Best Cataract Surgeons is the leading surgeon-led online educational resource for patients interested in learning about Modern Cataract Surgery.
We believe every patient having cataract surgery should have the best experience and outcome possible for their vision & lifestyle. When performed by an experienced surgeon, modern cataract surgery is nothing short of a miracle for millions of patients.
Patients have more choices than ever when it comes to cataract surgery. These choices will impact them for the rest of their lives. We provide patients the information they need about this life-changing procedure to help them make the best decisions for their eyesight & achieve the highest quality surgical outcomes possible.
Some things in life you only get the chance to do once. Get it done right!
Yes. These lens implants can all be used for presbyopia. If you don't technically have cataracts yet, the procedure of removing your natural lens and replacing it with a prescription implant to correct your vision is called "Custom Lens Replacement" or "Refractive Lens Exchange".
I have vivity - moderately happy. My eyes have gotten more dry and from what I understand vivity depends upon moisture for good focus. That is a problem with dry eyes, that's been my experience. Didn't know I could mix/match lens. Wish I had done PanOptix in one eye, or both, but halos at night would not be good either. I paid an additonal $4K - that's part of my dissatisfaction with the results.
Dry eyes will limit the performance of any lens implant. There are a variety of reasons why dry eyes & the tear film can worsen after any eye surgery -- but the good news is that any worsening related to cataract surgery is usually temporary.
I had cataract surgery on a Wednesday, Thursday morning went in for after surgery check up. The assistant touched my eyeball several times for pressure but forgot to put in any numbing drops before. It is Saturday and my eye is still blurry, can't see. Dr. gave steroid drops but nothing so far did the assistant ruin my eye ?
@@bestcataractsurgeons i’m holding out for the jellisee or juvene accommodative lenses, uses all the light for all distances using your own eye muacles
Great video ! May I ask how do you manage patients with ADHD, does IV sedation work well ? I'm afraid of moving or not understanding the instructions in time, however, the idea of being under general anesthesia makes me more anxious... Thanks.
IV sedation works very well on patients with ADHD. Of course, discuss with your surgeon. They may recommend that you don't take your ADHD medicine on the day of the procedure.
@@bestcataractsurgeons Thank you doctor for your reassuring answer ! That was my feeling too but my surgeon strongly recommended full anesthesia. He said that this is the norm for young patients because they are often more anxious than older ones and so they are not cool during surgery. I was a bit anxious but what he said to me definitely scared me whereas I was expecting more reassurance from him.
I love my LAL+ implants. As an OD since '77 as a post op Lasik -4.50 25 years ago I had femtosecond LAL+ OU a month ago with my cataract colleague surgeon I've been co managing since '88 and has done over 100K cat procedures.. I was 2 week post op about OD +.75 with cyl and OS +1.25 with cyl. I had my first lens power UV treatment 9 days ago OU. I am now Pl OU 20/20 in each eye and 20/15 OU. I probably have about a +1.00 add effect at NV. We did my first lock in yesterday. This is an amazing lens implant and you bet your life I am so happy I went with this option!
Would astigmatism of .75 warrant a Toric monofocal lens implant? I've read that leaving small amounts of uncorrected astigmatism can result in a minor added benefit of better intermediate vision with a monofocal implant- true? I'm getting my Panoptix explanted in about 10 days to a monofocal but not opting for toric just to minimize any further issues. TY
It depends. That's a borderline amount of astigmatism. I would say usually that's not enough astigmatism for a toric implant, but it is possible depending on which axis the astigmatism is at. You are correct that leaving a small amount of astigmatism can result in a great depth of focus (i.e. range of vision)... Discuss with your surgeon if that is your desired outcome. It's not automatic that "leaving small amount can result in better intermediate" unless a few other things are taken into account in the surgical plan. This is a very subtle question... a very good question!!! But let us be clear that this is not medical advice for your specific situation, and we recommend you discuss this excellent question with your doctor.
@@bestcataractsurgeons Thank you so much. Your response is very clear and I do recall my surgeon saying I had irregular astigmatism so I will follow up with him right away. I appreciate the time you took to explain it so well. 🙏
Lucidis is not available in the United States... so we don't have any experience with it. Here is a study: www.ncbi.nlm.nih.gov/pmc/articles/PMC9167139/
Good news. Cataract surgery is done about 5 million times in the United States annually. So many patients feel that way before their procedure... but the sedation will make them relaxed & sleepy. One of the first thing most patients say when it's over: "Is that it? Are we really done already!" :D
Do not worry! The vast majority of cataract surgeries are very quick and completely painless to the patient. I had mine in February of this year (2024), and there was absolutely nothing to it. I don’t remember a thing. You’ll be just fine.
Great question. Clearview 3 is new, and most surgeons don't have a lot of first hand experience yet with the lens to know how it performs. The best we can do at this time is point you toward the FDA report that reviews the clinical trial data in detail. You can find it here: www.accessdata.fda.gov/cdrh_docs/pdf20/P200020B.pdf Maybe it will make next year's list.
Thank you very much for your very informative video! Wanted to ask a question, I know the Clearview 3 is relatively new. I also know that no artifical lens is perfect. Do you know any weaknesses with the Clearview 3? I have read a lot about how it has a full range of vision with no halos at night but have not read anything about the Clearview 3 lens weaknesses since no lens is perfect. Thank you in advance for your feedback.
Great question. You are correct that it is new, and there are a lot of surgeons that don't have a lot of first hand experience yet with the lens to know how it performs. The best we can do at this time is point you toward the FDA report that reviews the clinical trial data in detail. You can find it here: www.accessdata.fda.gov/cdrh_docs/pdf20/P200020B.pdf
"Enhanced monofocals" are still considered monofocals by the FDA. However, they can provide an extended range of vision. The Eyhance doesn't deliver as much range as "extended depth of focus" implants... but does deliver more than many other types of monofocals. This is an in-between category... We may need to make a separate video just on this topic.
Also, it's the only one that most insurance providers will cover completely. Premium lenses are an out of pocket expense and usually require you to pay 8 to 10 times the cost of the lens itself. For those that can afford it, it's a good option. My advice would be to educate yourself before you choose a proper lens for your eyes. A healthy dialogue with your eye doctor is paramount as well. If you are not comfortable with a eye doctor, go somewhere else and ask questions, especially if you don't understand what they tell you. Take care and good luck to everyone.
This leaves out a lot of details. Monofocal lens implants provide the least range of vision. Monofocals also come in a variety of types, toric monofocals, enhanced monofocals, adjustable, and different materials. A monofocal will also not achieve clear vision unless astigmatism is managed. Every patient is different. Oversimplifying to "one lens is the best for everyone" is dangerous.
Insurance companies cover a basic monofocal that does not account for astigmatism or other higher order optical aberrations. Patients choosing a basic monofocal implant should expect to need glasses for all ranges of vision. That is, they should expect to need bifocal or trifocal glasses after surgery. Some patients may get lucky who happen to have low corneal astigmatism and not need distance glasses after surgery, however, if your astigmatism is not managed with imaging prior to surgery, there is no way to know this in advance.
I have diplopia. Came on suddenly last year. Have checked everything and no reason for it. Other than decomensating esotropia. I wear prism glasses. I’m about to do LAL. I am not confident this lens is best. I had PRK 30 + years ago. No astigmatism. Is a Vivity ok with past PRK? I expect to need prism glasses post.
I don’t understand, I thought multifocals are old fashioned. Now everyone is choosing EDOF technology as being non diffractive. Not a very informative video.
This is incorrect. The PanOptix Multifocal implant is the most popular presbyopia-correcting implant in the United States. It is used more often than the most common EDOF implants, which are the Vivity and Symfony implants. In general, EDOF lenses do not deliver as much range of vision as diffractive multifocal implants, however, they can have the benefit of less unwanted glare & halo symptoms. There is no one-size-fits-all "best lens". There are pros & cons to all.
@@bestcataractsurgeons Thank you for explaining that. Unfortunately my eyes are not suitable for multifocal so I will have to choose from what I will be offered.
I had my cataract operations done in March and I went with mono focal lens for the primary reason I always expected to have a need for glasses anyway. I been wearing glasses since I was 3 years old for extreme far sightedness (+6.00 in the right eye and +6.25 in the left eye) and of course a +3.00 on the bifocal. what I wanted intemindant to distance vision improvements. What I got after the surgery was far better than I ever thought was possible. I had my final post operative exam and intermindant and distance vision was 20/20 in the right eye and 20/25 in the left eye and I do need readers or what I did get a pair glasses with lined bifocals but the correction in the right eye for distance is just a clear lens and the left eye is +0.25 and the bifocal is a +2.25 for both eyes. Since I do still drive and do activities during night time I also wanted to avoid having the glare issues that other lens have the potential. Side note I am 66 years old
Great to hear your story! You were very farsighted indeed. Many patients with your extreme amount of farsightedness choose to have the best distance vision like you did.
@@bestcataractsurgeons This is a strong positive for me as I never expected what I got in the improvements to my vision. Everything is clearer focused and easier for me and I got to ditch those heavy clunkers of glasses and use just a pair of lightweight glasses. I for years would get the smallest possible wire frames and high index transition lenses. To be able to work out in the yard with some safety sunglasses and leave the glasses in my shop and not need them just so amazing to me.
Clearview 3 is relatively new and doesn't yet have a large surgeon following in the United States. Surgical techniques are constantly changing. If we find that surgeons report good results, increasing their preference for and use of the Clearview 3, we may consider it for next year's list.
I had no cataracts but wanted to get out of glasses and paid $7k to have PanOptix implanted in my right eye in Oct of 2022 and was planning to pay another $7k for PanOptix in my left eye 1 week later. I was not happy with the PanOtix at first and felt that it was a substantial reduction in my vision quality. Halos were a bit overwelming at times but have gotten better. I have gotten by for a year and a half with PanOptix in my right and and a contact in my left eye corrected for distance. I'm pretty happy with PanOptix now and considering Vivity in my left eye. I would do PanOptix in the left too if it wasn't for the halos at night. The Vivity/PanOptix combo seems to be the way to go IMO. It takes time for our brain to get used to the lenses. I also believe that folks that have cataracts and go to PanOptix or Vivity would be blown away but I had crystal clear vision with glasses and therefor saw this as a downgrade at first until I got used to it. I do LOVE not dealing with glasses.
Good points. Everyone has glare & halos after cataract surgery... For some patients it's bothersome for a few weeks. For others it can last months. In the vast majority of patients any long-term residual glare & halo symptoms are mild. However, every patient is different, and comes into surgery with different risk factors, such as dry eyes, corneal scars, irregular astigmatism, and more. Important to discuss your personal risk factors with your surgeon. Lastly... Yes! Many patients love the combination of PanOptix in one eye, and Vivity in the other.
Could you explain the difference between The Panoptic and symphony . I am having to choose between one of these or have a mono focal Lense in my dominant eye
Sure! The PanOptix has a trifocal design, which is designed to achieve vision free from glasses for distance, intermediate range, and near vision. The Symfony is designed to give an "extended range of vision" that is more continuous than the PanOptix; however, the Symfony will not give as much near vision. So you may expect to be more dependent on reading glasses if you choose the Symfony. This is a simplified understanding of the lens implants, which assumes your surgeon is aiming for a distance target. The most important thing in making your decision is going to a skilled surgeon who can discuss your lifestyle & vision goals with you, and match them to the right lens implant, taking into account your ocular health. Of course, since we do not know that information about you, we cannot give any recommendation on which lens to choose.
If I am a pool player who really needs to see between say 2 and 10 feet crisply, are either of these lens better than the other? Does intermediate distance cover the 2 foot starting distance?
"Intermediate" typically means the distance of a desktop computer monitor or the dashboard in the car. This is usually a bit closer than most pool players would like. Let your surgeon know, and they can set your vision a little further out, if that's your goal. Please like & subscribe :D
I have seen the "98-99%" satisfaction rate Alcon promotes for Panoptix (I have my doubts about that). I have Panoptix in one eye and I regret it. It's been almost 5 weeks since my surgery. I have significant night halos where I see the RINGS of the lens that radiate out quite a distance - no one talks about that. It is disturbing. Will this go away? I have shards of light streaking through the lens in various places as if gaps exist in the lens, and I still have flickering 5 weeks later. My vision is like looking through a mirage - meaning not in focus..more like a soft focus near through far. Do you think this is due to a biometry mis-measurement? Regarding this issue, I have searched endlessly for an explanation (no surgeon really spends much time to explain anything)...how does the biometry measurement extend or transfer to the lens choice? Does the surgeon pick a lens off the shelf that closely matches your measurements, or is a lens ordered to match, or is it one size fits all? Please do a video to explain what happens after biometry and how a surgeon selects the lens. Why are patients left out of this phase? Many people are unhappy with premium lenses but it is never discussed except on forums where real voices speak...not Alcon, and not ophthalmologists who might not have first hand experience if they themselves to not have an implant. I think I got in my 20 questions if you wish to answer any of the above - I'd be grateful.
Hard to say without examining your eyes... Things that can cause these symptoms: dry eyes, irregular astigmatism, residual refractive error, other corneal irregularities, persistent corneal edema, posterior capsular opacification, decentration of the lens implant... Often it takes a few months for your brain to adapt to these symptoms, and they eventually go away in most. For the small percentage of patients who remain persistently bothered by these symptoms, the lens implant can be removed and exchanged for another one. If your surgeon does not adequately address your dissatisfaction, then you should strongly consider a 2nd opinion.
Replacing a lens implant with another lens implant is referred to as an "IOL exchange". Some surgeons are more comfortable with doing this technique than others. Generally, it is better to do this sooner, rather than later. Some surgeons will only do exchanges during the first 3-6 months after the implant was placed. After that period of time, the original lens implant becomes more "stuck in place" and can be more difficult to get out.
Every patient is different... However, LASIK can impact the accuracy of the measurements taken for your lens implant. The Light Adjustable Lens is particularly good for many patients with a history of LASIK. This is because the prescription can be adjusted or "fine-tuned" after the implant is already inside your eye. This makes it the most accurate lens to hit the desired target for many patients. Check out our video about it!
I had Vivity lenses implanted 5 months ago. I had a lot of dysphotopsia especially at night. I couldn’t drive at night for a few months. It has gotten a lot better now and I feel fairly comfortable driving at night. At first I questioned my decision, but am actually very happy with my vision now. It took a while though. I wasn’t one of those people who was ecstatic right off the bat. I’m 20/25 in one eye and 20/20 in the other eye. If you’re having problems maybe give your eyes and brain some time to get it together.
I'm surprised you had as much night driving sight issues as you did with Vivity. The consensus opinion seems to that's mostly with the Panoptics. Do you find you need reading glasses for small print with Vivity, like they said?
Yes, I was surprised and very disappointed too. It’s quite a bit better now, hopefully it will continue to improve with time. Yes, I do need reading glasses for fine print and I use reading glasses in the evening or when the light is dim. I find light makes a big difference as to how I can read small print.
Read the truth -it’s about $$$ pubmed.ncbi.nlm.nih.gov/37369549/#:~:text=AUTHORS'%20CONCLUSIONS%3A%20This%20review%20of,acuity%20and%20quality%20of%20life.
CONCLUSIONS: This review of 42 studies provides evidence that there is probably little or no difference between FLACS and PCS in terms of intraoperative and postoperative complications, postoperative visual acuity and quality of life. Evidence from two studies suggests that FLACS may be the less cost-effective option.
It’s about $$$ - read the truth pubmed.ncbi.nlm.nih.gov/37369549/#:~:text=AUTHORS'%20CONCLUSIONS%3A%20This%20review%20of,acuity%20and%20quality%20of%20life.
I am at this thinking about lens inplants , the problem with the light adjustable is the cost my quote in BC Canada was $9,500 for both eyes . I had PRK surgery back in 2007 I may just stay with glasses .
Hi @shaunmckenna1923 A few things to consider: 1.) There's certainly no rush to get lens implants. The benefits should outweigh the risks, and you should have that conversation with your eye doctor. 2.) However, as long as you continue to have birthdays, at some point you will get cataracts. They are a natural part of aging. When it's time for cataract surgery, you will get lens implants. For some people it makes sense to get their implants sooner, to get more years of benefit from them... For others, it makes sense to put it off until later. Everyone is different :D
Is there a particular brand of laser that all these doctors are talking about? Is it the femtosecond laser? Is there more than one brand of laser available? If so, are all laser brands considered equal?
Hi @peggyribaudo4361, All of the lasers used for cataract surgery are "femtosecond lasers". The word "femtosecond" refers to the extremely short pulse duration of the laser. There are several different laser manufacturers in the United States, including Alcon, Lensar, and Johnson & Johnson. Different surgeons may have preferences for one company's laser over others. In general, they all perform the same steps during cataract surgery: imaging of the eye, astigmatism correction, bladeless incisions, capsulotomy, and cataract fragmentation.
It’s all about $$$ and paying off expensive equipment and marketing - read large independent retrospective studies to see no difference in patient outcomes yet more expansive and takes longer
I don’t get it. Laser is better but we need to pay out of pocket? Someone explain it to me. No where else can you do this. I can’t tell my photography clients they have to pay more if they want me to use the best equipment.
Hi Bill, Good question. Unfortunately, this has to do with the way medical insurance plans are set up in the United States. We assume that you don't accept "photography insurance"... If you did, you might find yourself in a similar situation in which insurance plans decide to cover certain things, but not others. Do you decide to offer these better services to your clients at an additional fee? Or only offer the basic covered services that the insurance plan covers? Medical insurance plans often (sadly) drag their feet on adopting new technologies. This allows them to save money. In the United States, medical practices are allowed to offer these "noncovered services" to patients; however, the patient must pay on their own (i.e. "out-of-pocket") for them. I hope that clarifies a little bit. Medical insurance can be quite a confusing subject. Also, every plan is different... and there are many, many different plans.
@@bestcataractsurgeons I get all that but I can’t tell my clients I just bought new gear and they have to pay more. I just bought a $6099 camera and now you need to pay more? Even without I insurance they would still do the same thing. Again why do we need to pay more for a machine you decided to buy? Also there is no way a lens could cost $3500. I know for a fact the markup on those is insane. I bet those lenses cost $10 to make I could be wrong but I would bet I’m not
@@billrhea You ask good questions. I believe the difference is that the laser corrects for astigmatism, which is not covered by medical insurance. In terms of cost of things like lenses, you are right in that the marginal cost of producing one lens might be fairly low, but as with all products, consumers pay for everything involved in the production, including research and development, capital expenditures, operating costs, etc.
Unfortunately that's how it is. Im in the same situation, insurance pays only for the basic procedure and the basic lens. Anything extra, such a laser surgery, it's additional.
Useful video. That’s right. I have been doing Vivity in dominant eye and Panoptix in the other in some of maya patients for a while. My patients are highly satisfied with that.
I was considering monovision correction … until I had retinal detachment in one eye … then I’m thinking … which depth of field range could I lose and still be okay…:-:
How does the lens change post treatment at 6 months, 12 months?. We are in AZ in severe light conditions. Post surgery/implant, is there a chance of change from sunlight AFTER the lens is locked in? Does it make sense to put in both eyes [is there an option; doc recommended Apthera for L eye, have astigmatism in both]. A+👍🇺🇸
