replace monofocal crystallin implants with multifocal lens

[mada_drs]

I’m 23 years old, I’ve had monofocal crystallin implants in both eyes for 5 years. I’m not satisfied with them because the accomodation is poor. The capsules are badly damaged and cannot be used to support a new implant. My doctor advised me to wait until new accomodative lenses appear on the market. He suggested Nu-lens or AMO’s Tecnis Multifocal, which are now still in the testing phase, but with promising results.  
What is your opinion on those type of lenses? Which of the two do you think would be more suitable in my case?

[Sandy Feldman, MD, MS]

Dear mada drs
Most patients do not want to lose distance vision in order to obtain reading vision.  If you were to consider such an option, I would recommend trying this prescription first in contact lenses and then, if you liked it you could consider laser vision correction.

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

[mada_drs]

A related discussion, the best solution for me?! was started.

[mada_drs]

A related discussion, . was started.

[mada_drs]

the doctor told me another option is to do laser surgery now in order to improve only my near vision, and use glasses for distance vision ,until an accomodative crystallin appears on the market.what do you think?  thanks for your advices

[mada_drs]

i understand but my vision procentually is 50%-60% to the left eye and 90% for right eye with corection so i think your solution is not possible for me :((

[Sandy Feldman, MD, MS]

Dear mada_drs,

At the present time, there is no perfect solution for young patients who have undergone cataract surgery.  Each of the implants that is FDA approved as well as the two under investigation in the US has some benefits and risks.  It is very important to have realistic expectations and to learn about the benefits as well as risks as we have no cure.  Because your capsules are damaged, there can be significant risk during an IOL exchange.

These are interesting technologies and the international results look good but until we use these in the U.S., their place in our armamentarium of lenses will not be fully realized.  There are other options including trying a contact lens to act as monovision, so one eye will read and one for distance.  This is often an acceptable solution for patients who can accept the visual compromise.    

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

[mada_drs]

Well, I've tried using progressive contact lenses and/or progressive glasses, but I haven't felt any better". I've been told by the doctor to wait another 2 yrs in order to implant the accomodative lens  in front of the capsule. and this because of  the capsule's destructions , caused by the yag laser. for ex nulens

[JodieJ]

Have you considered wearing a toric contact lens in that eye to give you the best possible near vision?  You could use your other eye for distance vision.  Or you could get some progressive glasses, which you wouldn't need to take off.  Risking your vision in order to get a multifocal lens sounds like a terrible idea to me.

[mada_drs]

I am 23 years old and I study dentistry at the University of Timisoara.
I have a very rare and complicated eye condition, which requires a difficult surgical treatment .At 18, I began to have problems with my vision. I saw a doctor who told me I had cataract, he removed my lens and replaced it with a monofocal implant. Later, I found out that the lens implant was unnecessary, because my problem was not cataract, but hyperopia. After the crystallin replacement, I had excimer laser therapy done to reduce the diopters for distance vison. Then I developed secondary cataract, which was treated with yag laser.Now I have to use glasses all the time for near vision
I asked about the possibility to replace the monofocal crystallin with a multifocal one, but every Romanian doctor I saw told me the surgical intervention is very difficult to perforom, and there is a considerable risk that my vision will get worse.  The capsule of the crystallin was damaged during the previous intervention and it will have to be removed, then the vitreus will bulge into the anteriour chamber
I asked about the possibility to replace the monofocal crystallin with a multifocal one, but every Romanian doctor I saw told me the surgical intervention is very difficult to perforom, and there is a considerable risk that my vision will get worse.  The capsule of the crystallin was damaged during the previous intervention and it will have to be removed, then the vitreus will bulge into the anteriour chamber, and an anterior vitrectomy will be necessary, as well as another intervention for my astigmatism.
Now I have difficulties with accomodation and I have to change glasses all the time in order to see clearly. Being a dental student, I need a sharp vision all the time and it is difficult for me to manage. I also have problems with driving at night, because I see halos around objects.

[cdn_glenn]

I can understand your frustration with being young and not being able to see near objects easily.  I lived with a similar issue for many years.  

I've had Tecnis mutifocal IOLs for the last two years.  Regarding accommodation they're "functionally" very good.  I can see well both near and far and have very good night vision.  The Tecnis MF has a 6 mm optic, larger than most multifocals, making it a better night vision choice for patients with large pupils.  Mid-vision starts at around 18" and goes to about 48".  Objects near or far are very sharp.  Within mid-vision objects display at 20/30, maybe 20/40.

There are a few general issues with multifocal lenses.  Ghosting, halos, starbursts, glare and many more anomalies may be created in your field of view.  In time many of these will reduce in prominence, but may never totally leave your sight.

There is another type of "true" accommodative IOL that mimics the focus of a natural lens.  Currently these haven't proven to give full near-mid-far vision.  In particular near vision seems to be limited.  One also has to adapt to these and get used to controlling them with the eye's ciliary muscles.  I'm not certain if you're capable of receiving one of these IOLs since your current one does not rely eye muscles to work.

There is no perfect accommodating or multifocal on the market.  I know you would like better vision.  Twenty-three ... you have lots of time on your side.  Patience?  I don't know.  I'd want better now too.  But take your time and research.  There will probably be no perfect IOL coming out on the market.  Maybe in time there will be a suitable one.

Glenn

[JodieJ]

From what I've read, the Tecnis multifocal is VERY similar to the aspheric ReStor.  Problems with halos might be more severe with the Tecnis multifocal due to design factors.  On the other hand, the Tecnis multifocal lens is supposed to provide (somewhat) better intermediate vision than ReStor.  Frankly, I wouldn't want either of these implants in my own eye.  I'm not familiar with Nu-lens.  (I'm a cataract patient, not an eye care professional.)

I agree that it's a bummer to lose accommodation in your teens.  I'm wondering if a variation of monovision (with either a contact lens or by laser vision correction) might give you a greater range of vision without the risks of an IOL exchange.