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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3193
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Cataract surgery scheduled for next week and I have chosen

Resolved Question:

Cataract surgery scheduled for next week and I have chosen the Crystalens AO. (as I did not want the recommended multi-focal lens) Could you tell me your experience in using this lens? Results and Side Effects. Recovery.

Thank you

Terri
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Dan B. replied 1 year ago.

Dr. Dan B. : Hello and thanks for your question. Pardon the length of my reply, but in order to advise you appropriately, I will need your patience in reading my comments so you can get a thorough understanding of what you may experience if you were to choose the Crystalens. When one considers having cataract surgery, there are essentially two different options. The standard of care in ophthalmology is for your surgeon to implant a monofocal intraocular lens (IOL). As the term suggests, implanting this lens allows a person to see clearest after cataract surgery at one particular focal plane or distance away from the eyes, when not wearing prescription glasses. For example, if the patient chose that focal plane to be for near, or reading distance, then (if they don’t have significant amounts of astigmatism and if the calculations of the surgeon are correct), they would have clear near vision at a comfortable reading distance, but then require glasses to see clearly at every other distance, including intermediate vision tasks such as computer work, but most especially for everything else (which is considered “distance” vision). Because most people, when asked to make an accounting of how long they spend during the day doing particular tasks, find that they spend most of their waking hours of the day looking in the distance, most people are then happiest if they choose a monofocal IOL implant that makes them as clear as they can be for distance vision (when they don’t have glasses on, after surgery), and then put on glasses to see near vision targets such as reading material or the computer. As implanting a monofocal IOL is the standard of care in ophthalmology, this is what Medicare and most insurance plans will reimburse for as part of their coverage for cataract surgery. In order to provide greater independence from glasses at all focal planes (near, intermediate, and distance) and thus counteract the disadvantages of presbyopia (the need for reading glasses after your mid 40s), premium or presbyopia-correcting IOLs have been and continue to be developed. These come in two categories. The first are accommodating IOLs, or lens implants that attempt to mimic the same shifting of the lens that happens when your natural, crystalline lens accommodates or focuses at near targets. The second type of premium IOLs are multifocal lenses which have multiple zones of different powers that allow for clear vision at multiple focal planes. Because multiple focal zones are available to the eye at once, the brain must adapt to these new lenses to learn which zone to look through for a particular visual task. In contrast, an accommodating IOL has one focusing zone and depends on shifting of the lens position during accommodation (near focusing) to allow for clear vision at multiple focal planes. The Crystalens is the only accommodating IOL approved by the FDA for use currently in the U.S., but there are several other accommodating IOLs that are in various stages of design or consideration by the FDA. Because an accommodating IOL, like the Crystalens, is vitally dependent on the position of the lens for appropriate functioning, if clouding of the capsular bag that holds the lens implant occurs (which happens to approximately one-third of post-cataract patients), the YAG laser treatment which usually and reliably takes care of this problem in patients with monofocal IOL implants, can cause a shifting of the lens position in patients with the Crystalens, causing new astigmatism to arise and a subsequent unwanted refractive error. Also, as can happen in monofocal IOL implants, contracture of the capsular bag can occur months to years after the surgery which can also cause shifting of the lens position, but which can also prevent optimal functioning of the lens. In addition, regarding visual performance, this lens is usually reliable at providing clear distance and intermediate vision, but patients are more likely to still need additional magnification provided by spectacles for some near tasks. Multifocal IOLs such as Alcon's AcrySof IQ ReSTOR and Abbott Medical Optics' ReZoom and Tecnis rely on multiple optical zones to provide clear vision at multiple focal planes. They tend to more reliably provide clear near and intermediate vision, but can produce bothersome glare and halos for more than a minority of patients; these symptoms are most markedly pronounced at night or in low-lighting conditions. While some have a resolution of these symptoms in just a few weeks, it is not uncommon to see these persist for several weeks to even months. Most with these bothersome symptoms have resolution by one year post-operatively, but even still there are some who never gain relief and require explantation of the lens in favor of a monofocal implant. In addition, because the brain requires an adaptation period to learn how to function with a new visual apparatus which is different from the native crystalline lens, patients can be frustrated with their visual dysfunction during these few weeks to months, especially when compared to heightened expectations of spectacle-free vision. In addition, most premium IOLs including the Crystalens (though less frequently than the multifocal IOLs) cause a degradation of contrast sensitivity in the vision. This means that images seen through these lenses are somewhat less sharp and vibrant than those seen through a monofocal IOL. This becomes especially apparent in someone who has a pre-existing eye condition which inherently reduces contrast sensitivity. This can include, but is not limited to, people with glaucoma, macular degeneration, chronic inflammation/infections, dry eye syndrome, and corneal or retinal dystrophies or degenerations. For this reason, it is vitally important to have a discussion with your surgeon regarding any risk factors you currently have that may make a successful implantation of one of these premium IOLs less likely to happen. If you do have one of these eye problems already, your chances of being happy with any of these premium IOLs are markedly less and the probability of significant side effects rise dramatically. Lastly, because premium IOLs are typically a $2,000-$3,000 upgrade cost per lens, a cost which has to be met by the patient, choosing a premium IOL can be a difficult pill to swallow when considering the potential side effects that often hinder post-operative recovery for at least a few weeks, or for some, even several months. When considering this also in light of the higher chance (compared to a monofocal IOL ) of needing to replace the lens because of side effects or complications, many patients opt to go with the more proven option of monofocal implants. This explanation is not meant to discourage you from choosing a premium IOL, but merely to provide a chance at a frank discussion of the benefits and risks of choosing one of these lenses, in case this type of discussion hasn’t happened with you already.
Dr. Dan B. : Does this make sense?
Customer:

Hi Dr. Dan

Customer:

Thank you for your extensive explanation of different type lens and results from each type or choice. I am hopeful I have made the right decision. I paid additional monies for the lens in hopes of optimal results (even better than the IOL). The good news is I have no pre-exsisting eye conditions. i.e., glaucoma, dry eye, astigmatism, ... I do have seasonal eye allergies. True, insurance did not cover this lens. I associated the additional costs with better results for intermediate and distance vision.

Dr. Dan B. : I hope this has been helpful. Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3193
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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