Cataract Surgery or Crystalens Implant: My Story
The experience of cataract surgery
This article, the third in a series, will discuss the experience and costs of having a Crystalens implant during cataract surgery. A final article will be written in the coming weeks to describe the recovery and results from the surgery and will be updated periodically; a this type of implant can take as much as a year to attain full effectiveness.
The first two articles concerned what a patient might have in the way of symptoms as they develop cataracts, as well as a discussion on making the choice regarding which lens to have implanted.
While every person is different and will have a different reaction to any surgical procedure, I hope this article will provide some useful information to the reader. The idea of eye surgery is more than a little scary, but cataract surgery the most common surgery in the world and is quite safe and effective.
The Mechanics of Cataract Surgery
In years past this surgery consisted of removing the lens from the eye and simply closing the incision. The patient was left with the need to wear huge corrective glasses to compensate for the loss of their natural lens, but it worked. At least to a point - while vision was definitely superior to what the patient had with occluded lenses, it left much to be desired.
Modern surgery includes the implantation of an artificial lens and technology has produced some amazing replacements for the biological lens that still has to be removed. To accomplish this a very small incision (about 3mm) is made into the eye and the capsular bag containing the lens carefully opened and peeled back. The natural lens is broken up with ultrasound into small pieces and vacuumed out, whereupon the new lens is folded and inserted through the same incision into the eye.
The new lens does not need any actual attachment such as stitches and the incision itself is self healing and does not require stitches either. The entire surgery normally takes only 15 to 20 minutes, although the visit will require several hours. They eye will be numbed and typically a relaxant is given to the patient and this takes a little time. Some quiet time may also necessary as a recovery period.
The video to the right is of an actual implantation of a crystalens and takes only a few minutes to watch if you wish to see what will actually be done. It is an actual surgery, however, and very graphic; if such pictures bother you, it might be wise to skip it.
Hollingshead Eye Center
I had tentatively chosen the Hollingshead Eye Center in Boise, Idaho, prior to this first visit. The visit itself cemented that decision; I was extremely pleased with the facility (where surgery would occur) and the people I met and spoke with. Dr. Hollingshead is the only eye surgeon in Idaho certified by Bausch and Lomb (makers of Crystalens) at the highest level and while that certainly played a part in my tentative decision, there were other factors as well. Not the least of which was cost - the eye center understands that not everyone has insurance and is willing to help considerably there. I also liked not needing a full blown hospital for a quick outpatient surgery. I have been extremely pleased with my choice of surgeons and will have the other eye done at the same eye center when the need arises. I would most definitely recommend this eye clinic for patients in the Boise area.
My doctor asked for two visits prior to surgery. The first was for a complete exam, including detailed measurements of my eye, and is a necessary step for successful cataract surgery with a premium lens such as Crystalens. Although I will be having surgery on only one eye at this time, both eyes were thoroughly checked out. The measurements are necessary in order that the new lens will fit optically into the eye and have the right focal length. The lenses are all the same size physically, but optically they vary according to the needs of the individual.
A good part of this visit was also consultation. I spoke to the doctor at some length as well as to other specialists at the clinic. The objective here is to match the patient to the right lens, whether it be a fixed focus old style lens, the newer multifocal lenses or the accommodating Crystalens. These all vary in what they excel at and discussion of the patients lifestyle, hobbies, and activities all play a part in choosing a lens. I went into the visit thinking that Crystalens would be the best choice for me based on lots of computer usage, considerable outdoor time and some reading. The doctor confirmed this, as the mid-range vision is where Crystalens excels. All lenses provide good distance vision and the multifocal lenses are typically strong in close distance vision but not nearly as good at the mid-range distance such as computer usage.
Risks and potential need for future adjustment (YAG laser, Lasik surgery) was discussed as well. As with any surgery there is some risk and there is a wide variance in how well any medical procedure works on differing people. If your surgeon won't discuss these issues, you need a different surgeon. The risks are very, very minimal, but they do exist and any patient should be aware of them. Loss of sight or decreased vision is rare but is possible. In my opinion, none of these were a deterrent - severe physical injury to the eye is so uncommon as to present no concern at all. Loss of vision is also very uncommon, but does happen very occasionally - patients might conceivably lose the vision in an eye that isn't working anyway. Basically, I felt there was nothing to lose but some cash - a very good bet to take.
The biggest surprise I had during this visit was setting a surgery date only 2 weeks away. I had assumed that it would take considerable time for a factory to manufacture a lens just for my eye, but the surgeon I had chosen keeps hundreds of lenses on hand at the clinic. I knew that he did large numbers of Crystalens implants (important - you do not want an inexperienced surgeon cutting into your eye) but had no idea he did enough to stock so many lenses. I was told that it was very rare that they would not have the proper lens already on hand, and that was reassuring.
The second visit was a few days before surgery, simply to meet the surgeon. In the first visit I never met the person doing the actual cataract surgery and was a little disappointed in that. While understanding that it would be unlikely that a very highly skilled surgeon would be operating the machinery taking measurements, discussing lifestyle, etc. I still wanted to meet him. The second visit was just that - a face to face meeting with the surgeon, giving him a chance to take a look at my eye and giving me a chance to meet him. Not a particularly useful meeting (for me - he got to see the eye he would be operating on and verify for himself there was nothing unusual there) I still appreciated the few minutes spent. I liked his attitude, his demeanor and his insistence that if I noticed anything at all unusual in the year after the surgery to come in immediately. This doctor offers a "guarantee" (as much as a medical procedure can) and will try to fix anything wrong in the first year for free when a premium lens is chosen. The YAG laser treatment mentioned above (new lenses fog up in about 20% of patients - a laser quickly burns it off) and Lasik (again useful in around 20% of cases) to improve vision are both covered for the first year and the surgeon emphasized that I need to take advantage of that as necessary.
The first visit had resulted in a prescription for three different eye drops; two antibiotics and one for swelling. The antibiotics were to be used starting three days before surgery and the third after surgery. Only one was inexpensive; two of the drugs were each over $100. The office gave me one of them as I had no insurance - they apparently keep some on hand just for that purpose and is a nice gesture even if they are most likely samples from the drug manufacturer. The expensive antibiotic was available as a generic, but on the recommendation of the doctor I chose not to use the generic. When I met the surgeon he was pleased I had made that choice and I was glad I did. It is only to prevent possible infection, but infection just after surgery can be much more of a problem that if the surgery hadn't happened. Best not to chance it at all.
The Day of the Surgery
The day started early, with surgery scheduled for eight AM. No food or drink since midnight the night before, not even an early morning swallow, and this obviously means no morning coffee. Not a good start. Not being familiar with early morning traffic in the area of the eye center we left a little early and got there ½ hour early, but it wasn't long until I was taken away for a blood pressure check, IV insertion and more eye drops, one of which was to keep the eye dilated for around 10 days. I also wrote the payment check; a little different to pay before the work but it made sense. A relaxing drug was given, but I was to remain totally awake during the procedure. A short wheelchair ride to the operating room and I was asked to lie down on the operating table. Nurses and assistants taped my head to the table, an anesthetist attached a heart monitor, the good eye was covered (after answering "which eye today?" a dozen times) and the surgeon appeared.
I had learned enough about the actual operation to know and understand what was going on most of the time. I was asked to look up directly into a bright light (it hurt but became bearable after a short time) and hold still. I was able to discern the probe as the surgeon peeled back the capsular bag surrounding the eye lens and see the bag itself somewhat as it was folded and pushed away from the lens. With an odd sound, an ultrasonic probe dissolved the lens into small pieces that disappeared as they were sucked out of the eye. The Crystalens to be used has two "wires" (certainly not wires, but that's what they look like) on each end and I could see those as the lens was inserted into my eye. I noticed an immediate improvement as the lens entered my eye, even before it was prodded into proper placement; everything used to appear as if looking through frosted glass and now it was very obvious that that "glass" was crystal clear. The details of that bright light became clearer as the lens was properly located - it was quite exciting to watch as these things happened and I knew that my vision was improving even then.
The only problem I had with the surgery was the eye wash that was constantly used; the surgeon would periodically irrigate the eye with water to keep it moist and the water was cold! A couple of times it made me flinch as much as I tried not to. There was no pain at all, just a little pressure occasionally.
There were no stitches to be made after the placement of the new lens and folding the capsular bag back into place as the tiny incision is self healing. The eye covering was removed from my "good" eye (soon to be the "bad" eye), the heart monitors and IV were removed and I stepped off the table back into the wheelchair for transport to another room. The entire surgery had taken perhaps 15 minutes. A few more eye drops and I was wheeled out to my waiting car.
Going Home With My New Lens - Early Reactions
The ride home was not very pleasant. Of course I was unable to drive (the eye center insists on a driver and for very good reason) and my wife took care of that task. Although the day was overcast it was still far too bright for my dilated eye and the dark glasses I had been given kept falling off. My eye burned some and it felt like something was in it - it took a lot of will power not to rub it as that was strictly forbidden. Without stitches the small incision could easily be opened again.
Upon arrival home I walked into the kitchen, but not my kitchen! This one was similar - a mint green and white color scheme - but the green was a lighter shade and the white was white, not a slightly yellowish off white color. The light was much brighter as well; the whole room was simply cleaner looking and cheerier. Even with a dilated eye that continued to produce tears, the difference was simply amazing. I couldn't focus well through the tears but colors were all different; brighter and more vibrant. Whites were white, not the slightly dingy yellow-white that I had come to associate with "white".
Everywhere was the same. Bright sharp colors. Dark corners were no longer dark and it wasn't from the dilation; I have been dilated many times and this was different. The biggest impression was the white, though - I hadn't seen true white for years and the change had been so slow that I hadn't realized it.
I still could not read a computer monitor without glasses, but the appearance was remarkably different. I've tried in the pictures below to demonstrate that difference. The lower photo, to my right eye alone, looks just like the upper one does to my "new" left eye. And my right eye was by far the better of the two before the surgery while the "old" left eye would see little more than general colors in a blur.
TV viewing was already improved and by evening (when the tears began to ease somewhat) the improvement was very marked. Computer usage was also improving in that I could almost read the screen without glasses by blinking out the tears. The left eye was definitely better than the right at mid distances possibly because it already has much better contrast.
A walk outside showed more wondrous results. A license plate that I mentioned in the earlier article on symptoms as being unable to read at six feet was now plain from fifty feet away!. A cedar tree from 10 feet looked very different between the two eyes; the repaired eye can now detect a yellow-brown color at the tip of each group of needles and far more detail. The green of the tree is lighter and shadows between branches have far more definition and contrast. The right eye is faded, darker and has far less definition by contrast. Houses a block away are considerably different as well, sharper and with much better color. Keep in mind that although my right eye has a cataract it has not materially affected vision. Or so I thought until I looked through the new Crystalens!
Problems that first day were few, but they did exist. Early in the day a sheet of paper had a "ghost" an inch wide all around the paper and bright lights had halos around them. Eye drops were necessary every two waking hours. For several hours my eye burned a little and had a feeling of something in it. The eye was dilated about halfway, with the associated unpleasantness that always brings with it. By evening the halos, the burning sensation, the feeling of something in the eye and most of the tears were dissipating and vision was obviously improving as a result. A computer screen could be read by evening without glasses, albeit with difficulty.
A clear plastic shield was to be taped over the eye at night. I was cautioned to stay out of dirty activities for a few days, even to the point of leaving the room if the carpet was vacuumed. No heavy lifting (over 20 pounds) for a week. No hot tubs or pools for two weeks; no lake or ocean swimming for a month. No eye makeup for a week. Eye drops for a month, three times daily after the day of surgery when they were every two hours.
The Second Day
A follow up visit was scheduled early the next day as a check up, just 24 hours after the surgery. That morning there was no real change in my vision although the eye had, for the most part, quit producing so many tears. It still needed to be gently wiped two or three times an hour but not every few minutes and that was a welcome change. This also helped the vision somewhat as an eye full of tears does not see well, but other than that I did not notice any radical difference.
Experiencing the Crystalens
The doctor visit went very well. A quick and simple check of my vision indicated that I was seeing at 20/20 - welcome news indeed and better than expected. Near vision checked out at a J5 level (about one step worse than normal vision) and that, too, was better than I had expected. At the same time, the doctor explained that the eye was to remain dilated for 10 days because the dilation paralyzes the focus mechanism of the eye and that would allow the new lens to settle into place at a lower level. If the eye were to be allowed to use the cilia and muscles associated with focus it was all too possible that the lens would become fixed at a higher point in the eye and would thereby lose much of it's ability to focus. There is a definite limit as to how far the eye can move the lens and if half that distance is already used by fixing the lens too high then much of the ability would be lost. I very much wanted the dilation to end, but understood the explanation why it was being done and fully agree - it is a small price to pay for extended focus ability in the future.
With no real results to report on the second day, that ends this portion of the series. Future results through several months will be reported and updated as time passes in the final article of the series.
Costs of the Crystalens Implant
First, it needs to be emphasized that the costs listed here are for only one small area of the US, and that they are for a patient without insurance. The surgeon I chose gives a discount of around twenty to twenty five percent for cash, which I took advantage of. They also offered brochures from a company that might provide an interest free loan - one of those plans that are free if paid off in a set period but suddenly become very expensive if not paid.The normal costs for a patient with insurance seem to be slightly lower in my locale than major metropolitan areas, but by only a few hundred dollars.
The costs I incurred included the following:
Prescription eye drops
Pre surgery visit
Time off work
Possible prescription glasses
24 hour checkup
Total without glasses
I managed some savings; as noted the surgeon gave a good discount for cash and provided one of the more expensive eye drops. I was able to have surgery on a Thursday, which resulted in only two days off of work for the surgery. At this point I doubt that I will need anything more but possibly a pair of reading glasses, but time will tell.
At the same time, there are possible additional expenses; future office visits may require additional time off work and YAG or Lasik treatments the same. These treatments will be free as "adjustments" under the "guarantee" policy of my surgeon, but will still require time off work.
Your own costs will of course be different; your location, your surgeon, possible sick leave time, the availability of insurance; all will make a difference. These numbers are offered only as a rough guideline in deciding whether cataract surgery, with or without a premium lens such as Crystalens, is worth investigating. If you have cataracts that are seriously interfering with your vision I absolutely encourage you to investigate that possibility; it is worth almost any cost to be able to once more see well and there are options to help cut costs some. My experience with cataract surgery and with a Crystalens implant has absolutely convinced me that this is so, and I would do it again without any qualms at all.
© 2012 Dan Harmon