Cataract Surgery or Phakik IOL (original plan)

I am 47 year old woman - wore contacs 18 hours a day without problem.  One year or so ago I developed severe dry eye and I am unable to wear contacs virtually at all (am on Restasis which has not helped).  I am severe myopic (-12R, -10L) so wearing pretty thick glasses - even the expensive "thin" ones.  As I like to swim, hike, etc., I really can't stand glasses so I decided to have Phakik IOLs implanted (after consulting with a local expert). 4 months after initial visit, I went back for the pre-op appointment, where the doctor discovered I have a developing cataract in each eye. This really threw me and I am unsure what to do.

For one thing, I do not use reading glasses now (single corrected glasses and I can read and see computer fine - although I know that day will come soon). My doctor recommended ReSTOR since I am on computer all day at work, and read as well, but I have read many horror stories and am fearful of the side effects. However, I really do not want to lose the ability to see near - like the person across the table from me, or my feet when I am hiking through rocks.  It seems like monofocal lenses will be great for distance, but intermediate and near tasks will be impossible without glasses - and the thought of taking on/taking off/searching for glasses is not appealing.   I also read about Crytalens, which might be a better option as it supposedly has good intermediate vision - which is my main concern.  

I am considering sticking with my original plan - and having the Veriseye IOL implanted now - then dealing with the cataract down the road in the hopes the accommodating or multi-focal lenses might improve (I read online about the "NuLens" which won't be in US for years).  The financial aspect is not important (I put money in a Health FSA to pay for it).  I just want to make the best decision for me and my 5 year old son for whom I am doing this so I can be active with him.  I am meeting with my doctor again before the surgery, but would appreciate any thoughts.  

Thank you. (Apologies for long post)

[Ray T Oyakawa, MD]

First, I would get a second opinion about the cataract.  A BAT test may give some idea about the amount of glare your have from the cataract.  This is some indication of how soon you may need cataract surgery.

Also, I would not consider having two surgeries when you can do one surgery to fix your cataract and refractive problem.  At your age your are loosing accommodation so many patient would op for RLE (refractive lens exchange--same a cataract surgery in someone where the cataract is not bad enough for insurance companies to pay for).  

The Veriseye is an iris clip lens and they can cause problems with pupil and iris disortion. Also, a large incision has to be made (last I heard the foldable version is not yet available) and can cause problems with astigmatism change over time (we saw this with large cataract incision surgeries in the last century before phaco was widely used).  There is small incidence of this lens causing cataracts and you will have some endothelial cell loss.   When you have your cataract surgery you have additional endothelial cell loss and another incision for the cataract surgery.

The Snychrony should be available soon.  One draw back is that it needs a larger incision than standard cataract surgery.

At this time I believe your best bet would be a Crystalens with mini-monovision.  Do a search on this and the other eye forum.

Dr. O.  

[JM_in_NY]

Thank you doctor.  I think we tend to think this type of surgery is no big deal since it is done so frequently, but I understand your points about the risk of cell loss and such, and will take that advice to settle this issue now.

I do have one follow-up question.  I was surprised you suggested Crystalens with mini-monovision.  Is it possible to get mini-monovision with a mono-focal lens?  Or is my prescription too severe? I read an earlier post by doctor Kutryb and was wondering if correcting my dominant eye to 20/20 distance (or trying to) with a monofocal would work.

After my research I am leaning toward Crystalens, especially due to the lack of side affects for most people (unlike ReSTOR), but I do recognize that mono-focals have fewer complaints/issues.