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

[berrywoo]

Thank you Dr. Hagan for this information.

[Harold14370]

Have they improved the night vision problems we hear about?

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

This article did not comment on night vision. If I read anything I'll post it.

JCH MD

[JodieJ]

This article is available online.  It's hard for me to know how to interpret the authors' opinions, since four of the five authors are paid consultants for Bausch & Lomb (the manufacturer of the Crystalens)!!!  Somewhere in the archives of this site, one of the manufacturers' reps stated that fees for such "consulting" can amount to more than six-figures annually.  (There are several articles in past issues of this journal written by paid consultants for Alcon which praise the attributes of the newest ReStor model.)

[JodieJ]

Sorry, you all--my post above is slightly erroneously.  Actually, ALL of the doctors (Devgan, Lindstrom, Singer, Whitman) who praise the performance of the Crystalens HD in the cited article are paid consultants for Bausch & Lomb!

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

Yes that is an important piece of information. However since they have been using it under investigational program they have the longest experience with it.

I don't get any money from any device maker and have no dog in this fight at all. Our surgeons have been very happy with the Crystalens HD also.

JCH MD

[JodieJ]

The results from the investigational program with the Crystalens Five-O greatly exceeded subsequent outcomes with this IOL.  I hope this doesn't prove to be the case with the HD.  I'm looking forward to reading reports from unbiased (i.e., not paid large fees by the lens manufactuer) surgeons and satisfied patients.

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

Remember that you will not find happy-satisfied patients posting questions on this or other health forums. These forums are a magnet for unhappy people with persistent problems.

JCH MD

[cdn_glenn]

"These forums are a magnet for unhappy people with persistent problems."

BINGO!

I do look forward to the few posts not clouded with anger.  The difficulty with accommodative or multifocal IOLs is that they might not initially function well, leaving the patient distressed and the practioner needing to reassure the patient.  Or later determining if corrective surgery is needed.

In particular, how is reading improved with Crystalens HD?

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

You would need to go to the manufaturer website to see the diagrams and read the claims. My understanding that depth of focus is better by a propriatary mechanism that addresses the weakness for reading vision of the Crystalens.

JCH MD

[walkietalkie]

Just curious, what is the out-of-pocket price of this latest 'premium' lens? Anything with 'proprietary mechanism' means $$$.

Also, if Rezoom is such a bad IOL why is it still in the market? Does that mean that there are ‘happy-satisfied patients’?

[JodieJ]

Not everyone is unhappy with ReZoom.  I've read several posts from satisfied ReZoom/ReStor patients.  There are probably people who are happy with bilateral ReZooms, but they don't seem to post online.

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

Depending on how much you load on your plate ("premium multifocal IOL" plus astigmatism reducing surgery and/or follow up Lasik)  You may be adding $1500-3500/ PER EYE)

JCH MD

[Eye-Kant-C]

I wish I knew why my surgeon was so adamant about pushing me into getting the previous version of the Crystalens when he knew this one was coming out soon, and supposedly is a good deal better. Especially when I didn't have cataracts and wasn't in a hurry. Maybe he was afraid I'd find out that there are numerous problems with multifocal IOL's and I'd back out of the surgery, since I was so uncertain. I wish I would have. Now it seems I may not be able to get close to the vision I had before the Crystalens ordeal for any amount of money.

I also was dumb enough to let him do YAG surgery on one eye, even though I didn't feel that I needed it -- which I didn't -- and now have huge starbursts that I didn't have before. No one seems to be able to tell me why I have this now or have ever heard of such a thing. I gave my surgeon a picture I found illustrating a starburst filter for a camera lens with huge stars coming from all light sources and told him that's what I see now, since the YAG. He said "Wow ... kinda pretty!" I am defeated.

[enian0313]

I am scheduled to have cataract surgery for the right eye on 01/29/2009, but I am not sure that I want to go through it with my current surgeon. I am seeking 2nd opinion with another doctor next week.

In my pre-op appointment, my current eye doctor told me that I am not a good candidate for the multifocal IOL's,  nor would I be happy with the accommodating len either since it doesn't offer good near and intermediate visions. She was pushing me to accept the Monofocal IOL/Glasses option. She was irritated when I wanted to get a better understanding of her choice for me. She didn't explain the different options, including the new Crystalens HD, fully and clearly to me.

I left her office feeling very depressed and insecure with her being the one who would operate on me. It's my eye, I should be fully informed of what IOL will be implanted in my eye and why, and will it achieve what works for me?

I don't think I am asking too much from a surgeon to explain fully and clearly. My feeling is that I probably won't go through the surgery with this surgeon.

[JodieJ]

Several people have posted here recently that their surgeons have stopped using the "premium" IOLs because of their poor outcomes in many patients.  However, if you have done your homework and continue to want a "premium" IOL, I'm certain that you can find a doctor who would be happy to implant them in your eyes.  (Why did the first surgeon feel that you are a bad candidate?)

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

-

[enian0313]

The truth is that she never discussed the type of IOL with me during the two years when I have under her care for dry eyes and my complaint of blur vision. She seems so busy that she hardly discuss my condition with me everytime I saw her. This past Friday was the first time she told me that the Monofocal IOL/Glasses option is what will be implanted into my right eye. When I asked for more information, she told me that she had three patients, didn't have time to discuss it with me, had her nurse came in the room to talk to me.

I called my family doctor to get me to another doctor for 2nd opinion right after I got home. Then I started searching the web for more information, this is how I stumbled into this site.

My current eye doctor got her MD in 1995, did her internship in 1996, completed her residency in 1999 and fellowship in glaucoma in 2000. She founded a practice, has great deal of buzz in the great metro area where I live. However, relatively in comparison, I don't feel that she is highly experienced in the field yet. I wonder how long it takes for a new MD to become a real expert in his/her chosen field?

The more I read the posts on this site, the more I feel inclined to defer my surgery for a few more months until I totally understand what I will be getting into.

[JodieJ]

I would not be satisfied with a doctor who had no time to discuss my surgical options.  The archives of this forum contain a wealth of information about options for cataract surgery.  You can use the search feature (upper right corner of your monitor) to learn more.

Everybody's priorities are different.  I had very good results with aspheric monofocal IOLs.  You can learn more about this type of implant by watching the patient education video at www tecnisiol com.  These IOLs can be set for "blended vision" (distance vision in your dominant eye, intermediate in nondominant eye) to minimize your dependence on glasses.  My friend who has this type of correction only wears glasses for prolonged reading or seeing tiny print.  If you have significant astigmatism, you should ask the surgeon about correcting it at the time of surgery.  The Crystalens HD, a "premium" IOL option, is reputed to provide good distance and intermediate vision (but variable near vision), although some people have had problems with glare and halos.  I hope you get referred to a doctor who will explain all your options and address your questions and concerns.

  

[enian0313]

Thanks for sharing your experience, I found this site is very helpful, at least I am not alone. I will update my status after next Tuesday's appointment with another doctor for 2nd opinion.

[starman6600]

Dear Dr. Pernoud,

I have read some of your postings and appreciate the good information that you share with others.  I do not have cataracts but am interested in improving my vision.  Please allow me to elaborate.

I am a 67 y/o male who has had RK (15 years ago) for myopia correction in my left eye, my dominant eye for distance, and Lasik (8 years ago) also in my left eye.   I also had RK (15 years ago) in my right eye, for a monovision outcome.  I was very satisfied with the outcomes of these procecures.   In the past eight years since my Lasik, I have become farsighted (+1.50) in my left eye.  At this time, I am interested in determining the best procedure for improving the distance vision in my left eye.  I have communicated with Dr. Hagen somewhat and he has been very helpful in sharing his thoughts.  I would like your thoughts as well if I may.  Here are my questions:

1.  What is the best first step ( Lasik, IOL, etc.) to take so that I can possibly keep my options open in the event that the first step is not successful?  

2.  If you recommend an IOL as my first step, I understand that prior RK patients are not good candidates for a multifocal lens.  Do you agree?  Do you have any suggestions as to how I can determine which monofocal lens would be appropriate for me.  Dr. Hagan is positive about the Tecnis.  

3.  Would there be any point in waiting for a year or so in order to see if a lens with better technology becomes available?

4. Do you have any suggestions as to how I can find a very good physician to perform the surgery?

Thank you in advance for any thoughts or suggestions that you may be able to share with me.  

Frank

[starman6600]

Please excuse my placing the above post to Dr. Pernoud in this location.  
Frank

[mike230]

I am a post RK patient of 1989 which corrected -1 & -1.5D myopia.  The outcome was great, as I turned 48 I had a hyperopic shift +1.25D in each eye with .75D astigmatism.
At age 50, my corneas were declared stable.  I had the crystalens HD 500 implanted in my right eye with an LRI (limbal relaxing incision) astigmatism correction.

With that said, being that you have had prior refractive surgery, the calculations were set for -.50D myopia and my refraction is perfect.  I maintain a strong 20/20 and the ability to read 20/15 for distance, 20/15 intermediate and J1 for reading.

Aiming for 1/2D myopic is a good insurance policy which will buy you many years of good vision should you continue to drift hyperopic (farsighted).  If being -.5D actually has me off, the crystalens will accommodate that difference.

I had this lens implanted 8/08.  This is my experience as an RKer.  Hope this helps you
Mike

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

Starman6600

Dr. Pernoud will not see it in this conversation thread. Post the question separately on an ODD number day for a Pernoud answer.

Also when "conversations" go on this long we can no longer monitor all the the long threads.

JCH MD