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Medical Forum / General / Vision / August 2008Accommodating Christalens
My new cataract surgeon is pushing me too hard to get Christalens (accommodaing) IOL. I recall one negative opinion on this group about this option. I believe his motivation is monetary -- since it's not covered by insurance he can charge me a very high price not subject to insurance approval. Does anybody have an experience, good or bad, with this type of IOL? Please notice, it's not a multifocal, but presumably a lens with accommodating ability. It should be Chrystalens, of course. Sorry for the misspelling. > My new cataract surgeon is pushing me too hard to get Christalens > (accommodaing) IOL. I recall one negative opinion on this group about [quoted text clipped - 3 lines] > with this type of IOL? Please notice, it's not a multifocal, but > presumably a lens with accommodating ability. > It should be Chrystalens, of course. Sorry for the misspelling. > [quoted text clipped - 5 lines] > > with this type of IOL? Please notice, it's not a multifocal, but > > presumably a lens with accommodating ability. actually, it should be "Crystalens". see http://www.crystalens.com/ i have two patients who have tried it. apparently some patients can regain a small proportion of accommodation but others cannot. the company claims that doing visual training-like accommodative exercises may help. it will take many years to be sure whether this approach actually works. my gut tells me that it won't prove to be that beneficial. We have a detailed article about the Crystalens at http://www.usaeyes.org/lasik/faq/crystalens.htm Glenn Hagele Executive Director USAEyes.org Patient Advocacy Surgeon Certification "Consider and Choose With Confidence" Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org Lasik Bulletin Board http://www.USAEyes.org/Ask-Lasik-Expert/ I am not a doctor. Copyright 2007 All Rights Reserved I probably bad mouthed it as much as anyone. I've only seen one, implanted by one of the world's best cataract specialists. I pushed and pushed and couldn't document even .25 D of accommodation with it. Why risk a larger incision, a clunky lens, and no chance of normal accommodation just so the manufacturer and the doc make a few extra bucks? Forget it. Get the best single vision lens you can get, and make them have prolate optics if your eyes are appropriate for them. > > [quoted text clipped - 22 lines] > > > I probably bad mouthed it as much as anyone. I've only seen one, > implanted by one of the world's best cataract specialists. I pushed and [quoted text clipped - 27 lines] > > - Show quoted text - He has probably presented the ReZoom and ReStor lens options too, right? I don't have eny personal experience with them, but have had several Ophthalmoligists lecture about these lenses being used in patients. The ReStor lens is a lens that gives you the ability to see near objects better, and the ReZoom lens allows comfortable distance vision. The ReStor lens is placed in the non-dominant eye and the ReZoom in the dominant eye. Neither of these lenses moves to allow the patient to see up close like the design of the Crystalens. This option is very similar to modified monovision contact lens wear where one eye is predominatly used at distance and the other is used for near tasks. The Crystalens touts +1.25D (80cm, 31 inches) of accommodative abilty, and I don't know if they actually get that, it is probably patient dependant, but if you ask your surgeon if you will still need glasses EVER with any of these lens combinations he will undoubtibly say "yes," for small print. You will be able to do most tasks without reading glasses, but will still need some occasionally, no matter which options you go with. Hope this helps. ODTOBE The ReStor lens is a lens that gives you the ability to see > near objects better, Better than what? Certainly not better than a single vision IOL that is corrected for the near point (if needed) by ordinary spectacles. and the ReZoom lens allows comfortable distance > vision. comfortable? Maybe. So long as you don't mind at least half the distant light rays being thrown out of focus by them... The ReStor lens is placed in the non-dominant eye and the > ReZoom in the dominant eye. Why? Maybe so you won't notice how bad the optics are? Neither of these lenses moves to allow the > patient to see up close like the design of the Crystalens. The crystalens only allows you to see up close clearly if it is over plussed. We know that they don't really accommodate very much if any. > The Crystalens touts +1.25D (80cm, 31 inches) of accommodative abilty, > and I don't know if they actually get that, it is probably patient > dependant In all fairness, for people who were very hyperopic before surgery, the extra strong IOL involved does give them a slight advantage, as any movement in the IOL will be more effective than with weaker IOLs. For myopes, forget it. The IOL doesn't have enough power to help you at near unless it's over-plussed. So why bother with these clunky lenses at all? I think most of them don't really move at all. , but if you ask your surgeon if you will still need glasses > EVER with any of these lens combinations he will undoubtibly say > "yes," for small print. You will be able to do most tasks without > reading glasses, but will still need some occasionally, no matter > which options you go with. By far most cataract patients are looking to rid themselves of the dim fog of cataracts. Any IOL will help that. The fact remains that the best post op vision comes with single vision lenses, prolate for most, standard for some. Multifocal and 'focusing' IOLs are bad news for just about everyone except the manufacturers. w.stacy, o.d. > The crystalens only allows you to see up close clearly if it is over > plussed. We know that they don't really accommodate very much if any. [quoted text clipped - 24 lines] > > w.stacy, o.d. --------------------------------------------------------------------------- My ophthalmologist has suggested the Chrystalens as the only lens that could offer some accommodation for my presbyoptic condition. (I'm considering cataract surgery because of difficulty in seeing under any degree of background glare due to crystallization in the lens(?) and highly variable eyesight). I would not expect to be able to read small print without glasses but would like to be able to see both distant and mid distance (e.g., 6 - 25 feet) objects clearly. I sense from your comments, and those of others, that you don't think the benefits offered by the Chrystalens are worth the extra cost. - However, I note at least one report regarding the results of FDA trials that seems to indicate that the lenses do help a majority of patients. See the following: "In the FDA clinical trials it was found that a vast majority, but not all, patients implanted with a Crystalens accommodating IOL achieved a measurable improvement in accommodation. It was also indicated that the Chrystalens provided vision quality equal to or better than a conventional IOL. It would appear that there is no significant downside to the Crystalens accommodating IOL, and the high probability of functional accommodation is most assuredly an upside." As understood, it takes a substantial period of time, e.g., six to eight months, for many patients to adapt to the Chrystalens lenses. Does anyone have information concerning the results for patients who have gone through such an extended, eight-month adaptation period? Thanks, Jim We have a detailed article about Crystalens at http://www.usaeyes.org/lasik/faq/crystalens.htm Due to the physics optics and the design of the lens, the most that you could reasonably expect to achieve from Crystalens is about 1.50 diopters of accommodation. Try using +1.50 reading glasses for an idea of what near vision that would provide. Not everyone who has the Crystalens implanted achieves any accommodative effect, however it is difficult to determine in advance who will and who will not. Glenn Hagele Executive Director USAEyes.org Patient Advocacy Surgeon Certification "Consider and Choose With Confidence" Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org Lasik Bulletin Board http://www.USAEyes.org/Ask-Lasik-Expert/ I am not a doctor. Copyright 2007 All Rights Reserved > We have a detailed article about Crystalens at > http://www.usaeyes.org/lasik/faq/crystalens.htm [quoted text clipped - 12 lines] > USAEyes.org > Patient Advocacy Surgeon Certification I'm not sure your comments are responsive to my question. The question was: Does anyone have information concerning the results for patients who have gone through such an extended, eight-month adaptation period? - - Do you have actual test results, peer reviewed, for patients who have completed such an adaptation perios? Jim ? Summary of FDA approval clinical trials is at http://www.fda.gov/cdrh/pdf3/p030002.html The National Library of Medicine (http://www.PubMed.com) shows a dozen peer-reviewed studies regarding the Crystalens. 1: Findl O, Leydolt C. Meta-analysis of accommodating intraocular lenses. J Cataract Refract Surg. 2007 Mar;33(3):522-7. PMID: 17321405 [PubMed - indexed for MEDLINE] 2: Cumming JS. Performance of the crystalens. J Refract Surg. 2006 Sep;22(7):633-4; author reply 634-5. No abstract available. PMID: 16995542 [PubMed - indexed for MEDLINE] 3: Cumming JS, Colvard DM, Dell SJ, Doane J, Fine IH, Hoffman RS, Packer M, Slade SG. Clinical evaluation of the Crystalens AT-45 accommodating intraocular lens: results of the U.S. Food and Drug Administration clinical trial. J Cataract Refract Surg. 2006 May;32(5):812-25. PMID: 16765800 [PubMed - indexed for MEDLINE] 4: Macsai MS, Padnick-Silver L, Fontes BM. Visual outcomes after accommodating intraocular lens implantation. J Cataract Refract Surg. 2006 Apr;32(4):628-33. PMID: 16698485 [PubMed - indexed for MEDLINE] 5: Jardim D, Soloway B, Starr C. Asymmetric vault of an accommodating intraocular lens. J Cataract Refract Surg. 2006 Feb;32(2):347-50. PMID: 16565015 [PubMed - indexed for MEDLINE] 6: Koeppl C, Findl O, Menapace R, Kriechbaum K, Wirtitsch M, Buehl W, Sacu S, Drexler W. Pilocarpine-induced shift of an accommodating intraocular lens: AT-45 Crystalens. J Cataract Refract Surg. 2005 Jul;31(7):1290-7. PMID: 16105597 [PubMed - indexed for MEDLINE] 7: Cazal J, Lavin-Dapena C, Marin J, Verges C. Accommodative intraocular lens tilting. Am J Ophthalmol. 2005 Aug;140(2):341-4. PMID: 16086970 [PubMed - indexed for MEDLINE] 8: Stachs O, Schneider H, Stave J, Guthoff R. Potentially accommodating intraocular lenses--an in vitro and in vivo study using three-dimensional high-frequency ultrasound. J Refract Surg. 2005 Jan-Feb;21(1):37-45. PMID: 15724683 [PubMed - indexed for MEDLINE] 9: Dick HB. Accommodative intraocular lenses: current status. Curr Opin Ophthalmol. 2005 Feb;16(1):8-26. Review. PMID: 15650575 [PubMed - indexed for MEDLINE] 10: Alio JL, Tavolato M, De la Hoz F, Claramonte P, Rodriguez-Prats JL, Galal A. Near vision restoration with refractive lens exchange and pseudoaccommodating and multifocal refractive and diffractive intraocular lenses: comparative clinical study. J Cataract Refract Surg. 2004 Dec;30(12):2494-503. PMID: 15617915 [PubMed - indexed for MEDLINE] 11: Marchini G, Pedrotti E, Sartori P, Tosi R. Ultrasound biomicroscopic changes during accommodation in eyes with accommodating intraocular lenses: pilot study and hypothesis for the mechanism of accommodation. J Cataract Refract Surg. 2004 Dec;30(12):2476-82. PMID: 15617913 [PubMed - indexed for MEDLINE] 12: Dick HB, Kaiser S. [Dynamic aberrometry during accommodation of phakic eyes and eyes with potentially accommodative intraocular lenses] Ophthalmologe. 2002 Nov;99(11):825-34. German. PMID: 12430034 [PubMed - indexed for MEDLINE] Glenn Hagele Executive Director USAEyes.org Patient Advocacy Surgeon Certification "Consider and Choose With Confidence" Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org Lasik Bulletin Board http://www.USAEyes.org/Ask-Lasik-Expert/ I am not a doctor. Copyright 2007 All Rights Reserved > Summary of FDA approval clinical trials is at > http://www.fda.gov/cdrh/pdf3/p030002.html [quoted text clipped - 102 lines] > Copyright 2007 > All Rights Reserved And, what are the conclusions expressed by the authors of these articles? Since you apparently are hoping to impress me by listing them, how do the articles relate to the specific question I asked? Or do they? Also, why should a layman be expected to study such materials, since most of us (like you) aren't physicians? Also, are the FDA approved testing procedures, and the resulting FDA approval of the lenses, of no consequence? Totally meaningless? Again, the question was: Does anyone have information concerning the results for patients who have gone through such an extended, eight-month adaptation period? Please understand that I haven't made any conclusions, one way or another. However, I seem to smell a certain bias in your statements. - In any evaluation of medical procedures or devices, one can usually find examples and opinions to support almost any desired conclusion or bias. A more significant factor would be: what percentage of patients who have had the Chrystalens implanted, and who have completed such an adaptation process, would do it again? - Do you have that information? Jim Copyright 2007 All Rights Reserved > Summary of FDA approval clinical trials is at > http://www.fda.gov/cdrh/pdf3/p030002.html [quoted text clipped - 102 lines] > Copyright 2007 > All Rights Reserved Here are some interesting comments regarding Glenn Hagele and CRSQA/USAEYES. - I have no idea whether they are all true, but it makes for interesting reading: CRSQA / USAEYES is a surgeons' referral service masquerading as a patient advocacy group, operated by Glenn Hagele from his home in California. Court records show that Glenn Hagele was a complete failure as a marketing consultant and filed a Chapter 7 Bankruptcy in the amount of $431,313 under the name of "Creative Marketing" from the same address as which he operates CRSQA / USAEYES. Court records also show numerous tax liens filed against Glenn Hagele by the IRS and State of California. Court records also show that the Sacramento District Attorney placed liens on his property for unpaid child support. Glenn Hagele "certifies" about 30+ refractive surgeons who pay it the fees of $7,000 in the first year and $5,000/year thereafter. In exchange, they receive CRSQA's bogus seal of approval in the hope that this will help them promote their Lasik practices. Harassment and Threats Against Patients by Glenn Hagele Part of Glenn Hagele's job is to patrol internet forums to promote LASIK, discredit patients who have had bad outcomes, and prop up the practices of surgeons to whom he provides "certifications". Glenn Hagele has harassed, threatened to publish the divorce records of a patient, and threatened to sue other patients. Violation of IRS Rules for Non-Profit Organizations As a non-profit organization, CRSQA / USAEYES is required to provide annual tax returns to anyone who requests them. Several individuals have requested these returns, however, he has never provided copies of these returns. Jim I am suing an individual in California Superior Court, Sacramento, for distribution of these and similar inaccurate, misleading, and defamatory statements. For details, visit http://www.GlennHagele.com Why anyone would republish potentially defamatory statements if s/he does not know if they are true is beyond me. Glenn Hagele Executive Director USAEyes.org Patient Advocacy Surgeon Certification "Consider and Choose With Confidence" Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org Lasik Bulletin Board http://www.USAEyes.org/Ask-Lasik-Expert/ I am not a doctor. Copyright 2007 All Rights Reserved Learn the full truth about Glenn Hagele's harassment of LASIK patients at the following web sites: http://www.theglennhagelereport.com/ http://www.lasikpimp.com/ http://www.usaeyes.us/ http://www.jackholladay.com/avoid_this_doctor.html Here's a copy of a lawsuit filed against Glenn Hagele and his organization "CRSQA / USAEyes": http://www.lasikpimp.com/docs/lauranell_burch_vs_hagele_and_usaeyes.pdf The above post by JimC is a huge pile of crap started by a few mentally warped psychos who started an internet site. Their goal in life is to whine and blame and they're not worth anyone's time. Actually, they make Otis look like a genius, now the picture is complete. > The above post by JimC is a huge pile of crap started by a few > mentally warped psychos who started an internet site. Their goal in > life is to whine and blame and they're not worth anyone's time. > > Actually, they make Otis look like a genius, now the picture is > complete. Not quite. This shows how the "patient advocates" treat lasik complication victims. It speaks for itself. Lasik complications can be very serious but to these salesmen,they're a joke. They just want to hide the truth. They spend their days attacking and discrediting victims,every day. Maybe that's part of their "job". They even seem quite proud of themselves. I know this is off topic but these clowns deserve to be exposed. Hi Jim, I submitted a petition to the FDA (in addition to 3 others) regarding known problems with sizing of intraocular lenses. I would suggest looking into having the lens removed before there's further damage to the endothelial cells. There's known problems with these types of lenses. The FDA is supposed to respond "shortly" 12/18/2006 2006P-0519 Michael Patterson, Ph.D., BSEE/Stop all approvals of medical devices used for implantable lens implants including, but not limited to Phakic IOLs (PIOLs) and Collamar Lenses or to place a moratorium on their use Pending 05/17/2006 2006P-0212 Michael Patterson/Stop Lasik due to the use of research from experiments conducted on human beings without proper basis to believe it is in the patients best interests and improper patient informed consent Interim Response 11/06/2006 05/17/2006 2006P-0213 Michael Patterson/enforce the single- use requirement for all Microkeratomes and their components used by Lasik Interim Response 11/06/2006 12/18/2006 2006P-0518 Michael Patterson, Ph.D., BSEE/Stop all approvals of medical devices and their components used for LASIK or place a moratorium on their use Pending > Hi Jim, > [quoted text clipped - 3 lines] > the endothelial cells. There's known problems with these types of > lenses. I haven't had the lenses implanted, so I don't have to remove them, although I am considering them. - I'm aware of some of the difficulties, but it seems to me that the more significant indice is whether patients who have them are satisfied with them and would have the procedure done again, if they had it to do over. - Do you have that information? > The FDA is supposed to respond "shortly" > [quoted text clipped - 4 lines] > a > moratorium on their use Pending I'm not sure I understand this statement. - Are you saying you would like to force the FDA to stop approvals of ALL implantable lenses, under any circumstances??!! Does that include all previously approved lenses?? > 05/17/2006 2006P-0212 Michael Patterson/Stop Lasik due to the use > of [quoted text clipped - 7 lines] > requirement for all Microkeratomes and their components used by Lasik > Interim Response 11/06/2006 > 12/18/2006 2006P-0518 Michael Patterson, Ph.D., BSEE/Stop all > approvals of medical devices and their components used for LASIK or > place a > moratorium on their use Pending Regarding Lasik surgery, I would again suggest that the more significant factor is whether a significant majority of patients who have undergone the procedure are satisfied with the results and would do it again, and secondly, what percentage suffered significant, permanent damage to the eye. IMO, the fact that SOME patients suffered damage or discomfort is NOT the key factor, provided the percentage is low and is disclosed to the patient. I did have the Lasik procedure. - I had a difficult prescription and was told about the potential complications but decided the benefits outweighed the possibility of complications, which, of course, are an issue with respect to any form of surgery. Bottom line is that I thank God for the improved vision I obtained as a result of the procedure. I also thank God that the FDA wasn't pressured into disapproving the procedure because of the very few substantive, uncorrectable complications. Again, do you (or anyone) know what percentage of patients who have the Lasik procedure, or have had intraocular lenses implanted, are generally satisfied with the results and would choose to have the procedure done if they had it to do over? Jim > i have two patients who have tried it. apparently some patients can > regain a small proportion of accommodation but others cannot. the > company claims that doing visual training-like accommodative exercises > may help. it will take many years to be sure whether this approach > actually works. my gut tells me that it won't prove to be that > beneficial. When you reviewed the matter with the two patients who tried it, how many months had it been since the lenses were implanted, and did their vision improve over time? Jim |
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