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Crystal lens problem
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Crystal lens problem

I recently had a cataract removed and a crystal len implanted. I was told I would be able to see clearly near and distance. I now can only see about 4 feet then complete blur. It has been 1 week since surgury. I could see perfectly up close the day after surgury. No improvement on distance also light seems to intence. A lot of glare night time.Can this be corrected. Thanks for any help
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Avatar_n_tn
I had the CrystaLens HD implanted in my right eye recently and it worked great up until 2 weeks ago. I could read in good light, and had great intermediate and distance vision. Now I can't see past the length of my arm. Essentially I'm blind. Can this be corrected?
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711220_tn?1251894727
It sounds like you have a myopic surprise. One treatment is to use cycloplegic drops to move the IOL to improve you near vision.  If the error is greater than  2 diopter, you might consider an IOL exchange.  This should be done fairly early since the Crystalens haptic get scarred in very early.  

A video of Crystalens exchange.

http://www.youtube.com/watch?v=BC6Jtw04cy0

The cycloplegic drops can frequently correct 1 to 1.75 diopters of a myopic shift.  The next would be to yag the posterior capsule and this would decrease myopia by about .5 to .75 diopter.  The remaining error can be corrected by 1) piggyback IOL 2) PRK or LASIK, 3) mini RK.


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711220_tn?1251894727
You may have an opacity of the posterior capsule.  A yag should be able to
correct the problems

Dr. O
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Avatar_m_tn
Thank you for your valued input. I watched the video you recommended. I meet with the doctor tomorrow and will discuss these possibilities. What time line, is getting to be to late for an exchange of the IOL? I will keep you informed on the response from the doctor.
Thanks again stick1

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Avatar_m_tn
If you are considering an explant and lens exchange, don't get a yag yet. The yag is a permanent prodedure that makes it much more difficult to exchange lenses later.

Did you have any refractive surgery like Lasik or RK prior to having the cataract?
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Avatar_m_tn
Thank you for the input.  I have not had any corrective surgery prior to the implant
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Avatar_m_tn
Also night time halos and reflections have diminished. What would be your choice Crystalens or a quality mono lens for distance? The more I research the more negativity I am finding regarding the multi focal lens.
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711220_tn?1251894727
I have had PRK for monovision and function fairly well.  My near vision has decreased as I am 61.  At this time I would get a Crystalens HD with the dominant set at plano.  

Most eyes will see 20/20 and j1  patients if target is achieved with less than .50 diopters of astigmatism.  If I achieved this in the dominant eye, I would set the non dominant eye target at -.50 and expect 20/25 and J1+

Dr. O.
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Avatar_m_tn
Hi Dr Ray
I met with the doctor today. My vision was at 20/80 last week 2 days after surgery and today is 20/60. Based on your recomodations, we discussed all concerns especially lens exchanged. She suggested possibly a contact!! Which I believe defeats the whole point of the crystalens implanted. She also stated that the lens was made leaning toward near site. Would your opinion be lens exchange before yag . It also seems with the slightest pressure I can focus up to about 40feet.
Thank you for all your help!!

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Avatar_m_tn
Exactly how long has it been since your procedure? Was your eye dilated for a week? afterwards? With my Crystalens, I had near vision first, and distance took a while to clear up. It sounds like your vision may still be improving.

Definitely get at least a second opinion (in person, not on the web :) ) before getting a yag or explanting this lens.
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Avatar_m_tn
Thank you for your Comments and concern!!
It has been 1 week,  with min improvement on distance. Everything I have read most had immediate distance and near came over time. Going back in one week at that time will decide on a course of action.As Dr. O has stated a possible piggy back lens. This is my dominant eye and it is very difficult not being able to see clearly regarding distance.
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Avatar_m_tn
Several of us on this forum have gotten Crystalens HD's and have been surprised to get near vision before far. In my case, the doctor used atropine to prevent my eyes from accommodating while the lens got locked into place. Apparently the lens was temporarily paralyzed in the "near-vision" location as opposed to the "distant-vision" location. This is in contrast to some doctors who allow the eye to accommodate during recovery but simply tell patients "don't focus on anything up close".

After 5 days, I couldn't see well enough in my done eye to drive, so I wore my old glasses and kept that eye closed. My doc said my eye was at -0.75 at that point but due to the dilation it seemed much worse. Looking through a pinhole gave me some confidence that my vision would be ok.

He also said the refraction would continue to shift out as the atropine wore off. It did, slowly. Each week got better until after about a month I started learning how to "push" my vision out farther. I think I used my first eye to drive on day 8 (and perhaps I shouldn't have).

You mentioned that you could see to 40 feet with "pressure". Can you describe that more?

This is a good example of why anyone considering a Crystalens should choose a surgeon who is experienced (has seen the patterns of recovery), and communicative (explains what is happening and what to expect).  I'm not saying yours isn't...just that it's important.

It is good to be aware of your options in case your vision doesn't continue to improve. But my (non-doctor) gut says it's still too early to be seriously considering piggyback lenses or explants. Don't give up yet.
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Avatar_m_tn
What you describe makes sense. It is like the lens is stuck. I am now on a prednisolone drop called omnipred. It is very frustrating being asked to consider a contact lens. It is as you say important to do ones homework. What is your vision now and how long did it take?
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Avatar_m_tn
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Avatar_n_tn
3 yrs ago I had cataracts in both eyes. I had a crystal lens implanted in the left eye (out of pocket cost $2,400) and a standard lens in the right, focused for distance vision (out of pocket cost $0).  I can process the monovision perfectly, with good vision at all distances.  The right eye needed a lasik procedure to correct some residual astigmatism and I have some minor floaters in both eyes, but other than that the procedures were successful.

However, my wife did not have a good experience.  She did not have cataracts, but she absolutely hated her trifocal glasses.  Based on my experience, she elected to get crystsl lens implants in both eyes, at an out of pocket cost of $8,000.  The left eye is OK, but the lens in the right eye did not unfold properly when implanted.   She has severe astigmatism, and still has to wear glasses.  The opthamologist has tried repeatedly to get the lens to unfold, by piercing it with a laser in numerous places, which he said was the manufacturer's recommendation.  He does not want to replace the lens as long as her vision can be corrected with glasses, because the replacement will be difficult and has significant risk involved.  Needless to say, she is not happy that she still has to wear those hated glasses after spending $8,000.  Is there anything you can suggest?
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Avatar_m_tn
If the Crystalens would not unfold, why isn't that considered a defect?  Defects are covered by a warranty.  It seems to me that either the Dr. or B&L should cover the cost of replacement as a warranty claim.  I wouldn't let the Dr. get off the hook so easily.  And, by the way, the reason Dr's charge so much for the multifocal IOL's is for the extra effort they have to expend to make them work properly. It's not just for the IOL.  I paid $4400 for both of my MF IOL's (one CL HD and one Restor)..

Explanting and replacement may be tricky and definitely requires the highest skill possible, but it has been done successfully.  Easier before a YAG capsulotomy though.
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Avatar_m_tn
I'm sorry to hear about your wife's experience. I'm no expert, so don't really have advice, other than to get a second or third opinion from highly qualified doctors.
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Avatar_f_tn
I had PRK about 10 years ago and 5 weeks ago I had the Crystal Lens implant in both of my eyes.  I can see fairly well at the distance, but I am about to lose my mind with seeing things close up.  The doctor said that this will take time.  Is this true?
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Avatar_m_tn
Only suggest a Class Action suit, to which I and several others are interested.
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Avatar_f_tn
This was suggested by Dr.Gary Bodiford to get Crystal lens so I did not have to wear reading glasses when I work at the computer, read, etc... I did not have cataracts (just couldn't see up close very well). I had just started buying the cheaters to wear. I was told by Dr. Bodiford I would never have to wear glasses again and a plus is I would never ever get cataracts. I now must wear glasses when I need to read anything, my vision is very blurry, it's like wearing dirty contact lens or smudged glasses all the time. My Dr's response is your the best 20/20 patient I've ever had in my clinic. Well 20/20 or not I can't see clearly, not even close to what I was seeing previously to this mess. I paid the full amount up front and then found that Dr. Gary Bodiford collected from my insurance also! I called Bash & Lombs I was given a case number and they were to get back with me after several attempts to find something out from B&L they told me they would send me a letter, it's going on 3.5 months and no letter thus far... Count me in on whatever can be done!
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