Lens implants

[FORANE]

They said I would go blind, and apparently, they were right...

I am considering an optional procedure of refractive lens exchange for worsening presbyopia. I believe I would like to get one of the multifocal lens implants on the market now such as Restor, Rezoom, Tecnis and the like. I believe I would prefer that over monovision with one distant and one near focusing lens.

Does anyone have experience with lens implants? Good? Bad? Ugly?
How will lens implants effect a 3rd class medical? Additional paperwork required?

 

[comanchepilot]

Lens implant for presbyopia? You mean like needing reading glasses? That can't be. . . .

 

[poadeleted20]

First, yes, there will be paperwork on this for the FAA, and Bruce will no doubt provide the details. I believe there will be a mandatory "down" time after the surgery for the eye to stabilize, and then a complete eye exam documented on an 8500-7 to be reviewed by the FAA before you can return to flying.

Second, while maybe you're hardover on this, but I can't imagine doing this on an elective basis just to avoid wearing reading glasses (which I'm wearing as I type this). Given the possibility of finding yourself permanently grounded due to problems or complications from such surgery (even if the odds are pretty slim), unless reading glasses (or even trifocals) won't fix the problem, I would not risk it, but YMMV.

 

[weilke]

The FAA isn't too thrilled about monovision, I believe that is since some RJ dragged its landing gear through a localizer antenna or something of that nature.

Do you wear glasses for distance at this time ?

Refractive lens exchange (cataract surgery without a cataract) is a fairly uncommon procedure.

 

[FORANE]

The FAA isn't too thrilled about monovision, I believe that is since some RJ dragged its landing gear through a localizer antenna or something of that nature.

Do you wear glasses for distance at this time ?

Refractive lens exchange (cataract surgery without a cataract) is a fairly uncommon procedure.

Distance vision is not too bad, but I wear +1.75 glasses 100% of waking hours now and occasionally will need higher power for near vision.

For background, I work in an operating room and am very familiar with the procedure.

I found this:
https://www.faa.gov/about/office_or...am/ame/guide/dec_cons/disease_prot/binocular/

• Adaptation period before certification:
  • Surgical lens implantation - minimum of 3 months post-operative

Does this mean I can self certify return to flight post op so long as my medical is not expired? Then my AME can renew my medical so long as 3 months have passed since the surgery and I meet qualifications?


The FAA Form 8500-7 does not need to be completed until time for medical renewal, correct?

 

[weilke]

Distance vision is not too bad, but I wear +1.75 glasses 100% of waking hours now and occasionally will need higher power for near vision.

Ever tried bifocals ?

Of course it is a personal decision, but for 'occasional' use of readers, surgery (including its certification rat-tail) seems to be a bit high of a hill to climb. Sure, you'll find someone who sells you the surgery, just not sure that the ends justify the means.

 

[bbchien]

Forane, put away the anesthetics, it's very simple. Working where you do, you SHOULD be wearing glasses anyway. Eye protection is critical.

Monovision (one implant for near, one for far) is not loved by FAA. Your opthalmolgoist will have you wearing them all the time for 3 months to make sure you can adapt. During that time frame, you are down. Then after the implants you have the mandatory 3 month period post op. Down time = 6 months min, total.

Multifocal L=Rt equal corrections: Three months down after.
8500-7 for both.

Go read 67.313 and see what you thinkg about flying to your next medical. Who would know the current policy of the Federal Air Surgeon? Why, the certification branch of course.

Lastly, note that on the "micro Fresnel" lens, few make 20/20. Most make 20/25, which means no upperclass certificate for you ever. If you are okay with that, have at.

The attachment is why they don't like monovision.

 

[FORANE]

Ever tried bifocals ?

Of course it is a personal decision, but for 'occasional' use of readers, surgery (including its certification rat-tail) seems to be a bit high of a hill to climb. Sure, you'll find someone who sells you the surgery, just not sure that the ends justify the means.

I understand the hesitancy many have about an elective procedure such as this and cannot argue with it. I think much of the apprehension folks have with any surgery stem from a fear of the unknown. We as pilots know fellow pilots who we know are quite capable and experienced; the type we would have no hesitation flying with. In my line of work having watched surgeons perform this procedure, I have a similar knowledge of their work which lends a degree of comfort.
I have not tried bifocals, progressives, etc. I feel I am heading that direction though.

 

[wabower]

FWIW, I've worn tri-focals for 30 years with acclimation time of zero. If you're interested in how pilots can be affected, I can tell you (privately) about a case in which I served as an expert for an orthopod whose lens "crinkled up like an accordian" when the surgery went awry. My testimony related to the sale of his jet that he no longer needed because his eyesight was insufficient for OR use.

When I recently spoke to an eye surgeon about various procedures now available, his answer was "have you ever noticed that all the opthomologists just wear glasses?"

I understand the hesitancy many have about an elective procedure such as this and cannot argue with it. I think much of the apprehension folks have with any surgery stem from a fear of the unknown. We as pilots know fellow pilots who we know are quite capable and experienced; the type we would have no hesitation flying with. In my line of work having watched surgeons perform this procedure, I have a similar knowledge of their work which lends a degree of comfort.
I have not tried bifocals, progressives, etc. I feel I am heading that direction though.

 

[bbchien]

In my line of work having watched surgeons perform this procedure, I have a similar knowledge of their work which lends a degree of comfort.

That is the most dangerous line of reasoning I have ever heard from a CRNA or an anesthesiologist.

Translation, "how hard can it be?"
Do you know that the criteria the profession uses to score adverse outcomes is REALLY REALLY favorable to the providers of the procedure?
Thinking "I understand this", and 'therefore, I'll get a good outcome" is a logic trap.

All 4 of our city's major lens provders.....wear glasses. That means something.

 

[weilke]

I understand the hesitancy many have about an elective procedure such as this and cannot argue with it.

My wife is a refractive surgeon......and wears glasses. That's all I need to know.

I have not tried bifocals, progressives, etc. I feel I am heading that direction though.

Before you consider going under the knife/laser, go to a good optometrist with an attached optical, spring for a set of lightweight bifocals or trifocals (chart, instrument panel, distant) and see whether that does the trick.

 

[wabower]

The Missus had cataract #2 done today. For the first one I thought we used most of the free world's supply of eye-drops and now it's started over.

 

[Clark1961]

The Missus had cataract #2 done today. For the first one I thought we used most of the free world's supply of eye-drops and now it's started over.

Yes but after that is over, it gets so much better...I wouldn't change my eye surgery.

 

[wabower]

She's loving it. Day 2 after the first one she was reading the crawl on the TV with the new lens. First time uncorrected in many years. Today was uneventful as well, so she is hoping for a big improvement. I on the other hand am somewhat concerned about the increased scrutiny.

Yes but after that is over, it gets so much better...I wouldn't change my eye surgery.

 

[Clark1961]

She's loving it. Day 2 after the first one she was reading the crawl on the TV with the new lens. First time uncorrected in many years. Today was uneventful as well, so she is hoping for a big improvement. I on the other hand am somewhat concerned about the increased scrutiny.

Best wishes on both outcomes.

 

[comanchepilot]

She's loving it. Day 2 after the first one she was reading the crawl on the TV with the new lens. First time uncorrected in many years. Today was uneventful as well, so she is hoping for a big improvement. I on the other hand am somewhat concerned about the increased scrutiny.

That 10lbs is gonna matter now . ..

 

[wabower]

Oh. Hadn't even considered that problem. May be forced to try the "So who are you going to believe, me or your lying eyes?" routine.

That 10lbs is gonna matter now . ..

 

[SCCutler]

She's loving it. Day 2 after the first one she was reading the crawl on the TV with the new lens. First time uncorrected in many years. Today was uneventful as well, so she is hoping for a big improvement. I on the other hand am somewhat concerned about the increased scrutiny.

My bride got the Crystalens procedure 4 years or so ago - calls 'em her bionic eyes.

Me, I read about what was involved and darned near puked.

Contacts, readers, whatever it takes for this old boy.

 

[wabower]

I was somewhat blasé about her complaints of poor night vision until a car trip a few months ago when she drove for a while as the sun set. Then I couldn't wait to help her find the best doctor for the job.

My bride got the Crystalens procedure 4 years or so ago - calls 'em her bionic eyes.

Me, I read about what was involved and darned near puked.

Contacts, readers, whatever it takes for this old boy.

 

[write-stuff]

Don't they replace the lens as part of cataract sugery? Why is this less down time than the lense replacement suggested by the OP?

 

[poadeleted20]

Doing eye surgery for cataracts which affect eyesight is one thing -- there's no other way to fix that. Doing elective eye surgery for something that can be fixed with corrective lenses (either glasses or contacts) is to me at this point a pointless risk. Had it been available 40 years ago, I would have done it in order to qualify as a military pilot -- in that situation, there would have been a return worth the risk. But not just to rid myself of the corrective lenses I've been wearing for over half a century.

 

[X3 Skier]

Having used monovision contact lenses daily for over twenty five years, it really irritates me to have to replace the reading lens with a distance lens and use readers to take the eye exam and fly when if I had cataract surgery and had the same monovision lenses it would be fine.

I guess I will have to wait for cataracts to grow.

Cheers

 

[poadeleted20]

Having used monovision contact lenses daily for over twenty five years, it really irritates me to have to replace the reading lens with a distance lens and use readers to take the eye exam and fly when if I had cataract surgery and had the same monovision lenses it would be fine.

Why not try multifocal contacts instead?

 

[oldShar]

Does anyone have experience with lens implants? Good? Bad? Ugly?
How will lens implants effect a 3rd class medical? Additional paperwork required?

Since you asked and since no one answered personally ----

I had implants put in 14 years ago (for cataracts).
For the majority of daily life, I go about like someone with 20/20 vision.
Although I have been prescribed (I actually use $5.00 Walmart specials) +2.50 lenses for reading, I get along just fine without glasses if the lettering is large enough. I feel a little strain reading small print on sectionals in my lap, but the rest of the panel is as clear as a bell without glasses, and my opthal says I'm still legally 20/15 in the distance. Passed my 3rd class without problems, and have no restrictions listed (relative to having to carry glasses with me, although I still do.)

Worst part about getting the implants? I was asked to eat a turkey sandwich during recovery post-op --- (I think that turkey is fowl (foul) tasting). Would have done it earlier if I knew how well it would have improved my life. My father just had his done. His worst experience is realizing how many wrinkles exist on his 90 year old face.

But, I have to agree with Ron --- If it ain't broke, don't fix it --- you're skirting with Capt. Murphy by doing so.

 

[X3 Skier]

Why not try multifocal contacts instead?

After 25 years with gas permeable monovision, I doubt my brain could handle it.

Hard enough with readers and two distance lenses.

Cheers

 

[FORANE]

That is the most dangerous line of reasoning I have ever heard from a CRNA or an anesthesiologist.

Translation, "how hard can it be?"
Do you know that the criteria the profession uses to score adverse outcomes is REALLY REALLY favorable to the providers of the procedure?
Thinking "I understand this", and 'therefore, I'll get a good outcome" is a logic trap.

All 4 of our city's major lens provders.....wear glasses. That means something.

Gosh Bruce, that's a little harsh don't you think? Perhaps I did not make myself clear and I apologize for that. Allow me to try again... By knowledge of their work I meant knowledge of the quality of the individuals work rather than knowledge of the procedure performed. I understand a good outcome is never guaranteed. I believe I understood your first post and thank you for that helpful post.

Plenty of helpful informative posts in this thread and I appreciate it.

 

[weilke]

Don't they replace the lens as part of cataract sugery? Why is this less down time than the lense replacement suggested by the OP?

The extended downtime is for achieving monovision (one eye far, one near). The air-surgeon wants to make sure you stop running into doorframes and stumbling down stairs before he allows you to fly a plane again.

In regular cataract sugery, an existing refractive error is typically addressed as well. Most adults who may have needed glasses for distance and readers will be left with only needing readers afterwards. Some short-sighted (myopic) individuals otoh prefer to still be somewhat myopic after the surgery as that is the world they lived in for a long time. They enjoy not neading readers and rather put on glasses for driving only (when seing beyond 20ft is beneficial ).

Some ophthalmologists/patients will aim for monovision after cataract surgery. In that case, the same limitations on certification apply.

After cataract surgery, there are now a couple of 'premium lenses' available that may allow you to not need glasses. They come in to flavors, one tries to mimic how the human lens works (by being bent into different shapes by the little muscles surrounding it), the others basically have a number of different focal points (fresnel lenses). The second type is the one that bruce mentioned earlier. Typically, you will not achieve 100% visual acuity at either far or near, many people will make that compromise if if means not needing glasses (or only needing readers for prolonged reading or small text but not to find the numbers on their cellphone). My dad for example is a retired engineer who had required readers all his life. When it came to cataract surgery, given the different options, he decided on monofocal lenses corrected for distance (the most common desired result). Getting the absolute best visual acuity and no glare was more important to him than getting rid of reading glasses.

 

[kyleb]

Re: Multifocal contacts.

After 25 years with gas permeable monovision, I doubt my brain could handle it.

Hard enough with readers and two distance lenses.

Cheers

I made the change to multifocals seamlessly about a year ago. I'm 48 and have been vision corrected for 25 years.

Ask your eye doctor. Mine offered a free set of multifocals to see if they worked for me... I had nothing to lose.

 

[X3 Skier]

Re: Multifocal contacts.



I made the change to multifocals seamlessly about a year ago. I'm 48 and have been vision corrected for 25 years.

Ask your eye doctor. Mine offered a free set of multifocals to see if they worked for me... I had nothing to lose.

Have an appointment in two weeks for an exam. Thanks for the suggestion. I will ask.

Cheers

 

[bbchien]

Have an appointment in two weeks for an exam. Thanks for the suggestion. I will ask.

Cheers

BUT NOT MONOVISION contacts.

 

[X3 Skier]

BUT NOT MONOVISION contacts.

Understood that, see my earlier post #22.

I was referring to multi focal contacts which I assume are acceptable.

Cheers

 

[JHW]

Doing eye surgery for cataracts which affect eyesight is one thing -- there's no other way to fix that. Doing elective eye surgery for something that can be fixed with corrective lenses (either glasses or contacts) is to me at this point a pointless risk. Had it been available 40 years ago, I would have done it in order to qualify as a military pilot -- in that situation, there would have been a return worth the risk. But not just to rid myself of the corrective lenses I've been wearing for over half a century.

amen. I can't fathom why people take the slightest chance with their eyesight when there are risk-free ways to see.

 

[bbchien]

Yes. Just completing the USN briefing.
You tell the men.
You tell them again.
Then you tell them what you just told them.

And your yield is about 40%. :wink2:

 

[SCCutler]

Yes. Just completing the USN briefing.
You tell the men.
You tell them again.
Then you tell them what you just told them.

And your yield is about 40%. :wink2:

If I were able to comprehend, process and retain 40% of what I heard, I'd be ecstatic...

...getting CRSS - "Can't Remember S*** Syndrome."

 

[wabower]

I gots some bad news for you about the future.

If I were able to comprehend, process and retain 40% of what I heard, I'd be ecstatic...

...getting CRSS - "Can't Remember S*** Syndrome."

 

[X3 Skier]

If I were able to comprehend, process and retain 40% of what I heard, I'd be ecstatic...

...getting CRSS - "Can't Remember S*** Syndrome."

What was this thread about again? I can't remember.

Cheers

 

[PilotAlan]

I gots some bad news for you about the future.

You can tell me. It's OK, I won't remember it tomorrow.

 

[wabower]

On Sunday I told the grand-kids that we were almost at the age that we could hide our own Easter eggs. They weren't sure exactly what that meant, so I didn't feel obligated to expound.

You can tell me. It's OK, I won't remember it tomorrow.

 

[tmyers]

OMG that is funny, and oh so true.

 

[Graueradler]

I have seen tragic outcomes of low risk minor surgery. I am very near sighted but made the decision a long time ago not to have surgery as long as my vision could be corrected with glasses. When surgery becomes necessary for cataracts or other reasons, then I will take the opportunity to see what other improvements can be made.