Help---what type of lens is best?

[SweatEyes]

I am a 47-year old female with a "ripening" cataract in my right eye. (Blunt force trauma nearly 5 years ago).  My optometrist & opthalmologist now say it is ready for surgery.  I'm confused on which type lens to pursue.  I had LASIK surgery in both eyes ten years ago with great success, electing post-surgery to have one enhancement and retain 20/50 vision in the left eye and 20/20 vision in the right.  Pre-cataract I had no problems with close vision, but I am getting older and realize presbyopia may be more of an issue from here forward.  I cherish close-up vision (doing much reading, needlepoint, embroidery, etc), but really miss distance vision.  I inquired about having a ReZoom lens placed in the cataract-affected eye, but my opthalmologist says it can only be done bilaterally and there's nothing wrong with my left eye lens!  I've read info on many internet sites & find it only confuses the issue.  Any professional opinions?  (Is it "safer" to go with a monofocal lens? Is it too soon to consider  ReStor, ReZoom, or Crystalens lenses...should I wait for more long-term results?  One site gave me the impression that these lenses may only be good for 5-7 years.  I have put up with the cataract vision for 5 years, I could wait longer. I do tend to have large pupils.  Recommended course of action?)

[Michael J Kutryb, MD]

Old records,if accurate, are very helpful and in my experiene I like to make predictions based on this and pentacam and compare the two for accuracy. Pentacam and IOLMaster should allow you to have fairly accurate - but not foolproof - readings.  This is as accurate as you can get.  I had two such cases last month and both, fortunately ended up 20/20 without glasses for distance but as I told the patients - that is generally not the norm and they did better than expected.  Just be prepared mentally to have to wear distance and reading glasses after surgery.

Michael Kutryb, MD

[Winterpeg]

Hi Dr Kutryb:
Thank you veru much:
The Lasik surgery that I had was done 12 years ago, 800 miles from where I currently live, but I just found out that the Lasik surgeon still has electronic versions of my information. The Cataract Surgeon has requested the "K" reading, both pre and post for the eye.to begin with.
Is there any other information that would be pertinent from my past records?
Thanks

[Winterpeg]

If you do not have your pre and post LAsik records, how would the IOL calculation be affected? Would the Pantacam and IOL Master be sufficient?
Thanks:

[Michael J Kutryb, MD]

Your new lens implant should last the rest of your life.  Previoius LASIK, one eye surgery, and large pupils would cause me to vote against rezoom or restor in this type of case although for properly selected cases they can be useful lens - just not for you.  The crystalens, I would consider to be a possibility for you - but I would be concerned about getting the proper refractive result - because this lens can sometimes be a just a little more unpredictable in getting the final refraction right on, especially in a previous lasik eye.  In the end the safest bet would probably be an aspheric monofocal implant like tecnis, acrysof IQ, or sofport AO.  One, precaution, however, if you had previous hyperopic lasik then the tecnis or acrysof IQ could be contraindicated because they could in theory worsen spherical aberration in these cases.  In that case the sofport AO would be indicated.  Finally, make sure your doctor has IOL MASTER for lens calculations and a Pentacam would be very, very helpful to get the proper keratometry readings.  I have found it to be invaluable for post-lasik cataract IOL measurments.  Also the pre and post lasik records should be obtained for you surgeon.  Remember, due to previous lasik, you may end up having to wear more glasses than you wanted - because it makes the measurements of proper corneal power diffucult and that can throw off the lens calculation formulas.  The Pentacam is good insurance in this situation since it can give very accurate readings despite previous LASIK - but I still tell my patients that there is a significant chance they will have to wear reading and distance glasses after surgery and also about a 1 in 10 chance of having to change out the IOL due to a problem with proper lens calcuation and a resultant unexpected refractive result.

Michael Kutryb, MD