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Cataract surgery

Started by RobertHowe, 04/02/2022 08:04PM
Posted 04/02/2022 08:04PM Opening Post
After increasing difficulty for 5 years, my dominant-eye cataract is ready to go.  I will appreciate advice from AMarters about the sort of replacement lens to seek and anything else I should know. 

I have found a couple of threads on CloudyNights and an amazing pdf by Jerry Oltion on the problems his wife faced from an unsympathetic surgeon.  I have ordered a book on Astronomy for Older Eyes. 

My long-time opthalmologist, himself an observer, retired two years ago, so I intend to seek three opinions, then go with the Doc who is most sympathetic to an observer.

Your thoughts will be appreciated. 

Robert Howe
Wilbraham MA


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Posted 04/05/2022 06:47AM #1
Hello Robert:

That's an excellent question. I had both myopia and astigmatism issues and wore bifocal lenses in my glasses. As a "cataract surgery survivor," (2012) who is also an astronomy enthusiast, cataract surgery was a big deal for me. Fortunately, I had a surgeon who was very familiar with this issue. Some of these may not be applicable to your condition. You have a range of options with IOLs. Straight plastic replacement with no myopic or astigmatism correction, or IOLs with correction for one or both of those conditions, or, a sort of bifocal option, or a "soft" lens option they had just come out with at the time, that would eliminate the need for bifocals, since the eye itself would be able to focus this lens near and far. The surgeon told me that the "bi-focal" and "soft lens" options would affect my ability to focus star images across a wide field. He recommended that I stick with the hard plastic lenses, with or without the correction built in.  That's what I ended up doing.  Post surgery, I was able to ditch my glasses entirely. The clarity and pinpoint star images were breathtaking in their magnificent contrast. It was like being reborn! This cataract stuff sneaks up on you over the years and you just don't realize how bad things have gotten.

That was 10 years ago. The third year in, my astigmatism began to return. I had to go back to wearing glasses to correct it. But I still don't need correction for myopia - just the astigmatism, so the lenses in my glasses are very thin.

Today, you probably have options that weren't available 10 years ago.  But here are a few ideas to discuss with you doc.  Good luck!

- Chuck     
Posted 02/06/2024 06:58PM #2
This thread is a bit old, but for anybody finding it later on and facing this I can give a few words on my experience. I didn't have cataracts, but had myopia and astigmatism. It wasn't severe but I needed glasses to enjoy the night sky (or to drive for that matter).

My wife, who had much worse vision problems, went for multifocal IOLs in each eye, that was in 2010. The type was called M-Plus (though the manufacturer has now gone bust, for reasons which will become clear). They have the part with a different strength (by 2 dioptres) in a segment, like a pizza slice. She loved them and went on campaign to persuade me to have the same procedure. After 2 years I relented and went for it.

However, there is a particularity with these IOLs: the different strength in a sectors has edges, which cause diffraction spikes, like the spikes around the support of a spider in a reflector telescope. They're not noticeable in daytime, but with bright lights against a dark background, whether it's driving at night, or looking at stars or the Moon, they show up as 2 horn-like projections.

I spoke to the designer (put in contact by the opthalmologist) and he actually advised me not to choose them in my situation, being interested in clean and clear night views. But my wife insisted it was not so bad and it's true that the brain does eventually adapt so that they are scarcely visible. As you might guess, my wife was persuasive and I did take them. The change in my vision was breathtakingly good, and after a time I did find the spikes to be less and less troublesome.

But, after about 9 years, I found my vision was becoming cloudy, just as if I was developing cataracts. It got so bad that I could only see the brightest stars and was unable to see nebulae in the eyepiece. It turned out that the lenses I had, in 2012, had been part of a batch which had been transported in a contaminated liquid, which caused internal crystalisation in about 10% of patients. The only option was to have them replaced. my opthalmologist told me that all costs would be borne by the IOL manufacturer, and sent me to one of only 2 surgeons in The Netherlands who could perform the procedure.

In the end, the company did not pay, because they had gone bust, quite possibly as a result of this. But the surgeon I chose had been able to obtain all thier stocks, so I only had to pay for his work, the replacement also being an M-Plus multifocal IOL.

This time the procedure was more difficult and required going in via the pupil, and not without risks. In fact the surgeon told me he thought he was the only one in Europe who could do it.

So now, almost a year later, the cloudiness has gone, but I'm left with myopia and astigmatism again -- pretty well back where I started -- and have to wear glasses to view the night sky.