Cure for Cataracts and Presbyopia

Discussion in 'Optometry Archives' started by David DeBar, May 16, 2004.

  1. David DeBar

    David DeBar Guest

    I just found out about "Crystalens". It seems everyone but me knows about
    these lenses. A Google search uncovered some information. Basically it's a
    implantable lens like those use in cataract surgery but this lens is on a
    hinged support that is attached to the eye muscles that were formally
    attached to the natural lens. After few weeks the patient learns to move
    the lens so he can see close as well as far without eyeglasses. There are
    some limits to the accommodation this lens provides. You will still need
    glasses to read very fine print.

    I'm 64 years old and my optometrist tells me that I have the beginnings of
    cataracts. She tells me that she is amazed that I can see as well as I do.

    I would love to be able to see to drive and see the dash and read a map and
    to wake up and see out the window and turn over and clearly see the face
    next to me in bed. This sounds too good to be true!

    Before I go under the knife I would like to learn a little more:

    1) I would like to hear from a few people you have had the procedure done.

    2) I read that currently the Crystalens optic is 4.5 mm. If I measure my
    own pupil with a ruler in a dim room, I get about 5 mm. Is that a
    problem?

    3) I read in the Internet about another lens under development that uses two
    lenses, one positive and the other negative. How far is this lens from
    introduction and what is the advantage of this approach?

    4) Who are the doctors with the most experience with this procedure that
    have good track records?

    I would be willing travel a very long distance and stay in a hotel to have
    good experienced doctor perform the operation.
    I live in Northern Virginia.

    Thank you for any information you can provide.

    Dave
     
    David DeBar, May 16, 2004
    #1
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  2. David DeBar

    LarryDoc Guest

    The Crystalens is a very new product in the USA (3 months) and has only
    a year or so of usage in Europe. I've attended a seminar given by a
    ophthalmologist who had done the procedure, who curiously is not on
    their list of practitioners that you can view on the company's web site.
    I also had the opportunity to view the procedure and talk with one
    patient who had the implant.

    I think it's a great idea that needs further development. If we're
    looking for a perfect fix for cats and presbyopia, this isn't it but
    we're getting close! The amount of add power that most patients
    (remembering the limited post-surgical data) get is not enough to free
    them from the use of near vision spectacles and the optics is, as you
    wrote, a little too small to best serve the majority of patients,
    especially the "younger" demographic.

    There are a number of other lenses under development that incorporate
    similar mechanics but with different materials. Additionally, combining
    this lens with other refractive surgery procedures might further enhance
    "the real life working success rate."

    I'd suggest a "wait and see" position for at least the next six months
    or so, unless you are willing to accept that which this product can
    provide for you.

    My opinion, of course. Do check with docs who have done this in your
    area and share with us any more info you might learn!

    --LB

    --
    Dr. Larry Bickford, O.D.
    Family Practice Eye Health & Vision Care

    The Eyecare Connection
    http://www.eyecarecontacts.com
    larrydoc at eye-care-contacts dot com (remove -)
     
    LarryDoc, May 16, 2004
    #2
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  3. David DeBar

    David DeBar Guest

    I guess we are the only ones in this group who have heard about it? I would
    like to hear from someone who has had it done.

    Dave
     
    David DeBar, May 16, 2004
    #3
  4. David DeBar

    David DeBar Guest

    Dr. Bickford,
    Thank you so much for for your knowledgeable reply. Yes I can adopt a "a
    wait and see" or in my case "it's a wait and not see up close" policy for
    six months or so.

    Thanks

    Dave
     
    David DeBar, May 16, 2004
    #4
  5. David DeBar

    David DeBar Guest

    David DeBar, May 18, 2004
    #5
  6. David DeBar

    David DeBar Guest

    Here is another lens under development that the company (Alcon) hope to have
    available in the U.S. in 2005.
    http://finance.lycos.com/qc/news/story.aspx?symbols=NYSE:ACL&story=200405030
    401_PRN__NYM153

    said Cary Rayment, Senior Vice President, Alcon United States. "Reducing the
    need for reading glasses after lens removal, without compromising distance
    vision, has been a goal of ophthalmology for many years, and it looks like
    the range of accommodative effect and predictability of this lens may
    finally get us there."

    Dave
     
    David DeBar, May 18, 2004
    #6
  7. David DeBar

    David DeBar Guest

    I spent a lot of time on google tonight looking for articals on this
    subject. It looks like there at least three competing companies coming out
    with lens that offer the promise of help for Presbyopia.

    Crystalens: has a single moving lens that provides considerable but limited
    amount of accomodation.

    Synchrony: Has a dual lens system with one lens moving that provides twice
    the accomodation of Crystalens BUT there is no perdiction when it will
    be availble in the US or anywhere else.

    Alcon: Has a multi-focus stationary lens that promises help with presbyopia.
    I hope this works better then the contact lenses that seems to work the same
    way. I tryed the contacts and gave up on them. Alcon hopes to have this
    lens to market by 2005.

    Dave
     
    David DeBar, May 18, 2004
    #7
  8. David DeBar

    David DeBar Guest

    Yes, this looks a lot like the Alcon lens. It does not move but promises a
    wide range of "PSUDO"-accommodation
     
    David DeBar, May 18, 2004
    #8
  9. David DeBar

    David DeBar Guest

    I spent a lot of time on google last night looking for articles on this
    subject. It looks like there are multiple competing companies coming out
    with lens that offer the promise of help for Presbyopia.

    Crystalens: has a single moving lens that provides considerable but limited
    amount of accommodation.

    Synchrony: Has a dual lens system with one lens moving that provides twice
    the accommodation of Crystalens BUT there is no prediction when it will be
    available in the US or anywhere else.

    AMO and Alcon: Both have a multi-focus stationary lens that promises help
    with presbyopia. These lenses do not move but offer "PSUDO"-accommodation.
    Alcon hopes to have their lens to market by 2005.

    Intuitively it seems to me like the lenses that take advantage or the
    muscles in the eye would provide a more natural feel to vision. These are
    very interesting developments. I hope a clear winner comes to market by the
    time I need it, in a year or two.

    Dave
     
    David DeBar, May 18, 2004
    #9

  10. Intuitively it seems you are a blunt idiot!

    Why do you have to wait for these bullshit companies to make such
    terrible invetnions instead of learning for yourself how to train the
    eye muscles to have your accomodation back?

    Who is preventing you?

    It's difficult to understand.
     
    Rishi Giovanni Gatti, May 18, 2004
    #10
  11. David DeBar

    David DeBar Guest

    Dear Dr. Bickford,

    Thanks again for responding to my post about Accommodive Intraocular Lens'.
    Your comments about new materials coming out soon interested me. I did
    some patent research on this topic. (Patent research is my business.) I
    discovered that dual lens intraocular lenses have been in the patent art for
    a long time. A very recent patent invented by Son Trung Tran and assigned
    to Alcon was issued Sep. 9, 2003. This is well written patent and cites a
    lot of prior art. Claims 3, 4 and 5 two mentions materials that the lenses
    could be made of. In the body of the patent Tron mentions the problems of
    the formation of "posterior capsule opacification" ("PCO"). He explains
    that by making the lens out of hydrogel or soft acrylic problems with PCO
    are avoided. This patent number US 6,616,691 is an interesting
    tutorial on this subject.

    If you want a copy of this patent I can, at your request, attach it as a PDF
    file and email it to you. You will need to email with a working email your
    current one is full.
    To email me remove the components of SPAM from around my name at the bottom
    of this text.

    Dave
    ----- Original Message -----
    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
     
    David DeBar, May 20, 2004
    #11
  12. Whenever you hear of a new miracle, check the previous miracles and
    expect something a bit less than miraclous.

    Yes, the CrystaLens does seem to be a viable accommodating intraocular
    lens (IOL), but there are some very real limitations to its acceptance
    in the US.

    The haptics of the CrystaLens must be placed in the ciliary sulcus.
    Those of you who know the anatomy of the eye understand that this is a
    small ridge that encircles the eye just underneath the iris. If the
    lens is not placed in the ciliary sulcus, it may not accommodate at
    all. If it is placed on the zonules, it can cause siginificant
    damage. Some people don't even have the ridge at the ciliary sulcus,
    but you can't determine any of this preoperatively because there is no
    readily available way to actually look. Even when implanting the IOL,
    the surgeon cannot see underneath the iris to determine if the IOL is
    implanted correctly or CAN be implanted correctly.

    To say the least, the skill of the surgeon had better be top notch.

    Of those who have accommodation, it tends to be about 1.00 to 1.50
    diopters. That is not bad, but nothing to write home about. Some get
    no accommodation at all. Whether or not the patient will have
    accommodation or not cannot be known until after the surgery and
    healing is completed.

    It seems that CrystaLens is a step forward, but like all first steps,
    it is a small step. Expect continued development and improvement on
    accommodating IOLs and the surgical techniques to implant them.

    If you talk with patients who have the multifocal
    "psydo-accommodative" IOLs, you will quickly learn that you must love
    halos to love these particular IOLs.

    When the rubber hits the road, CrystaLens and other superior
    technology IOLs come to a screeching halt. Not because of any problem
    with the IOLs, but because of problems with paying for the IOLs.

    Most US citizens develop cataracts at an age when they are covered by
    Medicare insurance. As a part of the federal government, the Medicare
    system has the ability to not only decide what insurance coverage to
    provide, but to back it up with civil and criminal penalties.

    Medicare determines how much will be paid for an IOL. No matter how
    much the lens actually costs, Medicare will only pay that amount.
    This sounds reasonable, but the next point may surprise you. Even if
    the patient wants to pay the difference for a superior technology IOL
    such as the CrystaLens, Medicare will not allow it.

    If a doctor receives from the patient the actual difference between
    what Medicare allows for an IOL and the cost to the doctor for the
    superior technology IOL (no profit), the doctor is subject to
    significant fines, being kicked out of the Medicare system, and jail
    time.

    Medicare will not allow a beneficiary to purchase superior technology;
    even with the patient's own money and even if the superior technology
    is clearly advantageous for the patient.

    For this reason, there is very little incentive for manufacturers to
    develop superior technology IOLs. If someone wants the CrystaLens,
    that person will be required to pay the entire cost of surgery
    including the physician component, anesthesiology, facility, and IOL
    out of his or her own pocket - even if the patient has Medicare.

    Currently no Medicare supplemental insurance will pay the entire cost
    of care to be able to receive superior technology, and none seem too
    eager to add this potential liability to their plans.

    This is an inequity that affects not only people wanting superior
    technology IOLs, but people needing other prosthetics and even
    pacemakers. The federal government will not allow a patient to use
    his or her own money to pay the difference and receive superior
    technology.



    Glenn Hagele
    Executive Director
    Council for Refractive Surgery Quality Assurance

    Email to glenn dot hagele at usaeyes dot org

    http://www.USAEyes.org
    http://www.ComplicatedEyes.org

    I am not a doctor.
     
    Glenn Hagele - Council for Refractive Surgery Qual, May 20, 2004
    #12
  13. David DeBar

    The Real Bev Guest

    Glenn, Hagele, -, Council, for, Refractive, Surgery, Quality, Assurance,
    wrote:

    ....
    When Jane Bryant Quinn said that that was a GOOD thing because it would
    keep dotty elders from being defrauded by evil doctors I stopped reading
    her column.

    Correct me if I'm wrong, but I believe the doc can also be
    medicare-defrocked if he uses the forbidden technology on a medicare
    subscriber who pays the full freight without going through medicare.

    --
    Cheers,
    Bev
    ======================================================================
    "Steve Balmer, CEO of Microsoft[0], recently referred to LINUX as a
    cancer. Unsurprisingly, that's incorrect; LINUX was released on August
    25th, 1991 and is therefore a virgo." -- Kevin L
     
    The Real Bev, May 20, 2004
    #13
  14. David DeBar

    David DeBar Guest

    Thank you Glenn for pointing out some of the complications with Crystalens.
    In this same thread you will see responce from Dr. Larry Bickford who
    advises to take a wait and see for at least six months. In my responce to
    Dr. Bickford I mentioned patent number 6,616,691. In it mention is made of
    posterior capsule opacification" ("PCO"). This is another danger that might
    manafest it's self years after the surgery. In the above Alcon patent it is
    claimed that silcone is a problem in that it causes PCO. On the other hand
    the Crystlens people tout their use of silicone. Who are we to belive?!?!
    I just hope that this is better understood by the time I need my cataract
    operation. I can still see 20/20 with my glasses. At 64 years of age I find
    that I need multiple perscriptions depending on what I'm doing. I can wait a
    while, and will be willing to pay for skilled medical care when I need it.
    I recently traveled have way across the country to have the best doctor I
    could find operate on my prostate. He was worth every penny. I'll do the
    same with my eyes when the time comes.

    BTW the above patent discribes a two lens device that greatly increases the
    amount of accommodation. Who know when it will come to market or how safe
    it will be?!?! In this patent they say that the lens is, "easily implanted
    in the posterior chamber."

    Dave
     
    David DeBar, May 20, 2004
    #14
  15. David DeBar

    David DeBar Guest

    Bev,

    I hope your wrong about that. I guess I could leave the country for my
    surgery if I had to.

    Dave
     
    David DeBar, May 20, 2004
    #15
  16. You will find that I firmly believe everyone has a right to my
    opinion.

    8^)

    Here is another one of those tidbits that make one realize just how
    little is understood about accommodation - and I'm not just talking
    about Schacher v. Helmholz here.

    In the CrystaLens FDA prospective clinical trial, 201 eyes were at
    least .50 hyperopic. 88% of this group achieved uncorrected near
    visual acuity of J3 or better, but that improved to 98.4% when
    implanted bilaterally. That result is consistent with the bilateral
    improvement of Schacher's implants when only one eye had the
    operation, but seems inconsistent with the improvement found in
    Conductive Keratoplasty (CK) for presbyopia.

    Hmmm.
    All and none.

    It is possible for Posterior capsule opacification (PCO) to happen
    with ALL materials. It happens with polymethalmethacrylate (PMMA),
    silicone, acrylic, collamer, hydrophobic acrylic, and hydrophilic
    acrylic hydrogel. I suspect that it will happen with the light
    adjustable IOL (LA-IOL) that Calhoun is working on. The only
    difference is how quickly it will occur, and even that is debated.

    Since PCO does not happen to everybody (there are some who have had
    all types of IOLs without PCO) there is the possibility that it is
    more an issue of the type of technique used for cataract extraction,
    the placement, the manipulation, and/or the physiology of the patient.
    Some manufacturers blame PCO on edge design, not on the material.
    Some claim a capsular tension ring will reduce or eliminate PCO. Thus
    far, this question has not been fully answered.

    If somebody says that PCO will not occur with their IOL, I would be
    very unlikely to believe them.

    Fortunately, laser posterior capsulotomy is quite successful and
    relatively non-invasive. I need to talk with the CrystaLens people
    about how blowing a hole in the back of the bag will affect a forward
    vaulting accommodating IOL. That will be an interesting conversation.
    Time and money are the two luxuries that should be afforded to all of
    us when we are 64. Heck, I'm game at 20 years your junior!
    It is unfortunate that not all have this opportunity.
    This is probably the Syncrony Dual-Optic accommodative IOL. The
    results of six (6) patients was presented at ASCRS, but they only
    showed distance corrected acuity at 1-2 months postop. Obviously, not
    ready for prime time. The company is Visogen in Irvine CA.
    When the company doesn't say much, it is hard to guess.

    I don't deal much with cataract, but I am involved heavily in
    refractive surgery. Since Clear Lens Exchange (CLE) is becoming in
    vogue, I've been brushing up on my IOL technology.
    Yea, "easily". Think about getting two haptics in the ciliary sulcus
    that may or may not exist and is behind the iris that the surgeon
    cannot see or even accurately know its diameter. How these docs
    actually do it is one of the great wonders of the medical world.

    Also consider the size of these IOLs. When you need a 6.0mm incision
    to implant an IOL, the probability of induced cylinder is possibly
    enough to counter any increase in accommodation. What good is
    accommodating if everything is blurred or distorted?

    Oh well, they can have LASIK for that...

    ....and the surgery goes on.

    Glenn Hagele
    Executive Director
    Council for Refractive Surgery Quality Assurance

    Email to glenn dot hagele at usaeyes dot org

    http://www.USAEyes.org
    http://www.ComplicatedEyes.org

    I am not a doctor.
     
    Glenn Hagele - Council for Refractive Surgery Qual, May 20, 2004
    #16
  17. David DeBar

    Dan Abel Guest


    As Glenn mentions in his response to the above, the key is whether the
    Crystalens responds to laser treatment the same way other IOLs do. I've
    had cataract surgery in both eyes, five years apart, and in both cases I
    got PCO about a year after the surgery. It's a single office visit to
    fix, with no pre or post op visits involved. You get the eye dilated, the
    doctor looks at it, you get set up at the laser machine and then five
    minutes later you are out the door. The longest part of the procedure is
    waiting for the eye to dilate. There is almost no pain or discomfort, and
    your vision is perfect by the next day.
     
    Dan Abel, May 20, 2004
    #17
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