Crystalens in one eye? (other eye -6.0)

[Chuckles960]

I need cataract surgery in my right eye (the left one is not as far along but getting bad enough that I don't have a good eye any more).

I am trying to do my own research and I like the idea of the Crystalens. I don't mind wearing glasses if I have to, but I would like to have some range of focus. Currently I don't do well at intermediate distances even with progressive bifocals.

Can I have Crystalens in one eye? Or will this cause aniseikonia or other problems?

My doctor wants to make the right eye myopic ( -2.5) in order to set it for reading and also to reduce the imbalance relative to the other eye (-6.0).  When the other eye is done it will be set for distance. Is this a reasonable strategy, and since an eye with Crystalens would not be myopic, is that the reason why it would not be a good idea?

My apologies if I am using technical terms incorrectly.

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

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[Chuckles960]

Thank you for the information! Yes, I will ask for a referral to a second eye surgeon.

[John C Hagan]

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[JodieJ]

There should not be a surcharge for an aspheric monofocal lens.  There are 3 aspheric lenses available:  from Alcon, AMO and Bausch & Lomb.  You can find out more about cataract surgery in general and aspheric lenses in particular by viewing the patient education video at www.tecnisiol.com.  BTW, there's no evidence currently available that one of the three aspheric lenses is superior to its competitors.  Few (no?) cataract surgeons bother testing for spherical aberrations.  (However, if you have had previous laser correction for farsightedness, an aspheric lens wouldn't be you best bet.)

You wanted to know why a surgeon might not automatically use an aspheric lens.  I can think of several possible reasons.  Based on my experience last year consulting three "top" surgeons in my area, I learned that many surgeons limit their practice to just two or three lenses, often from the same manufacturer  This allows them to fine tune their ability to select the correct IOL power, taking into account their own surgical techniques.  Some surgeons may be focused on incorporating one the "premium" lenses into their practice, while overlooking the benefits of aspheric IOLs.  One of the doctors I consulted, whose approach was obviously very conservative, expressed the belief that no lens could possibly surpass the conventional Alcon IOL, which he was very proficient at implanting.  I've also read that an aspheric lens might cost the surgeon more, even though there is no surcharge to the patient.  And an 85-year-old patient with other eye conditions might not see (literally) any benefit from an aspheric lens.

My philosophy is that it can be very helpful to consult more than one cataract surgeon for recommendations before making a final decision about your surgery.  Best of luck.  

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

Aspheric and cylinder do not mean the same thing. An eye without astimatism would benefit as much as an eye with astigmatism with an aspheric IOL.  Aspheric means literallyh "not round".

IOLs that correct for astigmatism are called "toric" IOLS.

Keep digging, a little knowledge is a necessary precursor to a lot of knowledge.

JCH III MD

[Chuckles960]

Sorry about the multiple posts. Aspherical means cylindrical, right? (I know they do not literally mean the same thing, but is that what they mean in practice for eyes?) So if I don't have much of a cylindrical  correction in my glasses now (I just have a -0.5 on a 90o axis) aspheric IOLs won't do much for me?

Or is a little knowledge a dangerous thing?

[Chuckles960]

Again, many thanks for the information! I am now better prepared.

One last question if I may. Correcting spherical aberrations seems like an entirely reasonable thing. But the fact that you are recommending aspheric lenses means that they are not (yet) standard. I realize that they probably cost more and also there is the cost of the effort to measure the eye for spherical aberration. Are these costs not reimbursed by insurance, and is that why these lenses are not universally used? If not, what is the reason why my surgeon may not automatically use an aspheric lens?

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

Anytime there is more than plus or minus 1.5 diopters difference in the two eyes trouble adjusting to the glasses or uncorrected vision is a problem for most people especially if they have good binocular vision and are use to using the eyes together. It's less of a problem or no problem in people with no binocular vision ie strabismus, amblyopia since they suppress one macula under binocular conditions and only "fuse" the peripheral vision.

The problem comes from an unequal refractive error (aneisometrophia) part of which is difference in image size (aneisoconia).  Sometimes the problem can be corrected by contact lens in one or both eyes often with glasses worn over it. Other problmes come from induced prismatic effect when looking off the visual axis.

See this link     http://en.wikipedia.org/wiki/Anisometropia

Note the difference in spelling most MDs use "my" spelling.

JCH III MD

[Chuckles960]

Many thanks for your expert advice! I did not realize that "IOL in one eye only" does not provide an acceptable solution. The surgeon I saw never mentioned that. (My second cataract is much less developed, mainly I'm having trouble with road signs at a distance.) What exactly does "won't work together" mean, and why does this happen? What kind of trouble am I likely to have?
A technical explanation would be most appreciated. (I'm not a doctor but I do know some optics.)


Yes, will wear bifocals if I get monofocal implants, so the exact correction does not matter. The main thing is to get rid of the fuzzies.

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

After you have your first eye fixed you will have trouble with the eyes working together. Your first eye will not match the remain -6.00 eye wether you chose to set it for "plano" (0.00) for distance or -2.50.  So you should figure you will have the first eye done let it heal when you're "happy" then you can have the second eye done. Typically in our practice this is 4 to 6 weeks after the first eye. Some surgeons do both eyes very close together. I personally think this a mistake.

You can have a Crystalens in one eye and a monofocal IOL in the other. This is sometimes called "mix and match".  Remember that the Crystalens is a premium IOL it will be much more expensive, there are many more things that can go wrong and the two eye forums are full of unhappy consumers that opted for the promise of not needing glasses.  Of the multifocal IOLs the Crystalens is problably the best, then ReStor then in last place ReZoom.

Many surgeons will put soft contact lens in the eye before surgery to give patients a feel for what "mixed" monovision is like. In your case one eye would be corrected fully for distance and the other eye corrected to leave you -2.50. As your surgeon about trying that.

I have said this before but if I were having cataract surgery needing excellent vision day and night I would use a Tecnis IOL  (no financial entanglements with the manufacturer) with one eye -2.50 and the other -1.25 and plan on wearing no-line bifocals most times after surgery.

JCH III MD