Having Too Many Choices Can Be a Bad Thing
It seems like life was much simpler when I was a child. Ice cream was offered in just three flavors: vanilla, chocolate, or strawberry. That was all I needed to make me happy.
Today, there are just too many choices available. I sometimes wish for someone to just take control and tell me which options to select. This has never been truer than when I was confronted with worsening vision.
I had a cataract removed from my left eye in 2010 and wasn't too worried. Cataract surgery is the most frequently performed surgery in the United States. Each year, approximately three million Americans undergo this procedure, mostly with satisfactory results.
Development of Better Contact Lenses
Decades ago, patients undergoing cataract surgery had no choice but to wear thick glasses for the rest of their lives since there was nothing to replace the natural lens that had been extracted. Eventually, however, researchers developed the monofocal, intraocular lens implant, followed by multifocal implants, and finally, in 2003, the Crystalens accommodating intraocular (IOL) lens implant.
The Crystalens IOL, unlike its counterparts, actually works like the eye’s natural lens. There is no fixed focal point where the eye focuses best. The lens actually mimics the adjustments that the eye muscles make when they shift from focusing on something near, like reading material, to something far, like the horizon. After weeks or months, the brain adjusts to the lens so that the transition from near to intermediate to far is seamless.
Some people who have the Crystalens implanted will enjoy freedom from glasses in most situations, with perhaps low light and very tiny print giving them difficulty. A significant proportion, however, will continue to need reading glasses.
Things to Consider as a Patient
The Crystalens has enjoyed consumer success. Globally, approximately seven million people are walking around with this lens implanted in their cataract-free eyes.
There are so many choices now and so many more difficult decisions. You, the patient, are a very important part of the cataract surgery process, and as a consumer, you also want to find the best value for your money.
The Crystalens is an expensive, premium IOL. In fact, it is very lucrative for the ophthalmologist who sells it to you. But don’t expect to find up-to-date prices by visiting various ophthalmologists’ websites. Their websites usually give you the same marketing information that the manufacturer Bausch + Lomb's website does. Also, don't expect to get much information by calling your ophthalmologist's office. You will likely be asked to make an appointment to examine your cataracts first.
How Much Do Crystalens Typically Cost?
In addition to having the price spelled out for me at two different ophthalmologists' offices, I have investigated reports online and have spoken with individuals to get an approximate range of prices for this lens. You can expect to pay from $2,500 to upwards of $3,000 per eye for your Crystalens. The cost may vary by area of the country, the length of time the doctor has been practicing, the doctor’s reputation and expertise with the Crystalens, and the overhead costs in their practice.
How Are Costs Distributed?
I paid $3,300 (slightly more than average) to implant the Crystalens in my left eye. Here is how the cost was broken down:
- $2,800 for the lens
- $500 for a co-management fee to my optometrist
Co-management with your referring optometrist is quite common with LASIK surgery and, apparently, with cataract surgery as well. However, since most people don’t need to wear glasses after they get a Crystalens, I cannot help but feel that the $500 was just my surgeon's kickback fee to my optometrist and not much more. It would be an excellent idea to inquire about these co-management possibilities when you go to your first surgical evaluation. It might save you some confusion if you are doing price comparisons between surgeons.
It is also important to be aware that different surgeons may price things differently, usually adding on costs. Some offices will charge more for the lens and collect a $1000 co-management fee. If the cataract surgeon also does a lot of Lasik surgeries, they may charge more for the Crystalens and throw in free Lasik or PRK (photorefractive keratectomy) touch-ups if you are not satisfied with your visual outcome. Essentially, you'll be paying more up-front, regardless of the need for post-operative Lasik or PRK enhancement. This could push the total cost to $4,500–$5,000 for one eye.
Read More From Patientslounge
What if You Have Astigmatism?
At your first surgical evaluation, you should determine whether your ophthalmologist can include an LRI (limbal relaxing incision) in the cost for your Crystalens. If you want to improve your astigmatism without any additional refractive surgery, you may want to talk to your doctor about LRI. It is a method of helping your cornea focus light by making small incisions in the cornea.
When I chose the Crystalens, my surgeon included the LRI in the purchase price. If a patient chooses any other lens, the LRI will be billed to the patient separately (it won't be covered by insurance because its purpose is refractive).
If you opt for an LRI, be certain about your insurance policy's coverage terms for this procedure. Somewhere in your consent forms, you should find a signed statement acknowledging your understanding of the costs.
If you don't have astigmatism and you have nothing to gain from getting the premium lens implanted, I would suggest getting a monofocal lens or a diffractive lens. Talk to your surgeon about the visual outcome you are looking for and the visual outcome you can expect from each type of IOL. With a monofocal lens, the lens is either set for far vision or near vision. This means you can either see well far away or close up, not both. The Crystalens is meant to be transitional, meaning it can help with near, intermediate, and far vision. However, in some cases—and certainly in my case—this may not be 100% true.
Will Insurance Cover the Costs?
Since I wasn't old enough for Medicare, and I didn't use Medicaid, I can't be too explicit about how their reimbursements work. I do know that Medicare covers cataract surgery but will only pay up to the cost of a standard, no-frills monofocal IOL; they expect you to pay the difference for a premium lens.
I have private insurance. I can’t imagine that any standard health insurance policy would pay for a premium IOL, and in fact, mine does not. They might if it could be proven medically necessary, but that is not going to happen; 99.9% of the population will function well enough with a monofocal implant, so that’s what they will cover. I had to pay for my Crystalens out of pocket. However, your doctor's office may offer some financial assistance. My doctor’s office offered a zero-interest installment plan until the lens was paid off.
Your Eyes, Your Choice
Do your research, ask around, and weigh all of the factors; it is ultimately your choice. If you choose to get an IOL, you’re going to want an excellent surgeon to operate on your eyes. I have had two cataract evaluations from separate surgeons. If you have extra time and money, you may also wish to undergo an examination with a different doctor. Be aware, though, that a cataract evaluation is an endurance test—mine took about three hours.
If you have a co-existing abnormality, as I do with my left eye, or you have a chronic disease, you might have to go for an evaluation with a retina specialist. From your two evaluations, you should get a good sense of how well they will cooperatively manage your condition. If you feel confident about undergoing the procedure, look no further!
Is Your Doctor Pushing the Crystalens?
You will likely be talking with office staff about IOL pricing. The doctor is usually too busy to go into detail with you about this. Don't be surprised if they seem to be pushing one type of lens over another. The only person you can really trust to help you make a decision is someone who has already had cataract surgery and an IOL implant and can talk about how they have adjusted to their new lens. Whoever you talk to, take what they say with a grain of salt. Check out what they say with another surgeon or do some research on the web.
If they're pushing the Crystalens, again, listen to what they have to say, but also do your own research. However, you don't have to be overly skeptical of the Crystalens (besides the price). It's true: surgeons are generally motivated by money, but on the other hand, it may be the lens they are most comfortable implanting. Many surgeons may have specialized in implanting a certain kind of IOL. With a quick Google search, you can find Crystalens specialists in your area.
My Experience With Crystalens Implants
I researched and deliberated to the point of agonizing over whether I should have cataract surgery or put it off for another year. Sometimes, I do wish someone would just make decisions for me or at least narrow down my options. Eventually, my retina specialist did just that. He said, "I believe your only choices are the Crystalens or a standard monofocal IOL."
My First Cataract Surgery
Toward the end of 2009, I decided to get a Crystalens IOL implanted in my left eye after cataract surgery. The same year I also had a vitrectomy and ERM peel in the same eye that gave me back several lines of vision. The first 90 days after your procedure is spent monitoring your healing progress with your optometrist. It is important to note that you may not see improvements right away. In fact, it may take up to a year to notice improvements. My optometrist also told me that Bausch + Lomb let you know what to expect in terms of needing glasses after the procedure. In some cases, this may differ from your own expectations.
Several months after the procedure, as my retina was healing, I experienced some improvement in my vision. The Crystalens was doing what it was supposed to do! I would remove my glasses when working at the computer. However, I still had to wear glasses while driving due to the development of myopia and a cataract in my right eye. The good news is, I have had no problems with my one Crystalens so far.
A year and a half after the procedure, during a follow-up visit to my cataract surgeon, he noted that I needed a Yag laser capsulotomy because the implanted lens had thickened and had become cloudy. This is a common procedure that is done after cataract surgeries. A few months after the capsulotomy, my lens and vision in my left eye were holding up. There were some occasional floaters in my eye, but I got used to them, and they went away after a while.
My Second Cataract Surgery
I decided to have cataract surgery and another Crystalens implant in my right eye two years after my first cataract surgery. People usually have cataract surgeries weeks apart. I decided to wait longer to see how my first lens would work out. My surgeon also made LRIs—this was included in the price of the lens implant—to treat my astigmatism.
A year after my second cataract surgery, I finally had improved vision—at least for my far and intermediate vision. I still needed glasses for close vision (e.g. for reading or knitting). I couldn't read department store labels or nutrition facts on canned foods, even in fluorescent supermarket lighting.
Was the Crystalens IOL the Right Choice?
The reason I have perfect far vision is because my astigmatism was corrected through the LRIs on both corneas. These incisions were also included in the cost for my Crystalens IOLs, so although I still have to wear reading glasses to see things close up, I think that I made the right choice. The LRIs, by themselves, can total around $2,500 for each eye.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: I have had cataract surgery on both eyes and could see pretty well afterward. Over time, it has worsened. I can't see the writing (very blurry ) on the TV. What do you suggest?
Answer: I would suggest returning to the ophthalmologist and telling him/her. Your vision should be stable, unless you begin having retinal problems.
© 2009 gracenotes
gracenotes (author) from North Texas on March 03, 2014:
Sorry it took a while for me to respond. I am glad that you are doing so well, but sorry you'll have to have the additional procedure. I was not familiar with B & L's new lense, so thanks for the update. I hope your vision goal is reached eventually.
I had some minor problems for a while with the "edges" thing, especially early in the morning. Be patient and I trust that everything will be resolved.
Denice Victor Ullestad from Marysville, WA on February 03, 2014:
It's been 4 weeks since my cataract surgery. My surgeon went with the newly FDA-approved lens by Bausch and Lomb: Trulign Toric. It's a Crystalens but it's specifically for correcting astigmatism from within the eye to minimize the need for further vision-correcting surgery or procedures.
My surgeon was the first to implant this and I was the first patient to receive it in my area. A representative from Bausch and Lomb was there to observe my surgery.
My vision was 20/25 the day after surgery with hopes it would improve after the dilation period was over. Two weeks after surgery though, it started to get worse and unfortunately the toric lens didn’t work 100% for me in correcting the astigmatism. It “almost” did, but things are slightly out of focus so I’ll be getting the corrective procedure in about 6 weeks. My doctor is confident that patients with a lesser degree of astigmatism will do very well with this new lens. If he'd used the regular Crystalens, I'd still be looking at getting the corrective procedure anyway with the amount of astigmatism I had, but now it'll be an easier fix since my vision is “almost” there. I was a good candidate for this new technology and I'm glad I was chosen to be the first.
I'm pleased with how it's gone so far and am hopeful that the halos and shimmering go away and that in time I can learn to ignore seeing the edges of the lens. All in all it beats trying to see through a waxed paper-like film and being blinded by bright light.
gracenotes (author) from North Texas on February 02, 2014:
Thanks so much for the comments. I apologize for how long it took me to reply.
But it looks like you had the surgery about 3 weeks ago. I hope it went well. Sorry you had to do this at age 46.
I hope you'll come back and report how you did with the surgery. How has the Crystalens done for you, so far?
Denice Victor Ullestad from Marysville, WA on January 07, 2014:
THANK You! I'm having my left eye cataract surgery tomorrow and despite advice from well-intended people to NOT look on the internet for Crystalens reviews, I did. Sadly, there are hundreds of horror stories and very few realistic, positive reviews. It sucks that my near-perfect vision was clouded by early cataracts. I just turned 46 last week and was disgnosed three years ago.
I'm nervous, excited and cautiously optimistic that I'm making the right decision to obtain the very best outcome for me.
gracenotes (author) from North Texas on January 14, 2013:
I do emphathize. If you're not going with the Crystalens, I cannot help with prices much. It's been 3 years since I got a quote of any kind, and I don't remember looking into the other lenses very much. You are correct that doctors just won't give you this information without making you go through the whole procedure and exam for cataract surgery.
I'd be willing to bet that some of the monofocal lenses can be had for $1500 or so.
stephen Bee on January 12, 2013:
please PLEASE can't someone give me a rough idea what lenses cost. I took a survey and it seems like Crystalens is not my best option, instead I should get the other lens, I do a lot of close work and medium range work, not hunting sheep 1 mile away or playing baseball in the outfield. so.. ANY PRICE INFORMATION????? Any??? Mahbe the name of a doctor that won't tell me "well we cant' say until its too late, ha ha ha".
gracenotes (author) from North Texas on July 31, 2012:
Susan, a macular hole is terrible, and as you found out, face-down positioning is not fun at all. I only did face-down positioning for 3 days with my retinal surgery, and that was enough.
If the lady at the pool spent $10,000 for both eyes for the Crystalens, that's not uncommon. Remember, I consulted with two surgeons. The one who charged the "premium" amount was including, in that price, future refractive surgery if not satisfied with the results. But I don't like that kind of pricing, because, in effect, you're paying upfront for something you may not need or want. And since I'm seeing 20/20 at a distance, could I actually do better? As my retinal surgeon said the other day, "This is as good as it gets."
As for email, it seems that HubPages has stopped including the "Contact the author" button on this page. That convenience would have automatically sent a message to me. Ah well. Feel free to contact me at firstname.lastname@example.org and I'd be happy to continue the discussion. Have a great day, Susan.
Susan on July 30, 2012:
Thank you for answering so quickly! I suppose my biggest fear as far as my eyes are concerned is getting a macular hole in my other eye, which my surgeon said could happen, but he saw no signs of a pucker. The face-down post opt was tolerable--only due to my determination--but I don't want to go through that again!
My doctor did explain the thinness of the lens, and went into a lot of detail (which is so important)
After reading your posts, I realize people are confused when given options re: cataracts and the decisions to make about the lens they choose (plus the cost!).
I've talked to seniors who believe at my age (72), why worry about not wearing glasses and pay all that money, and I did give this a lot of thought. I also got remarks about "oh- the doctor will try to sell you anything!!", "go to a surgical center and all you see are patches from doctors who pushed unnecessary procedures", "stay with the standard cataract lens and wear the glasses!", etc.
After having the Re-Stor lens in late May, I have no regrets - and put my former trifocals that I would reach for every morning away! (I would have had the Crystalens, but he believed the Re-Stor was what was best for me).
It also suddenly came to me this morning that I used to get headaches when I read, and I read a lot, and don't have this since I had the Re-Stor and use only cheap readers for small print. I'm back now when shopping to pulling out the glasses to see a price tag or ingredients!
A 65 year old woman at the pool told me last week she recently had the Crystalens in both eyes one week apart!!, and she loves them. Had little restrictions and adjusted beautifully, and her only concern was not telling people that she had this done due to their questions about the cost, which she wanted kept private (though she did tell ME she paid $10,000 for both eyes). This was more than my doctor would have charged for both eyes--but then everything seems to be more expensive in Connecticut!
From my experience (and I'm on a fixed income) I would tell people if they want freedom from glasses and the need to change the prescriptions often (which also can be costly), find a way to have one eye done at a time--it's worth it so far to me! But more important--research and find a doctor you trust!
ps: you're so right about teeth as well! Which leaves us with researching the best dentist, eye doctor and at my age--what next?
Off to the pool - want to hear who had the latest procedure and on what !!! (not exactly what I want to hear, but it comes with the age territory!!)
Wish I had your email address to continue to correspond with you about you and your Mom! We have a lot in common! (I am on Facebook but do check out any new Friend requests and have my info restricted)
gracenotes (author) from North Texas on July 30, 2012:
Susan, believe me, if I had a macular hole, I wouldn't be seeing 20/20. The small hole he sealed up is at the 9:00 O'Clock position on the peripheral retina. I suppose we could just think of it as the "law of unintended consequences" after cataract surgery. Not everyone would be a candidate for laser coagulation, but I was. There are risks, but my retina doctor felt it needed to be done (sometimes a person can develop a blind spot due to this procedure!) Yes, I like my surgeon very much, and the trust factor is high.
In truth, many kinds of surgical or mechanical interventions probably have risks that we can't foresee. For instance, as a kid during the 1960s, I was lucky to have parents who could afford to get my teeth straightened, but the methods, although state-of-the-art at the time, aren't necessarily what an orthodontist would use now, if he could help it. Many years later, my dentist was very surprised that I didn't have TMJ pain or grind my teeth as a result of the way my teeth and jaws were moved to achieve a better bite as a child. That's just the way it goes.
Sorry to hear about your mother's pain. My mother has probably had 5 or 6 kyphoplasty surgeries during the last 4 years, to try and fix compression fractures in various vertebrae, due to her severe osteoporosis. So I can relate, and certainly have developed some awareness in this area.
However, my mom is doing pretty well, and hasn't had any recent compression fractures. I hate osteoporosis, and hope to be able to stop my own bone loss before it proceeds further.
Nice to hear from you again.
Susan on July 30, 2012:
I was surprised to read this and since I had a macular hole in the past (prior to any cataract surgery), was wondering if a retinal hole was similar? I'm learning constantly about eye treatments and how they're treated! I previously wrote that my neighbor had the "regular" cataract surgery on May 29 (same day that I had the Re-Stor lens). She is is still being treated due to irritation and redness and told me it was probably because she also has been treated for glaucoma. This I didn't have, thank goodness! I'm doing well with the Re-Stor lens (only one eye) and only use cheap readers for small print.
Thanks for the update! You gave a lot of information about the lens that we would never know about, and you must have a great surgeon. Keep us posted!!