poor distance vision and night vision with crystalens

[golfadkt]

Hello
I have had crystalens implants in both eyes for about a year now.I am told that I have 20/70 in my left eye and 20/40 in my right eye. I developed a macular pucker in the right eye about six months after surgery. I was sent for an exam by a retina specialist and I am told my retinas are ok. My night vision is terrible.My near and intermediate vision is very good, my distant vision is not so good. My eye surgeon has done Yag laser in both eyes twice.My vision remains the same. I also have terribly dry irrtated eyes.I always had very dry eyes but now they seems worse. I have puntalplugs in the lower lids and have used restasis since the day it hit the market.My surgeon has suggested prk for my left eye. I am ataid to do anything more with these eyes.My biggest complaint is that I cannot see well at night and even with corrective glasses I cannot see well driving at night.I had lasik in my right eye done 13 years ago. My surgeon states that that made gettting the correct measurements for my right eye even more tricky. But... it seems to me that 20/70 in my left eye is not at all good??? Any auggestions would be so very appreciated!

[JodieJ]

You might consider retinal surgery to peel the pucker in your right eye.  This would improve your vision overall.  Visual outcomes for this type of surgery are better when surgery is not delayed.  You would want this to be performed by the most experienced retinal specialist in your area.

[Michael J Kutryb, MD]

I'm gathering that your top concern in poor vision in the left eye.  What puzzles me is that glasses don't seem to help - so that makes it even more difficult to improve.  If your retinal exam and OCT scan are normal in the left eye and you never had lasik or refractive surgery in the past, then we would expect your corneal topography to be normal or near normal and you would in theory have good vison potential.  I wonder if maybe you might have a history of amblyopia or a lazy eye or some other type of problem such as ischemic optic neuropathy in the past.  A corneal topography, visual field test, OCT scan, and possibly even wavefront analysis would be helpful to see if you have good vision potential.  If there is refractive error left over after the cataract surgery, then you could even try a trial of a contact lens to simulate what PRK surgery might be able to to.  You will need to, of course, be very aware of your dry eye problems and follow a very strict regimen of caring for this problem if PRK is done.

MJK MD

[golfadkt]

wow Dr kutryb... thanks so  very much for you thorough answer.I realized that I needed to provide you with more information(and please excuse all my typo errors),I did get a new glasses prescription which I am being told corrects my vision to 20/30. The prescription reads OD- sphere:plano, cylinder +.75, axis 090 Os is sphere -1.00 also with antireflective coating....  But it still seems to me like I struggle driving at night time even with the glasses. When I drive with bright lights on it is better. I do not experience halos or car headlights bothering me it just seems like I do not focus in well enough. No I have not had any previous surgery in my left eye nor any previous eye history of problems. I also have several floaters in BOTH eyes since the cataract and yag procedures.That is also very upsetting!I  I also was given Alphagan drops to try for night time driving and I have tried it recently once.Although it seemed a bit better it was not a dramatic improvement. The other strange thing I noticed when using these drops is that the left eye pupil was larger than the right eye(if that tells you anything)???I am also being always told that my dry eyes may be making my vision worse. When we tried twice now to put the plugs also in the upper ducts I had alot of tearing and they had to be removed I cannot recall if my vision was actaully better at that time I just know I haD alot of tearing.Perhaps I should try that again? Smartplugs were put in the bottom ducts several years ago and I also wonder if they have washed away in time?

The retina specialist(best in our area) indicated that there was a thin layer causing the macular pucker in the right eye and surgery at this time was not recommended unless it was so bothersome or if it gets worse. Perhaps I should also be looking at this option? Could the floaters and macular pucker be making my night time driving difficult. I am still too young to have to be off the road by 4:30!!!!!!!!!!

As you can imagine I am VERY distressed at the fact that I cannot drive safely at night and I am searching for answers! I also wonder why my eyes are so sore since these procedures?One other thing I will mention IF it sheds any light. I have Roscea(of the face) and have recently even tried a course of Doxyclycline to see if that would help my hurting eyes and vision issues(thinking that maybe I have occular roscea but it has not seemed to make a difference. I have only been on that (low dose 100mg oce a day) for three weeks. I had asked my regular doctor for me to try it and I am.

Any ideas,suggestions or thoughts will be sooooooooo appreciated.I have spent thousands on these eyes and I am very distressed at all the issues I am having?? HELP!!!!