Crystalens IOL:, looking for comments from people who have used it.

[Mintha]

Help! Am looking for feedback from patients who have had experience
with a Crystalens IOL following cataract removal surgery.  Am being told I am a difficult case due to: -7.76 with 4 dop[ters of astigmatism, large (6mm) pupils, and a history of a partially detached retina 14 year ago.

Have worn contacts for over 40 years and would like to not have to wear glasses full time after surgery. Because of increasing dry eye feel contact wear in future may be jeopardized.

Am being told radically different opinions by the surgeons I've seen.  Some suggest to wait for the new monofocal lens coming this Spring that will partially correct for astigmatism and maybe do PRK afterwards (these docs felt strongly I am not a candidate for a multi-focal or Lasik).  Others felt I could have only the Crystalens (they all agreed ReStor and ReZoom would not work for me) and felt if doing Lasik and Limbal Relaxing they could get rid of almost all astigmatism and needed correction.  The docs in the no corner were also concerned with the "silicone" material
of the Crystalens being a possible problem if there was a worst
case retinal detachment in the future needing silicone oil.  Has anyone experienced or heard of this actually happening?

Am experiencing doctors seeming to put their conservative or progressive mindset into their opinion and so am hoping to find
someone out there with actual experience with these. Any ideas of
where to go would be helpful also. I am in the Northwest.

Thank you for any of you who respond.  Mintha

[Forum-OD-MP]

someone will post.
good luck!

[Ag-i-doc]

no real comments from me...
good luck

[Jenta]

I have Crystal Lens in both eyes.  But I didn't have the problems with astigmatism and other things that you have.  I just had cataracts and a distance vision deficiency.  

If I was being told I was high risk, and was having problems with contact lenses, I'd go to glasses. I was told I was a "perfect" candidate for Crystal Lens, and I still ended up with a couple problems I didn't anticipate, like floaters, and my eyes just get exhausted half way through the day.  (I know that sounds silly, but it's true.)  

[Eagle eyes]

Where in the Northwest....I would go to Mark Packer in Eugene, OR. You might benefit from a Tecnis lens....the astigmatism would need to be corrected with ReSTOR, ReZoom, or crystalens. With a large pupil, I definitely would not have crystalens. with the astigmatism , it would be tough for the ReSTOR and ReZoom. Large pupils are not a contraindcation on ReZoom in and of itself, just needs smaller capsulorhexis during surgery. (MD knows what that is). But halos and glare would be bothersome with any of these lenses if smaller rhexis was not made. Mark Packer has experience with all of thsese lenses including Tecnis. If you can get there, that would give you peace of mind, I believe.

[Mintha]

Thank you for the advice Eagle Eyes.  I will get an opinion from the Dr. in Eugene.  Question:  Have you heard of astigmatism being corrected in this way....during the same surgery..a Lasik flap being cut right before cataract removal and insert of the IOL.  Finishing withLimbal Relaxing incisions.  Then several months down the road after everything has healed, the surgeon would go back to finish the Lasik?

Is the Technis lens also a multi-focal?  Have you heard of a new
Toric lens coming out that will correct astigmatism?

[JodieJ]

I've found that some of the posts by eye surgeons at www.eyetowncenter.com are very informative.  You'll find surgeons' opinions about the success rates/best candidates for Crystalens and other multifocal IOL's.  I've also found that the google group sci.med.vision has some good info.

[Mintha]

Thank you so much for the help.

[Eagle eyes]

Yes you can adjust astigmatism with LASIK. Yes Tecnis will be in multifocal, but not for another year or so. In Europe now and US clinical trials now. Yes toric IOL coming to correct astigmatism.

[Mintha]

Thanks for your advice.  I really appreciate it.

[hud]

Alcon has FDA approval for their AcrySof Toric IOL now. It is built on the same one-piece acrylic platform that is the most popular design in the world, because it moves very little. The Staar Toric lens has failed because the plate silicone design does not fixate very well, hence, the astigmatism correction moves and makes matters worse. The Alcon AcrySof design is well known to surgeons using the monofocal, aspheric, blue-filtering, and apodized multifocal (Restor) lenses today. When the Alcon factory gets caught up with the ReSTOR demand, then they will release the AcrySof Toric.
The Tecnis Multifocal is a full-optic (rings going all the way to the edge)multifocal. It is probably not worth waiting for as it has a 4 diopter diffractive add, just like ReSTOR but is not apodized. It's also known in Europe to produce more halos and glare than ReSTOR because when the pupil opens up in dim light, the full optic rings come into play with headlights. The ReSTOR diffractive portion stops at 3.6 mm of the 6 mm optic. Alcon owned the 3M Vision Care full-optic diffractive technology and modified it into the successful ReSTOR design. Pharmacia picked up the old 3M design  and sold it to AMO, who realizes that most ReZoom patients can't read. (42% spectacle-free with ReZoom vs. 90% with ReSTOR).

[Eagle eyes]

Hud is totally incorrect with his fuzzy math. The ReZoom % is 82% not 42%... Here are our % across the board --Most of our ReZoom and ReSTOR patients read J1 (20/20) at near. Or ReSTOR patients complain it is too close than what they like. The ReZoom near is more comfortable for them.

As for intermediate -- our ReSTOR patients get 0 - 10% intermediate vision, most of which are J7-J10 or worse, ReZoom pts get good intermediate J1-J3. Distance vision ReSTOR read about 20/25 to 20/40 for distance . Those that are 2030 and worse say there is a filmy waxy blur in the distance. Our ReZoom pts have crisper sharper distance vision 20/15 - 20/25 is the worst.

I believe Hud you are using the old Array data which was 41%.

The truth always comes out and sets us free. Honesty is not only a policy but a state of mind, as my economics professor taught me. My nursing instructor taught me what goes around, comes around.

[hud]

I have a powerpoint presentation produced by Advanced Medical Optics that states in the FAQ's that ReZoom patients more than likely would need to wear glasses for near, especially reading. It also stated that the first generation (Array) had a 42% spectacle-freedom rate. Jim Mazzo squirms with the fact that AMO cannot claim higher performance for ReZoom, because they did not do any clinicals to prove that it was significantly different than Array. AMO tookm a distance dominant lens and made it more distance dominant. That's presbyopia-correction? Geez. The ReZoom product insert backs this up.
I'll admit that the ReSTOR technology is not for every practice. You've got to know what you're doing.

[Eagle eyes]

To your point, there were not US clinical trials. If someone did not know that before reading this website they do now, which is great. The package insert of ReZoom has Array data to your point. There have been plenty of proactive individual studies done on ReZoom since it's introduction in June 2005. It was slow to take off, including in our practice, because yes, we were a bit skeptical even though we had used Array for years. Once we started seeing the results, as the MDs that have tried it, we were convinced it is definitely much, much, much better than Array. ReSTOR and ReZoom are working well. Our bilateral ReZoom patients do better if they enjoy intermediate and distance tasks than our bilateral ReSTOR patients. Our bilateral ReSTOR patients love their near, near, up close reading. Array data was 41%, ReZoom clinical trials done in Europe was 82%. We have found ReZoom % to be around higher than 87% consistently for near and 93% and higher for intermediate and distance.

[The Queen]

If the truth sets you free then maybe its time to tell the truth. The ReSTOR, ReZOOM and Crystalens all compete for the same patient base.  Why are some more popular than others? Simple, Company incentives and reps who have long standing relationships with  specific doctors.  Taken at face value, why would anyone implant bilateral multifocal lenses in someone over 50 years old.  Is no one concerned about loss of contrast in these patients, visual aberrations or night driving issues? -A monofocal lens would be better in this case, Moreover, a crystalens would be the lens of choice given that it accommodates provides all ranges of vision and has a monofocal optic. Given time, multifocals will wane just as the Array did in the early 90's.

[Eagle eyes]

Why? more predictable and reliable results. Better near vision, without glasses.

We are seeing a place for all, but marketshare has dropped by half for crystalens. dropped 25% for ReSTOR and grown 32% for ReZoom over Q1 of this year.

No lens is perfect.

[The Queen]

Dear eagle eyes,
Agree, ReZoom had a good 1st Quarter, the lens is still in the honeymoon period.  Only Time will tell - There is no silver bullet at this point - Look at the patents filed by all companies, accommodating IOL patents dominate.  Not multifocal..  Tells you that companies are working on the accommodating technology - Great industry to be in - Bottom line is patient satisfaction and well being.  All of us should strive to give the patients the absolutely best vision we can give them irregardless of who you work for or who you support!

[ss4]

A related discussion, cataracts was started.