Cataract surgery

[acepredator]

Hello. A recent thorough eye examination revealed that I have cataracts, at the relatively young age of 63. The doctor offered me the choice of two replacement lenses: mono-focal or multi-focal. The mono-focal are much simpler and cheaper, but would require using reading glasses. The multi-focal might also require reading or other glasses, but possibly not. The doctor informed me that there are potential complications with the multi-focal and strongly advised me to go with the mono-focal. I'm wondering if any readers have had cataract surgery and which lenses they chose and why. Also, what are your experiences since the surgery with the lenses you selected? This is a difficult decision due to the fact that I'll be stuck with the lenses I pick for the remainder of my life. I'm scheduled for surgery this June at Maharaj Hospital (a.k.a. Suan Dok) in Chiang Mai. Any information and insights provided by the voices of experience will be greatly appreciated as I struggle with this dilemma. 

[Rhacsyn]

Hi

 

I had intraocular lens replacement ten years ago. I did not have cataracts but both near and far sight had become poor with age. I was using numerous pairs of glasses for various activities and it was quite frustrating. I considered laser treatment but was convinced by my hospital that as i had poor near and far sight, both could not be fixed by laser and my best option was lens replacement. I was 51 years old at the time and as cataract surgery was / is far more  common than laser, I followed my ophthalmologists advice.

 

The operation was painless and less than six minutes per eye (operated on one week apart). I had multi focal lenses installed (again following the advice of global specialists) and my life was transformed. I am now 61 years old, and apart from a small occasional shadow effect, still have perfect vision. All of the above, including the selection of multi focal lenses, was done at the recommendation of Moorfields eye hospital in UK. Yes I am now in Thailand but have a close friend who recently did same in Bangkok eye hospital, again without complaint and 100% success.

 

Our incredulous brains, even older slowing ones (!), simply choose which part of the multi focal lens to use. The lenses themselves are the same so I am not sure, other than cost, why one would not follow the multi focal lens route.

[lopburi3]

Why do you need the cataracts removed?   If they are not causing issues you can normally wait until they do so.  Or were you having issues and that the reason for checkup?

 

Monovision is cheaper and less chance of issues and some people use reading in one eye and distance in the other to avoid need for glasses.  But reading glasses are inexpensive (cheap) and available everywhere and at your age not unusual to need. 

 

Surgery is easy and fast but should be done a month or so apart to rule out any issues.  I chose monovision and believe it was right decision (but was about 8 years older than you).   

[Sheryl]

As Lopburi3 mentioned, an alternative to the multi-focal lens approach is to go for monovision. this means inserting the standard mono-vision lens but leaving one eye a bit myopic.  To do this it is necessary to operate on the 2 eyes separately and leave enough time in between for the first eye to stabilize.

 

I have monovision after LASIK done more than 2o years ago - one eye is 20/20 (and has trouble reading up close) and the other eye is around 20/40 and reads up close fine, so I am still (knock on wood) able to avoid reading glasses.

[PaulS66]

Does anyone know if Queen Sirikit offer multi-focal lenses.  If so, any idea on ball-park prices?  I'd like to go for multi-focal (tri) which are obviously more expensive than monovision but if I can save a few bob on procedure costs by going with Sirikit or somewhere like that I'd be happy.  Or is Rutnin still the best bet?  Anyone  have any recent quotes on multi-focal at Rutnin? 

[Sheryl]

The lens cost is not going to vary much by hospital as the hospitals do nto produce the lens themselves, rather import them. What differs is the cost for the surgery.

 

No idea if QS carries multi-focal lens or not.

[acepredator]

12 hours ago, lopburi3 said:

Why do you need the cataracts removed?   If they are not causing issues you can normally wait until they do so.  Or were you having issues and that the reason for checkup?

 

Monovision is cheaper and less chance of issues and some people use reading in one eye and distance in the other to avoid need for glasses.  But reading glasses are inexpensive (cheap) and available everywhere and at your age not unusual to need. 

 

Surgery is easy and fast but should be done a month or so apart to rule out any issues.  I chose monovision and believe it was right decision (but was about 8 years older than you).   

Yes, I was having issues, which precipitated the eye exam. It had become impossible for my vision to be corrected with glasses, so I thought there must have been something more serious involved. I was surprised by the cataract diagnosis, but I have read that exposure to the strong tropical sun of Thailand can accelerate the development of cataracts. 

 

Very interesting idea to have one lens for distant vision and one for reading. I will talk to the doctor about it when I see him again next month. Thanks very much for your reply.

[acepredator]

10 hours ago, Sheryl said:

As Lopburi3 mentioned, an alternative to the multi-focal lens approach is to go for monovision. this means inserting the standard mono-vision lens but leaving one eye a bit myopic.  To do this it is necessary to operate on the 2 eyes separately and leave enough time in between for the first eye to stabilize.

 

I have monovision after LASIK done more than 2o years ago - one eye is 20/20 (and has trouble reading up close) and the other eye is around 20/40 and reads up close fine, so I am still (knock on wood) able to avoid reading glasses.

Very intriguing concept to have different capabilities in different eyes. Avoiding the need to use any kind of glasses is really the ideal situation for me. I will talk to the eye surgeon when I see him next month. Thanks very much for your reply.

[acepredator]

23 hours ago, Rhacsyn said:

Hi

 

I had intraocular lens replacement ten years ago. I did not have cataracts but both near and far sight had become poor with age. I was using numerous pairs of glasses for various activities and it was quite frustrating. I considered laser treatment but was convinced by my hospital that as i had poor near and far sight, both could not be fixed by laser and my best option was lens replacement. I was 51 years old at the time and as cataract surgery was / is far more  common than laser, I followed my ophthalmologists advice.

 

The operation was painless and less than six minutes per eye (operated on one week apart). I had multi focal lenses installed (again following the advice of global specialists) and my life was transformed. I am now 61 years old, and apart from a small occasional shadow effect, still have perfect vision. All of the above, including the selection of multi focal lenses, was done at the recommendation of Moorfields eye hospital in UK. Yes I am now in Thailand but have a close friend who recently did same in Bangkok eye hospital, again without complaint and 100% success.

 

Our incredulous brains, even older slowing ones (!), simply choose which part of the multi focal lens to use. The lenses themselves are the same so I am not sure, other than cost, why one would not follow the multi focal lens route.

According to my ophthalmologist, there can be an issue with excessive glare and a halo effect with the multi-focal lens. This could make driving at night even more perilous than usual. Also, some patients still need reading glasses, even with the multi-focal lenses. Fortunately for you and your friend that wasn't the case. I would be extremely disappointed if I paid the extra cost of the multi-focal lenses and still needed reading glasses. Thanks very much for taking the time to reply to my post.

[PaulS66]

18 hours ago, Sheryl said:

The lens cost is not going to vary much by hospital as the hospitals do nto produce the lens themselves, rather import them. What differs is the cost for the surgery.

 

No idea if QS carries multi-focal lens or not.

Yes I understand that.  Thanks for the reply.  The option of having a reader in one eye and far distance in another is very interesting and definitely warrants further research. 

[Sheryl]

1 hour ago, PaulS66 said:

Yes I understand that.  Thanks for the reply.  The option of having a reader in one eye and far distance in another is very interesting and definitely warrants further research. 

 

you can give yourself a trail of what it will be like (minus the cataract blurring) by wearing a contact lens in one eye only for a few weeks, discuss with your eye doctor.

[PaulS66]

6 minutes ago, Sheryl said:

 

you can give yourself a trail of what it will be like (minus the cataract blurring) by wearing a contact lens in one eye only for a few weeks, discuss with your eye doctor.

Thanks Sheryl.  Yeah that would be the sensible thing to do I guess.  It's incredible to think that the brain adapts to whichever lens is most suitable for a particular distance but this is the case right?  Have you encountered any major downsides with this approach?

[Sheryl]

None at all.  My brain is totally adjusted. But a small number of people apparently don't adjust hence the suggestion of a trail via contact lends first.

 

Basically my brain uses both eyes for anything not very close or very far (i.e. most things) but then one eye for far distance vision and one ye for reading. Happens automatically.

[PaulS66]

How do you go with the intermediate distance?  My PC monitors are approx 90cm away - guess it's likely I'd still need glasses there.

[PaulS66]

Ignore last post.  You've just answered my question.  Thanks a lot Sheryl

[frantick]

Tried multifocal contacts for one month, but never saw distance or close 100% clearly. It bugged the c..p out of me so I'll opt for fixed distance lenses when my time comes. The only thing I'll miss is being able to remove one contact to read when I don't have readers handy.

[Pib]

OP,

   When you say "multifocal" IOL, keep in mind there are various kinds and manufacturers (and of course in a wide range of prices).   But not to get complicated you will basically have two types: bifocal (designed for good focus at two distances....intermediate and far) and trifocal (i.e., designed for good focus at three/all distances....near, intermediate, and far).    With bifocal IOLs the chances are good you will still require glasses at least sometimes for good near vision….like smartphone and reading distances.   With trifocal IOLs the chances are good that you will "not" require glasses for any distance.  

 

The definition of near is approx the distance you hold a smartphone.....intermediate is arms-length or typical distance from a computer monitor....and distance is beyond arm’s length.  Based on your opening post I'm going to guess your eye doc is talking a bifocal multifocal IOL like the Symfony bifocal IOL vs a tri-focal IOL like PanOptix or FineVision trifocal IOL.

 

A monofocal IOL is good for one distance....usually for distance but can also be set for near or intermediate….but most people set it for distance.   As you've already read from other TVF members some have chosen to go with a mono-vision approach by having a monofocal IOL set for distance put in one eye and a monofocal IOL set for near put in the other eye.  With this setup the brain picks which eye to use for X-distance, but some people may a hard time adapting to mono-vision and you are probably still going to need glasses for certain distances.  

 

And up to about 10-15 years ago multi-focal IOLs were not available/super expensive so going the mono-vision approach was very common….but multifocal IOLs are now much lower in cost, improved, widely available where that was not the case in years past.

 

Pricing-wise a mono-focal IOL will be by far the lowest cost option, but when you go with a multifocal IOLs (a.k.a., a "premium" IOL) the price of the IOL shoots way up....and a trifocal IOL will cost more than a bifocal IOL.  Cost is probably the biggest reason the great majority of people go with monofocal IOLs as their insurance usually covers the cost the monofocal IOL when the surgery is due to cataracts…but if the surgery is not due to cataracts as in it’s just a person’s choice to not need glasses then insurance usually does not cover the cost of the surgery.   And the secondary reason being reason for using monofocal IOLs is there is less chance of having vision aberrations like halos (i.e., rings around lights to a degree).  

 

For me, I had trifocal IOL cataract surgery in Dec 2020...both eyes....two weeks apart.  I'm in my late sixties....have always disliked (hated) needing to wear reading glasses starting around age 45....and over the last few years the distance vision was getting blurrily also....had to juggle between +3.00 reading glasses and +1.50 glasses for driving....too cheap to spend big money on progressive/trifocal glasses that I would have to replace every few years as my eye lens continues to age or I broke the expensive glasses....remember, I'm not a lover of glasses.  

 

And cataracts were beginning to form in both eyes….for the great majority of people cataracts will begin to come along as a person ages normally in their 60s "just like grey hair and wrinkles."   It’s just a fact of life that unless you are one of the lucky few with the right genes/DNA your natural eye lens will begin to harden and cloud-up in your golden years which means your near/intermediate/far vision will head south.   Like I said….it’s like grey hair and wrinkles….nothing to be ashamed of.

 

Had the trifocal IOL surgery done at a govt hospital which specializes in vision just outside of Bangkok....approx Bt65K per eye with the PanOptix trifocal IOL being approx half of that Bt65K total cost per eye.  Now that was day of surgery cost….also need to add-in approx. $3K per eye for pre-op and post-op visits.  Both eyes done on an outpatient basis.   If I had went with a monofocal IOL the cost would have be around Bt25K-30K per eye on day of surgery.  This gives an example of how a premium/multifocal IOL can easily double the price of the surgery in comparison to a monofocal IOL.

 

Am I happy with the results--YES SIR!!!  No need for glasses at any distance.  I can put a smartphone a mere 20cm/8 inches from my eyes and the text is still perfectly clear.    One eye has great vision near, intermediate and far....and the other eye (which had PRK surgery approx 15-20 years ago) great vision near and intermediate but the far vision is a little blurred/soft when trying to read detail like lettering on a sign at approx 5 meters and beyond.  How much blur in that eye depends on the size of the lettering and the distance but generally distance vision in that eye is fine when just looking at houses, trees, vehicles, etc.,…and it continues to get better. However, since I don't walk around looking out of just one eye (like Popeye the Sailor Man)  but use both eyes (a.k.a., binocular vision) my vision near, intermediate, and far is very good.   For the eye with the slight distance vision blur right now I may end-up having touch-up PRK later this year after I’ve given it plenty of time for the vision to stabilize.  If I do have touch-up PRK it will just be more of a “I want to do it” because as I said my binocular vision is very good….oh so happy.

 

 ny eye that has had LAZIK/PRK type surgery in the past has forever altered the cornea shape/power which adds difficulty for the eye doctor in determining/calculating  the “correct optical power in diopters” of the IOL to insert…. and even if the IOL power chosen is correct “overall” since your cornea was reshaped in the previous surgery your vision may still end-up with some aberrations at different distances.  This can happen for a mono-focal or multi-focal IOL, but with a mono-focal IOL since it’s being set for one distance there is less chance of vision abbreviations occurring.    You gotta remember that a “non-torric” IOL is manufactured for a virgin eye (i.e., never had surgery before).   And when talking a “torric” IOL (i.e., an IOL made to also reduce astigmatism) then the price of the IOL to going to be significantly more.  But if you current astigmatism is less than 0.50 diopter your eye doc will not even recommend a torric IOL.

 

Now with multifocal lens you “will” see some halos around bright lights (mostly only at night)….it’s the result of the multiple rings that make-up a multifocal lens.  Like halos around vehicle headlights and streets lights depending on the distance from them and the angle of view.    The distance and angle is important because if I’m standing right under a streetlight and lookup at I do not see any halos….but when I start putting more distance between me and the streetlight as in walking down the street I start seeing two halos around the light…very close to the light.     Are these halos bothersome?—No…it just makes the bright lights look a little different.   Now when looking at lighting emitted from say a fast food store lighted menu sign, watching TV, looking at my computer/smartphone, etc., there are no halos.     And from what I read for most folks these halos fade and after approx. one year are hardly noticeable.  It’s been a little over three months since my surgery and the halos around bright lights I see at night are fading….I expect after about a year I won’t even notice them anymore.   Summary: halos shouldn’t pose any problem.   

 

 And you will hear about some folks seeing a shadow shaped like a quarter moon on the periphery of their vision/corner of the  eye which can happen with a multifocal or monofocal lens (this is caused by light reflections off the “edge” of the IOL….)….I have no such shadow with my trifocal IOLs.   These possible side effect of halos and shadows is just something you need to google about….I"m pretty sure after you googling you will see it only poses a problem for a small number of folks (i.e., just a few percent).

 

In closing, YES SIR I’m happy with my trifocal IOL results….been spectacle-free for near/intermediate/far vision since the surgery…totally glad I went this route.   Oh, by the way, the surgery itself is pain-free, only takes about 10 minute on the operating table….at most you will feel some discomfort (not pain) from the BRIGHT surgical light used during the operation….boy, or boy is that surgical light bright!!  And no pain or discomfort after the operation.  Cheers.

 

[PaulS66]

Fantastic post Pib - very informative.  Thank you.  Which hospital did you use?

[Pib]

2 hours ago, PaulS66 said:

Fantastic post Pib - very informative.  Thank you.  Which hospital did you use?

Metta Pracharak Hospital in Nakorn Pathom province....hospital is a 30 minute drive from western Bangkok....real close Wat Rai Khing which is well known to Thais in this part of Thailand.  It's now in a brand new 10 story building with all knew equipment.   While the doctors can speak English, when it comes to nurses and support staff don't expect to find much English conversation skills.   Best to first visit with a Thai in tow.

 

Pracharch Hospital in Nakorn Pathom province.

http://www.metta.go.th/

 

They also have an Eye Center of Metta Pracharck Hosptial close to the Ekamai BTS Station on Sukhumvit in Bangkok, but I've have never been to it nor know if that center charges govt hospital prices or private clinic prices.

http://www.mettaeyecare.org/th/index.php/contact/

 

[Pib]

 

Below weblinks cover the basic types of IOLs available such as monofocal, bifocal, trifocal, torric, EDOF, etc.  

 

As a reminder IOLs come in "non-torric" (does not correct astigmatism) and "torric (corrects for astigmatism) versions.   So when you see "torric" think astigmatism correction.  A torric version of any IOL will drive-up the IOL cost significantly...and unless you have astigmatism of around 1.0 diopter or more your eye doc is probably not going to suggest a torric version....can depend on the type of IOL you having inserted.  Like the PanOptix trifocal IOL can come in a torric model that corrects 1.5, 2.25, 3.00, or 3.75 diopters of astigmatism.  I had the non-torric PanOptix version as my astigmatism in each eye was only around 0.5 diopter.   I expect other types of IOLs made by different manufacturers all have their different astigmatism correction capability.  

 

https://floridaeye.org/cataract-lens-options/

 

https://www.allaboutvision.com/conditions/toric-iols.htm

 

 

A chart summarizing the range of vision capabilities of different IOL types.....and remember, when you say a "multifocal" IOL such an IOL could be a bifocal, trifocal, EDOF, etc.   And a monofocal IOL can be set for good vision near/intermediate but most people go with far vision then use glasses for near/intermediate vision unless they are going with the monovision method where one monofocal IOL is set for far and one monofocal  IOL is set for near.

 

https://www.bangkokhospital.com/en/content/cataract-surgery-and-intraocular-lens

 

[PaulS66]

Pib, 

 

I'm not currently in Thailand at the moment but will be towards the end of the year.  I'll be looking at something like the PanOptix trifocal and I will definitely check out Metta - sounds just the ticket.  Your posts and links have helped a lot.  I appreciate you taking the time - thanks again!

[acepredator]

Pib,

 

Thanks very much for the tremendous amount of information and insight you provided in response to my post. As I mentioned previously, there's nothing like the voice of experience. In this case, even more helpful in that your experience was so recent. You obviously did a great deal of research before selecting the lenses that would be best for you. It seems that your research paid off in the degree of satisfaction that you've obtained after your surgery. Armed with the extensive knowledge I acquired from your replies, I will discuss the matter with my eye surgeon when I visit him again next month. Thanks again for taking the time to provide highly informative responses, and best of luck in the future with your new lenses.

[Pib]

Like everyone thinking about cataract surgery or lens replacement surgery (both the same thing...just different names....in that the natural lens is replaced due to cataracts or some other poor vision reason) before I decided on whether to have such surgery and which IOL to go with I did ton of googling and watching Youtube videos on the subject. 

 

I think some of the best Youtube videos on cataract/lens replacement surgery are done by Dr. Shannon Wong of Austin Eye in Austin Texas.  Below is one of his Youtube videos from Dec 2019 where he explains the different types of IOLs, but concentrating on the "multifocal" IOLs...specifically the Symfony bifocal IOL and the PanOptix trifocal IOL which in the U.S. are apparently the most popular multifocal IOLs. 

 

Keep in mind that the PanOptix trifocal IOL was only approved for use in the U.S. in mid 2019 (but years earlier in other parts of the world like Europe), so in this Dec 2019 video he only has about 6 months of actual experience with the PanOtpix IOL . And the bifocal Symphony IOL has been in use since around 2015 in the U.S.  However, as you look at more recent videos by Dr. Wong you'll see that the PanOptix IOL has turned into his premium lens of choice since it provides good vision near, intermediate & far versus just intermediate & far.    Understandable...if a person is going to have cataract/lens replacement surgery why not pick the IOL that gives the widest range of vision if it's within the person's price range, you want the best chance of being able to ditch glasses, and your current overall eye health including the all important retina supports insertion of a multifocal IOL.  

 

 

Below is cut and paste of what the video covers...and the Uoutube link itself.
 

Quote

 

The Symfony and Panoptix Lenses are the most popular premium presbyopia-correcting lens implants currently available in the US. In this video we compare the strengths and weaknesses, pros and cons of these two lens implant technologies used for Laser Lens Replacement and Cataract Surgery. 0:01 Introduction 3:04 Two groups of people/patients that we use these lenses for 5:02 The normal aging process of the lens inside the eye and the how we use lens implants to correct vision 6:38 Why the panoptix and symfony lenses are considered "Premium lenses." 7:56 Do these lenses correct astigmatism? 8:04 The 3 zones of vision - far, mid-range and near 8:50 How the symfony lens performs 9:55 How the panoptix lens performs 11:58 How different lens implant technologies perform optically 16:38 Halos and the panoptix and symfony lenses 17:25 Do these lenses work well in patients that have had prior LASIK or RK surgery? 18:54: Do these lenses work well in patients with retina conditions such as macular degeneration, macular hole, epiretinal membranes and diabetic retinopathy? 20:38 Do these lenses work well in patients with glaucoma? 21:44 Comparison of the lens implants material and lens longevity 23:10 Glistenings associated with the restor and panoptix lenses 25:55: Scuff marks on the panoptix lenses 26:25 Cost comparison of the symfony and panoptix lenses 26:38 Comparison of the Symfony and Panoptix lenses on a chart.

 

 

 

 

 

 

[izod10]

Before covid came around I was in discussion with eye surgeon in India,so stopped me going. I have no cataracts so I was informed whilst there a few years ago,but obv could change

  Powered surgery is what I was most interested in,no knife,but laser,however soon as I get the covid jab Ill commence the journey.

 

  costing as far as could ascertain at ruthin was 190,000 for a similar procedure that I was quoted 35000 in India both eyes,but now Rp has crashed in the region of 20% since I was last there (knee surgery) it will be far cheaper

 

medifee.com

[Pib]

Another good youtube video on monofocal and multifocal IOLs....only 5 minutes long.

 

 

[PaulS66]

Thanks Pib.  Super helpful.  Was there much of a waiting list for surgery at Metta?

[Pib]

44 minutes ago, PaulS66 said:

Thanks Pib.  Super helpful.  Was there much of a waiting list for surgery at Metta?

About 3 to 4 weeks.

 

[Pib]

A good layman's version of how the eye works, main parts of the eye, how our natural lens loses its adaptability (i.e., ability to change shape which allows focus) and gets cloudy as we age, etc.   A person should have a good understanding of how the eye works before visiting the eye doc to talk about cataract/lens replacement surgery.

 

 

[Boomer6969]

On 3/26/2021 at 9:20 PM, acepredator said:

Very intriguing concept to have different capabilities in different eyes.

Intriguing indeed, and I wonder how this can affect 3D vision, which is absolutely essential for driving, and especially so in Thailand.

[Pib]

1 hour ago, Boomer6969 said:

Intriguing indeed, and I wonder how this can affect 3D vision, which is absolutely essential for driving, and especially so in Thailand.

It would be good to hear from some folks who have monovision "and drive frequently" in how monovison affects their depth perception which is important for safe driving.

 

And depth perception is something that is checked when initially applying for and when renewing your Thai drivers license (or at least that's been my personal experience with my Thai drivers license). 

 

When I googled "monovsion depth perception" I came-up with a long list of websites saying monovision can affect depth perception, but as nearly always the degree of impact varies from individual-to-individual (just a tad to a lot), other associated eye issues the person may have, etc.    

 

But my overall sense from previous research (googling, youtubes, etc.,) is most people get along just fine with monovision but for some people it can cause problems.....but hey, multifocal lens can cause problems for some people also.  For me, I'm getting along just fine with my multifcoal (trifocal) IOLs since the surgery in Dec 2020....definitely no depth perception problem while driving, walking, doing anything, etc., day or night.   And I drive daily.

 

If possible/if not too costly, probably best to give monovision a try with contact lens for a few weeks before making a decision to go this route for IOL surgery....and of course your eye doc is the expert on this issue versus a keyboard warrior using a google sword.   

 

Here's one weblink I googled about choosing between monovision and multifocal IOLs.....and the article even talks about the two types of monovision....Conventional and Mini.   

Choosing between monovision and multifocals

https://www.eyeworld.org/choosing-between-monovision-and-multifocals