Crystalens Cost with Cataract Surgery
It seems like life was much simpler when I was a child. Ice cream was offered in three flavors: vanilla, chocolate, or strawberry. That was all I needed to know to make me happy.
Today, there are just too many choices available. Once in a while, I have a compelling need for someone to take control and tell me which options to select. It has never been more true than this year, when I was confronted with worsening vision.
I’m having a cataract removed from my left eye in one month. I’m in good company. Cataract surgery is the most frequently performed surgery in the United States. Each year, approximately 3 million Americans undergo the procedure, mostly with satisfactory results.
How We Got Here
Decades ago, patients undergoing cataract surgery had no choice but to wear thick glasses for the rest of their lives, since there was nothing to replace the natural lens which had been extracted. Eventually, however, researchers developed the monofocal intraocular lens implant, followed by multifocal implants, and finally, in 2003, the Crystalens accommodating intraocular (IOL) lens implant.
The Crystalens IOL is now in its fifth generation, the Crystalens AO. When I had my surgery, I had the previous generation (the Crystalens HD) implanted in my eye.
The Crystalens IOL, unlike its counterparts, actually works like the eye’s natural lens. There is no fixed focal point where the eye focuses best. The lens actually mimics the adjustments that the eye muscles make when they shift from focusing on something near, like reading material, to something far, like the horizon. After weeks or months, an individual’s brain eventually adjusts to the lens so that the transition from near to intermediate to far is seamless.
Most people who have the Crystalens implanted will enjoy freedom from glasses in most situations, with perhaps low light and very tiny print giving them difficulty. A significant proportion, however, will continue to need reading glasses.
The Crystalens has enjoyed consumer success. Globally, approximately 7 million people are walking around with this lens implanted in their cataract-free eyes.
So many choices now, so many more difficult decisions. The patient is now a very important part of the cataract surgery process. And as consumers, we all want to find the best value for our money where we can.
The Crystalens is an expensive premium IOL. In fact, it is very lucrative for the ophthalmologist who sells it to you. But don’t expect to find up-to-date lens costs by visiting various opthalmologists’ web sites. These web sites tend to give you the same marketing information about the Crystalens that Bausch & Lomb offers. Also, you cannot just phone an ophthalmologist and expect the office assistant to blurt out their cost for a Crystalens. Very likely, they would encourage you to set up an appointment with the doctor for a cataract evaluation.
So, where do you turn to get an idea of the Crystalens cost? In addition to having the price spelled out for me at two different ophthalmologists' offices, I have investigated reports on the Internet and spoken with individuals to get an approximate range of prices for this lens. You can expect to pay between $2500 and $3000+ (per eye) for your Crystalens. The cost may vary with the area of the country, the length of time the doctor has been practicing, the doctor’s reputation and expertise with the Crystalens, and the amount of overhead he has in his practice.
How Are the Costs Distributed?
I paid slightly more than average for my Crystalens – about $3300 for a lense to be implanted in my left eye. But when I was ready to pay for my Crystalens, I found out that this cost was broken down into two amounts to equal $3300 -- that is, $2800 for the lens, and $500 to my optometrist for the co-management fee. Co-management with your referring optometrist is quite common with LASIK surgery, and apparently, with cataract surgery. But since most people don’t need to wear glasses after they get a Crystalens, I cannot help but feel the $500 is simply their kickback fee to my optometrist, and not much more. It would be an excellent idea to inquire about these co-management possibilities when you first go for your surgical evaluation. It might save you some confusion if you are doing price comparisons with a couple of surgeons.
Also, be aware that your surgeon may price things differently, and include more. Some offices will collect $1000 as the co-management fee to the optometrist, and will charge more for the IOL. If the cataract surgeon also does a lot of Lasik surgery, he/she may charge more for the Crystalens, and throw in free Lasik or PRK touch-ups if you are not satisfied with your visual outcome. In effect, you'll be paying up-front for the possibility of Lasik or PRK enhancement. This could make your lens cost $4500-$5000 for one eye.
What About Astigmatism?
You also need to think about whether or not your doctor includes the LRI (limbal relaxing incisions) in the cost of your Crystalens. If you want a chance of improving your astigmatism without any further refractive surgery, you may opt for your surgeon to put some tiny incisions in your cornea in the operating room.
When I chose the Crystalens, my surgeon included the LRI in the purchase price. If a patient chooses any other lense, the LRI will be billed to the patient (it won't be covered by insurance, because its purpose is refractive).
It is very important that you are clear about the coverage for LRI, if you approve this surgical procedure. Somewhere in your consent forms, you should find a signed statement acknowledging your understanding about the costs. In fact, you really should ask about the possibility of the LRI at your first surgical evaluation.
If you're confused about what LRI is, look to the right and watch the brief video. This is a short procedure that could make a difference in your outcome.
What About Insurance?
Since I am not old enough for Medicare and I don’t use Medicaid, I cannot be too explicit about how their reimbursements work. But I do know that Medicare has no problem paying for cataract surgery. Medicare will only pay for the cost of a standard, no-frills monofocal IOL, though, and expects you to pay the difference for a premium lens.
I have private insurance. I can’t imagine any standard medical policy would pay for a premium IOL like a Crystalens, and in fact, mine does not. They might if it could be proven medically necessary, but that is not going to happen. 99.9% of the population will function well with a monofocal implant, so that’s what they cover. I had to pay for my Crystalens up-front. If I had not had the money, the doctor’s office offered 0% interest installment payments until the lens was paid off.
Cataract in the Human Eye
Your Eyes, Your Choice
Weigh all of the factors, but you’re going to want an excellent surgeon to operate on your eyes. I have had two cataract evaluations from separate surgeons. If you have plenty of time and money, you may also wish to undergo an examination with a different doctor. Be aware, though, that a cataract evaluation is an endurance test – mine took about three hours. If you have a co-existing abnormality, as I do with my left eye, or you have a chronic disease, you might have to go for an evaluation with a retina specialist. You’ll get a good idea from visits to the two physicians as to how well they will cooperatively manage your condition. If you feel confident, look no further!
The Crystalens -- the real thing is only 1/4" long
Is Your Doctor Pushing the Crystalens?
Office staff will be the likely people to give you the pricing options for IOL's. The doctor is usually too busy to go into detail with you about this. Your communication with them may or may not include pushiness to make the sale for any particular lens -- it can certainly go either way. The most helpful refractive counselor in an ophthalmologist's office is the employee who has already had cataract surgery, and can talk about how he/she has adjusted to their lens. But you may not be so lucky as to find a gem like that. Whomever you talk to, be cautious. If at all possible, check out what they say with another surgeon, or do some research on the web.
OK, so maybe they're pushing the Crystalens. This is not necessarily a bad thing. True, surgeons are motivated by money, but think about it for a moment. Many surgeons have developed a particular expertise with implanting the Crystalens in the eight years it has been available. They feel confident in their skill and want you to have a good visual outcome. And the Crystalens has generated a comparatively small number of consumer complaints.
You'll definitely feel more confident if your surgeon's practice has been awarded the Crystalens Center of Excellence designation. To check to see if your doctor owns such a practice, go here.
The Crystalens IOL is not the best choice for everyone, but it can be a good gamble if you can afford it.
My Choice, Your Choice
I researched and deliberated, even down to the point of agonizing over whether I wanted to have cataract surgery right now, or put it off for another year.
Yes, there are just too many choices available today. And I do have a need for someone to take control, at least occasionally, and narrow down my options. And eventually, the retina specialist did just that. He said, “I believe your only choices are the Crystalens or a standard monofocal IOL.”
Update: I did opt for the Crystalens. It has been a year since I had a Crystalens implanted in my left eye. The same year I also had a vitrectomy and ERM peel in the same eye, which gave me back several lines of vision. In the last few months, as my retina has healed, I have experienced some accommodation with my vision. This means that the Crystalens is doing what it is supposed to do. I now remove my glasses to work at the computer. I must wear glasses for driving due to the development of myopia in my right eye, and with the added complication of the developing cataract.
I have experienced no problems with the lens either. My results are pretty good, considering I have only one Crystalens. It is possible, six months from now, that I'll have cataract surgery in the other eye, and with two of these IOL's, my accommodation should be even better.
Many people will have their cataract surgeries two weeks apart. It's a personal decision for most everyone. I have chosen to wait longer, and I remain positive about the Crystalens.
Update on June 14, 2011
On a follow-up visit to my cataract surgeon, he noted that I needed a YAG capsulotomy, which is a pretty normal occurrence months or years after cataract surgery. I will go in to have the posterior capsule, which has become cloudy, lasered and opened up so that more light can get through. This will likely improve my vision in the left eye, which has probably deteriorated some since last Christmas.
Update on September 13, 2011
I had the YAG capsulotomy about a month ago. With this procedure, one does experience a few floaters initially. I got used to them. After a few weeks, I haven't noticed anything unusual, and my optometrist has looked at my IOL in a follow-up visit. Everything looks clear with the capsule holding the lens now.
Update on October 7, 2011
I have decided to have cataract surgery on my right eye next month. After I get my second Crystalens, I will have a much better idea of how I did with this lens. I will write another update after the lense has settled in. My surgeries have occurred almost 2 years apart.
Update on January 13, 2012
I had my second cataract surgery on 11/15/2011. Everything went well, and my right eye was implanted with a Crystalens AO. One day after surgery, I was seeing 20/20 for distance! That's really great, since I have some astigmatism. During surgery, my surgeon did the LRI (limbal relaxing incisions) on my cornea, which lessens astigmatism. By the way, the LRI procedure is included in the price of the Crystalens.
But today, I went for the second follow-up appointment with the optometrist who is managing my after-care. He says the first 90 days after cataract surgery are spent monitoring the healing of your eye (I have not yet reached 90 days post-surgery, obviously). After the 90-day period, the person who got the Crystalens just needs to be patient -- very patient. It can take a year or more to see what your full visual outcome will be.
My optometrist also remarked that Bausch & Lomb will tell you what is a reasonable expectation for just how spectacle-free the patient is going to be, which may differ somewhat from patient expectations.
I would be ecstatic if I could read a novel without glasses, using good lighting. We'll see.
I'll be back in a few months with another update.
Update on October 3, 2013
It has now been about a year since the second cataract surgery. I have the Crystalens in both eyes.
Although I now have 20/20 at a distance, and my intermediate vision is good, I still need readers for a lot of close work -- reading or sewing, etc.
Most print books or periodicals have text that is about 10 point size. That is marginal for me, and I need to wear readers. With 12 point text, and with good lighting, I can get by without glasses.
So, for labels in department stores or on canned goods at the supermarket, I need my readers, or in poor lighting as you encounter in some restaurants.
Let me qualify my choice of the Crystalens, though. The reason I have 20/20 vision at a distance is because my astigmatism has been corrected through the LRI (limbal relaxing incisions) that were done on both corneas, with both surgeries.
Those two tiny incisions on each cornea may not seem like much, but they were responsible for the ability to drive without glasses.
Those two tiny incisions done on each cornea are included in the cost of the Crystalens, at least the way my surgeon prices it. If you get a monofocal lense, or a Restor lense, etc., the incisions MAY NOT BE included, and you could receive a bill of up to $2500 with each surgery. The total bill could, potentially, be more than the cost of a Crystalens.
So, was the Crystalens the right choice? It was for me. Even though I still have to wear readers, I got rid of my astigmatism, of which I had a "medium" amount.
I have good intermediate vision. Everything on my car's dashboard looks clear.
Do you have astigmatism? If so, how much? I would recommend a thorough conversation with your surgeon about the way he prices his products, and how you could benefit from trying the Crystalens. Your Crystalens will accommodate, or not, for close work. It will mimic the "flex" of the natural lense, or it won't. It's highly individual! Everyone has different expectations, as well.
If you don't have astigmatism, and you have nothing to gain from getting the premium lense implanted, I would suggest getting a monofocal lense or a diffractive lense. Ask your surgeon what kind of visual outcome you could expect. With a monofocal lense, you are going to have your lense "set" for distance, or "set" for close work, and you might be just fine, say, seeing great at a distance, but using readers for close work. Or vice versa. In this case, you will have to consider the kind of lifestyle you have, and just how important distance vision is. Or how important reading vision is.
I actually had the outcome of a person who had monofocal lenses implanted, with them set for distance. But I got rid of my astigmatism, too. I would not change my mind on anything I did with my two cataract surgeries.
Note: The information contained in this article is not meant to diagnose or treat any disease. If you have any of the symptoms mentioned in this article, consult your personal physician.
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