Is it possible to replace the artificial lens with another one. Is it possible to replace the artificial lens with a new one. Indications and contraindications

A procedure such as lens replacement is an effective treatment for cataracts. Modern medicine allows you to perform the operation quickly and painlessly, the procedure does not take much time. Since any surgery is dangerous and has its indications and contraindications, it is important for the patient to conduct a thorough assessment of his condition before the intervention. In order for the recovery period to pass without complications, it is important for the patient to follow the recommendations of the attending doctor. To replace the lens, it is advised to prepare very responsibly.

Indications for holding

The operation to replace the lens of the eye is indicated for cataracts, presbyopia, myopia and high astigmatism, when irreversible pathological processes (clouding, changes in structure) have occurred in the visual organ. The treatment allows the patient to return to a full-fledged lifestyle, to fully restore visual function. Elderly people with degenerative changes in the cornea fall into the risk zone, and the procedure is also indicated for myopia and hyperopia. The effectiveness of treatment depends on the timely detection of the disease and early surgical intervention.

A well-chosen posture during sleep after surgery contributes to a speedy recovery. When patients lie on their stomach or side, the risks of postoperative complications increase significantly.

Preparation for the procedure

Laboratory diagnostics will help prevent the development of postoperative complications.

During eye surgery, hospitalization is not needed, all manipulations take little time, they are done in 1 day. Preparation for surgery includes a thorough examination. To reduce the risk of complications during surgery, the patient is recommended to consult a cardiologist and an anesthesiologist. You should prepare for the procedure by passing all the necessary tests, such as:

• blood for sugar, hepatitis B, RW;
• general blood analysis.

Laser lens replacement for glaucoma requires a preliminary consultation with a general practitioner and a dentist, the latter issues a certificate of sanitation of the oral cavity. Prepare for cataract surgery. The patient needs to take a shower, wash his hair, put on completely clean clothes (preferably made from natural fabrics). On the eve it is forbidden to drink alcohol, exclude excessive physical activity, replace them with sparing ones. If a person uses drugs to treat diabetes, normalize blood pressure and blood sugar, he must be sure to inform the attending doctor.

Types of lens

Choosing an implant is a highly individual process.

In order for the replacement of the lens in case of cataract to give positive results, a suitable intraocular lens is selected individually by an ophthalmological surgeon. There are such types of artificial implants (IOLs) that successfully change the lens of the eye:

• accommodating monofocal lens;
• multifocal;
• monofocal;
• aspherical IOL.

Carrying out the procedure

The operation to replace the lens of a cataract is called ultrasonic phacoemulsification. The technology helps to correct a cataract defect and clouding of the lens, restore vision. A specialized instrument is inserted through a small incision, then the defective organ is turned into an emulsion using ultrasound. The split particles are removed from the eye, and an IOL is implanted. After the lens is placed, it straightens itself and falls into place. The time of the manipulation depends on the characteristics of the development of the pathology, the operation usually lasts 30 minutes. It is recommended to change the lens under local anesthesia.

Complications

The latest technology reduces the risk of complications to a minimum.

Lens replacement, which is called refractive lensectomy, rarely causes side effects if performed correctly and following all the recommendations of an ophthalmologist. Possible complications in children and adults include the development of secondary cataracts. The deviation is expressed in the opacification of the posterior capsule, a change in color from transparent to cloudy. The use of silicone and polymethyl methacrylate prostheses increases the chances of this side effect occurring. Removal of the lens of the eye in a child can stimulate fluctuations in intraocular pressure, IOP increases in cases of poor washout of the vicoelastic or lens displacement. Refractive lens replacement can cause swelling of the visual organ, sometimes cataract removal provokes pseudo-actual bullous keratopathy, rhegmatogenous retinal detachment, choroidal hemorrhage, astigmatism, inflammation.

Hello, is it possible to do a second operation to remove the cataract, I just became cloudy after a year and a half! and got the best answer

Answer from.[guru]
No. If the cataract has already been removed, then a new one will never appear again. Cataract affects the lens; During cataract surgery, the affected lens is removed and an intraocular lens is implanted in its place. After cataract removal, some patients experience clouding of the posterior lens capsule that holds the IOL in place. This phenomenon, known as a secondary cataract, is sometimes mistaken for a cataract, but, in fact, it refers to one of the postoperative complications. The patient may develop cataracts in both eyes, but more than two cataracts do not occur in a person's life.
You can read more detailed information about the restoration of vision here link

Answer from Kondor01[active]
I advise you to pay attention to the organization of tinshi, they have really good medicines there, they can and will cure themselves of cotoracts, I didn’t believe in them, but how I drank vitamins from them now, for 2 years, I have never gotten sick and my grandmother got up on her feet

Answer from Puppeteer[guru]
Here is what the Internet gives
1) To frighten the master, those who cannot really help with anything, except for scam. The treatment of severe, neglected, overripe cataracts - even for a high-class professional - is not an easy task, and the likelihood of complications increases exponentially the more you coward and delay with surgery. On the conscience of these scarecrows are many ruined human destinies. The issue is not painfully solved, beautifully and reliably, if we talk about replacing a rotting and cloudy lens with a transparent artificial one. 2) Not repeated, but secondary cataract. This name has long outlived its age, because it does not mean a cloudy lens that has grown again from scratch, but only a clouding of a thin capsular bag in which a transparent artificial lens is located. This is not always the case, and the longer you wait with surgery, the more likely fibrosis of the capsule is. This problem is solved without surgery. In a few minutes without hospitalization, a hole is made in the clouded capsule with a laser beam without pain and risk, and vision improves immediately. You go home immediately after the procedure. The procedure is performed once in a lifetime.

Answer from Valery Shchetkin[newbie]
Now a new achievement has appeared in the field of microsurgery of ophthalmology cataract treatment with laser therapy, you should undergo a comprehensive examination and discuss all the nuances with your doctor

Answer from Tatjana Zaika[guru]
incorrectly observed caution .. tilted her head and many more. other..

Answer from Vikusha[guru]
probably the lens was not changed, otherwise the question did not arise.

Answer from Elman Piriev[newbie]
GO TO THE DOCTOR!! ! HE KNOWS BETTER!!!

Answer from Alina Kostyria[newbie]
consult a doctor, health is your treasure and you don’t need to scatter treasures

Answer from Boris Pustovalov[newbie]
constantly watery eyes. the upper eyelid looks swollen and constricts the eye greatly, hanging from above.

Answer from Nata Petrenko[newbie]
Good day. if you think the answer is incomplete, we are ready to answer additional and clarifying questions on the site link

Answer from 3 answers[guru]

Hello! Here is a selection of topics with answers to your question: Hello, is it possible to do a second operation to remove a cataract, I just became cloudy after a year and a half!

Replacement of the lens of the eye in Moscow in 95% of cases is performed by a seamless method of ultrasonic phacoemulsification, which over the past 15-20 years has almost completely replaced the traditional extracapsular extraction technique. Moscow Clinic. Fedorova is one of the main eye clinics in the region, in which more than 3,000 patients with cataracts and refractive errors are annually replaced with the lens of the eye.

Thanks to the support of the Government of Moscow and the Foundation for the Promotion of Advanced Medical Technologies named after Svyatoslav Nikolaevich Fedorov, the Clinic pursues a liberal pricing policy, combining the high quality of medical services provided and the low cost of surgical treatment. At the same time, the Clinic sets itself the task of ensuring the availability of high-tech medical care to the general population, in connection with which in the Clinic. Svyatoslav Fedorov, there is a system of social benefits and discounts for the replacement of the lens of the eye.

Replacement of the lens in the Fedorov Clinic is

Hi-tech. Replacement of the lens in the vast majority of cases is carried out by phacoemulsification. The traditional technique of lens replacement through a corneal incision is used only in extreme cases where phacoemulsification is not possible. Since 2017, along with ultrasonic phacoemulsification, femtosecond cataract support has been performed for patients of the Fedorov Clinic. The introduction of laser cataract removal into the daily practice of our specialists has raised the level of surgery and patient comfort during surgery, postoperative treatment results to a qualitatively new level.

Operation security. More than half a century of observation of patients with the replacement of the eye lens allows us to firmly state the minimal risks of surgical treatment, high results of the operation and the invariance of the postoperative effect. It is also important to constantly improve both the technology of the operation and the instruments and equipment used in the course of surgery.

Versatility. Replacement of the lens in the Fedorov Clinic is performed for various ophthalmic pathologies. Both in older and elderly people with cataracts, and in young people with a high degree of myopia, astigmatism and hyperopia, the replacement of the lens of the eye allows you to completely restore sharpness.

Minimally invasive nature. Thanks to technological progress, it has become possible to refuse extracapsular extraction with a wide corneal incision, the use of general anesthesia during the operation, the need for hospitalization of the patient in a hospital, and the need for "ripening" of the cataract, when the patient could no longer navigate in space on his own. Now lens replacement can be performed if the patient has minimal visual discomfort on an outpatient basis, under local anesthesia, without incisions and sutures, through special self-sealing micro-punctures 1.8-2.2 mm wide, formed with a diamond dosed blade or using a femtosecond laser.

No age limit. Replacement of the lens in the Clinic. Svyatoslav Fedorov is performed at any age of the patient. Restrictions on surgical intervention in patients of the age group may be due solely to the general serious condition of the patient. In young people, surgery can be performed from the age of 18 in cases of high degrees of ametropia, when the possibilities of laser vision correction are limited.

Short term operation. The total duration of the entire operation, taking into account the preparatory stages, is about 15-20 minutes. The duration of the actual surgical intervention does not exceed 10 minutes. According to the internal regulations of the Clinic, surgical treatment is always performed on one eye only. If there are indications for the fellow eye, it is recommended to operate no earlier than two weeks after the first operation.

Painless surgical treatment. Replacing the lens of the eye is an absolutely painless operation for the patient. The minimally invasive nature of the intervention allows you to operate under local anesthesia. Anesthetic eye drops completely eliminate the occurrence of pain.

No hospitalization. Surgical treatment in the clinic. S. Fedorov is carried out without hospitalization in a hospital. In just 1-2 hours after the surgical intervention, the patient receives the recommendations of the attending physician and can leave the clinic.

Short rehabilitation period. The patient notices the restoration of vision after the replacement of the lens within a few hours after the operation. However, the process of improvement of visual functions and stabilization of vision will occur during the first two weeks after the surgical treatment.

Stages of treatment at the Fedorov Clinic

After completing the necessary medical documentation, the patient is placed in the preoperative ward, where he is examined by the attending physician, and preoperative preparation is carried out. After preoperative measures, the patient is invited to the operating unit.

Despite the outpatient nature of the operation and the absence of general anesthesia, the replacement of the lens of the eye in the Clinic. Svyatoslav Fedorov is performed in a sterile operating room. During the operation, only disposable consumables and microsurgical instruments are used, which completely eliminates the possibility of infection during surgery.

After disinfecting treatment and local anesthesia in the form of anesthetic drops, an eyelid expander is applied to the operated eye, which prevents spontaneous blinking of the eyelids.

Using a diamond ultra-thin dosed knife, the surgeon creates a corneal tunnel micro-puncture 1.8-2.2 mm wide, which is the main incision through which all further stages of the operation are performed. The special profile of the tunnel incision and its small size ensure good self-sealing in the postoperative period without the need for suturing.

Micro-puncture of the cornea with a diamond blade	Removal of the anterior wall of the lens capsule

After performing capsulorhexis - a round dissection of the anterior wall of the capsular bag - the surgeon, using an ultrasonic probe, crushes the lens substance to a state of suspension, which is simultaneously aspirated from the eye. Currently, the Clinic Svyatoslava Fedorova offers her patients a completely innovative way to replace the lens - femtosecond support of the operation. The main difference from ultrasonic phacoemulsification is the use of a femtosecond laser during surgery to form a corneal incision, create capsulorhexis, and crush the native lens substance.

Crushing of the lens of the eye

Having completely freed the “bed” of the lens, the implantation of a rolled-up intraocular lens (IOL) into the capsular bag is carried out. IOL is an artificial lens of the eye, individually calculated for each patient. Inside the capsular bag, the artificial lens opens independently, the surgeon controls the correct position of the haptic elements of the intraocular lens and its centering relative to the visual axis of the operated eye.

Implantation of an artificial lens	The position of the artificial lens

After completion of all stages, the edges of the tunnel incision are hydrated, the eyelid expander is removed, antibacterial eye drops are instilled, and a protective aseptic bandage is applied to the operated eye. And the patient is escorted to the postoperative ward, which he can leave 1-2 hours after the examination by the attending physician and go home.

The next morning after the operation, the patient arrives for a follow-up examination by the surgeon, receives all postoperative recommendations, medical appointments and a schedule of postoperative visits.

artificial lens. Types and models

In the Soviet Union, the pioneer in the implantation of an artificial lens was Academician Svyatoslav Nikolaevich Fedorov, an ophthalmologist, and our Clinic proudly bears the name of a great doctor and scientist of world renown. Fedorov's lens was the first model of a rigid artificial lens designed for intraocular implantation after extracapsular cataract extraction.

Subsequently, Fedorov's lens underwent significant changes in the shape, design used in the manufacture of the material, but for a long time remained the only option for an intraocular lens when replacing the lens.

The rapid transition to microinvasive surgical technologies and the development of cataract phacoemulsification techniques have led to significant changes in implantable IOL models - lens design and materials have changed dramatically, which led to the production of modern soft artificial lenses.

The need to replace the lens not only in cataracts in the elderly, but also in young and middle-aged patients has led to the creation of various types of intraocular lenses.

And now the Clinic. Fedorova performs implantation of all types and models of modern artificial lenses of the world's leading manufacturers, thus providing a personalized individual approach to each patient and his needs.

After replacing the lens in the Clinic. Fedorov you will receive

Replacing the lens of the eye is a completely new quality not only for your vision, but also for your standard of living. Fedorov's clinic will save you forever from low vision, and you will be able to enjoy the world around you without glasses, capturing the finest nuances of shape and color. Assistance from the Government of Moscow ensures the provision of ophthalmosurgical care at affordable prices for each of our patients.

Replacement of the lens. Price in Moscow. Clinic Fedorov

The cost of replacing the lens in the Clinic. Svyatoslav Fedorov, price per eye, rub.

In the complex structure of the human eye, the lens is one of the most important parts responsible for the refraction of light rays and the formation of an image on the retina. Changes in its structure or deformation lead to deterioration of vision and require immediate, most often surgical intervention.

Lens replacement surgery have long become an everyday event in ophthalmic practice, this is the result of the high development of modern medical science and medical technology - despite the outward simplicity and speed of execution, the operation is a serious, technically and technologically complex process that requires high professionalism of a doctor and appropriate medical equipment. Operations are performed only in cases where changes in the structure or shape of the lens of the eye are not amenable to therapeutic or laser correction.

Lens replacement is the only real way to get rid of cataracts and a number of other eye diseases.

Indications for surgery

The operation to replace the lens is carried out only according to indications, after an appropriate diagnosis of the visual system. These indications include:

Cataract

Opacification of the lens is a pathological change most often found in older people. With cataracts, objects visible to the eye lose their clear outlines, blur, the eye reacts painfully to bright light. They often develop nearsightedness or farsightedness. The disease is constantly progressing, only a timely operation will restore vision.

Presbyopia

This pathology is also common in older people. Patients complain of farsightedness, which develops as a result of lens sclerosis - tissue thickening. The lens hardens, its elasticity and ability to change its curvature decreases.

Astigmatism

There is a deformation of the lens, its shape and curvature are disturbed, and as a result, the inability to focus on the object. When the disease is characterized by blurring, vagueness of the image, the need to squint in order to consider a particular object, violations of orientation in space.

Myopia

Decreased visual acuity. The eye does not distinguish objects located far away, fatigue quickly accumulates when reading, working at a computer, driving a car. The operation is prescribed only for a high degree of myopia in combination with other eye diseases, when it is impossible to cope with laser or optical vision correction.

The operation is not carried out in the following cases:

• Inflammatory or infectious eye diseases (keratitis, conjunctivitis, blepharitis).
• Too small size of the eyeball or its anterior chamber. This may interfere or make it impossible to carry out the necessary manipulations.
• Retinal detachment. There is a risk of disease progression after surgery.
• Any inflammation in the active stage.
• Transferred over the past six months: heart attack, stroke, diabetes, multiple sclerosis, cancerous tumors.
• Pregnancy and lactation.

Operation progress

Held complete vision diagnostics(click to open the page in a new window) and assessment of the general condition of the body - clinical urine and blood tests. In some cases, specialist advice may be required.

The essence of the operation is to replace the natural eye lens with an artificial implant, an intraocular lens (IOL) - an artificial lens

Lens replacement surgery is usually performed on an outpatient basis.
The patient is given local anesthesia.
The doctor opens the anterior chamber of the eye with several punctures, and the contents of the lens are removed with a special suction.
A tube is inserted into the eye chamber, in which there is an implant in a folded form - an artificial lens. In the chamber, the artificial lens is straightened and set in place.
The punctures of the eye chamber are of the minimum size, so suturing is not required.
The eye is washed, a healing preparation is applied and a sterile bandage is applied.
The patient can go home.
The whole procedure takes 15-20 minutes and is absolutely painless.

Improvement in vision is observed immediately after the operation:

• Clear contours of objects
• The image does not double, there are no "flies" before the eyes.
• Bright colors
• Improves visual acuity

The full effect of the operation is achieved within a month.

The operation to replace the lens can be carried out in different ways, the method and treatment regimen in each case are selected taking into account the characteristics of the patient and the nature of the disease.

In modern ophthalmology, the operation to replace the lens is most often performed by the method phacoemulsification(click to open the page in a new window).

The use of modern techniques and equipment reduces the risk of complications from surgery to a minimum, but in rare cases, some patients may experience:

• swelling and inflammation of the eye
• intraocular bleeding
• displacement of the artificial lens
• increased intraocular pressure
• retinal detachment
• secondary cataract
• clouding of the back of the capsular bag
• double vision due to the difference in the characteristics of an artificial and natural lens

Therefore, the specialists of the First Eye Clinic, before deciding on an operation, conduct a thorough and comprehensive examination of patients in order to take into account and evaluate all possible consequences in advance.

According to medical statistics, the effectiveness of operations with the replacement of the eye lens is about 98%, and minor visual impairment a few (5-7) years after the operation is observed in less than 20% of patients.

The risk of getting a complication after surgery is many times, many times less than the risk of completely, irretrievably losing vision, refusing to have surgery.

No medications (drops, ointments), no means of "folk medicine" (tinctures, ointments, conspiracies), even theoretically, are unable to stop, much less completely cure a progressive cataract.

Our clinic is very attentive to its patients - postoperative care is provided, recommendations are issued, all necessary medical assistance is provided in case of a complication.

An artificial lens of the eye or an intraocular lens is an implant that is placed in place of a previously removed natural lens if the latter has lost its function.

Unlike glasses and lenses, the IOL is able to correct significant visual aberrations, including nearsightedness, farsightedness, and a high degree of astigmatism. Placed in the eye, an artificial lens performs all the tasks of a natural lens, which allows you to provide the required vision characteristics in full.

When is it necessary to replace the eye lens with an artificial one?

The main indication for replacing the natural lens with an artificial one is clouding of this area. The natural eye lens loses its transparency, which is why there is a decrease in visual acuity up to blindness. This process is called a cataract.

Another manifestation of visual impairment -.

Pathology develops under the influence of a number of factors:

• In old age;
• With diabetes;
• With radiation exposure;
• After an eye injury;
• as a hereditary pathology.

On the video - an artificial lens of the eye:

The disease causes at first only a blurry image. It becomes hazy and forked. The perception of color begins to be disturbed, photophobia appears. When these symptoms appear, the doctor decides whether it is necessary to remove the natural lens and replace it with an IOL. Drug treatment in such cases does not help, but it allows you to slow down the development of pathology. All that remains is an operation to replace this element of the organ of vision.

It is not worth waiting until complete blindness, otherwise the operation no longer helps and the person loses his sight irreversibly.

Based on the foregoing, we can conclude that this implant is used only in serious conditions that threaten with loss of vision. Accordingly, an intraocular lens is used in the treatment of:

• cataracts;
• myopia;
• farsightedness;

It will be useful to find out how the initial age-related cataract is treated according to.

The last three points are decisive in deciding whether to perform surgical procedures only in the case when there is a high degree of damage.

What does the artificial lens of the eye look like, service life

The artificial lens includes two elements:

• Optic;
• Reference.

Supporting artificial lens of the eye

The optical part is a lens made of a transparent flexible material that is compatible with the tissues of the eyeball. On the surface of the optical section of the IOL, there is a special diffraction zone that allows you to get a clear image.

Violation of the clarity of vision can be, if diagnosed.

The supporting element helps to securely fix the implant in the capsule, where the human natural lens was located. During the operation, the flexibility of the material plays an important role. This makes it possible to introduce an instrument with a compressed lens into the capsule area through a micro-incision with a diameter of no more than 1.8 mm and place it there.

It quickly straightens and independently fixes in the place of manipulation. The product does not have an expiration date and its functioning is designed for many years with the correct implementation of all surgical procedures and the choice of a specific implant with optical characteristics corresponding to a particular case.

Find out what rehabilitation after cataract surgery should be from.

Kinds

There are several types of IOLs that have their own advantages and disadvantages.

In general, in the modern market of ophthalmic surgery and implantation stand out:

monofocal lens

• Monofocal lens;
• Multifocal lens;
• Accommodating monofocal lens;
• Aspherical IOL;
• Spherical IOL;
• Toric IOL.

The monofocal element is most commonly used in cataract surgery. It gives excellent distance vision function in different degrees of illumination. But near vision may require minor additional correction with glasses (when reading, watching TV, and so on). If the patient is ready to use glasses to correct the function of vision after IOL implantation, this option is considered the most optimal.

Find out what to do if a black dot appears in the eye.

Often, after IOL vision correction, many complain about the need for additional correction. With certain implants, this factor is inevitable and cannot be avoided.

Monofocal IOL

The accommodating monofocal lens allows you to get an excellent degree of vision both far and near. This IOL can change its position in the eye so that the object is focused on the retina at any degree of distance from the object. That is, this lens is able to imitate the normal accommodation of a young lens.

American manufacturer

The only representative of this type of IOL is the American-made CRISTALENS IOL lens. In Russia, this element has not yet been tested. All patients who have been introduced such a lens do not need additional correction glasses when reading. This option is considered the most successful for those people who sit at the computer a lot or read.

Multifocal lenses

The multifocal lens is the latest in cataract surgery. This type of product makes it possible to achieve perfect vision at any distance without the use of additional accessories - glasses or contact lenses.

Specifically, this implant has all the necessary optical characteristics, which are characterized by ultra-precision, projecting an image to different points at the same time. In terms of action, only multifocal glasses can be compared with them. Three types of such products are used in the West. If the ophthalmologist is experienced, then he easily selects the required type of product after appropriate research.

The choice of lenses should be made with a doctor. In this case, preference should be given to high-quality lenses, because their service life is unlimited, and therefore they should serve until the end of their lives.

spherical lens

What does it look like? The spherical lens improves distance vision. It will also provide excellent vision in the central part. The disadvantage of this implant is the presence of some discomfort after the operation. Vision at first is distorted, but over time this effect disappears.

aspherical

An aspherical lens is used when visual function deteriorates due to the natural aging process. It usually manifests itself as a gradual decrease in visual acuity, as well as deterioration in near vision. Not so long ago, these lenses were developed with a special structure that allows you to perform all the necessary functions of a young natural lens. This increases not only visual acuity, but also contrast sensitivity. To put it simply, the patient begins to see as in his youth. These lenses have not been tested in Russia, but they are successfully used abroad.

Toric for astigmatism and cataracts

Toric IOLs are usually used in patients with high astigmatism (starting at 1.5 D). When compared with aspherical, toric ones are able to correct not only postoperative, but also corneal astigmatism. Corneal or physiological astigmatism develops with age. In such cases, it is not possible to choose the right glasses. an artificial lens of this type helps, due to the presence of a complex surface, to correct the curvature of the cornea, relieving both astigmatism and cataracts in one operation.

On the video - how to choose the right lens:

Is it possible to repeat the operation to replace

Most doctors do not replace the lens again, since incorrect vision some time after the operation is most often caused not by the quality of the implant, but by the presence of problems in other parts of the eye or other defects. This condition is corrected either with glasses or with the help of laser correction. The reason can be revealed only during a full examination.

You can find out about strabismus glasses in adults and how to use them correctly.

Replacement of the lens can be made according to indications, if the initial one did not fit for one reason or another. In other cases, doctors try to correct vision with more gentle methods.

Manufacturers and prices

Many companies produce artificial lenses for the eyes. The best are foreign companies located in the United States. Also, German IOLs are not inferior in quality. Here are the main representatives of these implants:

The cost varies depending on the type and characteristics of the item. Your doctor will help you choose the best option. As can be seen from the table, Alcon lenses, which are manufactured in the USA, have the largest price range. They are considered one of the highest quality. Treatment may be needed.