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My Cataract Surgery with the Crystalens Trulign Toric IOL
Cataract Surgery
At my annual eye exam June 19, 2014, my optometrist said that new glasses would not help a lot anymore, due to my cataracts. He recommended an opthamologist who did multiple types of implants, about 30 miles away.
On July 9, 2014 I had my cataract exam. Lots of tests. Had a nice long discussion with the Doctor about my options.
Monofocal lenses; set for distance, with a .5 to .75 diopter difference for better reading. Cheapest, fully covered by Medicare and my BCBS insurances. But would probably need glasses for ALL distances because of astigmatism.
Multifocal lenses, Tecnis or AcrySof ReStor. Premium lens so out-of -pocket costs of around $2000 per eye. NOT recommended due to many patient complaints. Astigmatism is the enemy of mutifocals.
Toric lenses, recommended for my astigmatism correction (about 1.5D in each eye). He does not do torics with traditional surgery because the results are so much better with laser and the Optiwave Refractive Analysis (ORA) System to insure correct placement and power of the lens. He uses Verifeye, which is the new version of ORA and says it give excellent results. But would probably need glasses for reading and intermediate (computer distance) vision.
Accommodative Toric lenses, Crystalens Trulign. Same as the Torics, but with the probability of good vision at all distances, including reading. May need drugstore readers for reading small print or low-light situations, such as menus in a restaurant. Out of pocket cost of around $2500 per eye. Laser and ORA are also included in that price.
His 1st recommendation is the Crystalens Trulign, 2nd the single vision torics.
At my annual eye exam June 19, 2014, my optometrist said that new glasses would not help a lot anymore, due to my cataracts. He recommended an opthamologist who did multiple types of implants, about 30 miles away.
On July 9, 2014 I had my cataract exam. Lots of tests. Had a nice long discussion with the Doctor about my options.
Monofocal lenses; set for distance, with a .5 to .75 diopter difference for better reading. Cheapest, fully covered by Medicare and my BCBS insurances. But would probably need glasses for ALL distances because of astigmatism.
Multifocal lenses, Tecnis or AcrySof ReStor. Premium lens so out-of -pocket costs of around $2000 per eye. NOT recommended due to many patient complaints. Astigmatism is the enemy of mutifocals.
Toric lenses, recommended for my astigmatism correction (about 1.5D in each eye). He does not do torics with traditional surgery because the results are so much better with laser and the Optiwave Refractive Analysis (ORA) System to insure correct placement and power of the lens. He uses Verifeye, which is the new version of ORA and says it give excellent results. But would probably need glasses for reading and intermediate (computer distance) vision.
Accommodative Toric lenses, Crystalens Trulign. Same as the Torics, but with the probability of good vision at all distances, including reading. May need drugstore readers for reading small print or low-light situations, such as menus in a restaurant. Out of pocket cost of around $2500 per eye. Laser and ORA are also included in that price.
His 1st recommendation is the Crystalens Trulign, 2nd the single vision torics.
On July 31, 2014 I had a 2nd opinion cataract exam, happily covered by Medicare and BCBS. Again, lots of tests, and discussed options with the Doctor. His recommendations were the same as the 1st Opthamologist, except he liked the Torics as 1st choice, and the Crystalens Trulign was the 2nd choice. He also suggested I AVOID the multifocals due to high dissatisfaction rates, including glare/halos, poor night vision for driving, and poor intermediate vision. Especially with astigmatism.
Back to the recommended Doctor’s office on August 6, 2014 to set up a schedule for the cataract surgery with the Crystalens Trulign.
Pre-Operation appointment on August 25, 2014 for more tests.
Back to the recommended Doctor’s office on August 6, 2014 to set up a schedule for the cataract surgery with the Crystalens Trulign.
Pre-Operation appointment on August 25, 2014 for more tests.
Pre-op completed, more tests to insure the correct IOL power and LOTS of discussion on the medications and how they are used, before and after the surgery. Signing lots of paper-work.
Addressed the surgery procedures and timelines involved for the surgery and the check-ups following each eye lens implant. Valium before the Laser and Versed at the Surgery Center, she says I’ll be on “vacation”. They gave me a prescription for all the fun stuff, Valium, Steroid, anti-inflammatory, and anti-biotic. Discount coupons included, and out-of-pocket costs for all the meds for both surgeries was $110. Surgical out-of-pocket cost $1950 for the Laser Assist Surgery and $599 for the Trulign IOL, for a total of $2549 per eye.
Surgical appointment on September 8, 2014 for my right eye (dominant).Surgical appointment on September 15, 2014 for my left eye.
Addressed the surgery procedures and timelines involved for the surgery and the check-ups following each eye lens implant. Valium before the Laser and Versed at the Surgery Center, she says I’ll be on “vacation”. They gave me a prescription for all the fun stuff, Valium, Steroid, anti-inflammatory, and anti-biotic. Discount coupons included, and out-of-pocket costs for all the meds for both surgeries was $110. Surgical out-of-pocket cost $1950 for the Laser Assist Surgery and $599 for the Trulign IOL, for a total of $2549 per eye.
Surgical appointment on September 8, 2014 for my right eye (dominant).Surgical appointment on September 15, 2014 for my left eye.
Surgery day. Arrived at the Eye Clinic 10AM, brought in, more questions (which eye, etc), given 1 Valium, prescription was for 2 for each surgery in case 1 didn’t do the job...it did. Double check with the slit lamp & eye topography, numbing and dilating eye drops, the into a waiting room for about ½ hour, looks like 3 or 4 more people getting surgery this morning. Into the laser room, lay down, given a teddy bear to hold (so hands don’t reach for things they shouldn't) hair covered with a hair net, then look at the light while much buzzing, flashing red and green lights. No pain, worst thing was heavy pressure on eyeball when the laser was docked. All done in a few minutes. Laser did perf cuts for the capsulectomy and the incision cuts. Then it divided the cataract and did initial cuts to make the phako emulsification go quicker and easier. Seemed like only a few minutes and laser was undocked from my eye. Felt irritation, like an eyelash in your eye. Nurse took my arm and walked me back to the front, feeling a bit wobbly, but alert.
Then my wife drove the short drive to the Surgery Center, parked fairly close to the entrance, and once again with my arm held to keep me steady we went inside the center to the front desk. At the desk more of the same questions and they took the checkbook information to pay for the IOL, $599.
Then I gave up my watch, hearing aids, wallet, and wedding ring to my wife for safekeeping and the Nurse took me to the pre-surgery area. A curtained small section with a small bed was all mine. I was told to remove my shirt and shoes, lay down, and cover myself with the blanket. After I lay down, the nurse came back and asked more of the same questions about which eye, have you eaten or drank anything, what meds, etc. Then another nurse came in to put in the IV line in the back of my hand. A numbing drop first, then it went in perfect, first time, with NO pain. Deborah and Carla were the preop nurses, but I don’t really remember which was who. My wife arrived to wait with me for the surgery in a chair to my left of the bed.
My ophthalmologist/surgeon came by, introduced him to my wife, he said I would be the 1st patient. He told her that I was his most knowledgeable patient, and could probably have done my own surgery using a mirror. The Valium probably made that sound funnier than it really was.
Then I gave up my watch, hearing aids, wallet, and wedding ring to my wife for safekeeping and the Nurse took me to the pre-surgery area. A curtained small section with a small bed was all mine. I was told to remove my shirt and shoes, lay down, and cover myself with the blanket. After I lay down, the nurse came back and asked more of the same questions about which eye, have you eaten or drank anything, what meds, etc. Then another nurse came in to put in the IV line in the back of my hand. A numbing drop first, then it went in perfect, first time, with NO pain. Deborah and Carla were the preop nurses, but I don’t really remember which was who. My wife arrived to wait with me for the surgery in a chair to my left of the bed.
My ophthalmologist/surgeon came by, introduced him to my wife, he said I would be the 1st patient. He told her that I was his most knowledgeable patient, and could probably have done my own surgery using a mirror. The Valium probably made that sound funnier than it really was.
Then Sabrina & Jason arrived with a gurney and I was wheeled into the surgery room. In the Surgery room I was transferred to another bed, rolled up blanket under my knees, head on a folded towel, and covered in a new warm blanket. my Doctor arrived and once again it was; look at my finger, look at the red light, look up, look down. No pain, lots of lighting effects and flashes, mostly green, I was awake but no clue when the scalpel went in or the cataract was removed, or even when the IOL was placed. Seemed like about 10 minutes, and he said it was done and everything had gone well.
Then back on the gurney and wheeled to another bed, with a wheelchair at the foot, in the post-surgery area where after 5 or 10 minutes of rest I was able to put on my shoes and shirt. Wife came in and I got back my stuff. Then I sat in the wheelchair. A volunteer wheeled me to the entrance and helped me into the car. He told us that vacuuming, washing dishes, and doing laundry would help bring a speedy recovery. (Ha,Ha)
Then the drive home wearing the smoked glasses, stopped for lunch, Big Mac, fries, and a strawberry shake, to eat at home.
I felt fine, but after a while I got VERY tired and went into the bedroom to lay down. I crashed for about 3 hours. What a day!
Then back on the gurney and wheeled to another bed, with a wheelchair at the foot, in the post-surgery area where after 5 or 10 minutes of rest I was able to put on my shoes and shirt. Wife came in and I got back my stuff. Then I sat in the wheelchair. A volunteer wheeled me to the entrance and helped me into the car. He told us that vacuuming, washing dishes, and doing laundry would help bring a speedy recovery. (Ha,Ha)
Then the drive home wearing the smoked glasses, stopped for lunch, Big Mac, fries, and a strawberry shake, to eat at home.
I felt fine, but after a while I got VERY tired and went into the bedroom to lay down. I crashed for about 3 hours. What a day!
1 day after surgery.
Right eye is blurry/foggy. Dr says possibly have to revisit this eye to see if the lens has rotated when the left eye is done next week.
2 days after surgery.
Blurriness is fading, colors are SO much brighter. White is now WHITE compared to the left eye which looks like a dingy yellow.
3 days after surgery.
Leaves on trees are clear, can read license plate across the street. Every day brings improvement. Range of focus from distance to intermediate is great.
7 days after surgery.
Vision in right eye is 20-20. Lens is evidently in perfect position, just needed some healing time. Doctor and I are both happy campers. Time for the 2nd eye implant. Dr says he is aiming for 1/4 to 1/2 diopter closer to blend the vision a little for better/closer reading ability with the accommodating feature of the Crystalens Trulign IOL.
Right eye is blurry/foggy. Dr says possibly have to revisit this eye to see if the lens has rotated when the left eye is done next week.
2 days after surgery.
Blurriness is fading, colors are SO much brighter. White is now WHITE compared to the left eye which looks like a dingy yellow.
3 days after surgery.
Leaves on trees are clear, can read license plate across the street. Every day brings improvement. Range of focus from distance to intermediate is great.
7 days after surgery.
Vision in right eye is 20-20. Lens is evidently in perfect position, just needed some healing time. Doctor and I are both happy campers. Time for the 2nd eye implant. Dr says he is aiming for 1/4 to 1/2 diopter closer to blend the vision a little for better/closer reading ability with the accommodating feature of the Crystalens Trulign IOL.
Another excellent diary of a different IOL.
Best wishes for a successful outcome for both lenses, and keep up with the progress reports.
More people really should run a diary from the start of treatment to give these valuable insights.
Phil
Best wishes for a successful outcome for both lenses, and keep up with the progress reports.
More people really should run a diary from the start of treatment to give these valuable insights.
Phil
Monday Sept 15th.
Surgery on the left eye, pretty much a repeat of the 1st surgery procedure. Although this time the numbing drops at the surgery center seemed to burn for a LONG time. Even when I was on the table the eye still burned. They increased the sedative and that helped but still uncomfortable. Lots of mostly green flashing lights and after the surgery and post-op recovery back home. I didn’t even try to stay awake, and went to bed to sleep off the drugs. Left eye was foggy and blurry, but this was expected by me after my experience with the right eye.
Tuesday Sept 16th.
First day follow-up on the 2nd eye. Vision still blurry, about 20-50 in the left eye. Doctor thinks the burning from the numbing drops was a result of the laser docking, the laser is held in place by suction and this eye was more irritated by the docking procedure. Doctor says I should now use 2.0 dollar store readers to read for 2 weeks and then 1.0 readers after that for another 2 weeks. After that, I will be using the accommodating muscles and the Trulign hinged haptics to focus. We are expecting, and hoping for, glasses free….except for really small print and very low light situations.
Surgery on the left eye, pretty much a repeat of the 1st surgery procedure. Although this time the numbing drops at the surgery center seemed to burn for a LONG time. Even when I was on the table the eye still burned. They increased the sedative and that helped but still uncomfortable. Lots of mostly green flashing lights and after the surgery and post-op recovery back home. I didn’t even try to stay awake, and went to bed to sleep off the drugs. Left eye was foggy and blurry, but this was expected by me after my experience with the right eye.
Tuesday Sept 16th.
First day follow-up on the 2nd eye. Vision still blurry, about 20-50 in the left eye. Doctor thinks the burning from the numbing drops was a result of the laser docking, the laser is held in place by suction and this eye was more irritated by the docking procedure. Doctor says I should now use 2.0 dollar store readers to read for 2 weeks and then 1.0 readers after that for another 2 weeks. After that, I will be using the accommodating muscles and the Trulign hinged haptics to focus. We are expecting, and hoping for, glasses free….except for really small print and very low light situations.
Sadly, the FDA is keeping the USA at least 5 yrs behind the rest of the world in IOL choices.
But, when the time comes that cataracts are causing problems with every day life style....you've got to make your best choice of the available options. I'm too old, too cranky, and I don't have enough patience to deal with all the multifocal lens issues, and my eyes don't dilate enough for the Light Adjustable Lens adjustments, so...Torics.
And, at this point, the Crystalens Trulign seems to be the Cadillac of toric IOLs, and I'm happy with them.
But, when the time comes that cataracts are causing problems with every day life style....you've got to make your best choice of the available options. I'm too old, too cranky, and I don't have enough patience to deal with all the multifocal lens issues, and my eyes don't dilate enough for the Light Adjustable Lens adjustments, so...Torics.
And, at this point, the Crystalens Trulign seems to be the Cadillac of toric IOLs, and I'm happy with them.
2+ weeks from the surgery on the 2nd eye.
I'm now using 1.5 readers, when I need them, which isn't often. Distance and Laptop vision are great. I can read my Kindle Paperwhite without glasses, and only needed for very small print, or if really close-up vision is required. At this point, I no longer feel the need to carry readers with me at all times.
Focusing with the Crystalens Trulign was a little strange at first, but easy to get used to. When I look up from reading, the focus to distance is now a lot quicker than when I started. And the focus back to close vision is also a lot quicker. And I no longer have to think about focusing, since my eyes now seem to be on automatic.
Night vision has also improved, halos around lights have pretty much disappeared and the side of the road is very visible.
Looks like my Medicare only covered about $600 or so per eye, but I knew going in what my out-of-pocket costs would be, and I feel that I made the right decision for me
I'm now using 1.5 readers, when I need them, which isn't often. Distance and Laptop vision are great. I can read my Kindle Paperwhite without glasses, and only needed for very small print, or if really close-up vision is required. At this point, I no longer feel the need to carry readers with me at all times.
Focusing with the Crystalens Trulign was a little strange at first, but easy to get used to. When I look up from reading, the focus to distance is now a lot quicker than when I started. And the focus back to close vision is also a lot quicker. And I no longer have to think about focusing, since my eyes now seem to be on automatic.
Night vision has also improved, halos around lights have pretty much disappeared and the side of the road is very visible.
Looks like my Medicare only covered about $600 or so per eye, but I knew going in what my out-of-pocket costs would be, and I feel that I made the right decision for me
1 month check up.
Vision is 20/20 in each eye. Able to read the smallest line in the hand-held reading chart unaided. Dr is happy. I'm happy. Scheduled for the 3 month check-up in mid December for probable YAG laser.
Now using 1.0 readers when needed, which isn't often. Basically, I have the vision of the early 40 year old. Be nice to have a 30 y/o vision, and eventually newer and better IOLs will make that possible, but, given the state of the FDA, US citizens will probably have to get on a plane to obtain it.
I am totally happy with my Crystalens Trulign torics, and highly recommend them to anyone who is a suitable candidate.
Vision is 20/20 in each eye. Able to read the smallest line in the hand-held reading chart unaided. Dr is happy. I'm happy. Scheduled for the 3 month check-up in mid December for probable YAG laser.
Now using 1.0 readers when needed, which isn't often. Basically, I have the vision of the early 40 year old. Be nice to have a 30 y/o vision, and eventually newer and better IOLs will make that possible, but, given the state of the FDA, US citizens will probably have to get on a plane to obtain it.
I am totally happy with my Crystalens Trulign torics, and highly recommend them to anyone who is a suitable candidate.
3 month check-up and YAG.
Vision 20/20 in both eyes, star-burst halos at night have gotten bigger. Not a problem as they are easily ignored.
Diluting drops for the YAG procedure, which is done in a small room. Looks like 4 red lights in a small square, clicking noise as the laser does its' job. The clicks come from the machine but feel like they are echoing from the back of my skull. No pain at all, about 20-30 seconds for each eye.
No follow up meds are required. Noticed some new floaters towards the bottom of the left eye, but they were totally gone in a few hours.
Piece of cake.
Vision 20/20 in both eyes, star-burst halos at night have gotten bigger. Not a problem as they are easily ignored.
Diluting drops for the YAG procedure, which is done in a small room. Looks like 4 red lights in a small square, clicking noise as the laser does its' job. The clicks come from the machine but feel like they are echoing from the back of my skull. No pain at all, about 20-30 seconds for each eye.
No follow up meds are required. Noticed some new floaters towards the bottom of the left eye, but they were totally gone in a few hours.
Piece of cake.
Hi
Are the halos not an issue for you? Dont they distract you from night driving?>
Are the halos not an issue for you? Dont they distract you from night driving?>
A week after the YAG, the halos are pretty much non-existent. Very faint around some headlights, and getting less and less visible each day (night).
So..not an issue, not a problem, and I expect them to be totally gone in a few weeks.
So..not an issue, not a problem, and I expect them to be totally gone in a few weeks.
Very glad to hear of your positive outcome and thanks for the informative and well-written diary. I had been considering the Tecnis monofocal for my post RK eyes but a Dr. recently recommended the Trulign. I understand the Trulign operates on a hinge. I was told that I will be given exercises to do to help me use the Trulign effectively. I don't really understand how this hinge works nor how long it will continue to work properly. 1. Can you pls share your thoughts about this? 2. What was the purpose of the YAG procedure? Thank you.
If an ophthalmologist is recommending a Trulign, he must surely have a model of this IOL and can show you how the hinges work with the eye muscles. If the ophthalmologist hasn't provided all the information needed for an informed decision, Insurances and Medicare (if applicable) are more than happy to pay for 2nd and 3rd opinions before cataract surgery. Given your previous surgeries, I'm thinking that a non-accommodating Toric IOL would be easier to target your best vision power and placement. But, I'm not a professional, so get those 2nd opinions. As many as you need!
After cataract surgery, cells can build up behind the IOL, causing cloudy vision, sometimes called a secondary cataract, which can be easily fixed with a YAG laser making an opening behind the lens. My understanding is that B&L thinks it is better to do the YAG sooner, to avoid acoustic shock wave and thermal conduction which can damage an IOL.
After cataract surgery, cells can build up behind the IOL, causing cloudy vision, sometimes called a secondary cataract, which can be easily fixed with a YAG laser making an opening behind the lens. My understanding is that B&L thinks it is better to do the YAG sooner, to avoid acoustic shock wave and thermal conduction which can damage an IOL.
Thank you. Your postings are always helpful and I have learned much from them. Regarding the Toric, I do understand that if it rotates, there would be a need to return for surgery. I plan to continue learn about the Trulign and Tecnis Toric before I proceed with my surgery.
Hi. Would you be willing to share the name of your surgeon? I had an odd experience. After my appointment with the surgeon, whom I just met, I was again being tested by the same gal that works in the clinic who tested me in the morning (because of previous RK the doctor wanted a mid-day measurement of my eyes) and she asked what lens he had recommended and I told her it was the Trulighn Toric. She said I should do more research. She said he is the only physician in the entire clinic of 13 (well known eye center too) that uses those lenses or would put them in me. I gathered from her that there has been a lot of patient dissatisfaction. Also, from your research, what at the best lenses over seas? thanks!
re: "best lenses overseas"
The lens best for each person will differ depending on their needs, since unfortunately no lens is perfect yet. I chose to go abroad to get the Symfony lens in December, which I felt was a better be than the Crystalens. It seems like the various trade industry publications here and abroad seem to indicate its one many in the field think is the most promising new lens. I have a thread with more info about my experience with it here:
http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258
The thread is cluttered with mention of a rare side effect I've had (the iris and perhaps other parts of the eye jiggling more than they are supposed to). That itself has nothing to do with the lens choice, though there is some chance the fact that its visually disturbing might be due to the fact that its not a monofocal (rather than the particular design of this lens), but since even people with monofocals have had this issue it seems likely it isn't the lens.
The lens best for each person will differ depending on their needs, since unfortunately no lens is perfect yet. I chose to go abroad to get the Symfony lens in December, which I felt was a better be than the Crystalens. It seems like the various trade industry publications here and abroad seem to indicate its one many in the field think is the most promising new lens. I have a thread with more info about my experience with it here:
http://www.medhelp.org/posts/Eye-Care/my-Symfony-IOL-results-after-cataract-surgery/show/2425258
The thread is cluttered with mention of a rare side effect I've had (the iris and perhaps other parts of the eye jiggling more than they are supposed to). That itself has nothing to do with the lens choice, though there is some chance the fact that its visually disturbing might be due to the fact that its not a monofocal (rather than the particular design of this lens), but since even people with monofocals have had this issue it seems likely it isn't the lens.
Today was the 6 month visit (9 mo from surgery, 6 mo from YAG).
Everything is going well, surgeon says "boring, but boring is good!".
Pressure 12 and 14. Muscles are working well, and good accommodation working with the Crystalens Truliign hinges. After reading or playing on the laptop, looking in the distance is not as sharp immediately, but clears in a minute or two.
Surgeon says this is normal.
Distance is 20/20, reading is great. Near, far, and in-between is all good.
Next visit scheduled 1 year from now.
Even the dents in the side of my head from 30 plus years of glasses are filling in.
No glares, no halos, no complaints. Love it!!!!
Everything is going well, surgeon says "boring, but boring is good!".
Pressure 12 and 14. Muscles are working well, and good accommodation working with the Crystalens Truliign hinges. After reading or playing on the laptop, looking in the distance is not as sharp immediately, but clears in a minute or two.
Surgeon says this is normal.
Distance is 20/20, reading is great. Near, far, and in-between is all good.
Next visit scheduled 1 year from now.
Even the dents in the side of my head from 30 plus years of glasses are filling in.
No glares, no halos, no complaints. Love it!!!!
I'm scheduled to have my fist cataract sugery in a few weeks but am still confused about which lens to chose. Thank you for your postings -they did help a lot! My choice is torics to correct my astigmatism or mono -and then I will still need glasses. I asked about accomodating lenses and was told there were none for torics. Upon research, I found the Trulign so I'm assuming that my dr. just does not use the Trulign. I'm feeling like I should definately get a second opinion.
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