Effect of a scleral buckle to the accomodation power of Crystalens

Dr Oyakawa:
You mentioned that the scleral buckle can have adverse effect to the accomodation power of the Crystalens. Can you tell me how much will it be ? After the implant, let say I can see 20/25 at far distance, can I still see 20/25 at intermediate distance (like 80cm).
I plan to implant the Crystalens but if I cannot benefit too much of the accomodation power of it due to the buckle, I may choose to implant  the mono-focal IOL.

Thanks

[Ray T Oyakawa, MD]

The macula is improving but slow.  The vision is good but I have distortion and blind spots.

Two weeks after Crystalens I was seeing I was seeing 20/30+2 (some of the 20/25 letters) and J2 (20/30) at near without correction.  Then I developed some macular swelling.  This was treated with avastin and later a Ozurdex implant.  In June I had a repeat peel with has left me some blind spots near center.  This should improve with retinal reorganization but it may take up to a year or more.  There has also been a mild myopic shift from -.75 to -1.00

My cataract surgeon and many of colleagues recommend an Acrylic lens due to my previous retinal detachment and if silicone oil is needed, silicone lenses (Crystalens) can be a problem.  My experience with eyes that need silicone oil is a poor visual outcome.

Dr. O.

[Ray T Oyakawa, MD]

I have a mild monovision.  I targeted-.50 and I am about -1.00.  The calculation was very complex due to the previous PRK, buckle and ERM.  My uncorrected distance is about 20/40 and near about 20/25.  When I am fully corrected for distance I see about 20/40 at near but it really depends on the amount of light.  I am not fully recovered from my last repeat ERM peel in June.  Scleral buckle does affect accommodation but you are almost 20 years younger than me and will probably have better accommodation.

Dr. O.

[taurus1203]

Dr Oyakawa:
Just want to clarify the numbers you described.

Do you mean
You are now -1.00 after the cataract surgery.
Without glass, you see 20/40 for distance and 20/25 for near
With glass, you see better than 20/40 for distance and 20/40 for near

Does eye exercise is necessary or helpful to have your cilary muscle to control the Crystalens.
Thanks

[Ray T Oyakawa, MD]

With glasses I see about 20/25  for distance and J3 through the distance correction, or 20/40 at near and J2 or 20/30 with good light.  There is mild metamorphopsia remaining after two ERM peels.


Dr. O

[taurus1203]

Thanks a lot.
Do you expect your near vision to improve when your eye is more adaptive to the lens in the future ?

It is so good to have a eye surgeon who can share his personal experience on the lens :-)

[Ray T Oyakawa, MD]

The macula is improving but slow.  The vision is good but I have distortion and blind spots.

Two weeks after Crystalens I was seeing I was seeing 20/30+2 (some of the 20/25 letters) and J2 (20/30) at near without correction.  Then I developed some macular swelling.  This was treated with avastin and later a Ozurdex implant.  In June I had a repeat peel with has left me some blind spots near center.  This should improve with retinal reorganization but it may take up to a year or more.  There has also been a mild myopic shift from -.75 to -1.00

My cataract surgeon and many of colleagues recommend an Acrylic lens due to my previous retinal detachment and if silicone oil is needed, silicone lenses (Crystalens) can be a problem.  My experience with eyes that need silicone oil is a poor visual outcome.

Dr. O.

[taurus1203]

I am looking for a cataract surgeon only with the criteria only with Crystalens.
Can you tell me why people think that Acrylic lens is better for the case with a previous retinal detachment ? What is the silicone oil ?

Another concern is if Crystalens is good for cataract surgey for only one eye ?

Please let me know your thought as I am going to make the appointment to the surgeons in the next few days.
Thanks a lot

[taurus1203]

Dr Oyakawa :
Do you mean your cataract surgeon and many of colleagues recommend an Acrylic lens due to the fact that in case you need another retinal detachment surgery in the future you cannot use the silicon oil due to you have the silcone base Crystalens.

Do they advise you not to use Crystalens because you just do implant for one eye ?

Thanks

[Ray T Oyakawa, MD]

No, you can use silicone oil, but it leads to more problems with silicone than acrylic IOLs.  I have the Crystalens in one eye.  Crystalens works better in both eyes but still works fairly well in one eye.

Dr. O.

[taurus1203]

Dr Oyakawa:
Does the cataract surgery overall makes you feel much more comfortable like removing pressure sensation due to the difference of vision strength ?

Thanks

[Ray T Oyakawa, MD]

It made my vision better but distortion from my retina worse.  I used a contact lens to manage the difference from my other eye.  Therefore I did not have astenopia (pressure sensation).

Dr. O.

[taurus1203]

Dr Oyakawa:
Would you mind share with us why changing the lens will make the distortion from retina worse ? I also have mild distortion of the side vision.  Is it common that cataract surgery will increase the distortion of image common for people have RD before ? What kind of contact lens do you use to correct it ?
Thanks

[Ray T Oyakawa, MD]

The answer is complex.  My cataract progressed to -6.75 (Accuvue).  This results in a reduction of the image size.  When the cataract was removed there was a magnification of the image and distortion.  In simple term when the cataract was removed the distortion present in the retina became "clearer" as well as larger to the loss of reduction in image size due to the -6.75 cataract.

Dr. O.

[taurus1203]

Dr Oyakawa:
Does it mean you should have removed the cataract earlier ? Is there special reason you need to wait for the cataract till -6.75 ?
Finally what is scale of the degree of cataract ? Would you please give me a key word such that I can search for that ?

Thanks