The Pandemic Of Eyes

Prologue

I wrote a blog on my issues with Hypermetropia, Myopia and Presbyopia Digital Ophthalmology | Kapil Khandelwal KK. It was around December 2021 and we were getting back to regular work after the Covid vaccinations. On my annual health checkup, my eye correction numbers were reduced for both my eyes for distance and reading glasses. But the eyes were seeing some other things. That’s the start of journey of my cataract.

Blurring of Vision

Over the next one year, I was able to see but there were situations when my eyes would hurt me especially under bright light. By December 2022, the eyes would accept my current spectacles would work on some days and on some days, there would be a hazy vision, dryness in the eyes. My lifestyle took a big dip as I was not able to play sports and do my regular walks. All activities were restricted to indoors. Work-life balance took a huge dip. Also my right eye’s vision was deteriorating faster and I could see better from the left eye. In other words, I would behave like the Mad-Eye Moody of the Harry Potter fame.

The Cataract – The Pandemic of Eyes

Cataract is a medical condition that causes clouding of the lens of the eye, which is typically clear. The cloudiness can cause a decrease in vision and may lead to eventual blindness if left untreated. Symptoms of cataracts include clouded, blurred or dim vision, trouble seeing at night, sensitivity to light and glare, seeing “halos” around lights, frequent changes in eyeglass or contact lens prescription, fading or yellowing of colors, and double vision in one eye. According to the Global Burden of Disease Study 2019, the global burden of cataracts has been increasing over the years, with a rise of 91.2% in disability-adjusted life years (DALYs) from 1990 to 2019. The study also found that globally, age-standardized prevalence and DALYs rates of cataracts peaked in 2017 and 2000, respectively. The prevalence rate of cataracts in 2017 was 1283.53 per 100,000 population, while the DALYs rate was 94.52 per 100,000 population in 2000. The burden of cataracts is expected to decrease by 2050. This may not hold true in the post Covid Era.

Earlier as per WHO, the prevalence of cataracts increases with age, from 3.9% at age 55 to 64 years to around 92.6% at age over 80 years. This epidemiology is fast changing to younger co-horts as per consensus building with the doctors and the intra ocular lenses (IOL) manufacturers. What is this new wave of cataract emerging from?

Sedentary lifestyle during lockdown leading to diabetes, high blood pressure or obesity
Excessive exposure to devices such as mobile, laptops over long working hours during work from home
Some of the experts believe (yet to be proven by longitudinal research) that it is the side effect of the covid vaccine.

But it is certain that cataract is spreading in a much wider age cohort.

Why did I go for Cataract IOL Implant Surgery?

After June 2023, the right eye’s sight started deteriorating faster than usual, despite the eye drops treatment. By early October, various tests recommended a surgical intervention. The surgeon also recommended for the IOL implant to the other eye within a month or two. Times up now. But the issue were:

What are my lifestyle requirements that the IOL implant needs to fulfill?
What type of IOL implant to select?
What make of IOL implant for the type selected?
Are there post-surgical life style modifications to be undertaken?

My Lifestyle Requirements

It is very important for those going in for surgery to decide on what sort of lifestyle modifications you would like to achieve post-surgery. In my case,

Reading: At the outset, I needed to get my eyes vision corrected that will enable me to read books, files on my laptop for 6 to 8 hours a day. I didn’t mind reading with corrective vision via spectacles. Therefore, post-surgery, there will still be a need for reading glasses.
Outdoor sports and activities: Wearing spectacles and playing aggressive sports has always been a handicap for me for years. Therefore, a full correction of my distance sight was very important to me

Types of Intra Ocular Lenses (IOL) to Select From

Depending on the requirements of the condition of the eyes and the vision correction for the lifestyle, there are different types of IOLs available. These include:

There are several types of lenses that can be used to replace the natural lens of the eye during cataract surgery. The most common types of lenses are:

Monofocal lenses: These lenses provide clear vision at a single distance, either near, intermediate, or far. You may need glasses to see clearly at other distances.
Multifocal lenses: These lenses have multiple focal points, allowing you to see clearly at different distances without glasses. However, they may cause some visual disturbances such as halos and glare.
Toric lenses: These lenses are designed to correct astigmatism, which is a common condition that causes blurred vision. They can also correct nearsightedness or farsightedness.
Extended depth-of-focus lenses: These lenses provide a continuous range of vision from near to far, with less visual disturbances than multifocal lenses.

Some of the factors that also need to be also considered are:

Visual needs: The type of IOL you choose will depend on your visual needs. Monofocal lenses are designed to provide the best possible vision at one distance, while multifocal IOLs have corrective zones built into the lens, allowing you to see both near and far objects. Extended depth-of-focus (EDOF) IOLs have only one corrective zone, but this zone is stretched to allow distance and intermediate vision. Accommodative lenses can also correct vision at all distances, using the natural movements of your eye’s muscles to change focus. Toric lenses have extra built-in correction for astigmatism.
Lifestyle: Your lifestyle can also play a role in choosing the right IOL. For example, if you enjoy outdoor activities or sports, you may want to consider an IOL that reduces glare and enhances contrast sensitivity.
Budget: Not all IOL types are covered by insurance, and some can cost more than INR 50,000 out of pocket. Medicare and most insurance companies cover the cost of the most common IOL, the monofocal lens. Multifocal, EDOF, toric, light-adjustable lenses, and accommodative IOLs are considered premium lenses and can reduce the need for glasses or contact lenses.
Health: Your overall health and medical history can also play a role in choosing the right IOL. For example, if you have a history of eye disease or other medical conditions, your ophthalmologist may recommend a specific type of IOL.

Based on the above-mentioned types and factors, I decided to go for monofocal IOLs.

Not all manufacturers make all types of lenses. Moreover, many of these players are leaders in one type of lenses in terms of innovation or have invented specific materials. So which are the key manufacturers that I shortlisted.

Key IOL Manufacturer’s in My Consideration List

For monofocal IOL, my recommendation list is as under:

Johnson & Johnson: Johnson & Johnson Vision is a subsidiary of Johnson & Johnson that specializes in eye health products. They offer a range of IOLs, including the TECNIS Eyhance™ Intraocular Lens.
Alcon: Alcon is a global leader in eye care and offers a range of IOLs, including the AcrySof IQ PanOptix Trifocal IOL.
Hoya Corporation: Hoya Corporation is a Japanese company that specializes in optics and photonics. They offer a range of IOLs, including the iSert Preloaded IOL.
Bausch Health Companies: Bausch Health Companies is a Canadian pharmaceutical company that offers a range of IOLs, including the Crystalens AO.
Carl Zeiss Meditec AG: Carl Zeiss Meditec AG is a German company that specializes in medical technology. They offer a range of IOLs, including the AT LARA Toric.

The key issue here is that not all eye surgeons implant all manufacturers IOLs. Therefore, eye surgeons will recommend the IOLs that they are trained to implant.

Post Operative Eye Sight Recovery

Voila! My distance eyesight was fully corrected. I have no myopia now. But there was residual eye sight correction for reading and near distance such as laptop. My eye surgeon recommended me for a progressive lenses spectacles. Although, progressive lenses are a popular choice for people like me, who need vision correction for both near and far distances. However, there are some drawbacks to consider when choosing progressive lenses:

Adjustment period: It can take some time to get used to progressive lenses. I experienced dizziness while my eyes adjust to the new lenses.
Peripheral distortion: Progressive lenses have a small area of clear vision in the center of the lens, with the prescription gradually changing towards the edges. This has some distortion in my peripheral vision.
Cost: Progressive lenses can be more expensive than traditional bifocal or trifocal lenses. The cheapest lenses are worth INR 15,000.
Limited frame options: Progressive lenses require a specific shape and size of the lens, which can limit your frame options.
Prescription changes: If your prescription changes, you may need to replace your progressive lenses.

It has been 5 weeks since my surgery. However, I am still struggling with my progressive lenses from Titan EyePlus after two rounds of measurement and lenses. I have still 4 weeks of protective eyewear when I step outside. I have started using Polaroid Ultraviolet rays protection sunglasses when outdoors in the sun during the day.

This is my first extended time in front of the screen to work. Coming back to the Pandemic of Eyes. I did see people who were younger than me for cataract surgery waiting in the pro-operative area getting prepped. Look out for more on this issue.