FAQ #1: “Why haven’t I heard of this lens before?”
Staar is a relatively small company compared to Alcon, AMO, and B&L (the big three IOL makers in the USA). As such, Staar simply doesn’t have the marketing budget to compete. Hate to break it to you, but doctors are just as likely to be swayed by marketing as anyone else. Whether it’s laundry detergent, a car, or an intraocular lens placed at the time of cataract surgery, we are all influenced by familiarity with a brand. Indeed, marketing studies have supported that familiarity breeds trust so the most heavily marketed brand tends to be trusted for that reason alone.
FAQ #2: “Why aren’t more surgeons using this lens if it’s so great?”
I can’t say for certain why the Staar nanoFLEX® IOL is not embraced by more surgeons, but I have a few thoughts on the subject:
It’s a plate haptic IOL. When plate haptic IOLs first came on the scene they were made of silicon which is a slippery, springy material. They could not be easily folded with forceps so required injectors to get them through a small incision during cataract surgery. As these IOLs left the injector they did so with significant speed and force. I’ve even seen a video of one that jumped out of the injector through the capsular bag and into the back of the eye! The Staar nanoFLEX® IOL, however, is not made of silicon. It’s made of Collamer®, which is a less “springy” material. I’ve found injecting it to be controlled and stress-free. Many surgeons, however, may simply not be willing to try another plate haptic IOL after their initial experience with silicon plate haptic IOLs.
The force of inertia (or habit). Everyone, surgeons included, tends to prefer what they are familiar with. Surgeons who have been using acrylic lenses (the most common type) may just not want to be bothered by trying out a different lens material which requires becoming familiar with a new lens injector, surgical technique, etc.
FAQ #3: If the Staar nanoFLEX® IOL works just about as well as the Crystalens® IOL which has a price tag of approximately $1,000 more than the Staar nanoFLEX® IOL, why do so many surgeons still recommend the Crystalens® IOL?
FAQ #4: “I’ve heard that I might have a greater chance of developing a condition called Posterior Capsular Opacification with this lens. Should I be worried about that?”
During cataract surgery the intraocular lens (IOL) is gently placed in a thin, transparent tissue called the capsular bag. After cataract surgery this bag shrinks around the IOL securely holding it in place. Over time, however, this shrinking process can result in some haze in that part of the bag behind the IOL. Just like a fingerprint on spectacle lenses blurs vision, so can haze in the capsular bag. This haze is called “posterior capsular opacification” (PCO).
It’s believed that the Staar nanoFLEX® IOL may have a higher incidence of posterior capsular opacification (PCO) compared to acrylic IOLs. In my own experience I have not found that to be the case. However, I take the extra step to polish the anterior and posterior capsule as well as remove the lens epithelial cells (LECs) during cataract surgery. These steps can be technically challenging, take more time, and are simply not performed by many surgeons. Nevertheless, there is growing evidence that these steps decrease the rate of PCO. If I were to leave the LECs in the eye then I do think that the rate of PCO may be higher with the Staar nanoFLEX® IOL than the more commonly used acrylic IOLs…but I don’t leave the LECs so I’ve not seen a significant increase in the rate of PCO in my own patients in whom I’ve implanted the Staar nanoFLEX® IOLs.
Posterior capsular opacification is treated with an in-office procedure called YAG capsulotomy. This laser creates small openings in the hazy portion of the capsular bag. At the time of the YAG procedure pits will often appear in an IOL. That being said, by the next day these pits have all but disappeared from the Staar nanoFLEX® IOL! With all other IOL materials, the pits created at the time of surgery stay the same size for the life of the patient. Ultimately, however, pits in any IOL are unlikely to cause a significant disruption in vision so I would never choose an IOL on this basis alone.
FAQ #5: Who is Not a Candidate for Implantation of the Staar nanoFLEX® IOL?
Unlike multifocal intraocular lenses (IOLs) which should not be used in anyone with significant eye disease, the Staar nanoFLEX® IOL may be implanted at the time of cataract surgery in almost everyone. There are, however, two exceptions:
- High astigmatism. If the shape of the cornea is too irregular then even though a Staar nanoFLEX® IOL may be safely implanted spectacles will be needed after cataract surgery to provide clear vision.
- Capsular bag weakness. If the bag that normally holds the IOL is weak, torn, or otherwise unstable then a Staar nanoFLEX® IOL cannot be used. It is not always possible to know prior to cataract surgery whether the bag has the necessary integrity to allow placement of a Staar nanoFLEX® The surgeon makes this assessment at the time of surgery.