Crystalens Update & Questions

My distance vision is crystal clear, I still have all the "central flash" and glare issues as before, and I still use the same power of readers (+1.50) that I used before the Miracle Surgery that was supposed to eliminate contacts & glasses.

Bottom line is: Crystalens IOL's aren't accomodating at all for me and probably never will, and since my surgeon left me with Monovision -- I am wearing one contact for distance -- I don't care for the monovision at all.

My questions are:

1. My surgeon says YAG would help my near vision (I am at trace haze in one eye and trace to +1 in the other) but my distance is very clear now and I'm high risk for Detached Retina. High degree of myopia and mom & sister previously had D.R.

2. Do bifocal or multifocal contacts work very well? I am plano in one eye and use -0.50 in the other and +1.50 readers for both eyes.

Apparently my eye surgeon is done with me, and said schedule another appointment in a year, so I'm going to try an optometrist in the mall to see if I can get contacts that work for me. I'm so frustrated and depressed about this whole thing!

Thanks for listening....

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

You need to be under the care of a comprehensive ophthalmologist. Your eye surgeon is really not done with you if he/she wants to do a YAG.  Unless it's a big problem you might consider NOT doing the yag because of your high risk for RD. If you do have a YAG you should be checked with dilated one week and one month and 3 months after the laser.

Bifocal contacts do not have a high success rate perhaps 50% max and usually much less in less motivated patients.

JCH III MD

[JodieJ]

I don't know if it will make you feel any better, but needing only +1.50 readers post-cataract surgery is the weakest script I've ever heard of for someone plano in both eyes.  (I need +2.25, and some others I know who are plano need an even stronger reading script.)  Who knows, maybe your lenses actually do accommodate a little.  I've never heard of anyone not needing weak readers with Crystalens.

From what I heard, the GP multifocals seem to work best (for people who can tolerate wearing them.)

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

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[Eye-Kant-C]

I'd probably be happy with the +1.50 readers after cataract surgery, but I didn't HAVE cataracts. I only did the Crystalens IOL's for one simple reason: to be rid of the reading glasses!!!!!!

So I accomplished nothing ... still have all the flashing/glare issues, and went through a lot of pain, apparently need the YAG, but I really don't know if I do or not. I have read that the vision would be unclear at all levels, near, intermediate, and far, if the cloudiness is actually interfering with vision. My distance is VERY clear and sharp, intermediate and near are corrected perfectly with +1.50 readers, which leads me to believe that I could sacrifice a bit of distance and gain closeup vision. I would be willing to do that, but my doctor just doesn't seem to want to do that and insists that the YAG would improve me the closeup vision.

He also said the YAG is much less risky for detached retina than the IOL surgery. I've read so many articles on the internet (written by doctors online and some in the cataract magazines) that say YAG greatly increased the risk of RD and does not usually improve vision in one range or another, rather only decreases cloudiness and dimming of light, which I don't have.

Is GP the brand name for the multifocals? I would be willing to go back to being a little nearsighted just to lose the readers. That's all I ever asked of this procedure and I never would have done it at all if everyone just would have been straight with me on the risks and potential benefits!

[John C Hagan]

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[JodieJ]

I know your experience has been awful, so let me focus on the positive.  Most people I know need at least +1.50 readers before they turn 50.  With the normal age-related loss of focusing ability, you would have soon been wearing +1.50 readers in any event, and your near/intermediate vision would have continued to deteriorate (with surprising swiftness).  With the Crystalens, you may never need a stronger reading prescription than +1.50.

I suspect that your surgeon was not very experienced with the Crystalens when he recommended it to you, and he probably believed all the manufacturer's hype. But please get a second opinion before doing the YAG.

My experience with bifocal/multifocal contacts would be different than yours because my right retina is slightly damaged from an epiretinal membrane (scar tissue).  There are a number of new brands of gas permeable (GP) multifocal contacts; they contain different vision zones similar to a multifocal IOL.  I tried several brands, and all of them gave me very good distant, intermediate and near vision in my good eye--with no adjustment period needed.  (Unfortunately, none of the brands worked well over a damaged retina, but you would not have this problem.)  You should consult an optometrist who specializes in bifocal/multifocal lenses; there are enough brands of gas permeable and soft bifocal/multifocals that you are certain to find something that works for you.

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

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[JodieJ]

BTW, having one eye plano and the other -.50D is NOT monovision, which generally involves about a 2.00 diopter difference (more or less) between the eyes.  A .50 diopter difference is very slight; certainly not enough to cause binocular vision problems for most people.  I don't know what else might be making your vision with both eyes so uncomfortable.  And your continued glare problems are also a major issue.  Please, please, please consider consulting another experienced cataract surgeon for a second opinion.  (I actually think that a very good optometrist might be able help you, although some optometrists are basically just technicians.)

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

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[Eye-Kant-C]

I am going to schedule an appointment with another doctor (a retina specialist) that my husband has been referred to by a very good optometrist at the mall (he used to work for my opthalmologist and I really trust his opinion). I will try the multifocal contacts if I can. I called my doctor's office and asked if they would order the contacts I asked to try to give me slightly nearsightedness in both eyes and they said that they will check with the doctor to see if he'll let me try them. I realize I would sacrifice a slight bit of my distance (I believe I am overcorrected in the one eye) in both eyes, but I'm so close to being satisfied with adequate near vision and slightly reduced distance if only he'd let me experiment with a happy medium between the two. I'm not looking for perfection, just enough to get by with.

It seems to me that if I was the doctor I'd rather see the patient experiment with different strengths of contacts rather than experiment with another surgery that may/may not help at all when that patient is high risk to start with. If my right eye absolutely cannot be corrected to give me functional near vision with the contacts, then I'd consider the YAG. But I am definitely getting a 2nd opinion from the retinal specialist before doing anything with that.

I just think better safe than sorry ... advice I should have listened to before this whole ordeal in the 1st place. I am really doing much better now, actually. I have learned to live with the flashing/glare, as many people would live with halos and starbursts. I just drive with my rearview mirror in the night position and left hand up to block glare from left side mirror and deal with glare from the right side mirror. Flashing from one side doesn't blind me nearly as much as all three, so I can handle it for the most part.

I am not nearly as depressed as before, I'd just like the chance to find something that works for me without risking surgery that I probably don't even need at this point. I'm not really sure what the symptoms would be like if the cloudiness was really a problem. My vision is very clear for distance in the "bad" eye and I would think it shouldn't be and I have no halos, etc. I've read in several places that YAG wouldn't improve just your near or just your distance -- that's a refractive issue.

Thanks to both you and Dr. JH for your help, as always.

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

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[JodieJ]

I'm really glad to know you'll be seeing other doctors.  You can get additional opinions about whether you need YAG.  Your plan to avoid additional surgery if possible sounds like a good one.  It doesn't make sense to me that you'd have glare issues with any IOL.  Being overcorrected (slightly farsighted) doesn't improve distance vision, and it definitely impairs near vision.  I'm sure that your optometrist will let you have the type of correction that is most comfortable to you.  Keep us posted on your progress.  I suspect that you'll be getting better vision soon.  

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

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