To Dr. Hagan

[starman6600]

Dear Dr. Hagan,
Thank you so very much for all of your most helpful thoughts. I do not have cataracts but am interested in the IOL issue.   I am a 67 y/o male who has had RK (15 years ago) and Lasik (5 years ago) in my left eye, which is my dominant eye for distance.  I also had RK (15 years ago) in my right eye, for a monovision outcome.  In the past five years since my Lasik, I have become farsighted (+1.50) in my left eye.  I am considering a Tecnis monofocal implant in the left eye  to improve my distance vision and then utilize reading glasses.  I have a few questions.

1.  How long might I expect the Tecnis lens implant to maintain my vision.  
2.  Would there be any merit in waiting a few years before having an implant in hopes that a multifocal lens might be developed which would not cause glare, halos etc.?
3.  I have learned that a new light adjusted lens implant will shortly be in clinical trials.  Given my hx, do you think that this would be worth waiting for?
Any thoughts or insights  that you can share with me will be much appreciated.

Thank you.
Frank
Menasha, WI



This discussion is related to IOL.

[DallasCPA]

Dr. Hagan,

Your responses are so well-informed and thoughtful-- I so admire your contributions and candor in these forums.

I am scheduled for crystalens HD surgery next week, but am concerned with the experiences I have read about, particularly with my us.

I have successfully worn gas permeable contact lenses up until about 1 years ago (35 years) due to dry eyes.  I am nearsighted with significant astigmatism, deemed unsuitable for lasix correction.  My cornea is very steep/irregular but not quite keratoconus.

Since I am only 52 & very dependent on my vision in my profession (reading, computer work, cruncing numbers) wear progressive glasses has not provided the crisp vision my contact lenses provided, nor the peripheral vision for driving, exercising etc. This has had an extremely negative impact on all facets of my health, work, and sociability as I can't get around as I did with my contacts, or even find things around the house...

Is there any potential solution die me -- even if I have to west glasses for some correction?  Is there any way to address my astigmatism & myopia?

I realize you can not prescribe a solution for me, but if you could share your thoughts I would be eternally grateful.  Your wisdom and integrity are greatly appreciated, and you are to be commended for your contributions to this forum.

Many thanks,
DallasCPA

[John C Hagan III, MD, FACS, FAAO]

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[starman6600]

Thank you Dr. Hagan.
Frank

[John C Hagan III, MD, FACS, FAAO]

It would depend on the state of the cornea, the thickness and the amoung of refractive error that needed changing.  A cornea surgeon should be able to answer this questions.


JCH MD

[starman6600]

Dear Dr. Hagan,

Given my hx of RK (both eyes) and Lasik (one eye) and the somewhat uncertain outcome with a Technis implant,  I am believing it might be best to wait a little longer before getting the implant.  Perhaps this waiting period may give my cornea  an increased chance to stabilize.  I am wondering about whether there is much risk in getting a second Lasik in my previously done left eye (my dominant eye for distance).  This left eye has become farsighted since my Lasik of five years ago. Thank you.
Frank

[John C Hagan III, MD, FACS, FAAO]

Good luck to you Frank.

JCH MD

[starman6600]

Dear Dr. Hagan,

Thank you.  This is are  excellent suggestions. I have much to comtemplate.  I am slow to make decisions but your comments are so very helpful in this process.   With much appreciation.  Best wishes.

Frank
Menasha, WI

[John C Hagan III, MD, FACS, FAAO]

Then picking a Technis with a post operative goal of -0.25 might make good sense. HOWEVER the potential error in guestimating your post operative refractive error is signficant due to your history of RK and lasik. The formulas are just not as accurate as surgery on a virgin cornea.  Your surgeon may want to set up a post op goals of -1.00 to leave some error room lest you be left still farsighted and not able to see distance or near without glasses.

JCH MD

[starman6600]

Dear Dr. Hagan,

Thank you very much for your informative and helpful response. It is super of you to take the time to do this.  Your comments have helped me very much to put some of my issues in perspective and  to rule out a multifocal lens and also rule out a light adjusted lens.

My dilemma at this point in time is whether to get a Tecnis implant for my left eye.   I don't have a family hx of glaucoma or macular degeneration (although, I could, of course, still acquire these diseases).  Given my experience over the past several years, I do believe  that there is a good chance that my cornea could continue to change.  Since, at my age of 67, I could acquire cataracts,  it would seem that getting a Tecnis implant in my left eye would have little downside, other  than the cost of the lens and the risk involved with any cataract surgery.  

As you can see Dr. Hagan,  I would like to avoid wearing glasses, other than for reading, if at all possible. Please know that I recognize that you cannot advise me as to what to do.  But if you should have any additional thoughts,  I would certainly appreciate them.

May I thank you again for your generosity in sharing your most valuable thoughts with those of us who are so confused about our vision issues.  My very best wishes to you.

Sincerely,
Frank
Menasha, WI

  

[John C Hagan III, MD, FACS, FAAO]

1.  The thing that is most likely to affect your future vision is either the development of eye disease such as glaucoma/macular degeneration OR reduced vision due to your cornea continue to steepen/warp (irregular astigmatism).  About 20% of people with all kinds of IOLs develop secondary cataracts and need a Yag capsulotomy. The tecnis itself is highly durable and quality manufactured.

2. Only you can answer this question. I believe it will be 5-10 years before multifocal IOLs will have good night vision and a complication rate not much higher than monfocal.

3. With so many qualifty monofocals and a few quality multifocal (crystalens and ReStor plus some others in Europe (NOT the problem prone ReZoom) I don't see the advantage (other than perhaps the free or reduced costs of participants in investigational IOLS) of having an experimental IOL put in your eye. The light adjusted has been around for years and has yet live up to its expectation.

JCH MD