Lens Imbalance

[NeLso]

I am still young (early 40's) and have an active lifestyle.  (golf, skiing, tennis, hiking, etc)

I am due for cataract surgery in one eye.  The other eye is normal and clear.
I have worn glasses all my life and prefer it over the hassles of contact lens.
Eyesight is -4.0D, with very slight astigmatism (-0.5).  
(prior to developing the cataract, both eyes were equal in prescription)

According to what I read here (Thank You so much to our fine doctors and
resident experts!!)  I will have Aniseikonia, post surgery.  

When discussing IOL options, my doctor went stright to CrystaLens 5.0 and Restor IQ.  
In order of preference for me is to first eliminate any risk of Aniseikonia, then ensure no weird visual phenomenons, then good near/intermediate vision (w/ depth of field), then halo/ghosting.  Good distance vision is least important.(since it can always be corrected with glasses)

For Aniseikonia, I can not do Lazik and inserting contact lens would be a lifestyle change.
Is it be possible to "tune" the strength of my cataract eye so that it matches my natural eye?
Does choice of IOL material (ie. refractive index) play into the this equation?  

I read that the Collamer Aspheric IOL from STAAR surgical has an index of refraction closer to the natural eye.
Would this be something I should consider?  (would this material be easier to explant 20 years from now?)

Thank you so much in advance!

[John C Hagan III, MD, FACS]

If you are -4 in one eye and you get a Restor or Cyrstalens HD set for distance 0.00 you will have aneisometropia (big difference in refractive error) and image size (aneosoconia). Probably too much to put up with.

You can use the search feature and archives to review your options.

If you are okay with glasses these the options many of my patients have found satisfactory.

Have a aspheric monofocal IOL put in the eye having surgery with a mid-range target -1.25   After surgery you may do fine with glasses (progressive no line) if not plan on lasik on the eye with no surgery either leaving it with a distance bias goal of 0.0 or near bias goal -2.00.  Likely your insurance will cover it if you cannot tolerate glasses

Or you could go near bias plan on leaving the surgical eye -2.00 if glasses don't work have lasik and leave the distance eye -0.25

Or if you have any aging changes in your lens and you likely do have the second eye operated on for insipient cataract and use the IOL to achive the same results.

You will have to do some research to understand your options.

JCH MD

[JodieJ]

Dr. Hagan has provided your best options.  As he stated above, neither the Crystalens nor the Restor will work with your fellow eye at about -4.  If these were your surgeon's first suggestions (and s/he was aware of your fear of aniseikonia), you should probably consider getting a second opinion.

I was in a situation similar to yours as the result of a rapidly developing cataract following retinal surgery.  I chose to have cataract surgery on my fellow eye.  I was delighted with the results (at least as good as my corrected pre-surgery vision), and my Blue Cross paid for everything.  I also know a man well over 60 who had never worn a contact lens before but had no trouble adjusting to a 1-day disposable contact following cataract surgery on one eye.  Your most conservative choice would be to choose a target close to -4 (maybe -3 or a little more in the plano direction.)  Buried in the archives of this website, there is a thread from a highly myopic woman with a cataract in one eye who didn't want to change the prescription in her relatively new progressive glasses following cataract surgery.  Her surgeon was able to grant her wish, and the woman was delighted.  

[John C Hagan III, MD, FACS]

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[NeLso]

Thank you so much for your speedy feedback!

To minimize the risk of aneisometropia and aneosoconia, is Restor/Cyrstalens not an option at all,... or only when set for distance 0.00?

What would be the risk for aneisometropia and aneosoconia with Restor-IQ set for -2.0D.  (my good eye is -4.0D)?

Thank you so much in advance!

[JodieJ]

People pay extra for a "premium" IOL in order to minimize/eliminate their need for glasses.  If you were to set a ReStor at -2, the distance segment would probably give you near vision and the near segment would give you about what you'd get with your fellow eye without correction (i.e., nothing very useful).  Why would you want to do this?  You could get good near vision with a monofocal IOL without running the risk of encountering the side effects associated with ReStor (halo, glare, loss of contrast sensitivity, etc.)  Unless you want to have LASIK or cataract surgery on your fellow eye, neither the ReStor nor the Crystalens HD would work for you.

[NeLso]

Hi JodieJ,


Thank you so much!!  But I'm freaking out now....  maybe I misheard my surgeon.

Basically I was told to choose between CrystaLens5.0 and Restor-IQ and come back after I did my research.

Unless I heard wrong, the surgery would be to set for Distance 0.00 or Near -2.0.
A contact lens (or Lasik) on the normal eye was the Dr's suggestion to address the lens imbalance.

But isn't there any way that I can stay with prescription (distance) glasses?

[JodieJ]

Of course you can stay with distance glasses, but apparently the surgeon you saw is most concerned with fattening his wallet.  Definitely get additional opinions from other cataract surgeons.  There's a directory of board-certified surgeons at www.aao.org.  Theoretically, your IOL can be set for any target you want, including -4D.      

[NeLso]

Thank you so much!
As my cataract was developing, my diseased eye became less nearsighted.  (both eyes used to be equal)

During that time, I had new glasses made... but could not adapt.  I could not believe how strange it felt!  The imbalance was so bad that I went back to my old pair of glasses!  (thus my post surgery aneisometropia concern)

I have experienced mono-vision though.  No problems.  Easy to adapt.  
I am now in the process of finding a 2nd opinion.  

Interesting to note that the surgery center that my Doctor uses (lease/rent/borrow?) lists only Crystalens and Restor on their website.  (the same two lens my dr suggested)

[JodieJ]

Both Crystalens and Restor are considered "premium" IOLs, and they require a rather hefty out-of-pocket payment by the patient.  They are also quite profitable for the surgeon.  They only make sense for people whose priority is to reduce/eliminate their need for glasses.  It troubles me that your surgeon gave you a choice between Crystalens and ReStor and never even mentioned the possibility of an aspheric monofocal IOL (probably your best option).  Hopefully, you'll have a better experience with another practioner.

[garybro]

No, No, No No No! I have Aniseikonia due to a detached retina. You absolutely do not want to deal with that. Now I'm no doctor and do not know what your particular problems are exactly but one thing I do know. If your good eye does not have any degenerative eye disease or cataract, do not have any IOL implants. Most of all seek other opinions from qualified specialists. My detached retina was from IOL implants and this is what happened. I did not have cataracts but was told I was a "perfect candidate" for Multifocal IOL"s. The fact that these lenses did not work for me is only half the story. It's all about the money. They tell you in the video and the informational papers that you might have some issues with light and glare from lights at night. Let me say again I had no cataracts and no other issues other than glasses for reading. When you have cataracts you have a clouding of vision that varies from bad to worse. So having you lenses replaced does great wonders for those who cannot see. And the trade off is the light issues I mentioned earlier. That for them is great. But for those of us with no issues these issues are enormous. Let me repeat ENORMOUS. you cannot begin to imagine the effect that this will have on your vision. From my experience I do not understand why they tell you that Aniseikonia post op will be inevitable. I would research that as much as possible. I have had Aniseikonia for just over a year now and have been told that there is no cure. But I keep on trying. My biggest thought to you is if you don't have cataracts do not get IOL's implanted. Get as many second opinions as possible. Do not go to the doctors that are IOL superstores. Had I gone to Mass Eye & Ear in Boston from the beginning I would not be in this predicament today.

[JodieJ]

Aniseikonia related to retinal disease/damage is VERY different from aniseikonia related to a difference in refractive errors between the eyes (sometimes called optical aniseikonia).  The latter is uniform across the retina, and it is reversible with a contact lens, laser vision correction, or an IOL in the fellow eye.  On the other hand, retinally-induced aniseikonia (like we both have) is really a special case of metamorphopsia (distortion) caused by a retinal condition.  It is usually much more severe than optical aniseikonia, and it can only be partially corrected.  (However, that "partial" correction can make a huge difference in terms of having comfortable, functional vision using both eyes together.  You can learn more about this at www opticaldiagnostics com.)  If retinally-induced aniseikonia is caused by an epiretinal membrane, it can sometimes be corrected by surgery.