Crystalens AO diopter shift post-op

[darad]

What is the average diopter shift post-op for Crystalens AO for a 60+ man.  My initial AO implant had -0.75D and -0.50 astigmatism after 2 weeks.  Would 35 days be sufficient to order night-driving glasses to get to 20/20?  or would one expect further shift.   I read Crystalens HD showed average diopter shift of -0.21D three months post-op.

Mid-range vision has been excellent since surgery, and sharp computer screen at 18 inches without trying. Outdoor daytime vision is excellent.  Night vision loses sharpness and definition, with doubling of light sources from residual astigmatism, and worse than other eye which is next in line for cataract surgery.  Now starting eye exercises to bring near vision still closer.

[darad]

Four months after 1st Crystalens, and one month after stopping Pred Forte drops, vision suddenly improved to -0.50D and ~20/30, from prior weak 20/40.  Two months after 2nd Crystalens, and two weeks after reducing Pred Forte drops from 2/day to 1/day, vision decreased from -0.50D and good 20/40 to -1.0 and ~20/60 - 20/80.  

No explanation from the surgeon, but I must have experienced anterior capsular contraction on the 1st IOL, causing a slight hyperoptic shift, and posterior contraction on the 2nd IOL, causing myopic shift.  I found these explanations on the web.

Of course, the surgeon quickly offers Lazik tune-up to fix the weaker eye to 20/20, and oh, by the way, we would first do a YAG laser capsulotomy to the rear capsule surface, to eliminate the refraction shift from a future PCO capsulotomy.

Lazik is offerred as extreme simply and minute to do.  They do thousands a year.  But there are so many pitfalls with Lazik, that no surgeon will inform, e.g. http://lasikcomplications.com/, that can be repaired with further surgery (perhaps).   So I thinks its better to wear corrective lens for the weaker eye when needed.  You agree?  Likewise, surgeons inform little about the downsides of Crystalens when promoting.  e.g. with Crystalens capsular contraction can cause the vision refraction to shift myopic or hyperoptic, that one cannot forecast, and if a PCO capsulatomy is needed later, the lens can shift again ... and many more.  If they did inform, it could require considerable time and counseling at expensive surgeon time.

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

All multifocal and accommodating have higher rates of dysphotopsia and reduced night vision compared to high quality aspheric monofocal IOLs.
JCH MD

[darad]

Thanks for really quick response.  I'm hoping the -0.75D stays, and not increase over next 3 months.  I read that Crystalens is supposed to have good night time vision, yet I distinctly note some degradation in acuity at night.  I'll likely have do with night vision glasses for serious driving.

For others, I should mention that the resultant -0.75D myopia, which allows excellent reading of computer screen at 18" (for my choice of font size), is not the same as reading an average books at 18", which have smaller font, and requires effort.  Reading newspapers at 18" is still more difficult, with smaller font than the average book.  

I find that practicing reading on the computer screen is easier, than with reading books, since I can start exercise movement with readable font and good contrast.  I can see that it will take some time, to get these old eye muscles back to working as its too early to detect any movement.

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

I don't that any study can be specific enough to give you an age specific shift. You sound like you're doing okay.
JCH MD