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Avatar universal

Non-correcting IOLs vs. Crystalens, ReZoom or ReSTOR lenses

I'm 51, in fairly good health, have cataract surgery scheduled for 5/15 & have already had 2 laser surgeries to repair retinal detachments in that eye. (I posted on the post-op floater thread earlier today.)

I'm very nearsighted, astigmatic & now presbyopic. That eye's vision is very poor & I'm worried spending $2500 on a Crystalens (plus $$$ more for subsequent Lasik to fine tune) makes no sense for me. My cataract/Lasik doctor is highly regarded, but after 5 minutes with a support staffer, I was handed a Crystalens brochure. I knew I was being "upsold" & tried to resist the sales pitch. After spending a total of 15 minutes with me the Doc recommended the Crystalens as my best option (surprise!). I caved in & shuffled out of her office feeling dazed & soon-to-be-broke. And hopeful it would all work out OK.

After reading this & other patient forums, I'm considering delaying surgery or having a lens implanted that either doesn't correct my vision or is at least covered by Blue Cross PPO insurance. My questions are, are potential complications the same for all IOL's? Even the non-correcting type? Am I being paranoid and/or cheap? Are my $400 progressive/transitions lens glasses going to be totally useless on the 16th? Thanks Very Much for any advice you can offer, Doctor.
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Avatar universal
The Crystalens IOL is silicone, and I believe that it is contra-indicated for a someone who has already had two retinal detachments.  (Check this out in the prescribing info at the manufacturer's website.)  From what I've read, someone with past retinal problems (like you and me)is better off with an acrylic IOL.  

If I were you, I'd definitely cancel the surgery.  I suggest that you consult with other cataract surgeons in your area who are experienced implanting a variety of IOLs.  It would also be good to find someone experienced in doing refractive surgery if you have astigmatism.  Meanwhile, try to learn as much as you can about all your options--it's your vision after all!
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Avatar universal
Many retinal surgeons feel that acrylic is easier to work with vs silicone during retinal surgery. This is because during retinal work, the silicone IOL can fog up making it trickier for the MD to see what he is doing behind the IOL on the retina. Sometimes silicone oil is used after retinal surgery. Silicone oil and a silicone IOL again are trickier.  Acrylic IOLs, according to some retinal MDs, don't fog up as much. Plus in Diabetic pts that need laser work done for bleeding of the retina, acrylic is often preferred here as well.

ReSTOR and ReZoom are both acrylic.
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Avatar universal
I wish the discussion above had been posted months earlier.  I had cataracts in my right eye and bought into the Crystalens sales pitch last Dec.  It wasn't a tough sell because I hate wearing glasses/contacts.  The fact that I had previous retinal detachment surgery in my other eye and preventive cryo in both was taken into consideration by my surgeon, but not deemed to be a significant risk.  I was pleased with the my distance and intermediate vision after the cataract surgery but not my near vision.
     Late last week, I experienced vision problems with my right (Crystalens) eye.  On Wednesday I had surgery for a detached retina in that eye (sceral buckle).  The surgery was successful.  I asked about my post-op vision and received conflicting answers regarding whether my vision will return or whether I will need corrective lenses or some sort of Lasik touchup.
     Going forward I intend to proceed more carefully, ask many more questions and perform extensive "due diligence" before making a final decision on the treatment of my eyes.
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Avatar universal
hud
there are no studies, but there should be no significant differences between the lens materials.
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Avatar universal
Does anyone know if there are statistics detailing retinal detachment AFTER implantation of ReSTOR lenses vs non-correcting IOLs?  I wonder if silicone lenses are more risky as compared to acrylic IOLs.
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Avatar universal
Yes, I believe it's something like this for ReZoom:

Pupil Size       Distance    Intermediate    Near
2 mm Bright        84%            16%         0%
5 mm Dim           60%            10%         30%

Of the available light, correct ?
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Avatar universal
100% of the available light going to the retina.
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Avatar universal
I hate to burst your bubble, but no lens uses 100% of the light. It seems to be a little impossible since the ocular media absord small amounts.
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Avatar universal
The Array was not a monofocal. However, AMO tells us it is no longer available. 100% of the light is distributed with the ReZoom as it is a refractive optic. I do not dispute that crystalens has better intermediate than ReZoom.
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Avatar universal
I'm back - just found out I got an AcrySof foldable acrylic lens, power 21.5 D, which accounts for my progressive lens glasses still working - think that eye is now just as - if not more - nearsighted than ever. Which is fine, I can continue to use my progressive superlight lens glasses, which cost me a fortune.

Downside: my eye is still sore & feels dry & scratchy (especially in the mornings) but all is as expected. Nothing too bad. Upside: That icky dark yellowish haze is no longer blurring or darkening my world anymore & the halos around all lights are much diminished. My floaters aren't as noticable amazingly enough, I can see every pore & freckle on my hands, arms, face without glasses (hmmm, maybe that's a downside) but using my glasses, can see every leaf on the trees across the street. Everything has a precise clarity I'd forgotten existed.

I found a helpful book today by Dr. Robert Abel called The Eye Care Revolution, wherein he outlines the cause, treatment & prevention of eye conditions & diseases. Wish I'd read it when it came out in '04, but I probably wouldn't have taken the bushel of recommended supplements, lost all my excess weight & reduced/stopped drinking wine then anyway. I sure will now, though!

If changing my lifestyle can delay or prevent another cataract surgery, I'll try it. My surgery wasn't terrible but also not that fun & will cost me big bucks in co-pays. Luckily work at home for my husband now. Would have been very tough to go right back to work after this. Drove a bit on Thursday but it tired my eyes out & needed to rest most of the day afterwards. I'm taking it easy until next week, as instructed by my eye doc. Sure is hard not bending over or picking things up, though. Turns out I drop stuff all the time...

Oh - Dr. Abel's website in case anyone is interested: http://www.eyeadvisory.com/index.cfm

In summary he strongly advocates living & eating as healthy as possible to increase overall & therefore eye health. No brainer, I know, but I seem to be cursed with self-destructive urges. My 83 yr old mother has eaten fresh, natural foods all her life & doesn't have cataracts, isn't overweight, isn't senile, most serious health problem was a benign cyst over one eye. No heart trouble, cancer, nada. Her parents & siblings all died fairly young of cancer, fyi. My 83 yr old dad drinks regularly, never wore hats or sunglasses, eats meat like a caveman, at 65 had a quadruple bypass, since then several skin cancers dug out of his face, arms, legs & now has degenerative rheumatoid arthritis & is bent over w/age. I assume he has cataracts too but he never complains anymore, says he's shot, so what's the diff. His sister & brother ate like frat boys & drank like fish & both had detached retinas & cataracts, both dead of cancer/alcholism-related diseases in their 70's, so in my family I've seen attitude & lifestyle matters alot when it comes to health.

For what it's worth, folks. Good luck to y'all!
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Avatar universal
Honey, you need to take your crown off and do some serious  homework....way off base on ReZoom!!! Where are you getting your numbers?

Crystalens is declining in popularity and marketshare week after week. Yes it can work, but much lower statistics 20% or so I am told by the surgeons that are using it, so surgeon has to be top notch.

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Avatar universal
Shame on you - You have made the array ALMOST a monofocal lens, clever use of re-distributing your zones. You do not have 100% of light rays deduicated to the area of focus that you are trying to see.  Who are you trying to convice? The truth is you cannot hold a candela to the crystalens when it comes to distance or intermdiate vision.  

This is not supposed to be an industry forum to bash competing companies, please keep this forum for which is was intended, patient resources.
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Avatar universal
I am not sure where the Queen is coming from. The ReZoom uses 100% of the light. Maybe she is thinking about something else and it is not the Array.
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Avatar universal
I'm glad to hear how well everything went for you.  Your surgeon must have done great calculations if your old glasses still work.  Congratulations on having all this behind you!
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Avatar universal
Hi--just enjoyed reading your shared comments.
My Retina doctor told me not to have silicone put in my eye(had had surgery for a macular hole).
However, a friend of mine had connections in Washington and she had the Crystalens reserched a; the way back to the patten for it and it was deemed ok for me./
But then my opthalmologist had not learned the procedure for it  yet so  had to go with the regular IOL. It worked out fine.
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Avatar universal
Hi Ladies,

Well, it's been 31 hours since getting my monofocal lens implanted (sorry, don't know what kind yet) and I can SEE!!!! When my doc took the post-surgery patch off this morning around 9:30 (PDT), my eye muscles were pretty sore, and there was some residual soreness in the eye itself, but I was amazed to see the colors and sharpness back that I only vaguely remember. My glasses still work, by the way - told my doc I'm used to being nearsighted, so give me a lens that will not force me into reading glasses. She apparently did exactly what I asked for.

And: whites are white again, not dull vanilla-color. My cheap RCA tv looks to me like the priciest HD models in the stores. Makes me wonder just how long my vision was affected by that darned cataract. Wow. I am VERY pleased with the results and my eye is still swollen from the surgery. After 6 weeks no doubt I'll see even better.

A friend whose father is a retired Opthamologist called me a few hours before my surgery to tell me in 24 hours I'd be feeling fine & seeing better than I had in years, and he wasn't kidding. The operation isn't exactly fun, but it isn't bad either. Way better than getting a dental filling. I was a happy girl right afterwards with the tranq in me, the OR staff got a kick out of my chirpy attitude.

Post Op: I napped most of the day away afterwards. When told to take tylenol for pain, I responded it doesn't do sh*t for me, so she said OK, take some ibuprofen. All I needed was 4 spaced out over 8 hours, fyi. Haven't needed any today. This whole thing had me worried, but I see now what a big baby I was.

I know my Doc tried to put a Crystalens in me but she took it well when I objected. Her good rep as a surgeon is well-earned, she was a pro and I'm not at all hesitant about going to her for my other eye. Have already noticed my vision is yellowish thru my right eye. I'm actually looking forward to having that one done so I can see the world sharply, clearly and in true color again.

Oh - another amazing effect is my floaters actually seem to have diminished. Thought I'd see them more clearly but that isn't the case yet. Perhaps my brain is ignoring them better now that that cloudy lens is gone.

Hope this all helps you - I'll check back in a few days.
Ms Magoo
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Avatar universal
Only 17% of light rays are dedicated to the ReZOOM lens, 100% of light rays are dedicated to the Crystalens.  How quickly people forget, the ReZOOM is nothing more than the Array - No clinical trial was ever done on the ReZOOM, package insert cites Array clinical data.  I do sincerely hope that you do not experience unwanted abberations.  Good Luck.
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Avatar universal
I suspect that medical practice has become so specialized that many practioners are not very knowledgeable about issues/developments outside their areas of expertise.  When I asked my retinal surgeon for advice about IOL selection, he told me to avoid the ones made of silicone but knew little about specific IOLs.  (Actually, he felt that IOLs were "all pretty much the same.")  Probably many cataract surgeons have only limited knowledge about the potential difficulties involved in treating retinal disease post-cataract surgery.

Crystalens hasn't been around that long, and your doctor has undoubtedly not (yet) had a Crystalens patient who subsequently suffered a retinal detachment or other condition requiring retinal surgery.  Still, her choice of Crystalens for you makes no sense to me.  Even if you had come in saying that your main goal was to not wear glasses (which, of course, wasn't the case at all), the importance you placed on having good near and intermediate vision makes ReZoom a better choice than Crystalens.

I think we're living in an era when the responsibility for identifying treatment options and then selecting among them often falls on the patient.  I hope your surgery went well today (and I'm really glad you decided against Crystalens.)


  



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Avatar universal
The warnings cited on the crystalens website refer to certain groups of patients who were were not part of the clinical study.  Generally, clinical studies excludes patients with pre-operative pathology.  crystalens has the best quality of vision of all the premium lenses.  Without doubt it has the best distance and intermediate vision.  My 73 year mother-in-law has crystalens in both eyes.  She loves them, she never wears glasses for distance or intermediate, she occasionally wears them to read very small print, or if she wants to read a novel for a sustained period of time.

Good Luck!

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Avatar universal
Whoa! You've delved way deeper than I did into the Crystalens. I really appreciate your msg & will read that material. It's scary to think I asked my doc point blank re: Eyeonics own statement re: the contraindications for patients w/retina detachments & she dismissed it - said in her practical experience that lens produces by far the best results & happiest patients. She also said my retina guy had given her no bad feedback re: Crystalens.

I was impressed by her assurances but told her I was more concerned with eliminating the negative effects of the cataract than potentially (at great cost & risk) eliminating my dependence on glasses. She said "Whatever you want, I'm not here to talk you into something you don't want" and let it go. If she hadn't backed down then, I had my "I'd feel more comfortable with a 2nd opinion" speech ready.

Her staff are all very personable & professional & have put me at ease re: the surgery, so although I'm pretty nervous about it & worried about the quality of my vision until full healing, I'm sure it will all work out. I'm otherwise healthy & that really helps recovery speed. Hell, much older folk than us have these operations every day & most are extremely pleased. Of course I'll be much happier when it's all over. I'll post another msg to you asap, Jodie!
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Avatar universal
The sutures from my vitrectomy have not entirely dissolved yet, but I've already done a lot of research about cataract surgery for patients at risk for retinal disease.  (This includes all high myopes.) In a representative article, a retinal surgeon strongly advocates the selection of an IOL which is (1) made of material other than silicone and (2) permits good visualization of the retina.  www.evrs.org/pages/meetings2/22.htm

I decided to check out the official Crystalens site to see what the manufacturers say about their own product. (www.crystalens.com)  The following appears under Presribing Information:  "WARNINGS... (8) The safety and effectiveness of the device has not been established in patients with the following conditions:  (e) history of retinal detachment (h) Patients in whom the intraocular lens may interfere with the ability to observe, diagnose, or treat posterior segment (i.e., retinal) diseases."

The Crystalens is probably a good choice for some people, but I can't understand why anyone would recommend it to you when there are safer alternatives.  Good luck with your surgery; let me know how it goes.
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Avatar universal
Hi Jodie,

Thanks for your comments--I've been distracted for a couple days. First off, yep, my retina specialist referred me to the cataract doc & they confer re: retina issues often. His rep is "one of the best in his field", as is my cat doc. Other people's mess-ups come to her for repair for cataracts & Lasik.

Had my pre-Op visit yesterday & I listed several concerns re: the Crystalens. She listened & then told me none of them was an issue for me. I told her I still felt it best to have a monofocal IOL implanted instead--her response was the results won't be as good but if that's what I want, she was fine with it. She was polite, but felt my worries were unfounded & that my results would be better with the Crystalens. She also said she sees no more complications or problems with it than any other IOL.

I stuck to my guns but was weakening before I left. My surgery is Monday. I'm getting a monofocal lens to correct for close-in vision, which mimics what that eye's been doing all my life. Until the cataract formed that eye was seeing great up to inches from my face. I'll still have to wear glasses for distance, but I never expected anything different. I need to have good near vision as I make jewelry, read & use a computer for a living. I was worried about the halos/blurriness some multi-focal IOL recipients report. My other eye has only the barest beginnings of a cataract and it could be years before it needs the surgery.

Phew... not sure what tomorrow may bring, but at least Blue Cross PPO covers 80% of the IOL I'm getting. What do you think?
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Avatar universal
Hold on to those $400 glasses!  They may not turn out to be totally worthless post-surgery.  I just read your comment about floaters in another thread, and I think that some of the comments in this thread may not have been addressing your particular situation.  As I now understand it, you are a high myope with astigmatism needing cataract surgery in only one eye.  I will soon be in the same situation, and I'll share the info I've been given.  The power of the IOL implanted is usually calculated to correct distance vision (i.e., eliminate myopia).  However, a difference of more than 2 diopters between the right and left eye would cause serious vision problems (e.g., double vision, etc.)  Therefore, if I chose to eliminate the myopia in the cataract eye with an IOL, I would have to address the myopia in my other eye, either with a contact lens or some type of refractive procedure (not covered by my Blue Cross).  I've been told that glasses would not work in this situation.  Alternatively, I could choose to have an IOL implanted that would not correct (or minimally correct) my myopia.  

Why not ask your retinal specialist for a referral to a cataract surgeon who has dealt with situations like yours.  (Please don't tell me that it was your retinal specialist who referred you to the doctor that wanted to implant a silicone Crystalens.  This would cause you serious problems in the event of future retinal tears/detachment.)    

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Avatar universal
Thanks very much Dr. Prince, I appreciate the info and your response!

And JodieJ, thanks for your advice. My gut feeling has been to put the brakes on until I have more info about my options. You helped convince me that was the right thing to do. Thanks!
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