Under 30, hard to please, and in a very rough situation, Please help.

[Anomalychick]

    I am 29 and was diagnosed with cataracts in both eyes affecting my vision when I was 25. I have never needed glasses. I have no family history, no eye trauma, health issues, or even risk factors. When I discovered that my chances of having vision half as good as a normal person my age after surgery were nonexistent, I decided to wait as long as possible. My doctor told me there was no risk in waiting. Unfortunately, they didn't clarify. I currently can see hand motion only in my left eye, I have a completely mature cataract, not hypermature, but still something rarely seen in this country. In my right, I can see 20/100 at distance, and maybe 20/40 or 20/50 at near, I can still read, but its difficult.  I found out about the higher risk of complications in mature cataracts only 3 weeks ago, and let me tell you, I am thrilled someone finally informed me! It would have been great if my doctor believed me 4 years ago when I told him I’d rather walk around completely blind for 10 years than have cataract surgery if it meant there was a chance I might get 100% of my vision back afterwards, but I guess he thought I was bluffing. The prospect of being completely blind temporarily was a lot less terrifying to me than having this surgery, and being what someone my age would consider to be extremely visually impaired for the rest of my life. I realize that if my capsular bag should tear, I will be limited to three piece IOLs only, so I know I need a back up plan should that happen. In the event  that the surgery goes beautifully, I still need to make a decision right now on what I think I can live with based on my current options.
     I wish to avoid multifocals. Studies show that eyes implanted with Restore read at around 70WPM, whereas eyes implanted with a monofocal read closer to 160WPM. Seeing as how I plan on going to medical school when this is over, I’d never be able to finish if I could only read all those textbooks at less than half the speed of everyone else. I understand that newer options such as the tecnis multifocal should be better, but I cannot risk handicapping myself in such an important area.  
     If I chose monofocals set for distance, I’d be very happy, for about 20 minutes until I got a text message and realized I couldn’t see my phone. I would then proceed to go completely beserk. I recently got engaged, and I keep having these recurring nightmares about looking down at hand to see my engagement ring and I can’t find it because it’s too blurry. And when I keep looking, I get nauseous and then I wake up because I need to vomit.
       I’d set both eyes for close up, but I hear then I wouldn’t be able to see well enough to walk around without my glasses so I’d need to wear them all the time, which means I’d basically have both eyes set for distance anyway! I did consider having my eyes focused for intermediate, but the only information on that on this forum is from someone whose eye doctor told them that they would only do that if someone was in a wheelchair! (Because they’d only be able to see clearly stuff that was 3-5 feet from them.)
     My doctors tell me how great minimonovision is, and I’d have done it already, except for one small problem. I am extremely visually impaired by anyones standards right now, and the worst thing about being nearly blind, isn’t what I thought it would be. It’s not being unable to drive, it’s not the fact that I can’t find things around my house anymore, or read recipes, or labels. It’s not that I can’t read more than a few sentences without becoming extremely nauseous. It’s not even that I can’t leave the house at night without holding someones hand at all times or I’ll trip. It’s the lack of depth perception. It’s pouring hot water all over my hand because I can’t line the tea cup up with the spout.It’s because I can’t watch 3D movies or do magic eye anymore. Now, I realize these things are extreme, but things being blurrier out of my left eye has been driving me absolutely bonkers since my right eye was 20/35 and my left eye was 20/50 four years ago. That difference is a lot less than what I would have with the most conservative monovision and it drove me insane.
      I think crystalens might be alright. based on reviews I think needing reading glasses for small print, or for extended reading is acceptable. I think that would be fine, even if Crystalens means colors might be a little bit off, or my vision at any distance probably wouldn’t be quite as sharp as it would be with a monofocal or I might catch reflections off the edge of the lens sometimes. I’m okay with those drawbacks. However, when I did enough research I found out that if it was implanted in the eye of someone my age, even if everything went perfectly, it wouldn’t accommodate for more than a few years. I would have an aggressive healing response leading to extensive fibrosis of my capsular bag, which would eventually stop the lens from accommodating for the little bit that it can. So I’d be happy for a year, and then I’d have worse than I would have gotten with a monofocal.
     I put the above preamble in because I don’t want anyone to have to waste any more of their time telling me to do what I already know I don’t want. I know what I do want, and I don’t think my requirements are unreasonable. I know of two ways to get there, but I can’t get enough information on them to make an educated decision. I am considering going overseas to get the Synchrony VU, or finding a good surgeon here who does the Nanoflex IOL. Unfortunately, infromation on these options is scarce, and the harder I look for answers the more confused I get. See my other posts for more info. I either need some straight answers to my questions, or I need another solution that will help me meet my visual needs. I want 20/50 vision at close up, (I am not sure if that’s J5 or J6) and 20/50 at distance. That’s enough for me to read a few paragraphs without eyestrain, and enough to be allowed to drive in my state. I will gladly wear reading glasses for extended reading, and I will gladly wear glasses for driving at night or downhill skiing. I will accept MILD glare or halos since I’ve lived with cataracts for so long, I don’t think I’d notice. However, I will NOT accept anything at any distance being noticeably “blurry” or a difference between what my two eyes see that I can easily notice.  I only need to be able to see well enough to FUNCTION without my glasses, as that is what I can do now and I think it’s really messed up if a woman who is considered BLIND by everyone she knows (and has her job through accomodations provided by division of blind services) will be LESS FUNCTIONAL after she has surgery to FIX her vision if she won’t wear glasses.
       We can put men on the moon, we can transplant entire organs and restore the sight of people who have been completely blind since birth, build cities under the ocean, but we can’t make someone who develops the MOST common eye problem in the entire world functional without three pairs of glasses afterwards? That notion is insane. Now, if anyone can assure me that the options listed above are not nearly as bad as my understanding of them makes them sound, or if anyone hs any options I have not considered, your help would be forever appreciated. I have made a large sacrifice (4 years of semi blindness) to try to get the best possible vision for the rest of my life. Due to bad medical advice, I may very well end up in a worse situation than I would have had I done something when I was diagnosed. I need to know what is the best i can do, anywhere in the world at any cost NOW. Thanks. I do nothing but have panic attacks and not sleep now, which really isn't helping my predicament.  

[Ray T Oyakawa, MD]

He was actually 34 and had the surgeries in 2006. I last saw him two years ago when he started diaylsis and was seeing 20/25 in each eye uncorrected with good near va (J2) and did not use glasses.  He had had bilateral yags.

The lens continues to accommodate even with some capsular fibrosis.  We do not know the exact mechanism of action.  I have one in one of my eyes and my opinion it will give a better quality of vision than a multifocal IOL and more accommodation than a monofocal IOL.  

Dr. O.

[Anomalychick]

Dr. Oyakawa,

      I appreciate your prompt response and thank you for the information. In my post I did mention that my research indicates that because of the way the haptics of crystalens are placed into the capsular bag, the movement of the lens causes scar tissue to form. Younger people usually have a more aggressive immune system response, so capsular fibrosis forms quicker. I have heard that after a year or two, crystlens would no longer accomodate if it were implanted inside my eye, and due to the drawbacks associated with it, I would be in a worse place than if I had used monofocals to begin with. How long ago did you implant your 33 year old patient? Can he still accomodate? Has he required YAG capsulototy? I am slso trying to avoid having my eyes focused differently, so I would love to hear if i ahve any other options. Thanks.  

[Ray T Oyakawa, MD]

I would recommend Crystalens with mini monovision.  33 was the youngest patient I implanted with bilateral Crystalens.  He had almost 4 diopters of astigmatism and diabetic retinopathy and he did well.  You need to find an experienced Crystalens surgeon.  You should be able to find one in your area or in Miami.

Dr. O.