Vision - Seeking advice between Cyrstalens and Tecnis

Author

Seeking advice between Cyrstalens and Tecnis

Wayne Stidolph

2005-01-15, 2:12 am

I need to have an ICL and crystalline lense replaced by a standard IOL
put in my right eye, and am trying to decide what to do - advice welcomed!

Background: I am naturally hyperopic, 50 yr old, software
engineer/manager (spend lots of time at a computer screen), and like to
go mountain biking. I wore monovision contats for a few years, but I
really disliked the maintenance and dust-sensitivity of the contact
lenses, and I was scared of night-vision effects with LASIK, so I
entered the FDA Phase III trial for Staar ICL, and had lenses implanted
bilaterally when I was about 45. Worked great for a while, but
eventually both eyes developed cataracts,probably due to zero vault of
the ICL over the crystalline lense.

Left eye: The left eye failed first. The doc took out the ICL and
crystalline lense and put in a standard IOL; good results, but then a
year later it clouded over (PCO) and so he YAG-blasted that eye. Fine,
except I have a monocular diplopia that is really annoying looking at
bright points in low-light conditions (as in, I can't read text on a TV
subtitle). I do fine wearing +2.75 readers with my computer and papers,
but can't read many street signs, car dashboards, etc.

Right eye: Next the right eye developed a cataract, but I held off on
treatment - I was hoping the Crystalens would get approved and I'd get
some accomodation, even from a unilateral implant. Well, the lense got
approved in Nov 2003, but just as I got ready for the operation, I
thought to call the FAA about it (I'd like to become a private pilot).
They said 'no' to that lens for at least another year; and, Eyeonics
didn't want my doc to do my eye until he had done ten "simpler"
implantations (the piggyback ICL was considered a complicating factor)
so I held off again. The lense has clouded over until I no useful vision
in that eye - I can see a bright light as a general glow in the haze. I
run into door frames from time to time

and I don't go mountain biking.

Which IOL: while I was waiting out that year, the doctor wavered in his
belief about how good the Crystalens was and how much accomodation might
be achieved; and, I saw the Tecnis IOL come on the market, saying great
things about "Functional Vision." And that lens wouldn't have the
"multi-focal" characteristic the FAA is wary about. So this has left me
wondering which course to pursue, and needing information/advice:

(1) How much benefit am I likely to achieve in a unilateral Crystalens?
If I'm still going to need readers, then the benefit seems small; but
since I adapted well to monovision before, maybe that says the right
(Crystalens) eye might handle reading, then both eyes kick in for
distance? If one eye adapts and the other doesn't, am I going to have an
near-field depth perception, anyway?

(2) Is the Tecnis really as great as the marketing material claims?
Experiences?

(3) Monocular diplopia - I see sharply (if dimly

through a pinhole.
The doc confirmed there wasn't any significant astigatism nor re-growth
after the YAG treatment. So, what can cause the ghost, and is there
anything I/he can do about it?

Thanks for any advice,
Wayne

DroneMan

2005-01-15, 4:10 am

I am an ophthalmologist, and a busy refractive surgeon - I don't think
you're going to get too much help with the Crystalens, (but it would be
better than nothing) and there are glare issues. Since you want to be a
pilot, the Tecnis lens would be good It minimizes spherical
aberrations), but I would avoid all bifocal and multifocal lenses
(Array lens from AMO) . Your right eye may have a lot of higher order
aberrations, and any of the wave scan analyses might help you find the
answer, if they can get a good scan through your implant. Treatment
(?Laser PRK) is a complicated matter as well.
Best of luck

DroneMan

2005-01-15, 4:10 am

Wayne Stidolph wrote:
> I need to have an ICL and crystalline lense replaced by a standard
IOL
> put in my right eye, and am trying to decide what to do - advice
welcomed!
>
> Background: I am naturally hyperopic, 50 yr old, software
> engineer/manager (spend lots of time at a computer screen), and like
to
> go mountain biking. I wore monovision contats for a few years, but I
> really disliked the maintenance and dust-sensitivity of the contact
> lenses, and I was scared of night-vision effects with LASIK, so I
> entered the FDA Phase III trial for Staar ICL, and had lenses
implanted
> bilaterally when I was about 45. Worked great for a while, but
> eventually both eyes developed cataracts,probably due to zero vault
of
> the ICL over the crystalline lense.
>
> Left eye: The left eye failed first. The doc took out the ICL and
> crystalline lense and put in a standard IOL; good results, but then a

> year later it clouded over (PCO) and so he YAG-blasted that eye.
Fine,
> except I have a monocular diplopia that is really annoying looking at

> bright points in low-light conditions (as in, I can't read text on a
TV
> subtitle). I do fine wearing +2.75 readers with my computer and
papers,
> but can't read many street signs, car dashboards, etc.
>
> Right eye: Next the right eye developed a cataract, but I held off on

> treatment - I was hoping the Crystalens would get approved and I'd
get
> some accomodation, even from a unilateral implant. Well, the lense
got
> approved in Nov 2003, but just as I got ready for the operation, I
> thought to call the FAA about it (I'd like to become a private
pilot).
> They said 'no' to that lens for at least another year; and, Eyeonics
> didn't want my doc to do my eye until he had done ten "simpler"
> implantations (the piggyback ICL was considered a complicating
factor)
> so I held off again. The lense has clouded over until I no useful
vision
> in that eye - I can see a bright light as a general glow in the haze.
I
> run into door frames from time to time

and I don't go mountain
biking.
>
> Which IOL: while I was waiting out that year, the doctor wavered in
his
> belief about how good the Crystalens was and how much accomodation
might
> be achieved; and, I saw the Tecnis IOL come on the market, saying
great
> things about "Functional Vision." And that lens wouldn't have the
> "multi-focal" characteristic the FAA is wary about. So this has left
me
> wondering which course to pursue, and needing information/advice:
>
> (1) How much benefit am I likely to achieve in a unilateral
Crystalens?
> If I'm still going to need readers, then the benefit seems small; but

> since I adapted well to monovision before, maybe that says the right
> (Crystalens) eye might handle reading, then both eyes kick in for
> distance? If one eye adapts and the other doesn't, am I going to have
an
> near-field depth perception, anyway?
>
> (2) Is the Tecnis really as great as the marketing material claims?
> Experiences?
>
> (3) Monocular diplopia - I see sharply (if dimly

through a
pinhole.
> The doc confirmed there wasn't any significant astigatism nor
re-growth
> after the YAG treatment. So, what can cause the ghost, and is there
> anything I/he can do about it?
>
> Thanks for any advice,
> Wayne

Jim Sharpe

2005-01-27, 8:44 am

Hi Wayne,

I had similar questions regarding unilateral Crystalens implantation.
However due to rapid cataract development I ended up getting them in
both eyes in April and May of last year. I as only 42 at the time and
was excited about the opportunity to have an accommodating option.
However, even under the excellent care of Dr. Doane, arguably the
surgeon with the most experience with the Crystalens the experience has
been a dismal failure and I will likely be having the them explanted.
In addition to having no accommodation, the physiology of my eyes
caused the power calculation to be off. But the most substantial
problem is that the lenses have essentially ruined my night vision due
to halos, flares and other effects. Although I suspect I'm in a
minority of patients with these problems, I think it's important to be
aware that such problems are a real possibility. Feel free to contact
me if would like to hear more about my research and experience.
Sincerely

Jim Sharpe