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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11309
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have moderate drusen in both eyes. I also have cataracts

Resolved Question:

I have moderate drusen in both eyes. I also have cataracts in both eyes that need to be removed and replaced with an IOC. One ophthalmologist recommended a corrective IOC like a Crystalens. The other ophthalmologist recommended monovision with a standard IOC. He said that the corrective IOC would make it harder for a retina specialist to see the retina and track my drusen and possible macular degeneration progress. Who is right? Thanks.
Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Rick replied 6 years ago.
Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

I am a retina specialist and the second ophthalmologist is correct.

Dr. Rick :

It can be difficult to see fine macular detail through the multifocal lens. Just as you give up some clarity so you can see at many different focal distances, so does the retina doc loose clarity when looking at the focal plane of the retina.

Dr. Rick :

Now. Is it enough loss of clarity to say "do not use that lens"? No. I can see well enough in 98% of cases through a Crystalens to do what I needs to be done. However, if your were listing pros and cons to getting this lens vs getting a monofocal lens, this issue would go on the "con" side.

Dr. Rick :

In other words, don't let this issue alone keep your from getting this very good lens placed into your eye.....

Customer:

Then you would recommend the standard lens IOC rather than the prescription IOC? What about the aspheric lens in the eye with the distance vision with monovision IOC where one eye has a lens for near vision and the other lens is for distance vision?

Dr. Rick :

Monovision is a good idea. Many people love it. Try to see if you can tolerate monovision with a contact lens or glasses trial first. Once the lens is placed inside your eye it requires another surgery to take it out -- with all the risks of the first surgery.

Dr. Rick :

Like I said above, I would not let just the retina issue keep you from the crystalens.....I'm able to work around it in the vast majority of cases. Does it make me work harder for my pay? Yes., but it's not that huge of a deal.

Customer:

The reason the second ophthalmologist suggested the monovision lenses is because my cataracts have caused one eye to see near vision and the other eye far vision and I have adapted to that vision quite well for the last two or three years. I actually don't mine wearing glasses that much. Would my vision be best with the crystalens or with the monovision with glasses. Which would provide the best macular detail? Thanks Also the crystalens costs a lot of money. Is it worth the extra money?

Dr. Rick :

The aspheric lens set for one focal point would give your retina specialist the best view of your macula. If you have adapted well already to "monovision" due to the luck of the draw of your cataracts I would go with that option. As you stated, it a lot cheaper then going with the crystalens.

Dr. Rick :

And all the money you save will be available for your kids in the future :o) At least that's what I tell my dad lol!

Customer:

Can the aspheric lens be used both with the near vision lens and the far vision lens, or is it just for the eye with the far vision?

Dr. Rick :

The aspheric lens can be "set" to give you excellent distance vision, excellent middle vision, or excellent near vision. But not all three. All three is what the crystalens tries to give you. Remeber, however, that where your final clear vision ends up has some chance to it. The doctor will use complicated calculations to pick the power lens that will give you the desired vision at the desired distance, but sometimes what you end up getting is not what the math says you should have got.

Customer:

The reason I mentioned the money is not because I wouldn't spend the money if my eyesight was much better, but because I didn't know if my vision would be any better. Why spend money that wouldn't make anything better. A cruise might be better. If it were your eyes with my condition, which lens would you choose?

Dr. Rick :

the aspheric lens has been used for many decades and there are billions of people who have enjoyed fantastic vision over the years with them in their eyes. I don't believe you can go wrong with this option.

Dr. Rick :

Hard to tell since I can't see your macula.....but I gotta go with the side rooting for a cruise.

Customer:

Thanks for your answers. You have been very helpful. The ophthalmogist didn't mention if he was using an aspheric lens. I just read about it. Do you think that is standard practice? The second ophthalmologist is Dr. Alan Crandall of the Moran Eye Center in Salt Lake City, Ut.

Dr. Rick :

yes, all the lenses placed in the eye nowadays are aspheric....even those used in Utah ;o)

Customer:

Dark ages Utah? I thought you might be familiar with the Moran Eye Center and also possibly Dr. Crandall.

Dr. Rick :

His face does look familiar....I wonder if I've met him at an AAO meeting over the years....

Dr. Rick :

I do know some of the folks there...Dr. Katz is very, very well known.

Dr. Rick :

Looks like you are in excellent hands there......

Customer:

Thanks again for all your help. I am sure you have met Dr. Crandall. He has been very active in leadership positions. The Moran Eye Center has a worldwide reputation. I think I will go with Dr. Crandall's recommendation--it correlates with yours. I also see Dr. Paul Bernstein for the macular at Moran. He is also a top researcher. It gives me confidence. You have helped. Thanks.

Dr. Rick :

My pleasure. Have a good day.

Dr. Rick :

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