lasik or prk after cataract/crystalens

I’m 41yo & had cataract surgery 1/09 w/crystalens implants. Had YAG on both eyes in 4/10. Have had horrible issues with glare/halos/ghosting. Had YAG again on left eye in 8/10. Eyes have progressed for the worse over the last yr. Now have 20/40 distance in rt eye (dominant) & 20/70 in left eye, good intermediate & okay close up, wear distance glasses. Use Alphagan P @ nt for driving which helps a lot w/glare. I’ve not been pleased with Crystalens results at all & have been extremely frustrated & discouraged. So now I’m looking @ having Lasik done. Surgeon recommends doing right eye for distance for monovision. I tried w/contacts & it was ok so I’m doing that w/the thought that I can have the other eye done @ at later date if I want. I’d like good vision at all distances but have come to accept that’s not going to happen. So now I’m trying to decide between PRK & Lasik. I’m a candidate for both. The surgeon & I have gotten to know each other very well as we’ve see each other quite frequently . When I asked what he would do he said if it was him he would do PRK. I asked given my history what he would recommend for me. He said Lasik because of everything I’ve been thru & he wants me to be done with all of it & be happy w/quick results. I think he knows we’re both frustrated because the results haven’t been great, but he’ll do whatever I want. Are there any benefits/detriments to having PRK vs Lasik after Crystalens? Is one better than the other for post-cataract surgery…dry eyes, infection, pain, long term results, glare/ghosting worse, recovery?
thanks!
Jen

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

1. You should be certain that with glasses each eye sees 20/20. If not you need to get a second opinion on why it doesn't. If you don't see 20/20 with glasses neither lasik or PRK will make you vision 20/20.
2. No matter what is done glasses are in your future for some or most things and no line bifocals at that. Be sure you want to invest the time and money chasing glasses independence.
3. I would get a second opinion no matter what you plan to do.

JCH MD

[momx2girls]

I'm a little confused by your response.  I have had a 2nd and 3rd opinion since my  cataract surgery because of the disappointing results from the crystalens. Both other opinions felt that lasik would be the next option to try to improve my vision. The lasik/prk cost was included with my crystalens fee, so there is no charge to me.  The goal is to get 20/20 vision with lasik in my right/dominant eye and then leave the left eye as it is (20/70 distance), then I would have the monovision.  We have been able to get a 20/20 result with glasses.  My prescription kept changing, but at this point it has stabilized for 5 months.  The 3rd opinion said he felt the next step he would take would be to do lasik. The whole experience has been frustrating & discouraging. I just want to get the best results I can for my eyes.  All of the surgeons I have gone to for my surgery, the 2nd & 3rd opinion are very well known & reputable drs.  

I understand I will need glasses for some things, but it sounds like you think I'll need them most of the time?  And why do you say bifocals?

And I'm back to the original question of lasik vs prk?

thanks.

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

Lasik vs PRK depends on how thick your corneas are and how much tissue needs to be ablated to readjust your present refractive error. For large amounts and think cornea the PRK works better. If your in the ball park for both I would go with what your surgeon feels most comfortable doing.

Since I don't know what your present refractive error in each eye is and what your visual demands for work and recreation are I can't predict how much you'll need glasses.

Progressive bifocals allow the eyes to be balanced for seeing at all distances from reading to looking at the moon.

Good luck

JCH MD