Modern cataract surgery can make a cloudy lens (cataract) disappear. Although cataract surgery is often called “miraculous” by those who have had this surgery, this is no magic trick. Great surgical skill and space-age materials are used to complete this seeming slight-of-hand. However, the current lens designs and materials cannot fully recover the range-vision many of us experienced in our twenties. Current intraocular lens (IOL) designs can provide excellent distance vision in cataract patients. For those willing to pay extra for a larger range of vision, the currently available FDA approved IOLs will return some (but not all) of our youthful vision. With newer lens designs such as the NuLens®, a magical return to the dynamic full-range vision can be achieved.
Unlike earlier pseudoaccommodating IOLs (Such as the Crystalens®) which just distort to provide an incomplete range of vision, the NuLens® works like a piston. The NuLens® is made of a flexible silicon gel that uses the eye’s own muscles to push against the lens. This pushes the gel through an opening within the lens. This results in a change the shape of the IOL. This change in shape increases or decreases the power of the IOL accordingly.
Because the NuLens® has a truly flexible lens, it has the ability to produce a wider focusing capacity compared to other rigid and flat intraocular lens. Amazingly, the design of the NuLens® may even beat the focusing power of a 20 year old by up to 40%. It also offers the promising prospect of better contrast, fewer aberrations and ghost images and a better range of intermediate (activities such as cell phone dialing) to near focus (such as with reading the phone book) without negatively affecting distant vision (as with driving or watching TV).
Candidates for NuLens®
Good candidates for NuLens® procedure generally include patients over 50 with cataracts and no other serious eye diseases. Patients who wish to reduce their dependency on eye glasses and contacts (and who value this enough to pay up to $3,000 per eye) will be prime candidates for the NuLens®.
Is NuLens® Safe and Effective?
Currently available studies show that NuLens® is safe and effective. NuLens® hopes to obtain CE marking in Europe by early 2011. It is expected to be available in the United States by 2014 (depending on the FDA clinical trial results). Not everyone, however, will be a candidate for this IOL. Only your eye surgeon can determine the most appropriate option for you and help you choose the right course of treatment.
The NuLens® is not a magic trick, it’s a science. But, like the best of scientific advancements, it has the potential to awe us like a great magic trick.
References:
- Ben-nun J,e t al. Cataract and Refractive Surgery Today Europe 2008;3:20-21.
- Dick HB. Curr Opin Opthalmol 2005;16:8-26.
- Rosen E. Accomodation: The dynamic range of vision. Available
- Innovations in ophthalmology 2010. The NuLens® Dynacurvature IOL. p72-73.
About NuLens Ltd.
NuLens Ltd. was established in September 2002 to research, develop and market innovative technologies in ophthalmology. The first technology the company has brought under development, the NuLens® IOL, is an accommodative intra-ocular lens (IOL) with over 10 diopters of accommodative power. The NuLens® IOL was designed to provide a viable solution which enables the complete restoration of post-cataract vision at all distances. It is also a candidate for the treatment of presbyopia, an age-related deterioration in near vision. NuLens is a privately-held company with offices in Herzeliya, Israel and Alicante, Spain. Private investors include Elron Electronic Industries Ltd. (Nasdaq: ELRN) and Warburg Pincus. For more information, please visit http://www.nu-lens.com.
Their website has not been updated since 2007. I know you say available in 2014 for USA, but how far are they exactly with clinical trials and people who have this IOL inserted ?
Mike, Due to the strict Federal Drug Administration regulatory process, I still don’t expect the NuLens to appear in the U.S. until 2012-2014. That being said, the latest published clinical trial is encouraging. This trial was conducted by Alio JL and colleagues in 2009 shows that accommodative power of Nulens implants remains consistent in establishing improved near visual acuity without compromising distance visual acuity. (see trial below) Cataract Refract Surg. 2009 Oct;35(10):1671-8. Visual and accommodative outcomes 1 year after implantation of an accommodating intraocular lens based on a new concept. Alió JL, Ben-nun J, Rodríguez-Prats JL, Plaza AB. Abstract PURPOSE:… Read more »
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Thanks for reply. I agree it looks promising, but I don’t understand why there is so little information. And 2014 seems very optimistic if they even haven’t been inserted into an eye with only cataract. But I do hope you are right.
Great blog! I genuinely love how it is easy on my eyes as well as the info are well written. I am wondering how I may be notified whenever a new post has been made. I have subscribed to your rss feed which ought to do the trick! Have a nice day!
Is 2014 the earliest Nulens will be available within the US? Are there US trials that I can participate?
2014 may even be optimistic as the FDA is very conservative with new device approval. Even the Alcon ReSTOR Toric (which is just the combination of two existing FDA approved platforms) will likely not be available here in the US until 2012 (already available in Europe). To date, I am not aware of any US trials of the NuLens IOL but will post an update if I hear of one.
The current patient base is looking for presbyopic reversal, that translates to J1. This demand is part patient need – – Part lack of staff’s ability to present and manage patient expectation wisely / effectively. Wil this less produce J1, if not . . it will be hard to move the needle!
Yes, J1 (or even J1+) is the real goal. When an IOL is available that can reliably provide 20/20 distance and J1+ near without spectacle correction and without halos, we will have achieved out goal. Of course, it would also be nice if it fit through a 2.2mm (or smaller) incision. But, alas, I’m dreaming…
I’m not speak english well but I had to write this comment – Nice Job !
Can you tell me if there are any trials in the United Kingdom. I am very interesed in finding out more and it the Nulens is suitable for me.
Kim
I haven’t heard of any recent news about UK trials. However, it’s not uncommon for these new technologies to get “snagged” in paperwork for months on end.
Sign me up! I’m in my late 50’s, in excellent health and I will travel and pay! I’ve been holding off having my cataract surgery for over a year, awaiting FDA approval on this lens. Should I keep waiting? I’m not sure I can last until 2014!
I’m afraid the only list you’ll be signing will be the wait list. God bless the FDA: they’ve saved many a person from dangerous IOLs that other countries have approved. Then again, there is great frustration among eye surgeons and their patients when the FDA seems to drag its feet on approving IOLs that have great track records outside of the US (such as the Alcon high power Toric IOLs). The NuLens IOL is simply too radical of a design for the FDA to be expected to approve in anything less than a glacial pace. Frankly, I think 2014 might… Read more »
I’m researching IOL products and my colleague had placed a few notable products under these categories:
UNIFOCAL: Starr Surgical (Collamer, Toric, Silicone IOLs), Hoya (AF-1 IOL)
MULTIFOCAL: Calhoun Vision (Light Adjustable Lens), Medennium (SmartPLUG, Matrix Acrylic, SmartIOL), AMO (ReZoom, Tecris, Verisyse)
HINGE-AUTOMATED: B&L (Crystalens)
CURVATURE-CHANGING: NuLens (RA-IOLs), PowerVision (FluidVision)
TELESCOPIC: Visiogen/Abbott (Synchrony IOL)
Was he right in doing so? Any help would be greatly appreciated!
I would make the following edits: MONOFOCAL: Almost all IOLs made with acrylic, silicon, or PMMA including the Medennium (Matrix Acrylic) and Calhoun Vision (Light Adjustable Lens) MULTIFOCAL: AMO (Array, ReZoom, Tecnis MF), Alcon (ReSTOR), and possibly the Calhoun Vision (Light Adjustable Lens) HINGE-AUTOMATED: Human Optics (ICU), B&L (Crystalens), LensTec (Tetraflex) CURVATURE-CHANGING: NuLens (RA-IOLs), Medennium (SmartIOL), PowerVision (FluidVision), Vision Solutions Technologies (LiquiLens) DUAL LENS: AMO (Synchrony IOL) PHAKIC: Staar Visian ICL, AMO Verisyse EXTENDED RANGE MONOFOCAL: Starr Surgical (Collamer/Nanoflex), LensTec (SofTec HD) A few notes: – The Calhoun Vision (Light Adjustable Lens) has the potential to be shaped into either a toric… Read more »
I have been diagnosed with cataracts & astigmatism. My Dr wants to implant Crystalens. I am interested in this new technology and would be prepared to travel to Europe if necessary. Where can I find out what is happening abroad with this Nulens
Unfortunately, a trip to Europe would not get you a NuLens. Assuming there are open human studies, the requirments of participation would be strict and it is unlikely that a non-resident would meet the “enrollment criteria.” This technology is so different from the current IOL technology that approval for use in humans is going to be glacially slow. Europe may approve it in the next few years, but it will probably not be available in the US for years beyond that. Most everyone with a cataract that requires surgery in the next year or two will probably not be able… Read more »
Which is better, Softec HD or Nanoflex? I am 30 years old with bilateral cataract, and I am planning to get monovision at -0.5 and -2.0, hoping to get atleast 0.75 of pseudoaccomodation, offering a relatively clear range of vision (atleast 20/25 or 20/30) from infinity to 36 cm, with possbly an island of minor blur around 67 cm. My current prescription is -0.5 and -1.5 and without correction i can see 20/25. which monofocal iol is the best for this circumstance, and is it likely i will get this result? I have 1.5 d amd 1.0 d of corneal… Read more »
Ah Jamal, unless you are also planning on potential laser refractive surgery (LASIK, LASEK, PRK) I doubt you are going to get the results you desire. Neither the Nanoflex nor the Softec HD can give you the kind of predictable results you are looking for: “with possible minor blur around 67 cm…” Take a moment and read out loud what you have written, “around 67 cm.” You are describing an exact distance, not a range (such as “between 60-70 cm). The latter is something that the current technology can provide. The former, “67 cm” is simply beyond what current technology… Read more »
Regarding the coming Nu-Lens IOL, there is little said about patients with astigmatism. Should they get a toric lens first then add this lens? If so does it matter if the Toric lens is in two different strengths to attempt pseudo accommodation?
With almost all presbyopia-correcting IOLs, the astigmatism would need to be corrected either at the time of surgery with limbal relaxing incisions or after surgery with laser refractive surgery (LASIK, LASEK, or PRK). I am not aware of any plans to make the first round of the Nu-Lens astigmatism correcting. Additionally, placing another (toric) IOL in the capsular bag with this new technology IOL would likely result in limitation of its function.
Thanks for your answer. If I get LRIs can I still get laser surgery afterwards? Also, I am curious about the difference between the vision experianced in pseudoaccomodation versus a young phakic eye. Lets say an aphakic ‘plano’ patient attains 1d of pseudoaccomodation and looks at an object or eye test one meter away, how is their vision different than if a young phakic person looking at the same object/eye test one meter away? Does the aphakic patient require greater light to see it? Also I wonder if you could do a study or a retrospective chart review to determine… Read more »
Briefly, there is no pseudo-accommodating IOL on the market that can come close to the clarity and accommodation of a healthy 20 year old eye. Anyone who is expecting such a result is bound to be disappointed. As for my impressions regarding the Nanoflex vs. the Softec HD I have not had the time to perform a retrospective chart review (though it is a good suggestion). However, I do review the final refractive error and uncorrected vision of each of my patients against my refractive target and my impression to date is that the Nanoflex outperforms the Softec HD in… Read more »
I have been holding off on my cataract until the Nulens is released. Now I have the option to have it done by laser and the IOL options are:
Crystalens HD
ReStor
Tecnis multifocus or the AcrySof Toric (if I have too much astigmatism)
In your opinion which would be the better choice.
Although I cannot state which IOL would be the better choice for you (as that would be impossible to do without performing a physical exam), I can make some generalizations about the lens technologies mentioned: Crystalens HD – I no longer implant this IOL as I have been underwhelmed by its performance. That being said, I know there are surgeons out there who implant quite a few of these IOLs and have been happy with the results. They seem to have developed some “special sauce” that gives them better results with this IOL. ReSTOR – This is my “go to”… Read more »
Does implanting a CTR make cataract surgery more risky or difficult? Does it have any other negative consequence? Would it make a future lens replacement more difficult (e.g. if technology advances and I wanted the newest lens implanted). Thanks for taking time to answer the questions, I appreciate it.
Capsular tension rings (CTRs) can be a bit tricky to insert so not all surgeons are comfortable using them. It is possible for the CTR to puncture through the capsular bag during insertion. Although I have yet to experience this complication, I’ve seen videos (of surgery done by very talented surgeons) where this has occurred. The newer insertion devices seen to make this event unlikely (initially these were “dialed in” by hand which I believe had greater risk). Long term, once a successfully implanted CTR is in the bag, there do not seem to be any real downsides. Indeed, a… Read more »
If Nanoflex is one of your prefered lenses to use, maybe you should do a blog post about it; there is very little information about it independant of the company that makes it.
That is a very good idea. As my schedule frees up considerably after the New Year, I will plan on posting about the Nanoflex in January.
It would be nice if this lens was available in the US already.
I’m 30 years old and need cataract surgery on my left eye, I was diagnosed 7 months ago and now I’m totally blind in that eye.
My right eye is -2.50 and 1.25 astigmatism, I don’t ever wear glasses my question is what’s the best option for me as far as an iol is concerned since I still have accomodation in my right eye? I’m also concerned about ocular imbalance. LRI’s?
i also have controlled (no meds) congenital glaucoma and some dry eye.
Thanks.
Yes, the slow FDA approval process can be frustrating – especially for those who need unapproved technology now. Currently the options I recommend for someone with glaucoma and dry eye would be the Crystalens (expensive and somewhat unpredictable) or either the Staar Nanoflex or Softec HD. The latter two IOLs can provide some limited range of vision and do not suffer from loss of contrast (as with the multifocal IOLs) which can be problematic when dry eye syndrome and glaucoma are also present.
I haven’t seen anything on this website about Prof Andrew Abell launching Calpain Therapeutics to commercialise cataract drug. According to their press release: The drug targets a protein in eye tissue that, when activated by triggers commonly associated with aging, causes the clouding of the eye lens we know as a cataract. Testing to date of Calpain’s drug compound has shown that it significantly slows cataract progression. I have level 2+ cataracts in my left eye and I’m hoping to slow its progression. If anyone has additional information about Calpain Therapeutics (based in Queensland, Australia) and when this drug will… Read more »
You’ve not seen anything on this blog about this because to date the only thing these “cataract drugs” have been proven to “clear out” is money from your bank account. When a peer-reviewed study shows that an available results in a statistically significant decrease in cataract progression then I’ll post about it. To date this drug has not been tested on humans. Press releases are nothing more than unsubstantiated marketing and should never be taken without a large grain of salt.
From http://www.optometric.com/articleViewer.aspx?articleID=106403 Scientists from The University of Adelaide, in Adelaide, South Australia, have developed a yet-to-be-named drug that may prevent cataract-induced blindness. Specifically, the drug inhibits calpain, a protein that when activated by several triggers, breaks down the lens protein crystallins, causing cataracts. Thus far, the drug has proved successful in slowing cataracts in animal trials. Now, the scientists, who’ve formed Calpain Therapeutics (http://calpaintherapeutics.com), plan to test the drug on humans. Based on the results from these animal trials, Calpain were the 2011 winners of The University of Queensland Business School’s $100,000 Enterprize competition. Dr Lovell stated “The $100,000 Enterprize… Read more »
I agree that being associated with a university gives it more credit. I am hopeful that the research to be done on humans will be well-controlled because a university will have oversight. In any case, if it ends up being a “by prescription only” drug then I wouldn’t expect to see it in the USA for at least five years.
Hi, I am 42 years old, I had I r.o.p. when I was born and my visual acuty is 1/20th. The visual field is limited to the left area of my right eye close to the nose. I will probably need cataract surgery due to an uveitis triggered by the other eye, so I underwent enucleation. Now uveitis has never reapeared again, but laser iridectomy had been performed due to 360 degrees posterior synechiae. Fibrine deposits are present on The anterior surfuce of the lens capsule reducing image contrast. I was wondering whether Nulens would be potentially sutable in my… Read more »
Cataract surgery is always a challenge in the presence of ROP. As the Nulens has not been approved for use in the US it is not possible to know whether this would be an appropriate IOL for someone with ROP. In general, the multifocial IOLs are not good choices for anyone with retinal diseases so the newer generation of IOLs (such as the Nulens) hold greater promise – though vision would still be limited by the underlying retinal condition. Thus, I currently do not usually recommend the more expensive IOLs to those of my patients with significant retinal, corneal, or… Read more »
Thank you for your reply. Do you think that even a psedo-accommodating lens like nanoflex is counterindicated in low vision patiants like me.
Is there any IOL more indicated for low vision people like me that because of the empaired retina performance, they need to get closer to the text they want to read without compromising the far vision? is necessary to use two pairs of glasses for far and near vision?
There are very few patients in whom I would recommend against the Staar Nanoflex IOL. For the best results, it is sometimes necessary to add additional support to the eye with the placement of a capsular tension ring. However, the recommendation of a given IOL in any patient with low vision must be individualized to the appearance of that person’s retina and/or optic nerve. I’m afraid that no generalizations can safely be made with respect to this.
Thank you for posting your reservations about the Crystalens HD and other info. I’m scheduled for surgery in 3 weeks in Norfolk, VA. A B&L website provides a graph & promo suggesting superior function with the newer AO lens. (1) Do you have any information on this newer lens?
I need cataract surgery, but I read that Crystalens works better for hyperopia than my -6.5 myopia. (2) Any news?
Your feedback is appreciated.
sources:
1. http://www.bauschsurgical.com/cataract/crystalens/crystalens-ao.aspx
2. http://www.allaboutvision.com/conditions/accommodating-iols.htm?gclid=CIeUgpnR560CFYFgTAodomyz6g
I do prefer the Crystalens AO over the HD. However, I no longer implant this IOL as I find the Staar Nanoflex gives my patients almost as much pseudoaccommodation without the risk of a “Z-configuration.” An added benefit to the patient is a much reduced cost compared to the Crystalens as my patients only have to pay for the advanced diagnostic testing and the extra work to reduce astigmatism and any residual refractive error – a savings of approximately $1,200 per eye.
Thank you so much for your reply. I will ask my doctor on the base of your considerations.
Regards
I have noticed a change on Abbott Labs Synchrony web page. It now directs you back to Visogen. How close are these IOLs for approval in the USA?
Word is that it is likely to be approved later this calendar year. That being said, the mantra at the FDA seems to be “delay, delay, delay.”
Hello Dr David, Thank you for taking the time to answer questions and provide information — it is very helpful and valuable. I’m considering the Nanoflex for my cataracts along with the Tecnis one piece acrylic (ZCB00) monofocal. My eyes are significantly myopic and I’m 41 years old. Right: -5.5 D, AL 27.32, astig .6 Left: -7.5 D, AL of28.12, astig .8 Both eyese have some slight positive aberration. I’m leaning towards mini-monovision set for distance. I’m a software developer and spend lots of time in front of a computer so having good intermediate distance is important and I do… Read more »
Capsular contraction and PCO do appear to be a bit more pronounced with the Staar Nanoflex compared to the acrylic IOLs (such as the AMO ZCB00). That being said, PCO treatment with YAG laser is a low risk procedure (granted, however, that high myopes are at greater risk of retinal detachment). I take the extra time during cataract surgery to polish the posterior capsule and aspirate the lens epithelial cells along the anterior capsular edge. This, combined with placement of a capsular tension ring, has kept my Nanoflex PCO rate down. The AMO ZCB00 is more forgiving of the surgeon… Read more »
Thank you for your response Dr David.
I am leaning towards the nanoflex and found a local surgeon who uses it. I have an appointment scheduled in a few weeks. I’m not sure he uses a CTR and I’ll ask at the appointment. Have you implanted any nanoflex patients without the CTR? If so, they still retain any accommodation over time compared to the CTR patients?
Do high myopes get any better accommodation benefits from the lens compared to patients with regular or short axial lengths?
Thanks again,
— John
I was using the precursor to the Nanoflex (the Collamer) IOL for years without placing CTRs (because they were not readily available here in the US). Even with that IOL my patients were experiencing significant pseudoaccommodation. There are no studies that support use of a CTR with the Nanoflex – it is just something that I (along with a number of other surgeons) have observed may have some benefit. I wouldn’t fault another surgeon for not placing a CTR as it’s really a personal preference. I believe it may provide benefit and the risk of placing a CTR is minimal… Read more »
Please could you tell me, if you are aware of any NuLens trials in the UK being undertaken? Or any progress approval of NuLens in Europe? Many thanks.
According to Dr. Stephen S. Lane M.D. (Medical Director, Associated Eye Care, and Adjunct Clinical Professor, University of Minnesota) “there have been human eyes implanted with Nulens in Mexico on a pilot basis…I know that preparations are underway to begin a full Phase 3 FDA clinical trial as well trials for CE mark in Europe. I do not believe however that any implants have been put in in Europe to date.” So, based on the novelty of this IOL design and the glacial pace of the FDA approval process, I don’t expect to see this IOL regularly implanted in the… Read more »
Even though it is too early to investigate whether Nulens or Fluidvision iols would be suitable in a low vision case like me, perhaps you could get some clues related to the use of the lens capsule made by these iols in a post-uveitis cataract surgery where fibrin deposits cover the iris side of the anterior capsule? For instance, I have read that Nulens uses the collapsed capsule to push agaist in order to displace the silicon gel to achieve a shape change of the lens or fluidvision iol is inserted inside the capsular bag. but does light continue to… Read more »
Cataract surgery in the presence of prior uveitis can be complicated. In general a PMMA or acrylic IOL is recommended as these are the least likely to develop inflammatory deposits. Newer IOL materials would not be most surgeons’ first choice for someone with a history of intraocular inflammation.
Are you using femotosecond lasers in your cataract surgery?
Ah, I knew it was just a matter of time before someone asked. Indeed, I am planning on writing a post about this very topic. In brief, I believe (and I am not alone) that femtosecond laser cataract surgery is the medical equivalent of buying an extended warranty at the electronics store checkout counter – it makes someone (in this case the laser manufacturer) a lot of money for providing a service of little real value to the consumer (patient). What, exactly, is the half-million dollar femtosecond laser supposed to do that is better than the $400-$4,000 hand held instruments… Read more »
I just heard a rumor that the IOL Synchrony was denied by the FDA. Can you comment on this?
The FDA has asked for more data prior to approval. More patients are being enrolled in the study. What this means is that we probably won’t see this lens used in the USA until 2013 at the earliest now. As this IOL is the first of the dual-optic IOLs to be passed through the watchful eye of the FDA, it is not surprising that the FDA is being overly cautious.
How do I get enrolled in the Synchrony study?
I’ve been asking around, but to date have not been able to get detailed information about the Synchrony study. This could be a good thing. Just as privately owned companies “go dark” during the pre-IPO period, medical device companies often get tight lipped just prior to getting a final decision from the FDA. Of course, that decision will not necessarily be for approval.
Where in the US is the study centered?
Is there information available on enrolling?
What are the results so far from Mexico?
An opthamologist said the Crystalens does not work as well for near-sighted people as for far-sighted people. Is that true for Crystalenz? Is it true for NuLens?
Assymetry: would an accommodating lens be installed in one eye, and a fixed focus in the other, or would that mess up the eye learning to control the accommodating lens? (It would be cheaper if it worked)
Thanks
Frustrating as it is to admit it, I do not have answers for any of the questions you pose. The company has been very tight lipped about the studies you asked about and I have not been able to find any publicly available information (which leads me to believe that the studies are either closed to new participants or being performed within a few contracted practices). As for the questions about the quality of pseudoaccommodation with the various lenses, there are not published studies that could be referenced to answer your questions so anything I would say would simply be… Read more »
I have 4 cut RK and the beginning of cataracts. Have been told that Powervision and Nulens would be best due to accomodating power and to wait. Has anyone else heard this?
Talked with the CEO of PowerVision and he said that human trials for European CE certification will start in Q1 2013 in Germany for FluidVision accommodative IOLs. General availability within Europe will hopefully occur in Q4 2013, but FluidVision won’t be available in the US until 2015.
Please excuse if this information has already been widely reported.
Thanks for the article; it’s really informative! I’m 29 and I already am developing cataracts. 7 weeks ago I had my natural lens in my right eye replaced by a monofocal lens… but now that I’ve read this article it gives me hope that I might be able to maintain my accommodation. I am definitely planning to wait as long as possible to have my left eye done so I can get the Nulens, but I’m worried about my right eye. Will my ciliary muscles eventually atrophy and die, never to be resurrected? Would it be better if I had… Read more »
All good questions. Unfortunately, no one really knows the answer to whether or not the ciliary muscles can be “resurrected” down the line. General consensus, however, is that they probably would not work well after years of disuse.
Thanks for the response Dr. David! I remember reading a comment of yours that said something to the effect that many surgeons find it difficult to get consistent results with the Crystalens, but that a few have found the “sweet spot” and have achieved reasonably consistent success. I’m interested in this lens, can you give me any names of surgeons that excel and implanting the Crystalens? I spoke to an Ophthalmologist the other day and he said that there is some professional doubt about the Crystalen’s ability to actually accommodate. He said some thinks it just pseudo accommodates, the lens… Read more »
Robin,
Dr. Steven Safran in New Jersey is who I would recommend to anyone whose mind is set on getting a Crystalens IOL. With regard to accommodative mechanism, no one knows for certain just how this IOL works (or why it doesn’t work when it doesn’t).
Thanks so much for your quick response, its much appreciated!