Cataract IOL choices

[sripley]

I need help in deciding which IOL is the best choice for me. I have a complete nuclear cataract in my left eye and one forming in my right eye that is starting to affect my vision.I drive as little as possible. I just turned 46 and I have had 20/20 vision until about two years ago. I am now using +2.5 D reading glasses for my one good(right) eye.                       My three IOL options are the standard lens ,monovision and Crystalens 5.0 mm. I have read several articles about IOL lenses and after reading this forum it seems like the standard lens is the safest choice. I have read several responses from Dr. John C Hagan III and he seems to prefer a standard non spherical IOL. The reason I am interested in the Crystalen 5.0 mm because it seems to be similar to a standard lens and of course it could give me some independence from glasses. I would like some independence from glasses because I do a lot of electrical repairs on anything from computer motherboards to automotive electronics and I currently have to use magnifying glasses and flashlight lights on most repairs. My other problem with glasses is that I live in Houston, Texas where the humidty and heat make eye glasses a hassle. So is it worth the risk try the Crystalens?
I have been to two opthalmologist in Houston,Texas. The first one who only does standard IOL's and does not recommend multifocal or accommodating lenses. The second surgeon uses AcrySof Restor,ReZoom and Crystalens but has not been available without an appointment to answer my questions.
I really appreciate this web site and all the articles I have read. Thank you for your time and any advice. Sincerely, Steve

[Occupant]

I can not comment on most of your questions, but since I was highly myopic before cataract surgery I was able to solder my own circuit boards without any visual aids whatsoever. I lost that ability after the surgery. Now I am in the same boat you were in before your cataracts and in my opinion there is no way that any multifocal lens, Chrystalens included, would allow you to do this without glasses or even a magnifying glass.

[2ndsight]

I had one Crystalens implant in my right eye 2 months ago and I'm highly satisfied with it, except as Occupant says, I need reading glasses to read small print and the computer screen. However I can see well enough without glasses to do close up tasks such as makeup, cooking, and in this regard it is better than monofocal. In your case you would very likely need reading glasses to do your close-up electronics work.

[JodieJ]

If your goal is good near vision without glasses, I don't think that the Crystalens will meet your needs.  The Crystalens works best for distance/intermediate vision.  Based on the posts on this forum, it's not problem free.  I've never seen a post from anyone with this IOL who didn't need readers.

The ReStor does provide good near and distance vision, at least when it works as advertised.  Good intermediate vision may be lacking.  This lens is also associated with other problems, such as glare, halos, and "waxy" vision.  If you want to drive at night, ReStor probably isn't for you.  (Absolutely forget ReZoom.)

Aspheric monofocals are probably your best bet for a problem-free outcome.  They can be set for "blended" vision, either distance/intermediate or near/intermediate.  If you chose the latter option, you could probably do electrical repairs without glasses, but you'd need glasses for distance vision activities, like driving or watching sports.

Although there's no perfect solution, most people enjoy improved vision post-surgery.

[sripley]

Thanks for your answers. The information from your response is very helpful. I realise I will need readers for close objects and I expected that to be the case. I hope to make my IOL decision this week.  

[John C Hagan III, MD, FACS]

If you are willing to accept the higher costs, higher complication rate, need to wear glasses some time and poor night vision then the Crystalens or ReStor IOL may be for you.

For myself I would avoid the ReZoom implant like the plague.

JCH IIIMD

[colavecd]

Having had a Crystalens implanted 4 days ago, I was wondering about your adjustment period. Are you continuing to see/notice changes in your vision acuity each day or has your vision stabilized?  I've read that it might take up to a year for the adaption to take place. Right now I've got good reading and intermediate vision, but am somewhat disappointed with distance and that has been status quo since the operation. Will my vision continue to improve?  THanks.

[2ndsight]

my distance vision is 20/25 and was that way immediately after surgery, and pretty much the same today as I was the first week or so. I have good vision at all distances except small print and text on the computer screen, I wear reading glasses for those. I also have astigmatism which seemed a little more noticeable after surgery so I have the glasses corrected for that too.

Other members on this board have described situations similar to you own, that they have better intermediate and/or close up vision, and this could be due to the measurements of your eye which were taken before surgery, possibly you were left more nearsighted than you wanted to be. It is disappointing but possibly you can get a soft contact lens prescription to correct your eye further for distance, or glasses. Most people with Crystalens seem to need vision correction for one thing or another so it is not a 100% solution to be rid of glasses forever.

[2ndsight]

p.s. it is also possible that you will improve, it is only 4 days and every patient is different. Talk to your surgeon and see what he thinks.

[John C Hagan III, MD, FACS]

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[colavecd]

Thanks for responding. It's been 11 days and my last measurements were 20/20 reading with adequate lighting and 20/30+ for distance. In-between is best of all. I am happy with the lens, but a little discouraged with night vision being so poor. Fortunately I still have my left eye which will be doing the driving at night! Basically from dusk to dawn the Crystalens is not at all adequate with that available light. I will be seeing the surgeon in two weeks to discuss my options on night vision which may include either Lasik or leaving it alone since I do have another competent eye. WHen that eye needs a transplant then I will be in a pickle!  Thanks for your interests.

[2ndsight]

I think your night vision will improve. Mine took a few weeks. I notice that the Crystalens eye is still a little slower to accomodate for instance when I go from a lighted room to the outdoors at night. My driving vision is better in brightly lit areas, not so good on darker streets.

[John C Hagan III, MD, FACS]

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