Crystalens HD With Non-Crystalens?

[mmmmpppp]

Hi,

I am 53 and had great vision most of my life at all distances.  I developed a PSC cataract at 51 in my non-dominant, right eye. It was replaced with a Crystalens HD that is plano,  20/15 distance, 20/15 intermediate and maybe 20/40 or slightly worse near.  My distance vision isn't perfect in the Crystalens eye in spite of the 20/15 measurement: it's not sharp unless I squint pretty hard.  Intermediate is excellent.

My left, dominant eye has gone through a strange transformation. When I got the Crystalens in the right eye, my distance in the dominant, non-Crystalens eye was 20/15 and crystal clear, but I needed readers because of presbyopia.  Since then, I believe that this eye has started developing a PSC cataract.  Now it is blurry at distance and intermediate but is 20/20 or better at near.  It's crystal clear at near, and I put away the readers about 9 months ago.  I had practically forgotten that I ever needed readers.

Before the cataracts, I needed readers, yet my eyes wouldn't tolerate them and I literally stopped most of my reading activity.

My question is what would you (the doctor and fellow patients) recommend I put in my left, dominant eye?  Since my distance in the right, Crystalens eye is lacking, I am considering an aspherical standard lens.  Since I have strong intermediate but not great near (or far), I am also considering a multifocal.  Since I assume one would normally use the same thing in both eyes, I am considering another Crystalens--and wondering whether it should be HD or AO.  (I assume that the Crystalens would NOT be set to improve near since my distance is lacking and this is my dominant eye.  Or maybe it should be?)  And I am even wondering if there is a better accommodating lens coming out next year, like a Synchrony or Tetraflex.

I fear needing readers because I couldn't tolerate them before, and I fear having substandard distance because my Crystalens HD isn't giving me the best distance.  I live in my computer, smartphone and TV, but I love to jog and go for walks, and if I ever have any money again, I love driving at night and traveling and seeing panoramas.  If I knew I would tolerate readers, I'd want the absolute best distance; so I'd strongly consider the standard lens and hope that my already good intermediate in one eye would mean that I'd still have excellent intermediate with no glasses.  I really would not want to have to wear glasses for the computer or TV.

Sorry for the long post, and thanks in advance!

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

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[mmmmpppp]

Thanks for replying and trying to alleviate my fears.  You're very kind.

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

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[eyesonyou]

You have used the word "fear" a few times, and I don't think it's too late to reply to your post.

Our human minds seem to be taken up with "fearing" what will happen with any kind of eye surgery.  I understand, because last year I had two eye surgeries.  The reality is that you make the best decision you can, and hope for the best, while keeping in mind that the ultimate result is really out of your control.  There might be a surprise or two, or things might go exactly as you imagined they would.

I have a very similar situation to yours -- with one Crystalens implanted, and the other eye becoming very myopic, with the cataract progressing, about 8 months after the Crystalens surgery was done.  I am reading with my right eye, and seeing distance with my left.

You seem to be uncertain whether you'd prefer excellent crisp distance vision or have the bias instead for close-up.  That is understandable, and I  seem to have the same lack of decisiveness for myself.

Since I can't seem to decide, I'm going to let my surgeon do the deciding about how the second Crystalens surgery will be done.  I have an HD in my left eye, and will get an AO in my right eye.  I'm sure that plano will be his intended surgical outcome  -- no 100% guarantees that it will happen.  That's just part of life.

Frankly, though I don't particularly like readers, I could still use them if needed.  Also, at some point, one can buy a Kindle and do a lot of reading without glasses, since you can increase the font size instantly to 16 point, if you need it!

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

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[mmmmpppp]

Thanks!

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

This question is asked often in one form or another many many times and has been discussed at length. You can access those discussions using the search feature and archives. There is no right or wrong answer. You essentially are using a form of monovision right now. RE for distance and mid range  LE for near.  The clear LE vision is surely due to a moderately dense nuclear cataract which makes the eye myopic ("second sight")  

A Crystalens with "near bias"  or a monofocial aspheric set for -2.5 would likely meet your needs. Also its likely that your distance vision could be improved with single vision distance glasses for driving, movies, sporting events etc.

Again there is no "right" answer just different answers. The choice is up to you.

JC MD