Lasik & cataract surgery

I am ready to have my cataracts removed. I told my doctor what I would like to achieve is the best possible distance vision and the best possible night vision. I do not mind wearing reading glasses. I had monovision with Lasik and would like to do the same with the cataract surgery. The plans was to have good distance vision in my right I and then put a Crystal Lens ($1500 extra) in my left eye for reading.(He was really pushing for me to upgrade to the multifocal lenses).

I had cataract surgery 2/17/11 on my dominant eye. A Bausch&Lomb monofocal lens was implanted. My vision is rather blurry.  At my day after appointment my doctor said we may have to replace the lens with another, that sometimes the machine does not calclulate perfectly. He also advises I should upgrade to a Tecnis multifocal lense for the reading eye ($2500). He says I will not be happy with the monovision with our current plan. I am not comfortable with replacing the implanted lens as I know there can be complications.

I am wondering if part of the problem could be  that I had Lasik surgery in 1998 (my doctor knows this).

Today, 2/22/11, my vision is still blurry.How would you proceed with a patient like me? I am 57 years old (in case that matters)

[Ray T Oyakawa, MD]

First, one cystalens does not work as well as two.  Accommodation affects both eyes and if one eye does not accommodate it hinders the accommodation in the other eye.

IOl calculation after LASIK is more difficult.  This was probably discussed with you prior to surgery.

Since you were successful with monovision I would have recommended a Crystalens set for distance in the dominant eye with the Crystalens set for a mild monovision in the other eye OR  Monofocal IOLs in both eyes with the nondominant set for intermediate to near.  

It would help to know why your eye is still blurry.  Since your surgeon wanted to exchange the IOL, I suspect your IOL power missed target by a significant degree.

Dr. O.

[diamond10]

Thank you very much for responding to my question, your answer was very helpful. We are very fortunate to have doctors that are willing to participate in a forum such as this!!

If you had a patient with a problem like this, would you replace the lens in the blurry eye? I believe the office tech said that eye is at 20/50. Isn't it rather dangerous to replace a lens? Do you know if insurance covers this in most cases?