Dave:

I asked about Crystalens a few weeks back and got no responses.

BZall@aol.com

The Crystalens is a very new product in the USA  (3 months) and has only
a year or so of usage in Europe.  I've attended a seminar given by a
ophthalmologist who had done the procedure,  who curiously is not on
their list of practitioners that you can view on the company's web site.  
I also had the opportunity to view the procedure and talk with one
patient who had the implant.

I think it's a great idea that needs further development. If we're
looking for a perfect fix for cats and presbyopia, this isn't it but
we're getting close!  The amount of add power that most patients
(remembering the limited post-surgical data) get is not enough to free
them from the use of near vision spectacles and the optics is, as you
wrote, a little too small to best serve the majority of patients,
especially the "younger" demographic.

There are a number of other lenses under development that incorporate
similar mechanics but with different materials. Additionally, combining
this lens with other refractive surgery procedures might further enhance
"the real life working success rate."

I'd suggest a "wait and see" position for at least the next six months
or so, unless you are willing to accept that which this product can
provide for you.

My opinion, of course.  Do check with docs who have done this in your
area and share with us any more info you might learn!

--LB

Whenever you hear of a new miracle, check the previous miracles and
expect something a bit less than miraclous.

Yes, the CrystaLens does seem to be a viable accommodating intraocular
lens (IOL), but there are some very real limitations to its acceptance
in the US.

The haptics of the CrystaLens must be placed in the ciliary sulcus.
Those of you who know the anatomy of the eye understand that this is a
small ridge that encircles the eye just underneath the iris.  If the
lens is not placed in the ciliary sulcus, it may not accommodate at
all.  If it is placed on the zonules, it can cause siginificant
damage.  Some people don't even have the ridge at the ciliary sulcus,
but you can't determine any of this preoperatively because there is no
readily available way to actually look.  Even when implanting the IOL,
the surgeon cannot see underneath the iris to determine if the IOL is
implanted correctly or CAN be implanted correctly.

To say the least, the skill of the surgeon had better be top notch.

Of those who have accommodation, it tends to be about 1.00 to 1.50
diopters.  That is not bad, but nothing to write home about.  Some get
no accommodation at all.  Whether or not the patient will have
accommodation or not cannot be known until after the surgery and
healing is completed.

It seems that CrystaLens is a step forward, but like all first steps,
it is a small step.  Expect continued development and improvement on
accommodating IOLs and the surgical techniques to implant them.

If you talk with patients who have the multifocal
"psydo-accommodative" IOLs, you will quickly learn that you must love
halos to love these particular IOLs.

When the rubber hits the road, CrystaLens and other superior
technology IOLs come to a screeching halt.  Not because of any problem
with the IOLs, but because of problems with paying for the IOLs.

Most US citizens develop cataracts at an age when they are covered by
Medicare insurance.  As a part of the federal government, the Medicare
system has the ability to not only decide what insurance coverage to
provide, but to back it up with civil and criminal penalties.

Medicare determines how much will be paid for an IOL.  No matter how
much the lens actually costs, Medicare will only pay that amount.
This sounds reasonable, but the next point may surprise you.  Even if
the patient wants to pay the difference for a superior technology IOL
such as the CrystaLens, Medicare will not allow it.

If a doctor receives from the patient the actual difference between
what Medicare allows for an IOL and the cost to the doctor for the
superior technology IOL (no profit), the doctor is subject to
significant fines, being kicked out of the Medicare system, and jail
time.

Medicare will not allow a beneficiary to purchase superior technology;
even with the patient's own money and even if the superior technology
is clearly advantageous for the patient.

For this reason, there is very little incentive for manufacturers to
develop superior technology IOLs.  If someone wants the CrystaLens,
that person will be required to pay the entire cost of surgery
including the physician component, anesthesiology, facility, and IOL
out of his or her own pocket - even if the patient has Medicare.

Currently no Medicare supplemental insurance will pay the entire cost
of care to be able to receive superior technology, and none seem too
eager to add this potential liability to their plans.

This is an inequity that affects not only people wanting superior
technology IOLs, but people needing other prosthetics and even
pacemakers.  The federal government will not allow a patient to use
his or her own money to pay the difference and receive superior
technology.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Do a lot of research, I had the IOL's implanted a year ago and met with a
disappointing result.  At the time I had the surgery I could find no
information on the results of these implants except the advertisements from
Eyeonics.   I found that the glowing remarks and comments were the same on
all of the Doctor's sites performing these implants.

Now I am beginning to see several posts on the internet from patients that
are experiencing disappointing results.