2nd IOL with Crystalens HD?

[mmmmpppp]

Hi Dr. O.,

You helped me two years ago when I had my first cataract.  I believe that I now have a second one going.

I'm 53 and had exceptional vision all my life until I needed reading glasses.  My eyes wouldn't tolerate reading glasses.  Then I developed a PSC cataract in my non-dominant eye.  It was replaced with a Crystalens HD.  When it's sunny, whether I'm indoors or out, I have near perfect vision at all distances In the Crystalens eye.  My distance vision isn't as crisp as my natural distance was, but it's pretty good.  If I squint, I can make it almost as good as my natural distance was.  As expected, I can't read the smallest print.  In good unnatural light, the Crystalens eye needs a reader for reading.  But overall, I pretty much have the best possible result (plano, 20/15, 20/15, 20/40).

At night, however, in the Crystalens eye, if I am in a well-lit place, my vision is excellent.  But as soon as I am in a poorly lit place, I have pretty awful dysphotopsias in the Crystalens eye if there are lights around.  Living in LA, there are always lights everywhere.  If I walk or drive at night and close the other eye, my vision in the Crystalens eye varies from excellent to scary as I pass through different levels of light.  In the wrong light, the scattered dysphotopsias muddy most of my visual field.

If I weren't afraid of dysphotopsias at night (I happen to LOVE night driving!), I would be here asking whether I should get another Crystalens HD or a Crystalens AO.  But because of this issue, I am wondering if I should consider an aspheric monofocal.

If I were to get a monofocal, would my near vision get no assistance from the monofocal eye (which I assume would be set to distance because it's my dominant eye)?  Would it be worse?  I assume that my intermediate would still be good with a monofocal because it's so good with the Crystalens?

If you would still recommend a Crystalens, would it be HD or AO?  If you would still recommend a Crsytalens, what would you say about the dysphotopsias?

Thanks!

[mmmmpppp]

If I'm in a dark enough spot, the dysphotopsias are excessive.  But after a couple of days of testing, the problem doesn't seem as bad.  I'll ask my doctor about the aphagen or pilo 1% or 0.5%.  

I'm glad I asked and grateful for your help.  I bet I'll go with the AO.

Thanks again!

[mmmmpppp]

Thanks!

I only started doing these one-eyed tests again in the last few days.  This evening, I had no problem at all with dysphotopsias.  About to go out for another walk . . .

[Ray T Oyakawa, MD]

I would recommend you get an AO.  You might first try aphagan or pilo 1% or 0.5% (you need to get this made a compounding pharmacist to see if it helps with the dysphotopsia in your non-dominant eye.  It will also help with your near vision.

Dr. O.