Crystalens HD IOLs for cataract surgery?

[askadvice]

I am scheduled for cataract surgery in both eyes.  Best IOL my doc recommends and uses is ReZoom (he also works with Tecnis).  I read on the web that Crystalens HD has just been FDA-approved in June 2008 and is the superior product on the market.  I would be grateful for any advice.


This discussion is related to Restor Lens: Potential problems.

[earl2643]

I had the emplants done about 5 weekds ago..I am not a happy camper...blurred vision when trying to read and see computer screen...large halos at night around on coming cars...goes away when they get even with our car....I got the multi lens  TECNIS....my left feels like it has something going on with it...I have been the steroid drops and now doing two drops a day in each eye....I just wonder if it will get better as time goes by....like now I have the pc set at 84% to see it and looking at the keyboard is not good...I am having to strain to do a lot of my work...and it is not working...was I expecting too much....does healing take longer than I thought?????
  LR

[bstaggs]

Just thought I would update everyone, after the YAG on the left eye with the Crystalens everthing stills seems good. Very happy with the pair (Crystalens/Restor), praying it may good fortune continues.

--
bstaggs

[allmymarbles]

I have been following this forum for several months because I am going to have to have cataract surgery. I have decided on the acrylic Tecris aspheric monofocal lens because those who have it are happy with it. From what I have read on this forum, problems are common with Restor and Crystalens and one of the doctors is totally against ever using the Rezoom. One of my brothers and one of my sisters had cataract surgery and chose monofocal lenses. Both are delighted. From day one they had no problems.

[rjf973]

I'm a 48 and had a crystalens implant in my right eye about 2 years ago due to an old injury that resulted in a cataract. I have a lot of problems with indoor florescent lighting and generally flee the building after 20 minutes or so because I can't stand to be in there. Feels like a weird pulling sensation and a kind of motion sickness. Headlights and neon signs at night are a big problem too (Halos)   I have to wear glasses to read and have had YAG laser for opacification also. My vision is excellent from about 3 feet or so. I just wonder if there is anything I can do to aleviate the problems indoors. Also driving at dusk give me the pulling sensation also. Is anyone else having the same problems? Any suggestions??

[crystannot_lens]

You too? I'd say to all, stay away from Crystalens. Huge problem with right eye and B&L avoids the issues. B&L also does not disclose any of the problems which they have "known" about for a long time!
Unless you like to feed dishonest companies that are only interested in ripping you off!

[mmrudy]

Great photo! How did you focus your camera to get it?

Sheer curiosity on my part, but do the starbursts that you see decrease as you come closer to the light sources?

I see starbursts (not as big as in the photo) at night and find that they increase in size as I approach the source, then diminish as I get even closer.  If I look at light sources w/o glasses, I see a semi circle of holiday lights. These seem to be caused by a cataract combined with moderate astigmatism. Weird and sort of fascinating.

[Eye-Kant-C]

PLEASE, don't do the YAG unless you absolutely have to. I just had it done 3 weeks ago after my doctor also laughed off my concerns. (About detached retina, etc.)

I have had nothing but problems with the Crystalenses and now have HUGE starbursts after the YAG. Here's a link to what it looks like. I guess it's caused by laser scuff and I don't know if anything can fix it.

Don't do it!!!

http://i15.photobucket.com/albums/a358/bkchickenboy/moms%20pics/eyes.jpg

[JodieJ]

Don't feel pressured to decide.  You can postpone doing a YAG for as long as you want.

[bstaggs]

I know that this is probably silly, but I have read about the fluid behind the lens membrane pushing the Crystalens forward (which is made to move by design) and causing problems after a YAG.  I discussed this with my doctor and he smilingly said that he has done hundreds without incident.  He also told me that he makes the YAG hole as small as possible with the Crystalens though. I am also concerned about possible "laser scuff".  

Honestly the more I read about YAGs the less interested I become.  I was born with cataracts and my eye sight progressively worsened all my life.  My new found vision is such a blessing that I am hesitant to role the dice.

There is an air of permanency about the whole YAG procedure that makes me nervous. If I understand correctly, having a lens replaced after a YAG is much more complicated. Again my doctor seems to believe that my fear is misplace.  Especially considering that with the cataracts I had there was a high risk of tearing the lens membrane during the removal of the cataract itself.  In his mind I have already taken a much bigger risk by having cataract surgeries in the first place.  But as I have told him, my vision had gotten so bad that I had little to lose.

I will have to resolve my issues shortly as I have a six month follow up in November and I am certain that he will want to do the YAGs.

[JodieJ]

Re the Crystalens eye:  Why are you reluctant to YAG?  It might improve your indoor vision. Other Crystalens recipients have reported that their night vision problems have diminished over time.

Your ReStor results are fantastic.  

[bstaggs]

My vision from the Crystalens is as follows:

Distance is great except indoors under low light (large indoor buildings).  I believe this has gotten worse since the surgery. Doctor told me that I was going to need a YAG at my last visit but I am reluctant to comply.  

Mid range is super (details like I have never seen before) under all conditions.

Close up is not good.  I wouldn't be able to read a newspaper or a normal print book without glasses (Thankfully the Restor does this very well)  I can tell that it does try to focus, it just stops short of being able to pull it off.  Some have said that it may get better in time, but I am not holding my breath.  

Contrary to what others have experienced, I have much more side effects from the Crystalens (Glare, Flares & flickers) than the Restor (light Halos from pointed light sources only).  The side effects from the Crystalens might actually cause me to be reluctant to drive at night if that is all I had.  With the Restor I hardly notice anything at all.  

Honestly if I had only the Restor or only the Crystalens I would be less happy than I am now.  They seem to be complementing each other very well.  The Restor's weak point seems to be mid range and that is where the Crystalens is at it's best.  The only real shortcoming of the pair (other than the previously mentioned side effects) is that the Restor's near vision stop just before the Crystalens' mid ragne start working well.  So I have a windows of a few inches between near and far that could be better.

I work behind a computer all day and read ALOT in my spare time and since the last surgery I have not worn glasses period.  As I read on this forum and see that not everyone has had the same results I feel doubly blessed.  

[JodieJ]

www visiometrics com/abu/pdf/OQAS%20papers/Reducedcontrastsensitivity.pdf

I don't think this site might censor the link, even with the dots omitted.

Google the following sequence:  multifocal iol light sharing

You'll find the Larkins article at visiometrics com.

[cdn_glenn]

Could you please provide a link to the Larkins article?  I would be interested in reading it.  Thanks.

[cdn_glenn]

I know exactly what you mean regarding reading under dim light.  It's good.  It doesn't appear to manifest itself as a loss of contrast, as much as the text looking a touch unsharp.  That is under -extremely- dim lighting.

Regarding better distance vision with the ReSTOR eye vs. the Crystalens eye under low light conditions:  it's the design of the ReSTOR.  The outer ring is refractive, and focused for distance.  With a dilated pupil in you should be looking through that ring.  That also could reduce the amount of halos, etc. you encounter in night time situations.

http://www.acrysofrestor.com/apodization-diffraction/restor-lens.asp

It looks like your surgeon got your prescription spot-on for that eye.  Congrats!

[JodieJ]

According to the Larkins article, the loss of contrast sensitivity results in ghosting, "waxy" vision, halos, and a general decline in vision quality (i.e., loss of fine detail).  The impact is reported to be greater in low light conditions.  I can imagine that there are significant individual differences in visual experience.  (The gain, of course, is in the ability to see both near and far without glasses.)

Bstaggs, I've read that it's easier to read with ReStor in bright light.  Maybe your excellent reading ability is attributable to pupil size--who know?  ReStor is supposed to work best with small pupils, and you seem to have had an outstanding result with this lens.  Congratulations!  Is your vision plano with your Crystalens eye?

[bstaggs]

I was informed by my doctor (prior to surgery) that due to the nature of a multifocus lens splitting the light for more than one image, I should expect some loss of contrast and would probably need good light to be able to read.  Oddly enough that has not been the case. I have not experienced any contrast issues. I can even read a menu in a dimly light restaurant.  

Another issue that I find odd is that very often in an indoor situation where light is marginal and at distance (large Church or other venue) I can see more detail with the Restor vs the Crystalens.  I would have thought that since the Crystalens is essentially a monofocus IOL with the ability (or arguably, lack thereof) to move, and not dividing the light the way a multifocus does it would out preform the Restor in low light.  ??

[JodieJ]

It's not MY generalization.  In fact, it was the topic of an address made last year by Dr. Woodhams to a session of the American Cataract and Refractive Surgery Symposium.

I realize that the Tecnis multifocal IOL is aspheric, which does improve contrast sensitivity somewhat.  But it's the the light-sharing feature inherent in the design of multifocal IOLs that I was referring to.  Please take a look at the paper by Larkins which I sited above.  It provides a far more articulate explanation than I could possibly write.

[cdn_glenn]

You said, "All of the multifocal IOLs involve a loss of contrast sensitivity."

I have proven increased contrast sensitivity with multifocals.  It is a design feature of the IOLs I have implanted.

I disagree with your generalization.

[JodieJ]

There are many professional papers which discuss the light-sharing feature involved in multifocal IOL design.  One of the better ones is Howard Larkins' "Reduced contrast sensitivity will dim the future for multifocal IOLs."  (His discussion does touch on "waxy" vision.)  Try entering the following into Google:  multifocal iol light sharing.  

Unfortunately, it seems that everything that expands the range of focus for IOL recipients involves some kind of compromise.  Full monovision with monofocal IOLs sacrifices some acuity and depth perception.  Accomodating IOLs seem to have limited accomodation capacity.  All of the multifocal IOLs involve a loss of contrast sensitivity.  I think we need to establish our personal priorities and choose accordingly.  There's no "best" solution for everyone, but it sounds like you've found one that works for you.  

[cdn_glenn]

I think this is the link for the discussion I was referring to.  It's on AC Lens Contact Lens Forums.  The resident physician Ag-i-doc describes the effects of annular and aspheric design on vision with soft multifocal contact lenses.

http://www.contactlensforums.com/default.asp?sub=show&action=posts&fid=7&tid=47648

[cdn_glenn]

I don't understand where you equate "light sharing" with "loss of optical quality".  I have read a similar discussion regarding multifocal contact lenses and there is some consensus this is true for multifocal contacts.  However, from first hand with multifocal IOLs is that when I see clearly it is very clear.

Both the ReSTOR (first 3.6 mm) and Tecnis (all 6 mm) multifocals are diffractive.  They focus both near and distant images on the retina, and leave it to the human mind to separate.  You mentioned that, "Only a fraction of the light entering the lens is used to produce an image."  If this were so I would be living in the dark.  But to clarify my surgery was for a CLE.  There was definitely a drop in light throughput between the natural lens and the IOL.  The best way I can describe it is "ten watts".  The bulbs in my living space were 60W long life incandescents -- I think that works out to 51 watts of light output to give those bulbs the long life.  I had to do a fair bit of shopping and trial & error until I found the perfect bulbs to replace the ones I was used to.  I now have the compact florescent equivalent for everything updated.

I will agree that the same split image seems to be the cause of glare, halos, ghosting etc.  Again many seem to neuroadapt to these issues.  Some never do.  Time seems to be the greatest issue.  They simply don't work 100% immediately.

JodieJ:  I would like a clear definition of "waxy vision".  I have experienced something I refer to as waxy vision.  Several people have reported this.  For some it has also gone away with time.  There were a few where I also would have been concerned after that length of time.

For the ReSTOR I'm still wondering if waxy vision is associated with pupil size.  The ReSTOR lens uses two strategies: the first 3.6 mm are diffractive multifocal, but the outer ring is (I think) refractive set for distance.  There are two reasons why the outer ring being set for distance would be beneficial.  Firstly, when one looks at distant objects the pupil naturally dilates (I have to find and post a link to the same discussion I mentioned above) and secondly, I believe this might be a strategy to improve night vision.  The eye would default to the distance ring when the pupil is dilated.  Also this may be why many report difficulty with the ReSTOR lens in low light, yet others are unaffected.

Regards,
Glenn

[cdn_glenn]

I have multifocals (Tecnis not ReSTOR) and also have had excellent experience with them.  Both day and night vision are excellent.  It is wonderful to see both near, fine detail and distant scenery.  I do miss the mid vision, but have adjusted my life around it.  Halos at first were an issue, but I rarely see them now except around distant lights at night; also prominent around halogen headlights.

Nice photo of the halo.  They were that strong at the beginning.  Interestingly I could not see anything but them.  Now not only are they less prominent, but I look through them.

Several posters on MedHelp reported waxy vision.  I'm not sure JodieJ's hypothesis (I'll address that shortly) is the reason.  I did have waxy vision -- not certain this is exactly what JodieJ is referring to -- in one eye for a couple of weeks after surgery.  It simply went away.  There was a mention of "lack of contrast" and in my experience there was no lack of contrast.

bstaggs:  How do you find the contrast in your ReSTOR eye now?  I actually have greater contrast with my Tecnis multifocals due to the nature of the IOL.

[JodieJ]

Yes, the new ReStor multifocal is aspheric, which reportedly gives a little boost to distance vision (over the older model ReStor).  However, it still incorporates the light sharing feature that is inherent in all multifocal IOLs.  Only a fraction of the light entering the lens is used to produce an image,  This is what is responsible for the loss of optical quality (as opposed to a monofocal IOL) and the complaints about glare, halos, "waxy" vision, etc.

Although monovision works for most people, it's not for everyone.  I'd expect that monovision would provide better quality vision overall (and better distance and intermediate vision), with a MUCH lower incidence of post-surgery problems (glare, halos, etc.)  ReStor might be better for reading very small print.

[bstaggs]

I can't say how a Restor would preform against a monofocal IOL since I don't have a monofocal IOL , but I can say that the Restor I have (Restor in one eye & Crystalens in the other) works pretty much as advertised.  Great close vision (I can read very small print) and distance vision is very good.  Mid range vision is not as good as the Crystalens ( I would need glasses to use the computer if I only had the Restor) and I do get the halos from pointed light sources. ( I will try and post a link to a graphic which shows pretty much what I see @ night with the Restor, but I think I have had trouble posting links here before, so no promises)

http://www.staggs.net/images/halos.jpg

www.staggs.net/images/halos.jpg

While they (the halos) did take some time to get used to, they are nowhere near as bad as the glare I get from the Crystalens and night driving is not a problem.  I have not experienced the "waxy" vision or low light contrast problem that some have. Unlike the Crystalens, they have worked from day one.

Based on my own experience (Your mileage may vary), If I could not have the combination that I now have (which has me glasses free but at the cost of Crystalens side effects) I would take the Restor over the Crystalens as I would then only need glasses for computer work.

Jodie:  not sure if you are aware, but I "believe" the newer Restor are "Aspheric" as well.  At least that is what I gleam from the specs I have read and also the Alcon website. Assuming that is what "Positive Corneal Spherical Aberration: Aspheric Optic" means.  Am I incorrect?

http://www.acrysofrestor.com/acrysof-restor-iol/restor-aconstant.asp

www.acrysofrestor.com/acrysof-restor-iol/restor-aconstant.asp