Thursday, June 25, 2020


Post #3: Why I Chose the IOL I Chose

When I finally realized that I had cataracts and that my only option for improving my vision was IOL replacement surgery, I started researching the various options that were available to me and learning the pros and cons of each type of IOL.

Mono or Multi-focal?

Being that I had cataracts and not just Presbyopia, that meant that our socialized healthcare/medicare system would pay for the IOL replacement surgery up to a point. Medicare would pay for all of it if I were to go with a basic monofocal lens. Such a lens would allow me to see very well at distance but for anything within about 2 m, I would need glasses or contacts. I've heard of people choosing one multi-focal IOL optimized for distance vision in one eye (the dominant eye I think) and one that's better for mid-range in the other eye. Intuitively, it seems that would require more neural-adaptation than having both lenses the same but it might give you more range in your vision. On the other hand, both of these options still require you to wear glasses or contacts, although maybe you'll only need a pair of magnifiers/reading glasses for the close-up stuff.

The upside on that type of lens was that they're reportedly easier to neural-adapt to and "reportedly" cause less issues with night glare, halos and starbursting than multi-focals although I've been told by at least one person who got monofocals that they had these night vision problems as well.

The bottom line for me though was that no matter which way you go with monofocals, you still need to wear glasses at least some of the time. I never wore glasses for anything until presbyopia started setting in during my 40s forcing me to have to use readers/magnifiers for close-up stuff. I don't like wearing glasses and I don't want to wear glasses for anything if I can help it so monofocals were definitely out for me.

Which Multi-focal Should I Choose?

That left me with having to decide which multi-focal I should go with. There are a lot of them out there to choose from. The choice is made somewhat easier, however, because not all multi-focals that are approved and in-use in other parts of the world like Europe (where the selection of available multi-focal IOLs is incredible) are approved and available for use in Canada. From what I learned when doing my research, some lenses which are approved in the US are not approved in Canada and some that are approved in Canada are not approved in the US. Typically, however, it's generally cheaper and easier to get an IOL approved in Canada than it is in the USA so a lot of lenses become approved and available for use in Canada well before they're approved and in use in the USA. This was the case with the Alcon Acrysof Panoptix tri-focal lens. This lens received US FDA approval in late 2019 whereas it was approved and in use in Canada a few years before that.

After doing some research, I learned that the multi-focal lenses that were available to me here in Canada are as follows: (Note: there may be others but these are the ones I know about)

Alcon Acysof Panoptix - A concentric ring tri-focal IOL.

PhysIOL FineVision - Another concentric ring tri-focal IOL similar to Panoptix. In Canada, this lens is marketed by optics giant, Bausch & Lomb.

Zeiss AT Lisa 809M - A concentric ring bi-focal IOL.

Bausch & Lomb Crystalens AO - An accommodating IOL. This means that rather than try to give an IOL multiple focal lengths by giving different parts of the IOL different refractive properties, an accommodating lens allows the eye muscle to flex the IOL to change its focus from far to near, etc., in much the same way as your natural lens works.

Oculentis MPlus MF30 - A fully rotational asymmetric multifocal IOL. This IOL has a very unique design that is not at all similar to any of the above concentric ring IOLs or the Crystalens AO. Below are pictures showing what the MPlus MF30 looks like compared to a concentric ring IOL.

Oculentis MPlus MF30 (Tri-focal IOL)
MPlus MF30 IOL

Concentric Ring Tri-focal IOL (FineVision)

FineVision IOL

As you can clearly see, the two lens designs are very different from each other.

After having my first thorough eye examination at the Mitchell Eye Centre, I got to discuss the results and options with my surgeon, Dr. Mitchell. Dr. Mitchell told me my eyes were in excellent health, and due to their shape, would likely see very well once the cataracts were replaced by new clear IOLs. He said I would likely do very well with any lens but he was recommending either the PhysIOL (Bausch & Lomb) FineVision or the Oculentis MPlus MF30. When I asked him what other options there were and what he was familiar with, he said he was also very familiar with the Zeiss AT Lisa Bi-focal and the B&L Crystalens AO having implanted hundreds of them many (like up to more than 10) years ago. He said everybody was implanting the Crystalens AO back then but as far as he knew, nobody was now. He also said he didn't recommend the Zeiss AT Lisa because they simply didn't give as good and as consistent results as either the FineVision or the MPlus and so for the last several years these have been his go-to choices. 

When I asked him about the Alcon PanOptix tri-focal, he said he hadn't implanted any and thought it was pretty much the same thing as the FineVision, owing to the fact that the two lenses have pretty similar designs. He never saw the need for switching over to using the PanOptix because he was getting such good and consistent results with the FineVision so he was more comfortable staying with what he knew worked well and produced very few complaints from patients. I thought of asking him if he would implant the PanOptix if I said I wanted it but I decided not to because I figured the guy's been implanting IOLs as long as anyone on this planet has and had literally implanted 1000s of them so he obviously knows a lot more about it than I do. As such, I don't know what he would've said if I had asked for the PanOptix.

The other reason I didn't ask him if he'd consider implanting the PanOptix was because up until that meeting, I hadn't heard of the Oculentis MPlus and was very curious to do some research on them. I also wanted to do some more research on the PhysIOL/B&L FineVision because I hadn't looked into those much either. No sense asking him if he'd consider implanting something he hadn't recommended when I didn't know enough to be picky about what he was recommending.

The Two Finalists and Why I Chose the One I Did

I will finish this section when I have more time.

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