Interocular Lens Implants

[Hysteresis]

Anyone here got any experience or information regarding Iterocular Lens Implants. IOL's.
These are implants that replace the natural eye lens in the exactly the same procedure undertaken in Cateract Operations. The only difference is that the Implants can be done privately before cataracts develop and Multifocal lenses can be implanted to correct near and distance vision similar to Bifocal spectacles. Now there are quite few variation of what is available the most common of which is a Bifocal implant which looks similar to a bifocal spectacle lens but this is where I get concerned as to the end result. What I have been told by an eye surgeon is that the distance and near vision is refracted onto the retina at the same point and the brain determines which of these images is the one required. The implant takes a little while to get used to but the end result is very successful I am told.
My problem is that the end result is unknown and the procedure irreversible as the natural lens is removed during surgery.
The sales Blurb states comments from very satisfied customers (as it would) but I can't find a source of all feedback both positive and negative from the multifocal lens implant patients using Google, hence my serious enquiry.
There are other types of implant called Trifocal and Accommodative Lenses and one called Light Adjustable Lens (LAL) which only one clinic in the UK uses.
So any feedback from experienced patients would be very welcome as I am considering having the procedure done at great expense.

 

[JBR]

Good question. I'd be interested to know as well, as I have been told I shall very likely need cataract removal (and lens replacement) within the next few years.

Having been told that, naturally my next course of action was to look it up on the internet, where I heard of the bifocal/trifocal possibilities. I couldn't find much more other than operations done on the NHS would not include these options.

 

[Hysteresis]

You are right JBR. The NHS will carry out the Cateract operation with the replacement lens being monofocal, but you have to go private for Multifocal lenses, I used the Optegra company to investigate what options they offered and it transpired that the Surgeon I saw only recommend the Bifocal implant and his opinion was that the trifocal lens was untried and was not in a position recommend its use. He also did not recommend the accommodative lens for the same reason. My own view was that the accommodative lens seems the natural option, but there are drawback of inferior vision correction was his opinion.
I therefore was left with the bifocal lens as the only option. Not knowing the result of such a lens cause me to hesitate as I think the relative success would be dependent on the differential between the Distance and Near prescription. This differential is evident if trying contact lenses with one eye a reading eye and the dominant eye a distance eye (so called Monovision). If the differential is high then the success is low in my experience.
I think the technical advances in these lenses is extraordinary but it is still in its infancy. New types of lens are continually being introduced such as the accommodative lens and toric type lenses. but none of these lenses will give a result to compare with the young natural lens which is of course what we all crave.
Lets hope we get a reply to my posting from some patient of Mulifocal lens implants.

 

[peterperfection]

Personally I would wait a while .
3 years ago I went to a clinic in Bolton -to have a consultation for CK (conductive Keratoplasty).
Monovision.
They simulate the effects of the proceedure by fitting you with a contact lens in ONE eye . It should stay in for 2 days .
It's one of those proceedures that require your brain to adapt .
I lasted 3 hours -before I took it out . It was a horrible frightening experience for me personally.

Eye surgery/correction is advancing so very much these days -very quickly .
My personal opinion is- wait a while and hope that improvements to any eye correction proceedure improve.
That is just my opinion though .

 

[chapeau]

Anyone here got any experience or information regarding Iterocular Lens Implants.
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So any feedback from experienced patients would be very welcome as I am considering having the procedure done at great expense.

You must be talking about accomodating IOLs. I'd wait until they had a lot lot more experience, you don't want to be a guinea pig when it comes to your eyes. Give it another ten years, IMO.

 

[Hysteresis]

That's Spot On Chateau, They only problem with waiting 10 years is that I will probably have developed cataracts by then and will need lens removal. as at that time surgery will be a necessity rather than an elective procedure, accommodative lenses will be a reasonable option to have a go at. Presently, I don't have cataracts and the speculative investigation to lens replacement is one of convenience and I must agree , convenience is not a good reason to 'give it a go'.
I think my option really is to migrate to Contact lens for distance and tolerate the requirement for reading glasses. I think that will be a better option to these Bifocal spectacles I presently have to endure.
Thanks for your input, it is appreciated,

 

[joinerjohn]

How do, bifocal and even trifocal lenses work then? I can't imagine you'd be able to look down or up (like I do with my varifocal glasses) and see through a different part of a lens fitted into your eye?

 

[JBR]

How do, bifocal and even trifocal lenses work then? I can't imagine you'd be able to look down or up (like I do with my varifocal glasses) and see through a different part of a lens fitted into your eye?

I thought that too. I do understand how bifocal contact lenses work - when you look down (the normal position for reading) the contact lens is restrained from moving down to the same degree by the presence of the lower eyelid, and so the line of vision is through the periphery of the lens (the area for close vision correction) rather than the centre of the lens (the part for distance vision correction).

However, an implanted bifocal lens would not move in this way and the line of vision must remain through the centre of the lens. So how does it work?

However it works, I too would like to hear the experiences of people who have had these lenses implanted.

 

[sooey]

I reckon the big problem with having those lenses fitted is that if you look up on a sunny day you might burn a hole in the back of your head.


just kiddin.

 

[TheVictorian]

I know someone in his 60's who had both eyes done a few years ago and it has changed his life. Overall a positive experiece for him, however this doesn't mean it will be the same for you...

 

[Hysteresis]

How do, bifocal and even trifocal lenses work then? I can't imagine you'd be able to look down or up (like I do with my varifocal glasses) and see through a different part of a lens fitted into your eye?

How these implanted lenses work is more neurological than physical optics I am told by my Ophthalmologist (Eye Surgeon).
Contact lenses are fine for single vision correction and one method of achieving accommodation (Reading and Distance correction) is to have the dominant eye corrected by a distance prescription and the sub dominant eye with a reading prescription. My personal experience with this is that when the differential prescription between reading and distance is around 1 diopter or less than it was successful, when this differential reached over 2 diopters then is was unsuccessful. Apparently this works by the visual cortex being able to filter the image out that it required, hence when the differential is greater than say 2 diopters then it is too much to expect the brain to sort it out.
Now these Bifocal interocular lens implants work in a similar manner I am told , but the distance and near images are refracted on to the same retina and I am told the visual cortex determines the required image to concentrate on. I am told it takes a little time to get used to it, but it works. My thoughts on that is that similar to mono vision with contact lenses, the degree of success depends on the prescription differential . So maybe the people that report a great success have a low prescription differential, (note I say Maybe, because I just don't know, hence my initial posting to try and get information from people who have experienced lens implants,) but the people with high differential could be less successful but their report are suppressed by the companies marketing the procedure.
My investigation before agreeing to the procedure has concluded that the way the bifocal implants work is similar to contact lens Mono Vision (a distance eye and a reading eye) and my personal experience of this is that prescription differential greater that 1 diopter it is not successful and as such I have decided not to proceed. Maybe the success 'TheVictorian' reported was not bifocal implant or maybe a low differential prescription, or I am maybe talking a load of 'B*llocks'.
When I started my investigation I genuinely thought what I was going to have was Accommodative lens implants. These lenses are artificial implants which effectively work in the same way as the natural lens in that they are soft enough for the eye muscles to distort the lens into different focal lengths as the natural eye lens does. This solution would be like having young eye back again. Sadly as 'chapeau' commented, these lenses are very much in their infancy and maybe worth considering in 10 years time when they are tried out by other patients. Accommodative lenses would seem to be the perfect solution when they are developed.
Hopefully we may get a reply in this thread from some one with bifocal implants with a high differential prescription who could throw some experienced light on to its relative success. I have no doubt single vision implants are highly successful but bifocal is quite another story I fear.
I am sure Joe90 has all of the answers.

 

[JBR]

Thanks Hysteresis. Your comprehensive explanation is very interesting. I think I understand how two different images can be projected on one retina and that the brain can determine which to use, although I too would like to know how successful this is from people with first hand experience.

My prescription, I fear, is probably too 'wide' for this type of lens to succeed in my case (over -5 dioptres distance, +2.5 reading) and so, when the time comes, I shall probably have to go with the single vision option and use reading glasses for close work. Hopefully, this should not be too much of an imposition.

I just wonder, however, what implications the lack of accommodation would have. As I understand it, anything beyond arm's length should be pretty much in focus (although I believe they cannot guarantee that there would be no need for corrective lenses). Obviously, softer accommodative implant lenses would be better but, as you say, they are not completely tried and tested as yet. Perhaps in about five years, when I am likely to need them, we may know more. Even then, I wonder what sort of cost would be involved. The basic operation is free under the NHS. Logically, the use of accommodating lenses, then, should involve only the cost of the lenses themselves (or even the difference in cost between single vision and accommodating lenses) and not the entire procedure. Unfortunately, I have a suspicion that this will not be the case!

 

[Hysteresis]

Thanks for your posting JBR. Your thoughts are completely in line with my thinking, My prescription is a little more than yours mine being -8.5 and +2.5 for reading, and my surgeon was very optimistic of a successful outcome, so your prescription is certainly with in the range of the implant procedure. Although they normally have an upper limit of about -9, they have been successful at -16.
I have the very early signs of cataract development and of course the rate at which cataracts develop is a total unknown, they can start and inexplicably stop developing , on the other hand they can accelerate in development. So I too can expect to need cataract surgery in the future but actually when - who knows.
As the result of bifocal implants is an unknown to me, the only comparison I can make is the performance of contact lens Mono Vision which I am presently assessing and with my prescription I am not impressed. I appreciate that contacy lens Mono Vision is not a fair comparisn as the Implant lens produces the distance and reading omage on the same retina, but it is all I have tot go on. My next move is, as you suggest, and that is to go for Single vision distance lenses and use reading glasses. As cateracts have not developed as to require removal, then I see no point in interocuar lens replacement as all this would achieve is removing the necessity for putting in contact lenses each day which for me is not a problem. My investigation into Iterocular lens replacement was driven by the misunderstanding that the lenses used where Accommodative, which clearly is not the case. This wuld have produced a redult of not requiring any spectacles at all and that would be a fantastic result,
I am concerned as to the result of Bifocal lens replacement as I have no perception as to what the final result would be and the whole procedure is irreversible. So I have decided that I will use single vision contact lenses with reading glasses as this is totally non invasive, wait until catarects develop such that surgery is a necessity and the only option, by which time maybe Accommodative lens technology may have advanced or at least been tested, then make the decision based on the necessity for surgery.
You mentioned costs of the procedure. The hospital I attended has a standard cost of £3,495 per eye (£7,000 for the two - they don't do buy on get one free), but my investigation took me to Optical Express who do the same procedure for £1,495 per eye, £4000 cheaper, and the surgery is done by consultant eye surgeons and in one case a Professor of Eye Surgery.
I think my conclusion to delay the decision in what to do until surgery is an absolute necessity is the right one at this stage as I have no feedback as to the possible outcome other than my eye surgeon telling me that it will be fine, which of course he would say that wouldn't he.
I am still hoping for a posting from someone who has had Interocular lens Implant who has a differential prescription similar to our ie +2.5 for reading. I won't hold my breath.

 

[JBR]

Looking at those prices, I shall go with the NHS when the time comes! Good news, though, that cataracts can suddenly stop growing. I live in hope!

 

[Hysteresis]

When I say that the cataracts can stop developing, I was told this from a non medical source and how accurate the statement is I don't know. I was told it can stop but that is very rare to do so.
Good Luck