Q:
What is the crystalens?
A: The crystalens is a new technology that is designed to
mimic the eye’s natural ability to focus on distant, middle, and near objects.
Used in conjunction with standard cataract extraction methods, the crystalens
was designed to provide a continuous range of vision, from distance to
intermediate to reading vision without total dependence on glasses or contact
lenses.
Q: What makes the crystalens different from other intraocular lenses?
A: The crystalens has the unique ability to focus on objects
at varying distances using the eye’s natural focusing system. This means that
the crystalens can provide a continuous range of vision, without corrective
lenses, from near to far and everything in between.
Standard (single vision) lens implants do not have the ability to provide a
full range of vision. Most people who have single vision lens implants MUST
wear glasses for middle and near vision. It was shown in the two year clinical
trial that supported the FDA approval of the crystalens that significantly
more patients implanted with a crystalens (88%) could see better at all
distances than patients implanted with a standard lens (36%).
Q: Can my vision be corrected to 20/20, for both reading & distance?
A: The crystalens has been designed to focus your eyes at all
distances after cataract surgery. While virtually everyone will experience a
significant improvement in their uncorrected vision after surgery, some people
will not see 20/20 at all distances.
It is interesting to note that many people who have not had surgery are not
able to see 20/20 at both near and far even with glasses or contact lenses.
This is due to a variety of ocular and physiological problems as well as
lifestyle preferences, yet most of these people function quite normally
although their vision is reduced.
The two-year clinical trial that supported the FDA approval of the crystalens
indicated that 92% of the people enrolled in the study (implanted bilaterally)
could see 20/25 or better at distance, 96% could see 20/20 at arm’s length and
73% could see 20/25 at near without glasses or contact lenses.
What is more exciting is that 98% of these people could pass their drivers
test, 100% could see their computer and dashboard, read the prices in the
supermarket or put on their makeup, and 98% could read the telephone book or
newspaper, all without glasses or contact lenses. It is important to keep in
mind that visual acuity is subjective and depends upon each individual’s own
ocular and physiological conditions as well as lifestyle preferences. Some
patients implanted with the crystalens still require glasses for certain
activities.
Q: What about my middle vision, like working on the computer. Will it be like
wearing trifocals?
A: Your ability to see at approximately arm’s length (middle
vision) will be greatly enhanced with the crystalens. Over 96% of people
enrolled in the clinical study were able to see 20/20 at arm’s length without
correction.
In addition, the quality of vision compared to wearing trifocals is
significantly improved. You will have a full range of vision, without having
to tilt your head to find that portion of your glasses that allows you to see
clearly. You simply look at something and the crystalens will automatically
focus your eye at near, arm’s length, or distance. The crystalens mimics the
natural focusing ability of your eye.
Q: Will I be able to read in all light conditions?
A: The crystalens functions very much like the normal human
lens. It is important to remember that reading vision in low light is also
influenced by the overall health of your eye and by the condition of the light
sensors in the retina. As we get older our ability to see in low light
conditions may start to decrease. It is always best to read in good light
conditions.
Q: How do I know if I am a good candidate for crystalens implantation?
A: Your doctor will perform a thorough examination and advise
you of a customized treatment plan for effectively correcting your vision.
Virtually everyone with good general health is a candidate for implant
surgery, but people with chronic infections, uncontrolled diabetes, or other
health problems may have to wait until these conditions are under control
prior to having surgery.
People who have had prior corneal refractive surgery are acceptable candidates
for crystalens implantation as long as their eye is in good health. Talk to
your doctor.
If you have already had cataract surgery, you are not a candidate for the
crystalens procedure.
Q: Should I have the
crystalens implant put in both eyes?
A: Typically cataracts will develop in both eyes. If only one
eye has a cataract, only one implant is necessary. If both eyes have cataracts
and the vision in one eye is worse, the surgeon will elect to implant that eye
first. If both eyes are the same, the surgeon usually starts with the
‘non-dominant’ eye.
Your doctor will look at a number of factors in deciding which eye to implant
first and when, if necessary, to implant the other eye. Most surgeons prefer
to wait two to three weeks between surgeries, but this may vary based on how
well the first eye is healing and the visual outcome.
Q: How long will the surgery take? Will I feel anything?
A: The crystalens procedure is typically performed in an
outpatient surgical facility. You will arrive at the surgery center about an
hour before the procedure. A number of topical drops will be placed in your
eye and you may be administered medications to help you relax. The eye drops
anesthetize your eye and dilate your pupil.
Once in the surgery suite, you will lie down on a comfortable bed, a
microscope will be positioned over your eye and you will be asked to look up
into the light of the microscope.
The actual surgery usually takes less than 20 minutes. The surgeon will
stabilize your eye with a device to keep your eyelids open. You will feel no
pain, only slight pressure on your eye. All you have to do is relax and hold
still.
Once the surgery is complete, additional drops will be placed in your eye to
prevent infection, decrease inflammation, and keep your pupil dilated. A patch
may be placed over your eye and someone will need to drive you home. Once at
home, you should rest for the remainder of the day. You should avoid any
strenuous activities. Your doctor will see you the day after surgery to remove
the eye patch and examine your eye. Do not rub your eye.
The doctor will give you additional medications that you will need to put in
your eye for the next week or two. These drugs help the eye heal, leaving no
residual effects.
Q: What are the chances that something could go wrong with the
surgery? What would they be?
A: The contemporary treatment for cataracts is to remove the
crystalline lens and replace it with an implantable lens. The crystalens
represents the state-of-the-art in implantable lens design and is the result
of over 50 years’ evolution in the treatment of cataracts.
The medical procedure to implant the crystalens is the same safe, proven
cataract surgery performed annually on over 7 million eyes globally. Over 40
million procedures have been done in the last 25 years. But because it is
surgery, it is not completely risk-free.
Complications of cataract surgery range from minor, usually temporary side
effects, to sight-threatening complications. Fortunately, significant
sight-threatening complications are extremely rare, and include, but are not
limited to, infection, hemorrhage, and retinal detachment. These and other
complications may occur as a result of the removal of a cataract, whether or
not an intraocular lens is implanted, and may result in poor vision, total
loss of vision, or loss of the eye. Dislocation of the lens and the need for
additional surgery, such as lens removal and replacement are also possible
risks of the procedure. In addition, people with existing medical conditions
such as diabetes, high blood pressure, chronic inflammatory conditions, and
chronic infections are at a higher risk of developing complications. Current
data indicates that 98% of people have no complications after cataract surgery
and more than 95% have improved vision.
Your doctor will perform a thorough examination and fully inform you of any
increased risk of a complication.
Q: What will my vision be like after surgery?
A: Your distance vision will usually be very good within a
day or two after surgery. However, your middle and near vision may be somewhat
blurred at first.
You may need to wear reading glasses to help you read during this time.
After about 2 weeks, you will notice that your middle (arm’s length) vision is
improving and your near vision is also starting to get better. It is important
that you discontinue the use of the reading glasses at this time so that you
strengthen the focusing muscle of your eyes.
It may take several months for your eyes to reach their full focusing
potential. The more you try to read without reading glasses, the quicker you
will be able to read without them. You may notice a difference in your vision
from one eye to the other after your eyes heal. This is normal. If the
difference in your vision is significant, your doctor may recommend additional
corneal refractive surgery. This is often done for the correction of
astigmatism after implant surgery.
Everyone’s focusing ability is different. Most people will be able to see
clearly in the distance, have excellent middle vision, and will be able to
read a newspaper without glasses, but some people may be more comfortable with
additional correction, particularly at night or in dim light.
It is important to remember that implant surgery cannot resolve pre-existing
visual conditions such as floaters, flashes, or visual field loss that are a
result of conditions of the eye and not related to the lens.
Your doctor will thoroughly discuss the restoration of your vision after
surgery and will recommend a specific plan for optimizing your uncorrected
vision for near and far. It is important to remember that while virtually
everyone experiences much improved vision after cataract surgery, some people
will have better uncorrected vision than others.
It may be necessary for some people to wear glasses for distance and/or near
vision to obtain optimal visual acuity. The difference from standard lenses is
that most people will not be dependent on these supplemental vision aids to
function normally.
Since this information isn’t intended to replace the advice of a health care
professional, be sure and talk with your doctor before making any decisions
regarding vision correction procedures.
The long-term safety and effectiveness of this lens have not been established.
Q: What can be done if my implant does not provide sufficient focusing
power?
A: There are various reasons why the power of your implant
may not be sufficient to provide you with a continuous range of vision,
including, but not limited to, measurement error, prior refractive surgery,
e.g., LASIK, RK. In these cases, your doctor will decide the best course of
treatment, which may include additional surgeries, such as removal and
replacement of the crystalens implant.
Q: What about glare, problems driving at night and
sensitivity to light? Can implant surgery create these problems?
A: Yes. These symptoms can be produced or exacerbated by
cataract surgery. Many people report these problems before cataract surgery
and even after surgery; however, they are rarely debilitating.
Sensitivity to light is often a temporary symptom. The crystalens optic
material is so clear that in some people it takes time to get used to how
bright colors are and how intense lights can be, particularly at night.
As with any intraocular lens, glare can be a problem at night when the pupil
widely dilates and occasionally light can reflect off the edge of the implant
and create a flash or halo of light. This typically does not occur in your
central field of vision, but rather in the periphery. People who have worn
contact lenses in the past may be familiar with this phenomenon.
Again, glare is rarely debilitating and if it does bother you, there are a
number of things that your doctor can do to improve your vision at night
including medications or night driving glasses.
Q: When will I be able to return to normal
activities after crystalens refractive implantation?
A: Typically, you will be able to return to normal activities
within several days after implantation with some limitations. Your eye may be
sensitive to touch and bright light, but you should be able to drive and
return to work in two to three days.
Your doctor will provide you with medications to prevent
infection and decrease inflammation, and may provide a protective shield to
cover your eye while sleeping. A pair of plastic, disposable sunglasses will
decrease your sensitivity to light as well as providing protection during the
day.
It is important that you avoid heavy lifting or straining that would increase
the pressure in your eye for several days after surgery. You also must avoid
rubbing or pushing on your eye. You should refrain from activities that could
increase your chances of getting hit in the eye. Wear your protective
sunglasses when outdoors.
You can shower and wash your hair as long as you avoid getting soap or shampoo
in your eye. Refrain from using eye makeup, lid liner, and mascara for several
weeks after implantation. You should avoid public swimming pools, hot tubs, or
other sources of bacterial contamination for several weeks.
Consult your doctor on recommendations for specific activities.
Q: How often do I need to have my eyes checked after surgery?
A: Your doctor will advise you as to how often your eyes need
to be checked. Typically, the doctor will see you one day after surgery, after
2 to 4 weeks, and again around 3 to 6 months after surgery. Thereafter, an
annual exam is usually sufficient unless you have a specific problem.
Q: Can I go to any eye doctor for check-ups after the surgery?
A: Your surgeon and/or his/her staff will want to see you
right after the surgery to ensure your eye is healing properly. This includes
the 1st post-operative visit and usually the following visit. After that, the
surgeon may allow you to see another qualified doctor to perform your
follow-up visits.
You should inform your surgeon if you would like a different doctor to
follow-up with you after surgery so he/she can consult with that doctor to
ensure a high level of care. You should immediately contact your surgeon if
you have problems or any doubts about your eyes after surgery.
Q: Will I have to have cataract surgery again?
A: Once your cataracts are removed and replaced with an
implantable lens, you will never have to have cataract surgery again.
Occasionally, several months after the lens has been placed in the eye, the
vision may start to become cloudy once again. This is sometimes called a
secondary cataract and refers to the clouding of the membrane that surrounds
the implant.
This membrane (the capsular bag) originally surrounded the human lens. When
the cataract was removed, all that remained was this membrane into which the
artificial lens was implanted. The membrane healed around the artificial lens,
securely holding it in place in the eye. Unfortunately, sometimes the same
conditions that caused the original cataract will cause the build up of cells
on the membrane behind the implant. These cells will block the vision and have
to be removed.
A laser is used to make an opening in the membrane behind the implant,
immediately improving vision. This is done painlessly without an anesthetic
and takes just a few minutes. Once this is done, no further surgery related to
your cataracts will be required.
Q: What happens if my eye is injured sometime in the future?
A: Eye injury can involve many different parts of the eye.
The clear front part of the eye, the cornea, and the back part of the eye, the
retina, are most often affected by injury.
The presence of an artificial lens does not make the eye any more vulnerable
to trauma. Indeed, once the human lens has been replaced by the crystalens,
eye trauma will not cause a cataract.
Q: What about future eye surgery?
A: Advanced implantation techniques and the biocompatibility
of the crystalens allow the body to treat the implant as a normal part of the
eye. The implantable lens is encased in the original membrane that surrounded
the crystalline lens. This membrane, called the capsular bag, traps and holds
the crystalens in the correct anatomical position in the eye.
Since the implant is fixed in the same position as the original lens, any
future eye surgery that could be performed in or around the normal eye can be
performed in an eye with the crystalens.
Botox treatments, plastic surgery, pterygium removal, and other cosmetic
procedures should not be performed until your eye is well healed. Typically,
this is around 3 months, but your doctor will advise you when it will be safe
to undergo these procedures.
Q: I have rosacea on my face. Do I need to do anything or take
anything before the surgery? Do I run a higher risk of infection after
surgery?
A: Rosacea is not generally considered a contraindication for
eye surgery unless symptoms are expressly related to the lids or the eye
itself. Your doctor will perform a complete examination and if symptoms such
as an infection of the eyelids, styes, eye irritation, and red eyes are
present, he/she may elect to treat these conditions with medication before
surgery.
If you have rosacea and are not currently exhibiting significant symptoms, it
is wise to inform your doctor of your condition.
Q: I have dry eyes. Will lens implantation help this condition or will
I still have to use artificial tears?
A: Implant surgery typically will have very little influence
on chronic dry eyes. This condition is related to a variety of internal and
external medical conditions and is sometime associated with aging. You should
consult your doctor on a therapy that is most suited to the cause and severity
of your condition as well as your lifestyle.
Q: Will the crystalens implant influence chronic red and irritated
eyes or headaches from eyestrain?
A: If eye irritation is a result of excessive contact lens
wear, sensitivity to cleaning and storage solutions, or what is generally
described as ‘eye strain’, implant surgery may reduce or eliminate these
symptoms. Eye irritation can be caused by a wide variety of internal and
external factors including allergies that have nothing to do with the
crystalens implant. Consult your doctor for proper diagnosis and treatment of
red, irritated eyes.
Q: Will security eye scanning still work after crystalens
implantation?
A: Security scanning should not be affected after crystalens
implantation. Security scanning usually relates to iris or retinal pattern
recognition. The implant has no influence on iris scanning and should not
interfere with retinal visualization through a normal-sized pupil.
Q: What will the crystalens procedure cost? Will insurance cover any of it?
A: Since each patient’s vision is different and unique, the
cost for the crystalens procedure will vary. Which qualified doctor you choose
and the city you’re in will also be factors. To find a doctor near you, go to
the Doctor Finder.
Insurance coverage varies greatly from policy to policy and state to state.
Generally speaking, private insurance may cover the cataract surgical
procedure and anesthesia and may also allow a certain additional amount for
the artificial lens implant. The insured is then required to pay a deductible
as well as any additional amount above the primary coverage. (Some patients
are completely responsible for payment – not all insurance companies will
cover some of the patient cost).
Payment for conventional IOLs furnished in an outpatient setting is covered by
Medicare. However, providers have generally not offered beneficiaries
presbyopia-correcting IOLs because the costs for this advanced technology
substantially exceed Medicare's payment.
A Medicare beneficiary may request insertion of a presbyopia-correcting IOL in
place of a conventional IOL following cataract surgery. In this case, the
presbyopia-correcting IOL device and associated services for fitting one lens
are considered partially covered by Medicare. The beneficiary is responsible
for payment of that portion of the charge for the presbyopia-correcting IOL
and associated services that exceed the charge for insertion of a conventional
IOL following cataract surgery.
Your surgeon will review your insurance coverage and your surgical
alternatives prior to your cataract surgery. It may also be beneficial for you
to contact your insurance carrier.
Q: How do I know who is a qualified crystalens implant surgeon?
A: All surgeons who are implanting the crystalens have gone
through a comprehensive training and evaluation course. Typically, these
surgeons have been performing cataract surgery for years and apply many of the
same techniques to implanting the crystalens.
Many surgeons have a webpage where you can learn about the doctor and the
practice. There is no substitute for a face-to-face consultation with one or
more surgeons prior to undergoing implant surgery.
It is also very useful to contact patients who have the crystalens implant in
their eye. Ask your surgeon if he/she can refer you to several crystalens
patients.
You can also contact your state medical society for information about a
particular surgeon.
Click here to locate a qualified doctor.
Q: How long will the crystalens continue to work?
A: The crystalens has been implanted in over 30,000 patients
with great success. Since FDA approval was received in 2003, data continues to
be collected that shows excellent visual outcomes with few reports of
complications, including glare and halos.
