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IOL Options: Crystalens

During cataract surgery in NYC eye doctors will replace the natural lens with an IOL (intraocular lens). Standard monofocal IOLs typically provide clear distance vision. However most people with cataracts are over 40, so they have some degree of age related near vision problems – reading glasses anyone? – which is called presbyopia. Enter Crystalens.

Premium IOLs Correct Presbyopia and Cataracts

Crystalens and Trulign Toric (both by Bausch + Lomb) currently are the only FDA-approved intraocular lenses (IOLs) that use a method called accommodation, enabling sharper vision at multiple distances for people who have undergone cataract surgery. The Trulign IOL is a toric version of Crystalens; it is the first of its kind to provide both accommodation and astigmatism correction. The Crystalens and Trulign belong to a select category of high tech intraocular lenses commonly called presbyopia-correcting or “premium” IOLs.

Watch as Florence Henderson tells about her treatment with Crystalens:

Accommodating vs Multifocal IOLs

Premium IOLs come in 2 basic forms: Accommodating and Multifocal. In addition to Crystalens and Trulign Toric presbyopia-correcting IOLs, there are also Alcon’s AcrySof IQ ReSTOR and Abbott Medical Optics’ ReZoom and Tecnis. The latter three brands are multifocal IOLs that contain different zones to sharpen vision at multiple distances — similar to progressive lenses in eyeglasses.

Multifocal lenses, including those found in IOLs, work because the brain learns to select the appropriate zone to “look” through to provide sight at near, intermediate or far ranges. But because limited space on multifocal IOLs must be divided into zones, some advantages of seeing through just one zone in “single vision” lenses are lost — such as better contrast sensitivity.

In contrast to multifocal IOLs, the Crystalens and Trulign Toric, because of their accommodating features, maintain one focusing zone, just as conventional eyeglasses and contact lenses do in single vision lenses.

Research indicates that the Crystalens, because of its design, is less likely than multifocal IOLs to produce visual side effects for distance vision such as night vision problems including glare and halos. At long distance, it is possible that vision may be crisper with accommodating IOLs. However, accommodating IOLs such as the Crystalens or Trulign may not provide as much of a range of focus (near to far) as multifocal IOLs, and this might lead to the need for reading glasses.

eyeonics Crystalens
Crystalens is designed to move within the eye, to provide focusing at all distances. (Animation: Bausch + Lomb)

Both multifocal and accommodating types of presbyopia-correcting IOLs have advantages and disadvantages. So you should ask your eye surgeon to clarify which type of presbyopia-correcting IOLs, if any, might work best for your particular vision needs.

If you are a perfectionist or hard to please, you likely would not be a good candidate for any kind of presbyopia-correcting IOL.

Cataract surgery outcomes typically are very acceptable. But you also must be prepared for the possibility that something can go wrong with any kind of IOL used in cataract surgery. Presbyopia-correcting IOLs can provide improved vision, but not perfect vision. And while you could receive at least some benefit of vision at all ranges, a monofocal or standard IOL might be the best choice for crisper distance vision. However, even standard monofocal IOLs also can be associated with night vision problems such as glare and halos.

Potential Complications

If a Crystalens is implanted, astigmatism can develop late in the healing process because of subtle shifting of the IOL’s position. As with any IOL used in cataract surgery, a complication that causes subtle clouding in the lens capsule (posterior capsule opacification) may occur. A procedure called a YAG laser capsulotomy may be needed to clear up the clouding.

 

Discuss the pros and cons of IOL options with your New York eye doctor Alan B. Shlussel O.D. who provides cataract surgery co-management in Manhattan.

     

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