Is Accommodating Lens working fine with only one eye implanted?

I am 40 yrs old, and have cataracts in left eye only, right eye is perfectly fine (except for nearsighted).
I would like to not wearing reading glasses and able to drive at night after surgery, and here is my hard contact lens prescripton as below (hope that helps).

LEFT
- 5.00 (Sphere)
   8.00 (BC)
   10.2 (Dia)
   .14  (CT)
Right
- 5.50 (Sphere)
   8.09 (BC)
   10.2 (Dia)
   .14  (CT)

My doctor suggested me "Techis Monofocal IOL" implants left eye which would be better than "Multifocal, such as Restor, Rezoom" becuase he said my brain won't able to adjust it.
But my question is, am I lossing depth perception if I have Monofocal IOL in left eye only after surgery?
Am I able to resolve this issue if I go for Accommodating Lens (Crystalens, or a new Tetraflex), are they working fine with one eye implanted only with another eye normal.  your comments and experience are welcome.

[Forum-OD-MP]

yes, you would in theory lose some depth perception with a monofocal implant in one eye.  you may be able to function with a crystalens, you may not.  difficult to predict.  

no, all of the literature suggests that bilateral multifocal implants work way better than monocular multifocal implantation.  so no i would not say they are 'working fine' with only one eye implanted.

http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/105273/lesson.htm

http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/105344/lesson.htm

[aimee37]

Thanks for reply,

"yes, you would in theory lose some depth perception with a monofocal implant in one eye. you may be able to function with a crystalens, you may not. difficult to predict."

You said I might or might not be overcome the depth perception with Crystalens, is it because of duzziness when see things with both eyes together or I misunderstood?

Thanks...

[aimee37]

dizzyness?  no.  this is complicated but i'll give it a shot:

an "accommodating" iol like crystalens attempts to mimic the focusing ability and amount of the human eye.  you need to focus the same amount in each eye (or unfocus the same amount) in order to obtain/retain binocularity.  easy to do in the human eye with both of your own lenses.  reasonably easy to do with 2 cyrstalens implants.  doubtful to have even accommodation/focusing with 1 implant and one natural lens.  my guess would be the implant wouldnt focus nearly as well...

unrelated to any "dizziness"

[aimee37]

I see.  
Then how can a Monofocal to obtain/retain binocularity in this case, in term of amount of focusing or unfocusing to objects.  
How the monofocal solve (or not) this issue?

[aimee37]

i'm confused as to what you're asking me.

a monofocal implant could very likely be worse than a cyrstalens, as far as retaining binocularity and not needing reading glasses or reading correction (bifocals, etc).  there is no great solution for this.  

[aimee37]

I am trying to ask difference opinion on which "Monofocal, Multifocal, or Accomdating" lens provide the best result for my case - Speaking of only left eye implant.
Result to achieve - Without wearing glasses most of the activites including Reading, depth perception and night driving.
So far, I hear...
Monofocal - Will loss the depth perception.
Crystalens - Will have difficult time to focusing/unfocusing becuase implant len for left eye only.

my eye doctor sometimes suggest me Crystalens (due to night driving and halo), some time Rezoom (due to my job duties needs to read computer screen), and last minutes changed to Monofocal (due to better sharpness, plus my right eye is normal), I just don't know what to do.
Do you agree there is no good solution for me as of today available technology?

[aimee37]

Your doctor has given you sound advise with regards to not having a multifocal lens at any cost.  The Tecnis lens is a fine lens, but a standard monofocal lens.  How do I know this, I worked on the tecnis monofocal lens during the clinical trial phase.  I can categorically tell you that all patients needed glasses for intermediate and near vision. Lets be honest here, the only lens that will give you good vision at all distances without unwanted abberations. is the accommodating lens by eyeonics.  Since the lauch of their latest product the five-O they have the competition running scared.  The lens provides excellent distance, superb intermediate and J2 near - no loss of depth perception or other unwanted  abberations.  You mentioned the Tetraflex, that lens is currently in clinical trials here in the US, it is available in europe Do yourself a huge favor and at least check out the five-O by eyeonics. You can find a doctor in your neighborhood from their website.  I am totally sold on this product I personally know at least 50 people who have had the eyeonics product, even my mother-in-law

[aimee37]

Quote from "Forum OD_RMP" from above.
"an "accommodating" iol like crystalens attempts to mimic the focusing ability and amount of the human eye. you need to focus the same amount in each eye (or unfocus the same amount) in order to obtain/retain binocularity. easy to do in the human eye with both of your own lenses. reasonably easy to do with 2 cyrstalens implants. doubtful to have even accommodation/focusing with 1 implant and one natural lens. my guess would be the implant wouldnt focus nearly as well..."

Then how the new Five-0 handle the issue of obtain/retain binocularity if I have only LEFT eye implant with Crystalens Five-0

[aimee37]

Dr. Crysta, no offense intended, but you sound more like an Eyeonics rep than a doctor.  In all fairness to readers of this forum, please let us know what your credentials are.

Bluehippodog, you're saying that you're 40 years old, have a cataract in one eye only and have moderate/high myopia in your other eye.  And you're also saying that you don't want to wear reading glasses.  I'm not an eye care professional (just a post-cataract patient myself), but I think that your doctor's suggestion of a monofocal lens is a good one.  If you don't need reading glasses now, I don't see why you would need them post-surgery.  You undoubtedly will begin to develop presbyopia in the next few years.  If you don't want to wear reading glasses, you can either do monovision or get bifocal/multifocal contact lenses.  By the way, I hope that your doctor has explained that if your surgical eye is corrected for distance, you will need to wear a contact lens in your other eye all the time.  Glasses won't work for you post-surgery.  

[aimee37]

I am flattered that you think I am an eyonics sales rep. That would be incorrect. I have been involved with the design and implementation of ophthalmic clinical research trials for the US and europe for over 18 years.  My comments are my own personal observations. With regards to the original question " can you have one accommodating eye implanted".  I suggest, you under freedom of information read the FDA transcript with regards to the crystalens.  You will see that in Phase I of this study 100 eyes were implanted unilateraly. All eyes received excellent results with no complications. You can draw your own conclusions.  

[aimee37]

bluehippo, I have the post-op eye situation you describe and my pre-surgical Rx was almost identical to your Rx.  I have a monofocal implant in one eye and a contact lens in the other.  The last eye exam I had, IMO, I did just awful on the depth perception test. It seemed that out of ten or so examples, I only perceived "depth" in one of them, however, I have not noticed any limitation on my daily activities.  Without having the test, I would have thought that I was doing OK. I wonder what I am missing? I do, however, have to wear a contact lens in my non-surgical eye virtually all waking hours as the visual disparity I have between my surgical and non-surgical eye is about 5 diopters.  I have been told that the maximum visual disparity the brain can tolerate in a pair of glasses is in the range of 2.5 diopters or so. It is a pain to always have to have a contact in my other eye, but I'm not yet ready to go through another cataract procedure, so I'm coping.

Dr. Prince, is it worrisome to not do well on the depth perception test?  The optometrist who did the test did not seem that concerned.  

[aimee37]

no, not worrisome.  IMO binocularity is a subjective thing.  some patients (like me) have no binocularity and dont miss it.  on the other hand some patients can definitely tell when their binocularity is compromised.  but is it "worrisome" to have little or no depth perception?  definitely not.

[aimee37]

Jmadison, THANK YOU SO MUCH for sharing me with your post-surgical experience.  It was very helpful for me to understand what I walk into.
Do you have any issue seeing near objects (reading book), intermediate object (computer screen) and far objects (driving), halo after wearing contact lens, except issue other than depth perception.

Forum OD_RMP, to be my best (limited) knowledge, Part of the depth perception could be resolved by using Accommodating IOL such as Crystalens or Tetraflex (available in UK).  But it introduces to another issue; such as "discrepancy of focusing/unfocusing the same amount between implanted accommodating lens and one natural les" which you mentioned above.
How difficult a patient to overcome this issue,  and will you agree implanting Monofocal lens would have better overall, less trouble than implanting Accommodating lens only in one eye in this case?
Your input is greating appreciate.

[aimee37]

its so hard to predict.  yes, in theory an acomm iol would probably be better than either a monoocal or a multifocal iol in a case of a monocular implant in a patient with a healthy contralateral eye that can still accommodate.

but as for "how difficult would it be to overcome"...that is very difficult to predict.  different eyes respond different ways, and there are vast differences in  perceptions and tolerances in different patients.  i'm not trying to skirt the issue, its just that this is probably nearly impossible to predict...sorry!

[aimee37]

Hi Jmadison,
Other than the above question, I asumme your doctor set your Monofocal lens implant to distance object.  How near/or far objects you feel you lack of depth perception when you are wearing contact lens in normal eye?  
Again, Jmadison, your input is greatly appreciate, and helping me to understand what am I walking into.
I wish there is a virtual reality goggle (just like playing video game) to help patient to understand what they are facing after surgery... :-)

[aimee37]

Here is my experience.  I have an aspheric monofocal lens (AcrySof IQ) that has settled at about -0.5 diopter, or slight nearsightedness, in my left dominant eye.  At my last exam, I could read two letters in the 20/25 line.  I have described my vision as decent, although not perfect, for near, intermediate, and distance purposes.  I see fine to drive when it's daylight.  On a few occasions, I have used glasses, correcting my left eye only, for night driving just because I felt a need for crisper vision. I suppose I could wear a contact correcting for -0.5 in this eye, but so far I haven't found it to be worth the bother.

As for near vision, I usually sit about 24" from the computer screen and I can read the screen well enough from this distance with my surgical eye. I can read the newspaper at arm's length, but to read fine newsprint closer I would need +1.25 readers.

I find I rarely need the readers, though, because I wear a modified monovision contact in my right eye so that eye handles the close reading.  As I said above, I wear that contact about 18 hours a day, because my naked vision is now left, -0.5, and right, -5.25. which causes an unbalanced visual processing systtem.  Without my contact in, I feel my perceptions are very off and I notice double vision problems.

I am 13 weeks out from my aspheric IOL cataract surgery.  Early in my healing period, I was at -1.0; there I could read the newspaper at a closer distance, but I also had to wear my driving glasses for all driving, not just occasionally at night as I do now.

My most recent surgery was an exchange because the wrong power IOL was implanted a month earlier.  That surgery left me at -3.0 and I was absolutely miserable! As for night vision, I do recommend the aspheric lens.  My first lens was a traditional monofocal and, to me, the aspheric is an improvement in terms of night vision and less overall glare in bright conditions. I haven't noticed any halo or depth perception problems (at least until I took that test I described above!).  To me, my vision with the IOL now seems close to what it was with my pre-surgical contact lens.

In both my original and exchange surgery, the target refraction WAS PLANO (20/20 vision), so MY experience has been that what is targeted is not achieved. The teaching hospital I used for the exchange told me that 90% of THEIR results are within .25 diopters of target and the remaining 10% are within 1.0 diopter of target.

The result of my first surgery and the subsequent exchange were very traumatic for me, so I am presently abstaining from cataract surgery on my other eye until I feel I have no other choice.  I did the best I could to improve my visual situation by having the exchange, but my cataract experience has been so emotionally draining that I have no desire to repeat it soon.

bluehippo, I would read through the cataract threads in this forum to help you make an informed decision. I would find a doctor who keeps you out of your hard contact lens for an adequate period of time prior to IOL power measurement and one who has an IOL Master.  Best wishes on whatever choice you make.

[aimee37]

I had a ReZoom multifocal implanted in one eye in Jan 2006. My prescription is similar to yours at -5.5 in my surgery eye and -7.0 in my remaining eye. I wear a multifocal contact in my non-surgical eye. At 50, I am also very active and work full time. I have had excellent results and see well at all distances. My ReZoom eye does give me slight halos around lights at night, but only when I think about it! It is true that I must wear my contact lens at all times as glasses do not work.

In my situation,I have great depth perception and a balanced vision. It has been more than a year now and I must say my choice in IOL's was a good one for me.

[aimee37]

I had a monofocal distant focused lens implant in one eye 6 years ago because of a cataract in that eye.  Now my second eye has developed a cataract.  The first ophthalmologist that I talked to recommended that I get a Rezoom in the second eye, 1st choice, or a Crystalens, 2nd choice.  The second ophthalmologist recommended a Crystalens.  Both ophthalmologist use ReStor, Rezoom and Crystalens, and one of the ophthalmologist is also doing clinical trials with Tetraflex - which cannot be unilaterally implanted during the trials. I am concerned about having different technologies in the two different eyes, and I am also concerned about halos and ghosting.  Most of the people I talk to say I should just go with anther monofocal and stick with the same technology.  But most of them do not have cataracts.  I would like to get my reading vision back, at least in some part if I could.  I am only 49 and I hope to live with this decision for a long time.  Since I will only have one eye implanted with a new lens now, I was interested in reading about the transcript you referred to in a previous post in this thread.  In a previous post you suggested that we "read the FDA transcript with regards to the crystalens. You will see that in Phase I of this study 100 eyes were implanted unilateraly. All eyes received excellent results with no complications."  Where would I find these transcripts?  I did go to the FDA web site and found some information about Crystalens, but I did not find this information.  I suspect that in most, if not all of these cases the second eye was their natural lens.  For about 5 of the last 6 years I had a monofocal lens (distance) in one eye and a my natural lens in the other eye.  I would see at a distance with both eyes, and just read with my natural lens until it has now also developed a cataract (this last year or so).  So that combination of two different lenses worked OK, although I would have preferred to have been able to read with both eyes.  Also most of what I read says the multifocal lenses work best if implanted bilaterally.  That is also what the Drs and lens mfr companies tell me as well, but they will not say that you could not or should not have just one eye done with a multifocal lens.  They encourage me to do it.  (I use the term multifocal very loosely here and also mean accommodating as well.)  If anyone else has information that might help me out with this decision, please let me know as well. Thank you.

[aimee37]

I had cataract surgery in both eyes in late September and early October of 2005 at age 67.  Other than my eyes, I enjoy excellent health, now at age 69.  I had the Crystalens flexible lens implanted in my left eye successfully.  The surgery on my right eye didn't go as well, and the usual fixed lens had to be implanted in it.  It must have been fate, because the cataract surgery left me with vision similar (though better) than what I had had previously, using contact lenses.

Before my cataract surgery, I wore contact lenses, using the monocular approach, with the prescription in my left contact lens set to let me read, but giving me  reduced distance vision, and the prescription in my right contact lens set for 20/20 distance vision. I found the arrangement quite satisfactory.  I also had another contact lens for my left eye that would give me 20/20 distance vision, should I so choose.

I am very pleased with the flexible Crystalens. I can read everything unaided except the very small print they use for ingredients on food labels, etc..  I do have to hold normal size print, as in newspapers and magazines, a little further away than I used to, but not to a great degree.  My distance vision with the Crystalens falls short of 20/20 but it is better than when I was using the "reading" contact lens in that eye.

I have no restrictions on my driver's license and notice no problems with depth perception.  

I have needed glasses since I was 11, and getting the lens implants was like starting anew with my vision.  

Unfortunately, I recently experienced a severely torn retina in my right eye, so my "re-born" vision lasted only about a year and a half.  But that is another story and has to do with the general condition of my right eye, not with the lens  implants as such.  My Crystalens in my left eye still functions just fine.