crystalens

[mrsteve]

I had a crystalens implant in my non-dominant eye a month ago. Distance (20/100 with implant) and the close in vision are not very good and doesn't seem to be changing. Have delayed the second eye for now. Wondering if they missed the prescription or a manufacture error. Should I accept these results? If they have to exchange the lens, is there a time limit. Not knowing how these things work, seems like you would not want to wait too long and let the lens adhere. The doctor has been throwing around all kinds of possibilities since one day post-op (another ascan, exchange, lasik, muti-focal for the other eye etc). I'm confused and worried, I can only function now because I have my old contact in the non-surgery eye. Any help would be appreciated. Thanks

[LasikExpert]

The Crystalensaccommodating intraocular lens (IOL) is great in concept, but not always so great in reality. The theory behind the Crystalens is that it moves inside the eye and mimics natural accommodation - the process of changing focus for near objects. Sometimes the Crystalens simply does not accommodate. Unfortunately it is difficult to know before surgery if the Crystalens will or will not accommodate.

It takes some time for the eye to understand how to manipulate the Crystalens. Waiting 3-6 months before making a decision about the outcome is reasonable. There are a few events that would require you to urgently make a decision about changing the Crystalens. Your surgeon should be able to advise you about this timeline, based upon your individual circumstances. This is usually not a situation where you suddenly must make a trip to the surgeon for lens exchange. You should have a reasonable amount of time to make the decision.

If the Crystalens does not accommodate, then you have a rather fancy (and expensive) regular single focus IOL.

You provided your Snellen 20/100 distance visual acuity, but what would be most helpful is your current prescription for full distance vision correction and the amount of plus that is required for adequate near vision. Being within 1.00 diopter of target refractive error is relatively common after IOL surgery. Being within 0.50 diopter is generally considered an excellent result. It is possible that you are within that range, but without the prescription it is impossible to know. There is no real correlation between diopters and Snellen, and Snellen does not tell us if you are myopic (nearsighted, shortsighted) or hyperopic (farsighted, longsighted) or if astigmatism is contributing to the problem.

If your refractive error is less than 1.00 diopter myopic, then it is likely your surgeon will recommend against a lens exchange if there are no other problems. If your refractive error is greater than 1.00 diopter or if your refractive error is hyperopia, then a lens exchange may more likely be considered appropriate.

I am personally not a fan of multi-focal IOLs. I hear so many complaints about halos around light sources from multi-focal IOLs that it seems the reliable single-focus IOL may be better. Multifocal IOLs are very dependant upon pupil size and pupil reaction. Your surgeon will need to evaluate these measurements to determine if a multifocal is even a reasonable consideration. For people who like them, they love them. For people who don’t, they are pretty unhappy. There does not seem to be much middle ground.

Have you discussed monovision correction with single-focal IOLs with your surgeon? This may be the most appropriate method to reduce the need for reading glasses, depending upon your needs. If you don’t mind reading glasses all that much, single focal IOLs corrected for distance vision may be best.

What you don’t want to do is Lasik or any similar cornea-based surgery until you have decided you are sticking with the IOL that is already implanted. There is no advantage to messing with the cornea if you are going to end up exchanging that IOL.

I am curious if you had this surgery because of a cataract, or if this was Refractive Lens Exchange (RLE).What is your age and what are your normal activities?

[mrsteve]

Thank you for your response. This was a clear lens replacement. I'm 53 and work outside and do some driving at night. I'm pretty convinced to not do the IOL in the other eye. I don't care for the halos etc. that I see at night. If the lens does not accommodate I leaning towards a slight Lasik correction in the IOL eye if the doctor agrees. Then lasik in the other eye to get me to a workable mono vision. I wore mono vision contacts for over a year with no real problems. I ended up in the surgery center to explore mono vision lasik, but changed to the IOL because lasik was almost half of the IOL price. I was thinking that the lasik procedure would be sort of temporary, so why not do the IOL's and have the full range of vision (advertisement) and not have to worry about cataracts later. I hope my results are not typical and applaud those who have had successful lens replacement. Knowing what I have experienced, I would suggest the single vision replacement lens over the Multi focal type, and would not replace a clear lens (no-cataracts). That is only my opinion based on my personnel situation. Once your natural lens is removed it's gone. If you have developed cataracts then the lens needs to be replaced and you can make up your own mind about the replacement options. I hope I can one day say that everything worked out. My surgeon is very competent and provides the whole range of services (lasik and IOL's), and is still evaluating my case.

[LasikExpert]

The halos you describe are undoubtedly because the width of the lens portion of the Crystalens is not large enough for the width of your natually dilated pupils. Lasik will not resolve this and Lasik may make it significantly worse. If my assumption is correct, only an exchange with an IOL of the proper width will stop the halos.

Your logic regarding going for Crystalens was accurate based upon the information you were provided, but the reality is that the IOL is not accommodating, is not large enough for your pupil size, and it is not the proper power to provide good distance correction. Nothing screws up a perfectly good theory faster than reality.

Based upon the information I have gained from many patients and surgeons who have implanted the Crystalens, your result is not "typical", but your result is relatively common.

Replacing a clear lens (Refractive Lens Exchange - RLE) is a generrally appropriate and successful way to resolve refractive error for someone who is fully presbyopic, but the proper lens and target correction is necessary. I'm sure you would have been satisfied if you had single-focus IOLs that replicated your monovision with contacts.

It's good that you have a surgeon who can provide many options that may respolve your problems. That is probably your greatest asset.

[mrsteve]

My latest follow up visit showed a little vision improvement. I was myopic to start with (20/400 pre-implant), so that maybe has an effect on what I can expect as far as improvement. I'm at 20/60 and reading around J3 with a lot of light and cheating a bit. To see at J3 I have to hold the card out a little farther than normal. The Doc has suggested to implant the second eye and really nail the distance vision. Then maybe tweak the first eye with lasik for the complete package. When I asked about lasik for distance in the second eye instead he said I would not have the close vision, and that is what this whole deal was about in the beginning. Trying to eliminate the need for reading glasses or contacts. I have scheduled another ascan in a couple of weeks. So that once that is done I will be about 8-9 weeks out from the first eye and will decide then what to do. Could there be any reason to expect more vision improvement based just on time since implant?

[LasikExpert]

It is possible that you will gain vision improvement with the Crystalens. It is possible that it will settle in a position that will provide better vision or that your eye will learn how to manipulate the lens for accommodation.

I don't want to rain on your parade, but there is a very simple truth here: there is no surgery that "cures" presbyopia. Crystalens is probably the closest to a surgical correction for presbyopia, and you are experiencing what you can get from that.

Even when the Crystalens works perfectly, the physics of its optics are such that the very most you can expect is about 1.50 diopters of accommodation. That's not bad, but that much accommodation from the Crystalens is the maximum and the exception, not the norm.

Because you were successful with monovision it seems prudent to consider this an appropriate target.

[mrsteve]

In my effort to troubleshoot my own situation, does this make sense? When I look through the pin hole device the halos are gone along with much better vision. I understand a little about the concept of the pin hole test and how it helps to show refractive error (something with the light rays), but is that the same reason that in my case the halos disappear when looking through it?

[LasikExpert]

We have a detailed article about pupil size issues and night vision problems. It relates primarily to Lasik, but the concept is the same. If light is able to reach the edge of the IOL, it can cause the halos you report. If your pupils are small, such as in bright daylight, the light entering the eye passes only through the center of the IOL and does not touch the edge. A pinhole will do the same thing.

A small pupil or a pinhole also has the effect of concentrating light to a single focal point in the eye and creates a greater depth of focus. These too will improve vision when looking through a small aperture.

If you move the pinhole around to the periphery of your cornea while looking straight ahead in a low light environment you will probably be able to find the halo.

[mrsteve]

Here's a report on my progress to date. I started with a right eye that needed -4.75 of power to correct for distance. I had been wearing a -3.00 contact right eye to get a type of mono vision for the last year (a -2.75 in the left eye). After the crystalens was implanted (right eye) and some time has past (two months), I've settled in around 20/60 to 20/80 for the distance.

I can see very good at 18" to 3', dashboard and computer with the implant, but distance is blurry. The only way I can drive or work is to keep wearing the left contact.

My Doctor suggested another ascan on the left eye as a check before implanting it. Since I would need to be out of the contact for a week I asked to get a temporary contact for the implanted eye so I could see to drive etc.

With -1.00 of correction over the crystalens my distance is great, however I lost some of the near. I need reading glasses for the computer now. As soon as the ascan was done I went back to the contact in the non-implanted eye (mono vision again).

The second eye is on the books to be done in a couple of weeks. They are trying to hit the power this time for distance. I would be lying if I said I wasn't concerned.

[LasikExpert]

The Crystalens does not often immediately provide accommodation. It can sometimes take many months. As previously stated, accommodation may never occur or may be very limited.

Your surgeon's plan to provide monovision with Crystalens in both eyes is probably very wise. Even if the Crystalens does not accommodate, you would have a function workaround for presbyopia. You would have an extended range of near and mid vision if you are able to accommodate in both eyes with the Crystalens.

Express your concerns with your surgeon and determine if what is planned is most appropriate considering your experience thus far.

Please keep us informed of your progress. Many people are considering Crystalens and your experience will be helpful.

[mrsteve]

I'm now 4 days out from Crystalens implant in my second eye. My first reaction was that it is all relative.

The dilated post surgery eye made the not so good first implanted eye look good. With the eye still dilated big time I felt encouraged that this might work.

I took the day after surgery off, and did nothing but the three different drops three times a day. I had serious halos around lights but could see at a distance well enough to drive. The two eyes seemed to be working together ok.

I didn't have any pain or even a red spot on the white of the eye, things couldn't have been going any better.

Then I went to work. At work I bent over to pick a piece of paper up and felt something odd. Looking across the room I realized that I had caused an event, that took away vision.

My first thought was that the implant had moved off center. I called my Doctor and got an appointment that afternoon.

He said the position was still good but seemed a little puzzled by what might have happened. The Crystalens rep. happened to be there and also took a look at the eye. She said the lens had gone flat.

I guess I was happy that the position was good, but I still can't see very well. The Doctor said it was not a big deal to pop it out (my words). He said something to the effect of restore it to the right condition. Before doing that though they want to try keeping the eye dilated for five days and see if would go back on its own.

I should say that post op instructions are to not lift anything heavy, strain or stoop. I just couldn't believe, that simple bending over to pick something up would do this.

So far there has been no improvement, and I'm not looking forward to a whole week of dilation. It was my fault for not being more careful. I guess I thought I could just breeze through the second eye.

At this point I'm not a poster boy for Crystalens. I will post results of my case as they develop.

[mrsteve]

Now ten days out from the second eye. I was dilated for a week and miserable.

When I went back at one week post op, the lens rep. said there was curvature again. They told me to stop the dilation drops but continue with the other drops. As the dilation began to wear off my vision improved. I am very much encouraged that this may work.

My first eye has settled in (after about three months) at around 20/40 distance and J3 close. I can see to read (best at almost arms length) and distance is not to bad (nothing really sharp at a distance).

The good news is that the two eyes seem to be working together pretty well. The new left eye is not great up close (would need readers for the computer if looking only through the left), but both eyes together are good. Might be able to pass the drivers test.

I will have a two week post op next week and will see what the numbers are at that time. I have more opinions but will save them for later.

[mrsteve]

Two weeks out from the second implant now. My visit today had my first eye at 20/50 for distance and J3 when holding a little farther out than where you would for a book.

The second eye is fair for distance maybe 20/30 but up close I could only get the top line on the jaeger chart. The Doctor gave me the official you can pass the drivers test comment (with both eyes).

I still have hope that the new (second eye) implant will improve as time goes by. My Doctor is still on the case and wishes I had better vision now, but has tweaking up his sleeve for a later date, I think.

I realize that I signed off for the procedure and can't complain. I do have pass the drivers test vision, and am thankful for that.

My brother-in-law had Cataract surgery the same day I had my second implant and is having some complications. So compared to him I have it made.

In my opinion, given what I know about my own procedure, I would not recommend clear lens replacement at this time. The total cost for one and what your are giving up in losing your natural lens. It may be that I change my tune down the road, time will tell. I still remember how sharp and halo free my second eye was with a contact before surgery.

[LasikExpert]

Please keep us informed. The Crystalens is often recommend and potential patients will undoubtedly find your long-term outcome interesting and valuable.

[mrsteve]

It's been a little over five months since my second Crystalens implant. Vision using both eyes has settled in at J3 up close and 20/25 distance.

Not wanting to lose any up close sight but needing a little more distance I elected to have my Doctor Lasik my left eye (my distance eye). He determined that I needed about .75 more correction.

Three days out from the procedure things seem good. One day follow-up had me seeing 20/20, and no ill effects. I must say after having the implant surgery, the Lasik was a walk in the park. I'm encouraged that this may be all I need to function without glasses or contacts. J3 for near is not great but I can do most things without readers.

My wife has asked me at this point would I do it again (implants)? My answer is still no, I would not.

That is because I didn't really have a problem with contacts or reading glasses. It is nice now not to have to depend on anything to see, but in my opinion you risk a lot (remember my case was a clear lens replacement - I didn't have to do this). I have floaters (after the Yag laser), and night vision is full of halo's and starburst.

My situation is, I believed the hype of the advertisers (near middle and far vision restored). The best advice that I have heard concerning these lenses is don't think you will have the sight of someone young again.

That is very true, at least in my case. You may end up with acceptable vision if there are no complications. I would be very cautious about going down this road (Crystalens), especially if it is an elective type procedure like it was for me. I'm thankful to have the results that I have and the problems I can live with. Please do your homework, talk to real people that have had the procedure and make your decision based on their results, don't just look at the brochures.