Crystalens vs Intermediate or distance IOL

[UncertainKatie]

I am 50 years old and have 2+ cataracts in both eyes and need surgery. I am very picky about the clarity of my vision and I do not mind wearing glasses. I do not want to do the multifocal lens implants (like RESTORE) because I have read that they sometimes do not perform in low light conditions and can have halos. My surgeon says I am a candidate for either the crystalens (accommodating) or a single focus IOL. I have read on earlier postings that there is an increased risk of opacification of the posterior capsule with the crystalens and that placement of the crystalens is trickier than with single focus IOLs. Is this true? If I go with a single focus IOL I was thinking of having it set for intermediate rather than distance because I do a lot of work on the computer and I sew, etc. However, I am active (ski, bike.) My surgeon has said he has only set single focus IOLs at intermediate for wheelchair bound people and that it only gives you clear vision for 3 to 5 feet and he strongly recommends against it. I don't know what to do (my surgery is next week.) Should I take the risk with crystalens or go with the single focus IOL and if so, do what he recommends, i.e. distance? Thanks for any insight you can offer!

[Sandy Feldman, MD, MS]

Dear UncertainKatie,

The advantage of the crystalens is that it enables you to see at more than one distance.  No lens is perfect; however, since you have cataracts the surgery is likely to be considered successful by you as your vision will improve.  Another possible option is to use the crystalens with a little monovision to give you the better reading as well as computer.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[JodieJ]

There was a woman who posted recently who was thrilled with mini-monovision (intermediate/near).  She only needed glasses for driving, movies, and a few other distance-vision activities.  On the other hand, distance/intermediate vision would definitely be better for skiing and biking.  I think you'd do fine with either version of mini-monovision.

Dr. Hagan answers questions on the other eye care forum.  (There are 2 different forums.  See the link on the right side of your monitor.)

[UncertainKatie]

Thank you for sharing your comment. I have decided not to get the Crystalens but I do wish you all of the best with your readers and hope you don't lose many more!

[UncertainKatie]

Thank you so much. Your comment made me check with the optometrist who prescribed the contacts for me and I learned that it was full monovision (over 2 diopters difference.) I did have trouble tolerating that much difference. I have spoken to a few other people and they have strongly advocated for the mini-monovision and said that it was easily tolerated.

I have also thought about the Crystalens and although I do think my surgeon is skilled enough, it seems like there might be more room for error with that lens (I also heard of increased risk of fibrosis in younger patients.) Therefore, I think because I really hope to live another 30 years and I don't want to be obsessing over whether my IOLs are fibrosing in place, I think I will stick with the tried and true of single focus IOLs (I guess I should be so happy that they do give great optics!) but have them set for mini-monovison.

So now I guess I have to decide whether to have them set for near and intermediate, like you suggest and like Dr, Hagan would want (Dr. Hagan I wish you would comment!!) or for intermediate and distance. That is a tough call. While I think I would feel so comfortable having my near/intermediate vision, there is something appealing about having some distance vison for the first time in my life.

Has anyone done the near/intermediate that you know of? If so, have they been happy?

[caren123]

Regarding crystalens - You may not get good reading vision with Crystalens (one of my eyes has this lens) . I found this very frustrating.  I would by several pairs of readers and a pair of prescription readers.  Too frequently I needed them suddenly to see price tags, directions on packages, etc.,. but couldn't find them.   I had put them away or down somewhere and forgot where.  For the first time in my life, I have a magnifying glass and flashlight handy to use for some things.  I t must be that as time goes by, the printing on most products has gotten smaller and smaller.  I lost so many pairs of readers that I now wear them all the time, at the end of my nose, and look over them when I am driving the car. You say that you wouldn't mind weaing glasses for distance even with your interests in skiing and tennis.  I think that comment is important to convey to your surgeon.  Many of them assume that everybody wants great distance vision.

[JodieJ]

Most people who are used to being nearsighted are not happy having both eyes set for distance.  They miss having good near vision.  With this vision, you might wind up wearing progressive glasses most of the time to perform near and intermediate tasks (including cooking, grooming, reading tags in the store, using the computer, etc.)

If you tried monovision with contacts, that must have been full monovision (dominant eye for distance, non-dominant eye for near vision.)  About 75% of the people who try it can adapt to full monovision.  It's my impression that just about everyone can adapt to MINI-monovision (distance vision in dominant eye/intermediate in non-dominant), and I believe that the effect on depth perception would be minimal (probably not noticeable).  This option would significant reduce your dependency on glasses.  Maybe one of the forum docs can comment more about mini-monovision.

Frankly, intermediate vision in both eyes doesn't seem like a great option to me.  What about mini-monovision with a near bias (intermediate vision in dominant eye; near vision in non-dominant)?  This would give you good intermediate AND reading vision, and you'd only need glasses for distance.  Dr. Hagan, who answers questions on the Community Eye Care forum, has stated that this is the setting that he would choose for himself.  Again, I believe that just about everyone adjusts easily to mini-monovision.

The Crystalens is another option to consider, but getting good results generally requires a surgeon who is experienced with this IOL.  If your surgeon is not listed on the Crystalens website, he might not be a great choice for implanting the Crystalens.  In addition, some younger (i.e., under age 60) patients have large pupils, which might not make them a good Crystalens candidate.  

[UncertainKatie]

Thanks so much for your comment. Here is a little more info: my surgeon did suggest mini-monovision but said I might lose some depth perception. I do ski and play tennis so I am worried about the loss of depth perception affecting those activities. I am also worried that I might not adapt because I briefly tried mini-monovision with contacts a while ago but felt a little nauseous and headachey although I must admit I didn't really push myself to see if I could adapt to it. But I am scared to do it surgically because then I am really committed.

I had actually asked my surgeon to do both eyes for intermediate vision but he strongly suggested not to do that -- that I wouldn't be happy. I had wanted intermediate because I do do a lot of computer work and I don't mind wearing glasses for distance. Like you suggest, I AM VERY worried about not seeing near because I have been tremendously near-sighted my whole life. I don't know what the experience would be to not have everything fuzzy within arms length; meanwhile, I don;t mind things fuzzy at a distance. So that is why I thought the crystalens would be fine because at least it would give me intermediate and distance and I would have to wear reading glasses for near. However, I am worried about the long-term wear of the crystalens i.e. does the fact that it moves inside the capsule contribute to any increased risk of fibrosis or being dislodged?

In sum, I am trying to decide between the crystalens (but am worried about long-term wear) the mini-monovision (but am worried that I might not be able to adapt) intermediate in both (which I had earlier decided to do but am not told I should not do it) and distance in both (but am worried that I will feel like I am living in a fog with the clearing area just beyond my reach.) Finally, my priorities are the clearest vison possible and I don't mind wearing glasses.

Any thoughts? Has anyone you know gotten both intermediate and been happy?

[JodieJ]

I'd suggest mini-monovision--distance vision in dominant eye, intermediate in non-dominant eye.  With a little luck, you'd only need glasses for seeing small print.

I don't know why your surgeon didn't suggest this.  It sounds like he gives all his monofocal patients (except those in wheelchairs) distance vision in both eyes.  If you are used to being nearsighted (or spend a lot of time on the computer), you probably won't be happy with this.  I suggest that you schedule an in-person consultation with your surgeon.  If he strongly recommends against mini-monovision, you might want to consult a different surgeon before proceeding.

Getting good results from the Crystalens generally requires a surgeon who is very experienced with this IOL.  You can get referrals from the Crystalens site.