Crystalens AO Review - Results Of An IOL Lens Implant
Crystalens AO Review
This article is to describe and discuss the results seen in one patient having a Crystalens IOL implanted during cataract surgery. It is the fourth in a series of articles on my own experience of developing cataracts and having the problem diagnosed, choosing an artificial lens to be used, the cataract surgery and costs and finally this one.
While the results discussed here can in no way describe what you the reader will see should you choose to have the same lens implanted it should give at least an idea of what might be seen. Every patient will be different and have different results - please keep that in mind while reading.
The last article, primarily describing the experience of the surgery, ended with observations of the first two days after that surgery - this one will begin at that point.
A Short History
A very short recap of what has happened for those readers that did not follow this series from that first description of finding symptoms of cataracts and having it diagnosed may be in order. I first thought I might have cataracts something over a year ago and had that diagnosed by an optometrist during a regular eye exam. Lots and lots of research followed as I learned about the various IOL implants that were available as well as what cataract surgery entailed and what it would cost. I had the surgery done on my left eye in April, leaving the right eye for a later date. The cataract in that eye was not nearly as bad and I still had considerable vision left there (although far from perfect) - it was a reasonable choice.
I chose the Crystalens as an IOL and was given the Crystalens AO model. Crystalens has made several major improvements over the years and this is the latest model, showing several improvements. The biggest difference is that it is larger in size than the earlier HD model - this is expected to help reduce glare and halos at night.
Typical Results of a Crystalens Implant
Bousch and Lomb gives an overview of their clinical trials of some 500 eyes implanted with a new Crystalens IOL at their crystalens website. Among the data are the following facts:
- All the patients receiving two implants could, without glasses, pass a drivers license test.
- All recipients could see at mid range distances, or about 24" to 30". Such things as computer usage, the dashboard of a car, and grocery store prices fall into this range.
- 98.4% could read well enough without corrective lenses to read a newspaper or look up a number in a phone book.
- Over 80% reported that they were not wearing glasses for computer usage, putting on makeup or shopping.
- Most patients with two implants could see at 20/32 without glasses. While not perfect, this is good - the surgeon that operated on my eyes mentioned that his own vision was only 20/25.
- 85% reported little to no problems driving at night and the same number did not wear glasses at night. Bear in mind here that one of the major problems with lens implants is glare at night, and that the lens is smaller (lets in less light) that a biological lens.
Some patients, of course, still required glasses for reading or computer usage (particularly reading), but they were definitely a minority. As my cataracts had developed to the point that reading a newspaper for more than 10 or 15 minutes with glasses was impossible this all sounded very exciting. Yes, there are risks and some patients ended up with 20/40 long distance vision or worse, but overall the statistics are impressive.
The Crystalens IOL Begins To Take Effect
As was mentioned in the earlier article, I was given eye drops to dilate my left eye for an extended period of time - that eye was to be dilated for about ten days. This also paralyzes the muscles that allow the eye to focus, meaning that mid and near range vision would not be good during that time. Long distance vision was very good (given that the eye is dilated) and colors were deeper and much more vibrant. Whites were white for the first time in years instead of yellowed. I did not need glasses for the first time in a decade to drive or have long distance vision.
By the fourth day I was beginning to almost use a computer without glasses. The dilation had decreased a little and that is probably what made the difference; I still could not detect any focusing ability at all. That day was a real test as well; With specific permission from the doctor I played a round of golf. By the end of last year I was unable to follow the ball past about 100 yards; a 7 iron would take it out of sight, and I lost a lot of balls that way. It was with great interest that I teed off on the first hole and it was with even greater delight that I found I could actually see that little white ball falling through the sky well over 200 yards away. There were three others in my group, all much younger and with good eyesight, but I seemed able to follow the ball at least as well as they could. I took it as an indication of what the future held and have not been disappointed.
On day 6 I became concerned the the dilation in the eye had decreased to nearly nothing; as I understood it would last 10 days I felt it best to call the doctor. Told that I was right on track and this was normal, I then ask if I should begin reading (or trying to) without glasses. The answer was yes, and that night I read part of the newspaper for the first time in years and years without the use of glasses. It didn't work well, and caused my eyes to burn a little, but I worked at it as this is a part of "training" and "strengthening" of the muscles of the eye when a crystalens is implanted. The rest of the evening was spent at the computer, marveling that I could see the monitor just fine without the aid of prescription lenses.
Another concern communicated to the doctor was that I was seeing a very brief flash of shadow at the extreme edge of my peripheral vision. I was told this was probably the edge of the lens and would most likely disappear as the dilation wore completely off. It could also indicate that the lens has moved within my eye; the three week check will tell the story there.
At the twelve day mark I sat down to go through my evening struggle with reading the paper as I did every night and got a pleasant surprise. There was no pain after 30 minutes (normally 10 minutes is about all I could take) and the print was quite clear - better than it used to be with glasses. A very encouraging sign.
A Three Week Checkup On The New Crystalens
At just under a month I had a thorough check up on the eye. My concerns at that point were that I was still seeing a flash of a curved shadow whenever I moved the eye to look at something and that it often felt like something was in it; a scratchy feeling on the left side. In trying to place exactly where the curved shadow was, I found that I had double vision at the far left side of my peripheral vision: as I looked straight ahead and slowly brought my hand from behind on the left side I saw two hands for a short distance. As it passed the location of that shadow the "ghost" hand disappeared and appeared normal. This was not particularly objectionable, but rather a curiosity. The shadow was more objectionable, particularly when quickly scanning a written page or a grocery shelf for a particular product - it came and went with such extreme rapidity that it was almost constant.
Although I had been very concerned that the lens had moved within the eye and would need a second surgery to properly locate it once more that fear was dispelled by the exam. The Crystalens, even though larger than earlier models, is still smaller than the natural organic lens we are born with and that curved shadow I was seeing was the edge of the lens. It was explained to me that over time the brain will learn to ignore that shadow and it will effectively disappear. The double vision at the very edge of my vision was unusual (the doctor had never heard of anyone complain of that) but I am certain that it is connected; it occurs only where there is no lens for the light to pass through.
Distance vision was still measured at 20/20, with near vision at a J5 level, one step worse than normal. These were the same results I had gotten during the 24 hour checkup.
At this point I was able to read a newspaper occasionally, but not for long periods - it's as if the muscles of the eye tire very rapidly and easily. Early in the morning the experience was better, while reading late at night didn't work well at all, and I could only read for a few minutes.
Computer usage - mid range vision - is very good and long periods of computer work pose no problem at all without glasses. I hadn't worn glasses, except for reading or other near vision tasks, since the surgery.
YAG and Lasik Laser Treatments After Cataract Surgery
Yag Laser Treatment
Approximately 20% of cataract surgery patients will develop a fogging of the posterior capsule that contains the lens, the result of epethelial cells left after the cataract surgery growing onto the capsule.
The treatment for Posterior Capsule Opacity is done via a YAG laser. In most cases the eye will be dilated and the portion of the capsule in the vision line of sight will be removed by the laser without ever touching the eye. Recovery and return to normal routines is immediate, although many surgeons will prescribe an anti-inflammatory medication for a few days.
The treatment is entirely painless with no post-operative discomfort. It is also very effective in restoring vision. There may be a few "floaters" but these normally resolve within a few weeks.
At my first, 24 hour, checkup my doctor indicated that I would likely need a YAG treatment, but the three week check did not confirm this; there was no indication that it would be needed. It was still early, however, and that could change.
Lasik surgery is also done with a laser, but for very different reasons. Each lens implanted is a specific prescription, just for that eye. Very precise measurements of the eye are taken and used to produce that lens, but the procedure is not always perfect and can leave something to be desired in vision. Lasik surgery can be used to re-shape the cornea of the eye, focusing the light better on the back of the eye; by doing this it can correct for deficiencies in choosing the exact prescription for a lens implant.
Recuperation from Lasik is not too different from that of cataract surgery. This is not surprising as the eye is opened for the laser to operate properly, and must heal. Although quick, patients must not drive the day of the surgery and will need a driver to get home. Most people suffer no pain, but a few do need pain medication. Activity may be limited for a few days and nothing strenuous for up to 2 weeks. Most patients will see quick improvement in vision, but some require a few days for full vision to be restored.
At my 3 week check, there was no indication that Lasik would be helpful but it was still a little early to know for sure. If I retain the 20/20 vision I currently have, and there is no reason to think I won't, Lasik surgery would provide no benefit.
Final Thoughts About Crystalens
At about 5 weeks after the surgery there is no doubt in my mind that I've made the right choice for me. I still can't read well without "cheaters" although that experience varies. A restaurant menu in dim lighting after a long day of trying to focus at just a few inches distance was beyond my abilities just last night but this morning's newspaper was readable in bright light for instance. I still think that how much I have recently used the focus ability of the eye plays a large part in whether I can read as the eye tires rapidly.
The dark shadow is almost gone, visible only in bright sunlight, and hardly noticeable even then. There is still some "scratchiness" some days, but that is fading too and a simple nonprescription eyedrop quickly alleviates the symptoms when they do occur.
The bottom line is that I am very pleased with the result. If I never develop the ability to read for long periods without glasses I will still be quite happy. I spend more time on a computer than I do with a book and I would rather be able to do that without glasses even if I do need a cheap pair of reading glasses to read a book. In addition, I recently purchased an e-reader and find that by now I need no glasses to use it - increasing the brightness and print size somewhat gives me something that I can use for several hours without any trouble, and without glasses.
I will need to have the other eye done, probably within a few months, and actually look forward to the experience as I think there is little doubt that having both eyes done will help the reading aspect. As my surgeon commented, eyes are designed to work together and results are better when they can. Reviewing my experience, the costs and the results of the Crystalens implant it is apparent that, for me, it has been very worthwhile and I would (and will) repeat it in the future.
There is just one more article in this series, describing the procedure and effects of having a YAG laser on both eyes. By the time the laser procedure was done, the second eye had had cataract surgery nearly a year prior, and the vision results of the second eye are also reported.