By Pam Walatka

Ophthalmologist Mark Volpicelli prepares for accommodative implant surgery. Above, diagram of an eye’s components.

Ophthalmologists have dreamed for years of being able to implant a lens in the eye that would adjust to correct both near and far vision. Now Crystalens™ - the first “accommodating” intraocular lens approved by the Food and Drug Administration - comes close to that goal.

As people age, their natural lenses begin to thicken, harden and get foggy, eventually forming cataracts. Cataracts can be removed and replaced by implanted plastic lenses, which replace the fogginess with clear vision.

Cataract surgery can provide excellent distance vision, but poor near vision because traditional implant lenses have no means of accommodating for near vision as the natural lens does. Cataract patients often discard their distance glasses but find they still need reading glasses.

Tiny hinges are the key to the ability of Crystalens™ by eyeonics inc. to accommodate for near vision. Although the lens does not change shape, it moves forward and backward within the eye to change the focal distance of the lens.

“When you focus close,” said ophthalmologist Dr. Daniel Beers, “the muscles in your eye contract and cause the lens to move forward, allowing you to focus on small, close objects such as words on a page. The Crystalens™ allows patients to focus both near and far.”

Beers said that patients are “very, very satisfied, very excited” with the procedure. Even so, patients’ vision cannot be restored to that of a 26-year-old, he said, and a few patients still need reading glasses.

“I’ve been wearing contacts for eight years,” said Phillis Lauper of Santa Clara, about her newly implanted Crystalens™ intraocular lenses. “Now I don’t need glasses for reading or for distance,”

Lauper had her eye surgery done at Peninsula Laser Eye Medical Group, where Beers and Dr. Mark Volpicelli specialize in the new procedure. Accommodative implant surgery is also available at Camino Medical Group, the Laser Eye Center of Silicon Valley, and by several area ophthalmologists.

In May, Medicare agreed to pay for part of the procedure of replacing cataracts with Crystalens™, leaving about $2,200 per eye for the patient to pay. Without Medicare, the procedure costs about $4,000 per eye.

Accommodative implant surgery also is possible for patients who do not have cataracts and as such is a form of refractive surgery known as Refractive Lens Exchange. It differs from LASIK surgery, which corrects moderate nearsightedness or farsightedness by modifying the cornea without affecting the lens or treating cataracts. The cornea is the transparent front part of the eye that covers the iris and the pupil, providing most of the eye’s optical power.

Crystalens™ may be an option for people who are not candidates for LASIK because of the magnitude of the correction they need or the thinness of the cornea. While the vision correction achieved from LASIK occasionally degrades with time, the optics of an intraocular lens does not change with age.

Eyeonics inc. is a venture-backed medical device company in Aliso Viejo. It was founded in 1998 by J. Andy Corley, chairman and CEO, and Dr. J. Stuart Cumming, chief scientific officer, who was a cataract surgeon for more than 50 years and developed the lens, according to the company Web site.

Two other refractive intraocular lenses have recently been approved by the FDA. The Restor™ lens from Alcon Co. and the Rezoom™ lens from Advanced Medical Optics Inc. are multifocal implants and work like progressive bifocal glasses, using concentric rings of differing focus power. By looking through a different part of the lens, you change the focal point. Neither Restor™ or Rezoom™ is an accommodating lens because they neither change the shape of the lens nor move it forward like Crystalens™ does.

Not all ophthalmologists are ready to endorse the procedure. There are known risks to consider. For example, extremely nearsighted people, who make up a large share of the refractive surgery market, have a 3 percent chance of retinal detachment following implant surgery.

Ophthalmologist Dr. John Sullivan, a Los Altos Hills resident who practices in San Jose, is among those doctors recommending caution.

“It is important to cautiously select well informed patients for elective procedures particularly when new technology is involved,” he said. “This procedure is a major improvement with clear benefits, but patients do not fully understand the risks of intraocular surgery. The risk of loss of vision is small but very real.

“Even without complications, those with unrealistic expectations may be disappointed with the results of well-executed surgery,” Sullivan said. “Implanted lenses do not provide the type of vision that exists in a natural lens of someone under 40.”

But Lauper and Diane Elliot of Carmel rave about the new intraocular lens procedure.

“It was like being reborn,” said Elliot. “It was the most wonderful thing I could have done for myself.”