Best IOL To Get?

I realize their is no one size fits all answer here, but I thought I would post my questions and get opinions.  First, I am nearsighted in both eyes and have a cataract in my left eye.  My left eye is the weaker of the two, but it is almost like splitting hairs.  I have worn glasses or contacts for most of my life.  My right eye with correction has really good vision.  I am torn between gettting aspheric monofocal lens vs Crystallens HD in my left eye.  I go for measurements on Dec 1.  I have -1.25 astigmatism in my left eye too.  After reading about halos, etc..., I wan't to steer clear from multifocals.  I would prefer very good distance and good intermediate vision.  I want to see at night when I drive and I user the computer for my job.  Since, I need correction now to see long and intermediate in my left eye anything would be an improvement.  Can an aspheric monofocal get me great long distance and good intermediate vision?  If I have to put on glasses to read fine print, I am ok with it.  Also, I have 8.00 power in my left eye.  I fear the doctors and aides are going to push the more expensive Crystalens HD.  Thanks!

[Ray T Oyakawa, MD]

Aspheric IOLs do not always give you a good intermediate.  There is a new Crystalens Aspheric which will be release to the general public in about a month or so.

You need to know the corneal astigmatism not the total.  Part is from the cataract and it will be removed.  

Dr. O

[JodieJ]

I vote for aspheric toric monofocal IOL for your left eye, which would correct your astigmatism.  I would insist on having a surgeon who was experienced with toric IOLs.  (Unless your astigmatism is reduced, you won't get good vision at any distance with any IOL,)

Are you saying that you need cataract surgery in your left eye only, and your left eye is now very nearsighted?  In this case, glasses won't work for you after your left is done.  You would have to wear a contact lens in your right eye all the time.

In your situation, I'd choose to have my right eye done sooner (rather than later.)  I'd go for mini-monovision:  distance vision in my dominant eye and intermediate vision in my non-dominant eye.  With a little luck, you would only need glasses for prolonged reading or seeing small print.  If your right eye also has significant astigmatism, you'd need a second toric IOL.

You are already scheduled to have eye measurements, yet I get the feeling that you haven't discussed your goals for your vision with your surgeon.  I'd definitely opt for a consultation with the surgeon before any measurements were done.  How will the surgeon be addressing the issue of your astigmatism?  Is s/he experienced with implanting toric IOLs?  What about your right eye?  Is s/he experienced with mini-monovision?  If you do opt for the Crystalens, how much experience does this surgeon have with it?  (Lots of experience raises the odds of getting a good Crystalens outcome.)  If you're not entirely satisfied with the surgeon's answers, you'd want to consult another board-certified surgeon for a second (or third) opinion.

[jfprog]

First, I do see pretty good out of my right eye with correction.  I don't believe at this time I have a cataract in my right eye.

I anticipate my vision goals will be discussed on my Dec 1 appointment.  When I say measurements, I believe they will analyze my left eye to determine what my options are and to eliminate some IOL's.  

I am 51 years old.

I have chosen to get my eye done with the Pepose Laser Vision which I have heard good thiings about including Dr. Pepose.  I believe they have alot of experience with Crystallens HD.

I will definitely discuss my astigmatism.  Again, I lean to the aspheric monofocal lens option.  I know I can get great long distance vision.  If I can get good intermediate where I can see my computer then I am sold.  If I need to read fine print then I can put on glasses.

I will post more after I have my appointment.

[jfprog]

I am now scheduled for surgery Jan. 25.  I have chosen the Crystal Lens HD.  However, the cost is significant around $4000.  I kept getting hit with you will wear glasses if you chose monofocal aspehrics.  Also, you will want to schedule your right eye which is fine in a couple of weeks after the left eye surgery.  I have started to reach out to family members who have experience with cataracts and will probally scheduled a second opinion.  The thing  I don't get is why can't I put in a monofocal aspheric in my left eye and then put a progressive contact lens on top of it?  I have worn glasses or contacts lens my whole life, my goal isn't to get rid of corrective lens.  I have done considerable research and the Crystal Lens HD is a really good lens; good distance, intermediate and maybe some near vision.  I expect that a YAG maybe done and finally, to perfect my vision a Lasik procedure ($250) will be done later.  I have family members questioning on the cost; is it really worth it?  

[JodieJ]

Is a Lexus worth the price?  Why are you counting on needing a laser vision touch-up?  Many surgeons can hit the refractive target the first round and eliminate astigmatism at the time of surgery with limbal relaxing incisions.  (Then you don't have to wait 2-3 months post-surgery for a touch-up and cope with impaired vision during the interim.)

A regular contact lens worn in the second (unoperated) eye works very well for many people with high myopia.  I've read posts from people who used a contact for months or even years.  From my own perspective, I wouldn't want to have to insert a contact the first thing in the morning.

[caren123]

Just for the record, monofocal lenses, the alternative to premium lenses,  can also work well.
by John C Hagan III, MD, FACS  , Oct 20, 2007 09:49PM
What some people and surgeons do is set one eye "plano" for distances of > 20 ft and the other eye at -1.50  The near sighted eye can see nicely for shopping, dashboard, computer and in bright light can usually read high contrast printing.

OR if someone wishes to emphasize their near vision they can leave one eye -2.50 to -2.75 and that eye will read beautifully even small print and the other eye -1.00 to -1.25 for intermediate vision. Glasses are worn for distance.

Since I have been near-sighted all my life and greatly enjoy reading and doing computer without glasses, if I were having cataract surgery this latter is what I would ask my surgery  to shoot for with aspheric monofocal IOLs.

[jfprog]

I have now asked to have a monofocal implant done.  The technician stated they will target my left eye for closer vision.  My right eye will be corrected via a contact lens.  My surgery is scheduled for January 25.