Crystalens Result

[mmmmpppp]

Hi,

I am 51.  I had a totally maxed-out PSC cataract in my right eye.  My left eye is 20/15 but needs a reader.  I had a Crystalens HD put in my right eye yesterday morning.  I removed the patch last night.  Since I have benefited tremendously from everyone's stories here on MedHelp, I thought that I would share mine.  Also, mine may turn out to be an extremely happy story.  I figure that happy patients are underrepresented on MedHelp.  Before the cataract, I had excellent vision in the right eye.  I've never worn glasses and, in the past, my eyes have almost totally rejected reading glasses.  (Too-weak readers still feel 100 times too strong.)

Let me just preface this by acknowledging that a lot can happen after Day 2.  This is just a report about how things seem now.  I will update it as I get farther along if it seems like anyone is interested.

So far, I am thrilled out of my mind.  I took the patch off last night at around 9:30 p.m. in front of a supermarket.  I had just bought bandage tape, allowing me to take my doctor up on his suggestion that I could redo my patch and didn't need it back on again until I went to sleep.  I was so curious to see my new vision, but I wasn't going to take off the patch until I knew I could repatch.  My first reaction was, "I AM SO SCREWED!"  The reasons were that a) I had a strong feeling similar to when one puts on glasses with a prescription 20 times too strong, and b) there were huge, bright, thin rings of colored light around every light source.  Because of a mispent youth in the early '70's, I could have pulled off driving at night with that much visual disturbance, but it would have been worse than criminal.  And the feeling of wearing a 20 times too strong prescription was downright depressing.  Why had I done this to myself?

I was home a few minutes later (I live across the street from the supermarket).  Inside, I noticed that from the Crystalens eye, everything looked clear, bright, and perfect.  I was told not to read, but my eyes fell on a few words of text smaller than newsprint size, and I thought I noticed that I could read the words.  I didn't want to test because I wasn't supposed to read.  I also noticed that everything looked a little yellow through the natural eye.  (I'll be using "Crystalens vs natural" throughout to distinguish the two eyes.  Remember that the natural eye can't read without a reader.)

(continued in next post)

[mmmmpppp]

Day 30

Had a checkup with the ophthalmolgist today.  Told I need a YAG!  It is scheduled for 10/20/2009, a little after my 90 day mark.  Partly to clean up residual staining from my terrible cataract, partly because the Dr. sees more clouding now than previously, and I think partly because of my insistence that my vision is blurrier in the Crystalens eye than the natural eye in spite of measuring so well.

I also told him that I have some dysphotopsia's at night that are like light reflections.  He doubts that those will go away until age leads my eyes not to dilate as much at night.  My pupils are 4 cm and my Crystalens is 5 cm.  He said that it is normal for someone my age with my size pupils to dilate more than 5 cm.  (Is it cm or mm?)

I measured at 20/15 distance, 20/15 intermediate, and 20/40 near.  Plano refraction.  I'm confused because I had thought that I had been told twice that it was 20/25 near, and I would have said that reading gas always been easy and has only gotten easier--during the day, at least.  Today I was told that last time it was 20/50 near.  Outside I can hit 20/20 near, but in my apartment it is either 20/25 or 20/40--during the day.  Come to think of it, I've been afraid to measure at night.

My binocular vision is perfect at every range during the day.  At night my binocular vision is perfect at distance and intermediate, while reading is challenging, but fine under a strong light.  Outside at night, I see some slightly annoying light reflections.but generally have perfect vision.  I still see the edge of my lens fairly often and there is still some occasional flickering beside it.  That problem seems to be distinctly better than originally--with less flickering and the "hair" looking thinner and more off to the side more of the time.

Generally speaking, so far (we'll see in 20 years), I am extremely happy with my decision and my results.  I do think that becoming relatively well-informed ahead of time, largely with the help of the wonderful MedHelp community, helped enormously.

[mmmmpppp]

I was thinking: I'll bet that if they had an eye chart designed to be placed anywhere farther than, say 150 feet away, but especially, say, a mile or two away, my Crystalens distance vision wouldn't test so well.  I wouldn't put it past Bausch and Lomb to focus more on how they will be measured, namely from 20 feet, than on real life.

But binocularly I would test extremely well, I guess primarily thanks to my natural eye.

[mmmmpppp]

Midday in my apartment, which is sunny but gets no direct sunlight, I can read the 20/13 line from 20 feet away with the natural eye covered, i.e., with the Crystalens eye.  I can also read print about half the size of newsprint or less (not from 20 feet away, of course).

It is astonishing.

The only imperfections are that I still see the edge of the lens sometimes---the occasional flickering with it is almost gone---and it puzzles me why the Crystalens eye alone is not as focused as the natural eye at distance.

Just before I went to college over 30 years ago, my father took me to an optometrist who told me that I had the best vision he had ever seen in his career.  Maybe that's part of the explanation for my amazing results.

And I am more amazed because my cataract was so bad, no doctor could see my retina or measure my eye with the IOL Master.

[JodieJ]

If you can read the 20/20 line with your Crystalens eye, your distance vision is excellent.  Your outcome is remarkable.  I'm just surprised that you had so many problems with night vision with the Crystalens.

[mmmmpppp]

Any reading I do is with the Crystalens eye.  I printed out a near vision chart and the natural eye couldn't read the biggest line.

With my desk lamp at night, I can read anything that I can read (anywhere with no lamp) during the day.

So if neither visual acuity nor astigmatism accounts for a blurriness in the Crystalens eye at distance, what could it be?  With the natural eye closed, I cannot focus the Crystalens eye completely at a distance, mostly, anyway.  With both eyes open, everything is clear at virtually all distances.

[JodieJ]

I don't think that it is astigmatism induced by the surgery.  It's interesting that your day vision is so much better than your night vision with the Crystalens.  How is it reading with the Crystalens eye vs. the other eye?

[mmmmpppp]

Sigh . . .  This all makes no sense!

I took your suggestion and printed out an eye chart and carelully measured 20 feet from the chart and measured the big E to verify that it had printed correctly.. With the natural eye closed, the Crystalens eye is 20/15.  And with the Crystalens eye closed, the natural eye is 20/15.  But I could see distinctly that the 15 foot line of the chart was sharper to the natural eye than to the Crystalens eye.

Now I'm wondering if what I'm experiencing is astigmatism in the Crystalens eye induced by the surgery?

[mmmmpppp]

Thanks!  I do feel very satisfied overall.  I was thinking that if "correcting" the Crystalens at distance might cost some reading ability, I'd definitely rather not.  I do think that what I have is a bit similar to monovision.

I definitely have no reason that I can think of to patch the Crystalens eye.  But in the interests of promoting my "monovision," I will not patch the natural eye anymore either.

I did keep seeing myself test at 20/15 distance, yet I also saw that the natural eye by itself was clearer than the Crystalens eye by itself; so it will be very interesting to see what happens on August 6th.

Thanks again, JodieJ!

[JodieJ]

There's no reason for you to patch your Crystalens eye for lengthy periods.  You might try reading for a few minutes with that eye only--I suspect that you'll be successful.  (I was able to download a free eye chart to be read at 10 feet, and the results obtained seem to be very accurate.  You could do the same if you want to test your distance vision yourself.)  You mentioned that your Crystalens eye never had the crisp distance vision of your fellow eye, and it's probably doubtful that it ever tested 20/15.

So actually your results aren't bad at all, even though they aren't what you expected with the Crystalens.  You have good vision at all distances, which may be more than you'd get with monovision using monofocal IOLs.  And your adjustment to monovision was very rapid.  (Based on your posts, you've already adjusted.)  Your dysphotopsia is diminishing.  In your place, I'd probably be feeling pretty satisfied overall.  

[mmmmpppp]

Further experimentation strongly suggests that indeed my distance vision isn't what it was, or what I thought it was, initially.  The Crystalens eye by itself never was as clear at distance as the natural eye, but I'm not sure if it's actually gotten worse.  I sort of hope it has because I wouldn't want to think that blurry distance vision still tests out at 20/15.  On the other hand, I have doubts that my near vision has changed.  I can read print significantly smaller than newsprint, but I think I could do that initially.  So I'm afraid that I may have simply lost some distance vision in the Crystalens eye.

Maybe what I have at the moment is a monovision that pretty nearly covers my entire range of vision.  If that's true and I decide to accept it without further intervention, maybe I should stop closing or patching the natural eye for experimentation purposes.  Maybe I should let my brain get into monovision.

[mmmmpppp]

Thanks once again!  I am grateful for your attention.

I guess I'll wait until the 6th and then possibly start a new thread.

I'll post agin on the 6th.

I really can't thank you enough JodieJ!

[JodieJ]

When you see your surgeon next week, your vision with your Crystalens eye will be evaluated and any changes can be noted.  It seems like your dysphotopsia is diminishing when you use both eyes together.  This is a good sign.  Maybe it's best not to experiment with the eye patch.  Dr. Oyakawa is an expert with the Crystalens.  You could start a new thread directed to his attention for further advice.  

[mmmmpppp]

P.P.S.  The experiment was so awful, I'm too afraid to try the patch during the day.  Aside from the awful time I had while the patch was on, everything is still not 100% of where it was before the experiment.  The rest of that night I was tired, slightly dizzy, and the two eyes didn't quite seem to work together properly.  And a lot of long-passed, relatively minor dysphotopsias came back the next night (last night) but were going away throughout the evening.  I'm still recovering from the experiment in that not all these once-passed, now-returned dysphotopsias are gone yet, I think.

[mmmmpppp]

P.S.  With both eyes open at night, reading is a challenge without a lot of light but everything else is beautifully clear and sharp.

[mmmmpppp]

You must be right.  The strange thing, though, is that the Crystalens eye alone was never as good as the natural eye alone, but I saw myself acing every VA test and reading the lines that corresponded to the measurements I reported.  When I close the natural eye during the day, I am pretty sure I would get the same great measurements with the Crystalens eye.  All measurements in the Dr.'s office have been with the natural eye covered.

I don't know if it's just me, I certainly doubt it, but day vs night now makes a much bigger difference for me since getting this lens.  My experience may be consistent with a combination of a) poorer night vision with the lens and b) the brain only learning to suppress dysphotopsias with both eyes open.  Certainly b) is true.

As I mentioned, hopefully I'll find out if I am rationalizing on August 6th.  I'll be paying attention to how much sunlight gets into the examining room, but if there is a lot of light it may not matter.

Thank you, JodieJ, very much!

[JodieJ]

It does not sound to me like you have 20/15 vision in your Crystalens eye (or anything close to plano).  It seems more likely that you have 20/15 vision with both eyes because you are relying on your left eye for your distance vision.  If you can read now and couldn't do this before surgery, it is probably because your Crystalens eye is nearsighted.  If this were the case, then you now have monovision (and dysphotopsia).  Somehow, your surgeon's office has led you to believe that your surgical outcome was spectacular when this was not the case.

First, you need to determine what your vision with your Crystalens eye really is.  It is not 20/15 distance, and it may not be 20/20 intermediate or 20/25 near.  Then you need to decide whether it is something you can live with or whether you'd like to improve things.  If your current surgeon is not helpful, then do consult someone else.

[mmmmpppp]

JodieJ, are you sure that this is not OK?  Why did they discourage me from patching the natural eye in the first place?

My vision is so wonderful with both eyes open.  Yes, I can still read.  And with both eyes open, incredibly long distances are crystal clear.  The Crystalens eye by itself was never as good as the natural eye by itself (but seems better than the natural eye when both are open).  Last night was the first and only time I completely patched my natural eye and went out at night.

I too worried (and am worried a little) about myopic shift, but I don't really think that my vision in the Crystalens eye has changed much.  I have a feeling that had I patched the natural eye earlier, I would have seen the same things.

But I will find out on August 6th.  If Lasik could somehow make my two-eyed vision even better, that would be wonderful, but it is unfathomable.

If it's fixed, will my reading not be as good?

Thanks!

[JodieJ]

I'm really sorry to read about the results of your recent experiment.  Your vision with your Crystalens eye certainly doesn't seem to be consistent with 20/15 acuity.  I'm wondering if there has been a myopic shift in the position of your IOL.  (Can you still read with the Crystalens eye?)  I suggest that you return to your surgeon to see what can be done to improve your vision with your right eye.  You might also consider getting a second opinion from another surgeon experienced with the Crystalens.

[mmmmpppp]

Amazing--disturbing--experiment!

Last night, Day 21, I tried patching the natural eye to force the Crystalens eye to be as clear by itself as the natural eye is by itself.  My vision with both eyes open is magnificent (except for edge-of-lens sometimes) at virtually all distances, but with the natural eye closed, the Crystalens eye is a little blurry, especially at great distances and especially at night.  (Crystalens really depends on the extra blue light it gets from sunlight.)

With the natural eye patched at night, walking around outside was a NIGHTMARE!  I had overwhelming dysphotopsias and everything was mostly quite blurry.  Such a contrast to the sparkling (not literally),crisp,clear,beautiful vision I have with both eyes open.

It makes me worry that if I were ever to lose the natural eye or had the remaining natural lens replaced, I'd be in big trouble!

My Dr.'s tech recommended against patching the natural eye to improve the Crystalens eye.  Boy was she right (I guess)!  Recovering from the experiment took much longer than the experiment itself, which was about 15 minutes.  It scared me.

[mmmmpppp]

Hi Dr. Kutryb,

Thanks for reading and asking.

Since cataract surgery, I haven't had my vision measured with both eyes open.  All measurements have been of the right, Crystalens eye.

My left, natural eye is 20/15 for distance and maybe 20/60 for near.  I couldn't read prior to any cataract symptoms (in my right eye) without reading glasses.  Now I can, read without reading glasses easily in sunlight no matter how indirect, and not quite as easily in artificial light.  With my desk lamp, I can read easily at night, but not with my dining room or living room lights.  I believe that my left, natural eye is plano, if that is possible given the presbyopia.

My right, Crystalens eye measured as of Monday 7/13, Day 6: 20/15 distance, 20/20 intermediate, and 20/25 near with plano refraction.  It turns out that my left, natural eye is the dominant eye.  Yet, everything seems vastly richer with more contrast and depth perception at all distances in the way that I could see initially only through the Crystalens eye (*if* the natural eye was open).

Seems like I've got to be reading through the Crystalens eye.  Since I was virtually blind in the Crystalens eye prior to cataract surgery, I don't know how much contrast and depth perception to attribute merely to having two good eyes instead of one.

Sadly, I'm already getting used to my new vision so that I am forgetting what an astonishing improvement it was.

[Michael J Kutryb, MD]

It's difficult listening to you to tell which eye is doing the upclose work and which is doing the reading.  Or is the crystalens eye stronger for both?  At plano 20/15 in the left eye, that eye will still have a significant degree of near, intermediate and distance vision.  This is such a nice instance to compare eyes since you apear to be plano in the right eye as well now.  I'm really curious how the right eye by itself is doing for distance and near (both compared to the left eye by itself.)  Thanks for any more input.

Michael Kutryb, MD (from the other eyecare forum)

[Glad4Help]

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[Glad4Help]

Hi mmmmpppp.

Great account of your Crystalens experience!  I am so glad to hear you see so well at all distances!!

I'm now into day 10 with my new Softport aspheric IOL in R eye.  I was also seeing a hair-like strip on the incision side off and on; sometimes it seemed more like a shadow, and I have been seeing it less over time.  Yesterday at my checkup, I was told it was probably from the incision and should go away.  I don't remember seeing it yesterday or today.  

Also, yesterday I was seeing what looked like debris on the lens.  I will explain it in more detail in my post "Great Results with Aspheric IOL" for anyone interested.

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

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