Lens Implants in Cataract Surgery

[GeeBee]

After my last eye exam, the time has come for cataract surgery. I am considering advanced lenses such a "ProOptix" or "Vivity" which will eliminate my need for glasses. The ProOptix will eliminate glasses entirely, but there is a 20% rate of "halo" around lighting at night. Vivity has less chance of "halo" but near vision will be functional but not perfect. My concern about "halo" is night flying. I don't want to be restricted to daytime operations if I turn out to the the "20%". So if you have any experience with these products or others, tell me your experience. We are talking Basic Med requirements here by the way.

 

[MikeOH]

Had my right eye done last February and no issue with 3rd Class.  Instant fix and no post-op complications whatsoever. I wish I had done it sooner.

However, my Dr. did NOT recommend the adjustable "no glasses" lens; said the tech wasn't really there, yet.  So, I went with fixed and still need glasses for near.  YMMV

[Hank]

Halos and other visual phenomena sometimes occur with IOLs. The key is to ignore them, as concentrating on the illusions will make your brain perceive them forever.

I've been out of IOL manufacturing for a decade now, so am not up to speed on the different makes and models, just know that new versions are introduced frequently. Avoid getting a lens on the bleeding edge of technology. I worked for Alcon, and back then the progressive lenses had up to 13 different zones.

Check with your surgeon, as there were two classes of people that were generally not good matches with progressive lenses:  pilots and engineers (I'm both!). This is due to high expectations, but like with an airplane, there are tradeoffs--multifocal lenses do not produce as crisp of an image as monofocal lenses.

But I've yet to talk to anyone who does not enjoy the tremendous improvement to their sight, which happens instantaneously when the new lens is put in.

[MooneyMitch]

I received the Vivity IOL's in both eyes one year ago.  My experience...................Distance and mid is excellent.  Driving [night and day], watching TV, that sort of activity is excellent.   Close up vision is as described, "functional".   Functional for me means that I can read phone text, computer screen, books, etc. mostly without glasses.   For prolonged up close reading, I do use 1.50 readers.   Small fine print, 1:50 definitely needed. 

My cataracts had not advance too far, but I wanted these new custom lenses so that I could read music without glasses. Reading music with the Vivity lens is mostly very successful.  I say mostly because depending on the lighting at night, I will occasionally miss a small sharp or flat symbol on the music. 

Since I no longer own or operate an aircraft, I can't speak to flying.  I have been told that pilots that have cataract lens replacement choose the standard lens fixed for distance, and use glasses for up close. 

The Vivity IOL's with lasar assisted surgery were out of pocket and quite expensive.  Medicare paid only the surgery [except for the lasar assist] portion of the procedure.  The standard distance cataract lenses have been around a long time and are tried and true............not to mention they are paid by Medicare. 

I am really happy I did have cataract lens replacement as vision is overall much brighter and colors are more brilliant!

Yes, I agree that the technology for IOL's are not perfected yet.  It's probably still a few years away.   If I can answer any further questions with my experience, please ask me.

[Rick Junkin]

@GeeBee Three years ago I chose the Vivity IOL for my right eye after considering the caveats presented by my ophthalmologist. I too am both an engineer and pilot and with my expectations aligned to the data I was presented I am absolutely satisfied with my decision and the performance of the IOL.

I observed haloing immediately following the procedure but didn't focus on it, as @Hank mentioned, and it significantly diminished over a week or two to where I don't particularly notice it now. The brain has amazing powers of adaptation. I have no problems flying at night.

My distant vision is 20/15 and both mid and near vision are 20/20. I do use 1.50 cheaters in low light and for extremely small text, and have a pair of FlyingEyes sunglasses with the 1.50 bifocal that close the gaps in the cockpit, but part of that is due to the health of my left eye which has a minor cataract not "ripe" enough for replacement.

Here's some important info that was valid three years ago. Someone please correct me if this has changed. Since you're on BasicMed this doesn't affect you, but for those who are in your same situation with a regular medical certificate you need to consider the 90 day grounding period associated with multifocal IOLs. With a monofocal IOL you are able to resume flying as soon as your eye doctor clears you for unrestricted activity, which is generally within 2 weeks after your procedure. Possibly even days after your procedure. But with the multifocal IOL the FAA requires you to sit down for 3 months to get acclimated to the new lens and verify no haloing or other negative issues. I had a second class medical at the time so I lined up my procedure with some planned airplane down time. For what it's worth I assessed I was good to go about a week and half after the procedure so if I had been on BasicMed at the time I would have been flying then.

Otherwise my experience is very much the same as @MooneyMitch

Cheers,
Junkman

[donkaye]

I've attached the article I wrote for the Mooney Flyer a couple of months ago.  For me I wanted to get off a Special Issuance and get my 2nd Class Medical back.  I got a Special Issuance 2nd class after a Medical Flight Test the 1st year that I had 20/20 in one eye corrected but only 20/25 in the 2nd eye corrected.  The next year both eyes were 20/25 corrected and not only did the FAA refuse the second class, but they issued the 3rd class requiring a yearly Opthomology  exam and said I couldn't get a medical through my AME, but only through the FAA.  That did it.  They basically bullied me into having Cataract Surgery.  After the fact I'm glad they did.  A month after the surgery I had an eye exam showing both eyes 20/20 corrected and I was immediately issued a 2nd Class Medical and taken off Special Issuance.

I read too many places where the multifocal lenses were not satisfactory, especially for pilots.  They took time and many appointments over a period of a month for adjustment before they were locked in.  I chose the monofocal Toric far distance lens due to astigmatism.  I did one eye at a time.  The surgery was easy taking only about 15 minutes for each eye.  The eye drop requirement required a spreadsheet to keep track of drop times, especially after the 2nd surgery, where each eye was on a different schedule.  The eye drops were needed for 5 weeks.

I've worn glasses since I was 10 or 11.  I don't need glasses for far vision now.  I love it!  I definitely need them for medium and close vision, but with the astigmatism corrected, the close vision is better than ever.  Although I got Progressive glasses from the Doctor, the best medium and close vision I get is from a $35 pair of Foster Grant multi focus glasses 2.5 strength.

Medicare won't pay for anything other than standard lenses.  The Toric lens at my location was $2,000 each.

Although I didn't notice the mild cataract, as others have said, the vision difference now is amazing.  I have to thank the FAA for their bullying.  I should have done it immediately and not gone through the hassle of the Special Issuance.

Special Issuance and the Long Road Back.pdf

[MikeOH]

@GeeBee

Don's post reminded me about the eye drops.  Not sure if this is universal, but I was offered 3-in-1 drops (expensive, $100 for a VERY small bottle) that didn't require the elaborate keeping track of drops; simple protocol of several times a day, tapering off over a 2 week period.  Something to ask about.  I found it worth the $100.

[Mark942]

So this is Saturday and I am having my first eye done this coming Thursday, with the second eye scheduled for two weeks later. I went with the simpler Mono lens because my doctor said about 20% of people still end up needing glasses for either near or far and then there are sometimes complications with halo.  I have been wearing serious coke bottles since I was 5 years old, so glasses seem natural and I have been assured that my vision will be far better even without the $7000 up-charge for the multi focal lens (rip off in my opinion).  My question is how is your vision in between surgeries and then following.  All my doctor told me was that my glasses prescription would be totally different than it is now. Do I take the lens out of one side for two weeks?  Then when the second eye is done, how long until my eyes settle down enough to be tested for glasses?  I've read on line you should wait 4 weeks.  I asked that my vision be set for arm's length to correct my nearsightedness.  The surgeon mentioned that they will provide a glasses prescription for $45.  I should have asked if this is several weeks later after testing or based upon theoretical from the pre-op measurements they took?  If it is based on theoretical, how accurate is that? Can anyone give me your experience regarding this.

[donkaye]

58 minutes ago, Mark942 said:

So this is Saturday and I am having my first eye done this coming Thursday, with the second eye scheduled for two weeks later. I went with the simpler Mono lens because my doctor said about 20% of people still end up needing glasses for either near or far and then there are sometimes complications with halo.  I have been wearing serious coke bottles since I was 5 years old, so glasses seem natural and I have been assured that my vision will be far better even without the $7000 up-charge for the multi focal lens (rip off in my opinion).  My question is how is your vision in between surgeries and then following.  All my doctor told me was that my glasses prescription would be totally different than it is now. Do I take the lens out of one side for two weeks?  Then when the second eye is done, how long until my eyes settle down enough to be tested for glasses?  I've read on line you should wait 4 weeks.  I asked that my vision be set for arm's length to correct my nearsightedness.  The surgeon mentioned that they will provide a glasses prescription for $45.  I should have asked if this is several weeks later after testing or based upon theoretical from the pre-op measurements they took?  If it is based on theoretical, how accurate is that? Can anyone give me your experience regarding this.

Your vision should be normal after 1 day.  Your eye was dilated by drops that, unlike simple dilation usually done when a doctor examines your eyes that lasts for a couple of hours, this one lasts a day.  You might as well throw your old glasses away after the first eye.  The brain seems to adjust with one eye done and the other not.  In fact some people permanently have one eye implanted with a far vision iol and one with a close vision iol.

The eyes take around a month to settle down according to the Opthamologist, so they don't do prescriptions until 4 weeks after the last eye is done.

Knowing what each of the eye drops did, I religiously adhered to the protocol, particularly those for the 1st week, one of which was an antibiotic.

When I asked the Doctor when I could fly, he said I could fly when I could meet the requirements of a medical.  They did a quick exam right after the 2nd surgery and my sight was so good I started flying a week after the 2nd eye was done.

[Hank]

I've known people to remove one lens from their glasses so they can see out of both eyes between surgeries. So you can look a little funny for a few days, or you can throw them away and see funny for a few days.

[MooneyMitch]

I will add that at my last eye exam, my vision was 20/15 with the Vivity multifocal lenses.  

[hubcap]

I had both eyes done about 8 years ago. No starbursts at night around lights at all. I pass my physical with 20/20 uncorrected. I do use reading glasses. 

[GeeBee]

Thank you all for your wonderful and helpful responses and experiences. You have helped me greatly. Of note, I found out now that if you use the laser scalpel, there is no eye drops as they place the medicine in you eye during the surgery. That is nice! Plaining for a late January procedure date. I will update you on the outcome!

[Hank]

@GeeBee, I had laser surgery (not on my eyes) last fall. It was easy, doctor said it was more accurate, and recovery was a breeze.

[Danb]

I’d consider RxSights LAL lenses, which are light adjustable lenses which provided 20/15/distance and 20/25 close up, I had a later complication where I dives PCO like a secondary cateract which was repaired by another laser treatment, scary since originally my close up was 20/15 post surgery but now is as mentioned 20/25 not many doctors are doing the new lense due to cost and the need for multiple adjustments where they change the prescription in the lense then after three treatments they lock in the prescription. It’s the wave of future lenses I’d research them I went that way only for flight.

I only use 1.50 readers when I’m working close up for hours to not get eyestrain. There about $6000 per eye 

[Fly Boomer]

I would add that we have a significant range of ages on this forum, so don't base your expectations entirely on someone else's experience.  Even someone exactly your age may have a completely different experience.  Also, I wouldn't hang my hat on new glasses in 4 weeks.  What if your eyes for some reason require 5 weeks to settle down after surgery?  You could end up with glasses that are not quite right.

[Hank]

5 hours ago, Fly Boomer said:

Also, I wouldn't hang my hat on new glasses in 4 weeks.  What if your eyes for some reason require 5 weeks to settle down after surgery?  You could end up with glasses that are not quite right.

Buy your glasses from Zenni Optical online, you will care a whole lot less. I've been a very satisfied customer since 2014.

Mu current glasses (single vision, titanium frames, Transitions for sunglasses outdoors) cost $90. I haven't pursued reimbursement from insurance . . .

[Fly Boomer]

6 hours ago, Hank said:

Buy your glasses from Zenni Optical online, you will care a whole lot less. I've been a very satisfied customer since 2014.

I need to try that.  My current lenses were a little over $500, and I had them put in an old frame that I liked.  Maybe they were expensive because they are progressives.

[Mark942]

Same here.  Good tip on a place to buy glasses at a more reasonable price.  Also really appreciate all the insight from all of you into what I should expect following my cataract surgery.

[TMitchell]

Anyone have opinion on going with Clareon Toric IOL (2,300 per eye) or the Clareon vivity Toric IOL (3,000 per eye)

[Hank]

Talk with your doctor about the benefits and drawbacks of each. There are so many different versions available now, singly and in combination. What extra benefits do you get for the extra money? Newer lens models, regardless of features, always cost more.

• Toric
• Wavefront
• UV-A
• Multifocal
• and more

I've been out of IOL manufacturing for ten years now, and even more options are available. 

Two population groups are generally not recommended for multifocal lenses:  engineers and pilots, as both groups have high expectations and particular strong desires (and I am in both!).

I used to make multifocal IOLs with 8-13 focal zones depending upon prescription strength, as the small radius lenses have more surface area than the flatter ones.

Good luck with your choices, the improved vision is immediate while still in the OR. Don't get hung up or annoyed with any visual disturbances afterwards, or your brain will learn to concentrate on them and they become permanent (halos around lights at night, out of focus areas in your peripheral vision, etc.).

[larryb]

I have the Vivity Toric multi-focal in both eyes. First eye done a year ago and second one done just this September. As a pilot and engineer with high expectations, I couldn't be happier with the choice. I only use reading glasses for extended reading. I do not need reading glasses for incidental use of my phone or activity such as reading a restaurant menu. I have no halo effect at night. I see better now than ever before. 

Edited November 10 by larryb

[donkaye]

Larry was lucky.  Multifocal lenses were not recommended for pilots when I was a doing my research earlier this year.  I'm, also, a flight instructor and former engineer.  I didn't like that multiple visits were necessary before the lenses were "locked" in.  If you "accidentally" exposed them to improper light they could get locked in by mistake.  I wanted the least risky and best chance to get off the Special Issuance and get my 2nd Class Medical back.  Therefore, I chose the Toric lens for far vision.  One month after both eyes were completed I got off the Special Issuance and got my 2nd Class Medical back.  I feel that was the least risky for me.  I've never had better distant vision, but need glasses for near vision.  Night vision is excellent, but I don't think the halo effect was applicable for the regular Toric lens.

[Rick Junkin]

5 hours ago, donkaye said:

Larry was lucky.

 

5 hours ago, donkaye said:

I didn't like that multiple visits were necessary before the lenses were "locked" in.  If you "accidentally" exposed them to improper light they could get locked in by mistake.

Well count me as lucky too. I got the Vivity multifocal IOL in my right eye in 2021 and didn't have any additional visits for adjustments or "locking in" that @donkaye speaks of. It works great for me and met all of my expectations, and I'm a scientist/engineer/test pilot/CFII.

Perhaps the adjustable lens technology is new in the last 3 years and I received an older fixed version of the Vivity multifocal IOL. At any rate it was a good choice for me and I'll make the same choice when my left eye cataract makes it uncorrectable by conventional means.

@Hank, you're the expert on IOLs. Any clarification on multifocal IOLs you can add? I'd hate for people to be scared away from considering an option that has clearly worked for some of us (puns intended).

EDIT: Reading back through the thread I see @Danb already answered my question about the latest tech advancements.

[larryb]

There was one single follow up visit after surgery and no discussion about locking anything in.