Accommodating lenses are not working yet.

[Carlhcv]

Hello all. My name is Carl and I am 61. I had cataract surgery done on both eyes on July 8 and July 22. I paid thousands of dollars extra for accommodating lenses that would give me at least some close vision and eliminate my nearsightedness. I am very happy with my distance vision and am 20/20 in both eyes. I've worn glasses all my life and no longer need to! My concern is that I have not yet gained any close or intermediate vision improvement. Anything beyond four feet requires glasses. I have been told that it can take up to three months for these lenses to work fully but after no improvement in two months I'm not feeling very optimistic. Can anyone share their experience with these lenses? Did I waste a lot of money? Is there still hope that I will gain some close vision, like at least enough to be able to read a text message.

[JohnHaganMD]

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[Carlhcv]

I will do that. I will wait until four months have passed post surgery.

[JohnHaganMD]

Please consider reposting a follow up in 3-4 months so those following this discussion have an outcome. Thanks

JCHMD

[Carlhcv]

That is good news! Thank you very much Doctor.

[JohnHaganMD]

Crystalens is the preferred IOL in our practice for patients that opt for a multifocal/accommodating IOL.  3-4 months would be a suitable time for the dust to settle and your focus muscle (ciliary body) to assist with near vision.

JCH MD

[Carlhcv]

Thanks again. Dr. Hagan, thank you for following my thread. SD, thank you for the long definitive answer! I sure hope I'm not one of the few that sees no benefit from the Crystalens. I accept that I will probably need glasses to read a book but I hope that I gain at least a little near vision. The lens is supposed to hinge forward and backward but so far doesn't seem to be doing anything. I guess I will hold out hope for another month. I appreciate all of the posts.

[JohnHaganMD]

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[SoftwareDeveloper]

The reason you were asked about your refraction is that a residual error is one explanation for what you are experiencing. It is possible that for instance you were left slightly hyperopic, farsighted, which would take away from your potential near vision. If you are for instance say +1D then any added "near" vision from the lens is actually mostly only going towards giving you good  distance vision and not leaving any left over for actual near.

In my case with the Symfony lenses the last check showed one of my eyes as being plano (no spherical error, 0D) but my other eye was +0.5D, which is enough to lead to a very noticeable difference in my near vision with that eye if I compare the two, I'm relying mostly on my plano eye for reading things like my phone. Any residual astigmatism can also have an impact on the quality of your  vision.

Unfortunately the formulas used to determine lens powers aren't an exact science. They tend to be less accurate in those who were highly myopic beforehand (as I was) and usually work well for those who were only a little nearsighted. However there can be errors even with those with low myopia that are  large  enough error to be noticeable. If so the error can be corrected by laser, or by wearing correction. They could also adjust one eye to make it slightly nearer vision than the other, monovision, to give you a bit better near.

Unfortunately in general the results from the Crystalens can vary quite a bit between patients, and in a small % of cases the lens doesn't seem to provide any benefit over a monofocal lens. This is what one surgeon reports on his blog:


http://www.garyfostermd.com/cataract-surgery-and-choosing-intraocular-lens-iol/
"Half of my crystalens patients get not just distance and intermediate, but also near vision.  However, 10% of patients can’t flex the lens at all so they end up with a single vision lens."

This recent article quotes another surgeon noting the wide range of near visual quality:

http://www.eyeworld.org/article.php?sid=7715
' But Dr. Packer finds that these patients are often not completely spectacle-free and need a low-powered pair of reading glasses. “If you have 20/20 distance vision [with the Crystalens], the average near is going to be 20/40,” he said, adding that the range tends to be from 20/20 to 20/80."  '

Impression of another surgeon:

http://www.eyeworld.org/ewsupplementarticle.php?id=375
"Overall, about 30% of my patients don’t need any spectacle correction; about 50% wear glasses only for reading fine print or in dim light; and about 20% still have to wear readers - but they’re low power readers."  

I think I've seen a few articles saying about half of patients use reading glasses with the Crystalens at times. An article from a few years back notes some being more pessimistic (though its possible their impression was colored by older Crystalens models, even though the most recent model was out by then):

http://crstodayeurope.com/2010/10/survey-of-accommodating-iol-technologies
"Almost all recipients obtain good distance and intermediate vision, but only 67% get good near vision. ...

On the other hand, the majority of patients implanted bilaterally with any model of the Crystalens should be counseled to expect to wear low-power reading glasses postoperatively (usually 1.25 to 1.50 D).  "

[CBCT]

It indicates that he read the posts, but is not adding anything else to the discussion at this time.

[Carlhcv]

Why are all the blank posts showing up from Dr. John Hagan MD? Am I missing something?

[JohnHaganMD]

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[Carlhcv]

OK. Good stuff. I was hoping to at least get enough close vision to read a text message or the buttons on a remote. I'm also using dollar store glasses. I forget what they are but I have a weak pair for computer work and slightly stronger for up close reading. I will be very disappointed if I don't have a little close vision in another month.

[JohnHaganMD]

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[CBCT]

I had Crystalens IOLs in both eyes.  My "close" eye ended up being too close with a refraction of -2D and I had no accommodation.  My surgeon believed that the lens had fibrosed and rushed to YAG, which did nothing to loosen the lens.  After more than a year, and some more serious problems unrelated to accommodation, I had both lenses exchanged for monofocals.  

There are no guarantees for achieving target refraction or accommodation.  You may end up getting Lasik or some other touch up corneal surgery.  Apparently Crystalens does not work for everyone.  It wasn't right for me, but my brother had a great outcome.  Give it time.  Hopefully you will develop more accommodation.  Best wishes.

[KayakerNC]

I had the Trulign (Crystalens Toric) 1 year ago.
My Dr had me get just the cheap dollar store glasses for reading.  Started out with the 2's for a couple of weeks, and went to the 1 1/2's for a another few weeks, then the 1's.  I no longer carry reading glasses at all.
You do have to exercise your eyes.  I think there are some word puzzles for Crystalens exercise online.  The print gets smaller as you get used to the bigger prints.   But I just used the glasses routine, and I'm happy with my results.

[JohnHaganMD]

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[Carlhcv]

Crystal Lens. Doctor says it takes time for the eye muscles to start working again. I get a feeling by the way he acts that there should be some activity by now. I don't know what my "refraction" is. I was nearsighted but not real bad. I chose lenses to correct that and they did.

[CBCT]

What brand of lens did you get?  What does your surgeon say?  What is your refraction?