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Post-cataract op eyewear

 Poster: A snowHead
Poster: A snowHead
Quote:

He felt his eyesight was bad enough, those few years of his life were wasted

I'm not in that position. I just find swapping spectacles a bit of a pain. But my new driving glasses have largely solved the problems I had with driving in the dark, which were caused, ironically enough, by a significant improvement in my sight, which meant the old varifocals were too strong. But the optician said that it would probably change again quite quickly. No way would I say my life is "wasted".
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Obviously A snowHead isn't a real person
Tiredoldskibum wrote:

For skiing, next season, I'll try flat light contrast enhancing lenses, any views as to which are best? I had a peep through someone's this year (think they were pink Smith ones) but I didn't notice much difference (didn't ski in them).


Opinions vary. I like Smith Chromapop Storm Rose and was gutted when my goggs were nicked but others swear by Storm Yellow or Oakley Prizm Hi Pink or Prizm Hi Yellow. I've also had decent but not spectacular results in Dragon Pink Ion and Decathlon Cat 1 yellow.
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 Well, the person's real but it's just a made up name, see?
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@abc, That was my first thought. But on reflection it's probably good advice. For almost all purposes my vision is fine. Why fix what isn't (mostly) broken? When it deteriorates to the point where it's an issue (rather than an occasional inconvenience) I'll have it done.
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@Dave of the Marmottes,

Quote:

Opinions vary. I like Smith Chromapop Storm Rose and was gutted when my goggs were nicked but others swear by Storm Yellow or Oakley Prizm Hi Pink or Prizm Hi Yellow. I've also had decent but not spectacular results in Dragon Pink Ion and Decathlon Cat 1 yellow.


Cheers.

Read elsewhere that the Smith Chromapop is the way to go with the Storm Yellow being touted as the "best" for flat light. As I said before I did peep through a Chromapop (pink one, don't know which) on the slopes but didn't really see much difference, but maybe you don't need much?

I currently use a yellow visor on a Bolle helmet which I like but it doesn't help much with flat light vision.
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The only "benefit" of waiting is the unknown "improvement in technology". It's not like your eyesight is going to improve on their own by waiting (unlike some other conditions). The surgery will have to happen, just at a later date. The only way you can avoid the surgery is if you die before then.

The activities my father subconsciously curtailed during the "waiting" years, he was at a much worse position to resume post-surgery, as he's then a few years older and other health issues intrude.

@Tiredoldskibum, I like my surgeon's response better: "I do it when my patients say they're fed up with not able to see well enough to do what they want to do, whatever it is they want to do".
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Quote:

I like my surgeon's response better: "I do it when my patients say they're fed up with not able to see well enough to do what they want to do, whatever it is they want to do".


I agree with that. But so far I can do whatever I want, except for flat light skiing.
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I wasn't good at skiing in flat light even in my 30s!
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pam w wrote:
I wasn't good at skiing in flat light even in my 30s!

Being based in North America, I've rarely had to ski in flat lights. My first time being forced to ski in flat light was in one of my trips to the Alps. Flat light for so many days I couldn't just sit it out. I got totally bored with the few trail that were below tree lines.

But I've since gotten much better at skiing blind. I mean BLIND!

In the vast expanse of Vail back bowl, I just turn and turn and turn... With no visual reference, the only way I know how fast I was skiing was how bumpy the snow surface was. I know eventually I will see the lift. But before that, I really had no need to slow down nor stop anyway. I saw it in time without crashing into it!

I'm much better at skiing since that trip to the Alps. I think that help me ski better in flat light.

@Tiredoldskibum, choose resorts that has substantial below tree line skiing (Austria? Italy? or North America!), you'll be without problem.
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Quote:

@Tiredoldskibum, choose resorts that has substantial below tree line skiing (Austria? Italy? or North America!), you'll be without problem.



I have a place in Andorra (in the Pyrenees) so do all my skiing there these days. Mostly below the tree line.

Agree there's an element of getting used to it (flat light with compromised vision), and also confidence.
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I have early onset cataract (hereditary, so I have a fair idea of how it'll go base on how my father's went). When it first appeared, I had a hard time with its effect (night time driving, flat light skiing, seeing shadow details in bright sunny days...) But I slowly got used to not seeing perfectly. Basically, I managed to "cope". I also curtailed some of my activities that doesn't really matter too much to me any more (a couple of competitive sport).

Mine is quite slow progressing. Still, I keep in mind of my father's advice not to "waste" my life away as a result. So if there's something I feel strongly about that are impacted by the cataract, it will be the time to get it done.

Just be mindful of doctors who thought as long as you can find your way to the fridge for your next beer, it's "good enough vision" and can wait some more years before having the surgery. They may mean well. But it's your active quality of life that may get wasted by the wait.
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Quote:

The only "benefit" of waiting is the unknown "improvement in technology"

That could be quite significant, given how fast this stuff is developing. And, oddly, my eyesight has improved - at 75. I went back for an eye test less than 6 months after the previous one, having found that driving in the dark I was MUCH better off with no specs than with my expensive varifocals/ I was told I'd have to pay for the test, which I was prepared to do, but the optician said my vision had changed (improved) so much she could put it through on NHS. She said sometimes raised blood sugar could cause this, but that was ruled out by excellent long term blood test results, and the only other explanation was cataract - which will change again before long, no doubt.
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And love to help out and answer questions and of course, read each other's snow reports.
pam w wrote:
Quote:

The only "benefit" of waiting is the unknown "improvement in technology"

That could be quite significant, given how fast this stuff is developing. And, oddly, my eyesight has improved - at 75. I went back for an eye test less than 6 months after the previous one, having found that driving in the dark I was MUCH better off with no specs than with my expensive varifocals/ I was told I'd have to pay for the test, which I was prepared to do, but the optician said my vision had changed (improved) so much she could put it through on NHS. She said sometimes raised blood sugar could cause this, but that was ruled out by excellent long term blood test results, and the only other explanation was cataract - which will change again before long, no doubt.


improvement in vision needs further investigation, it can indicate possible problems.....hopefully not but you need to chat to your GP
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Quote:

you need to chat to your GP

Laughing You need to have a lot more going on than an improvement in vision to get to chat to my GP!!
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 You know it makes sense.
You know it makes sense.
The optician did say she needed to rule out diabetes/high blood sugar. But as it happens I had just had a whole battery of blood tests and my Hba1c was OK, though not brilliant (5.7%). Are there other bad reasons for vision to improve?
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Tiredoldskibum wrote:
So I had my consultation. Surgeon opines that my cataracts are still early stage and that he is disinclined to recommend surgery at this stage. Reasoning being that my general vision is still very good, that there is always some level of risk with any procedure (including lasting slightly increased chance of detached retina) and that if I wait a few years, depending on how fast they progress, I might benefit from improved technology.

He also suggested that I would easily find another surgeon who would be happy to take my money now but he would not be. A conservative opinion but an honest one, so I will probably wait.


For skiing, next season, I'll try flat light contrast enhancing lenses, any views as to which are best? I had a peep through someone's this year (think they were pink Smith ones) but I didn't notice much difference (didn't ski in them).


Due to the loss of an eye 5 years ago, I have spent a lot of time playing with lenses for less than perfect conditions; in good conditions I'm fine, but I lose depth perception exponentially faster than anyone with 2 working eyes as conditions worsen. For me, the Smith low light (rose) Chromapop are by far the best out there - there's a lot of pre-Chromapop Smith out there still and you need to be sure of what you're trying. Oakleys are a distant second, and everything else might as well not be doing anything.

That said, anything to do with eyesight is incredibly personal. There's a huge number of factors involved, and they're not fully understood even by the the best surgeons and professors, so there's absolutely no substitute for spending time in shops (and even borrowing demo goggles if they're offered - ask and you'll be amazed what's available in resort).
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abc wrote:


Just be mindful of doctors who thought as long as you can find your way to the fridge for your next beer, it's "good enough vision" and can wait some more years before having the surgery. They may mean well. But it's your active quality of life that may get wasted by the wait.


This. Cataract surgery is about more than just cataracts. I didn't have significant cataracts at all, but I got it done. No more contact lenses, no more reading glasses. And never cataracts. Life changing.
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Obviously A snowHead isn't a real person
pam w wrote:
Quote:

you need to chat to your GP

Laughing You need to have a lot more going on than an improvement in vision to get to chat to my GP!!


Hopefully, your optician is on the ball and will know what is or what isn't going on. If they thought it needed further investigation, they would have written to your GP about it or requested a referral. Hubby had a recent improvement in his vision but we think the deterioration at the previous appointment could have been due to an eye injury that hadn't quite healed. (He was hit in the eye with a ball). It did nothing for his reading prescription though, so our optometrist wasn't concerned.
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frogslegs wrote:
For those considering which corrective lens to chose seeing as the thread subject is widening:

I didn't have cataracts but had elective lens replacement surgery October 2020 following advice that my deteriorating relationship with contact lenses would be forced to end within a couple of years following an abscess/infection and increasingly dry eyes as I aged. Pre-op I was -8 in both eyes and an astigmatism in one of them and achieved reading comfort by removing my specs. CL in daily life needed cheap reading glasses to read menus etc and for work I never wore CL. I had to endure 3 ski trips in specs with v expensive over specs goggles (sadly, which I lost...) But skiing in specs for me was every bit as inconvenient and annoying as I expected. However, by this stage a full day in my daily contacts was also uncomfortable and they were a higher priority to remove than taking off my boots at the end of the day!

I had both eyes done the same time as it was lockdown and hospitals were minimising contact and I had tri-focals and laser treatment on the astigmatism. Wow. No correction required at work, reading, driving, watching TV, football etc etc. Absolute game changer in all areas of my life. Due to Covid it was just over a year before I got to test them out on the mountain. Skiing, I am a goggle wearer whatever the weather (habit developed due to dry eyes and CL) and I continue to be as eyes still dry, but my vision on the mountain is just as amazing whatever the light compared to my pre-corrected days. The only area that is not 100% is a bit of glare at night from bright lights but I used to suffer in CL too. Flat light or a change of shadow etc requires lots of quick blinking to adjust but this was the case before as well.

Obviously there was nothing wrong with my cataracts and now never will be, and I had to finance it myself, and the NHS does not (yet) offer trifocals anyway but, to anyone who is able to choose their type of lens my experience is go the very best lens you are able to in the circumstances. Especially, if you have had a life time of vision correction!! Its worth it.


Interesting post. I'm a dry eye sufferer so contact lenses aren't a regular wear anymore and i'm considering lens replacement as laser isn't an option due to the dry eye.

My younger brother had cataract surgery about 15 years ago when he was was aged 25. He's now going to need the same operation again as apparently the replacement lens can get a coating on it that is similar to the yellow vision people get with cataracts. My brother is quite severly disabled and has some specific medical issues that caused the premature cataracts and therefore may be the cause of this repeating issue, but i'm wondering if this is something that was discussed with you about the long term prospects of lens replacement?
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lower wrote:

My younger brother had cataract surgery about 15 years ago when he was was aged 25. He's now going to need the same operation again as apparently the replacement lens can get a coating on it that is similar to the yellow vision people get with cataracts. My brother is quite severly disabled and has some specific medical issues that caused the premature cataracts and therefore may be the cause of this repeating issue, but i'm wondering if this is something that was discussed with you about the long term prospects of lens replacement?


I did ask about deterioration of the IOL before my op. My surgeon had 2 comments - firstly, that the premium IOL manufacturers pretty much guarantee it won't happen, and secondly, that in all his years of doing cataract and lens replacement surgery, he had never seen it happen. Of course the caveat to all this is that the great majority of candidates for lens replacement are probably in their sixties, so the IOL will comfortably last the rest of their days. I was sufficiently convinced.
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Quote:

the premium IOL manufacturers pretty much guarantee it won't happen

I'm curious how they do their testing to support that guarantee?

Quote:

the great majority of candidates for lens replacement are probably in their sixties, so the IOL will comfortably last the rest of their days.

People has been living longer and longer. An IOL implanted in 60 year olds 30 years ago haven't got their limits tested for another 10 years. Unless you feel you don't want to think about the clarity of your IOL in your 90's...
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abc wrote:
Quote:

the premium IOL manufacturers pretty much guarantee it won't happen

I'm curious how they do their testing to support that guarantee?

Quote:

the great majority of candidates for lens replacement are probably in their sixties, so the IOL will comfortably last the rest of their days.

People has been living longer and longer. An IOL implanted in 60 year olds 30 years ago haven't got their limits tested for another 10 years. Unless you feel you don't want to think about the clarity of your IOL in your 90's...


I guess for most cataract patients, if the alternative is being blind, it’s not a difficult decision.

Edited to add, re the other question : https://www.sighttrust.com/tag/do-intraocular-lenses-expire/
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Quote:

if the alternative is being blind, it’s not a difficult decision.

Indeed not, @telford_mike, but what's clear from this interesting thread is that some people are having IOLs not because they're going blind but because they don't want to have to use the spectacles and contact lenses which have been used up to now to correct defective vision. That's a more difficult decision - both because of the inherent (if slight) risks and the high cost. Perhaps the cost will come down
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telford_mike wrote:

I guess for most cataract patients, if the alternative is being blind, it’s not a difficult decision.

True if "most cataract patients" are only having the surgery at the point they're about to go blind. But not before that point.

And reality is "most patients" had their surgery done long before they're about to go blind. So it's a legitimate question.
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abc wrote:
telford_mike wrote:

I guess for most cataract patients, if the alternative is being blind, it’s not a difficult decision.

It's not difficult at the point they're about to go blind, yet. But not before that point.


Some (me included), had no cataracts before the op. It’s a lifestyle choice. There's a good chance it will last you the rest of your life. If it doesn’t, it takes only 15 minutes per eye to do it all again. Those having laser surgery in their 30s and 40s are in a far worse position. Their surgery won’t stop them getting presbyopia, and it won’t stop them getting cataracts, so in 30 years or so they'll very likely need more surgery. Yet millions still do it, as the balance of risk is favourable.
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@telford_mike the link you provided offered a very different explanation on the longevity of the IOL. Namely, all IOL are made of materials that are chemically stable. So 30 years or 60 years, they should stay the same (apart from defects). If so, it's a moot point.
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telford_mike wrote:
lower wrote:

My younger brother had cataract surgery about 15 years ago when he was was aged 25. He's now going to need the same operation again as apparently the replacement lens can get a coating on it that is similar to the yellow vision people get with cataracts. My brother is quite severly disabled and has some specific medical issues that caused the premature cataracts and therefore may be the cause of this repeating issue, but i'm wondering if this is something that was discussed with you about the long term prospects of lens replacement?


I did ask about deterioration of the IOL before my op. My surgeon had 2 comments - firstly, that the premium IOL manufacturers pretty much guarantee it won't happen, and secondly, that in all his years of doing cataract and lens replacement surgery, he had never seen it happen. Of course the caveat to all this is that the great majority of candidates for lens replacement are probably in their sixties, so the IOL will comfortably last the rest of their days. I was sufficiently convinced.


Having read around the subject a little more, it appears that secondary cataracts are nothing to do with the quality of the IOL. Its more to do with cells in the capsule in your eye in which the IOL is inserted into growing in an unexpected way and can happen to anyone that has IOL's fitted.

It also appears that the younger you are when you have an IOL installed, the greater the chance of secondary cataracts, albeit it remains a small risk and relatively easily corrected.
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And love to help out and answer questions and of course, read each other's snow reports.
Quote:

Due to the loss of an eye 5 years ago, I have spent a lot of time playing with lenses for less than perfect conditions; in good conditions I'm fine, but I lose depth perception exponentially faster than anyone with 2 working eyes as conditions worsen. For me, the Smith low light (rose) Chromapop are by far the best out there - there's a lot of pre-Chromapop Smith out there still and you need to be sure of what you're trying. Oakleys are a distant second, and everything else might as well not be doing anything.

That said, anything to do with eyesight is incredibly personal. There's a huge number of factors involved, and they're not fully understood even by the the best surgeons and professors, so there's absolutely no substitute for spending time in shops (and even borrowing demo goggles if they're offered - ask and you'll be amazed what's available in resort).



Many thanks for that @Saintsman
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This is a very interesting thread. My eyesight is fairly good - I wear glasses (+2.5?) for pooter and reading (+3.5?). TV is sharper with some +1's and on days I'm not working I put in +1 contacts just to sharpen the world a bit. Not legally necessary but I wear +1 for driving too. I'm 57 and I'm liking the sound of modern IOLs as glasses are a faff!

Do I sound like a good candidate, and roughly what's the cost?
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Quote:

This is a very interesting thread. My eyesight is fairly good - I wear glasses (+2.5?) for pooter and reading (+3.5?). TV is sharper with some +1's and on days I'm not working I put in +1 contacts just to sharpen the world a bit. Not legally necessary but I wear +1 for driving too. I'm 57 and I'm liking the sound of modern IOLs as glasses are a faff!

Do I sound like a good candidate, and roughly what's the cost?


You'd have to take advice about suitability.

Cost is around £2500 per eye for a standard mono IOL (fixed focus so you'd still need reading glasses)

Guy I know paid nearly £10,000 for both eyes (including consultations & follow up) with multi-focal premium lenses at Moorfields last year (and is delighted)


The prices I was given by the surgeon who advised me to wait was around 2500 per eye plus a supplement of between 150 and 850 per eye for premium lenses depending on choice (I'm insured so the 2500 is a price negotiated by the insurance co for cataract surgery)
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@Tiredoldskibum, Cheers. I'd happily pay £10k to have them done at Moorfields. Probably wait a couple of years though - need to get my head round it! - and allow the technology to mature a bit. Maybe get cheaper too!
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Quote:

This is a very interesting thread. My eyesight is fairly good - I wear glasses (+2.5?) for pooter and reading (+3.5?). TV is sharper with some +1's and on days I'm not working I put in +1 contacts just to sharpen the world a bit. Not legally necessary but I wear +1 for driving too. I'm 57 and I'm liking the sound of modern IOLs as glasses are a faff!

Do I sound like a good candidate, and roughly what's the cost?


No idea if you are a good candidate, but expect your optician will have an initial view before you start spending money. Most people I know who did it, including myself, were quite significantly myopic to start with. It was coping with CL in ageing drying eyes and still needing spex that sent me over my tolerance point. I am in my 50's.
I paid around 6.5k for trifocals in Sussex in 2020 including all the pre and post op appointments. My sister had the same op as me but 7 or 8 years ago and paid about 8.5k at Moorfields. She also had to have Ylag correction about 2 years later when she got clouding (normal). I have not had the need for that yet, but my surgeon said that procedure is available on the NHS anyway (and I can be referred to him if I want), my sisters Moorfield surgeon didn't mention the NHS option Smile. . Possibly its changed since then though. I was very happy with my surgeon in Sussex.
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 Obviously A snowHead isn't a real person
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Resurrecting this thread.

My cataracts seem to have got worse in the last few months to the point where driving at night is becoming an issue (can still see, just have to be much more careful). Only skied a few days this year so far but flat light is also worse. Bought some Oakley Prizm goggles which help a bit.

So I’m biting the bullet and will have lens replacement in the spring.

Thing is though, there are a range of IOLs (replacement lenses) available and the choice is confusing. From what I read the best two currently are Panoptix & Vivity, both made by the same company, Alcon.

The Panoptix is a multi focal lens which will likely give the best range of vision but gives halo and starburst effects around lights at night (more in some people than others) while the Vivity lens (extended range)may not avoid a requirement for reading glasses altogether.

Also, the Vivity lens, I read, may result in reduced “contrast sensitivity”, which for skiing in low/flat light sounds likely to give me the same problem I currently have, or maybe worse?

I’m leaning towards the Vivity, subject to learning more about the contrast issue.

Bit of a long shot but does anyone on here have any experience here?

I will of course be discussing it with the surgeon but chances are low light skiing is not something that he or she will be too concerned about.
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@Tiredoldskibum, useful resurrection. Look forward to the discussion about different lenses. Problems with night driving are the main reason I'd consider surgery - so if some lenses do that more effectively than others, that's important.
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This may help to describe the product if you've not seen it previously https://www.ophthalmologytimes.com/view/physicians-sort-out-pros-and-cons-of-several-new-iols-on-the-market in decent detail.
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@Tiredoldskibum, I had my eyes done in August. I chose the surgeon, not the implant.

From what I have seen and chatting with a friend who used to sell multifocal implants, monofocal are pretty much 100% reliable, but you'll need reading glasses. I find them excellent and have been wearing readers for years anyway.

I had/have astigmatism so I've just ordered some specs to correct that specifically for driving. My optician thinks I'll really like them. My optician also reckons that the surgeon got the implants spot on in terms of correction.

My mate said that - in his experience, multifocals are somewhat marmite. Half of the patients loved them, half hated them, and there's limited / difficult redos.

I don't do anything special regarding lenses for skiing. But I do like my Smith Chromapop goggle lenses and my Serengeti specs.

Oh and I use the water attached reading inserts on my other sunglasses.
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@under a new name, liking the sound of the reading inserts for my sunglasses.
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@Hells Bells, these sorts of things work pretty well https://www.amazon.co.uk/Sunglasses-Stickers-Magnifying-Removable-Reusable/dp/B09TZLRCLS/ref=sr_1_1_sspa?crid=1BHX5CICRQFG0&keywords=reading+lenses+for+sunglasses&qid=1675592756&sprefix=reading+lenses+for+sunglasses%2Caps%2C122&sr=8-1-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1&tag=amz07b-21
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ski3 wrote:
This may help to describe the product if you've not seen it previously https://www.ophthalmologytimes.com/view/physicians-sort-out-pros-and-cons-of-several-new-iols-on-the-market in decent detail.


Thanks for that. I hadn't seen it. There are a lot of similar comparisons out there but I've not seen anything that specifically covers low/flat light skiing. Contrast on snow is a bit unique really, can't think of anything else that relies so much on white/white contrast sensitivity.
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under a new name wrote:
@Tiredoldskibum, I had my eyes done in August. I chose the surgeon, not the implant.

From what I have seen and chatting with a friend who used to sell multifocal implants, monofocal are pretty much 100% reliable, but you'll need reading glasses. I find them excellent and have been wearing readers for years anyway.

I had/have astigmatism so I've just ordered some specs to correct that specifically for driving. My optician thinks I'll really like them. My optician also reckons that the surgeon got the implants spot on in terms of correction.

My mate said that - in his experience, multifocals are somewhat marmite. Half of the patients loved them, half hated them, and there's limited / difficult redos..



That's my understanding but my reading vision is still pretty good uncorrected so I'm reluctant to sacrifice that.

My cousin had multifocal iols a year or so ago an is free of glasses altogether and has no halos or flare at night. He hasn't skied with them and doesn't know which lenses they are though so not much help really.

Another guy I know had Panoptix and isn't happy at all, says they "f**ked" his night vision, but there are lots of people online who swear by them.

Confusing.
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@Tiredoldskibum, yeah, I think tho' only confusing because patients' experiences are so varied.

If I had to do the decision I'd do the same again. I had tried various types of multifocal contact lenses (OK not the same thing but still) and I just really didn't like them at all.

But I am used to having reading glasses in pockets and scattered around the house ... these are pretty handy as well https://www.amazon.co.uk/Rimless-Folding-Reading-Glasses-Telescopic/dp/B07L3Y5Q45/ref=sr_1_5?crid=240AR44ALNHF&keywords=telescopic+reading+glasses&qid=1675594497&sprefix=telescopic+reading+glasses%2Caps%2C168&sr=8-5&tag=amz07b-21

edit to add, I'm not sure there's anything that they can put in your eye that will improve poor light skiing!!
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