1	Crystalens - More Steps to Success Paul Krawitz, M.D. Huntington, NY pkrawitz@HuntingtonEyeCare.com
2	Considering Crystalens? Is it worth the effort?
3	Why Bother? MORE TIME to explain the lens to prospective patients. MORE TIME to explain the details of surgery at the pre-op visit The surgery takes MORE TIME and is MORE DEMANDING The patients EXPECT MORE post-operatively
4	Time is money, right? The multi-focal lenses seem easier And they go in just like my usual lenses As long as I warn the patient about night glare, I’ll be OK
5	Ask yourself… After years of performing 5-10 minute surgeries, can you now learn to be patient? Are you willing to modify details in your surgical technique? Can you handle the unhappy refractive surprise? Is your surgical track record predictable?
6	Maybe it’s too long a road!
7	Survey says…
8	Do you have what it takes? Front staff who will talk positively and knowledgeably when patients call Technicians who work to get good quality measurements for the sake of the team An office system that provides patients with thorough explanations The technology to give you predictable results
9	Staff The entire team needs to embrace and understand the technology AND the increased demands that it puts on the practice.
10	Axial length and more… No more applanation axial lengths
11	Manual K’s
12	The Calculations SRK-T (for axial lengths > 22.0) and Holladay II Software (for axial lengths < 22.0, both available at www.docholladay.com Don’t throw away your immersion A-scan just yet. (Need lens depth on short Axial Lengths)
13	Tough Questions… Will I need glasses? Will I be 20/20? Why is this so expensive? Can you replace my old implant? What will I do if the patient is not happy with his/her result?
14	Surgical Success Depends On Following recommended surgical steps (for now) Under-promise and Over-deliver
15	Operative Technique It has less to do with skill and more to do with problem avoidance
16	Potential Early Post-Op Problems Wound leaks with anterior IOL vault Capsulorhexis problems Retained cortex High IOP Post-Op Other issues unique to this lens design
17	Avoiding Wound Leaks Main Wound Architecture Scleral tunnel Limbal vs. Fornix-based peritomy Suture vs. no suture Paracentesis Wound Architecture
18	Capsulorhexis 5.0 mm diameter is the magic number Not off-center or oval Need more thorough hydrodissection Avoid anterior rhexis radial tears through the smaller operative window
19	Capsulorhexis I use 6.0 mm corneal marker (Katena item #K3-8414) Trace at or just inside the mark Creates 5.5 mm apparent rhexis and a true 5.0 mm rhexis Go slowly and carefully so you don’t have to say, “Unfortunately, we weren’t able to put in the Crystalens…”
20	Get All Retained Cortex Prevents capsular phimosis and “Z” Syndrome Use effective method for superior cortex Bimanual vs angled I/A tip Rotate lens 90-180 degrees after it’s in, using additional viscoelastic as needed
21	Preventing IOP Post Op Why? Paracentesis “burp” post-op may cause an anterior IOL vault Methods: Remove all retained viscoelastic Drops: Timolol, etc Diamox or Neptazane
22	Things That Help Me Sleep At Night Absorbable suture Cyclopentolate and Atropine Post Op Clear shield first 24 hours post-op More frequent steroids first 24 hours
23	Is It Worth The Time & Effort? Patients see range of vision Accommodation or pseudo-accommodation - Who cares? No blend zones, apodization or neuro-adaptation Night glare, when it occurs, is not debilitating
24	Is It Worth The Time & Effort? Yes! Happy patients that feel special
25	Thank you! pkrawitz@HuntingtonEyeCare.com