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Avatar universal

Crystalens Explant?

In your answer to the previous post, you suggested lens exchange for the patient who is having trouble with distance with a Crystalens. As you may remember, I am losing my mind from all the flashing/glare with my Crystalenses. I tried the green colored contacts my opthalmologist suggested and it didn't help at all. Neither do the Allergan drops. I have seen somewhere on the internet that they can "texturize" the edge of the lens to cut down on edge problems.

I thought most IOL mfgs. were using the new edge design, but my Crystalens model 52-SE, gives me the impression they may be Square Edge, which has been shown to cause the problems I am having.

1. Do you know anything about texturizing the edges?
2. I heard it's almost impossible to explant Crystalenses. I am 12 weeks/8 weeks post-op.

I'm desparate... thank you.
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Avatar universal
I had my first eye done on 9/12 and my second eye done on 10/13. Believe me I was as scared as you are because I was feeling the same things. My 1st eye had 20/30 the day after and my second eye had 20/25 the day after, then I went through a "period of decline" so it seemed. Every day now it's getting better and better. My doctor told me that the healing process could take up to 6 months. He plans to go back in the 1st eye in Dec. because my near vision isn't quite as good as it should be. There's one spot that has a bit of a blur and he's going to take care of that with a procedure that doesn't require any anesthesia and only takes a minute to do.

Would I do it again? You betcha'. I'm 51 and have worn glasses since I was in the 5th grade. Remember, with glasses you could probably see really well, don't expect miracles overnight. To me, the fact that I'm functioning without any help (glasses or contacts) is a miracle. I work all day looking at a computer. I am an avid reader. The fact that I couldn't see as well as I thought I should with my near vision, literally, scared the bejesus out of me, but I think that patience, in this case, is really going to be a virtue. It keeps getting better, hang in there.
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Avatar universal
The Crystalens rep is a salesman for Eyeonics (the manufacturer of Crystalens), NOT an ophthalmologist.  Something (maybe a complication of surgery?) is causing your problems.  Personal experience has taught me that if one doctor can't help me with a problem, it's time to get a second opinion.  Keep us posted.
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Avatar universal
I promise you... I'm not going to do anything with my 2nd eye until this first one is fixed.  What I don't understand is why is it for 2 days I could see perfect and the day after my surgery my vision was 20./20 and I could see great close and far away.. but... after 2 days I woke up the next morning and it was gone... couldn't see across the room. For the past week... my night vision had been a little better just seeing doubles/triples were down just a bit... but tonight they were back.  My question there is... why does it come and go.  My surgery was on 10/4/07 and it should be showing signs of improvement by now.  The crystalens rep was at my 2 week post op exam and she said... they thought i would have to have the yag because i have whatever its call right directly in the center of my eye on in the back and that the yag would clear that up.  But the astigmatism is what is bothering me more.  I think that's what makes the pain at times when it's really bright outside or in front of the computer screen which is really bright.    

The surgery that I went to is in with his father and has been doing these surgerys (not all with the crystalens... but with others too) for about 5 years now.  Alot of people had recommended him to me and my father had his surgery performed by him too.  So I felt safe with him until now.  I hate this lens though.. I wish the rep would know more about it and not just try to comfort me.  That's what I feel like.
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Avatar universal
Reading your post is enough to make me shudder.  Please get a second opinion from an experienced cataract/refractive surgeon (preferably someone experienced with Crystalens) before doing ANYTHING  to your second eye.  I don't think your problem has anything to do with "not being a good candidate" for the lens.  Your results are way outside the norms for what someone should expect from Crystalens (which, IMO, is good distance and intermediate vision and maybe needing weak readers for near).  Best wishes.  
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Avatar universal
I too have had the same problems that everyone else is having.  I have had a topo that showed an exstreme astigmatism since my surgery.  Before the surgery It was in the shape of a 8 and now it's all in a dime in the front of my eye.  At night.. the only way I can hardly drive is to cover my eye up or squint almost to the closed position with my lid. Leaving just a small amount of light to get in. I also have the flickering under florescent lights which is worse with some lights more than others.. but I can not even stand to go into a store with these types of lights.  I haven't had the problems of being able to see around the edge of the lens but If I close my left eye and try to look through the crystalens in my right eye.... it's like everything in the forground is digital and everything in the back is like taking a picture with your camera and blurring the background out.  The first 2 days I had the lens... It was perfect. I was so excited.  I could see colors and lights and didn't feel like I was sitting behind cotton.  My right eye needs to be done too and I am sooooo affraid to have it done because I can't even drive at night.  I see 4 yellow lines 3 road signs and or should I say halos around the signs which makes it look like 3 signs.  I work 3rd shift.. so get that.  It royally sucks and I feel like I have been a guinny pig for this lens.  My doctor has even had the rep back to the office for my post op visits to check my eye also. So I don't know what to do.  Has anyone heard of anyone that has had luck with getting this lens to work or were we all not good canidates for this lens?
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Avatar universal
I think that it would be worth trying a contact lens in one eye that would give you +.75D of monovision.  This is the type correction that most people target with monofocal implants (now called "blended vision').  It should not noticeably affect your distance vision, but it would definitely help your near/intermediate vision.  It's very comfortable for most people, and you would probably prefer it to what you have now (either with or without the contact.)  Wearing contacts in both eyes would definitely impair your distance vision.

If your glare problem is not improving (and it hopefully will be), please consider getting a second opinion from an experienced doctor.  It's possible that a minor adjustment could make a big difference.
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Avatar universal
I have about 1.50 monovision with the Crystalenses. My doctor gave me a 14.0 lens in one eye, which actually needed 12.5. So I am still 1.5 nearsighted in one eye. Since the monovision was too much for me (I never got to try it with contacts, and really don't like it) he gave me a -1.5 contact to give me 20/20 distance with both eyes. But I believe my eyes are actually more like 20/15 or better distance, which may be why my close range is so bad (Crystalens in one eye-slightly overcorrected and the near eye with contact is definitely overcorrected). My plan is similar to what you suggested. I'm going to try for a little nearsightedness (both eyes) to get back a little more closeup. If the distance vision is not good enough, I will probably try the modified monovision, like you talked about. I am slowly getting used to it at home, but when I go out (I drive a lot) the monovision just isn't working, especially at night. The blurriness along with all the flashing is rough! If I do end up with too much nearsightedness at night, I could use driving glasses, I'm not really against that.

At least most of my eye pain is controllable with Ibuprofen now and at times, it actually seems to go away completely. I am a lot more hopeful when I'm not in excruciating pain!

I'm not really opposed to wearing the contacts and occasionally readers, and I can deal with the glare, if I have to now. It seems to be slightly better than a month ago. Some other people here said theirs got a little better after a year or so.

I called the Crystalens support line and she said "We're not doctors. All we can do is consult with your surgeon and make some suggestions to try to remedy your problem. We very rarely have people with problems, but if they do, we can try to work it out with their doctor. We have to get you to sign a full release of information from your doctor so that we have access to all your records."

I understand with the Privacy laws they need a release, but I was a little leary giving them access to all my records. And I'm afraid my surgeon might be insulted if I suggested that he talk to them. I don't really know how he would take it. He is a really nice guy and has taken a lot of time with me.

You're right about losing my intermediate vision soon, I probably would have. But it was such a shock to lose it all at once and to be expecting these lenses to help as promised. But over time, who knows, maybe they will work better.
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Avatar universal
I still think you should consider getting a second opinion about your glare problem from a doctor who is very experienced with the Crystalens.  I'd also be very interested in knowing what help (if any) the Crystalens clinical support line would give you (it's free!)

If you do decide not to explant your lenses, my own experience with monovision might be helpful to you.  I'm also a former high myope.  I absolutely hated wearing my coke-bottle glasses for distance, but I really had no objection to occasionally wearing thin reading glasses.  Nevertheless, my eye care provider insisted that I try monovision contacts when I began having problems reading small print.  For whatever reasons, he gave me +1.50 D monovision correction.  I absolutely hated it, but at his urging I waited it out till my return visit.  At the point, I still hated monovision and did not want to continue with it for one more day, so he agreed lower the monovision to +.75D.  What a difference!  The modified monovision just seemed like good vision with both eyes, without the problems I had had with near vision.  I needed more monovision over time, but the gradual buildup to +1.75 D over many months was not a problem.  (I just kept changing the power of one contact lens.)   I'm wondering if wearing a contact in your nondominant eye to reduce your monovision to about +.75 D might make your vision much more comfortable, yet give you with good intermediate vision and some near vision.  (You would probably need low power readers in some situations.)  After a few months you could consider experimenting with a different power contact lens.

I'm not sure that this will help to minimize your loss, but the near/intermediate vision that you had with your contacts before your Crystalens surgery probably would not have lasted very long.  I seemed to experience a steady decline in my ability to accommodate during my late 40's.      
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Avatar universal
My surgeon says he's only explanted one Crystalens and really recommends against it. The pupil size doesn't seem to matter at all. When using the drops, my pupils were constricted to the size of pinholes! I read somewhere that a person with similar problems had a "corneal topography" test and found some problem with the corneas that were causing the reflections. I don't know if they can do anything about that.

I asked my doc about that test and he said he could do that. Also I asked if I have astigmatism, thinking maybe that was a contributing factor. He said my astigmatism was very slight. I have very light blue eyes and several members of my family have been told they have "albino eyes." (Their eyes are similar in color to mine.) I don't really know what that means and have never been told that myself or if that would be a factor.

My vision is nice and clear for distance in one eye and fantastic in the other (with a contact -1.50). I am struggling with worse near vision that I had originally. (the reason I got this surgery in the first place!) But if I lost any more vision by problems with explant, I would really be devastated. I just can't risk it. I am not a risk-taker and NEVER would have done this at all if I had even the slightest hint of all these problems. That's why I post a lot -- to warn others. I wish I had found these forums before I did this.

My nice clear vision is thrown off at times by the glare, but at times is really good and if I get contacts to make me slightly nearsighted again, I may be able to function with the closeup/intermediate range again. I just want it to be over and get on with my life! I'll deal with the flashing if I have to.

Again, thanks for listening!
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Avatar universal
Sorry to hear that your vision problems have persisted.  I think that they are probably related to the size of your pupils, not your high myopia.  Why do you think that it's not worth considering explanting the lenses?  It's not my impression that it's a terribly risky procedure when performed by an experienced surgeon.
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Avatar universal
I saw my surgeon yesterday and he gave me a new type of eye drop to try to cut down on all the flashing/edge glare. It's stronger that the Alphagan P. My pupils were like pinholes! And I would swear we were having a brownout in the house -- all the lights were so dim. But no difference in the flashing. So, since I've tried 2 kinds of drops and opaque green contacts, he has run out of ideas. Luckily I think he believes I have a problem. But out of over 150 people that he's done the Crystalenses on, no one else seems to have had this problem. I wonder if it's because my lenses are probably pretty thick -- I have a high degree of myopia. He finally suggested explanting, but I told him it wasn't worth the risk. I'll live with it.

I wanted to let you know that I went for about 5 weeks between 1st & 2nd surgeries (wearing a contact in one eye) and it was really disturbing. (There's a name for it.) Even though I hated the Crystalens in the 1st eye I couldn't wait to get the 2nd one done to make them the same. And I actually do have monovision now with the 2 implants. A lot of people love it. I really don't, but it's not nearly as bad as one implant and one contact. Best wishes on your 2nd surgery. I hope the 2 different lenses will not cause more problems for you. Some surgeons are really against mixing lens types (mine is).
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Avatar universal
No, I don't have any eye pain.  Just the photopsia.  LOL....a month ago, I didn't know what that word meant.  In addition to the flickering, glare and edge, I have floaters that come and go.  The other day I had one that was a red circle.  I could have sworn it was blood but it went away. I certainly identify with the people who say they are afraid they are having a nervous breakdown or that their doctors don't believe their symptoms.  Bottom line is the opthamologist cannot see through your eye.  I think that is part of the reason they don't warn us about every possible thing that could occur.  Also, as Jodie mentioned, there is the profit motive.
I am really afraid to have my other eye done, but I am more afraid not to have it done.  The disparity between my 2 eyes is enormous.  Is this what people with monovision experience?  If so, I would be very unhappy with that.  My second surgery is scheduled for October 30th with the ReStor.
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Avatar universal
I will be seeing my surgeon next week and if he doesn't have any ideas on what to do next, I will contact the support line. I'll let you know what happens. Thanks for all the advice. I would have been in a bad way without you & the very kind doctors here!!!
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Avatar universal
There have been a couple of modifications of the Crystalens since it was introduced a few years ago.  The previous version was the 45-SE (and I believe that the SE stands for "square edge.")  I suspect that the current model (the Five-0) has a smaller diameter than other implants because of the larger "legs" needed to make the lens accommodate.  Unfortunately, "younger" patients tend to have larger pupils (making even the larger 5 mm diameter a problem) and are more prone to developing PCO.  Why didn't your doctor know about these problems?  Probably because he relied heavily on information supplied by his Eyeonics representative.  (And the Crystalens can be a profitable addition to a practice.)  There isn't a lot of independent research conducted in the area of cataract/refractive surgery, and I suspect that many practitioners don't read their professional journals every month.  Plus many of the ophthalmologists writing for the journals are paid consultants for one (or more) of the lens manufacturers!  It's probably almost as difficult for a practicing surgeon to get unbiased information about the performance of the premium lenses as it is for us patients.

Please try the Eyeonics clinical support line for help.  (You might mention that you saw the phone number posted on this forum, where you've been writing about your problems with their product.)  They are experienced with the issues you are having, and they should be highly motivated to help you (if they have any marketing sense!)  This forum is read all over the world by prospective recipients of the Crystalens.  All they need to do is type "Crystalens problems" into Google to find out about your experience.    

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Avatar universal
Thanks for your words of encouragement. I had mine done 7/6/07 and 8/2/07. I wonder if a lot of people getting this newest lens (probably square edge) are having all these problems. I think the most recent version (before the 52-SE) may not have been square edge, which is possibly why my doctor seemed not to have ever heard of these problems with Crystalens. I don't think I have astigmatism, but I may be slightly overcorrected. Do you have eye pain at all? My right eye is in extreme to moderate pain all the time and left is fine except for a little "muscle pain" toward top of the eye just below the eyebrow. Not sure if it's from the muscles straining to "accomodate" or not.

I saw on the internet where a man had extreme edge glare problems with another type of lens and his surgeon did a "piggyback" procedure with a slightly larger IOL and this cured his problem. I'll reference this if I can find it. I'm not sure if it's better or worse than explanting. I heard that cloudiness can form between the 2 implanted lenses and can't really be fixed.
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Avatar universal
We should start a club.  I had a Crystalens implanted in my left eye on 8/14/07.  I thought the glare, flashing lights and edge view would drive me nuts.  In my case, there has been some improvement. I still can't use the flourescent lights in my office and I still see the edge at times but I think my mind is starting to block it out.  I'm not saying you will get used to it but I am saying, I am getting used to it.
However, my distance vision is really good.  In fact, it is now better than my other contact lense corrected eye.  My intermediate and close vision, not so great.  My surgeon will do some relaxing limbal incisions to correct some minor astigmatism and he thinks this will help significantly.
All I can say is there are a lot of things they can try short of explantation.  I hope it works out for you. But I have to agree, if I had it to do over again, I would've waited.
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Avatar universal
Thanks so much for your responses. I'm sure I'm driving you all crazy with this!! It helps to have someone to "talk" to and the info/advice is very much appreciated. I must have the newer lenses because my card does say 5 mm and obviously the square edge idea didn't work for the PCO. One of the other doctors on this board said it does relate to your age (hard to believe I'm considered "young"!!!) and in babies/young children 100% do end up with PCO. I wish my surgeon had even mentioned such a thing and told me about the increased risk of Detached Retina and the high chance of edge problems with the square edges, etc. etc. -- I NEVER would have done this. I will see my surgeon early next week and tell him some of what I've discovered here. I'm fairly certain my problems won't get any better and he's pushing for the YAG. I know that won't fix it. I wonder why the Eyeonics people insist on making their square edge lenses so small if it's known that the larger lenses work better. My surgeon measured my pupils (after both surgeries - not sure if he measured before) and said they weren't unusually large. The "constricting drops" didn't seem to make any difference. I saw somewhere on the internet how the capsule "wraps" around the edge of the lens, eliminating much of the edge problems -- I just wish mine would. The article recommended surgeons to do something .. I couldn't understand what exactly ... to ensure this would happen so that problems with the edges would be avoided.

It's an article by Dr. Randall J. Olson of the Moran Eye Center at the University of Utah, in case you're interested. I don't have the web address.
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Avatar universal
I did a little online research.  Actually, the purpose of the square edge Crystalens is to ELIMINATE PCO.  However, just about everybody I know who has gotten implants under age 55 has needed the YAG procedure soon after surgery.  (I'm sure it's related to us being in the "younger" group of patients.  It's nice to be part of the "younger" group; but not for this reason.)  The older model Crystalens (45-SE) had a 4.5 mm diameter; the new Five-O model has a 5 mm diameter.  I know that my pupils expand to 6 mm in the dark; yours may be larger than mine, which is causing the edge glare you're experiencing.  You must have the newer Five-0 Crystalens if your card says 52-SE.  (Most implants have a 6 mm diameter, which reduces the chances of getting the glare problems you are experiencing.)

I still think that you should get a second opinion from a doctor very experienced with Crystalens.  The Crystalens clinical support line might be able to give you some referrals.  (I'd be inclined to cross reference them with Castle-Connolly or a trusted M.D. before setting up an appointment.)

I've had some terrible vision problems myself in the past, which my ophthalmologist had no idea how to treat or who to refer me to.  It was totally up to me to find a solution, and it was terribly anxiety-provoking.  So I can really relate to your current distress.
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284078 tn?1282616698
MEDICAL PROFESSIONAL
I'm so sorry about your problems.  It must be difficult for you.  As far as edge design, modifying the lens edge is something done during manufacturing on some implant models to reduce internal reflections - AMO is the main proponant.  There is nothing you can do about the current design of the crystalens in your eye.  Just about any intraocular lens can be removed if necessary - but some are more difficult than others.  As a rule - if you are going to remove an implant to exchange it - the sooner you do it the better - before the lens capsule has a chance to shrink wrap around it tightly.  On the flip side, with multifocal and accommodating lens implants - the surgeon will often want the patient to wait and adapt to the newer type of implant - but this time of waiting also makes the lens more difficult to remove in the rare cases it needs to be removed.  If at all possible, it's usually a good idea to try all things possible to avoid an expantation - but if it absolutely had to be done - it can be done - maybe a little difficult - but not almost impossible at all.  You may want to consider getting a good second opinion.  I wish you well.
Michael Kutryb, MD
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Avatar universal
Another idea--try call the manufacturer's clinical support line (6am eastern to 6pm pacific time) for your very specific concerns about their product.  The number is 1-888-393-6642 as posted on their website.  They must have experience with problems similar to yours.   BTW, I think you have the older Crystalens model.
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