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Generally, yes, but this is not an absolute rule. I've had plenty of patients who have different lens types, manufacturers, and visual parameters in a huge range of contexts. This is a really important question and one you should discuss with your surgeon as to whether mixing lens tech is a good idea - for you. each eye/person is different as to what they can tolerate.

Hi, so this is a tough question because I don't have access to your measurements. Generally, the formulas are quite good, so if a toric is recommended to neutralize the astigmatism, no matter how small, then generally that's going to give you your "best" vision. 0.75 of cyl is just on the edge of where it could be considered. LRI would almost definitely be a good option, coupled with a monofocal implant, to address the cyl and still give great distance. However, there is a very slight increased risk of dryness - so that depends on your current dry eye status and risk tolerance. Generally, I think you'd probably be fine with a standard monofocal, but again the formulas may reveal a toric since there are other aspects (posterior curvature, axis, surgeon's factor, etc.). The lower torics are fine, but usually for small amounts of cyl <1.00 I either leave it or treat with LRI. I wouldn't necessarily worry about your doc's experience because a toric lens is implanted the same no matter the power. Regarding gun recoil, you should be fine to return to normal activities after 1-2 weeks. Good luck!

@@cohenlaservision Thank you so much!! I wish you were closer! Awesome video and information, regardless!!

@cohenlaservision I had surgery yesterday and all is well. The new colors were a surprise 😮 I got the monofocal and went ahead with the LRI. No trouble so far! The Bausch & Lomb lower strength Torics, it turns out, don't cover quite as much of the field of vision as the Alcons and I didn't want to see peripheral edges... Thank you again!

@@virginiainla8085 awesome news! thanks for the update and glad things went well :)

Yes! Most EDOF and MFIOL lenses also come in toric options, but not all.

ICL doesn’t alter the cornea much, so generally it’s been my choice over PRK for patients with suspected keratoconus. I have some videos on ICL you can check out!

Depends on your corneal measurements. If your cornea is thin, even PRK can be risky.

@@cohenlaservision so do u mean CXL thins the cornea?

No, CXL doesn’t thin the cornea but PRK does. Most people who undergo cross linking already have thin corneas…

@@cohenlaservision Dr THANKS, which means Cross linked eyes can't under go refractive eye surgery since their cornea is already thin and expected to flatten with time after undergoing CXL.

@@captsonko.9345 yes, if you have thinning from keratoconus CXL should stop progression, but there is still a chance of further thinning over time. If your cornea is highly irregular, topography-guided PRK can be considered, but if you're seeing that well with glasses then I'd assume that's not the case, in which case I'd recommend ICL most of the time. Of course, I can't make any formal recs but definitely address these questions with your doc. good luck!

No, the red circle means the alignment is off. It only deploys the probe when it’s aligned properly. If you attempt to fire the prob when the probe is too close or far away it doesn’t harm to the patient.

Yes it has. This version with camera centration made by Reichert is new - and new to our clinic!

It’s definitely easier for some patients :)

Glad you had a good experience with monofocal lenses!

Hi, if the eye is capable of seeing 6/6 with glasses then likely yes. If the vision cannot be improved with glasses or contacts the no, lasik or other surgery won’t help unfortunately.

Most likely, yes. But there are some important factors and measurements that will need to be evaluated prior to surgery. I have a few other videos about whether lasik is “right for you.” But you can certainly get a consultation and make a decision from there!

So glad you had a good experience! thanks for sharing

@@martimlobao we will see long therm...

@@protosfotod2416 It’s been more than a decade now, still seeing better than when I wore glasses

How is it high risk?

@@ZerixDaGod google search "Lasik Complications" you will see the truth

@@RenatoDamascenodudu what I found is that lasik surgery complications are extremely rare and it’s a shockingly low risk procedure with a massive success rate. 😂🤦‍♂️

hi Renato, I appreciate your concerns about LASIK, but I can assure you that while there are certainly risks, the vast majority of patients believe the experience was well worth it and I hear daily how "it was the best decision I ever made!" A thorough exam and detailed explanation of potential risks and complications is essential, as LASIK (or any procedure) may not be a good idea for everyone. Countless peer-reviewed studies and recent FDA guidance are all in agreement that modern techniques are safe and among the most successful procedures ever developed in medicine. I've made other videos specifically about this topic as many people have sincere apprehensions, and I respect that.

The complication rate is far higher than reported.

Hi Rohit, if you are under 45 then ICL would likely be my recommendation. Otherwise lens replacement is a better option for older folks. Of course follow the recs from your doc!

Those prices are towards the extreme on both ends, a bit pricey for ICL and comparatively cheap for PRK. Really depends on anatomy and recovery limitations as to which is “better”.

Thanks so much for the feedback!

Insurance challenges are no doubt a constant frustration for both docs and patients.

That’s the ultimate goal! Accommodating IOLs are constantly being tested, but you’re correct that there isn’t a “perfect” replacement lens yet. Today most patients are still very satisfied with their lenses overall. Keep in mind the aging natural lens isn’t the same as a 25yo lens and far from perfect 👌

@@cohenlaservision Crystalens was approved by the FDA in 2003 but had issues. We have had 20 years to fix the issues but it looks like Juvene won't be approved for another 3 years. Meanwhile, I am being forced into cataract surgery with a rigid IOL that has side effects and I will probably still need glasses. Why has it taken so long to get accommodating IOLs approved??

Yes, it is possible to change out a lens but it’s a more complicated and risky procedure. Generally we try not to exchange IOLs unless absolutely necessary.

Thanks so much, Toby! Glad you found it helpful

Keep in mind your rx may change after pregnancy, so might be best to wait until after nursing. However, I would trust your doc’s guidance that LASIK may not be ideal based on your measurements. I tend to think SMILE has similar restrictions to LASIK re corneal thickness, so PRK may be better? ICL is another likely fantastic option since the cornea isn’t altered. Good luck! Of course, I can’t formally make any recs without examining you ;)

Thank you for your answer But would like to tell you i had already waited for long after my first baby and now she is 3 years old that is why i am planning for refractive surgery now before planning for my 2nd baby So can you guide me that 2-3 months after surgery would be risky to be pregnant? Will it effect on my refractive surgery if i will be pregnant after surgery?

@@sidrazafar5316 If you've wait this long, and your doctor is OK with proceeding, then I'd say go for it! There is SOME risk that your rx may change, but even in that case you can still get a touch-up if needed in most cases. If your rx was stable after your first pregnancy/nursing then you should be ok, as long as you know the risks.

Sorry vivity lens not Vivitar 😂

Thanks for sharing!

🙏

It bonds quickly in a matter of weeks. However there isn’t “scarring” between the flap interface, or else transparency would be compromised. Rather the epithelium heals over the edges, so it is possible with VERY significant trauma that the flap can move years later. This is extremely rare.

I know! sorry…

Hi Amber, sorry for speaking too quickly for your comprehension! I'll take that feedback to heart. Regarding IOLs, yes you CAN replace a lens but there are risks to going back into the eye after primary implantation, so this is a matter to be discussed with your surgeon. these lenses are designed to last forever! Good luck with you and your wife's surgery!

Yup, but there are some limitations. Generally a monofocal and a multifocal may not play well, since the optics are different. We have several patients who tolerate it fine, but not everyone can.

You would likely be a candidate for many types of IOLs, depending on your goals after surgery. A monofocal +/- toric may be chosen for optimal distance, but there are many EDOFs and MFIOLs that also treat astigmatism if you want to preserve your reading without glasses. Of course, I can't say for sure without an exam what would be optimal, but ask your doctor if there are any contraindications to certain lens types based on your exam.

Flexible accommodative lenses like Occumetics and earlier prototypes like Juvene are certainly promising, but challenging to implement and tend to lose flexibility over time, like the Crystalens. I don’t have any direct experience with it but look forward to reviewing the data!

Generally after the first week your eye is back to normal and additional precautions aren’t needed. However, even years later damage to the flap can still occur with enough trauma. This was more of an issue with keratome flaps as femtosecond lasers make a more secure flap nowadays.

K, thanks now which is the best because I went for eye scan to see if my eyes are candidate for LASIK,and the Dr checked and found that my eyes are fit for LASIK.but now am scared if the flap can't permanently bond heel then looks PRK is the best.

@@captsonko.9345 Both are really fine and have equal long-term outcomes. Flap complications are not possible in PRK or SMILE, but generally you don't have to worry. Femtosecond flaps are very secure, and the quick recovery makes LASIK still the most common choice unless you are a boxer or footballer :)

Hi Bambi, of course I can't make any formal recommendations without an exam and diagnostic testing, but based on your numbers generally any procedure *could* be a good option. However, given your history of dry eye, LASIK can worsen symptoms and pose other risks if you rub your eyes. I think that an ICL would be a great first choice, especially with your astigmatism. PRK or SMILE would be next and LASIK likely last based on what you said and the limited information I have. I'd just talk frankly with your doc about your concerns and see what they recommend.

Are you asking what would happen if a patient elects to have lens replacement surgery with good preop vision and no presbyopia? This would almost never be recommended and would be a downgrade from physiologic vision in a patient without presbyopia, with any IOL and certainly an Eyhance. Anyone who has an Eyhance (or any IOL) will have fundamentally changed the optics of the eye and would be dependent on the properties of the new IOL. Not sure if that answers your question…

Yes. What is recommended after the cataracts are removed from the patient in this scenario?

@@CC-uh8gl Any IOL can be used, but as a general rule cataract or lens removal is not performed without a replacement IOL unless under very unique circumstances.

thanks for the question! It's difficult to answer this, as in my experience people's near vision with Eyhance has been highly variable, with some patients experiencing minimal mid-range vision at 25-30 inches and others achieving relatively excellent near vision at 14-16 inches. Generally, most patients can see their computer screen, dashboard, but not their phones or small text. I'd still plan on needing reading glasses if you go with an Eyhance, unless you target one eye with monovision.

Thanks for the quick response!

Hi! First of all, don't fret about cataract development. In the 11 years of pre-clinical data not a single cataract had been reported with EVO, but there was a low incidence with the prior generation (<5%). Any surgery, ICL included, can induce inflammation which can affect IOP, cataracts, endothelial cells, etc, but it seems your vault is perfect and ECD is looking great as well! It seems your surgeon did an excellent job and you should be in good hands no matter what develops, but overall I wouldn't worry and enjoy your new vision. Explantation is typically performed at the time of cataract surgery (way in the future) or if something happens (e.g. trauma) that causes the IOL to become damaged or decentered. Removing the IOL is more complicated and the procedure itself causes more risks for cataracts developing than leaving it alone. Keep in mind, everyone develops cataracts eventually, some earlier, some later in life. Hope that helps.

Thank you very much for the reply!! I am not intend to do the removal. Some other doctors that I visited told me the similar things as well. I just want to get comfortable with the worst case scenario, and I think removal is probably the worst case scenario. Therefore could you please tell me whether it is feasible or possible to remove the lens without causing damage to the inner eye structure like the natural lens or causing significant ECD loss, if it was performed with great technique. Thank you 😊

Hope you can get evaluated soon! Best of luck

…and counting!

Generally most docs will perform an IOL exchange or offer additional refractive corneal surgery options if applicable, like PRK. Some include these services in their upfront costs, some charge extra or will bill insurance when able. Good questions to ask your surgeon beforehand to discuss any potentialities :)

Yes, it’s “always possible”, but as long as your retina was examined and clean of any holes or tears your risk is still pretty low. I’ve implanted many Panoptix IOLs with high myopes with excellent results. Good luck!

Glad you found it helpful, Eric! Best of luck :)

@@cohenlaservision Thank You So Much!!! I Really Hope Everything Goes Well!!! 🙏

Thanks so much!

If your symptoms are managed well prior to surgery, you should be fine. Dry eye can worsen, but this is usually temporary and might require some additional treatments after the usual post op period. All depends on a thorough exam and your particular severity. Hope that helps!

Thanks for the feedback! I suppose this is possible, but I’ve never seen it done. Femto is so quick (30-40s) and requires the eye to be in the proper alignment, which is difficult under general.

@@cohenlaservision Thank you, Doctor, for your response ! 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.

Yes, both IV and oral sedation can be used even with patients on stimulants for ADHD. Just discuss your meds and concerns with your doc beforehand!

Thanks so much! hope our patients find it helpful as well :).

Honestly, costs for upgrades (premium IOLs, toric, monovision, or femto) all depends on your particular surgeon’s or ASCs costs. Usually an Eyehance isn’t charged extra at our clinic, but we do charge a few hundred for monovision. Toric and multifocal lenses usually range from $1-4k per eye, but there is definitely variability. Local markets, doctor’s experience, included bundles for drops, etc all play a roll. Don’t be afraid to ask your doctor about pricing! Insurance will usually cover a standard monofocal IOL, anesthesia, post op period etc. We charge a small fee for special testing and combination drops that are compounded for us as a convenience for patients who don’t want to fiddle with multiple bottles.

Glad you found it helpful! I’ve heard good things about the Odyssey so far. Haven’t used it yet though

I haven’t yet placed these lenses, but I hear good feedback from colleagues. some better glare performance, but mixed reviews regarding intermediate vision for some. I hope to implant some soon so I’ll prob make an updated video

@@cohenlaservision Looking forward to 2024 updates and beyond. Thanks and subscribed.

@@juicer52 Thanks for your support!