IOL decision

[SirenaCansone]

Six or seven years ago I had an IOL implant in my left eye.  I specifically asked the doctor to correct for distance vision since that was most important to me.  As it turned out, the measurement was off and I was very near sighted in the left eye.  Now my right eye is cloudy and the vision w/o glasses is poor overall so I am considering another IOL.  

QUESTION:  Since the left eye is a fixed focus and my vision is good for near-sighted to intermediate can anyone tell me which IOL to choose for the right eye that will give me good distance vision but NOT make me feel like I"ve got mono vision?  I'd like to see FAR but I'd like the right eye to compensate somewhat for CLOSE viewing with the left eye so I don't lose depth perception (which has been terrible and makes me stumble!)  My doctor says the Crystalens is not a good bet because determining the result is less sure.

[John C Hagan III, MD, FACS]

1. Picking the IOL power is not an exact science and an error of + / - 0.50 is the rule, larger in cases of long, short or post RK or lasik eyes.
2. A fixed focus lens is just that if you set if for distance 0.00 refractive error you will not be able to see intermediate or near.
3. You should probably resign yourself to wearing progressive bifocals at least some of the time post surgery.
4. You can only have matched eyes if you set the left eye for distance, have lasik on the right eye and wear progressive bifocals.

JCH MD

[JodieJ]

I'm not an eye care professional, but it seems that the refractive error in your left eye greatly exceeds the customary error noted above by Dr. Hagan.  You might consider having a different surgeon do your right eye.  Try to find a doctor who is experienced, board-certified and uses an IOL Master to do your eye measuremets.

[John C Hagan III, MD, FACS]

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[peakhope]

You should probably get a second opinion.

Crystalens HD is probably your best hope of having vision at all distances without glasses, which would also give you stereo near vision (to whatever degree your Crystalens HD eye can focus up close). However, it is not a perfect lens, so you should be aware of all the risks and potential problems with it.

A doctor might say differently, but if you end up with a distance-only lens in your right eye, you might be able to get glasses (bifocals, probably) that could give you some amount of stereo vision. Or maybe a combination of a contact lens plus glasses. Or maybe you could get laser surgery on your left eye to make it less nearsighted, which might open up more options with contacts and glasses.

[John C Hagan III, MD, FACS]

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[SirenaCansone]

Thanks, all.  I suppose I was looking for a miracle but I should probably just resign myself to the fact that I can never correct the FIRST mistake. (And, yes, I did choose a different and more experienced specialist for this surgery....the one I should have used in the first place!)

[John C Hagan III, MD, FACS]

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[JodieJ]

Who says that you can never correct the first mistake?  LASIK, a contact lens, or glasses can correct it.

You mentioned that you don't want to "feel like you have monovision."  Have you had a bad experience with monovision?  If you can adjust to it (and the great majority of people can), it feels very natural--like you still have the same range of focus you had as a young adult.  Having both eyes at plano with IOLs is great for some tasks, but everything within arm's length will be blurry.

I'm glad to know that you found a good surgeon.  Best of luck.

[SirenaCansone]

Can you get LASIK in an eye that already has an IOL?  Thanks for the encouraging words about monovision too.

[JodieJ]

Yes, you can get LASIK in an eye with an IOL.  In fact, getting a LASIK "touch up" after cataract surgery has become increasingly popular in the past few years.

I'm one of the few people who can't do monovision--I developed strabismus with monovision contacts.  (This is very rare and probably involves a genetic vulnerability.)  But I loved monovision and envy those who can take advantage of it.  ("Blended vision" or mini-monovision is a great alternative, too.)  Currently, both of my eyes are at plano with monofocal IOLs, and I need glasses or bifocal contacts for the computer, cooking, or any close vision task.