Crystalens vs Monofocal Intraocular

[Noccera]

I am 54 yrs old.  I have been very nearsighted since I was about 10.  I started with the "old age" problem of seeing close around 46.  And now, cataracts.  My dr. is recommending Crystalens and is really hyped on them.  She is around my age, states she is more near sighted than me and would definately implant the crystalens if she had to select.

My eye dr. told me that he didn't think I would be happy with Crystalens because I would not be able to see well near or far.

I don't know what to do!  I would LOVE the idea of no glasses since I have worn them all my life.  But, I'm concerned that I won't have good distance vision after the surgery.

My question is.  If you're extremely nearsighted, can a lens be adjusted so that you can see far really well and near really well?  It is my understanding if there is a big difference between the two you wouldn't be able to do that.

The other question is. Would I get better distance vision with the monofocal lens vs the crystalens.

Really need some advice.  Help!!!!

[Michael J Kutryb, MD]

Do your research - just check out the posts on this forum alone to learn about some of the problems that can occur with accommodating (crystalens) and mutifocal (rezoom, restore) implants.  As far as quality of vision - I'm a big believer in aspheric monofocal implants (tecnis, acrysof IQ, LI61AO) used either both for distance or one eye for distance and the other mildly nearsighted.  The patients have to wear reading glasses at least part time and sometimes for all reading but distance can be awesome.  How many posts have you seen on this site about someone unhappy with their aspheric multifocal implant??? None that I know of.  Just FYI, crystalens optic is 5.0mm  vs 6.0mm for aspherics.  Cystalens has no UV filter like aspherics do.  The very nature of the crystalens that makes it able to provide limited accommodation is the very same thing that can make it move unpredicably in the bag in the early post op period causing unpredictable post-op refractive errors.  Ask your doctor which will give you better vision: bilateral crystalens or bilateral aspherics with one eye plano 20/20 at distance and one eye 20/20 at near with monovision or blended vision aspheric.  Which is a better value, the crystalens procedure which willl cost you about $5000 out of pocket or the aspheric lens procedure which will cost your nothing.

MJK MD

[cook456]

A related discussion, toric vs monofocal was started.

[JodieJ]

I'm afraid that you're just seeing the tip of the iceberg.  I work in a health-related field, and I'm regularly treated to lavish catered lunches by the drug companies.  I'm also frequently invited to dinners at the best restaurants in town (I've never gone), where the only price is the need to listen to a speaker from the drug company.  And I can't even legally prescribe drugs in my state!!!  (The M.D.'s get better perks!)Obviously, corporate interests play an important role in our health care industry.

I suspect that a lot of people are pleased with their vision with multifocal/accommodating lenses because they're used to impaired vision with cataracts.  Little do they know that their vision would be crisper with aspheric monofocal lenses.  And they'd probably have a broader range of focus if the monofocals were set for "blended vision."

There is little in the way of independent research done in the area of cataract surgery/IOL  Most of the studies are sponsored by the manufacturers and are far from unbiased, IMO.

[Eye-Kant-C]

I would never recommend Crystalens IOL's to anyone. They are very clear, but they definitely don't deliver on the "accommodation" hype that the salespeople pitch to the doctors. I'm sure many doctors really believe in them, because so many patients post-cataract are thrilled with how clear their vision is. But they don't focus "near, far & everything in between" at all. Probably not for anyone, as I found out the hard way!!!

Besides the fact that the Eyeonics people give the doctors (and other staffers) really good incentives to use their lenses, which I don't think is very ethical. "Enough about the lenses. Doctor, what can Eyeonics do for you ... I mean personally?" is what I overheard during a conversation between a rep & one of the eye surgeons at the office I go to!!!

[Michael J Kutryb, MD]

If you currently wear +3.00 reading glasses and you have acrysof IQ lens placed for distance correction, then you will most likely still need to wear reading glasses in the +2.25 to +2.75 range.  HOWEVER - this is not exact science - your eye is a living organ and all our measurments are just our best estimate of what implant should give you the best visual acuity.  You could still need glasses not only for reading but also for distance.  Rember that.  Astigmatism, in particular could cause you to still need distance glasses.  If you have significant astigmatism, your surgeon would need to talk to you about possible reducing it surgically or with a toric IOL - if you really, really have your hear set on going without distance glasses.

MJK MD

[tessy252]

I am diagnosed with ripe cataract on my right eye. I  wear  reading glasses  at  grade of 300 now.  i have the impression that  if  i  undergo iol with any  lens, which mine will be acrysoft IQ lens(monofocal) for treatment, my vision will return to a 20/20 range, both eyes. so, please  confirm this - will  i  still need reading glasses after the iol of monofocal acrysoft IQ? Or do I have to advise my opthal which is my preference -- a reading glass or glass for far distance ?

[Michael J Kutryb, MD]

Blended means a little different refractive result in the two eye - for example one eye 20/20 at distance and other eye just a little bit blurred in distance but able to read a little up close.  Monofocal implants can only focus at one focus length - but if you use a different power in each eye - then with the two eyes together you can achieve some decent distance vision and some near vision as well.  These are all imperfect solutions - but we have not yet been able to match God's design of young accomodating eyes with excellent distance and near vision.

MJK MD

[Noccera]

Thank you all for your information.  It's certainly becoming very obvious that the monofocals are the way to go over multifocals.  

When you use the term blended does that mean using one eye for distance and the other for near ? And monofocal means the same.  Sorry, just want to be clear on these terms.  No pun intended.  

[Michael J Kutryb, MD]

I meant aspheric monofocal implant.  My best advice to you is to go with either both eyes for distance with aspheric monofocal IOL's or do blended vision or monovision with bilateral aspheric monofocal IOL's.  You can easily do it- regardless of what your current prescription is.  One note - don't do blended or monofocal vision unless you have tried it with contact lenses in the past so you know exactly what you are getting into.  If it were my eyes, I would go bilateral monfocal aspheric IOL with dominant eye as close to 20/20 distance and non-dominant eye around -0.75 to -1.00 myopia with the understanding that I would need reading glasses for reading books but might be able to read price tags or light magazine reading without glasses with good lighting.  The optics of aspheric monofocal IOL's are really great.  Tecnis, Sofport AO and Acrysof IQ are all great lenses and you can't go wrong with any of them.  People get fooled and think that just because they pay more for a multifocal or accommodating lens that they are better.  Just different - very different.  
MJK MD

[JodieJ]

There are three aspheric monofocal IOLs on the market, but AMO's Tecnis has the best website.  Check out the patient information video at www.tecnisiol.com for more information about aspheric monofocal lenses.  BTW, I have aspheric monofocal lenses in both eyes (mine are by Alcon), and I'm very pleased with them.  My pre-surgery Rx was slightly more myopic than yours, and my post-surgery vision is at least as good as my best-corrected vision was before I developed a cataract in one eye due to retinal surgery.  (My other eye didn't have a cataract, so I had high standards for my vision.)  I predict that you'll be pleased with your outcome.

[Noccera]

Thank you very much for your response.  Very informative.  I do want to clarify something.  In your response you state, "How many posts are on this site unhappy with their aspheric multifocal".  Did you mean monofocal??  

You also suggest bilateral aspherics with one eye at 20/20 for distance and one eye 20/20 at near with monovision or blended aspheric.

Is that possible to do with a  my prescription of Right  -600 with -1/4 cyl, 75 axis and Left -575. The bifocals are 250.  Or would it make me a little cross eyed feeling?  

Does "aspherics" mean monofocal lens?

I appreciate your comments.  I am driving myself crazy with this decision, but it  seems so far that all recommendations beside the dr who will do the surgery lean to the monofocals.

Can you suggest anywhere else to do research.  This was the only question/answer I found.