Help me understand presbyopia-correcting IOLs surgery
August 20, 2015 6:25 AM Subscribe
I am getting cataract surgery (which is fully covered by my insurance) but they also gave me the option to pay out of pocket for "not medically necessary" presbyopia-correcting IOLs which I don't really understand, and it costs about $2,261 per eye.
What does this presbyopia-correcting IOL do exactly? And is it worth the money for me? I am very confused. Tanks
I had cataract surgery about a year ago. I had had extreme nearsightedness and astigmatism since childhood, and glaucoma since my 30s. My vision started to blur and become un-correctable in my mid-40s, and my eye doctor diagnosed cataracts. IOLs are used in *all* cataract surgery - the surgery is to break up and remove the natural lens which is cloudy and brittle, and replace with an artificial lens. Here's where the insurance comes in:
* most insurance covers a basic lens that corrects the cataract issue, but is only optimized for distance, so you need reading glasses, even if you had 20/20 before. The basic IOL doesn't flex like the real one and can't adjust to different distances well, which can be annoying but maybe is ok if you're 75 :-)
* various companies make fancy IOLs (I have CrystalLens) that flex or move in a way that can give you better adjustment at different distances. Not covered by insurance and typically a few thousand bucks per eye.
I'm not sure about the specific type you mention (for correcting nearsightedness). What my surgeon did is combine laser surgery with the cataract surgery (wheeled through two different rooms one after the other) and at the end I had the adaptive fancy IOLs and corrected vision including the astigmatism. I now have 20/20 distance and mid vision (typing this without glasses) but I have glasses for reading print stuff like books. I don't need them for Kindle since I bump up the text size a bit.
Make sure you have a doctor who has done a ton of these surgeries - shop around if needed. If you are young I'd go for the higher cost IOLs. Usually the price includes all the follow-up care. I went back 2-3 more times for minor adjustments (15 seconds with a laser while sitting up, easy peasy) and they were great about assuaging my fears and worries. It did take 6+ months for my vision to get where I wanted it, and you get minor annoyances like itchy eyes and the zillions of drops you take for the first few weeks, but I love walking and driving without glasses.
Good luck!
posted by freecellwizard at 6:50 AM on August 20, 2015 [4 favorites]
* most insurance covers a basic lens that corrects the cataract issue, but is only optimized for distance, so you need reading glasses, even if you had 20/20 before. The basic IOL doesn't flex like the real one and can't adjust to different distances well, which can be annoying but maybe is ok if you're 75 :-)
* various companies make fancy IOLs (I have CrystalLens) that flex or move in a way that can give you better adjustment at different distances. Not covered by insurance and typically a few thousand bucks per eye.
I'm not sure about the specific type you mention (for correcting nearsightedness). What my surgeon did is combine laser surgery with the cataract surgery (wheeled through two different rooms one after the other) and at the end I had the adaptive fancy IOLs and corrected vision including the astigmatism. I now have 20/20 distance and mid vision (typing this without glasses) but I have glasses for reading print stuff like books. I don't need them for Kindle since I bump up the text size a bit.
Make sure you have a doctor who has done a ton of these surgeries - shop around if needed. If you are young I'd go for the higher cost IOLs. Usually the price includes all the follow-up care. I went back 2-3 more times for minor adjustments (15 seconds with a laser while sitting up, easy peasy) and they were great about assuaging my fears and worries. It did take 6+ months for my vision to get where I wanted it, and you get minor annoyances like itchy eyes and the zillions of drops you take for the first few weeks, but I love walking and driving without glasses.
Good luck!
posted by freecellwizard at 6:50 AM on August 20, 2015 [4 favorites]
I had cataract surgery about a year ago on both eyes, and opted for the multi-focal lenses you're asking about. As I understand it, they automatically "adjust" somehow to let you see well both near and far. They cost about $1,000 more per eye and were not covered by any insurance, including Medicare which I've got, so it came out of pocket. I've found them worth it. My vision is now virtually perfect in one eye, and almost perfect in the other although that second eye still has occasional issues with tearing up a little when I read or watch tv or hang out on the computer too long. That's tolerable though, and I'm told that most people don't even have that much trouble. Before the operation, I had terrific close-up vision--much younger friends asked me to read the small print for them--and I lost a bit of that with the new lenses, and I sometimes need a bit brighter light than before when I read. But I don't need specs for distance anymore. No more awkward glasses!
Bottom line: Highly recommended.
posted by fivesavagepalms at 7:30 AM on August 20, 2015
Bottom line: Highly recommended.
posted by fivesavagepalms at 7:30 AM on August 20, 2015
Your experience might depend on how your vision was previously, and how you felt about the correction you wore, not considering the cataracts.
You should ask your surgeon about what sort of corrective lenses you may have to wear after the surgery, both reading lenses and/or further nearsightedness correction. If you get the corrective IOLs you may not need correction of either type any more, but that depends on your vision.
In fact, if I were you, I'd call the office and request a full explanation of what your vision will be with either choice (getting the presbyopia correction, or not). You might also ask how your vision could be in a decade, and what further corrective options will be available to you then.
(My mother, very nearsighted and with astigmatism, used to wear hard contacts; evidently rigid gas-permeables correct astigmatism partially by forcing the eyeball surface to their shape. Her IOLs corrected for the astigmatism, so she can't wear rigid lenses anymore, because then it would be double-corrected. Her nearsightedness was bad enough that the IOLs couldn't totally fix it, so she had to start wearing soft contact lenses which she did not like.)
posted by nat at 8:35 AM on August 20, 2015
You should ask your surgeon about what sort of corrective lenses you may have to wear after the surgery, both reading lenses and/or further nearsightedness correction. If you get the corrective IOLs you may not need correction of either type any more, but that depends on your vision.
In fact, if I were you, I'd call the office and request a full explanation of what your vision will be with either choice (getting the presbyopia correction, or not). You might also ask how your vision could be in a decade, and what further corrective options will be available to you then.
(My mother, very nearsighted and with astigmatism, used to wear hard contacts; evidently rigid gas-permeables correct astigmatism partially by forcing the eyeball surface to their shape. Her IOLs corrected for the astigmatism, so she can't wear rigid lenses anymore, because then it would be double-corrected. Her nearsightedness was bad enough that the IOLs couldn't totally fix it, so she had to start wearing soft contact lenses which she did not like.)
posted by nat at 8:35 AM on August 20, 2015
Response by poster: I am 59 years old. If I am wearing reading glasses I can read so-so. Is my reading-vision likely to get worse over the years? Will there be a point I can't read even with glasses? If so, I'd be much more likely to get the corrective IOLs
posted by kikithekat at 9:03 AM on August 20, 2015
posted by kikithekat at 9:03 AM on August 20, 2015
Will there be a point I can't read even with glasses?
I don't think so, but I would ask the doctor that. Go in with a very specific list of things that are important to you (like being able to read comfortably), and talk about options in that context. My doctor actually had me fill out a survey where I checked off the things that I cared most about. Also ask about the risks!
Generally near/farsightedness and astigmatism can always be corrected with lenses, so as your vision changes you'll just get different prescriptions like you've always done. Cataracts require surgery because the brittle/cloudy natural lens is diffusing the light inside the eye, and no prescription can solve for that. Basically if you go in for a checkup and no amount of twiddling the dials on the vision testing machine (better ... or worse? 1 ... or 2?) produces 20/20 vision, it might be cataracts. That's how I found out I had them.
posted by freecellwizard at 11:31 AM on August 20, 2015
I don't think so, but I would ask the doctor that. Go in with a very specific list of things that are important to you (like being able to read comfortably), and talk about options in that context. My doctor actually had me fill out a survey where I checked off the things that I cared most about. Also ask about the risks!
Generally near/farsightedness and astigmatism can always be corrected with lenses, so as your vision changes you'll just get different prescriptions like you've always done. Cataracts require surgery because the brittle/cloudy natural lens is diffusing the light inside the eye, and no prescription can solve for that. Basically if you go in for a checkup and no amount of twiddling the dials on the vision testing machine (better ... or worse? 1 ... or 2?) produces 20/20 vision, it might be cataracts. That's how I found out I had them.
posted by freecellwizard at 11:31 AM on August 20, 2015
I have had cataract sugery in both eyes now.
I'm aware of three "accomodating" IOL lenses:
My first eye I did chose a crystalens (and paid out of pocket for it). My experience has been fine, but I haven't noticed much accomodation/focusing from it. This eye ended up with good intermediate-distance focus.
For my second eye, I went with a single-focus standard IOL. I ended up with good distance vision.
With one eye distance-focused and one intermediate-focused, I have what I believe is called "monovision". I haven't worn prescription lenses for a few years now and am pretty psyched about it. Sometimes when I go to the movie theater I pop a contact lens in my computer-distance eye to have both eyes long-distance focused.
I'd suggest sticking with the normal single-focus IOLs, but who knows - I'm sure in 10 years there'll be great bionic accomodating lenses!
Best of luck with your eyes! It's not the most comfortable surgery, but the vision improvement is almost always great!
posted by sarah_pdx at 10:18 PM on August 20, 2015
I'm aware of three "accomodating" IOL lenses:
- rezoom and restor: work by having alternating rings that focus at two distances
- crystalens: has mechanical "wings" that your eye focusing muscles are supposed to be able to move to move the lens - somewhat like a natural lens
My first eye I did chose a crystalens (and paid out of pocket for it). My experience has been fine, but I haven't noticed much accomodation/focusing from it. This eye ended up with good intermediate-distance focus.
For my second eye, I went with a single-focus standard IOL. I ended up with good distance vision.
With one eye distance-focused and one intermediate-focused, I have what I believe is called "monovision". I haven't worn prescription lenses for a few years now and am pretty psyched about it. Sometimes when I go to the movie theater I pop a contact lens in my computer-distance eye to have both eyes long-distance focused.
I'd suggest sticking with the normal single-focus IOLs, but who knows - I'm sure in 10 years there'll be great bionic accomodating lenses!
Best of luck with your eyes! It's not the most comfortable surgery, but the vision improvement is almost always great!
posted by sarah_pdx at 10:18 PM on August 20, 2015
> I am 59 years old. If I am wearing reading glasses I can read so-so. Is my reading-vision likely to get worse over the years? Will there be a point I can't read even with glasses? If so, I'd be much more likely to get the corrective IOLs
Don't feel rushed into cataract surgery. If you're still comfortable with your vision, you can wait. Over time cataracts tend to get cloudier and vision usually gets worse - but it might not - you never know!
Once you've had cataract surgery, your vision should stop deteriorating (at least due to lens-related issues).
When you decide it's time, you can always get one eye done first to see what it's like. Usually one eye is worse than the other anyway. I waited several years between my cataract surgeries.
posted by sarah_pdx at 10:27 PM on August 20, 2015
Don't feel rushed into cataract surgery. If you're still comfortable with your vision, you can wait. Over time cataracts tend to get cloudier and vision usually gets worse - but it might not - you never know!
Once you've had cataract surgery, your vision should stop deteriorating (at least due to lens-related issues).
When you decide it's time, you can always get one eye done first to see what it's like. Usually one eye is worse than the other anyway. I waited several years between my cataract surgeries.
posted by sarah_pdx at 10:27 PM on August 20, 2015
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Whether it's worth it to you depends on how you feel about wearing reading glasses.
posted by mskyle at 6:46 AM on August 20, 2015