pros/cons monofocal set for intermediate vs. plano

Hi everyone,
I am a 25 year old dental student with a left eye cataract.  My right eye is healthy and is -4.0 and my left eye is -2.0 with about -1.25 astigmatism.  I went to see an opthalmologist today for a consultation, and basically the two options that we discussed for my treatment are 1) Crystalens HD set to around -.75 with either glasses or laser surgery to correct the astigmatism in that eye or 2) monofocal IOL set for plano or intermediate distance -1.25 with either glasses or laser surgery to correct the astigmatism.  In both cases, my right eye would wear a contact lens and get LASIK in the future.  He seemed to be leaning towards the Crystalens rather than the monofocal, as he said it would give me accommodation. However, I am to expect that it will not give me accommodation for the rest of my life, rather, sooner or later (he said anywhere between 1-15 years) my capsules will shrink and I will essentially have a monofocal lens.  This is due to my young age and more vigorous healing response.  
I am leaning towards the monofocal solution, as I have read quite a few posts on the forums here, and most forum docs tend to recommend the monofocal solution, and sooner or later I can expect my Crystalens to become a monofocal lens anyway.

So finally to my question to the community.  What are the benefits to setting the monofocal to plano vs. -1.25?  I am a  dental student and my vision between 10-20inches is vital.  I understand that with monofocals, I will need reading glasses to see up close regardless if it is plano or intermediate distance.  Are multifocal contact lenses a possibility?   I will be getting loupes as soon as I get my cataract surgery done.  Any information would be helpful, and I will bring them up at my next appointment with my surgeon in January.

Thank you and happy holiday season!

HH

[Ray T Oyakawa, MD]

You can do your own research regarding your options.  I would recommend Crystalens set at plano in your cataract eye and a LASIK in the other eye.  The -1.25 astigmatism is meaningless.  Part of this is due to your cataract.  LRIs can easily correct 2 diopters of astigmatism in most patients and someone skilled in LRIs can correct almost 4 diopters. My youngest patient with a Crystalens was about 33 and had diabetes and did well.  He had 4 diopters of corneal astigmatism which I corrected with LRIs.  One of my patients is a former American Dental Association president and functions well with monovision contact lenses.

Dr. O.

[hh04]

Thank you Dr. O for your insight and recommendation!  As for your Crystalens recommendation, should I be concerned about the decline in my accommodation ability with that lens over time?  I would hate to pay for the premium lens and end up with essentially a monofocal lens a couple of years down the road, and have to readjust to the new conditions.  The former ADA president that you mentioned, did he also have cataract surgery and Crystalens implanted, or did he just wear monovision contact lenses for a separate issue?  Thank you for your help!
HH