CRYSTALENS HD LIKELY BEST PREMIUM IOL

[John C Hagan III, MD, FACS]

Reports are starting to come in that the new Crystalens HD is a definite improvement over the Crystalens Five-O. This according to reports from eye surgeons generally considered good clinical researchers. This is the reference: First Impressions of the Crystalens HD, by Uday Devgan, Richard Lindstrom MD Jack Singer MD and Jeffrey Whitman MD Cataract and Refractive Surgery Today November 2008 page 17 volume 8 number 11


What does this mean? For those that have done the research and determined that they wish a presbyopia correction "premium = more expensive" IOL it appears to me that the Crystalens HD is the best available in the USA and that the new lens addresses most of the problems with near vision. The surgeons say they generally aim for residual refractive error of 0.00 in distance eye and -0.37 to -0.50 in intermediate/near eye.

The main research into NEXT generation presbyopia correction IOLs will likely be accommodating like the Crystalens HD and not light splitting multiple image IOLs like the ReStor (not a bad lens for mid range and near vision) and the ReZoom IOL that I do not recommend at all for anyone.

JCH MD

[berrywoo]

Thank you Dr. Hagan for this information.

[Harold14370]

Have they improved the night vision problems we hear about?

[John C Hagan III, MD, FACS]

This article did not comment on night vision. If I read anything I'll post it.

JCH MD

[JodieJ]

This article is available online.  It's hard for me to know how to interpret the authors' opinions, since four of the five authors are paid consultants for Bausch & Lomb (the manufacturer of the Crystalens)!!!  Somewhere in the archives of this site, one of the manufacturers' reps stated that fees for such "consulting" can amount to more than six-figures annually.  (There are several articles in past issues of this journal written by paid consultants for Alcon which praise the attributes of the newest ReStor model.)

[JodieJ]

Sorry, you all--my post above is slightly erroneously.  Actually, ALL of the doctors (Devgan, Lindstrom, Singer, Whitman) who praise the performance of the Crystalens HD in the cited article are paid consultants for Bausch & Lomb!

[John C Hagan III, MD, FACS]

Yes that is an important piece of information. However since they have been using it under investigational program they have the longest experience with it.

I don't get any money from any device maker and have no dog in this fight at all. Our surgeons have been very happy with the Crystalens HD also.

JCH MD

[JodieJ]

The results from the investigational program with the Crystalens Five-O greatly exceeded subsequent outcomes with this IOL.  I hope this doesn't prove to be the case with the HD.  I'm looking forward to reading reports from unbiased (i.e., not paid large fees by the lens manufactuer) surgeons and satisfied patients.

[John C Hagan III, MD, FACS]

Remember that you will not find happy-satisfied patients posting questions on this or other health forums. These forums are a magnet for unhappy people with persistent problems.

JCH MD

[cdn_glenn]

"These forums are a magnet for unhappy people with persistent problems."

BINGO!

I do look forward to the few posts not clouded with anger.  The difficulty with accommodative or multifocal IOLs is that they might not initially function well, leaving the patient distressed and the practioner needing to reassure the patient.  Or later determining if corrective surgery is needed.

In particular, how is reading improved with Crystalens HD?

[John C Hagan III, MD, FACS]

You would need to go to the manufaturer website to see the diagrams and read the claims. My understanding that depth of focus is better by a propriatary mechanism that addresses the weakness for reading vision of the Crystalens.

JCH MD

[walkietalkie]

Just curious, what is the out-of-pocket price of this latest 'premium' lens? Anything with 'proprietary mechanism' means $$$.

Also, if Rezoom is such a bad IOL why is it still in the market? Does that mean that there are ‘happy-satisfied patients’?

[JodieJ]

Not everyone is unhappy with ReZoom.  I've read several posts from satisfied ReZoom/ReStor patients.  There are probably people who are happy with bilateral ReZooms, but they don't seem to post online.

[John C Hagan III, MD, FACS]

Depending on how much you load on your plate ("premium multifocal IOL" plus astigmatism reducing surgery and/or follow up Lasik)  You may be adding $1500-3500/ PER EYE)

JCH MD

[Eye-Kant-C]

I wish I knew why my surgeon was so adamant about pushing me into getting the previous version of the Crystalens when he knew this one was coming out soon, and supposedly is a good deal better. Especially when I didn't have cataracts and wasn't in a hurry. Maybe he was afraid I'd find out that there are numerous problems with multifocal IOL's and I'd back out of the surgery, since I was so uncertain. I wish I would have. Now it seems I may not be able to get close to the vision I had before the Crystalens ordeal for any amount of money.

I also was dumb enough to let him do YAG surgery on one eye, even though I didn't feel that I needed it -- which I didn't -- and now have huge starbursts that I didn't have before. No one seems to be able to tell me why I have this now or have ever heard of such a thing. I gave my surgeon a picture I found illustrating a starburst filter for a camera lens with huge stars coming from all light sources and told him that's what I see now, since the YAG. He said "Wow ... kinda pretty!" I am defeated.

[enian0313]

I am scheduled to have cataract surgery for the right eye on 01/29/2009, but I am not sure that I want to go through it with my current surgeon. I am seeking 2nd opinion with another doctor next week.

In my pre-op appointment, my current eye doctor told me that I am not a good candidate for the multifocal IOL's,  nor would I be happy with the accommodating len either since it doesn't offer good near and intermediate visions. She was pushing me to accept the Monofocal IOL/Glasses option. She was irritated when I wanted to get a better understanding of her choice for me. She didn't explain the different options, including the new Crystalens HD, fully and clearly to me.

I left her office feeling very depressed and insecure with her being the one who would operate on me. It's my eye, I should be fully informed of what IOL will be implanted in my eye and why, and will it achieve what works for me?

I don't think I am asking too much from a surgeon to explain fully and clearly. My feeling is that I probably won't go through the surgery with this surgeon.

[JodieJ]

Several people have posted here recently that their surgeons have stopped using the "premium" IOLs because of their poor outcomes in many patients.  However, if you have done your homework and continue to want a "premium" IOL, I'm certain that you can find a doctor who would be happy to implant them in your eyes.  (Why did the first surgeon feel that you are a bad candidate?)

[John C Hagan III, MD, FACS]

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[enian0313]

The truth is that she never discussed the type of IOL with me during the two years when I have under her care for dry eyes and my complaint of blur vision. She seems so busy that she hardly discuss my condition with me everytime I saw her. This past Friday was the first time she told me that the Monofocal IOL/Glasses option is what will be implanted into my right eye. When I asked for more information, she told me that she had three patients, didn't have time to discuss it with me, had her nurse came in the room to talk to me.

I called my family doctor to get me to another doctor for 2nd opinion right after I got home. Then I started searching the web for more information, this is how I stumbled into this site.

My current eye doctor got her MD in 1995, did her internship in 1996, completed her residency in 1999 and fellowship in glaucoma in 2000. She founded a practice, has great deal of buzz in the great metro area where I live. However, relatively in comparison, I don't feel that she is highly experienced in the field yet. I wonder how long it takes for a new MD to become a real expert in his/her chosen field?

The more I read the posts on this site, the more I feel inclined to defer my surgery for a few more months until I totally understand what I will be getting into.

[JodieJ]

I would not be satisfied with a doctor who had no time to discuss my surgical options.  The archives of this forum contain a wealth of information about options for cataract surgery.  You can use the search feature (upper right corner of your monitor) to learn more.

Everybody's priorities are different.  I had very good results with aspheric monofocal IOLs.  You can learn more about this type of implant by watching the patient education video at www tecnisiol com.  These IOLs can be set for "blended vision" (distance vision in your dominant eye, intermediate in nondominant eye) to minimize your dependence on glasses.  My friend who has this type of correction only wears glasses for prolonged reading or seeing tiny print.  If you have significant astigmatism, you should ask the surgeon about correcting it at the time of surgery.  The Crystalens HD, a "premium" IOL option, is reputed to provide good distance and intermediate vision (but variable near vision), although some people have had problems with glare and halos.  I hope you get referred to a doctor who will explain all your options and address your questions and concerns.

  

[enian0313]

Thanks for sharing your experience, I found this site is very helpful, at least I am not alone. I will update my status after next Tuesday's appointment with another doctor for 2nd opinion.

[starman6600]

Dear Dr. Pernoud,

I have read some of your postings and appreciate the good information that you share with others.  I do not have cataracts but am interested in improving my vision.  Please allow me to elaborate.

I am a 67 y/o male who has had RK (15 years ago) for myopia correction in my left eye, my dominant eye for distance, and Lasik (8 years ago) also in my left eye.   I also had RK (15 years ago) in my right eye, for a monovision outcome.  I was very satisfied with the outcomes of these procecures.   In the past eight years since my Lasik, I have become farsighted (+1.50) in my left eye.  At this time, I am interested in determining the best procedure for improving the distance vision in my left eye.  I have communicated with Dr. Hagen somewhat and he has been very helpful in sharing his thoughts.  I would like your thoughts as well if I may.  Here are my questions:

1.  What is the best first step ( Lasik, IOL, etc.) to take so that I can possibly keep my options open in the event that the first step is not successful?  

2.  If you recommend an IOL as my first step, I understand that prior RK patients are not good candidates for a multifocal lens.  Do you agree?  Do you have any suggestions as to how I can determine which monofocal lens would be appropriate for me.  Dr. Hagan is positive about the Tecnis.  

3.  Would there be any point in waiting for a year or so in order to see if a lens with better technology becomes available?

4. Do you have any suggestions as to how I can find a very good physician to perform the surgery?

Thank you in advance for any thoughts or suggestions that you may be able to share with me.  

Frank

[starman6600]

Please excuse my placing the above post to Dr. Pernoud in this location.  
Frank

[mike230]

I am a post RK patient of 1989 which corrected -1 & -1.5D myopia.  The outcome was great, as I turned 48 I had a hyperopic shift +1.25D in each eye with .75D astigmatism.
At age 50, my corneas were declared stable.  I had the crystalens HD 500 implanted in my right eye with an LRI (limbal relaxing incision) astigmatism correction.

With that said, being that you have had prior refractive surgery, the calculations were set for -.50D myopia and my refraction is perfect.  I maintain a strong 20/20 and the ability to read 20/15 for distance, 20/15 intermediate and J1 for reading.

Aiming for 1/2D myopic is a good insurance policy which will buy you many years of good vision should you continue to drift hyperopic (farsighted).  If being -.5D actually has me off, the crystalens will accommodate that difference.

I had this lens implanted 8/08.  This is my experience as an RKer.  Hope this helps you
Mike

[John C Hagan III, MD, FACS]

Starman6600

Dr. Pernoud will not see it in this conversation thread. Post the question separately on an ODD number day for a Pernoud answer.

Also when "conversations" go on this long we can no longer monitor all the the long threads.

JCH MD

[starman6600]

Thank you Dr. Hagan.  I appreciate your help.

[starman6600]

Thank you Mike.  This is very helpful information.  I appreciate very much hearing from a kindred spirit.  After goofing with placing my post in this thread, I started a new tread using "Hyperopia, RK, etc. "  Thanks again Mike.  Best wishes, Frank

[John C Hagan III, MD, FACS]

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[Damon107]

Thought I could add a bit to the discussion. Approx 14 months ago I had Crytalens 52 implanted in my right dominant eye after 50 year hx of myopia. I was a -7.0 with contacts.
Truly minimal accomodation and inability to read better than J3 with extreme effort. However distance and mid vision was incredible from 20/20 or 20/15. No blur, no halos no night difficulties at all.
My left eye progressed to dense cataract over next 14 months so my discussion with  ophthalmologist covered Crys HD. Based on this column I insisted on at least a 1.25-1.5 diopter difference from plano to mild myopia. I stressed that selling points from Bausch and Lomb do not make a great lens. I measured out as needing a +11.5 but instead a +13 HD was implanted just yesterday.

Even one day post op I have better reading capability from my left eye than with my plano R eye.
Of course my eye surgeon at CorrectVision here in S. Florida deserves some credit. (No I don't work for him)
The eye is still dilated with some glare and swelling but it is extremely clear and should only improve with time.  The focal point seems to be sharper than the AT52 and I have not noticed any awareness of edges.
I doubt accomodation is happening yet, but the advice of Dr Hagen to insist on at least a 1 diopter decrease....forget what the company claims...is dead on.
Hope this helps. I am going for one day post op exam later today so I will have more details.

[John C Hagan III, MD, FACS]

Thanks for the comments. The national experience with Crystalens HD indicates that with bilateral implantation to get good near vision one eye needs to be left myopic anywhere from -0.50 to -1.00.

JCH MD

[Mark060656]

I am a 52 year old male highly myopic -12 in contacts and + 2 in readers.  I do no  have astig. in either eye.  I have been thinking of getting RLE since I am highly motivated to get out of my glasses and contacts.  If I had the choice I would prefer great distance and interm. vision and if I had to I guess I could use readers for up close. but I would prefer good vision at all ranges.  

My question is how do you determine what lens is the best for me.  Would the new crystalens HD be a good choice for me and finally what questions should I ask my refreactive surgeon, thank you

Mark

[John C Hagan III, MD, FACS]

Assuming you understand the risks involved and understand the increased costs and possible complications and night vision problems of any multifocal IOL then the Crystalens HD with one eye set for -0.25 and the other at -1.00. Would be a good choice.

JCH MD

[Mark060656]

Thank you for the response to my post above, I am rather new to this forum and have just started investigating RLE as a solution to my high myopia.  It appears that you do not favor this procedure unless you have cataracts. Since cataract surgery is very common I was under the impression that this surgery (while never without risks) was fairly straight forward since it is done so frequently.   Are the risks different for someone with clear lens and higher myopia (remember I am -12 in contacts) and 52 years old than an older person with cataracts.  Struggling to understand,  thank you for your patience.

[JodieJ]

During the past 1-2 weeks, Dr. Oyakawa has made detailed comments about the Crystalens HD.  He is a big fan of these IOLs, and he stated that they would currently be is first choice for his own eyes.  (I believe that the initial subject for this thread was about ReZoom success.)

I'm not an eye care professional, but based on many posts on this forum I'd be wary about getting the Crystalens HD if I had larger-sized pupils (more common in "younger" cataract patients).  Since the Crystalens has a smaller diameter than other IOLs, some people posting here have had terrible problems with edge glare and halos in many lighting situations.  Check the archives to learn more about this.

[Ray T Oyakawa, MD]

Mark,

RLE has retinal detachment as the main risk in a hi myope, especially male less than 50 years old without a posterior vitreous detachment.  Most patient this age has some cataract.  The beginning of a cataract is when you loose the ability to see at near (accommodation).  Next, the lens slowly becomes harder and cloudy and when vision can not  be corrected to approximately 20/40 or glare testing results in a vision of less than 20/40; it is considered a clinically significant cataract (Insurance and Medicare will pay for it).  This is a general rule and there are exceptions.  Severe anisometropia or uncorrectable double vision, etc.

I put in Crystalens 50 in a 51 yo male two years ago.  He was about -8 ou with axial lengths of over 28mm with 20/25 cataracts.  One year after surgery I yagged both eyes and one eye developed an inferior retinal detachment.  He had a HMO, but fortunately, I knew the retinal group who did the work and I contacted the senior doctor to see him( after I got approval from the general HMO ophthalmologist- I also knew this person).  He did well and maintained his 20/20 visual acuity.

JodieJ,

Regarding the optic size.  Dr. Jack Holladay (the optics guru--Holladay I and II formulas for IOL Calculation) stated the posterior position of the crystalens gave an effective optical zone that was similar to a 6mm optic.  This lens sits more posteriorly than other IOL-near the nodal point compared to standard IOL.

Clinically,  the I found more problems with crystalens after a YAG unless I make the YAG much larger than usual.  I have had patients have asymmetrical symptoms after a yag and when I enlarged the yag in the area corresponding the symptoms-they resolved.
  

[JodieJ]

You are convincing me that many (most?) of the worst problems involving multifocal/accommodating IOLs described on this forum might have been avoided if the surgeon had been more skilled and experienced.

[Ray T Oyakawa, MD]

Yes, yes, & yes,  Pick a surgeon who also does LASIK.  They are more willing to enhance an residual refractive errors.

For multifocal IOLs, if you elminate patients who drive a lot a night, have unrealistic expectations, take antidepressants, do a PAM test and exclude anyone with PAM test less then 20/25 (or OCT on all premium IOL to rule out subtle macular problems-A must), appropriate pupil size,  hit target, and eliminate astigmatism,  90+% will be happy. These unhappy patients are the ones who do not neuroadapt and pilo or Alphagan did not help-some of my ReZoom and Array patients took up to one year to neuroadapt with a lot of post operative chair time hand holding.    Post operatively, you need to spend time with patients and answer their questions, manage their dry eyes (especially with LRIs),  and treat any residual astigmatism with LRIs,  enhance refractive errors with LASER or two cut RKs.


For Crystalens patients pupil size (not too large-uncommon) is not as important and macular function is not as critical since the Crystalens and monofocal give essentially the same vision with the same surgical results.


Most surgeons do not spend enough time with their follow-up data.  Many surgeon I know do not optimize their a-constant and look critically at their post op data.  Post op visits are no charge and many physician do not spend the time to look at their results.

Crystalens requires a more consistent surgical technique with a large capsularrhexis, posterior vaulting of the IOL at the end of the case and minimal shallowing of the AC during viscoelastic removal--if it occurs rocking the IOL to seat in the fornix of the capsular bag.  Near perfect surgery is needed!

[Mark060656]

First many thanks for you response and educating me.  So I am a bit of a numbers guy in fact I am an accountant spend lots of time looking a a computer screen.  So I am looking a the crystalens hd product and I understand the first thing I should find is an excellent surgeon who does lasik.  I have the following questions for  you

1.  I have two appointments set up as of now ( I live in the Philadelphia PA area), one with Dr. Richard Tipperman (who I believe doesn't use crystalens) and one with Dr. Stephen Seipser who uses all lens.  Are you allowed to comment on your fellow surgeons and if so can you comment on the above and or suggest others who you feel are excellent in the Philadelphia area.  If not what questions should I ask a surgeon to qualify them.

2.  You mentioned that in RLE retinal detachment is the biggest risk, so being a numbers guy can you tell me the percentage of  RLE in high myops (I'm -12 in contacts) result in detachments.

3.  Are halos and starbursts a big concern with RLE as they are in Lasik.

Thanks a gain for your patience with me, big decision.

Mark

[Ray T Oyakawa, MD]

1)  I do not know either surgeon personally.

2)It depends on your age, axial length and the presence or absence of a posterior vitreous detachment.


3)  Your halos and glare should be less than LASIK for -12.00.  Less likely is your pupils are small.

[Ray T Oyakawa, MD]

I forgot to mention that you should have your retina examined by a retinal specialist and let him know that you are considering RLEs in both eyes.

[Mark060656]

I visted a refractive surgeon yesterday who deals with the Restor lens. He said that he prefers this lens over Crystalens because of its design that it is more secure an that Crystalens can drift off center because of its center.  He therefore doesn't use Crystalens.  He said he had no financial interest in pushing Restor just liked the design better.  Any comments from the docs whether this is accurate.  I was under the impression that the Crystalens HD product could provide better vision results than the Restor product

[peakhope]

I'm not sure about the etiquette for this board, but you might want to start a new thread for your question(s), as this thread is a bit crowded.

My understanding (I'm not a doctor) is that inserting a crystalens is more challenging, and keeping it in place for the first couple weeks is important. My doctor "paralyzed" my eye for about 2 weeks to let the lens get locked in, but not all doctors do that.

If I were going to get a crystalens (and I did), I would choose a doctor that has done lots of them, and likes them (and I did).

[John C Hagan III, MD, FACS]

The Crystalens is more challenging to put in the eye (has moving parts). Restor is a good lens for near and intermediate but not for distance and has been associated with waxy vision in some cases.

In the study that we will post in public access areas that will be in the Jan/Feb 09 Missouri Medicine medical journal complaints about the results of surgery were 10 times more common among multifocal IOL patients than monofocal but the frequency of insertion is 93% or 92% monofocal and 7-8% multifocal.  It doesn't take a supercomputer to figure out that multifocal are generating many more complaints than monofocal.

JCH MD

[Mark060656]

Dr. Hagen so the way you would go if monofocal at this point.  What monfocal lens provide superior results meaning very good intermediate, distance and night driving.  I am an accountant I look at a computer screen most of the day.  I wouldn't mind readers but the other areas of vision would have to be very good for me to go with a RLE operation.  Finally how long would I have to wait in your opinion before a multifocal lens comes along that solves all aspects of vision in a superior way.  As I said I am 52 I have the beginning of cataracts (enough for insurance albeit very minor) but decent visoin with glasses and contacts now.

[John C Hagan III, MD, FACS]

If you mean with glasses (progressive bifocals) yes good vision all three distances. If you want some glasses independence then you could choose mini-monovision with near bias. You can use the search feature to read about this option. I suspect it will be about 5 years before multifocals are good enough that they become more popular. This year in a survey of US eye surgeons multifocals were LESS popular than 2 years ago.

JCH MD

[Mark060656]

Dr. Hagen, so after careful research, it appears if I want to go forward with RLE, in your opinion monofocal lens are the way to go (is this correct).  I am looking for the best monofocal lens available to provide intermediate and long distance vision, also with very good contrast and depth of field.  What lens would you recommend?  I understand that I would need readers for close up work, thanks

[John C Hagan III, MD, FACS]

The way most of my patients choose is use a high quality monofocal IOL our practice used Tecnis aspheric  the distance glasses is set for -0.25 and the intermediate for -1.25.  With that distance and intermediate ae generally good without glasses.

JCH MD

[Mark060656]

Dr. Hagen - and with a monofocal lens, is the depth of field and the contract vision superior than that of the present mulitfolcal IOL's?

[John C Hagan III, MD, FACS]

The depth of field with a multifocal changes by moving the focal point a monofocal has a stationary DOF.  Contrast sensitivity is better with a monofocal.

JCH MD

[cdn_glenn]

Please forgive me for amending the above post.

"The depth of field with a multifocal changes by moving the focal point"
should be:
"The depth of field with an accommodative IOL changes by moving the focal point"

A multifocal IOL, like monofocal, has a stationary depth of field.  The recently FDA approved Tecnis aspheric multifocal IOL has increased contrast sensitivity, similar to its monofocal namesake.  Other negative issues with this multifocal IOL are the same.

Monofocal IOLs are the most reliable for both the patient and physician.

Still the Crystalens HD is sounding very favourable with the right physician.  See Dr. Oyakawa's detailed posts above.

[Mark060656]

thanks for your replies Dr. Hagen, how would I go about finding a superior surgeon in the Philadelphia PA area, I would like someone who does both crystalenshd and also monofocal lens.  Is there published listing. or what questions should I be asking the doctors I visit

[John C Hagan III, MD, FACS]

Every cataract surgeon does monofocal IOLs, only about 8% of IOLs in the USA are multifocal. I would talk to friends that have had cataract IOL surgery and ask their experience, ask your family physician, check out www.aao.org to be sure he/she is a member of the american academy of ophthalmology.

Anyone on the faculty of one of the many medical school in Philly is likely quite good. If necessary visit two or three potential surgeons to see whom you feel comfortable with.

JCH MD

[Mark060656]

Dr. Oyakawa:

First let me thank you for your past replies.   I am visiting a second surgeon tomorrow who deals with all lens for RLE and cataracts.  As a reminder I am a highly myopic 52 year old male (-12 in contacts, +2 in readers, virtually no astigmatism). I am interested in RLE for better vision and getting rid of glasses and especially contacts.  I have visited one surgeon who specializes in ReStor lens and he said that I had the beginning of cataracts (minimal but enough for insurance) so that RLE would be the way to go.  Now my decision seems to between a superior monofocal lens and the new Crystalens HD.  I guess I could live with readers but if I am to go through with RLE I want very good intermediate, distant and night vision with good contrast and depth of field.  If you were me, what would you do (ie the new Crystalens HD or a monofocal lens - please recommend your preferance for the brand of monofocal lens you prefer.  Obviously this is a tough decision for me and I want to get it as right as I can.  If there is other information you need to know please advise.  Thanks for your patience with me and your appreciated advice.

Mark

[bobanlou]

Hi Jodie,
I'm a 66 year-old male with a cataract in my right eye that needs to be removed.  I'm mildly myopic, i.e. -2.00 diopters, and have been so for all of my adult life.  I've ruled out going with a multi-focal lens.  I'm torn between a monofocal IOL and the Crystalens.  I recently had my eyes examined by two different surgeons, and both of them recommended the Crystalens.  One of them, however, recommended the 5-0 version of the lens rather than the new HD, while the other recommended the HD (although he had no first hand experience with it).  The surgeon that recommended the 5-0 said that the experience in her practise has been that the HD seems to sacrifice distance vision in order to get better near vision.  She said that there was a "button" at the center of the HD that is not there on the 5-0.  I've searched the internet for an explanation of the changes that were made to the 5-0 to come up with the HD, but have not found anything.  Do you, or anyone else, have any info on the technology changes leading up to the HD?

[John C Hagan III, MD, FACS]

Mark if you want Dr. O to answer your question post it as a new post on an EVEN day.

JCH MD

[JodieJ]

Dr. Oyakawa is really the forum expert about the Crystalens, and you should direct your question to him.  I've read that the newest HD version provides the best near vision.  I believe that both the Five-O and the HD provide crisp distance vision if the surgeon hits the targeted refraction (near plano) and eliminates astigmatism.

[bobanlou]

Thanks for your prompt response.  I'll redirect the question to Dr. Oyakawa.  I asked you the question first because of all the commenters on this forum, you seem to be the straightest shooter.

[John C Hagan III, MD, FACS]

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[John C Hagan III, MD, FACS]

Dr. Kutryb and I are publishing our second study on "premium" IOLs and Crystalens HD is best,  ReZoom is WORST.

JCH MD