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LENSES and OUTCOMES
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DECISIONS |
A major goal of IOL surgery is achieving the OUTCOME desired by the patient. This means understanding in advance the "Big Picture" of options that are available. This way, when different lenses are presented and trade-offs discussed, the patient will be in strong position to make an informed choice. These overlapping choices can seem overwhelming which is why its important to have an experienced surgeon to navigate the process. Depending on the comfort level of the patient different styles of decision-making are used. 
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VISION GOAL (distance or other target) Matched distance has long been the goal of glasses and contacts. Similarly, IOLs are typically chosen to target distance (plano). An alternate concept to understand is MONOVISION. In the 1960s clinicians noticed some people adapted well to one contact lens for distance and one for reading. In the 1970s it gained popularity when monovision-with-contacts was marketed to avoid bifocal glasses. In the 1980s the concept was used to select IOLs for the same reason. Monovision is not for everyone though. People who rely heavily on precise depth perception and 3D clarity for spatial judgment are said to be poor candidates. Their brains are used to extracting high-quality, matched images from both eyes—and don’t like giving that up. Because adapting to monovision can't be predicted, many surgeons will trial a patient with contact lenses to test monovision before surgery. MINI-MONOVISION is when the range is narrower (-.75 to -1.50). This is said to have better depth perception and fewer side effects. TOLERANCE FOR TRADE-OFFS With glasses and contacts, achieving a focus-range from the eye to infinity is difficult. Progressives and bifocal glasses use multiple lenses to widen the range. Similarly, a standard monofocal IOL has a fixed range and the trade-off is using a pair of readers or computer glasses. EDOF monofocals and Multifocal IOLs use their own methods to widen the range. Their trade-off can be halos on light sources or a period of time for the eye to adapt. Just as with testing monovision a good surgeon should be collaberative and openly discuss the pros/cons of lens types without bias. INSURANCE ONLY COVERS BASIC MONOFOCALS The purpose of covering standard monofocals is to return the patient to "useful vision". Useful means to drive legally, read signs, watch TV, and navigate daily life. This low bar is acceptable, but the highly-visual pace of life in the 21st century requires better results IMO. Unfortunately, the more expensive lenses such as EDOF, LAL, Torics, and Multifocals are not typically covered by insurance. While a profit motive can exist for any product or service this doesn't mean that these enhancements have no value. If I can get a better outcome I will gladly pay extra. Why accept mediocre vision for the rest of my life? After some thought my Outcome is: the ability to drive glasses-free day and night — traveling, hiking and outdoor activities with no worry that if I lose my glasses that I'm stranded — watching live music events and cinema with few anomalies or halos — and getting up in the morning and going straight to the kitchen with no glasses. Most of the people I know over the age of 45 need readers, even without IOLs. So having to wear readers at times seemed a small price to pay. Glasses adapt easily—IOLs don’t. My next step was to schedule surgery.
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