Pseudoaphakia, lens for this condition?

[sevalav]

Does any now what is the best lens for pseudoaphakia condition? Is some characteristic important (base curve, aspheric, or sferic, AR, PAL, etc.)?

[chip anderson]

Same criteria as a phakic eye with no accomodation.

[sevalav]

Well, Im looking for best lens options for some patient who had cataract surgery (phako). He must weare glasses (-1.0sph=-0.75cyl ax90) and with this corection he have good VA = 1.0. The problem is in optical sensivity and condition without acomodation. Can we, with some proper type of lens, offer higher level of visual comfort for this patient? Is lens design important in this case (sferic, asferic, atoric)? Single vision lens or PAL? Etc.
Everyone who have some information or some expiriance about that, please share this.

[chip anderson]

Is the patient monocularly pseudophakic or binocularly pseudophakic? What is the age of the patient if monocular? All these are things you have to know before making suggestions.

[sevalav]

Man, 74 years old, but with good health, and dinamic life. He is a profesor, reading and writing is his occupation. One eye is pseudoaphak, other is with his own human lens, but with cataract . With corection on this eye (-4.00sph) VC = 0.3-0.4. Do you need something else?

[chip anderson]

I don't think it's a false assumption that the phakic eye has some sort of bi-focal or trifocal. Use the same type on the pseudophakic eye. This also assumes that the distance correction (and the near for that matter) are not too far apart from each other. In any event the fact that one eye is pseudophakic should not enter into the situation. Patient at 70 years old has no accomodation left anyway.
The only way aphakica or pseudophakia would be relevant to the situation would be if the non operated eye had some accomodation left or there was a large to medium power difference between right and left.

Chip:cheers:

[Kyle]

What IOL did the surgeon use? ReSTOR, ReZOOM, Crystalens?

Accommodation: it's not just for "yoots" any more.

[braheem24]

Do we know his VAs?

at -1.00 and -4.00 he may have problems with image sizes no matter which lens you use unless his VAs are deminished in either eye.

Whatever the outcome it will probably require at least a slab-off and match B.C. to try and minimize image size differences.

[sevalav]

In the end, the patient use this correction:
for distance:
OD: -3.00sph (VA=0.3)
OS: -1.00sph=-0.75cyl ax90 (VA=1.0)
(Good corection.)
near:
OD: +0.50sph
OS:+1.50sph=-0.75cyl 90
But this corection (for near) was not so good. This corection was brescribed by ophtalmologist. After second refraction the better corection is OS: +1.50sph.

[shellrob]

Is he planning on getting his other eye done anytime soon?

[chip anderson]

What was the age of the patient, how long are his arms. I think the reason you had to leave the cylinder off the phakic eye is you overcorrected the add. Just because the pseudophakic eye (which has zero accomodation) needed a 2.50 add, there is no reason to use this strong an add on the phakic eye unless the patient is old enough (70+) to need a 2.50 add. If the patient were under 38 or so he might have needed no add at all in the phakic eye.

While it is generally good practice to ballance adds, this is not good practice amoung unilateral aphakics and pseudophakes.

Chip

[rdcoach5]

Use 1.67 aspheric lenses, matching the base curve and using a slab -off with A. R. cote and, if you want to do everything, add edge cote to reduce reflections off the edges , especially at night. On hyperopes, matching the thickness is most important.

[sevalav]

Because his correction is not high, spherical lenses is good too. Now he have lenses with AR and UV protection.