Yet another Crystalens coming up

First, let me thank the contributors to this forum - especially the medical professionals. It has been very useful in helping me understand and figure out what to do about my eyeballs - keep reading for info/questions!


I'm a 48 year old male who has been in good health all my life. I was near-sighted as a child ending up at about -7 diopters (minimal astigmatism) and fairly stable prescription from ~20 to 40. No major trauma to the eye or Lasik.

Presbyopia showed up (on time! ;-)) in my 40's so I need reading glasses when wearing contacts. I wear disposables a few days/week ... the dry air in Colorado is tough on contacts.

Unfortunately, a Posterior Subcapsular Cataract started interfering with my vision a bit over a year ago, and I'm now ~20-50- best corrected in my right eye ... with very noticeable triple vision/ghosting on point sources of light.

I've seen several MD's that feel strongly about multi-focals, but agree with my primary MD that the Cystalens seems to be "right" for me. I'm concerned about the overall vision compromise with multi-focals (plus halo/glare) and am willing to wear glasses for reading/close-in work. I'm an engineer/photographer so I'll notice visual abberations ... but also realize that no solution will give me perfect 20-10 at Far/Inter/Near!   ;-)

I'm scheduled for surgery on September 12th and hope to have the 2nd eye done a week later.

A very successful outcome for me would be sharp (good contrast with no halos, glare, etc.) 20-20 vision at distance and intermediate to 1/2 meter ... i.e. would be super to get a full 2 diopters of accomodation. I realize that is close to ideal and my MD prefers to say he'll shoot for "20-Functional"


Would love to get some advice/feedback on a few specific questions:
1. The IOL calculcation for the Crystalens AO is 11 diopters - i.e. almost out of their range (10-33) ... should I be concerned that I'm an "edge-case" ... or this is just a natural by-product of high myopia?

2. I've been told/understand that high myope's often have higher amount of accommodation due to the "football'ness" shape of the eye allowing more squeezing of the IOL - is this generally true?

3. I imagine that the time period between eyes is going to be tough due to the 7 diopter difference in vision ... but am I making a "mistake" doing the eyes one week apart?

4. I have just over a diopter of astigmatism so LRI's will be done ... but my impression is that MD's will "eyeball" these cuts and hope the healing process "gets" most of it. What would be a reasonable expectation of the amount of residual astigmatism afterwards?

I've put up a webpage with lots more info (plus eye biometry) here:
      http://www.komar.org/faq/colorado-cataract-surgery-crystalens/

Again, thanks for a great forum and appreciate any comments/suggestions.
alek

[Ray T Oyakawa, MD]

1) No. 2) No. 3) You can use a disposable contact lens for weeks between eyes.   This depends on the results of the first eye.  Google Oyakawa and Youtube.  There are a number of videos on how to determine if astigmatism correction  is need and some videos on LRIs done at the time of cataract surgery.  

Dr. O.

[alekk]

Thanks for the response Dr. O

As mentioned, I have difficulty wearing a contact for 8-10 hours/day a couple of days a week ... and gotta believe that wearing "one-lens" glasses would be pretty uncomfortable with the 7+ diopter offset.

I watched your YouTube videos (lets hope I don't need my Crystalens removed!) and while I see the technique used for LRI's (and understand where the cut is done), I'm curious how you determine the depth and length of cut depending on the amount of astigmatism.

And again, any thoughts on what would be a reasonable expectation for the residual astigmatism?

Thanks,
alek

P.S. And any thoughts/comments on my Cataract writeup at http://www.komar.org/faq/colorado-cataract-surgery-crystalens/

[Barbarella1880]

Hi alekk,

Thanks for your question and info on your webpage. You sure have done your homework! I'm scheduled for cataract surgery on 9/7, with the left eye the following week. I'm  wondering the same things you are. I've been near sighted by whole life and also developed a condition last December called "myopic degeneration." But it's been treated and I've been OK'd for surgery. I also see triple with ghosting through my right eye and hope the surgery takes care of that. I look forward to more constructive responses and hope this goes well for both of us!

Barbarella1880

[alekk]

Figured I'd followup with my experience having cataract surgery in both eyes with Crystalens implanted. Nutshell summary is so far, so good as I'm seeing quite well at distance and starting to see some accommodation - hopefully more will be forthcoming. A LOT more details (with pictures) can be seen at:

http://www.komar.org/faq/colorado-cataract-surgery-crystalens/