Suitability for accommodating IOL.

[Chasman]

I'm only 47 and I have cataracts in both eyes and I am severely myopic -5.5/-5.75 and severely astigmatic and getting presbyopia.  I wanted an accomodating premium IOL like TetraFlex or Crystalens HD but the surgeon said (something like) the anterior chamber of my eye is huge 4mm deep when most are 2-2.5mm, so the range of movement in an accommodating IOL would be no advantage to me as its such a small fraction of the chamber size. Makes perfect sense to me.  He also explained the aspheric monofocal lens he recommended (Acrysof IQ) has a very low incidence of posterior capsular opacification (a consideration given my age) and has great characteristics for Yag if needed.  I was as happy as I could be given I knew the limitations of monofocal - I thought I'd ned glasses for reading/computing only.

I was about to have the surgery when I realised  will only give me clear vision beyond about 6 feet.  Fine for TV and cinema but for reading, computer work and even driving (to read the instruments).  I love driving and track days so this was a deal breaker.  The "no more gasses" is not only a pipe dream but actually I'll spend 90 percent of my time wearing glasses.

I don't want monovision (tried it, hated it) or multifocal (halos and problems with Yag if needed later).

Any suggestions?

[Chasman]

Better late than never... I went to one (private) clinic which recommended a toric lens and said I was unsuitable for Tetraflex because of my astigmatism.  The guy seemed really annoyed that I was trying to suggest a preferred IOL and that he was having to explain why I couldn't have it.  

Because of the stroppy vibe (after a brief email exchange he basically told me to get a second opinion)  I went to Optical Express. Their scans showed most of the astigmatism was being caused by distortion because of the cataracts in my lenses, not the shape of my eyes and Tetraflex was indeed an option.

It was a bit of a bun fight to get it bilaterally but in the end that's what I got, over 4 years ago now.

No halos, no glare, no neuroadaptation issues. UV protection as standard. I can read the tiny writing on food packets at arms length under a strong light in our kitchen, kindle Paperwhite at 8-10" no problem, at 4" in bed needs a +1 reader.  Distance vision is absolutely superb in all conditions. 3D movies, no issues at all.  

The only problem with night driving is that my eyes let in so much light now that modern Xenon headlights are very dazzling but there are no noticeable artefacts from the implants.  I am absolutely delighted.

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

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[JodieJ]

Given your high astigmatism, you sound like a good candidate for Alcon's toric IOL.  I believe it comes in an aspheric version.  With both eyes at plano, everything within arm's length (not 6 feet) will be blurry without glasses.  A good alternative would be mini-monovision--leaving your non-dominant eye just a little nearsighted.  This should not be difficult to adjust to, and it will give you a wider range of vision.  (You'd still need glasses for most reading but your intermediate vision would be improved.)

You might want to get another opinion from a surgeon who is very experienced with the Crystalens.  Since this lens does not correct astigmatism, you would need to do something (LASIK?) to address your astigmatism.