Will YAG Capsulotomy After Crystalens Help?

I am still optimistic that I will be one of the very happy Crystalens patients, but . . .

I had a terrible, very large, dense PSC cataract replaced with a Crystalens HD six weeks ago.  I am 51.  The other eye is 20/15 distance but needs readers.  In the Crystalens eye, I test 20/15 distance, 20/15 intermediate, and 20/40 near (I can get to 20/25 in the right light).  My refraction is plano.  Yet, I am pretty sure that I noticed immediately that with the natural eye closed, my vision in the the Crystalens eye was a little blurry, more so at greater distance.  I am also pretty sure that it has gotten worse.  At night with the natural eye closed, my vision in the Crystalens eye is pretty awful: quite blurry with significant dysphotopsias.  They look like a cross between halos and starbursts with a few, thick, irregular bars forming semi-rings around light sources, and also some rainbow patches.  During the day with the natural eye closed, the blurriness is just enough to bother me though it is minor.  Binocularly, my vision is perfect at almost all distances day and night (although the dysphotopsias can spill into my binocular vision a little at night and I can see the edge of my lens).

My doctor told me that I should have a YAG Capsulotomy after 3 months both for posterior capsular opacification and for staining left over from my PSC cataract.  Another doctor who examined me had also predicted that I'd need the YAG at 90 days for the same reasons.  Yet I can't seem to find anything on the internet about staining from a PSC cataract or about posterior capsular opacification developing to a significant level in less than six weeks.  The doctor told me that I needed the YAG at my 1 month checkup.

Do you think that the YAG will resolve the blurriness in the Crystalens eye?

[mmmmpppp]

P.S.  Would you worry about the YAG scuffing or moving the Crystalens or having any negative effect on my vision?

[OldNavy966]

I'm kinda in the same boat as you.  Stay positve.  I will post on my appointment this thursday.  Yag or explant?  See, our choices have narrowed from Restor, Rezoom, Crystalens, or Monofocal to Yag, explant or live with it.  We are on the right track :)  I just wish the doctors kept a data base on this stufff.  I mean besides in the bank...

[OldNavy966]

by the way, my doc also mentioned the 90 day mark for the yag.  Let's see what happens on thursday..

[ace399]

My Dr. observed clouding of the capsule in my left eye immediately after surgery.  The reason they wait for 90 days is so your insurance will cover it.  If it is really bothering you, you should push to get it done now.  I did that and my Dr. and the surgery center did it at no charge.

YAG capsulotomy really does clear things up, if it is indicated.  Hopefully it will work for you.

[mmmmpppp]

Thanks guys.  I probably wouldn't have it explanted for a number of reasons.  The main one being that with both eyes open, my vision is beyond my expectations and I am very happy with it.  I'd be afraid to risk that.

Unfortunately, I am uninsured; so I think my doctor is just being cautious with the 90 days.  He is a wonderful doctor and I even sent my mom to him, but his only blemish is that the day after surgery, I asked about left-over staining and he said that it "surprised him by all coming out easily"; yet at day 30, he said that he saw staining in surgery that he thought he'd have to get with a YAG.  That, the fact that I don't really see "clouding" per se, that it seems quick for opacification, and the MedHelp thread on Crystalens where several people say thay have blurry distance vision all have me wondering.  .  

The main reason for my question is that I will only know whether I have a real problem after the YAG capsulotomy---a procedure that makes explantation much more difficult.

Plus I don't know how much to fear the YAG in regard to scuffing, dislocation, or jeopardizing my great measurements and binocular vision.

[Ray T Oyakawa, MD]

You have a very good result and the YAG will most likely help.

Dr. O.

[mmmmpppp]

Thank you so much, Dr. Oyakawa!

I learn so much from you on MedHelp.  Thanks for that too!

[Suzyq6986]

One thing they fail to tell you is you can be left with floaters and flashes as I am esperiencing after Yag surgery 2 months ago and there is nothing that can be done for  them except surgery and a retina specialist want do it.

[mmmmpppp]

That's not good!  I'm sorry to hear what you are experiencing.

My doctor told me that 5-10% get floaters but that they go away, I think he said after several weeks, for all but 1%.

I was born with floaters in both eyes.  In fact, I didn't know that everyone doesn't have them until this year when I was researching my cataract.  I am worried about extra floaters on top of what I already have.  I read another post in which it sounded like the doctor cut away one big circular piece from the capsule, which became one big circular floater that the patient was very affected by.

Thanks for the heads-up!

[JodieJ]

I think you should do the YAG.  I'll bet that your night vision will improve.  I had noticeable PCO within a few weeks of surgery with a monofocal IOL.  The YAG really did make my vision brighter and crisper.  I did get a few floaters, but they completely disappeared within a day or two.

[mmmmpppp]

Great to hear!  Thanks!

[OldNavy966]

Jodie,
Do you think I could have developed or had PCO imediatley after surgery?  My distance vision as well as night vision are very poor.  So is my near but I kinda expected that.

[JodieJ]

I'd expect that PCO would affect your vision at all distances, especially at night.  Maybe PCO is an issue for you, too, and you might also be slightly nearsighted.  Dr. Oyakawa is an expert about the Crystalens, and you could try posting your question to his attention tomorrow.  (What does your surgeon say?)

[OldNavy966]

Went to see my surgeon a few days ago.  He seemed to dismiss every concern I had very easily and told me "you will always have problems with this lens because your pupil is too large".  Now he acknowledges that fact?  Didn't I ask him this question before the surgery?  No PCO yet.  I am using pilocarpine 4 or 5 times a day but only really helps during night driving.  We all want to make money but are there no limits?  At least now he will be able to buy his children shoes...

[JodieJ]

I hope you expressed your dissatisfaction to your surgeon.  I'd be interested in how he responded to your questions (above).  If your insurance permits, you might consider following up with someone else.  There are various online websites for rating doctors, and your detailed comments might be appreciated by other prospective patients.

[mmmmpppp]

What does the pilocarpine do for you?  What does the doctor believe that you are supposed to do longer term?

I remember you asking questions on MedHelp about pupil size before you had surgery.  If your doctor is now, in effect, saying that you were ill-suited to Crystalens in respect of something you specifically asked about, then a) that is reprehensible, and b) I hate to even mention these words, but maybe you do need to have it explanted.

What exactly are you experiencing?  I gather part of it is the edge of your lens, but I don't understand how it can be in the middle of your vision.

[OldNavy966]

The pilocarpine restricts my pupil size.  It seems my pupil is too large in all but direct sunlight.  Pilocarpine is the long term plan.
I experience all the common edge effects such as double vision or ghosting to my periphery, shimmering, and the usual dim light problems.
In addition, I get arcs in the shape of a cresent in the center of my vision as if the light is hitting the edge of the lens and is being reflected to the center of the lens.  This occurs in normal room lighting thus the need for the pilocarpine.  LIke I mentioned in my previous post, this only really helps in night driving but does give me some relief during the day.

[mmmmpppp]

I'm very sorry to hear all of this.  Truly.

Thanks for sharing it and probably saving others.

[OldNavy966]

Thanks.  I now find myself in a position I didn't want to be in.
Anti Crystalens crusader.  IF YOU HAVE LARGE PUPILS, DO NOT GET THE CRYSTALENS!  If you feel you have large pupils, ask your doctor how large your pupils are.  If he/she doesn't bother to mearure them, time to find another opthamologist in my opinion.  Don't believe the posterior vs. anterior position of the Crystalens propaganda.  There really is a strong push for "premium" lenses in the eye care community.  Some large practices barley break even with the implantation of a standard iol.  Their bread and butter are "premium" lenses.