I agree with you that a multifocal lens is not a good option, in someone with retinal issues. I have been underwhelmed with the amount of accommodation provided by the crystalens. You might consider toric implants to correct your myopia and astigmatism for diatance, and then wear reading glasses. Before surgery, have the ophthalmologist demonstrate monovision in the office, with one of your eyes corrected for distance, and one corrected for near. If you do not like this option in trial lenses or contact lenses, then do not opt for it surgically.
The Calhoun Light Adjustable Lens (LAL) is an option north and south of the US, but not available in the US just yet, as the FDA seems to be in hibernation mode on IOLs.
You could google this lens and also check out the Codet Vision Institute for information on this technology. Right across the border from San Diego, so medical-tourism is a pretty good option.
Just wanted to comment that the Calhoun Light Adjustable lens, while an amazing technology, is a monofocal lens. It does not have adaptive or multifocal properties, which I think is what the original poster was seeking.
That said, the LAL sounds perfect for patient (like me) who are high myopes and are not candidates for LASIK after a cataract procedure. It sounds like it can be difficult to calculate the exact power needed for an IOL in high myopes; the LAL would allow the surgeon to tweak the power of the implanted lens - and the exact contour of the toric correction - AFTER surgery, through directed UV light exposure on the lens. It's very cool technology to be sure. I hope the FDA approves it soon for use in the US.
As with other monofocal lenses, the LAL can be used to deliver mini-monovision (if both eyes have a cataract replacement performed). But it's my understanding it doesn't differ from 'traditional' monofocal lens surgery in terms of mini-monovision, except that the exact degree of correction can be adjusted in the few weeks after surgery.
BTW my OD has also said that his patients have been disappointed in the Crystalens and thinks the accommodation provided by those lenses is below most patients' expectations.
If you do a Google search for "Eyeworld Article 6878" you will come up with a very interesting article by Arturo Chayet, MD on customizing the LAL for near and far results meeting patient satisfaction.
Avoiding Halos, Glare, and additional surgeries just seems like a super advantage.
Thanks for the pointer to the article by Dr. Chayet; very interesting.
I also saw an article by a cornea fellow from Toronto reviewing the LAL in 2012 in European Ophthalmic Review. This article mentions experimentation was beginning at that time with creating different 'zones' on the LAL lens to help enhance near-vision while preserving distance vision (all in the same eye). Here's a link if you want to read this review:
I don't know if their technology does a better job than a typical multifocal lenses in preventing halo and glare which seems to be a major side effect of most multifocal lenses. I haven't yet found any articles comparing vision using LAL implants customized to provide 'multifocal' capabilities with traditional MF lens implant acuities. This is probably because not many patients have had the LAL as yet, given how new it is, and fewer yet have had the multi-zone customization. It will be interesting to see how this product evolves in the coming years.
An interesting article on customizing the LAL for near and intermediate. Since it is on Calhoun's website, they may be tooting their own horn, but there does seem to be a lot of options. We live in interesting times, for sure.