Quality Eye Care, P.C.

CRYSTALENS®

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Available since its U.S. FDA approval in 2003, the crystalens® is a type of implant that mimics the natural human lens.This "accommodating" implant, when used in cataract surgery, can greatly reduce or even eliminate the need for glasses, for both distance and reading! The topic of intraocular lenses (IOL) is a complex one, so let's spend a little time going over the concepts.

Routine cataract surgery, with a traditional type of implant (not the crystalens® implant) will not completely eliminate the need for glasses. While distance vision can be made clear, reading vision is compromised (again, when a traditional intraocular lens implant is used).

In patients under approximately 40 years of age, the natural crystalline lens retains the ability to flex in a process called accommodation. This allows an individual to generate the extra focusing power needed to read up close. After 40, the ability to accommodate diminishes more quickly, which results in a person needing bifocals or reading glasses. While most cataract-age patients have already lost this accommodation, the need for reading glasses can be “accelerated” by removal of the natural crystalline lens; for all purposes, the traditional intraocular lens implant cannot accommodate.

TRADITIONAL MONOFOCAL IMPLANT

The traditional monofocal intraocular lens implant only focuses at one point, either distance or near, or somewhere in between (intermediate), but almost never at two or all three points simultaneously. Hence, the term monofocal or one focus. With monofocal implants, one of three strategies can chosen, if both eyes are having surgery:

a) Implant selection so that both eyes focused at distance. While glasses may still be necessary for distance, they will almost certainly be necessary for reading and intermediate vision.
b) Implant selection so that both eyes focused at near. While glasses may still be required for reading or intermediate vision, glasses almost certainly required for distance.
c) Implant selection so that one eye focused at distance, and the other eye for reading.
Glasses may still be required for both distance and near, but choosing this option can reduce overall dependence on glasses. This is called monovision. Monovision can work well but it is a compromise. Decreased depth perception and difficulty with vision under dim lighting conditions (such as night driving) may occur. Golfers and pilots may not like this. People who drive at night extensively may not like monovision.

ACCOMMODATING IMPLANT: THE CRYSTALENS® IMPLANT

Crystalens

Crystalens in eye

The crystalens® implant is quite different from the traditional monfocal implant. It is a highly sophisticated implant that provides a continuous range of vision, from distance to intermediate, to near. This implant bends or flexes like a normal human lens, to create extra focusing power. The benefit of using this implant is that each eye can see distance, intermediate, and near. This is quite different than the monovision option using the more traditional monofocal lens implant, where only one eye is focused at distance, and the other eye is focused at near. In a study of the crystalens® implant, 93.8% of patients reported performing most visual tasks without glasses. About 74% never or almost never wore glasses after surgery. In the original FDA trials, of the patients who received crystalens® in both eyes, 92% could see 20/25 or better at distance, 96% could see 20/20 at arm's length, and 73% could see 20/25 at near, without glasses or contacts. Reading vision with the crystalens® in both eyes is good, but fine print, prolonged reading, or reading in dim lighting may require the use of weak reading glasses.

The best visual results are obtained when both eyes receive the crystalens® implant. It is not recommended that only one eye receive the crystalens® implant. This is an implant designed to be used in both eyes.

The optimal result with the crystalens® implant requires getting as close to a zero distance prescription as possible. A few patients who have refractive lensectomy using the crystalens® implant, will require a "touch-up" procedure to realize the full potential of this lens implant. In other words, to fine-tune the visual results, sometimes an additional procedure may need to be done afterward. The additional procedure may involve correction of astigmatism with either a limbal relaxing incisions (LRI) or astigmatic keratotomy (AK), both of which can be done in the office. Another procedure which is sometimes used to refine the crystalens® results is laser vision correction, like LASIK, which is done at another facility.

Are you a candidate for the crystalens® implant? Only your ophthalmologist can tell you. After a complete eye exam and additional testing, your doctor will be able to determine if you are a suitable candidate for crystalens®. Your doctor will talk to you about the risks of surgery, and those specific to multifocal implants. For patients who meet the criteria, the crystalens® implant can be a life-changing experience.

Frequently Asked Questions about Crystalens®

Are you a candidate for the Crystalens® implant? Only your ophthalmologist can tell you. After a complete eye exam and additional testing, your doctor will be able to determine if you are a suitable candidate for Crystalens®. Not everyone should get a multifocal implant with their cataract surgery. Your doctor will talk to you about the risks of surgery, and those specific to multifocal implants. For patients who meet the criteria, the Crystalens® implant can be a life-changing experience.

What if I don't have Cataracts? Can I still get the Crystalens®?
For patients who do not have visually significant cataracts to justify cataract surgery, the Crystalens® implant can be used with refractive lensectomy or clear lens extraction (or presbyopic lens exchange or PRELEX). In other words, the natural lens of the eye can be removed and replaced with the Crystalens® implant. The only difference between refractive lensectomy and cataract surgery, is that the natural crystalline lens of the eye is clear or nearly so with refractive lensectomy, but is cloudy with cataract surgery. Because there is no medical necessity for refractive lensectomy, it is a non-covered procedure, and the entire cost of surgery and the Crystalens® implant is the responsibility of the patient. For patients over 40 who are using bifocals or reading glasses, this may be a reasonable option, especially since other refractive surgery procedures such as Lasik can only provide reading vision through the monovision strategy (one eye distance, the other eye near). Again, not all patients who do not have cataracts are candidates for refractive lensectomy with the Crystalens®. Call and make an appointment with your doctor to find out.

Will insurance pay for my Cataract surgery?
If you have a cataract which is visually significant, medical insurance typically covers the cost of surgery, though you may be responsible for a deductible, and there may be higher out-of-pocket costs if your primary insurance is Medicare and you do not have secondary insurance. You may speak to our billing specialist, Sharon, to find out about coverage. Remember, medical insurance is different than vision insurance which many people do not have. In general, vision insurance pays for glasses and contact lenses.

Medicare and other insurance companies pay for medically-necessary procedures. Routine cataract surgery with a monofocal-type or non-Crystalens® implant is what they consider medically necessary. Medicare and most insurance companies realize that more testing and care is required for a patient who has opted for cataract surgery using the Crystalens® implant, so they allow surgeons to charge more for cataract surgery with the use of this implant. However, they consider the Crystalens® implant a deluxe or luxury item, and more than medically necessary, hence, they will only pay the surgeon fee up to what they pay for cataract surgery using the traditional monofocal implant. The additional surgeon fee for surgery using the Crystalens® implant is the responsibility of the patient. Medicare and the insurance companies will only pay surgery centers (hospitals or ambulatory surgery centers) the cost of a monofocal implant; the difference in cost between a monofocal implant and the more expensive Crystalens® implant is the responsibility of the patient. The end result is that a patient who opts to have cataract surgery using the Crystalens® implant is responsible for paying an additional fee to both the surgeon and surgery center.

Financing is available for the additional costs associated with the Crystalens®. Both traditional and no-interest loans are available. The application process is very simple, and if approved, can make the Crystalens® an affordable dream come true!