Crystalens-Focusing Lens Implant

Cataract surgery has undergone a remarkable evolution over the many years since it’s inception. At first, a large incision had to be made so the natural lens could be removed and an Intraocular Lens (IOL) could be inserted. The first IOLs were placed in the anterior section of the eye in front of the iris. This dramatically improved the procedure from the time when there were no implants. The problem with these anterior segment IOLs were that they vibrated resulting in endothelial (inner most layer of the cornea) damage often requiring corneal transplants.

The next big advancement was the development of the posterior IOL. This implant was place behind the iris thus eliminating the vibration and therefore protecting the cornea. These still needed a large incision requiring 7 sutures. The next big step forward was Phacoemulsification. This required a small incision through which a tube was placed, and the natural lens could be sucked out in pieces. Then a fold-able lens implant was placed in the eye behind the iris. This procedure only needed 1 suture.

A major issue with all of these implants is that they require the use of reading glasses in order to see close, or read. Over the years, many types of multi focal implants were tried. They had concentric rings, multiple focal zones and other creative attempts at permitting the patient to see clearly both near and far, without the use of reading glasses. They all failed in part because of glare, and the lack of clarity at some distance.

The newest lens is called The Crystalens Accommodative Lens. It is a revolutionary concept that mimics the natural lens. The natural lens that we are born with is attached to the ciliary muscle by a series of small fibers called Zonules. The ciliary muscle contracts, causing the lens to change shape via the zonules. That is how we accommodate, or focus our natural lens. During cataract surgery, the zonules are broken and the implant has NO attachment to the ciliary muscle. The Crystalens bypasses the needed attachment with a new concept in accommodation. It is placed in the posterior chamber behind the iris just like older IOLs, but it’s unique design permits focusing.

Most implants are held in place by little side arms call haptics that go out horizontally. The Crystalens has haptics that are attached to the central part of the implant by hinges. These hinges permit the implant to move forward and backward changing the focal point of the light. This mimics what effectively takes place with one’s natural lens. It is the only lens of it’s kind. However, it does take some work to have it work properly. Following surgery the patient is expected to read at least 6 hours per day for a number of weeks to position the implant properly, and get the ciliary muscle used to physically pushing the implants haptics forward and back. Failure to do so will result in poor focusing ability.

Statistics thus far show that 98.4% of Crystalens implant patients are able to read newspapers comfortably (although which newspaper they do not say) and 100% of these patients say they can see computers and car dashboards clearly. 98.4% of these same patients also say that they are able to see 20/40 in the distance or better with out eye glasses. These are statistics reported by the manufacturer and may vary as more individuals have the implants. Time is always the best indicator as to how effective a new procedure is.

This surgery has already been expanded to include patients that don’t have cataracts but are older then 40, and need reading glasses. This implant would eliminate that need forever. So far the results are mixed. There are those that love the final vision, and there are those that are not totally thrilled. As with all procedures, realistic expectations are a requirement for a completely satisfied patient. It should be noted that most surgeries today replacing the natural lens are sutureless, since a small incision is placed in the cornea through which the natural lens is removed and implant inserted.

Before undergoing this or any other surgery all patients must know what to expect and understand that nothing is as good as the equipment that we are born with.