Using different brands of intraocular lenses in the left and right eyes?
Dear Director Gao,
1.
My right eye has severe myopia and after developing cataracts, the prescription increased to -1000 diopters.
I underwent cataract surgery in March last year, using the "Rein" aspheric monofocal intraocular lens, with a planned myopic reserve of -150 diopters.
Post-surgery measurements indicated -200 diopters, but I experienced significant photophobia and fatigue throughout the day.
A year later, I developed a secondary cataract and recently sought treatment from another ophthalmologist, which improved my photophobia.
My new myopic measurement is -250 diopters, allowing me to see my phone at a distance of 40 cm.
2.
My left eye has -575 diopters of myopia and mild cataracts, with wrinkling in the macula causing slight distortion in the lines on the grid chart.
The disparity between my two eyes is significant, making it uncomfortable to wear glasses (left -550, right -200).
If I undergo surgery on the left eye, my current plan is to reserve a prescription that allows for intermediate distance viewing for computer use, so that I won't need glasses for looking at my phone or computer, but will wear glasses for distance vision (such as driving).
3.
The subsequent doctor indicated that the "Rein" hydrophilic intraocular lens used in my right eye is more prone to developing secondary cataracts, while hydrophobic intraocular lenses are less likely to do so.
Therefore, it is suggested that I use the "Bausch & Lomb" aspheric monofocal intraocular lens (hydrophobic) for my left eye, reserving -150 diopters of myopia; or the "Johnson & Johnson" short extended depth of focus intraocular lens (hydrophobic), also reserving -150 diopters of myopia, but with a longer depth of field extending near vision.
4.
Regarding the use of monofocal or short extended depth of focus lenses in the left eye, you previously mentioned that both options are viable.
Since the brand issue was not addressed before, I would like to further inquire:
1.
If I use either the "Bausch & Lomb" or "Johnson & Johnson" intraocular lenses in my left eye, which are different brands from the "Rein" lens in my right eye, will there be any image differences that make it harder for my brain to fuse the images, potentially causing discomfort in uncorrected vision or while wearing glasses?
2.
Considering my eye conditions as described, would it be better to reserve -150 diopters of myopia for the left eye with a 100 diopter disparity from the right eye, or should I reserve the same prescription as the right eye to avoid disparity? What is your opinion? I apologize for seeking more professional advice.
Thank you!
Mr. Li, 60~69 year old female. Ask Date: 2022/09/08
Dr. Gao Pilin reply Ophthalmology
Hello Mr.
Lee:
1.
Different brands will not exhibit this phenomenon.
You can follow your physician's recommendations.
2.
Depending on your needs, if you want to wear glasses all the time, you can choose the same prescription as your right eye.
If you prefer not to wear glasses constantly, as you mentioned in your second point, you may consider leaving a myopic prescription of -1.50 diopters.
If you are uncertain about your preferences, you can follow the advice given by your attending physician.
As for the 1.00 diopter difference between the two eyes, it should not cause any discomfort.
Reply Date: 2022/09/08
More Info
Choosing different intraocular lenses (IOLs) for each eye can indeed have significant impacts on vision, particularly in cases where there is a substantial difference in refractive error or other ocular conditions, such as cataracts. In your situation, you have a complex history with your right eye, which has undergone cataract surgery and experienced a significant increase in myopia, and your left eye, which has mild myopia and early cataract formation.
When considering the use of different IOLs for each eye, several factors come into play:
1. Visual Disparity: The difference in refractive power between the two eyes can lead to visual discomfort and difficulty in achieving binocular vision. If one eye is corrected for distance and the other for near vision, it may create a situation where the brain struggles to fuse the images from both eyes, leading to symptoms such as double vision or eye strain. This is particularly relevant in your case, where your right eye has a significantly higher degree of myopia compared to your left eye.
2. Type of IOL: The choice of IOL can also affect visual outcomes. You mentioned considering hydrophilic (親水性) versus hydrophobic (厭水性) IOLs. Hydrophobic IOLs are generally associated with a lower risk of posterior capsule opacification (PCO), which is a common complication after cataract surgery that can lead to decreased vision. If your right eye has already experienced PCO, opting for a hydrophobic lens in your left eye may be beneficial in reducing the likelihood of similar issues.
3. Presbyopia and Near Vision: If you plan to reserve a certain degree of myopia in your left eye to facilitate near vision tasks, it’s essential to consider how this will interact with the vision correction in your right eye. If the left eye is set to -150 degrees and the right eye to -250 degrees, this could lead to a situation where you may need to wear glasses for certain tasks, particularly if the disparity in focus becomes too pronounced.
4. Adaptation: The brain can adapt to differences in vision between the two eyes, but this process can take time and may not always result in complete comfort. If the differences are too great, adaptation may be challenging, and you might experience discomfort or visual fatigue.
5. Consultation with Your Eye Care Provider: Given the complexity of your case, it is crucial to have a thorough discussion with your ophthalmologist about the potential outcomes of using different IOLs. They can provide insights based on your specific ocular health, lifestyle needs, and visual goals.
In conclusion, while it is possible to use different IOLs in each eye, careful consideration of the potential visual disparities, the types of lenses used, and your individual visual needs is essential. It may be beneficial to aim for a closer match in the refractive power of both eyes to minimize discomfort and improve overall visual function. Your eye care provider can help guide you through this decision, ensuring that you choose the best option for your unique situation.
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