CRYSTALENS HD LIKELY BEST PREMIUM IOL

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

Reports are starting to come in that the new Crystalens HD is a definite improvement over the Crystalens Five-O. This according to reports from eye surgeons generally considered good clinical researchers. This is the reference: First Impressions of the Crystalens HD, by Uday Devgan, Richard Lindstrom MD Jack Singer MD and Jeffrey Whitman MD Cataract and Refractive Surgery Today November 2008 page 17 volume 8 number 11


What does this mean? For those that have done the research and determined that they wish a presbyopia correction "premium = more expensive" IOL it appears to me that the Crystalens HD is the best available in the USA and that the new lens addresses most of the problems with near vision. The surgeons say they generally aim for residual refractive error of 0.00 in distance eye and -0.37 to -0.50 in intermediate/near eye.

The main research into NEXT generation presbyopia correction IOLs will likely be accommodating like the Crystalens HD and not light splitting multiple image IOLs like the ReStor (not a bad lens for mid range and near vision) and the ReZoom IOL that I do not recommend at all for anyone.

JCH MD

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

well there are two ways of looking at it. First the surgical companies want the best surgeons using their research IOLs since the data has to be turned in to the FDA. On the other hand not every "new" IOL turns out to be better, or even as good, as IOLs already on the market.

The yag cap is not a standard part of surgery or post op care. It is only done when the posterior capsule turns cloudy. It makes IOL exchange more difficult and if it effects the postion of the IOL it may change power or ability to focus.

LRI  and post op lasik are the most common ways of dealing with astigmatism. If monofocal IOL then toric IOL can be considered. Also small amounts can be treated with making the incision longer than normal and placing it in the steep axis of the astimatism and using more steroid drops than normal

JCH MD

[DallasCPA]

My prospective surgeon is one of the investigational surgeons listed above... Is that a good thing? My bigger concern is expertise dealing with astigmatism that exists pre-op since HD is said to result in more astigmatism...  And, is it unusal to perform Yag post-op? Should the procedure for pre-existing and resultant astigmatism be variable depth LRI, and is it incorrect to assume an FDS investigation surgeon is capable & equipped to perform such ancillary surgery?

Thank you for clarifying any details, but I do not want to undertake a permanent surgery blindly (sorry for the pun) & many thanks to answers from those with more knowlege and experience; it is truly invaluable as I would hope to be able to report a positive outcome to this forum.

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

Dr. Kutryb and I are publishing our second study on "premium" IOLs and Crystalens HD is best,  ReZoom is WORST.

JCH MD

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

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[bobanlou]

Thanks for your prompt response.  I'll redirect the question to Dr. Oyakawa.  I asked you the question first because of all the commenters on this forum, you seem to be the straightest shooter.

[JodieJ]

Dr. Oyakawa is really the forum expert about the Crystalens, and you should direct your question to him.  I've read that the newest HD version provides the best near vision.  I believe that both the Five-O and the HD provide crisp distance vision if the surgeon hits the targeted refraction (near plano) and eliminates astigmatism.

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

Mark if you want Dr. O to answer your question post it as a new post on an EVEN day.

JCH MD

[bobanlou]

Hi Jodie,
I'm a 66 year-old male with a cataract in my right eye that needs to be removed.  I'm mildly myopic, i.e. -2.00 diopters, and have been so for all of my adult life.  I've ruled out going with a multi-focal lens.  I'm torn between a monofocal IOL and the Crystalens.  I recently had my eyes examined by two different surgeons, and both of them recommended the Crystalens.  One of them, however, recommended the 5-0 version of the lens rather than the new HD, while the other recommended the HD (although he had no first hand experience with it).  The surgeon that recommended the 5-0 said that the experience in her practise has been that the HD seems to sacrifice distance vision in order to get better near vision.  She said that there was a "button" at the center of the HD that is not there on the 5-0.  I've searched the internet for an explanation of the changes that were made to the 5-0 to come up with the HD, but have not found anything.  Do you, or anyone else, have any info on the technology changes leading up to the HD?

[Mark060656]

Dr. Oyakawa:

First let me thank you for your past replies.   I am visiting a second surgeon tomorrow who deals with all lens for RLE and cataracts.  As a reminder I am a highly myopic 52 year old male (-12 in contacts, +2 in readers, virtually no astigmatism). I am interested in RLE for better vision and getting rid of glasses and especially contacts.  I have visited one surgeon who specializes in ReStor lens and he said that I had the beginning of cataracts (minimal but enough for insurance) so that RLE would be the way to go.  Now my decision seems to between a superior monofocal lens and the new Crystalens HD.  I guess I could live with readers but if I am to go through with RLE I want very good intermediate, distant and night vision with good contrast and depth of field.  If you were me, what would you do (ie the new Crystalens HD or a monofocal lens - please recommend your preferance for the brand of monofocal lens you prefer.  Obviously this is a tough decision for me and I want to get it as right as I can.  If there is other information you need to know please advise.  Thanks for your patience with me and your appreciated advice.

Mark

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

Every cataract surgeon does monofocal IOLs, only about 8% of IOLs in the USA are multifocal. I would talk to friends that have had cataract IOL surgery and ask their experience, ask your family physician, check out www.aao.org to be sure he/she is a member of the american academy of ophthalmology.

Anyone on the faculty of one of the many medical school in Philly is likely quite good. If necessary visit two or three potential surgeons to see whom you feel comfortable with.

JCH MD

[Mark060656]

thanks for your replies Dr. Hagen, how would I go about finding a superior surgeon in the Philadelphia PA area, I would like someone who does both crystalenshd and also monofocal lens.  Is there published listing. or what questions should I be asking the doctors I visit

[cdn_glenn]

Please forgive me for amending the above post.

"The depth of field with a multifocal changes by moving the focal point"
should be:
"The depth of field with an accommodative IOL changes by moving the focal point"

A multifocal IOL, like monofocal, has a stationary depth of field.  The recently FDA approved Tecnis aspheric multifocal IOL has increased contrast sensitivity, similar to its monofocal namesake.  Other negative issues with this multifocal IOL are the same.

Monofocal IOLs are the most reliable for both the patient and physician.

Still the Crystalens HD is sounding very favourable with the right physician.  See Dr. Oyakawa's detailed posts above.

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

The depth of field with a multifocal changes by moving the focal point a monofocal has a stationary DOF.  Contrast sensitivity is better with a monofocal.

JCH MD

[Mark060656]

Dr. Hagen - and with a monofocal lens, is the depth of field and the contract vision superior than that of the present mulitfolcal IOL's?

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

The way most of my patients choose is use a high quality monofocal IOL our practice used Tecnis aspheric  the distance glasses is set for -0.25 and the intermediate for -1.25.  With that distance and intermediate ae generally good without glasses.

JCH MD

[Mark060656]

Dr. Hagen, so after careful research, it appears if I want to go forward with RLE, in your opinion monofocal lens are the way to go (is this correct).  I am looking for the best monofocal lens available to provide intermediate and long distance vision, also with very good contrast and depth of field.  What lens would you recommend?  I understand that I would need readers for close up work, thanks

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

If you mean with glasses (progressive bifocals) yes good vision all three distances. If you want some glasses independence then you could choose mini-monovision with near bias. You can use the search feature to read about this option. I suspect it will be about 5 years before multifocals are good enough that they become more popular. This year in a survey of US eye surgeons multifocals were LESS popular than 2 years ago.

JCH MD

[Mark060656]

Dr. Hagen so the way you would go if monofocal at this point.  What monfocal lens provide superior results meaning very good intermediate, distance and night driving.  I am an accountant I look at a computer screen most of the day.  I wouldn't mind readers but the other areas of vision would have to be very good for me to go with a RLE operation.  Finally how long would I have to wait in your opinion before a multifocal lens comes along that solves all aspects of vision in a superior way.  As I said I am 52 I have the beginning of cataracts (enough for insurance albeit very minor) but decent visoin with glasses and contacts now.

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

The Crystalens is more challenging to put in the eye (has moving parts). Restor is a good lens for near and intermediate but not for distance and has been associated with waxy vision in some cases.

In the study that we will post in public access areas that will be in the Jan/Feb 09 Missouri Medicine medical journal complaints about the results of surgery were 10 times more common among multifocal IOL patients than monofocal but the frequency of insertion is 93% or 92% monofocal and 7-8% multifocal.  It doesn't take a supercomputer to figure out that multifocal are generating many more complaints than monofocal.

JCH MD

[peakhope]

I'm not sure about the etiquette for this board, but you might want to start a new thread for your question(s), as this thread is a bit crowded.

My understanding (I'm not a doctor) is that inserting a crystalens is more challenging, and keeping it in place for the first couple weeks is important. My doctor "paralyzed" my eye for about 2 weeks to let the lens get locked in, but not all doctors do that.

If I were going to get a crystalens (and I did), I would choose a doctor that has done lots of them, and likes them (and I did).

[Mark060656]

I visted a refractive surgeon yesterday who deals with the Restor lens. He said that he prefers this lens over Crystalens because of its design that it is more secure an that Crystalens can drift off center because of its center.  He therefore doesn't use Crystalens.  He said he had no financial interest in pushing Restor just liked the design better.  Any comments from the docs whether this is accurate.  I was under the impression that the Crystalens HD product could provide better vision results than the Restor product

[Ray T Oyakawa, MD]

I forgot to mention that you should have your retina examined by a retinal specialist and let him know that you are considering RLEs in both eyes.

[Ray T Oyakawa, MD]

1)  I do not know either surgeon personally.

2)It depends on your age, axial length and the presence or absence of a posterior vitreous detachment.


3)  Your halos and glare should be less than LASIK for -12.00.  Less likely is your pupils are small.

[Mark060656]

First many thanks for you response and educating me.  So I am a bit of a numbers guy in fact I am an accountant spend lots of time looking a a computer screen.  So I am looking a the crystalens hd product and I understand the first thing I should find is an excellent surgeon who does lasik.  I have the following questions for  you

1.  I have two appointments set up as of now ( I live in the Philadelphia PA area), one with Dr. Richard Tipperman (who I believe doesn't use crystalens) and one with Dr. Stephen Seipser who uses all lens.  Are you allowed to comment on your fellow surgeons and if so can you comment on the above and or suggest others who you feel are excellent in the Philadelphia area.  If not what questions should I ask a surgeon to qualify them.

2.  You mentioned that in RLE retinal detachment is the biggest risk, so being a numbers guy can you tell me the percentage of  RLE in high myops (I'm -12 in contacts) result in detachments.

3.  Are halos and starbursts a big concern with RLE as they are in Lasik.

Thanks a gain for your patience with me, big decision.

Mark