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LENSES and OUTCOMES
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The goal of cataract surgery is to deliver the OUTCOME that matches the patient’s expectations. Yet there is no one-size-fits-all approach for the millions of cases treated with IOL implantation each year. This means it's very important for a patient to understand in advance the “big picture” of options. This way when different lenses and their trade-offs are discussed, the patient is positioned to make an informed decision.
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 matched 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 outcome. 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, it’s difficult to achieve focus across the entire span from near vision to infinity. Progressive and bifocal designs address this by incorporating multiple lens powers into a single lens. Contact lenses share the same limitation, though multifocal options exist. Monofocal IOLs have the same range limitation and can require reading glasses for close work, while EDOF and multifocal IOLs use different optical strategies to extend the range of vision. A good surgeon should be collaborative and openly discuss the pros/cons of lens types without bias. After much thought I decided my Outcome is: driving glasses-free day and night — traveling, hiking and outdoor activities — 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 I don't consider wearing readers a trade-off. GLASSES ADAPT EASILY — IOLS DON'T. 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? My next step was to schedule surgery.
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