Cataract lens choice: Nanoflex or Light Adjustable Lens

Hello,

I'm 41 and have cataracts in both eyes and the right eye has gotten considerably worse over the last year.

Both eyes are myopic (L: -7 with 28.12 mm AXL, R: -5.5 with 27.32 mm AXL). my astigmatism is around .7 in both eyes.

I've been research possible options and lens choices over the last year. I would like to be glasses free for distance and intermediate and do not mind glasses for reading. Night vision is important to me having good contrast no halos or glare is important in my lens choice. Like most patients and doctors, I want the best refractive outcome. I have narrowed things down to the following options for a mini-monovision setup set for distance (I would wind up doing the dominant right eye first followed by the left a few months later):

1) Staar Nanoflex Collamer lens -- I have the option of having the LensX femtosecond laser used for the surgery (w limbal relaxing incisions which should hopefully result in a good and centered capsulorhexis as well as faster recovery/healing. From what I've read about the laser, it seems that statistically the refractive outcomes are significantly better than manula capsulorhexis (studies had the same surgeon using and not using the laser for cataract surgery). I may also get some accomodative benefits from this lens which would help with a larger range of vision and better refractive outcome -- my axial lenght may limit that though.

2) Calhoun Vision light adjustable lens. This is not available in the USA (currently under FDA trials) but it has been used for a while in Europe as well as Mexico and seems to be a proven lens from what I have read so far. The big benefit of this lens is due to light adjustment a 95% or higher success rate is achieved for refractive outcome. Additionally ,the lens can be adjusted to be more aspheric so a wider depth of field and range of vision can be achieved in a mini-monovision setup.

I've also considered the AMO Tecnis one piece (ZCB00) but am leaning more towards either of the above options. Due to my myopia, I am stuck with lesnes that come in .5 D steps instead of some that come in .25 D steps so my refractive outcome is limited to a larger amount of error on the lens. Additionally my axial length and eye shape/myopia makes iol power calculation and lens placement a little more inaccurate.

PCO rates seem to be eqaul in both lenses from the little research and clinical data I've gathered. Costwise the two choices are about the same (the LensX laser is additional cost that would not be covered by my insurance)  from what I have been quoted so far (using Codet Vision in Mexico for the LAL) but travel expenses and followups could add up for the LAL. If any complications occurred, then the Nanoflex would be the safer choice.

My question are:

1) Are there any downsides to the above choices?
2) Is there a choice I'm not considering? Crystalens is out due to problems reported (none of the 3 surgeons I've talked to seemed very comfortable with it) as well as significantly higher costs for little benefit if any. Multifocals are out as well due to night driving needs. I've considered the Synchrony lens which is available in Europe but not available in the powers needed for my eyes.
3) If you had my eyes and lifespan to live what would you choose?

Thanks for any help and insights.

-- John

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

We do not try and answer questions like that. No-one is you but you.  You will need to do your own research and make your own decision.

JCH MD