality lenses might not necessarily be the best option for me, especially considering issues like nighttime glare.
Ultimately, the clinic only offered the Alcon monofocal lens as a self-paid option.
Before the surgery, my vision was 1500 degrees without astigmatism.
The day after the surgery, my vision was 0.8, and the doctor said everything looked great.
I was supposed to be happy about the successful surgery, but after three days of careful recovery, I felt quite frustrated.
I overlooked the issue of presbyopia (the doctor did not inquire about or guide me regarding my daily needs).
Over the past few days, I found that when looking at my phone, computer, writing, or reading (at intermediate distances), everything appeared blurry, and I could only rely on my left eye (1300 degrees) for close vision.
Doctor, I am not yet 50 years old, and I still need to work.
I do not want to wear reading glasses, as it would complicate my work and daily life (taking glasses on and off).
Initially feeling frustrated, I remembered that I still have hope for my left eye.
I researched online and found information about new "extended depth of focus" lenses that can address distance, intermediate, and near vision without the glare issues associated with multifocal and trifocal lenses.

Could you please advise me, based on your professional judgment, whether these extended depth of focus lenses would be suitable for my left eye needs? (I personally lean towards this option.)
2.
If you were to treat my case, would you recommend that my left eye receive the same Alcon monofocal lens as my right eye? If this eye is left with a certain degree of myopia, can it truly prevent presbyopia? How much myopia should be reserved to prevent presbyopia (1300 degrees)? This is what I most want to know—can having one eye for near and one for distance truly achieve balance? I am placing my hopes for my vision in this left eye.
I am grateful for this platform to consult with you, and I sincerely appreciate your response amidst your busy schedule.
Wishing you peace and joy!
Best regards.

Jane, 40~49 year old female. Ask Date: 2021/03/10

Dr. Gao Pilin reply Ophthalmology

Hello Jane,
I believe this is a great approach: using single-vision lenses for distance without glasses and wearing reading glasses for close-up work.
This may provide better quality vision.
If you prefer not to constantly take glasses on and off, you might consider multifocal lenses, which allow for both distance and near vision.
However, if you really do not want to wear glasses, you could leave your left eye with a prescription of 250-300 degrees, using it for near vision and your right eye for distance vision.
As for whether full-range lenses are suitable, my understanding is that they can provide continuous clear vision for long and intermediate distances.
For example, they would be clear for driving, looking at the dashboard, and navigation.
However, for close-up tasks like using a smartphone, you might still need mild reading glasses.
Full-range lenses have just been introduced, so it would be best to discuss this with your physician.
At the E-Hospital in Puzi, Taiwan, the ophthalmology department is available on:
Monday, Tuesday, Thursday, and Friday mornings from 8:00 AM to 12:00 PM,
and Wednesday afternoons from 2:00 PM to 4:30 PM.
Please note that online responses should only be used as a reference; it is essential to seek medical care at a healthcare facility when necessary.
I hope to have the opportunity to assist you.
Best regards,
Gao Pi-Lin

Reply Date: 2021/03/10

More Info

Choosing the right intraocular lens (IOL) for cataract surgery is a significant decision, especially for patients with a history of high myopia and previous laser eye surgery. Your journey highlights the complexities involved in selecting an appropriate lens, particularly when considering the impact on daily life and work.

1. Understanding Your Current Situation: You have undergone cataract surgery on your right eye, where an Alcon SN60WF monofocal lens was implanted. While your immediate post-operative vision improved significantly, you are now facing challenges with near vision, which is common for individuals who have undergone cataract surgery with monofocal lenses. These lenses are designed primarily for distance vision, which means that additional correction (such as reading glasses) is often necessary for tasks that require near vision.

2. Considering Multifocal or Extended Depth of Focus Lenses: You mentioned the possibility of using a "full-focus" lens, which typically refers to multifocal or extended depth of focus (EDOF) lenses. These lenses are designed to provide a range of vision, allowing patients to see clearly at various distances (near, intermediate, and far). Given your desire to avoid reading glasses and your active lifestyle, these lenses may be a suitable option for your left eye. However, it is essential to discuss the potential for glare and halos, which can be more pronounced with multifocal lenses, especially in low-light conditions.

3. Balancing Vision Between Eyes: If you opt for a multifocal or EDOF lens in your left eye, it may create a more balanced visual experience compared to having both eyes with monofocal lenses. However, if you choose to have the same Alcon monofocal lens implanted in your left eye, it is crucial to consider the degree of myopia you have in that eye (1300 degrees). Some surgeons may recommend leaving a slight degree of myopia in the non-dominant eye to help with near vision, but this approach can vary based on individual circumstances and preferences.

4. Preventing Presbyopia: As you are not yet 50, presbyopia (the age-related loss of near vision) is a concern for many individuals. While monofocal lenses do not prevent presbyopia, the use of multifocal or EDOF lenses can help mitigate its effects by providing a more versatile range of vision. If you decide to go with a monofocal lens, you may need to consider how much myopia to leave in your left eye to assist with near tasks. This is a nuanced decision that should be made in consultation with your ophthalmologist, who can provide personalized recommendations based on your visual needs and lifestyle.

5. Consultation with Your Surgeon: It is vital to have an open dialogue with your eye surgeon about your concerns and preferences. Discussing your daily activities, work requirements, and visual expectations will help them guide you toward the best lens option. They can also explain the potential risks and benefits of each lens type, including how they may affect your vision post-surgery.

In conclusion, your journey emphasizes the importance of thorough research and communication with your healthcare provider when choosing an intraocular lens. Given your unique circumstances, exploring multifocal or EDOF lenses for your left eye may provide the balance you seek in your vision. Ultimately, the goal is to enhance your quality of life and ensure that your visual needs are met as you continue your daily activities.

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