Contact lenses before eye surgery

[wilt2448]

I have had cataract surgery on one eye at present (crystalens). I will soon be having a crystalens implanted in the other eye also. The MD wants me to stop wearing a contact lens in the soon to be operated eye one week before surgery. Since I am very myopic this puts me in a difficult position of basically seeing out of only one eye for a week. Can anyone tell me why it is necessary for me to stop wearing the contact lens one week before surgery. All of the eye measurements have already been done, only the surgery remains. I understand the reason for having the contacts out for a few weeks before the measurements but why for one week before the surgery itself? Thanks.

[JodieJ]

You shouldn't have a problem adjusting to plano in your right eye and -.50 D  in your left.  This is a very small difference.  I'll be very interested in learning about your results.  Spend the weekend listening to music or books on tape.  I hope your outcome exceeds your expectations.

[wilt2448]

I had an appt with the MD yesterday (8/7). We have decided to go with an aspheric monofocal IOL set for distance in my right eye. I'm not sure which brand, I will leave that up to him but he says he implants only aspheric lenses (for monofocals). Surgery is scheduled for 8/12. I am now in my four day preop period of no contact lens so it's going to be a LONG weekend seeing out of only one eye.

So far with a Crystalens HD in the left eye set for about .5 diopter nearsighted and using a contact in the right eye (corrected fully for distance) my brain is unable to successfully blend the two images for distance. Maybe I'm just thinking too much about it. The MD says that my brain should be able to blend the two images much better once the IOL is implanted in the right eye. We will see. I do also get some of what appears to be edge glare and flickering from the Crystalens but just under certain conditions. Hopefully that will go away with time.

Once the right lens is implanted and the dust has settled a little I'll report back on the results. Again thanks to you, 2ndsight and Dr Kutryb for the advice and feedback.....Wilt

[JodieJ]

The modified monovision that you'll have is much easier to adjust to than full monovision with contacts.  I really don't think you'll have a problem.  You should have a very nice range of vision, and I'll be eager to read your report about how your Crystalens HD performs.  With a little luck, you'll have very good distance and intermediate (computer) vision without glasses.

[wilt2448]

Thank you Dr Kutryb, JodieJ and 2ndsight. I am now leaning very strongly toward an aspheric monofocal lens. I am not that concerned about upclose vision. I went with Crystalens because I wanted crisp distance vision and decent intermediate vision. I thought Crystalens offered the best chance of that. If I have to wear reading glasses for reading and computer use it would not bother me at all. I strongly prefer both eyes set for distance and will accept whatever near vision is left. I didn't realize my MD was going to deliberately make my left (nondominant) eye a little nearsighted.

My plan now is to go with an aspheric monofocal lens set for distance in the right eye and then kind of let things heal and settle down. Assuming I end up with good distance vision in the right eye I'll then try to adjust to the modified monovision. I tried it with contacts some time ago and did not like it. I prefer both eyes set for distance. If I can't adjust then I'll get a weak contact for the left eye to bring it to good distance vision and see how I like it. If all is well then I'll ask him to zap the left eye to try and set it for distance. That's my game plan. Thanks to all of you again for the advice....Wilt

[2ndsight]

the Crystalens data and their own advice to physicians suggests patients see better and have the most satisfied outcome when the lens is implanted bilaterally. You will get better accomodation at  closer distances even if the lens is set for distance than with a monofocal lens. I would get the lens which comes in your correct power, since the IOL measurements are not a 100% guaranteed exact science.

[JodieJ]

Since your left eye has already been set for intermediate vision (modified monovision), this is the eye that will carry the burden for near/intermediate tasks.  Your right eye will be used for distance vision.  You will not have good distance AND near/intermediate vision in each eye.  I don't think it would make much difference whether the lens in your right eye were a Crystalens HD, a Crystalens 50, or a monofocal--your right eye won't see up close as well as your left eye.  What's important is that your right eye has good distance vision.

You might want to re-post this question on the "expert" forum to get feedback from one of the forum doctors.  

[Michael J Kutryb, MD]

Your last post sounds like a lot of work for a no-guarantee result.  What sounds a million times easier is to have an aspheric monofocal implant set for distance.  Your other eye should have just a little bit of near vision as it is.  This question is an easy one in my book.  I advise against the crystalens/lasik route.  Listen to Jodie J - he has a lot of good advise for you as well.

MJK MD

[wilt2448]

What about going with the Crystalens HD at the highest power available then having Lasik in the future to set for distance? This is actually the option the MD suggested to me after he realized the HD was not available in my power..

He said I would probably end up about 1 diopter nearsighted and then we could use Lasik to enhance for distance after the eye has healed completely from the surgery. This way I would eventually get the full benefit of the HD. He won't do any enhancements for at least 6 months after the surgery in order to give things time to settle down first. In the meantime I could wear a contact lens for distance vision until the Lasik can be done.

The $2400 (per eye) that I paid for the Crystalens upgrade includes any enhancements.

To me this may sound like a better long term solution. Any thoughts?........Wilt

[wilt2448]

Thank you for your thoughts.  I appreceiate your input....wilt

[wilt2448]

Jodie,
Thanks for the suggestion. I meet with him again on 8/7 to decide what I want done.  

Thank you very much for the help............wilt

[2ndsight]

the Crystalens I have is the AT-52 SE, which I think is the most recent model before the HD. My vision at all distances except very close up is excellent.  I use 1.25 reading glasses for small print and computer. I think you would be happy with it and your two eyes would be more balanced at the closer distances.

[JodieJ]

I agree that your surgeon should have foreseen the situation.  But I still have a great solution for you.  Get an aspheric monofocal IOL set for distance vision in your second eye.  Then you will have blended vision with a boost, courtesy of the Crystalens HD.  You should have good distance vision in your right eye (where a second Crystalens would be of little to no benefit) and good intermediate (and maybe near) vision in your left eye.  Plus you save more than two thousand dollars!

BTW, you would not have had good distance vision in your left eye regardless of what lens you had in your right eye.  Your surgeon (wisely?) set your left lens for modified monovision, anticipating that the accommodating ability of the Crystalens HD might not be as great as the press releases implied.

[wilt2448]

Thanks for the input. Here's the problem with what you suggested. He already set the first (left) eye for intermediate/near vision. I am about 20/30 or thereabouts in that eye. The plan was to set the right (second) eye for distance. That now cannot be done since the Crystalens HD is not available in the power needed. I need a 9.0 to be plano in that eye. The HD is not available at this time at that power and B&L has no target date at this time for when it will be. I get the impression it could be a LONG time.

Had he informed me of the limited power availability of the HD going in to this I would have just opted for aspheric monofocal lenses in each eye and saved my self about $2400 per eye. I think he blew it by not realizng the correct power was not available

Basically what I want out of this is good distance vision and good intermediate vision in both eyes. This is why I selected Crystalens. I don't really care if I have to wear reading glasses for up close things.

Thanks for any suggestions.....Wilt  

[JodieJ]

During the past few days, Dr. Kutryb reported on another thread that according to his research, the Crystalens 50 provides only .5 diopter of near vision.  This is not sufficient to make a significant difference in near/intermediate vision, and it certainly doesn't justify spending thousands of dollars in "premium" lens fees.  Reportedly, many surgeons give the Crystalens a boost by setting them for modified monovision.  But you could get the same results (or possibly better results) with an aspheric monofocal lens in your second eye--and you would not have to pay any surcharge.  AMO, Alcon, and Bausch & Lomb all make aspheric lenses in your power.  I'd recommend that you get one and have your second eye set for intermediate vision.  

[wilt2448]

Also for JodieJ or anyone else who would care to comment. (including MD's)

I just checked with the MD. The issue is possible infection and after pleading with him he did agree to reducing the time without the contact to four days instead of seven. That's as generous as he would get.

Another issue has come up. The Crystalens HD is not made in the correct power for my right eye. The highest power available in the HD is 10 (which I have in my left eye). My right eye requires a 9 which Crystalens does not make at this time and they aren't sure when they will. I cannot go unbalanced indefinitely so I have to make a choice.
1. standard or aspheric monofocal IOL in right eye
2. Crystalens HD (10 power) in right eye then have eye lasered to get correct distance RX
3  Crystalens 50-(older model) (which is available in my power) in right eye.

What would you do? Thanks....Wilt

[2ndsight]

no I don't think it has to do with the Crystalens. I think some MDs might be more conservative about these issues wanting possibly to reduce their own liability. I agree with Jodie that you should discuss this with your surgeon. Maybe he has a different reason other than what my surgeon told me. Let him know you will find it difficult going for a week without the lens and see what he suggests.

[JodieJ]

If the issue is possible infection, the choice of IOL should not make a difference.  This is a question to discuss with your surgeon.

I have a theory about why there is such a variance in attitudes among surgeons on this issue.  I'm thinking that more "younger" (i.e., under age 60) people are having cataract surgery today than in the past (although technically it may be a "clear lens exchange" in many cases.)  And many people in their 50's and early 60's grew up wearing contact lenses.  So I'm guessing that cataract surgeons are seeing many more contact lens wearers today.  Yet there might not be an established "tradition" about how to handle contact lens issues.

[wilt2448]

Thanks for responding. This is also for 2ndsight and/or anyone else who would care to comment. A thought just occured to me. I wonder if the fact that a crystalens is being implanted (as opposed to a standard lens) has anything to do with the longer time frame to leave the contact lens out?

I would think not but..............Any thoughts?

[JodieJ]

I'm hesitant to say this on a public forum, but you might try to negotiate this issue with your surgeon.  Mine initially told me to leave my contact out for 24 hours before surgery.  Subsequently, he said it would be all right to wear the contact the day before surgery.  It certainly made it easier for me to function at work (and safer for me to drive there.)

[wilt2448]

Thank you for responding. I had no idea that the reason was risk of infection. You are right about different doctors recommending different time periods. Where I am having the surgery done there are at least three different MD's who do cataract surgery. In asking how long I should leave the lens out before surgery I received four different answers from  four different people at that facility. They ranged in time from one day before the surgery to seven days before the surgery, depending on what MD is doing the surgery. Unforunately my MD says seven days. Thanks again for the input.

[2ndsight]

My surgeon explained to me that the contact lens, even a disposable lens, can carry tiny amounts of bacteria that can remain in your eye.  He told me to leave mine out for 3 days prior to surgery. Every surgeon seems to have his own protocol for this and I'm sure they base this on what has resulted in safe and successful surgeries.