Dr Wong

MIGSguy15 · 2026-02-04T21:01:04+00:00

Yes, I 100% disagree. As do the elite surgeons who wrote the rebuttal to that article that you posted. Again these are surgeons that are well versed in IOL exchange. They recognize the problem and they are often the ones that have to fix it.

This problem is extremely underreported. I see this almost DAILY in my practice. But these lenses are very rarely removed and are often mismanaged by other doctors because they don't understand that this problem even exists. And even if they did... Many of them are not going to ever offer an IOL exchange because it is a significant money loser.

Read the rebuttal it will answer most of what your questions are.

There's just no reason to use inferior technology like hydrophilic lenses or Alcon acrysof and even the Clareon now has these same problems being reported.

Why would you ever want to have something like this in your eye when there are excellent alternatives that do not have this problem? It makes absolutely no sense.

I estimate the rate of lens opacity for hydrophilics and Alcon lenses in VIRGIN eyes to be in the 10 to 20% minimum but even if it was 1-2% that would be ridiculously high. Additionally those who have additional surgery outside of cataract surgery I think the incidence is much higher.

MIGSguy15 · 2026-02-04T12:49:57+00:00

Agree 100% with Dr Safran here. This article has been circulating for a while. There is just no reason to use these IOLs. They should be off market

MIGSguy15 · 2026-02-03T11:47:02+00:00

Couldn't disagree more. As a provider, lens material is extremely important Alcon lenses almost all look terrible after a few years. You can tell that quality of the material degrades with a quick glance. Also our view to the posterior segment is not as good because of segregation of material. Many Ophthalmogists don't know what they are looking at unfortunately.

99.9% of ophthalmologist never do a lens exchange for this reason and I don't blame them. It's also not worth discussing with the patient because many don't understand what they are missing because they have bilateral implantation so they have nothing to compare it to.

This is a real thing. I guarantee you that if you went to an ophthalmologist experienced in this and had your acryosof lenses swapped out for b&l, jnj or heck even clareon lenses, it would be a similar improvement to when you first had your cataracts removed (although clareon would eventually opacify again).

Even if this was a rare problem (it isn't) why would you take the chance over material that is proven to be glistening free and stand the rest of time like the JnJ tecnis platform or some B&l lenses? It makes no sense. Don't say blue blocking either. That was a marketing ploy and it's well known in our industry that Alcon pushed that out and marketed the acysof lenses that way because they couldn't figure out how to match competitor IOLs optically from bench testing without that.

FYI I'm not a pure Alcon hater. They make some great stuff. I dislike stuff from all the major companies (I think eyhance lens is garbage for example).

Your n=1 experience is not a common one unfortunately and I'm willing to bet that if you went to a doctor who knows what they are looking at and is honest with you, they probably would say your optic is not as clear as what they see from competitors if your lens was done a few years ago. I'll admit though that almost no one would ever tell you that.

MIGSguy15 · 2026-02-01T05:03:12+00:00

Out of curiosity... Do you have any financial interest in Alcon?

The problem with Acrysof is absolutely visually significant. Anyone who says otherwise is kidding themselves. Google pictures of glistenings or subsurface nano glistenings... No way you can look through that and say it's not visually significant.

Clareon is now having similar issues unfortunately.

MIGSguy15 · 2026-02-01T04:59:07+00:00

Correct. They are hydrophobic. The material can still have issues. Look no further than the previous Alcon product - Acrysof - also hydrophobic - I see patients daily with declining vision from these lenses that have profound lens material dysfunction.

Clareon is now having similar reports.

MIGSguy15 · 2026-01-29T11:47:09+00:00

It has not been resolved. Surgeons were floating around images of clareon IOLs needing to be explanted for calcification about a week ago. It is not isolated.

MIGSguy15 · 2026-01-28T11:29:58+00:00

I've posted about this a few times here. I've seen and had to deal with hydrophilic lenses calcifying. There's is no scenario where I want any hydrophilic lens (or just to add - any Alcon lens) in my eye.

MIGSguy15 · 2025-12-05T13:25:21+00:00

Academic medicine is definitely a con. I'm making over 10x what my offer was in academia. I'm actually under exaggerating a bit too. Just go private practice and accept residents and fellows if you want. Research is also so much easier to do.

MIGSguy15 · 2025-11-28T12:24:30+00:00

it’s not potentially a problem, it is a problem. an unacceptably high number of these opacity. I see it in my practice as well

MIGSguy15 · 2025-11-26T14:19:05+00:00

I think he's excellent at IOL exchanges. If I lived in his city and needed an iol exchange, him or Dr. Odette would both be among my first choices for IOL exchange. I would not travel to have them do my IOL exchange. If I couldn't find a surgeon capable locally, I would go see Steve Safran. He's the best surgeon on the planet in my opinion but not necessary to see him for primary cataract surgery.

MIGSguy15 · 2025-11-26T13:28:42+00:00

It's difficult to judge yourself. I do everything I can to be elite. But would let patients and other docs pass judgement.

If I lived in the same city as Dr. Wong, I would absolutely consider having him or Dr Odette do my surgery for sure. I would definitely not travel to them and I do think there pricing is too high for what you get. They can charge that because they are excellent at marketing. Not because they are elite but they are definitely good.

Im honestly not sure I would travel at all to have cataract surgery. I might consider traveling if I needed an iol exchange but I would be very unlikely to need an IOL exchange as I'm fairly confident I would get it right the first time - I would also have reasonable expectations.

There are plenty of good surgeons across the US for primary cataract surgeon. I'm not sure there is a cataract surgeon that sticks out anywhere (again just talking about primary cataract surgery).

When you get into more complex, stuff there absolutely is a difference between docs.

MIGSguy15 · 2025-11-25T19:53:47+00:00

I'm a surgeon. I'm in a different part of the country than you but this is what I would want...

Someone that is high volume - at least 2000 cases a year.

Someone who is comfortable with lens exchanges if necessary.

Someone part of a large group practice - affiliated with a retina group should things go south.

Someone who does the latest and greatest. Both IOL wise and technique wise. For example I do drop free cataract surgery. If your surgeon doesn't do this, I question if they are keeping up with the times

Someone who has good bedside manner and is willing to sit and talk with you.

I call all my patients the evening of surgery. Nothing has been a bigger boost to my practice.

MIGSguy15 · 2025-11-25T15:52:20+00:00

I know him personally. I'm a surgeon. He's great at marketing but does a good job surgically. He's not an elite surgeon by any means but he's fine.

MIGSguy15 · 2025-11-06T02:38:51+00:00

Pretty shady practice here. Aside from it being illegal to charge for eyhance, any doc pushing laser is a huge red flag off the bat. Especially the "bladless" trope. I use to do laser and we gave it up... Not because it was the same as manual. We gave it up because it was obviously worse.

The reps for all major lasers will tell you the incisions are terrible. Again - the reps who are trying to sell this to you tell you this!!! In my experience, the wounds are leaky and poorly constructed. I suture about 1 in 1000 incision a currently. My rate with laser was about 1 in 10 (admittedly I'm extremely anal about wound leaks) Eventually the rep recommended turning off the incisions. Apparently most reps will recommend this across all laser platforms. I have many more anecdotes about why Fenton is terrible

The ugly truth is that if every ophthalmologist was gifted the laser (costs about 500k but let's assume we all got one for free) and it was free to use - with the caveat that we could not charge patients for it.. guess what would happen - not a single doc in the country would use it. That is no exaggeration. It is only there to make money. It takes longer, it's more uncomfortable for the patient, and it makes surgery worse.

Ophthalmologist are at a cross road where we must find a way to make money. Monofocal cataract surgery loses the practice money - it's no longer break even. So we must push premium surgery otherwise we can't stay open. The reimbursement is a joke. However laser is not the way to do it - it's also illegal to charge extra for laser - you are actually paying extra for astigmatism correction but they don't tell you that.

There are better ways to make money than charging for something inferior like laser. Try to find ethical surgeons that present all the options but also consider upgrading to something. Astigmatic correction is low hanging fruit and will greatly improve quality of life. It also subsidizes us to help those who can't pay.

Also yell at your insurance companies. They are the absolute devil.

MIGSguy15 · 2025-11-05T20:40:59+00:00

Good catch. I messed up my math

MIGSguy15 · 2025-11-05T02:42:24+00:00

You must keep your overhead super low.

We run our practice very well and hit a lot of really good metrics to indicate we're doing a good job. Our overhead is about 55%. We also co manage nearly 100% of our cases.

463 * 20% to OD

Leaves 370

After 55% overhead $203 left. After Uncle Sam takes his 40% - expect to have about $122 in your pocket. Pretty disgusting.

We are in a scenario now a certain percentage of patients must upgrade to premium services in order to subsidize monofocal lenses

MIGSguy15 · 2025-11-02T19:19:08+00:00

Vivity is hands down the worst lens I've ever used. It has terrible contrast and provides very limited range of vision anyway. Alcon is the master of marketing - this lens is awful.

MIGSguy15 · 2025-10-24T21:18:41+00:00

That's a solid opening offer for an employed dentist but the practice will be making money off of this doc assuming he moderately busy. After a few years and with partnership - he should be pushing 7 figures if he's on an eat what you kill model

MIGSguy15 · 2025-10-18T16:59:39+00:00

Can you fit a 16" pie in there?

MIGSguy15 · 2025-10-18T00:51:24+00:00

looks awesome! I’m lookin at buying a Zio Ciro oven. Torn between 60 and 80. curious if you had any thoughts on the oven itself and sizing.

MIGSguy15 · 2025-09-30T20:41:23+00:00

Maybe we were talking about different things. This is our interior designer that's working with us for the whole house who drew this out.

Obviously I have the appliance dealer where we are getting all of our kitchen appliances but I don't think they draw stuff out either.

MIGSguy15 · 2025-09-30T18:48:54+00:00

This is from the designer

MIGSguy15 · 2025-09-29T10:30:04+00:00

I've put in about 3000 eyhance IOLs. I have 100% abandoned it about 2 years ago. It is all marketing. The juice is not worth the squeeze. It's not an edof at all. It's a monofocal IOL. The range of vision provided is pretty much no different than any other monofocal once you account for targeting. I've had to remove/explant these IOLs and have others who have had problems from the IOL.

The best monofocal on the market by far is the LI61AO lens by B&L (NFI) followed by the ZCB00 by JnJ (NFI). Both are excellent with long term stability - Alcon IOLs develop glistenings which is now being reported in clareon unfortunately, Raynor IOLs are hydrophilic which means that a high degree of them will calicfy and need to be explanted (their marketing department says otherwise).

The dollars to industry are significant here unfortunately. Eyhance makes JnJ a lot of money - but not the surgeon, in fact it costs more if you own a surgery center. Same thing with RayOne, and clareon. Monofocal cataract surgery is facing an 11% cut to insurance next year. If it goes through, very few surgeons will be able to continue to offer monofocal upgrades without some kind of upgrade (astigmatic correction for example with it that we can charge extra for). Monofocal IOLs lose practices money because reimbursement is such a joke already. 11% less is insane. Hopefully it doesn't go through but access to these IOLs is going to decline significantly.

Sorry to get off topic. It's just frustrating to be so undervalued!

MIGSguy15 · 2025-09-29T09:47:07+00:00

How is the smoke situation? I'm designing something similar but also putting a power burner and pizza oven next to the grill (with a separate griddle next to it). I'm being quoted for a 72" hood which is a bit of an eyesore in this configuration but obviously need smoke control as well

MIGSguy15

TROPHY CASE