Crystalens HD unpredictabilty or degradation

[hkphilip]

I live in Hong Kong, have cataract and have been trying to choose between multifocal IOLs and Crystalens HD. I tend to prefer Crystalens because of its advantages in reading computer screens and less halos, while realizing its shortcomings in near vision (40cm and under).
As Crystalens HD is still kind of under a trial peroid in Hong Kong, it may be more convenient for me to have surgery in Singapore which has passed the trial stage.
A doctor in Singapore just told me, based on his experience, it is difficult to predict the results of Crystalens. Many of his patients were happy just after the surgery, but after 1 or 2 months, the performance slipped. Some may have changed from very good near vision to say 200 degrees. Some had perfect long vision but had to wear glasses later. It is somewhat like loss of accomodation after  1 or 2 months.
He said the biggest problem is unpredictability. He normally aims at 0 degree, but the result after 1 or 2 months may be minus an unpredictable degree and in a unpredictable way (-100 degrees?  -200 degrees? -?degrees?  in near vision?  in long vision?  in?vision?)
For multifocal lens, while they have many shortcomings, they are predictable.
These comments are a big surprise for me as I have not read similar comments by U.S. patients and doctors.
Certainly no patients including myself would like to implant a premium IOL which "degrades" or loses most or many of its advantages in just 1 or 2 months after surgery.

If this "unpredictability" or "degradation" problem happens in  Singapore, I cannot see why it does not happen in the U.S. or why I have not seen it on the internet.
For the benefits of all cataract patients, I would truly appreciate anyone, patients and doctors, to share his/her experience or what he/she has heard on this issue.

[hkphilip]

Thank you very much for your comments.

Unfortunately, I have Grade 4 (out of a maximum of 5) dense cataract in my right eye and cannot wait.

Since your comment, another doctor in Singapore also told me Crystalens HD is unpredictable.

After carefully reading your comments, I have the following questions:

1) Are you saying Crystalens HD does not lose accomodation over time?

2) Its "unpredictability" mentioned by 2 doctors in Singapore can be managed if the surgeon concerned has ample experience in Crystalens HD and if proper post operative management such as the use of reading glasses for 2 weeks and yag are applied?

3) Should the use of reading glasses be applied to only the patients who need reading glasses before cataract or before operation OR to all patients? I am 57, have myopia and no or little hyperopia and have never used reading glasses. For the 2 weeks after Crytalens HD implantation, should I use or not use reading glasses or even wear myopia glasses for seeing long distance?

4} If yag of the anterior/posterior capsule can correct the corresponding hyperopia and myopia, I wonder why it has not been mentioned by the doctors in Singapore? To put it another way, if yag is a readily available remedy, then why "unpredictability" is such a big issue?

Your answers will be invaluable to me.

[Ray T Oyakawa, MD]

Crystalens is the more challenging to implant and manage postoperatively compared to other IOLs.  To achieve target is the same as other IOLs after you personalize you a-constant.  Astigmatism needs to reduce to about 0.5 diopters. Capsulorhexis size and meticulous anterior and posterior capsular clean up are important. Post operative changes can be managed by careful and frequent followup.  I believe that the use of atropine at the end of the case and use of reading glasses for the first two weeks are important.  Some of the changes are due to the IOL being fixated to near by early reading before the IOL is fixated by the capsule bag in the distance position.  Unpredictable contraction of the capsular bag can change the refraction since this IOL is very flexible.  This can be managed by yag of the anterior capsule is hyperopic and posterior capsule if myopic.  Also, pilocarpine can be use to help the focusing muscle of the eye to improve near vision.

The new HD also is sensitive to target.  I would target the nondominant eye for a micromonovision with the previous versions of Crystalens, but this does not work well with the HD.

Success with Crystalens is more surgeon dependent on surgeon experience and post operative management than other IOLs.

Wait until the surgeons in your area are more experienced.

Dr. O.