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Crystalens Accommodating Premium IOL

For cataract surgery and Refractive Lens Exchange (RLE) as an alternative to Lasik, Bladeless Lasik, PRK, LASEK, Epi-Lasik, CK, and P-IOL.

Image of Crystalens accommidating intraocular lens.  
The Crystalens unique design replaces the eye's natural lens while restoring or retaining accommodation.  

Crystalens is the brand name of an intraocular lens (IOL) that is designed to provide distance, midrange, and near vision for pseudophakic patients. Crystalens is commonly used in cataract patients, but may also be appropriate for patients considering RLE. Crystalens may be an appropriate alternative to monovision for some patients.

Presbyopia and Accommodation

As we mature, the natural crystalline lens in the eye expands, firms, and loses its ability to accommodate from distance to midrange to near vision. This normal condition is known as presbyopia and develops in most people in between 40 and 60 years of age. It is first noticeable when it becomes difficult to read items close to you, often requiring reading glasses, bifocals, or trifocals.

Cataract Surgery & RLE

During surgery for cataracts or RLE, the crystalline lens of the eye is removed and replaced with an artificial IOL. A conventional IOL is commonly focused for distance vision only. It does not change from distance to near vision, and reading glasses or monovision are required for the patient to be able to see items at all distances. The purpose of the Crystalens is to provide cataract and RLE patients with the ability to accommodate.

Vaulting for Focus

The Crystalens accommodating IOL is specially designed so it may move forward and backward within the eye in response to flexing of the same muscles that manipulated the crystalline lens for accommodation. This is sometimes called pseudoaccommodation, but is actually real accommodation with an artificial lens. The vaulting movement changes the focal point and may allow a patient to accommodate. This accommodation may reduce the need for reading glasses, bifocals, or trifocals, and does not require any special exercise or thought process on the part of the patient. Accommodation with a Crystalens is the same as accommodation with a natural lens. Two and three year follow data indicates that the pseudoaccommodation of the Crystalens does not significantly diminish with time.

Measurable Improvement

In the FDA clinical trials it was found that a vast majority, but not all, patients implanted with a Crystalens accommodating IOL achieved a measurable improvement in accommodation. It was also indicated that the Crystalens provided vision quality equal to or better than a conventional IOL. It would appear that there is no significant downside to the Crystalens accommodating IOL, and the high probability of functional accommodation is most assuredly an upside.

Limited Improvement

Despite all the apparent good news, do not expect too much from an accommodating IOL. Accommodation will not be restored to the level of function you had when you were 30. For a few, accommodation will actually be less after a Crystalens, but will be more than with a conventional IOL. Keep expectations reasonable.

Patient Selection

The Crystalens is not for everybody. If the natural ciliary muscle contractions are weak or the zonules are damaged, the Crystalens IOL may not accommodate even if implanted correctly. If the ciliary muscle or zonules do not function, a pseudoaccommodating IOL essentially becomes a conventional IOL. If the patient's pupils do not chemically dilate adequately, the doctor will be positioning the haptics around a blind corner, but if the patient's pupils naturally dilate too large, the Crystalens may induced glare in low light environments. It is possible that a posterior capsule opacification may occur, but a quick laser procedure usually takes care of this problem. The recovery time for a Crystalens may be slightly longer than with a conventional IOL. Also, the cost of the Crystalens is significantly more than a conventional IOL, and some insurance plans may not pay for all or part of the surgery if the patient elects to use a high technology Crystalens.

Implanting the Crystalens is more challenging than implanting a conventional IOL. It will be important to seek the care of a doctor with a reasonable amount of practical knowledge of RLE or cataract surgery and the Crystalens accommodating IOL. You may find that a cataract doctor has more experience with IOL implantation than a Lasik doctor.

Medicare Allowed

Thanks to a change in Medicare policy, patients who need cataract surgery and are covered by Medicare may now elect to purchase the Crystalens at an additional cost over a conventional IOL. Before this policy change, Medicare's restrictions made it nearly impossible for a patient to acquire a Crystalens IOL. Now the patient may elect to pay the additional fees for the doctor, facility, and lens. See Crystalens Medicare Policy Details.

Improvement Over Time

Lastly, if you have the Crystalens, be patient. It takes time for your brain and eye muscles to become accustomed to the new possibilities afforded with the Crystalens. Although accommodation may be immediate, expect the changes to be slow with improvement in real function over the first year. For more information, visit the FDA or the Crystalens. Crystalens is sometimes misspelled as CrystaLens, Crystal Lens, Crystal-Lens, or Crysta-Lens.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

Recent Crystalens Medical Journal Articles...

Related Articles

Long-term visual outcomes after Crystalens(®) HD intraocular lens implantation.

Clin Ophthalmol. 2014;8:937-43

Authors: Karavitaki AE, Pallikaris IG, Panagopoulou SI, Kounis GA, Kontadakis G, Kymionis GD

PURPOSE: Our purpose was to evaluate the long-term visual outcomes after bilateral implantation of Crystalens(®) HD (Bausch and Lomb, Inc.) accommodative intraocular lenses.
METHODS: In this study, 25 patients (50 eyes) who underwent cataract surgery and bilateral Crystalens HD accommodative intraocular lens implantation were included. The Crystalens HD lens was implanted in the bag in both eyes, without any intra- or postoperative complications. The visual parameters measured before and after surgery were: uncorrected distance visual acuity, corrected distance visual acuity (CDVA) (using the Early Diabetic Retinopathy Study [EDTRS] logMAR charts), uncorrected intermediate visual acuity, and uncorrected near visual acuity using a Birkhäuser reading chart, at a distance of 66 cm and 33 cm for intermediate and near vision, respectively, directly illuminated by a lamp of 60 watts. After surgery, the patients were evaluated at 1, 3, 6, 12, 24, and 36 months.
RESULTS: The mean age was 68.70±7.1 (range: 54 to 83) years. The mean follow-up was 42.72±0.49 (range: 42.33 to 43.27) months. The uncorrected distance visual acuity improved from 0.56±0.41 (range: 0 to 2) preoperatively to 0.19±0.13 (range: 0 to 0.38) (logMAR scale) at the last follow-up visit, and the CDVA improved from 0.17±0.18 (range: 0 to 0.7) preoperatively to 0.05±0.05 (range: -0.02 to 0.22) at the last follow-up visit. No eyes lost lines of CDVA during the follow-up period, while 54% of patients gained one or more lines of CDVA. The uncorrected intermediate and near visual acuity was J2 or better in 71% and 69% of our patients, respectively.
CONCLUSION: Crystalens HD implantation seems to provide an improvement in visual acuity for far, intermediate, and near distances.

PMID: 24899793 [PubMed]


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