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What are the cataract IOL choices when there is diabetic retinopathy?
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MedHelp Member's Question

What are the cataract IOL choices when there is diabetic retinopathy?

by MMEE, Jan 02, 2007 12:00AM
I have diabetic retinopathy but I have tight control of the diabetes now (last A1C=4.9). I have had several steroid injections which have caused serious cataracts to form in the last 6-months. I have a consultation next week and would like to go in with some familiarity about the choices, if any, available to me. So far, from reading the forum, I have gleaned that silicone lenses are probably out of the question. I am wondering whether I will have the choice of multifocals, or aspheric lenses, or is standard monofocal my only choice?  Thanks to this forum and to its participants for all the information.  I have learned a lot here.
Doctor's Answer

by Forum-OD-MP, Jan 03, 2007 12:00AM
many opinions on this.  differs by surgeon.
Member Comments (6)

by JodieJ, Jan 02, 2007 12:00AM
To: MMEE
You're right, many (but certainly not all) retinal surgeons don't favor silicone lenses for people with a history of retinal problems.  (Mine told me that any lens was okay, as long as it wasn't silicone.)  But there are many other factors that might make one lens better than another for a particular person, including pupil size, astigmatism, IOL power needs, and the familiarity of the cataract surgeon with a particular lens or manufacturer.  (I was initially surprised to learn that many surgeons work with only 2 or 3 lenses, usually from the same manufacturer.)



It's great that you're doing some research in advance so that you'll know more about what's available.  I suspect that you'll have some choice after hearing the cataract surgeon's recommendations.  (And you can always go for a second/third opinion.)  It would probably be best if your retinal surgeon approved of the selected lens, too.

by MMEE, Jan 02, 2007 12:00AM
To: JodieJ
Thank you for your reply, Jodie.  I've read many of your posts and I value your comments.  In fact, my mentioning 'aspheric lenses' originates from some of your posts. I have been thinking that they might be my best choice, if they are available to me.  Maybe one lens set for distance and the other lens' focus set a little back as you mentioned in one of your posts.  Unfortunately, I know very little about my eyes. For example, I don't know whether my pupils are large or small; and I guess I don't have any astigmatism since I've never worn glasses.

I hope that your Acrysof IQ aspheric lenses are working out well for you. I am more than a little interested in your having a successful outcome.  Like you, I don't want to deal with halos and would like to be driving safely at night years from now. Moreover, I don't think that psychologically I could stand the long adjustment period that may be necessary with multifocals.

by JodieJ, Jan 03, 2007 12:00AM
To: MMEE
I think that the monofocal Tecnis (which comes in both an acrylic and silicone model) by AMO and the AcrySof IQ by Alcon are both excellent aspheric lenses.  I actually had to argue with my cataract surgeon to get aspheric IOLs--he thought that nothing could be better than the conventional AcrySof lenses.  There's an excellent website demonstrating the enhanced night driving ability provided by the Tecnis.  For me, anything that might allow me to keep driving at night in the years to come

is a real bonus.



Best of luck with your surgery!

by MMEE, Jan 03, 2007 12:00AM
To: JodieJ
Jodie, did you mean that there is a website with a demo of the enhanced  night driving abiliity?  All I can find are these results:

"In a simulated night driving study, patients viewing a rural road through the TECNIS(R) lens identified a pedestrian hazard significantly sooner than through a traditional spherical IOL. The TECNIS(R) lens also provided a 45-foot advantage in detection and identification distance. At 55 MPH, this would provide an additional 0.5 seconds to perceive and react to a pedestrian hazard."

Jodie, how are you doing with the aspheric implants and the bifocal contacts?  I really hope all is well. I was thinking that you made a good choice in the sense that the Acrysof IQ aspheric is a basic lens with benefits like possible protection from macular degeneration (UV/blue light filter) and, of course, the the low-light driving ability. And perhaps as contact lens technology improves over time, you will acquire future vision enhancements more easily than with a more complicated lens. Hopefully, you have left more options open with this choice. You've inspired me to probably choose this myself. Thanks.

by JodieJ, Jan 03, 2007 12:00AM
To: MMEE
The website www.tecnisiol.com has an excellent patient information video explaining what cataract surgery involves and demonstrating the advantages of an aspheric lens over traditional models.  It runs about 15-20 minutes, and I thought it was interesting and informative.



But I don't want to leave you with a biased picture.  (And that Tecnis video makes you want to sign up for a Tecnis implant right now.)  I've been disappointed in the results of the two small, independent  (i.e., not paid for by the IOL manufacturers) studies I've read comparing vision with aspheric vs. traditional IOLs.  In one study, there was no difference in distance vision between the two types of lenses but near/intermediate vision with traditional lenses was better when measured objectively.  In a second study, people who had a different lens implanted in each eye generally preferred their vision in the eye with the traditional lens--even at night!  It's been reported that decentration and tilt can negate the benefits of an aspheric IOL, so maybe that partially explains these results.  Both studies involved a very small number of participants.



If you leave one of your eyes a little nearsighted, you'd probably only need readers occasionally for very small print.  With both eyes set to plano, I wear my bifocal contacts or progressive glasses almost all the time--except for driving and watching movies.

by MMEE, Jan 04, 2007 12:00AM
To: JodieJ
Jodie, thank you so much for all your posts, especially your last answer to me. You have helped me so much in gaining some understanding and information about my situation.  You are very intelligent and conscientious and kind--and unselfish to share  what you have found. You've saved me much time and effort.  It's been difficult for me to read lately. But even with good vision, I doubt that I could have accomplished the extensive research that you have done. I really appreciate your help.  My best wishes to you.
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