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lenses available to us, including the Crystalens AO, so that we can find the solution that will make the patient happy after surgery. Dr. Dick: From an objective point of view, the Crystalens is an IOL that has been developed over a long time into its current state. Subjectively, it is easy to implant, it offers good visual acuity for distance and intermediate, and has been re- fined over the years. And now, with this new optic, it is aberration-free, which is increasingly important not only for visual acuity but also for visual quality—quality of vision, in my opin- ion, means contrast sensitivity in mesopic conditions. I feel confident offering this lens to my patients. We use it at our clinic on a routine basis. In our clinical experi- ence, we have excellent results, and it works better than all models before. My experience comes with some of the very first models, beginning about 10 years ago. Dr. Kent: I'm a refractive cataract surgeon, and I have used multifocal Dr. Dell: Yes, and we routinely see that. Dr. Yogi: I think we have to have some experience with all premium IOLs to make that decision, and I think that the Crystalens AO, because of the high quality of vision it provides, is very important for patients who really care about this difference in quality. Before surgery I used to discuss with my patients the shortcomings of all the different IOLs. I would find it easier to talk to them about losing some points in J1 with the Crystalens AO and having them complement their vision with the sporadic use of glasses than to deal with glare and halos with multifocal IOLs, concepts that are somewhat hard to transmit to patients. Dr. Fernandez: In our experience, we have learned that one solution for presbyopia isn't universal for our patients. We believe that we have to customize the solution; each patient is absolutely different from another. We have to identify the objectives of our patients for their vision after surgery, and we have to have all the types of intraocular lenses since the late 1990s. When the Crystalens became available in New Zealand in early 2009, I started using it and I've been very happy with the results of my patients. My patient satisfaction levels are very high. Overall, about 30% of my patients don't need any spectacle correction; about 50% wear glasses only for reading fine print or in dim light; and about 20% still have to wear readers —but they're low power readers. With people undergoing lens replacement surgery, because they've got cataracts or if they're having refractive lens exchange for hyper- opia, the level of patient satisfaction is high as long as you counsel your pa- tients. They can read if they're in good light, but with small print or bad light, they might need low power readers. The two main advantages over putting in multifocal IOLs are 1) the quality of the vision is better—the patient isn't looking through a diffrac- tion grating; rarely do patients com- plain of fuzzy or waxy vision, and 2) there are few reports of nighttime visual disturbances. For most people, I think it's a choice between quality of vision and a high level of (but not complete) spec- tacle independence, versus multifocal IOLs, which may provide more specta- cle independence, but poorer quality vision. Most of my patients, when deciding between the two, do choose the Crystalens option because the quality of vision is better. There's still a place for multifocals, and I still offer multifocal IOLs for those patients who are the right personality type. But for most of my patients, I've been getting good results with the Crystalens AO, with high levels of patient satisfaction. More than just aspheric Dr. Lindstrom: It's great to have the same quality of vision that we have with the monofocal aspheric lens, but I think some critics of the Crystalens AO 2 March 2012 Advancements in accommodating IOL technology: A global perspective

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