Any experiences of lens replacement (cataract or otherwise)?

[hugh flung_dung]

Has anyone here had experience of lens replacement? I'm thinking of it as an alternative to specs but am getting conflicting info about how long I would be grounded for.

[mad_jock]

None persoanlly but there have been quite a few threads in the medical section on the subject.

I do know a couple of commercial pilots who have had Cataracts removed and they had a period of grounding followed by a consultant report and they were flying again. 3-6 months rings a bell.

[Blues&twos]

Do you mean laser surgery? Lens replacement won't necessarily free you from glasses...fixed distance focus means you'll need specs for close up stuff like reading, checking instruments etc., and you may still need glasses to sharpen up your distance vision anyway. That's how my lens replacement worked out! (For cataract...when I was 26!)

I was driving again inside a few weeks once my new specs had been sorted, but don't know about grounding period for flying I'm afraid.

[Another_CFI]

I had cataract operations on both eyes and the UK CAA requirement was that I was grounded from the day of the first operation until six weeks after the second operation, which in my case meant a total of eight weeks. The requirement to have my medical reinstated was simply that I underwent a Comprehensive Eye Examination at my local optician and submitted the results to the CAA.

Once this had been done it took the CAA less than 48 hours to contact me and wish me happy flying.

[hugh flung_dung]

Thanks to all. Six weeks might be just-about tolerable, but 3-6 months would be a no-no.
Another ... :
Was there any reason not to get them both done at the same time and just tolerate a couple of days relative blindness? Did you consider the new'ish IOLs which are supposed to give some accommodation, or going for different corrections in each eye to get around the need for reading specs?

[Another_CFI]

The reason for having each eye done seperately was that that was the protocol that the surgeon followed. He never did both eyes at the same time.

The reason for having each eye optimised for distance viewing was that I now only require to wear glasses for reading, since my distance vision is now slightly better than 6/6. There is no guarantee that you would obtain the same result and it is possible that you may have to wear glasses for distance as well. I suspect that with different corrections in each eye you would have to wear glasses all of the time since one eye would require distance correction and the other near vision correction.

[hugh flung_dung]

Yes, the accommodating IOLs (such as Crystalens) seem to work for some but there's no guarantee of performance; it's useful to hear your scepticism.

There seems to be a fair chunk of evidence that monovision works for most non-pilots after a settling period (although I know someone who tried it with contact lenses and couldn't adapt). I'm +2.5 distance and a further +1 reading (middle-aged http://images.ibsrv.net/ibsrv/res/src:www.pprune.org/get/images/smilies/boohoo.gif). I wonder if it would be an option to go for monovision and then wear spectacles when flying, in order to give acceptable binocular vision(?) If this was acceptable it would at least mean that specs weren't needed on the ground.

[BroomstickPilot]

Hi Hugh,

I am currently in the position of having to consider intra-occular lenses as I now have cataracts in both eyes. So I have done a good deal of research into the intra-occular lenses available. I am now trying to make up my mind which to go for. As my eyes are not bad enough to justify treatment by the local PCT under the NHS, I shall have to pay for whatever lenses I have.

There are in fact five different kinds of lenses available, depending on which ones are most suitable for your requirements and how much you are prepared to spend. However, only a couple of the lenses available are acceptable to the CAA for flying purposes.

Since you seem to suffer only from Presbyopia, (i.e. the need for longer arms when reading,) my guess is that you would be ineligible for new lenses under the NHS anyway, and would have to pay for treatment yourself.

I also suspect that with the basic, single focus lenses you would still have to have new spectacles from time to time as advancing age continues to lengthen your eyeballs.

All together, these are the options: -


basic single focus lenses
accommodating lenses
multi-focal lenses
light adjustable lenses
the Synchrony lens


My optician has advised me that he has heard too many stories about people having to have accommodating and multi-focal lenses removed and replaced by basic single focus lenses. So his advice was to stick to the basic lenses, both set at distance vision, and then wear vari-focal spectacles to give me my other focal distances. He also advised against having one lens set at distance and the other set at close vision, as I believe is common in the States.

The LAL (light adjustable) lens and the Synchrony lens are very new in the UK. They have only been introduced in the last year and only one surgeon at the London Eye Hospital (private) installs them.

LAL is totally unsuitable for anyone who flies or who drives at night. These cost £5,000 for EACH EYE!

The Synchrony is the 'bobby dazzler' as you don't need spectacles of any sort ever again, but it is still very new. When I saw the surgeon at London Eye Hospital, he told me that at that time he had so far only installed them for just six patients. The other problem is that they cost £4,500 for EACH EYE!

There is a vast amount of information available on the 'net. If you access NICE, you will see the advice of that august body to the NHS. If you access London Eye Hospital's website, you will see info about the new lenses. I suggest you do your homework very carefully before you choose any but the basic lenses and you should be prepared to pay for them yourself.

[orionsbelt]

I had both eyes done in 1997 due to cataracts. This enabled me to upgrade to a CAA class 1 medical. However things can go wrong and within 2 months of the operation on the left eye it reacted in that the rear of the lens sack started to thicken such that I was seeing multiple PAPis at night and multiple defocused images in my peripheral vision. As the work had been done by my companies private health insurance my eye surgeon used a Laser system to blast a hole in the rear of the eye sack. This fixed the problem and I flew as CPL/FI until I retired in 2008. My AME was sympathetic and supportive. Not sure what the reaction would have been if I had wanted to do Public Transport Operations.
Additionally I have been using vari focal glasses ever since 1980 and continued to use them after the operations.

Now however I have a problem with the left eye in that the sack seems to have distorted and the centre of focus is off to the left. Its not a major issue but its makes things difficult during eye test in that we cant get a good crisp focus.

So suggest you chat to CAA eye experts as well as your eye surgeon and understand the risks and the long term effects.

***

[Zamfire]

Broomstick -

I think you got wrong info on the Light Adjustable Lens - it is perfectly fine for night and flying; it is essentially a monofocal lens like a standard IOL, except it can be altered after insertion in a totally non-invasive way (by UV light from a very clever machine) to fine tune the power. Apart from it's "tunability" it is exactly the same as a regular monofocal.

The lenses that are discouraged for pilots are multifocals - these have concentric rings of varying power which can cause some halos or glare, though it is far from universal; some people cope fine with them, but you get nothing for free in physics and the price you pay is the loss of crispness in your vision, though you may be able to focus perfectly, you simply don't get to use all the available light.

Just thought I'd clear that up.

[dirkdj]

You may want to read up on this: chapter 20 applies, the rest is very interesting too:

The Healing Factor: Vitamin C Against DiseaseC (http://vitamincfoundation.org/stone/)

[gingernut]

Have seen many patients with "IOL" (Implantation of lens), following surgery for cataract. (If that's what you're talking about).

Don't think I've ever seen a complication. Ever.

Can't imagine you'd be grounded for too long, but expect the authorities would like to ensure that the bubbles had gone (14 days or so) and that you can tell the difference between 05R and 05L.:) For some, that could take longer.

[Phororhacos]

I believe that the UK CAA would consider intraocular lens replacement as a type of refractive surgery, (if done for refractive error rather than cataract).

They suggest contacting the medical department for advice on revalidation requirements for all types of refractive surgery.

See page 2 of this.

http://www.caa.co.uk/docs/49/SRG_MED_JAR_C1_Initial_Visual_Stds(December2010).pdf

(Page 2 also mentions that mulitifocal implants are not approved by the UK CAA).

[alankjones]

I had a consultation at the London eye Hospital for the Lal implants just over a week ago, the cost of these with long and close vision is £20,000. They actually start off at £12,000 but if you have them installed with laser and adjustment for all sight I was quoted £20,000.

[saddie_maddie]

Don't make the same mistake I did and get a multi focal lens. Despite being convinced about glare and halos being reduced by the surgeon and their lterature, I have very poor vision now in the eye and will be getting the lens removed soon and replaced with a mono focus lens. I have unacceptable halos and blurred vision in all but bright sunshine. That means indoors, outdoors in cloudy weather, at work, I am effectively using the other eye as the eye with the implant gives next to useless vision. Don't be fooled like I was. These types of lens are still prone to all kinds of problems, not least because they let in about 20% less light than monofocals and this makes contrast difficult, something no amount of time will cure.

I am really p*ssed at myself for not doing my homework properly. Be very sceptical of the marketing hype around these lens. In my opinion, they should be banned.

[soggyboxers]

I had Refractive Lens Exchange surgery done by Optical Express nearly 3 years ago (aged 65) and had my natural lenses replaced with multi-focal intraocular lenses. It cost me £3,590, have had no problems whatsoever with halos, find everything much brighter than it was with my old natural lenses which were yellowing with the passage of time and I have perfect and clear vision at all ranges. I can read the standard eye test board with either eye right down to the last line.

My operation was done by Professor Jan Venter, a South African surgeon who has performed over 60,000 eye operations. I had a 10 day gap between eyes being done and in each case, the morning after the operation I had perfect vision which has remained the same ever since. I found it very liberating and have never worn spectacles or contact lenses since the day my lenses were replaced :ok:

[leemartinez6]

I was tested at Optical Express in February 2017 and deemed a good candidate for refractive lens surgery, as my eyesight is appalling, and I struggle to do my oil paintings as a result, with stinging eyes after a while wearing my prescription glasses. I was told to see my Surgeon 2 weeks prior to the planned op, and was then surprisingly rejected, and told that as an "Artist", the surgery would make my vision 'worse', for something like that!
Now I'm confused as to where to go. I've heard of people paying around £6000, and then being anle to see everything as clear as when they were a child,
but I have just read of someone being quoted £20,000 by a well known eye hospital.
Also, I'm short sighted, but can't see 6 feet ahead either. Help!:confused:

[ypilot]

Hi Guys,
I know this topic has been discussed here, however, not fully yet.
I am a young commercial pilot who has been diagnosed with unilateral cataract. EASA Class 1 medical holder (EU).

I have already studied both European and other regulations and have established some technical requirments, such as:
monofocal, aspheric IOL, set for distance (plano), acrylic, preferably hydrophobic (in order to reduce PCO likelihood).

However, there's one big issue.

I was discouraged by my AME (in Europe) from choosing blue light-filtering IOLs due to alleged unfavourable influence on scotopic vision and colour perception. Other AME confirmed this recommendation.
But my surgeon says it is completely unwise due to cumulative blue light expousure starting from such a young age.

However, I could NOT find ANY regulation whether blue blockers (yellow intraocular lenses) are actually disapproved in Aviation worldwide or not.

Thank you for your help.

Regards

[ypilot]

@Blues&twos
Could you specify what exact brand of IOL you have had implanted?
I am going to have my lens replaced soon at the same age..

[obgraham]

I had my IOL's for cataracts done 8 months ago. Being a physician, I'm not interested in the hype of the latest gadget, so I went with standard old monofocal IOL's. My ophthalmologist agreed that would also be his choice, "but I have to offer you all the choices". Since I've worn Varifocals for 30 years, I still happily wear Varifocal specs. My view is the old KISS -- keep it simple.

Can I see better? -- yes, but it has not been the "miracle" some report. I do appreciate the vibrant colors now, though, and my vision is now corrected to 20/15 in both eyes. In addition, my eye pressure dropped, and I've been able to stop medication for that. All good.

[MaximumPete]

I was talking with a friend today who's wife has had a lens replacement due cataracts on the NHS. They were advised that going for private treatment won't break the bank and you get a better quality lens. I had both my lens's replaced just over two years ago privately. This was very small price to pay for near perfect vision and reduced strength reading glasses.

ypilot:-I had Alcon AcrySof Iq IOL lens. Model number SN60WF UV with blue light filter.

There's a good website for the manufacturer.

Good Luck
MP

[ypilot]

I had Alcon AcrySof Iq IOL lens. Model number SN60WF UV with blue light filter.
MP

Are you a commercial pilot? I mean I was adviced by AME that blue-blockers (blue light filters) are prohibited, or at least not recommended, in Aviation.

[ypilot]

Hi guys,

are there any EASA (or ICAO) medical regulations prohibiting blue light blocking IOLs implementation as a result of cataract surgery? These intraocular lenses are now widely popular.
EASA medical class 1.

Kind regards,
ypilot

[MaximumPete]

Not sure about the legality bit but mine work fine in all light levels from strong sunlight today to low light levels when I was out on a bat watch last night!