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Medical Forum / General / Vision / March 2005Advised against CrystaLens by Dr.
I visited a prominent eye specialist in Northern VA today for a consultation about getting CrystaLens. He advised me not to it get for several reasons. 1) My eyes are still correctable to 20/20 and the slight clouding of my lens is consistent with what would normally be seen in a 55 year old man not 65 my true age. 2) Virginia law is screwed up and as it is now, he can not perform the surgery on anyone illegible for Medicare (i.e. 65 or older). 3) While I could go to Maryland and have the procedure done by another doctor (who's name he gave me) as a "Clear lens replacement" and pay out of pocket, he advised me against it. He said that currently there is a problem with one hinge flexing the wrong way causes the lens to sometimes bend in a "Z" shape that causes optical distortion. 4) By the time I need cataract surgery both of these problems should be resolved. He expects improved accommodative lens replacements to be available within a few months and that the Medicare law should also be corrected by then. He then asked, Is your vision recently been giving you problems prompting you to consider this procedure? I explained that when I was younger I could take glasses off that correct my myopia and read very fine print. Now I find that I can no longer see very fine print even when I take my glasses off. He said this is due to loss of contrast and most people experience this in their forties and that they find that they need more light to see. I wish I asked him if Crystalens surgery will improve the contrast. I did not think of this until I left his office. I decided to hold off on getting any elective eye surgery until I really need it or the lens manufacture has fixed the "Z fold" problem. BTW The office I was in has a doctor who is trained in the CrystaLens procedure but has opted to hold off on doing the procedure until the above problems are resolved. Dave Why are you contemplating lensectomy if your vision is correctable to 20/20! Are you just trying to get away from using reading glasses? I think this is a mistake. There is no good surgery for correcting Presbyopia yet. Better would be conductive keratoplasty but it's longterm success rate isn't so good. There are complications from eye surgeries too. It's not worth the risk. Good question and on point. I had two reasons. (1) I have two passions mountain climbing and photography. I use contact lenses when I climb because they do not get fogged. I find that my prespiopia make it very difficult to see my camera equipment at arms length. I would happy If I could focus from infinity to just short of arms length. The doctor I saw today agrees with you and told me to hold off for a while longer. Beside I have a trip planed to climb mountain in Peru next month. He tells me that after such surgery I must stay out of planes until I heal. (2) I had the mistaken belief that the longer I delayed such surgery the more my eye muscles would atrophy, resulting in less accommodation when I finally did get the surgery. He told me that this is wrong and waiting until I'm 70 will not hurt a thing. > Why are you contemplating lensectomy if your vision is correctable to > 20/20! Are you just trying to get away from using reading glasses? I > think this is a mistake. There is no good surgery for correcting > Presbyopia yet. Better would be conductive keratoplasty but it's > longterm success rate isn't so good. There are complications from eye > surgeries too. It's not worth the risk. >Good question and on point. >I had two reasons. >(1) I have two passions mountain climbing and photography. I use contact >lenses when I climb because they do not get fogged. I find that my >prespiopia make it very difficult to see my camera equipment at arms length. >I would happy If I could focus from infinity to just short of arms length. How about putting a "near vision" contact in the eye that better accomodates itself to close work? I know a couple of folks who do this, they both claim they've adjusted to having what sounds like monocular vision for both distance and close vision. > How about putting a "near vision" contact in the eye that better > accomodates itself to close work? I know a couple of folks who do > this, they both claim they've adjusted to having what sounds like > monocular vision for both distance and close vision. I have considered this and even tried special contacts that had concentric lenses that provided two different focal lengths to each eye. They drove me nuts! I could barely drive my car. I'm not good at compromise. One of the joys in climbing to a mountain top is to stand on the top, breath in the cold clean air, and see the world spilled out before you in three dimensional 20/20 vision. One blurry eye would upset me. My mountain climbing partner has a lazy eye and has monovision. She is able to see very well at both close and far. My mind can't ignore or integrate the out of focus portion of the total image the way she can. Dave That statement alone suggests to me that you are not a good candidate for any refractive surgery procedure at this time. nipidoc I'm not good at compromise. > Dave When you say "contrast", I believe you are talking about accomodation. Crystalens will allow some accomodation, but not a whole lot (< 2 diopters). Also, the doctor I spoke to said that no further improvements in accomodating technology will be available in the US within the next 10 years, and that the Crystalens will not have anything significantly improved on it. This doctor has performed 100s of Crystalens procedures. So, I don't know where yours came up with the statement that "He expects improved accommodative lens replacements to be available within a few months.." I could only wish that my vision was correctably to 20/20. > I visited a prominent eye specialist in Northern VA today for a consultation > about getting CrystaLens. He advised me not to it get for several reasons. [quoted text clipped - 34 lines] > > Dave Eddie, I guess time will tell which of our doctors is right. I think contrast is much different from accommodation. We both understand accommodation but I'm unclear just what the doc meant by contrast. I could take a guess and say it in less distinct demarcation between say black ink on white paper, caused by a cloudy lens. Maybe a knowledgeable lurker will clear this up. From what I read about the CrystaLens, with a little luck you should be able to drive your car and read a map at arms length with out glasses. That would be good enough for me. The trouble is that it takes a little luck. If you are unlucky you could end up with poorer vision. I'm unwilling to gamble with my eyes. I'll put up with carrying an extra pair of reading glasses until the odds are proved to be much better. Have you been told that you have cataracts? If so I believe an operation could give you 20/20 vision or better. I recall a friend of mine who had cataract surgery many years ago. They did not implant lenses in his eyes. They gave him coke bottle eye eyeglasses. He could remove his glasses and place them on top of his car in line with his eyes and see better then I could at far distance. Back then I had 20/15 vision. Maybe he was pulling a trick on me. Dave > When you say "contrast", I believe you are talking about accomodation. > Crystalens will allow some accomodation, but not a whole lot (< 2 [quoted text clipped - 9 lines] > > I could only wish that my vision was correctably to 20/20. Dave, Yes, time will tell, but unfortunately I don't have much time. I have cataracts that are progressing fast, and I will need surgery within 6 months. So, I will have to make a decision soon. Since I am only 34, whatever decision I make will have to be a good one, since I'll have to live with it for 40+ years. Crystalens is not perfect, and it's very expensive. But it might be the best out there now. Synchrony looks even more promising, but it's a couple of years away, and I won't be able to wait that long. I have considered waiting for the Restor lens which will be available this year, but it's a multi-focal (albeit a good one), and those are not perfect either. My last possibility is to just get standard IOLs now, with the hope that they can be replaced for something better when the time comes, but my doctor indicated that that was not possible. So, who knows. I just wish there were more OBJECTIVE informational resources available to people. > Yes, time will tell, but unfortunately I don't have much time. I have > cataracts that are progressing fast, and I will need surgery within 6 > months. So, I will have to make a decision soon. Since I am only 34, > whatever decision I make will have to be a good one, since I'll have to > live with it for 40+ years. > So, who knows. I just wish there were more OBJECTIVE informational > resources available to people. The problem is that this isn't an objective problem, but a subjective one. Furthermore, it's not really a cataract issue, other than the fact that you will be getting full presbyopia at 34 years of age rather than the usual later age. Most people face increasing presbyopia with increasing age. You thus have the same options available to most people. These include glasses, bifocals, trifocals, progressives, contact lenses and bifocal contacts. Depending on the strength chosen, you can have binocular vision or monovision (one eye set for close, one for far). I would suggest that you consult with your OD, who deals with presbyopia quite a lot. Different people are comfortable with different solutions, which is why I say that this is a subjective problem. Another option that you have that most people don't, is the ability to request IOLs with the strength you want. You can have them set for close, or for distance, or one of each, or something in between. Most people choose far vision, and then add reading glasses for close work. Some of us *almost* even looked forward to cataract surgery. I wore very thick glasses for 35 years, but now after having cataract surgery in both eyes, I need no correction for distance.  SignatureDan Abel Sonoma State University AIS dabel@sonic.net Because your time window is so short, I thought I should give you the source of my information. I was Dr. Young who mentioned the "Z" fold problem with Crystalens and that they expect it to be fix in a matter of months. I mentioned that I will wait for about another three years before I consider the Crystalens operation. His response was that will more then enough time for the problems with the law and the "Z" fold lens. He went on to say that he expects both these problems to be solved within the next three months. Until such time as these problems are resolved, they are holding off on performing any Crystalens operations. The Doctor in that office who is qualified to perform the Crystalens operation is Dr. John Baldinger. You might consider calling them at (703) 876-9630. Get the story right from the horses mouth. From my experience with doctors I would not be surprised with anything he tells you. You mentioned the Synchrony lens as being "even more promising". While the Synchrony lens provides about twice the accommodation as measured in dioptas, this only translates to a few inches in real life. What I mean is, with a Crystalens you can expect to see from infinity to your wrist. With a Synchrony lens you can expect to see from infinity to your elbow. Is that 10 or so inches all that important? The name of the group I'm referring to is Capital Eye Consultants located in Fairfax Virginia. Good luck with what ever you decide to do and please keep us posted. Dave > Dave, > [quoted text clipped - 15 lines] > So, who knows. I just wish there were more OBJECTIVE informational > resources available to people. Dave, Many thanks for the followup. Futher research has revealed that the Synchrony is at least 4 years away from the market, so that's pretty much out of the question for me. You are right that the extra diopter or two won't make that much of a difference, but the difference between zero accomodation and a couple diopters is huge. Thus, I'll wait as long as possible for the Crystalens. i'll do more investigation on the issues that you brought up.. There are a few qualified doctors down where I live, so I can get a consultation with another one and bring up my new questions. Thanks again, and I'll keep everyone posted. Eddie > Because your time window is so short, I thought I should give you the source > of my information. [quoted text clipped - 44 lines] > > So, who knows. I just wish there were more OBJECTIVE informational > > resources available to people. Eddie, While Crystalens have been advertised as the solution to number of vision problems I would advise aganst having them implanted. I had the Crystalens implanted last year (10 months ago)and have had problems. My Doctor, while not admitting there are issues with the lens did stop the implants for a period of time and did acknowledge that all results had been as expected. In my case the lens implant resulted in near sighted in one eye and far sighted in the other with 20/30 and 20/100. I am now faced with a lasik decision to correct the eyes to fixed distances. Obviously I am proceeding with caution. Again DO NOT believe the hipe being presented by Eyeonics or their representatives. Also Eyeonics will not discuss this with you, referring you to your Doctor. A vicious circle. In a word, DON'T, it's your vision. David Eddie, While Crystalens have been advertised as the solution to number of vision problems I would advise aganst having them implanted. I had the Crystalens implanted last year (10 months ago)and have had problems. My Doctor, while not admitting there are issues with the lens did stop the implants for a period of time and did acknowledge that all results had not been as expected. In my case the lens implant resulted in near sighted in one eye and far sighted in the other with 20/30 and 20/100. I am now faced with a lasik decision to correct the eyes to fixed distances. Obviously I am proceeding with caution. Again DO NOT believe the hipe being presented by Eyeonics or their representatives. Also Eyeonics will not discuss this with you, referring you to your Doctor. A vicious circle. In a word, DON'T, it's your vision. David
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