H. D. Crystalen lens

Question for Dr. Hagan, a while back you suggested that if someone asked your opinion as to replacement lens, you would suggest mono focal lenses with monocular vision.  My question for you is as follows:

Eliminating the extra cost of the H.D.
Crystalen lens from the selection criteria, what is your personal advice to a 50 year old high myope with grade II cataracts. O.D. -10.5 O.S. -14.5.  Assume cost is not a factor.  A professional who will accept having to use reading glasses to read, if he can drive a car without glasses. Obviously, being able to read without reading glasses would be nice but not necessary.

Second, based on your annedotal data, how do the risks of the H.D. Crystalen lense compare to the risks associated with monofocal implants.  ie any higher rates of retinal detachment?  Higher rate of needing a YAG?  Higher rate of needing lasix?

This information, based on your opinion and experience as of March 2010 would be extremely valued by me and perhaps others considering lens implants.

[John C Hagan III, MD, FACS, FAAO]

Everyone is different. IF you want the best quality vision, especially night vision and don't mind glasses then aspheric monofocal is the best available. You can chose minimonovision with either a distance or near bias.

The studies done by me and Dr. Kutryb on these forums indicate that a multifocal IOL like Crystalens was 23 times more likely to lead to a complaint on this forum than a monofocal. Yag risk about same. lasik much higher.

Date on RD is not available but the risks should be the same. That is a significant risk as the highest RD risk is highly myopic early middle age male. It may be as high as 2-3%.

JCH MD

[Fleetfoot197]

Thanks doctor.  I did read your December of 2009 study and thank you for the same.  If I am understanding you correctly (while folks may differ) it appears that you would still recommend monofocals  with reading glasses over the current Crystalen H.D. for most high myopes that need cataract surgery even without considering the cost.  Risks of rd and need for YAG about the same but a larger chance for the need of lasik post surgery with the premium lense to improve refraction.

I appreciate your time. I just wondered whether 2010 experience (perhaps outside the forum) was becoming more favorable to the Crystalen HD..

[John C Hagan III, MD, FACS, FAAO]

There are many patients that are very happy with Crystalens HD. They have just come out with a aspheric optic Cyrstalens which should be even better.

We have a surgeon in our practice that does like 75% Crystalens and has about 95% satisfied patients.

It takes very special expertise to achieve that type of "happy" factor. Superlative surgeon, meticulous technique, careful choosing of patients, setting realistic expecatitons and having total corneal/refractive skills so that LRI, lasik, PRK, IOL exchange, etc are part of the surgeons expertise.

There are a number of ophthalmologists that have had Crystalens put in their eyes.

JCH MD

[Fleetfoot197]

Would you please explain the theory of why the new aspheric optic Cyrstalens might work better than the H.D.  Also, has it been tested?  Any results reported?

[John C Hagan III, MD, FACS, FAAO]

aspheric lens optics are the new thing. Optical tests have shown they improve visual parameters like contrast sensitivity and reduce glare. Yes its been tested and is an improvement over the sphrical optic.

JCH MD

[Fleetfoot197]

Thanks. How long have private facilities been implanting the new aspheric optic Cyrstalens?  

If it truly does reduce the number of reported problems with the HD Crystalens, might that change your recommendation for monofocal lenses with monovision for most patients where cost is not a factor?  Or is it just too early to tell?

Thanks in advance. I have to feel this is a really important topic for this board given the previous threads.

[John C Hagan III, MD, FACS, FAAO]

I cannot continue this thread. Most of this is not new. THe HD Crystalens is just realeased. You can also visit the manufacturer website for information.

There is simply not enough time to give unlimited answers in multiple parts. No other forum answers near the volume we do nor give individual answers on two forums.
JCH MD

[Fleetfoot197]

Thanks for your time, Doctor Hagan. I truly do appreciate the professional courtesy you have extended.  By way of correction, I assume your above post meant the Crystalens AO was just released as the HD was released in  2008.  I have read all of the other threads.  Unfortunately, with the only access to FDA records being through the Freedom of Information Act and then the selection criteria being limited to the best candidates, the data is less useful than anecdotal experience. There are relatively few posts regarding results in 2010 with the H.D. and only Dr. O concerning the AO. The B & L press release for the A.O. While encouraging, physician and patient experience is preferable.

If any 2010 Users of either lens would add their experience it would be much appreciated.