Choice of IOL

[menaches]

I'm a 32-year-old male and was recently diagnosed with cataracts, particularly dense in my dominant right-eye. I have been near-sighted since grade-school, with approx -7.0 prescriptions in both eyes. No other eye problems exist (retinas were recently checked; no astigmatism). It is clearly time to look into cataract surgery and I'm faced with the inevitable question of which type of IOL to choose. I'm currently leaning towards the Crystalens, but as I've read more, it sounds like the results with Crystalens tend to be hit-or-miss, and that a 'miss' can cause huge life-long discomfort.
I have read many of the posts on this web site about this topic (and don't want an unnecessary repeat of the topic), however, several generations of new Restor and Crystalens have been brought to market since many of the posts were written, and I wanted to know if any opinions have changed with the introduction of these (possibly) improved choices. Further, my particular circumstances may also change what people would recommend, including:
a) I'm a financial analyst by profession, and computer-distance vision is extremely important for my work
b) Since I'm young, I want to be sure that what I impant into my eye is capabale of lasting for the rest of my life (and won't wear out, or put undue strain on my eye muscles).
c) While I have always worn glasses, I am used to having near-vision (reading) without any glasses, and I am not used to progressive lenses. My impression is that monofocal IOLs, while seemingly the most 'reliable' in temrs of surgical outcome (clarity of distance vision, no-glare, etc.), would do away with my near-vision, and likely need progressives for reading/computer work/etc., which would be a big step from what I'm used to. (Perhaps this would be less of a leap for someone older who's natural lens has already lost some ability to focus by itself.)
d) From what I've read, night-glare with the multi-focal IOLs (e.g., Restor) are a virtual certainty. As I do a decent amount of night-driving, I am afraid that such glare would bother me tremendously. I have also read that computer-distance would be in the weak spot of this IOL.
e) The accomodating IOLs (Crystalens) in theory are hyped up to be just what I need at my age - the ability to clearly see at all ranges (once the eye muscles figure out how to actually focus the thing), with no glare. As I have been reading, though, this IOL is not necessarily the wonder that it's hyped up to be. However, many of those posts preceeded the release of the 5.0, HD, and AO versions of the Crystalens. Perhaps these later generation lenses are better?
f) If I'm going through the trouble/expense of having the surgery, and it can cure me of needing any glasses, obviously that would be ideal. But I'm not willing to roll the dice on my vision just for the sake of possibly losing the glasses. My greatest fear (and I'm sure that of many people) is to wake up the next morning and have new, man-made vision problems from a poor choice of lenses.
Based on these factors, is the choice for me to either roll the dice with the Crystalens and hope for the best (which in some cases I understand is very good), or go for monofocals but need progressive glasses? Or is there something else that you and the forum members would recommend?
Separately, I was wondering if you had a referral to an opthamologist in the New York City area who has deep experience with Crystalens? Most doctors that I've looked into can implant the lens, but they do it on only a small fraction of their patients. I would imagine I need someone with special experice with the lens if I'm going to opt fot the Crytalens.
Thank you in advance for your advice/comments.

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

I have been myopic most of my life. I have always read by removing my glasses. My near vision is more important to me than my distance vision. Not everyone feels this way. Thus I would want to be able to read and use my computer without glasses. Thus my choice. With this configuration anything further than 4 feet or so would become progressively more blurred.  

Again this is my choice, not right for everyone.

JCH MD

[menaches]

Thank you, Dr. Hagan for your thoughts.

I had seen on the blog one of your posts from several years ago (copied below). Is the type of configuration described (e.g., targets of -1.00 and -2.50) something that could be a useful possibility in my case? If such a configuration was used, for what distances would glasses be required after the surgery?

Thanks for your respnse and for all the useful information that you post to this blog.

Copied text:
If it were me. I would chose a monofocal aspheric IOL and set my dominant right eye at about -1.00 and my non-dominate left eye at -2.50  I would then expect to be able to read and use my computer nicely without glasses. With no line bifocals (the prescription would be RE -1.00  LE -2.50 and +3.00 Add) I would expect to have great night vision and excellent vision and depth perception to do surgery with.

If I wanted to emphasize my distance vision then I would ask the surgeon to shoot for -0.50 for distance and -1.50 for intermediate and wear glasses to read.

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

The multifocal/accommodating IOLs are improving. I will bottom line this:
1. It's your choice, no one can make the deicsion for you.
2. All surgery carries risk. The ReStor/Crystalens have more risk, more expense, no chance of needing to be removed, more chance of night vision problems and you will still likely need glasses for some things.
3. Some people have these "premium" lens and are happy. Some aren't so happy.
4. If it were me and I was your age I would chose aspheric single focus IOL.

I do not know any crystalens experts in NYC.
JCH MD