LASIK or RLE for 62-year-old

[garya505]

I am 62 years old, currently using progressive lens glasses, +1.75 with 1.25 add in both eyes.    I have been considering LASIK or RLE and have two consultations tomorrow.  I would imagine I'll get an idea of how much cataracts I have then, but at the moment I don't know.  I'm starting to think that maybe RLE would be a better choice for me, even though it costs much more.  I'm thinking I'll eventually get cataracts and need RLE anyway, so why get LASIK now and then have to get the RLE later anyway?  For RLE, I'm thinking that the aspheric monofocal lenses might be good, AcrySof IQ Aspheric, B&L Aspheric, or Tecnis Aspheric.  Or, possibly the Crystalens.  I don't mind using readers for close-up work, I'd rather avoid the potential problems with the multifocals.  Any thoughts or suggestions?

[garya505]

Seems that each doc has a different opinion.  I want to another well-known doc today who said he would not want to do Lasik for me, and felt the RLE was a much better choice.  He said he no longer does ANY multifocal or accomodating lenses like the ReStor and Crystalens because the results are not as reliable or predictable as he would like.  He's know locally and a very conservative doc.
He suggested monovision at a difference of -1.50, which I've seen other people mention as very popular for heavy computer users.  Simulation with spectacle lenses seemed to show a best computer vision at -1.25, but I'm not sure how good that really simulates what you would get with IOLs.
Anyway I'm not comfortable making a decision in a few minutes that I will have to live with long-term, so I'd want to try some contact lenses of various powers to see what I like best.
Good?

[garya505]

I forgot something from the last consultation. The doc suggested that I consider RLE with mini-monovision. He said that mini-monovision gives you much the same vision as what you get with the Crystalens, excpet for the near.  IOW, good distance and good intermediate, but still need readers for near.  This is attractive to me as I spend much of the day in the computer.

I'm not so concerned about the cost of the Crystalens as I am about finding a local doc who can do the Crystalens real good.  

[KayakerNC]

Try the Surgeon Locator at Crystalens *******.
Look for the star that shows they have implanted at least 100 Crystalens IOLs.  They call it their "Center of Excellence".
I'd start there.

[garya505]

Update:  I went to my second consultation today.  This place does both Lasik and RLE.  They said my tear film was not good (not real bad, just not good) so Lasik might cause problems with dry eyes.  Eyes are OD +1.25 sph and OS 1.75 +0.50 at 88.  Cataract development is very slight, maybe less than 1 on the scale of 1-4. The doc thought I should go with RLE so I don't have to have it later when I do get cataracts.  He suggested monovision or mini-monovision would be the best choice considering cost, or Crystalens if cost is not an issue.  He said he's done a lot of Crystalens but I don't know how many actually, or how experienced he is with lens.  I'm not a fan of monovision.  So, I think that leaves RLE with standard lens (set to distance), or the Crystalens as my choices. At this place, the standard RLE is $2500/eye and Crystalens is $4500/eye.  I can afford the Crystalens, but I would want to find someone good at it.  So, If I go with the Crystalens, how do I find someone that is really good at it?

[garya505]

Thanks Dr O.  I'm sure I'll have more questions as I proceed.

[Ray T Oyakawa, MD]

I personally target +.25, most docs do not.  This usually ends with the best possible distance vision.  If my patient ends up +.50, I yag the anterior capsule, one cut, check, then another cut and end up about Zero and excellent distance vision.

Dr. O.

[garya505]

Thanks again, Dr O.  I saw some of your videos on YouTube.   I'll be talking to some more people and doing a lot more research before I decide which way to go.   At this time my thinking is that I don't like the compromises that would come with monovision LASIK (I've use contacts for monovision), so I would go with with either monofocal (not monovision) LASIK, or RLE with the Crystalens AO.

I don't mind using "cheaters" for reading or computer work.  I used contacts in a monofocal configuration for years, with reading glasses over them for work, so it's no big deal for me.

When you say .25 in the dominant eye, is that +.25 or -.25?

[Ray T Oyakawa, MD]

No one used Crystalens HD.  It did not do well.  I would recommend Targeting plano to .25 for the dominant eye and target -.50 for the non-dominant eye.  I would see someone who is very experience with the Crystalens.

Dr. O.

[garya505]

I have a consultation today with one of our top local LASIK docs.  He said I had no sign of cataracts, nice thick corneas, and I'm an excellent candidate the LASIK.  He suggested monovision.  I'm still leaning towards the RLE with Crystalens AO, but if I went with LASIK it would just be for distance only.

[garya505]

Thanks Dr O, thanks great info.   I've read that some people will get a Crystalens AO in the dominant eye and a Crystalens HD in the non-dominant eye.  Do you know why they would do that?

[Ray T Oyakawa, MD]

Cost for a RLE is about the same as LASIK now and premium IOL in the future.  Also,  cataract surgery after LASIK is more difficult to hit target due to the alteration to the cornea.

Get a RLE with Crystalens or Trulign (the toric version of Crystalens).


Dr. O.