Cataract Surgery with Crystalens and Trulign. See Distance, Up Close, and Everything in the Middle.

The Crystalens® is a new technology that is designed to mimic the eye’s natural ability to focus on distant, middle and near objects. Used in conjunction with standard cataract treatment and extraction methods, the Crystalens® was designed to provide a continuous range of vision from distance to intermediate to reading vision without total dependence on glasses or contact lenses.

The Crystalens® has the unique ability to focus on objects at varying distances using the eye’s natural focusing system. This means that the Crystalens® can provide a continuous range of vision, without corrective lenses, from near to far and everything in between. Standard (single vision) lens implants do not have the ability to provide a full range of vision. Most people who have single vision lens implants MUST wear glasses for middle and near vision. It was shown in the two year clinical trial that supported the FDA approval of the Crystalens® that significantly more patients implanted with a Crystalens® (88%) could see better at all distances than patients implanted with a standard lens (36%).

Your distance vision will usually be very good within a day or two after surgery. However, your middle and near vision may be somewhat blurred at first. You may need to wear reading glasses to help you read during this time. After about 2 weeks, you will notice that your middle (arm’s length) vision is improving and your near vision is also starting to get better. It is important that you discontinue the use of the reading glasses at this time so that you strengthen the focusing muscle of your eyes. It may take several months for your eyes to reach their full focusing potential. The more you try to read without reading glasses, the quicker you will be able to read without them. You may notice a difference in your vision from one eye to the other after your eyes heal. This is normal. If the difference in your vision is significant, your doctor may recommend additional corneal refractive surgery. This is often done for the correction of astigmatism after implant surgery. Everyone’s focusing ability is different. Most people will be able to see clearly in the distance, have excellent middle vision, and will be able to read a newspaper without glasses, but some people may be more comfortable with additional correction, particularly at night or in dim light. It is important to remember that implant surgery cannot resolve pre-existing visual conditions such as floaters, flashes, or visual field loss that are a result of conditions of the eye and not related to the lens. Your doctor will thoroughly discuss the restoration of your vision after surgery and will recommend a specific plan for optimizing your uncorrected vision for near and far. It is important to remember that while virtually everyone experiences much improved vision after cataract surgery, some people will have better uncorrected vision than others. It may be necessary for some people to wear glasses for distance and/or near vision to obtain optimal visual acuity. The difference from standard lenses is that most people will not be dependent on these supplemental vision aids to function normally. Since this information isn’t intended to replace the advice of a healthcare professional, be sure and talk with your doctor before making any decisions regarding vision correction procedures. The long-term safety and effectiveness of this lens have not been established.

Generally speaking, Medical insurances cover medically necessary cataract surgery but not the upgrade to the more sophisticated (presbyopia correcting) implants. The insured is required to pay deductibles, co-insurance, and the costs associated with the upgraded lens. Generally, insurances could care less whether you need reading glasses or not. It’s something you do for yourself. Medicare will pay for medically necessary cataract surgery but does not consider presbyopia correcting IOL’s medically necessary. After all, you could wear reading glasses after surgery. A Medicare beneficiary may request insertion of a presbyopia correcting IOL in place of a conventional IOL during cataract surgery. Medicare pays the same as if an regular implant was used but the beneficiary pays for an upgraded lens implant and the associated services for Crystalens®. We cannot bill your insurance or Medicare for services that we know in advance are not covered or medically necessary- i.e., Crystalens®. In the past, patients who have tried to submit their Crystalens® upgrade costs to their insurances have put their ability to get their other eye done in serious jeopardy. Don’t even think about it. Our charges for Crystalens® are perhaps the cheapest in Florida. We invite you to compare!

Typically, you will be able to return to normal activities within several days after implantation with some limitations. Your eye may be sensitive to touch and bright light, but you should be able to drive and return to work in two to three days. Your doctor will provide you with medications to prevent infection and decrease inflammation and may provide a protective shield to cover your eye while sleeping. A pair of plastic, disposable sunglasses will decrease your sensitivity to light as well as providing protection during the day. It is important that you avoid heavy lifting or straining that would increase the pressure in your eye for several days after surgery. You also must avoid rubbing or pushing on your eye. You should refrain from activities that could increase your chances of getting hit in the eye. Wear your protective sunglasses when outdoors. You can shower and wash your hair as long as you avoid getting soap or shampoo in your eye. Refrain from using eye makeup, lid liner, and mascara for several weeks after implantation. You should avoid public swimming pools, hot tubs, or other sources of bacterial contamination for several weeks. Consult your doctor on recommendations for specific activities.

The Crystalens® functions very much like the normal human lens. It is important to remember that reading vision in low light is also influenced by the overall health of your eye and by the condition of the light sensors in the retina. As we get older our ability to see in low light conditions may start to decrease. It is always best to read in good light conditions.

Once your cataracts are removed and replaced with an implantable lens, you will never have to have cataract surgery again. Occasionally, several months after the lens has been placed in the eye, the vision may start to become cloudy once again. This is sometimes called a secondary cataract and refers to the clouding of the membrane that surrounds the implant. This membrane (the capsular bag) originally surrounded the human lens. When the cataract was removed, all that remained was this membrane into which the artificial lens was implanted. The membrane healed around the artificial lens, securely holding it in place in the eye. Unfortunately, sometimes the same conditions that caused the original cataract will cause the buildup of cells on the membrane behind the implant. These cells will block the vision and have to be removed. A laser is used to make an opening in the membrane behind the implant, immediately improving vision. This is done painlessly without an anesthetic and takes just a few minutes. Once this is done, no further surgery related to your cataracts will be required.

The Crystalens® has been designed to focus your eyes at all distances after cataract surgery. While virtually everyone will experience a significant improvement in their uncorrected vision after the Crystalens® surgery, some people will not see 20/20 at all distances. It is interesting to note that many people who have not had surgery are not able to see 20/20 at both near and far even with glasses or contact lenses. This is due to a variety of ocular and physiological problems as well as lifestyle preferences, yet most of these people function quite normally although their vision is reduced. The two-year clinical trial that supported the FDA approval of the Crystalens® indicated that 92% of the people enrolled in the study (implanted bilaterally) 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 contact lenses. What is more exciting is that 98% of these people could pass their drivers test, 100% could see their computer and dashboard, read the prices in the supermarket or put on their makeup, and 98% could read the telephone book or newspaper, all without glasses or contact lenses. It is important to keep in mind that visual acuity is subjective and depends upon each individual’s own ocular and physiological conditions as well as lifestyle preferences. Some patients implanted with the Crystalens® still require glasses for certain activities.

Dr. Mahootchi has been implanting the Crystalens® since 2004. Dr. Mahootchi has performed over 1000 Crystalens or Trulign surgeries. He is listed as a Crystalens® surgeon on the Crystalens® website: www.crystalens.com. In 2008, Bausch and Lomb named Dr. Mahootchi’s practice as one of only 100 Crystalens® Centers of Excellence in the entire US. There is no substitute for a face-to-face consultation with one or more surgeons prior to undergoing implant surgery. It can be very useful to contact patients who have the Crystalens® implant in their eye. You can read about our happy Crystalens® patients here.

Your doctor will perform a thorough examination and advise you of a customized cataract treatment plan for effectively correcting your vision. Virtually everyone with good general health is a candidate for Crystalens® lens implant surgery, but people with chronic infections, uncontrolled diabetes, or other health problems may have to wait until these conditions are under control prior to having surgery. People who have had prior corneal refractive surgery are acceptable candidates for Crystalens® surgery as long as their eye is in good health. Talk to your doctor. If you have already had cataract surgery, you are not a candidate for the Crystalens® procedure.

The Crystalens® surgery is typically performed in an outpatient surgical facility. You will arrive at the surgery center about an hour before the procedure. A number of topical drops will be placed in your eye and you may be administered medications to help you relax. The eye drops anesthetize your eye and dilate your pupil. Once in the surgery suite, you will lie down on a comfortable bed, a microscope will be positioned over your eye and you will be asked to look up into the light of the microscope. The actual Crystalens® surgery usually takes less than 20 minutes. The surgeon will stabilize your eye with a device to keep your eyelids open. You will feel no pain, only slight pressure on your eye. All you have to do is relax and hold still. Once the surgery is complete, additional drops will be placed in your eye to prevent infection, decrease inflammation and keep your pupil dilated. A patch may be placed over your eye and someone will need to drive you home. Once at home, you should rest for the remainder of the day. You should avoid any strenuous activities. Your doctor will see you the day after surgery to remove the eye patch and examine your eye. Do not rub your eye. The doctor will give you additional medications that you will need to put in your eye for the next week or two. These drugs help the eye heal, leaving no residual effects.

Your doctor will advise you as to how often your eyes need to be checked. Typically, the doctor will see you one day after Crystalens® surgery, after 2 to 4 weeks, and again around 3 to 6 months after surgery. Thereafter, an annual exam is usually sufficient unless you have a specific problem.

Your ability to see at approximately arm’s length (middle vision) will be greatly enhanced with the Crystalens® lens implants. Over 96% of people enrolled in the clinical study were able to see 20/20 at arm’s length without correction. In addition, the quality of vision compared to wearing trifocals is significantly improved. You will have a full range of vision, without having to tilt your head to find that portion of your glasses that allows you to see clearly. You simply look at something and the Crystalens® will automatically focus your eye at near, arm’s length, or distance. The Crystalens® mimics the natural focusing ability of your eye.

The contemporary cataract treatment is to remove the crystalline lens and replace it with an implantable lens. The Crystalens® represents the state-of-the-art in implantable lens design and is the result of over 50 years’ evolution in the treatment of cataracts. The medical procedure to implant the Crystalens® is the same safe, proven cataract surgery performed annually on over 7 million eyes globally. Over 40 million procedures have been done in the last 25 years. But because it is surgery, it is not completely risk-free. Complications of cataract surgery range from minor, usually temporary side effects, to sight-threatening complications. Fortunately, significant sight-threatening complications are extremely rare, and include, but are not limited to, infection, hemorrhage, and retinal detachment. These and other complications may occur as a result of the removal of a cataract, whether or not an intraocular lens is implanted, and may result in poor vision, total loss of vision, or loss of the eye. Dislocation of the lens and the need for additional surgery, such as lens removal and replacement are also possible risks of the procedure. In addition, people with existing medical conditions such as diabetes, high blood pressure, chronic inflammatory conditions, and chronic infections are at a higher risk of developing complications. Current data indicates that 98% of people have no complications after cataract surgery and more than 95% have improved vision. Your doctor will perform a thorough examination and fully inform you of any increased risk of a complication.

There are various reasons why the power of your implant may not be sufficient to provide you with a continuous range of vision, including, but not limited to, measurement error, prior refractive surgery, e.g., LASIK, RK. In these cases, your doctor will decide the best course of treatment, which may include additional surgeries, such as removal and replacement of the Crystalens® implant. One very important advantage for patients that choose The Eye Clinic of Florida and Dr. Mahootchi is the cost of such treatment. In the rare case (less than 2%) that you would require some refractive surgery to see your best after Crystalens is done in the first two years, we pick up the cost. At several of our competitor’s you pay the cost. We want patients to know we stand behind our product. Also, the extra cost of Crystalens at our clinic goes farther in avoiding future refractive surgery costs compared to others providing the same product.

Implant surgery typically will have very little influence on chronic dry eyes. This condition is related to a variety of internal and external medical conditions and is sometimes associated with aging. You should consult your doctor on a therapy that is most suited to the cause and severity of your condition as well as your lifestyle. DON’T SMOKE. Smokers have worse dry eyes and worse surgical results. Dr. Mahootchi treats dry eyes prior to surgery and wants patients to know that chronic eye conditions still need treatment afterwards. Crystalens® is not a treatment for dry eyes.

Typically cataracts will develop in both eyes. If only one eye has a cataract, only one implant is necessary. If both eyes have cataracts and the vision in one eye is worse, the surgeon will elect to implant that eye first. If both eyes are the same, the surgeon usually starts with the ‘non-dominant’ eye. Your doctor will look at a number of factors in deciding which eye to implant first and when, if necessary, to implant the other eye. Most surgeons prefer to wait two to three weeks between surgeries, but this may vary based on how well the first eye is healing and the visual outcome.

These symptoms are much less likely to occur with Crystalens® than other presbyopia-correcting lenses. The incidence of these problems is low with standard implants and not higher with Crystalens®.

An advantage of Crystalens® over the other presbyopia correcting IOL’s is that Crystalens® patients generally complain a lot less about nighttime driving glare, halos or starburst than the Technis Multifocal, Symfony or Restor family of multifocal lenses. Also, Crystalens requires less “brain adaptation” to the new vision.

The Crystalens® optic material is so clear that in some people it takes time to get used to how bright colors are and how intense lights can be, particularly at night. Again, glare is rarely debilitating and if it does bother you, there are a number of things that your doctor can do to improve your vision at night including medications or night driving glasses.

Crystalens® isn’t your ordinary lens. The post-op measurements and follow up are critical for life-long performance of the lens. At our clinic, the doctor who performs the surgery sees you himself for most of the visits. We will want to see the day after the surgery and about 10-14 days afterwards to ensure your eye is healing properly. Follow-up other doctors outside the practice during the 90 day post-op period should be the exception rather than the rule. In case of travel difficulties after surgery that prevent follow up with the surgeon, we will need to pre-qualify other providers to ensure a high level of care and the best interests of the patient are met. You should immediately contact your surgeon if you have problems or any doubts about your eyes after surgery.

Security scanning should not be affected after Crystalens® implantation. Security scanning usually relates to iris or retinal pattern recognition. The implant has no influence on iris scanning and should not interfere with retinal visualization through a normal-sized pupil.