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Feedback wanted on Crystalens

I am considering Crystalens and would like to hear from anyone who has had it for the purpose of vision correction not cataracts.  I am 43 and have been told that I am a good candidate since I am not a candidate for Lasik but have also been told noboby my age should have it done.  I'm confused.
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Avatar universal
I would say your pushing the envelope at 43 with Crystalens. (The reading vision is not that great anyway.)  50 is a more likely age to think about clear lens exchange.  Remember, the market is changing fast!  Now we have Restore, Rezoom, and Veriseyes.  As far as refractive procedures go, have you considered PRK or Epi-LASIK?  PRK is a slower healing, more uncomfortabe prodeure, BUT it does spare your cornea the most tissue and allows the eye to remain closer to it's original structure.  The down side to doing an intraocular surgery at such a young age, is the long term complication rates.  The patients are usually 70-80 that have surgery now.  You are doing it 30 years sooner.  No one can tell you for sure what the effects of having a lens in your eye for that many years.  That's why they make knee replacement patients wait.  Trust me, we all want everything these days, but these are our eyes, the most precious sense we have.  Please don't rush into it.  You don't see too many ophthalmologists getting these accommodative IOL's do you?
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Avatar universal
A related discussion, Why are there 2005 questions still up? was started.
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Avatar universal
Looks like a big argument is on and the right time for me to drop in.

I have -8 in left eye and -10 in right with slight astigmatism in both eyes.

Say with the apodized/diffractive multi-focal lenses, is small correction required post the implant if the results are not on spot? I mean these IOLs are meant for making you spectacles-free for most of your work BUT is it a possibility that one might have to use spectacles OVER the MF IOLs sometimes for some type of work? Personally, I don't mind wearing spectacles for some work. I normally wear contacts.
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Avatar universal
To PUD/HUD (Cute eyecu...)

OK HUD,,,,,,since you say you are not in the eye business, then why do you keep regurgitating the same balogna on here? Even if you haven't been properly and thoroughly educated before coming to this website, the info is here. Expand your knowledge and attempt to be honest. You don't see eyecu saying that ReSTOR is the old 3M diffractive. Stop reliving the past. The 3M lens had changes and is the new and improved ReSTOR and the Array had changes and is the new and improved ReZoom.

As far as Tecnis goes, the FDA gave it 2 safety claims which is not something Alcon nor B&L have. No wonder AMO just got it NTIOL status for Tecnis. Seems like John Sonntag, MD is right. Lots of reasons to look at AMO products. We use them all Alcon, crystalens, and AMO ReZoom, Tecnis monofocal and looking forward to Tecnis multifocal, but definitely are using more ReZoom than ReSTOR. The proof is in the pudding. Our ReZoom patients are happier than our ReSTOR across the board.




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Avatar universal
hud should change his name to pud on this board. It will be some time before any other NTIOL approval. There is much more to NTIOL approval than just submitting. Alcon tried to gain NTIOL on their natural lens and it was turned down. They were not even invited back. The B&L lens corrects for lenticular correction with no correlation to the cornea. The classification speaks for itself and is public posted knowledge. I have over 20 years experience in the OR with opthalmology and have a sincere interst in patient outcomes, not my stock portfolio. Without going into daily surgical outcomes that I am aware of, I truly want the best for everyone involved and want them to be aware of every technology. I know that the ReStor has a place to provide great outcomes as well as the Crystalens and ReZoom. I will let the patients on this board relate their experiences. The cream wil rise to the top inspite of biased opinions. I work with a surgeon who has implanted a significant number of Array and ReZoom lenses with many happy patients. He does have unhappy patients as well as that it is a fact of life. There is nothing perfect but it is far better than what we had before and will get better in the future. Lets move science forward. Every technology has its place.
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Avatar universal
hud
excellent post from the Sales and Marketing Department of AMO, eyecu.
In an attempt at fairness, I would like to clarify that AMO was successful in being the first applicant for this NTIOL status for the Tecnis monofocal lens. This goes into effect Feb. 27, 2006, by which time Bausch and Lomb and Alcon will have their NTIOL submissions approved for their respective aspheric IOL designs. (B&L's AO, Alcon's IQ). Also worth noting is that Staar Surgical received NTIOL status for their astigmatism-correcting (toric)IOL a few years ago, and that design failed miserably due to poor performance. The Array was also a NTIOL and sold for $195 and created a bigger niche than the Staar, but is now on the trash heap. Rezoom is the an acrylic Array with the optic devoted to more distance than near vision. But so are all monofocals.
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Avatar universal
hud
excellent post from the Sales and Marketing Department of AMO, eyecu.
In an attempt at fairness, I would like to clarify that AMO was successful in being the first applicant for this NTIOL status for the Tecnis monofocal lens. This goes into effect Feb. 27, 2006, by which time Bausch and Lomb and Alcon will have their NTIOL submissions approved for their respective aspheric IOL designs. (B&L's AO, Alcon's IQ). Also worth noting is that Staar Surgical received NTIOL status for their astigmatism-correcting (toric)IOL a few years ago, and that design failed miserably due to poor performance. The Array was also a NTIOL and sold for $195 and created a bigger niche than the Staar, but is now on the trash heap. Rezoom is the an acrylic Array with the optic devoted to more distance than near vision. But so are all monofocals.
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Avatar universal
bbd- An NTIOL (New Technology IOL) is defined as an IOL that CMS(Center for Medicare and Medicade Services) determines has been approved by the FDA for use in the labeling and adverstising the IOL's claims of clinical advantages and superiority over existing IOL's with regards to reduced risk of intraoperative or post operative complication or trauma, accelerated postoperative recovery, reduced astigmatism, improved post operative visual acuity, more stable postoperative vision or other comparable clincial advantages.

In a final notice published in the Federal Register, CMS stated, "CMS approves AMO's claims of clinical advantages and superiority of the Tecnis IOL for ocular spherical aberrations and simulated night driving. We find the AMO Tecnis lenses models Z9000, Z9901 and ZA9903 to meet the NTIOL definition and are to be given new NTIOL classification of Reduced Spherical Aberration".

The Tecnis IOL is the only lens approved for NTIOL. "Tecnis NTIOL status confirms the unique design of the lens and the very real benefits it provides to patients" said Dr. Ralph Chu, a cataract refractive specialist in private practice in Minneapolis and an early adopter of the Tecnis IOL technology. "The unique modified prolate technology increases the patients functional vision in varying light conditions, which is critical for every day tasks conducted in low light conditions such as reading, diving at night or in the fog."

Dr. Mark Packer, clinical assistant professor of ophthalmology at the University of Oregon and clinical study investigator for several Tecnis IOL studies, including a driving simulation study said, "The Tecnis lens is the only IOL available that was specfically designed, based on wavefront measurements of a representative sample of the population, to fully compensate for the spherical aberration of the cornea."

Dr. Michael Colvard, and eye surgeon in Encino, CA with over 20 years of clinical practice and speciality interest in IOL technology and cataract surgery added, "The Tecnis IOL, which takes into consideration the importance of correction of spherical aberration with cataract surgery, is one of the truly major advances in intraocular lens technology over the past two decades."

Dr. R. Bruce Wallace, III, cliinical professor of ophthalmology as LSU Medical School stated, "We have a number of our Tecnis patients comment on their enhanced vision at night and in other low light conditions, adding a margin of safety to their activities, espcially for driving.

An analysis by the Potomac Institute for Policy studies states that improved driving performance from reduced spherical aberration with the Tecnis lens could translate into annual preventable costs of automible accidents raning from $450 million in 2004 up to 2.4 billion by 2014.

This information came off a press release on AOL and can probably be found on any of the financial websites.

I would just work with your doctor and take your time if you are not pushed. Techology will move forward and offers so much more today then yesterday. My dad is very happy with the Array lens. Could he be happier with the newer ones. Probably. But he has better vision now than he did before and that what counts. There are happy patients with all lenses. The most important thing is working with you surgeon to try to determine which one would be best for you. There is a website that a surgeon has which is pretty cool and shows the pro's and con's of all the lenses. I think it is a Dr. Harvard in California.
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Avatar universal
To bbd

I think you should seek the opinion of an ophthalmologist that does all 4 ReSTOR, ReZoom, crystalens, Tecnis monofocal, and get info on the progress of the  clinical trials for the Tecnis multifocal from someone other than our financial advisor and buddy HUD...
To your question, I think the vision will be better with a lens implant than a MF contact lens. With the CLs you have external eye issues, fit, movement of the CL, eye irritation, allergy/ environmental issues. Plus as we get older, (starting around age 40) even if we do not develop cataracts, our natural crystalline lens gets thicker and harder so we have distortion and changes in our vision anyway. There are some patients that do opt to get multifocal in one eye and monofocal in the other eye, especially when it is Tecnis. Years ago, our patients that had Array in one eye and a monofocal didn't do as well, but with the improvements with the technologies (ReZoom and ReSTOR) that is not so much of an issue anymore. Also, it is possible to get a monofocal and then later get a piggyback or another lens on top of the existing one, that is Multifocal.  That is where AMO has a definite advantage over Alcon because of the advantage of putting two different materials in the eye. (Silicone - Acrylic) vs (Acrylic - Acrylic). My point is that if you desired Tecnis in one eye and a multifocal in the other eye and you later decided you prefer the MF eye, you could have the Tecnis exchanged for a MF or a MF piggyback on top of your Tecnis. You mention intermediate vision, that would weigh towards ReZoom than ReSTOR for your MF eye. Lots to ponder. I ponder daily because I am contemplating the same thing myself as I have previously mentioned.

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Avatar universal
hud
The tecnis monofocal has an aspheric optical design like the Bausch and Lomb AO lens, and the Alcon IQ. These new technology lenses improve the sharpness of your vision when the pupil is larger.
This feature is being added to the diffractive multifocal created by 3M to become the Tecnis multifocal. 3M sold the rights and the name "Restor" to Alcon, who took the diffractive concept and apodized it, but limited the diffractive portion to just the center of the lens optic. Alcon patented this treatment, and then sold the rights to Pharmacia/Pfizer, who then sold to AMO. 3M's study results showed a 59% spectacle freedom, with significant unwanted effects, due to the diffractive portion going all the way out to the edge of the lens (creating a lot of glare and halos). Alcon took 17 years of R&D to revise the 3M lens to the current day ReSTOR, which the FDA study patients show 80% spectacle freedom, with minimal glare and halos. For comparison, AMO's Rezoom, did not have to submit study data to the FDA for approval, saying it was a minor change from it's predescessor, Array, which reports a 41% spectacle freedom. Rezoom is an acrylic version of the Array with more distance vision enhancement.
What might be worth waiting for is ReSTOR IQ, the aspheric version of the presbyopia correcting ReSTOR with blue-light and UV filtering. But this is somewhat like deciding when to upgrade your computer, as technology keeps getting better.
To answer your question about when the Tecnis Multifocal might be available, it won't be until sometime in 2007, maybe 2008.
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Avatar universal
bbd
I'm reading with great interest everyone's comments on the IOLs currently available.  I'm 51, have have posterior sub-capsular cataracts, and have been told that I could do the surgery pretty much any time now.  I'm still correctable to 20/20 distance during the daytime, but the glare test shows what I experience in real life, that my night driving acuity is going downhill.  Still legal at this point though, so I have a little time.  

I'm intrigued by the tecnis MONOFocal lens, and their claims for increased contrast sensitivity, and enhanced night driving vision.  I presently wear multifocal contacts which do a pretty good job at all distances.  Good enough that I never wear readers, and I still see pretty well for distance.  I would really miss not having near and intermediate, however, if I didn't do something else in addition to the tecnis monofocal.  To that end, I've been considering this plan:  tecnis monofocal (not monovision; I tried that with contacts and didn't like it), + RGP contact lenses for near and intermediate, or maybe in the evenings when I want to ditch the contacts, spectacles for near and intermediate.  My thought is that at the present time, perhaps one is better off taking an a la carte option, rather than trying to find an IOL that does it all.  I'm just not hearing a lot about folks who are committed to the multifocal contact (mine presently are RGP, which I understand gives better acuity than soft) after IOL implantation.  Could it really work?  Assuming the IOL power for distance was spot on, and IOL alone gave 20/20 distance, would the presence of a "plano" distance portion of a multifocal RGP contact act as a refracting element on its own?  So do you have to plan for this approach in selection of the IOL distance power?

Alternatively, the tecnis monofocal + another surgical correction for the near and intermediate?  I don't know much about what that would entail.  

All that said, I also am interested in the tecnis MULTIfocal, not yet FDA approved.  Does anyone know how that's coming along, and when approval might be granted?  Another surgeon I've consulted was among the docs doing the FDA trials for that IOL.  Is it likely that the multifocal will retain the same characteristics that the monofocal has with respect to contrast sensitivity and enhanced night driving vision?  This same doc implants restor, rezoom, and crystalens, in addition to tecnis monofocals, so with him, I'd have lots of options.  Right now, I'm exercising my option just to wait until either my vision deteriorates to an unacceptable level, or my research heads me unequivocally in one direction.  Thank you to those of you who share your experiences for the sake of those of us trying to learn.
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Avatar universal
Agree and enjoyed the discussion.  All lens have positives and negatives.  I simply want people reading this board to examine all options.
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Avatar universal
Jesse Optics
Your points are well taken and I agree with most of them. However, not all unhappy Crystalens patients can be fixed. It is very difficult to explant that lens. Fuzzy vision can be caused by many different problems, so yours is a blanket statement against multifocals. Let's leave it at all lenses have their strong points and any given lens can be less than optimal. Again, I am happy your Dad had a great result.
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Avatar universal
Dear Eagle eyes,

As suspected it is your opinion used to support your claim that "Most" doctors have abandoned the crystalens.  The ability to market in Europe has nothing to do with the clinical performance of a technology.  (see Excimer Lasers for details)   Here is a fact for you, multifocal contact lens have been available for 20 years, and they have less than 5% share of the market.  What would the share be if the fitting optometrist couldn't take them out as is the case with the Restor/ReZoom intraocular lens?  

As I have previously posted, compare the labels of the Restor and cyrstalens.  There are driving warnings and low light warnings on the multifocal and none exist on crystalens.  None of the lens are perfect and reading this board reveals that all lens have complications.  At least with the crystalens you can do something about it, currently there is no cure for the fuzzy vision created by multifocality other than explantation.  In the final analysis that is why I choose crystalens for my dad.
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Avatar universal
Dear Eagle Eyes,

How can you comment that MOST crystalens patients are unhappy.  The practice my dad had surgery in uses it exclusively.  I'm very impressed with his vision.  The crystalens is a small company and doesn't have the marketing muscle of the major companies but if you compare the FDA labels, objective data, the crystalens is the clear winner.  Is this your opinion or do you have some data support your claim?

JO
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Avatar universal
Jeese Optics:

1. Look at the Crystalens experience in Europe.. They got it first as is often the case, and for the most part abandoned it altogether. 2. If you research the number of US surgeons that are trained to use Crystalens, their are very few that do it alot and do it well. Your Dad most likely went to one of the handful of surgeons that gets good results. If you look at the majority of trained surgeons, you will find a different story. Good for your Dad that he is pleased. Within the past 6-9 months, even the really good Crystalens surgeons are coming over to ReSTOR and ReZoom for certain patietnts. They are smart because one lens does not work for everyone. Customized service for unique lifestyles.
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Avatar universal
Just (December 23, 2005) got the second eye corrected with the crystalens.  The dominate eye is set for distance and intermediate and the other is set for close up and some intermediate.  My cost was 1500 per eye in addition to the insurance payment of 5200.  I was surprised by the fact that the lenses were not the same power and a little disappointed.  I supposedly have 20/20 while using both eyes but having been one with superior vision until the cataracts set in, at age 63 I guess I can't complain.  Most lose near vision in the forties and mine lasted well enough to read while even having the cataracts.  I lost the ability to read the road signs until up close and had some double vision as first indicators of the cataracts.  I now have the crystalens and they are much better than when I had the cataracts.  My dominate vision lens had the wrong power initially and had to be replaced within 2 weeks.  Supposedly, the lens will improve somewhat during the coming year.  It's only been 3 weeks so all the symptoms may not remain.  My eyes tire quite a bit during the day,(computer work)and I see halos from indirect light rays at night or when subjected to flourescent lighting.  The night vision is ok but not perfect.  I do recommend lots of research on the up to date lenses and a consultation with a know competent doctor prior to the lens selection.  My dominate eye cannot read without correction and the other is blurry at a distance presently.  I don't know how much this will improve.  Maybe I'll remember to update in six months or so, memory is not improved with the lens.
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Avatar universal
Crystalens works but not the majority of the time. If you have very small pupils and if you are willing to exercise your eyes after surgery and if you don't pick up reading glasses after surgery as this will be cheating and cause the lens not to move hence not work, then you should be ok. The ReSTOR is good for people who don't drive much or at all, don't work on computers at all, aren't active outdoors, etc. but want really strong, really close near vision. The ReZoom is gaining popularity amongst our patients as it is very reliable, predictable, no need for eye exercises, and few side effects. It is not perfect, nothing is, but gives a broad range of clear vision from up close to far away and everything in the middle. Definitely is important to find the right doctor though. More and more are doing these new lenses, but the measurements need to be very accurate to pick the right strength of lens. If you are an unhappy Crystalens recipient, ask your surgeon about a piggyback lens on top of it. (like Array) This will give you what you wanted in the first place and then you don't have to get the Crystalens removed (which is a very difficult and tedious procedure). The happy Crystalens patients love it, but unfortunately, the majority of them are not that happy. Some doctors do it in one eye and ReZoom in the other. Very confusing I know, but you have to tell the doctor what you do everyday and how willing you are to wait things out.
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Avatar universal
The ReZoom results have been very good. It is a second generation multifocal lens. The side effects from the Array which were mainly halos at night have been reduced through a redistribution of light at night plus some other changes. All multifocal lens give you halos or some visual symptoms due to defocused images. Even monofocal lenses can give you halos or edge disturbances. The technology keeps getting better. The ReZoom just has not been advertised as much but your results are becoming more of the norm which is enlightening.
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Avatar universal
I am 51 years old, and quickly developed catarcts in both eyes.  I have worn glasses since a teenager.  I had the ReZoom multifocal implant surgery in my left eye just before Thanksgiving.  The procedure was uneventful, and to my delight I was tested 20/20 the following day.  What a difference!  Since then, I have not been wearing glasses as I wait for my right eye surgery scheduled for early January.  My brain is still 'learning' reading distance with the lense but middle and far distance is just perfect. I experience halos during night driving, but this is very minor.  I wanted to share my positive results with the ReZoom implant, and I can't wait to get the right eye corrected as well.
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Avatar universal
You can always look at a lens exchange. Plus, there are more treatments on the market for dry eye such as Restasis. Don't give up as you can search deeper for an answer. lasik can also cause dry eye. Besides drops there is flaxseed oil and another pill you can take. Do not go around being unhappy until you have exhausted your resources.
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Avatar universal
Had Crystalens surgery in July.  Still not happy.  Have great distance, middle and closeup vision in one eye, but have "fuzz" for distance in the second.  Had laser surgery two months ago to correct the problem.  Didn't help.  Only picked up a "floater".  Will have LASIK in a couple of months.  Two friends have had this procedure.  One uses eye drops constantly due to dryness and wears glasses.  Her vision is slowly improving.  The other friend refuses to have the second eye done since she isn't satisfied with the first.  We had different doctors but were told it might take up to a year to get 20/20.  So far, it isn't worth the money.  We don't work, but would not have been able to hold down jobs after Crystalens.  You don't wake up the next morning with perfect vision.  I'm not sure I'd do it again, but I have two friends that wouldn't.
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Avatar universal
I would say that eye guy is on the money. This has been fun to read. The good news is that you have a lot of choices and more on the way. The Crystalens in the only true accomodating lens. It uses a single focus lens which will not give you the other images being defocused such as the Array, ReZoom and ReStor so you cut down on the halo effect. But with large pupils at night and a 4-4.5mm optic you could experience some. It works by moving back and forth. The problem can be, that over time with capsular changes it might not move back and forth as well and you can end up with decreased near vision. But you will have great distance and possibly intermediate. The ReStor gives you great near with a 4.0 diopter ad but no light goes to intermediate and there is a loss of light due to diffractive optics so it can cut down on contrast. The yellow lens deal is really debatable and there is no proof to the claims. In fact you can go the Federal Register and find out that they were turned down for New Technology IOL claims because it cannot be proven. There is also a feeling that yellow lenses cut down on blue light which furthers contrast loss at night. If that is the case, buy some blue blocker glasses and wear them during the day and take them off at night when you do not need them. There are also some debates on color perception and there are patients who have one in each eye and can tell the difference. Younger ones more than older ones.

At 43, you can surely wait. The Tecnis multifocal lens is under study in the US now and is one of the most preferred lenses in Europe at this point. The ReZoom is gaining in popularity as it is an improvement over the Array lens. Spectacle independance has just about doubled from the Array. This is due to a refocus of light at night to distance so the halo effect is minimized. With the Array, surgeons shot for a plus .50 correction to minimize halo. WIth the ReZoom, they are shooting closer to plano since they are not as worried about the halo effect so the near results are much better. There are some other changes which have enhanced performance.

You will get different opinions from many people but that is why you talk to more than one, research it and make your decision. You will find happy and unhappy people with all types of lenses, even monofocal lenses.

Go to www.tecnisiol.com and www.visioninfocus.com for the AMO lenses.

The bottom line is to research it and try to decipher and assimilate all of the informaion which is what you are doing. My father has the Array lenses and loves them. An eye doc in Houston has the Array lenses in his own eyes and so does one in Austin and he is a pilot as well.

Good luck.
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Avatar universal
Had the crystalens implanted, and found wonderful results at the beginning, great distance vision, after the second implant, seem to lose distance but gain reading, and a film developing in first implant, may need laser surgery, anyone else having these problems?
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