In regards to what now?
I see that your thread has been quite active with posters giving you a variety of advice, encouragement & information, which was the same thing I went thru during my deliberations.What I found to be the most helpful in the end was 1. To pick a realistic goal ( no glasses or contacts) & stick to it 2. Take good notes on all you have seen, heard or read & then take them your surgeon & get his take on all of it 3. If both of you are still on the same page make a plan to make it happen. In the end it will come down to only the 2 of you.
Now for additional concerns- if I were in your shoes, I would be focused more on the explant/implant procedure than on the type of combo you should get.(since your surgeon only offers the reZoomn) Other than sooner is better than later, good info is sorely lacking on this thread. Why don't you open another thread askling for specific info or experiences relating to explanting of the Restor lens?  It would give you more to talk about with your doc.

To HUD:  Let me clarify a couple of points in response to your comments.  I am not shopping for body parts on the internet; I am diligently seeking a solution to a very real problem I have encountered with the ReStor implants.  If the doctor could have simulated pre-op my intermediate vision results so that I could see what the result would be, I would have RUN away from these implants.  My individual results are unacceptably poor.  I have rejected contact lenses in the past that gave me this kind of vision difficulty.  However, I incurred the risk and expense of this procedure in order to get out of contacts and eyeglassess.  I am in the middle of this now, so I cannot go back; I need to find the best "permanent" solution to my intermediate vision deficiency.

My surgeries were on 11/8/05 (right) & 11/21/05 (left).  I did not start wearing the +1.25 contact lens in the left eye until 4/10/06, approximately 5 months post-op, because the poor intermediate vision was useless to me.  I could read a building directory (no matter how large the print) from more than about 18 inches distance.  There was NO improvement in my intermediate range vision in 5 months.  I felt that was long enough to wait for improvement, as it was obvious in my case that no improvement was forthcoming.

Your comments about the risk of explanting are very troubling to me, as are the remarks of "eyecu" on this subject, especially the conept of how the capsular bag "shrink waraps the implant over time".  How much time?  Is 7 months (i.e. late June) post-op too later to explant a ReStor lens?

When I asked my eye surgeon on 4/10/06 about the risk of removing the left ReStor, he replied that there was virtually no risk, he's done it numerous times to change the power (although never replacing with a ReZoom, but his national colleagues have done many "combo" implants).  I do not know if he has performed an explant more than 6 months post-op; I will ask him that soon.

I believe that I have been very patient, following doctor's orders and waiting for healing / improvement throughout this ordeal.  But something further must be done.  While I do NOT relish another eye surgery, I relish far less struggling through the rest of my life with such poor intermediate vision, which affects the vast majority of my daily activities.  This situation is "broke", and it definintely needs fixing.

It most likely depends on pupil size and refractive error. There is an OD, MD in Indianapolis - Kevin Waltz...he has Array lenses in both of his eyes since 1998. He is 20/15 in each eye and J1+ at near. J1 at intermediate. He has commented at various major meetings that he enjoys reading by the pool and can read the smallest of print, as stated above at J1+. He states that he gets a pinhole effect. To achieve the pinhole effect, it helps if the refractive outcome is slightly minus.

To your point, the ReZoom like the Array is distance dominant, so for some patients they may not read well with small pupils in bright light, particularly if the refraction is plano to slightly plus.

When a person has small pupils and is outdoors alot, this is the biggest advantage of mixing ReSTOR with ReZoom. Bright light ReSTOR reads well, as you have stated. Dim light, ReZoom reads better.

Kevin Waltz is a paid consultant for Advanced Medical Optics, the maker of Array and Rezoom. He is virtually an employee, as is Eagle Eyes, of the company that they tout. Dr Waltz is one of the 42% of Array/Rezoom patients that achieved spectacle freedom in the FDA clinical study. The other 58% keep readers in their pocket. Keep this in mind when reading posts with "advise".

You know it's funny, I had a patient who had recently been bilaterally implanted with ReSTOR lenses,call me from the Virgin Islands and he was telling me how great it was to read on the beach without glasses. I guess that might be a problem for a patient with ReZoom. Am I right Eagle Eyes ? Since 0% of the light is used at near in bright light....

I am reading the package insert of the ReSTOR and quote:

"In bright lighting conditions with a constricted pupil, the apodized diffractive pattern of the Acrysof ReSTOR lens sends light waves simultaneously to both near and distance focal points. As lighting dims and the pupil dilates, the Acrysof ReSTOR lens send a greater amount of energy to distance to improve vision quality while maintaining near energy, and minimized visual disturbances."

I see the depth of focus, but I don't see where light is going to intermediate within the optic.

Check your facts, the ReSTOR isn't a bifocal. Just check the defocus curve.

eagle-what city are you in?

I suggest you find a surgeon that does ReZoom if you want to be less dependent or spectacle free. ReSTOR stops at +10
ReZoom stops at +6 (on the low end)

What city are you?

I totally agree with eyecu on this one. Also, both Alcon and AMO require a surgeon to do standard IOLs first to get the best outcomes before gaining access to the ReSTOR/ReZoom respectively. I believe Alcon has now raised their requirements from 30 cases to 60 cases in some areas of the country. AMO requires 25-30. This is not just AMO as hud states.

Mustang Mike --- 7 mos out is not necessarily too late, assuming upon exam your surgeon feels like he can do it based upon what he is seeing. We aren't seeing it, he is.

Intermediate vision does not appear or come in after months of not being there. There is no intermediate correction in the ReSTOR optic -plain and simple. The ReZoom is not a bifocal. ReZoom does have near, intermediate and distance correction in the optic - plain and simple. Yes, ReSTOR gives closer near but most people don't like holding things just beyond their nose to see it.

You hang in there , MM.....

Thank you and the other folks for some very supporting, encouraging and helpful comments.  You are giving me the info I need to discuss with my surgeon.  He never once indicated that 8 months out would be a problem, not even when rejecting (as impractical) the option of waiting for Alcon to release the improved ReStor lens in 9-12 months (or more).  I cannot believe that when I ask him about risk of vitreous, fibrosis or other problems if we wait(ed) too long to explant, that he will slap his forehead and say "Oh wow, I never thought of that."  My surgeon is too good, reputable, and renowned to make a bonehead mistake like that.  Like you have said, HE is looking at the chart and at my eye, so he and I will have to decide if this is feasible or not.  Trust me though, if he hesitates or even hiccups when I ask about the timeline, I will walk away from explanting.  Only if he is certain of his succuss will I proceed with explant.  Thanks.

I would agree that 6-7 months out could be difficult for IOL removal but eyes react differently and I would let the surgeon be the judge. If he is good and it sounds like he is, I doubt he is going to go in and try to take the lens out if it is fibrosed and he sees trouble. We don't have the chart and we are not looking throught the slit lamp.

As far as blended vision or the ReZoom ReStor Crystalens combo, it is not selling body parts. In a EyeQ Report from an independent consulting group that reports on Eye meetings:

After one year of real world clinical experience, the reality has not lived up up to the initial hype. Alcon is still expressing strong oppostion to mix/match strategies involving the ReStor, arguments which surgeons are increasingly viewing as commercial rather than clinical.

If bilateral worked so well, why would surgeons even have started trying mixing in the first place.

They also reference a Frank Bucci,MD who talked of his data on 55 bilateral ReStor patients and 39 ReStor/ReZoom combo patients. His findings were that there was no statistically significant difference between the groups in bilateral near vision: J.100 for the ReStor and J1.07 for the mixed. Unilaterally the ReStor delivered mean near vision of J1.25 verus J1.56 for ReZoom.

There was statistcally significant difference in the bilateral intermediate vision with the ReStor group acheiving and average of J.381 versus J2.39 for the mixed group. Unilaterally, ReStor delivered mean near vision of J4.42 versus J3.03 for ReZoom.

These findings are consistent with data presented in February at the World Cornea Congress in Brazil.

The combination is leading to higher levlels of spectacle independence and patient satisfaction.

ReStor delivers the strongest near vision for close up reading. But it is not without compromise with a key drawback being intermediate vision (computer) and glare/halo and loss of contrast as with all multifocals. Some bilateral ReStor patients use a +1 D or +1.25D reading glasses to adjust their distance vision to computer distance, while others us 1D spectacle correction to extend their near vision to reach a computer screen.

It goes back to the DFU in the lableing of the lenses and physics.

The bottom line is that you listen and learn. You move forward with all the hype and than find out what is real and adjust. But the bottom line is do what is best for the patient and their lifestyle. At least there are three good choices out there and more on the way. There will be happy patients with all combinations but the cream will rise to the top.

By the way, the ReZoom is not the Array. And the Array has the longest track record of any multifocal IOL. The ReZoom is already a second generation IOL which has been adjusted and improved from the first generation. It also picked up market share in the first quarter in the US at the expense of the others which can be noted in the stock and industry reports.

Real life experiences of patients on this board speak for themselves. Blended vision is here to stay and will not go away. And technology will move forward to help us try to regain our youth. The bottom line it to make the patient happy and if they are not, then try to get to the bottom of what is going on and correct it if possible.

Am I the only one who actually read the comments by Dr. Michael Wong (posted by hud on 5/15/06), which are apparently addressed to other surgeons who are considering adding the ReStor IOL to their own practice.  His remarks strike me as being so cynical as to be totally outrageous!  Dr. Wong describes the distance optics for ReStor as being "adequate but not fantastic."  (And we all know about Restor's intermediate optics.)  Consequently, he suggests that surgeons reserve the use of ReStor to "true cataract patients (who) cannot distinguish between the wow of the cataract operation and that of the Restor lens."  At the last post-op visit with a ReStor patient, he actually advocates placing a -3.00 diopter lens in front of both of the patient's eyes and telling them that this is how they would see with a conventional IOL!!  Apparently, he believes that this degree of deception is necessary "to prevent buyer remorse."

Hud, I thought that you worked for the makers of ReStor.  After reading Dr. Wong's remarks,  I'd turn and run (fast) if anyone ever suggested implanting a ReStor lens in my eye!  And I can't believe that others wouldn't do the same.

fcsmd---Sound advice.  This afternoon before reading your latest comments, I printed out this entire thread and highlighted the points I want to discuss with my surgeon.

Your last idea is a good one, to start a new thread specifically on explanting the ReStor (after 7 months).  Let's see what that yields.  

Thanks to all for your input.  I do have more info to discuss with my surgeon.

fcsmd---The forum has reached its limit of questions for the day.  I will try to post the new thread, focusing on ReStor explant after 7 months, tomorrow after they open it up for questions again.  Thanks for re-setting my compass.  :)

You may want to consider an accommodating or focusing lens for your other eye. The manufacturers of ReSTOR may not reccomend this approach but you will likely get the intermediate vision that you need. The ReZoom is a multifocal lens that is designed to provide primarily distance and near vision after cataract surgery. Approximatley 17% of the light that is focused through the lens is dedicated to intermediate vision. It sounds like this may not be enough for you. The accommodating IOL, the crystalens, is designed to provide clear vision independent of the distance because it focuses or accommodates. It's the best bet at getting good distance, intermediate, and near vision in the eye that needs surgery.

Dear Mustang Mike:

You might want to consider a low power piggyback lens to induce myopia. This would pull the distance vision in on one eye and should improve your intermediate vision. It's similar to modified monovision, but you get the benefit of keeping you stereo vision and depth perception. Plus, this allows you to keep the same optical system in both eyes.

My eye surgeon is the best in the area in which I live.  He particpated in the clinical trials and studies for the ReStor lens.  He has vast experience in Lasik and cataract implant procedures.  

I have the best.  Now what??

Every ReZoom and or Restor credentialed surgeon must be certified first by having experience with the monofocal precursors. It sounds like your doc is preparing for you, and maybe other potential Rezoom patients, and cannot offer it yet until he clears the hurdles set by the company.
I also wonder if he has addressed any residual astigmatism, as ReSTOR's "High Definition" design is very sensitive to astigmatism. The contact you wear addresses the "spherical equivalent" meaning roughly, the combination of power and astigmatism. If you have what is called irregular astigmatism, that cannot be treated with current technology, but may not be as much of a negative factor with the lower tech ReZoom. Currently there have been over 50,000 ReSTORs implanted in the US, and is still the premium lens of choice. The problem is that nothing is perfect, even the lens God gave you needed improvement. If your surgeon is strictly a cataract surgeon, and not refractive also, you need another opinion from a refractive specialist.

I was glad to hear someone say something good about Crystalens.  I have Crystalens in both eyes.  I have great vision at all distances.  There was an accomodation period where I was concerned, and a learning period for reading, but the final outcome has been excellent.  

My only problem now is floaters which drive me crazy.

Mustang,

I can so relate to your horrible anxiety, as probably everyone that has posted a concern on this board can relate to also.
I know the hours and hours that you must have read to research on your choice of lens and doctor.  And then, to have unexpected results, is just so upsetting, that it affects your every thought.
I posted on this board in Feb.  I was so upset because of unexpected problems that I was also having  after my surgery.  The best advise that anyone can give to you is to get to the best doctor possible!  I was so fortunate, as I have a wonderful doctor in my area, that is ranked a Top Doc, (not to imply that you have to be so ranked to be an excellent surgeon.)  And even then, when I was initially disappointed with the results, and so anxious,  I had confidence that he could correct my concerns.  In the mean time, my original problem completely changed, and my initial blurred distant vision is now unbelievely perfect!  It is so clear, crisp, and beautiful! I have never seen this clear before, and I never wore glasses.  I was so concerned that the lens power was incorrect initally, because of blurred distance vision. But the calulation was "right on", and just had to settle where it was suppose to. But even now, almost 3 months post op,  my vision  continues to improve. Presently without glasses, my daytime outside vision is spectacular! My intermmediate vision is excellent without glasses.  Reading without glasses is good in certain lighting and blurr in other lighting. Reading seems better with less lightening.  No big problem for me though.  I do notice that when inside, my perfect outside vision changes.  Depending on the lightening, it is either perfect, or somewhat blurry past a certain point and so I was wearing glasses inside when evening came.  But since I am not wearing my glasses inside anymore , I notice that, even 3 months out, that is also improving.  I do have night time outside halos and circles around lights. And sometime glare inside, under bright light.  But even that is less of a problem for me, as I guess the brain does adapt. The night time halos freaked me out at first, but not everyone has them. Get the best doctor possible.  That is the most important advise you can receive.  And like me, maybe the unexpected will happen when you are not even expecting it. And just maybe you may not need an exchange.  But if you do, check and check and check to make sure you have the best doc possible for the exchange. Best of luck!
  p.s.  I presently have one Rezoom in my dominate eye.

Well, I have to do something, soon.  Wearing a +1.25 contact lens over left eye ReStor is unacceptable to me, for several reasons.  The ReStor alone is unacceptably deficient in the intermediate vision range.  In my opinion, this product should have never been released with this deficiency---Alcon should have continued their R&D to improve if not "perfect" the intermediate range vision before going to market with it.

I'm stuck in the middle and cannot go back.

So, what do I do, beyond praying a lot?

Beware of the ReZoom lens.  It is the Array lens in an acrylic material.  The Array did not catch on, and many docs explanted as many as they implanted.  Its just a matter of time before the same problems start to emerge with the ReZOOM.

Dear Mustang Mike,

I believe it is too late to have the ReSTOR implants removed.  

Of interest, the physician labelling for the ReSTOR, under intermediate vision cites " At at distance of 70cm (30"), the percentage of eyes achieving 20/20 or better uncorrected visions and 20/25 or better uncorrected distance corrected vision was significantly worse for the ReSTOR IOL as compared to the monofocal control.

Go to the FDA website and retrive the DFU (directions for use).  You will find some very interesting information.