Crystalens Hd

[TW101]

I am 54 and just had surgery on 11-13-08 I had the new CrystalensHD installed in my right eye. Everything went well and I could see long distance very well immediately. I cannot read without readers and have trouble with glare but my doctor says that is due to the eyedrops I'm taking and it will improve with time. I tried wearing my old glasses for the help with the other eye but that just doesn't work, so I wear a contact lens in the non operated eye. Eventually I'll have that eye done with a Crystalenshd and then not have to deal with the contact lens which I absolutely hate wearing. I'm hopefull that in time I'll experience great vision.


This discussion is related to Crystalens HD 4th Generation Lens.

[2ndsight]

most of us with Crystalens need readers for small print and computer,  although some patients with the newer HD have posted that they could see close up but not far away! Sounds like you had a pretty good outcome.

[richardjbaker]

Check out the article "First Impressions of the Crystalens HD"
in the November, 2008 issue of Cataract & Refractive Surgery Today.

http://www.crstoday.com

[JodieJ]

Glad to know that your distance vision is good.  Please keep us posted on improvement (or lackthereof) in your near vision.

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

The Crystalens has a good track record and the new "HD " model appears to be even better. Read the article referenced above.

JCH MD

[richardjbaker]

I read that the Crystalens HD has an A Constant of 119.0.  
What is the A Constant?  Why is an a Constant of 118.9
even better?

I also saw an MTF Comparison chart.  What does it mean?
What is the advantage of having a modulation betwenn 0.8
and 1.0 while in the eye's spatial frequency of 6 to 20 cycles
per mm?

The Crystalens HD has a lens diameter of 5.0 mm.  What
does the ACD of 5.55 mm mean?

Thanks in advance for being so helpful.

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

A constant is a number used in the formulas used to pick an IOL that will leave a certain predicted post operative UNCORRECTED refractive error. that is if you want no glasses at very long distances the goal error would be 0.00 where as for reading it would be between -1.25 and -2.50  It varies from IOL to IOL and from surgeon to surgeon.

MTF is modular transfer factor or the ability of an IOL to discriminate between small fine lines. The less aberrations an IOL has the better it will see under all conditions.

ACD is anterior chamber distance another factor in the IOL power forumula.

JCH MD

[richardjbaker]

Thanks.

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

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[TW101]

UPDATE - While my distance vision is still terrific, I now really regret having the surgery. My near vision is terrible and using reading glasses makes me very nauseous. Additionally, the glare in my repaired eye at times is unbearable. As I mentioned, I have to wear a contact lens in my other eye which is nothing short of torture. I can only watch TV comfortably by patching over my repaired eye and wearing my old glasses for my other eye (without the contact lens). I was so much better off before the surgery since the cataract was not that bad. This is pure hell.

[JodieJ]

I'm sorry that you have had so many problems.  If you don't have significant astigmatism, please try out a 1-Day Acuvue Moist contact in your unoperated eye.  (They are stocked by many optometrists.)  This contact works for me even when my eyes have become very dry, and it might increase your wearing comfort significantly.

[TW101]

Thanks Jodie - I'll keep your suggestion in mind. I meet next week with doctor and have lots of questions.

[johnnypro]

How bout wearing glasses with a clear plain lens on the implanted eye. That's what my doctor had me do and it works well with TV and Computer use. I'm getting away with reading without any glasses so I guess I'm lucky. Good luck.

[TW101]

I tried unsucessfully to wear my glasses with the clear lens. It caused a spacial effect and made me "seasick" - although I've heard that it does work for some people.

[2ndsight]

sometimes having an IOL implanted in one eye only causes adjustment problems. Your two eyes are not equal with an IOL in one. Several other people have posted here about this in the past. using glasses for the unoperated eye (even if you have a clear lens for the operated eye) won't work because there is too much of a refractive difference.

I would try Jodie's suggestion about the Acuvue Moist, and see if you can work with your surgeon and whoever does the fitting of glasses/contacts for the practice, and adjust the contact lens prescription until you can see with more balance. You may also need reading glasses with a different strength for each eye. You are only two weeks post-op and sometimes this adjustment can take time.

[dmr1027]

I'm scheduled for Crystalens HD surgery next week, 2/11/09.  I am very nearsighted and have great close up vision without glasses.  I rely on this close up vision and don't want to lose it.  Because of this I've requested the first CHD lens be set for near to middle distance.  The first eye to be corrected will be the non-dominant eye.  Based on the results I get from the first CHD lens, I plan to have my dominant eye corrected for middle to distant vision.  I've worn glasses all my life and don't care if I continue to wear them for distance, but I'd hate to lose the close up vision I've always had.

Would anyone in this forum please comment on the quality of near vision they've experienced with the fourth generation Crystalens and the amount of time it's taken to achieve it.  And also on what amount of distance vision they've achieved.

Thanks,
Dee

[ace399]

Dee,
A Crystalens HD was implanted in my right eye on 1/20/09.  After 3 days I was still dilated.  At the 1 week post op exam, I still could not read the close up chart.  My far vision was 20/30 but still not totally clear.  My vision from about 2-1/2 feet and further is really good.  I cannot read the computer monitor with my right eye.

Please review the question I posed about "Crystalens in the right eye, Restor lens in the left eye."  There are a lot of good comments.  Bstaggs raved about this combo.  I am also myopic and can read with no glasses close up.  I would hate to lose that ability.

So, I am now seriously considering getting a Restor lens in my left eye, so I can see close up.  This was suggested by my Dr., since I had no accommodation after 1 week.  I am getting a 2nd opinion tomorrow.  In the mean time, I will continue to exercise my right eye to see if I can get more accommodation.  peakhope, also a Crystalens wearer (both eyes) wrote that his eye muscle did not return to normal until after 3 weeks because of the atropine.  My next surgery is now scheduled for 2/17, so I'll see if the Crystalens will accommodate more by then.  If it does, then I might consider another Crystalens in the left eye, otherwise it will probably be the Restor.

[peakhope]

I think the main thing is that you really won't know your Crystalens HD results for at least 2-3 weeks, and probably more like 4-6. So if you can't wait that long before your second procedure. you'll have to make a decision without all the information. My eyes were done 1/7 and 1/15. I'm a 45ish male with lifetime significant myopia and astigmatism. Each eye was ballpark -4 sphere and -4 cylinder.

Both of my eyes got HD's targeted at -0.25. I don't yet know if that was hit or not. Each eye can focus to about 16 inches, but reading with both eyes at that distance is not yet comfortable.  My vision and reading at 20-24 inches is so good that I actually reduced the system font size on my laptop about a week ago, to 9 points. In good light, I can read the tiny print on the back of a credit card, which is a pleasant surprise.

I can see great out to about 6-8 feet. Beyond that, it sort of comes and goes. I think I may have some residual astigmatism in my left eye that is causing some ghosting. I find that my distance vision improves as I take a deep breath, and just totally relax into it. I feel completely safe driving. It is possible that my eyes landed at -0.75 (for example), but I won't know that until my next exam in the middle of February. I believe my near and far vision will continue to improve over the next weeks and even months as my brain learns how to use these lenses.

My goal was to be free of glasses, and assuming I can pass a driver's license visual test, I will have achieved that. I work on computers for a living, and that vision is excellent. I have no trouble reading the newspaper or a phone book (in good light). My distance vision is "good enough", so I'm already a satisified HD customer, even with distance vision that is worse-than-expected so far.

[niteowl7]

I had the Crystalens HD put in end of July 2008 when it first came out. I have it in my left eye. It's been 6 months of misery. No near vision, no intermediate vision, nausea w/ reading glasses. Timeline: July 2008 Crystalens implanted, August 2008 YAG laser, October 2008 "piggyback" lens implant to improve far vision, November 2008 'piggyback" lens removed due to high eye fluid pressure, February 2009 still waiting for vision to stabilize as it is different, both far and near everytime I go in. My vision is actually getting worse. Glare, flares, moving light at the bottom of my eye, burning, redness, floaters, you name it. I've been checked for everything, like retina detachment. My eye is otherwise "healthy" it's this horrible Crystalens. I have one of the top surgeons in the country and he is as frustrated as I am.  Next visit is in a few weeks. I still need my right eye done. I'm a 42 yr old, female. I am very active in motorsports and I have been able to do nothing now for 6 months. This lens should not be on the market. The "HD" is "Highly Defective".  

[ace399]

I'm sorry to hear about your bad experience with the Crystalens HD.

I had a Crystalens HD implanted in my right eye 3 weeks ago.  My Dr. had recommended this because I am an active tennis player.  My far vision is between 20/30 and 20/40.  I've not had a Yag Laser yet, but my Dr. is seeing the start of clouding in the capsule.  He said this is common in youger patients.  I took this as a complement becasue I'm 62.

I cannot see well at all closer than 2 feet, but I've been exercising my right eye by doing the Crystalens word puzzles (1 per day) to improve accommodation.  I see flares and sometimes the edge of the lens, especially in low light, but they don't bother me.  I recognize that there is no perfect solution and afterall, this is a piece of plastic in your eye.

My Dr. recommended implanting a Restor lens in my left eye.  He says he has a lot of patients who did this and are very happy.  I got a 2nd opinion and have decided to agree with him.  This will be done next week.  Member "bstaggs" did this and he is extremely happy with the results.  It seems this combination is very complementary.

My Dr. did say that the new Restor, which has improved near vision is gaining on Crystalens and there are a number of Dr's in my area who prefer to implant the Restor lens.  Have you considered replacing the Crystalens with the Restor?  Restor does produce halos around bright lights, etc., so you will have to put up with them.

[peakhope]

I'm really sorry to hear you have had so many problems. It sounds like you were the unlucky "one in a thousand" or "one in a million" where more than one thing went wrong. The rest of this post is not specifically about your case, as only you know the full details. It's a reminder to people considering any procedure that there are risks.

Any lens can be great or terrible for any given person. Even the Array and Rezoom lenses, hated by many, worked well for some people. I think it is a combination of the skill of the surgeon, your expectations, and some luck.

Especially with the Crystalens, you want a doctor who knows exactly how to place the lens, as well as one who can correct any astigmatism that remains, and who can do a good yag if it is needed (and who won't rush to do a yag if it's not needed!). The doctor needs to pick the right lenses for the individual, taking into account the other eye, and needs to be able to handle whatever unexpected events come along.

Patients who expect perfect vision at any or all distances are likely to be at least somewhat disappointed. The target may not be hit, and even if you get 20/20 vision, things will appear a bit blurry. IOL's today can be better than the alternatives (cataracts, presbyopia), but are not perfect. If you choose Crystalens, you are betting that the advantages (sight at multiple distances unlike monofocals with less glare than multifocals) will outweigh the drawbacks and risks.

Finally, luck. Will you need a yag? Will the yag work well? Will your retina be fine? Will your brain adapt well to the lens? Will any glare or halos be annoying or debilitating? Will you get full accommodation with the Crystalens or not? Will your eye hit the target or be off by .5D one way or the other? Will you get an infection?

For many issues like that, there really is no way to know in advance. Medicine is like that. The best you can hope for is to fully understand the risks and benefits, find a great doctor, and then make your choice and take your chances.

I had HD's installed a month ago. So far, the procedure has been a success, but I realize that things could still go wrong (yag, rd). I still don't have great distance vision., which was a surprise, since most CL HD patients have great distance vision immediately. Mine seems to be about 20/40-50 in one eye, and (after a few weeks) 20/20-30 in the other.

So distant vision is disappointing (at least so far), but I'm still happy with my lens choice, because my intermediate and near vision are excellent. And I realize now (more than before the surgery) that near and intermediate are much more important to me than distance. What I have, while imperfect, is preferable to me than either monovision or the risk of glare with Restor lenses.

Informed decision + good doctor + modest expectations + luck.

[coolac]

Hello Peakhope,

i noticed you mentioned that your distance vision is not great, but is it correctible better with glasses? You also mentioned vision with the crystalens HD is blurry - i was wondering if you knew whether most people with a crystalens implant experience this ?

"and even if you get 20/20 vision, things will appear a bit blurry." - or did you mean all IOLs here?

[peakhope]

20/20 vision is not perfect vision. In fact, it's not even great. It's somewhat mediocre. So any IOL or contacts or glasses that only correct to 20/20 would be slightly blurry. With my vision ranging from 20/20 to 20/50 (so far), it can be a bit blurry.

I haven't tried correcting my distance vision with glasses, and probably won't. As long as I can pass my drivers license test, I'm ok with how I can see. I don't want to overstate the blurriness. I have functional vision.

My understanding is that most people have excellent distance vision with Crystalens. In my case, my best guess (not confirmed) is that my eyes ended up at -0.5 or -0.75 instead of the targeted -0.25, plus maybe some residual astigmatism in my worse eye. I'll find out more next week when I go back for a checkup.

I hope that's clearer (hee hee).

[ace399]

It seems that your HD has settled in where it gives you good near (1 to 2 feet) vision, but sacrifices some far vision.  My HD seems to have settled in where I get really good vision in the 2 to ~20 feet zone but is not good at < 2 feet and only 20/30 to 20/ 40 far.

If what I just said is correct, then wouldn't we have been better off with the standard fixed IOL, or does the Crystalens HD still offer a wider range than a fixed?

[peakhope]

My understanding is that a monofocal lens would have, on average, only 1D of accommodation, with some people having as little as .25, and a few lucky people getting 2-3.

In my case, let's assume each eye landed at -0.5, and that I can focus clearly from 2 meters to 2/5 of a meter (I think it actually is and/or will be better than that). That would mean that I have 2D of accommodation (from -0.5 to -2.5).

In your case, if your accommodation goes from (let's say) -0.25 (4 meters) to about 2/3 of a meter (1.5D), then you are only getting 1.25D of accommodation. That is less than I would expect for an HD, although still better than an average monofocal lens. Do you know whether your far vision is plano, -0.25, or whatever? Supposedly Crystalens users continue to improve their vision for months or years, so it may get better.

[In case you're wondering about the math, 1/meters = diopters, and 1/diopters = meters]

Oh, and I'm learning how to get better distant vision with less effort. It feels kind of like I'm pulling on a string that runs from the back of my eyeball to the front. I don't know what I'm physically doing, but it seems to be the opposite of accommodation, presumably flattening my lens. So far, I can only do it for one eye at a time, but I think with time it will become second nature for both eyes simultaneously.