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Laser or new lens?

 Poster: A snowHead
Poster: A snowHead
So, having done a bit of research into lens replacement and lasering, I'm even less sure of what's best for me or even who to speak to Very Happy

Clearly I'll take professional advice (not something I could do myself anyway...) but would appreciate the views of the SH Massive.

I'm 57 and benefit from +1 for distance and need +2.5/3.5 bifocals for pooter/reading - so not that bad really. Prescription hasn't really changed for a few yrs (reading has got a bit stronger)

I want to ditch the specs totally if possible, although could manage with just needing specs for reading as long as pooter and further were spec free.

What are the advantages/disadvantages to laser vs multifocal lens replacement, and am I too old/young for either (one of the ambiguous things I've found in my research). Cost is not really an issue although if laser is nearly as good it may be a consideration.
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Ask your GP to refer you to the local ophthalmologist who is the refractive specialist - there are 2 laser options and you can discuss which might suit you best.
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@mozwold, that. Also, there are at least 2 lens technology options - when we visited the local laser centre for the Mrs - at 55 I was declared too young for new lenses (I'm -2.75 and -1.25 with +2.5 correction for reading) also that replacement lenses for correction were not as good as the OEM versions.
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I did say I'd take professional advice...... Just wanted some thoughts/experience.

@AL9000, Cool Cool
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Quote:

Just wanted some thoughts/experience


Just make sure the laser eye surgeon is properly qualified.

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Shouldn't have gone to specsavers Very Happy
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MorningGory wrote:
...What are the advantages/disadvantages to laser vs multifocal lens replacement, and am I too old/young for either (one of the ambiguous things I've found in my research). Cost is not really an issue although if laser is nearly as good it may be a consideration.
Dunno. But I had my eyes lasered at a younger age than you and it's the best thing I ever did.
I went to the best UK surgeon I could find, the one who does the celebs, at Moorfields.
PM me if you want details. Cost a few quid, but I've only one set of eyes, and it was a fair but cheaper than a week's heliskiing.

Lens replacement... I have in my future, as the same surgeon tells me I'll get cataracts sooner or later if I don't die.
They have some really cool technology, but I'm waiting until I need it as it gets better all the time. I really want eyes with a built in heads up
display... well I can hope.

I don't think you need a GP referral for this, or at least I don't remember doing that. You can just walk into a high street optician and get
someone to do it, after all. I just wanted mine done right.
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@MorningGory, That’s what you get if you don’t go private. Laughing
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@MorningGory, If you have laser, you're still very likely going to have to face the cataract problem at some point. Lens replacement eliminates this. You don't necessarily need multi-focal IOLs. I was -3.50 and -2.75 for distance, and +1.5 for reading. I had lens replacement 3 months ago correcting 1 eye for distance and the other for reading, a solution known as 'monovision'. Works a treat. I am 20/20 for reading and 120% for distance according to my 3 month checkup this morning. I tried multifocal contact lenses and there were too many downsides, particularly driving at night. Monovision does rely on your brain being 'wired' a particular way though, but it can be mocked-up with contact lenses prior to surgery so you can try it out. Talk to your eye surgeon.
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I have shocking vision and asked about laser surgery. My opthalmic specialist said my condition would not be solved by laser or lense replacement. They also said that I wouldn't find an opthalmic specialist that had ever had laser surgery.
There are risks.
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Thanks all.

@philwig, Was your prescription similar to mine? and do you now have perfect vision?

@telford_mike, I tried multifocal contacts too - OK in sunshine but no good once the light dropped so not for me.
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@MorningGory, I just got a new set of specs with gradient lenses. Focus on my laptop no problems then flick my eye up to look at the monitor behind and the top of the specs have a different focus so it is also in focus.

Nothing wrong with old school specs rather than eye lens or laser.
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@GlasgowCyclops, Na - too much faff for me. It would be OK if my distant vision was 100% but it isn't.
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Frosty the Snowman wrote:
I have shocking vision and asked about laser surgery. My opthalmic specialist said my condition would not be solved by laser or lense replacement. They also said that I wouldn't find an opthalmic specialist that had ever had laser surgery.
There are risks.


Like you I am extremely short sighted (at one time my prescription was just over -10 dioptres, but over the recent years it has decreased slightly). The mechanical strength of the cornea is provided by perfectly transparent collagen fibrils called stroma. If you have LASIK surgery this entails cutting a flap in the front of the cornea, this cuts through the stroma and when the flap is repositioned the mechanical strength of the cornea is permanently reduced (mechanical strength is important to withstand the intraocular pressure and maintain the corneal shape).

As you say there are risks, most people with moderate prescriptions have good outcomes from laser surgery, but for people with high levels of myopia the risks are greater and laser surgery may not be a good choice.
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Another high myope here, lifetime specs wearer. Phakic IOL are another option, where a lens is implanted between the cornea and the iris in the aqueous humor. These were mentioned to me when I queried, not seriously, LASIK surgery. Which would never be suitable due to the correction needed and thickness of the cornea. I had cataract surgery six years ago and one of the effects this had was the loss of my ability to focus, or accomodation. This is little talked about and a bit disconcerting to start with.
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@philwig “eyes with a built in heads up display” now that’s a great idea!!
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blueski2 wrote:
@philwig “eyes with a built in heads up display” now that’s a great idea!!


You did watch BBC near/current future dystopian drama Years and Years didn't you?
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HutToHut wrote:
I had cataract surgery six years ago and one of the effects this had was the loss of my ability to focus, or accomodation. This is little talked about and a bit disconcerting to start with.

For the majority of people needing cataract surgery, they're old enough they lost much of their ability to focus anyway. (that's why they need reading glasses). That's why it's little talked about.

For those who have early onset cataract, losing the ability to focus is a trade off. And that's also why many choose to wait till either 1) their ability to focus is almost useless or 2) their cataract is unbearable.
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@abc,
Quote:

For the majority of people needing cataract surgery, they're old enough they lost much of their ability to focus anyway...
...For those who have early onset cataract, losing the ability to focus is a trade off.

I know first hand about the trade off Toofy Grin The OP at 57 may still have some accommodation and its loss is another factor to think about. Varifocals are no substitute.
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If you have laser Tx to correct your distance vision you may be lucky and just need single vision specs for screen/near use. More likely you'll need office type varifocals albeit with zero strength distance zone. Main risks of surgical complications are chronic dry eyes which I find is common and regression of prescription after a period of time.

Multifocal lens implants - I've got several clients in their fifties who have had this procedure recently with fantastic results. No specs needed at all and no complications. Until recently, I only had older clients who tried multifocals and most of them were disappointed. Things change as we age, one of them is that the pupil often reduces in diameter. If this happens then the peripheral zones of the multifocal implant become inaccessible and so the visual results are less satisfactory. Specs are required and I've heard many complaints from disappointed patients who were expecting better results. Whether these implants are well suited to younger clients and become ineffective with age remains to be seen. Also, some clients are extremely particular and expect perfect vision; some are very easy going and tolerate quite a lot of blur with little discomfort; and, of course, there's everybody in between. Nothing to do with the actual prescription, all to do with your own personal tolerance.

Multifocal lens implants are developing tech. Nobody can really predict your visual outcome and whether they will meet your visual requirements. The only way you're going to find out if they are good for you is by having the procedure. The surgery itself is the same as for cataracts and is as safe as can be. Very low rate of serious infection or complications; your concerns are all about the visual outcome.

As an aside, I've never come across a surgeon who carries out these procedures who has had it done themselves. There must be some, somewhere, but I've never come across one. Their lackeys are encouraged to have it done and have it done for free so they don't count! And I've had neither myself.
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@MorningGory, Just a thought - You can roughly simulate what the outcome will be with contact lens. You can get your distance prescription corrected with single vision CL and then see what you'll be left with for near.

Quality MF CL such as Total1 Multifocals or NaturalVue are about the best and work in a similar manner to MF implants. Don't bother with the cheap multifocal CL from the bottom feeding practices, you won't learn anything from them. Any half decent practice will charge you for the trial but it will give you a much better idea of how you'll end up.
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@Snow Monkey! No mention of the other risks associated eg increased risk of retinal detachment from a blow to the head, particularly pertinent for us snow users?

My wife had cataract surgery last year (early onset at 50, both her parents had the same - her prescription was changing so fast that by the time her glasses were made up, they were out of date). The results have been excellent vision wise - she’s gone from a life time of -5.5 (pre-cataract) to almost perfect distance vision and can use her phone without reading glasses. She has a long distance and a medium-ish distance eye (the surgeon advised against full monovision) with multi focal lenses with some accommodation that also correct for astigmatism.

But - while obviously anectdotal - both her parents have suffered retinal detachments after their surgeries, resulting from relatively minor blows to the head - indeed, her mother’s while skiing (her fathers from an altercation with an ex-wife, but that’s a different story). This has made her understandably a fair bit more cautious on the slopes.

It would also make me think twice about having this kind of surgery electively.
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At about the same age as @MorningGory, I spent a half day at the eye hospital at Sunderland. Lots of options talked through. Well worth it.
Everyone is different.
I had never needed reading glasses but in my personal situation it was made clear to me that I would need them within a few years.
For me, the solution was contact lenses, one with a prescription for distance and the other eye for closer up.
Surgery would require further surgery to make adjustments or the need for glasses on top of surgery and adjustments would be likely to be needed within a few years.
Now aged 65
It was the right choice for me
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@MorningGory, which multifocal contacts did you try? I'm now happily using them but have been thru 4 models/manufacturers. I'm now on some weird ones that don'r appear to be retail available ...

That said, I'm happy with my progressive specs. I'm not a huge fan of sort of elective eye surgery haha!
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@under a new name, Not sure - tried 3 types, none of which was good enough. Shame really as the concept is great!

I've made an appointment with https://kierendarcy.com/ - looks like he knows what he's doing! Will report back on the outcome in 5 weeks Very Happy
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@MorningGory, he looks good.

I have an opthalmologist appointment in Annecy week after next as 1. bizarrely opticians in France don't prescribe - i.e. they'll provide the specs but you need to see an opthalmologist to get the prescription and 2. I have a weird left eye since a huge cold (bat flu?) around xmas, the guy in Annecy is apparently one of the top in the region and my local one didn't take me seriously Shocked
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@Pejoli, Retinal detachment after lens replacement surgery is not at all common. A big risk for detachment is myopia and if your wife was -5.50 then maybe one or both of your in laws were myopic, too? Still very unlucky for both of them to suffer detachments, though.
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Laser for me, obviously unless you have cataracts.
I’m a GP and see patients complaining about lenses sometimes but never about lasers.
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@motdoc, Interesting - what sort of complaints, and how bad? (and how often!)
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Pejoli wrote:
.... She has a long distance and a medium-ish distance eye (the surgeon advised against full monovision) with multi focal lenses with some accommodation that also correct for astigmatism ...
Which reminds me - I can't remember my precise numbers, and my stuff was lasers, but I had the "monovision" thing and it works well for me. I'm not sure how you tell in advance if it will or won't, but I didn't think I'd have any trouble with it. The lasers I believe tackled some astigmatism for me to. In case I didn't already say it, getting lasered was the best thing ever and I should have done it earlier. And there's a reason they don't do them one at once any more.

I shall no doubt need my lenses replacing in due course if I live long enough. I fancy the multi-focal jobbies, which sound coolest. With some UV filtering so I don't need to protect my eyes when surfing.
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@philwig, I wonder if you can get them with a mirror coating? Cool
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Laughing Now you're talking. Neuromancer I think had those.
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@MorningGory, Mrs kitenski was all set for lens replacement, expert said no, he'd only do laser. She is 56.
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@kitenski, Any idea why?
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philwig wrote:
I had the "monovision" thing and it works well for me. I'm not sure how you tell in advance if it will or won't

Can be simulated with contact lens.
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Quote:

Can be simulated with contact lens

This is reassuring. When I wore contact lenses, relatively briefly, I had different lenses right eye (for distance) and left eye (for closer) and found them fine. Once they were in - it was getting them in and out which I found a hassle because I have little piggy eyes.
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@MorningGory, I'll ask her when she gets back....something to do with retinal detachment risk I think
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@kitenski, Ta - at least I can question the guy about it when I see him!
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@MorningGory, ok she says it was due to her high prescription and the fact her lenses were very clear. Higher prescription meant higher chance of retinal detachment (nothing to do with the operation).
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