Cataract - phaco for dense eye and accomodating IOL information

I am in my fifties and live in Hong Kong.
1. .I had been in the waiting  list for cataract surgery in  Hong Kong Eye Hospital (government) but was suddenly told my right eye now has a density of about 4 and needs to use the old method of knife surgery (no more  micro-incision).
Some nurses told me the government doctors are conservative and private doctors most probably will perform micro-incision in my case.
I checked with a private doctor yesterday, but he is very conservative and said I only have a 50/50 chance of using micro-incision. He can try micro-incision for me but during the operation, he may change to knife surgery depending on the situation at that time. He even said my left eye's chance is also 50/50 (but even the government hospital said my left eye's density is 3 point something and micro-incision is no problem and has been put on the waiting list for surgery at least 1 or 2 years from now.) He even claimed that there is no number or degree for density, so the density 4 advised by the government hospital means nothing.
He also said he does not suggest me or any patients to use multifocal IOLs as some patients complain about the multi-images they project.
My overall impression is  that he does not take any  risks. I  also do not know whether  he has the latest phaco equipment in his  clinic which may or may not affect his claims/comments.
On the contrary, I have called a well-documented doctor in California before who cared to  take my call and said with the latest  cold phaco developments he did not expect problem in using micro-incision in my case.
I wonder anyone in this  forum can tell me if there are numbers or degrees in density. Suggestions on my next step will be well appreciated.
(Information on eye doctors in HongKong other than names and contact info is not readily available. Having the surgery done in California is a last option as the time (3 or 4 weeks) and costs (hotels and higher surgery fees) are substantial. Surgery in Singapore (more open-minded hospitals) is a difficult 2nd choice which involves extra time
and costs.)

2. I would like to use multi-focal or accomodative IOLs, preferably the latter. But Crystalens has only  been used by a few doctors in HongKong. Almost all doctors who has no experience in Crystalens just comment negatively on it (but avoid mentioning their null  expereince in it). The doctor I  saw yesterday even claimed Crytalens has stopped in HongKong due to some recent problems (which he refused  to reveal the details) in some other country.
All this does not sound very logical. Why should some problem in another country affect Crystalens'  usage in Hong Kong while it  is business as usual in the U.S. and Singapore?
And then, the  nurses of the  2 to 3  doctors who  have used Crystalens in Hongkong said they can use Crystalens, but  the cost is typically DOUBLE that of monofocus IOLs. (Surgery+monofocal =$1.  Surgery + ReStor=$1.3 to1.4.
Surgery+CrytalensHD=$1.9 to 2.2.) (All prices without insurance coverage.)

What I want to get is no-stitch micro-incision surgery by a highly experienced, well-equipped doctor who can also give me a fair assessment of choosing between Crystalens (and Tetraflex, if possible) and ReStor (or a mix of them) in my case, based  on his/her experience with both Crystalens HD and ReStor.
It may be impossible as it appears that there is quite a tangled mess of conflicting self-interests and marketing/pricing misplacements in Hong Kong now.

Could someone tell me if there was really some problem of Crystalens in some countries. I cannot find it in the net.
The price differentials seem too large in Hong Kong as compared to in the States. Is this true?
(Strangely, Tetraflex is used by more doctors in HongKong than Crytalens and the price is just about the same as ReStor. But the info  I  can find on the net is very little so I am not  sure if it is a Crystalens alternative. The doctors I saw yesterday said he has NEVER heard of Tetraflex! The nurse of a doctor who uses Tetraflex said cataract patients without presbyopia should not use Tetraflex; they should only use monofocal IOLs, not even multi-focals. All  very confusing and too biased.  Could anyone tell me  more  about Tetraflex?)  

[John C Hagan III, MD, FACS, FAAO]

Individual eye surgeons often grade the thickness of cataracts using grades 1, 2, 3, 4. HOWEVER it is totally objective, what one surgeon might call a 2 another might call a 4. It's like trying to judge how attractive someone is, totally subjective. Also in places like Hong Kong of USA rarely do people wait to stage 4 cataract before having surgery but in places like India and Africa in cataract clinics all they may see are 4 pluss cataracts.

If you have money to burn and want to go elsewhere to have you evaluated you can but I think you may end up unhappy and much poorer.

Use the search feature and read all the unhappy patients with multifocal IOLs.  Combine that with a 4 cataract and you are not a good candidate.  AVOID THE REZOOM IOL AS IN MY OPINION AND RESEARCH DR. KUTRYB AND I HAVE DONE IT IS OLD TECHNOLOGY AND VERY PRONE TO UNHAPPY PATIENTS.

JCH MD

[hkphilip]

Thank you for your comments. By the way, the doctor who said I have a grade 4 thickness right eye told me the maximum grade is 5.  

[John C Hagan III, MD, FACS, FAAO]

That proves its subjective, some use 3 stages soft, medium hard cataracts
JCH MD