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Crystalens vs. Restor Lens IOL implants

Crystalens vs. Restor Lens IOL implants

Hi All:
I am an optometric intern currently finishing my external rotations and I have been observing several cataract extractions using current techniques.  One of my parents is goig to need cataract surgery sometime in the near future and I was wondering which of the two multifocal implants has been met with the greatest patient satisfaction.  I have personally seen the Restor lens implanted but have not yet seen the results from these patients at followup.  I have not seen the Crystalens implanted not have I heard any patient testimonials.  I was wondering if anybody has personally seen and/or managed both of these types of implants.  Thanks.
EyeDoc007
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37 Comments
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I have read the vision newsgroup where it is said that none of the multifocal IOLs work well.
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See my 9/27/05 posting; first implant was a bifocal lens -vision was never good and had complications; this lens was removed and regular lens was used, had problem with the "leg" not being inserted.
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I've just been thru this with my dad and his cataract surgery.  I used the FDA website to compare labels for both the Restor and the crystalens.  My dad and I selected crystalens and are extremely happy with the outcome.  Issues we considered, Restor carried a warning label for night driving and crystalens did not.  The bifocal optics of the Restor were also a concern for my dad who had struggled with the bifocals in his spectacles.  My dad rarely uses glasses now.  I think the surgeon you choose plays a tremendous role in your success regardless of what lens you choose.  Make sure you find someone with experience
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RECENTLY HAD RESTOR IMPLANTS WITH NOT GOOD RESULTS.  MUST READ WITH GLASSES AND REQUIRE MAGNIFYING GLASS TO DISTINGUISH NUMBERS. MID-RANGE IS BETTER BUT I HAVE CONSIDERABLE GHOSTING AND ROAD SIGNS ARE NOT SHARP AND THERE IS CONSIDERABLE GLARING.  I MUST HAVE FOLLOW-UP LASIK.  SPECIAL CARD IS REQUIRED FOR MAPPING EYE BEFORE LASIK AS THERE IS TOO MUCH REFLECTION FROM LENS.  I DO NOT KNOW WHY IMPLANTS ARE A PROBLEM.  MY EXPECTATIONS WERE NORMAL - I WAS QUITE ACCEPTING THAT I MIGHT HAVE TO USE READING GLASSES AFTERWARDS.  MY INSTINCT IS THAT CALCULATIONS WERE OFF.  YOU SHOULD BE AWARE BEFORE SURGERY THAT THERE MAY HAVE TO BE FOLLOW-UP PROCEDURES.   I AM TREPIDACIOUS ABOUT LASIK - THIS IS SUCH A NEW LENS.  IS THERE ANYONE OUT THERE WHO HAS HAD LASIK AFTER RESTOR IMPLANTS, AND WHAT WERE RESULTS?
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Dear RosiePosie,  Can you try contact lens before you have more surgery?  The contacts would give you an idea of what your vision will be after lasik surgery, that way you can make an informed decision on whether the lasik will be a good decision.

JO
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Rosieposie:  Both my wife and I had Restor implants done on Nov 9 and Nov 16 respectively.  Results sound similar to yours - - we are extremely unhappy.  We both need reading glasses to read newspaper, although I can read most anything else if it's black on white. Both of us have have distance vision problems.  Objects are not clear. In my case, particularly in left eye  - - right eye is much better.  Has your vision improved?  Have you had lasik surgery, as yet?  Any suggestions?  Stonewall
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I had a Restor lens installed in my right eye five days ago (12/12/05)at Victoria Eye Center, Texas. The results to date are poor. Long distance vision is not good at all, near vision is so-so. There is also glare and sort-of double vision. If it doesn't improve over time I will (1) regret the $2800 I paid beyond medicare cost (although they advertise $2500)and (2) go with a fixed-focus in my left eye and wear glasses. I will make some follow-up postings describing my results over time.
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I had a Restor lens installed in my right eye seven days ago (12/12/05)at Victoria Eye Center, Texas. I had a follow-up exam today and the poor results were confirmed.  The examining optomitrist said I still have astigmatisim that would require follow-up lasik surgery that should bring my vision to near normal. More follow-up postings describing my results over time to follow.
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On Dec. 5, 2005, I had the Restor lens implanted in the right eye. I am experiencing incredibly bright and huge, nearly blinding concentric circles around headlights and lights. Have others experienced this? My mid-vision is very blurry. If I had the implant in the left eye, I know wouldn't be able to see to drive even during the day. Do either of these "side effects" improve? Except for close vision in the right eye, all the rest is worse. I'm so frustrated and disappointed since my eyesight is worse than before the surgery.
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I had a Restor lens installed in my right eye 12/12/05 at Victoria Eye Center, Texas. I have had two follow-up exams (most recentloy 12/29/05 confirming poor results. The examining optomitrist said I still have astigmatisim and other vision issues that would require follow-up lasik surgery that "should" bring my vision to near normal.

My current concern is that the outcome statistics offered by Victoria Eye Center for ReSTOR lenses is 80% of those with the lenses don't need glasses and 90% would do it again.  Yet, none have posted here anything positive in their personal experiences with the ReSTOR lens.  I would welcome some positive comments from people who have had these lenses installed.  

More follow-up postings describing my results over time to follow.
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In March of 2004 I had cataract surgery (in both eyes - 2 months apart) and had restor lens implanted in each eye.  My reading & distance vision is excellent.  My mid-range is not good and I wear glasses to work on my computer which is not an inconvenience.
Over the past several months I have experienced a situation where my head turns to the left and if I cover one eye the situation is relieved.  Could this be a reaction to double vision (my optometrist says I have slight double vision)?  This has only started to happen since my cataract surgery.  Anyone else experiencing this?
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Sherry Berry
Have you gone back to your surgeon to see if you need a YAG laser? This is a common office procedure after cataract surgery.
The bag or cellophane membrane that the lens implant is resting in clouds up like was paper over time. A simple, painless laser procedure which only takes a minute clears it up. You may need a prescription change afterwards.
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Sorry to hear about your ReSTOR results. For those of you that have not had surgery yet, ask about ReZoom. It gives better intermediate vision (computer, dashboard, etc) than ReSTOR. Plus sharper distance vision.
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sounds like sherry was an FDA study patient since the product was not approved until 2005. I disagree with eagle eyes assessment of a poor result. Good near and distance vision, and only for computer work she needs some cheaters. Two years out and she might need a yag capsulotomy in one eye? crystalens pateints are getting yagged routinely in the first month to avoid assymetric fibrosing. AMO changed the Array platform from rounded silicone to be more like Alcon's square-edged acrysoft acrylic to minimize opacities.
Here's the deal:
standard monofocal implants are great for distant vision. crystalens is great for distance-because it's a monofocal.If it moves, great-you get maybe 1 diopter of accomodation for only as long as your muscles keep their tone, and other age-related breakdowns don't defeat it. Big deal, and a hell of a gamble. Rezoom is best at distance because of the 6 mm optic, the central 2mm is distance only. Then there is a near ring, then another distance ring. And then near, and one last (5th) ring for distance. Pretty much the same as the Array. Just less near-vision ability.
Restor has 12 apodized steps in the central 3.6mm, any part of which gives near, intermediate, and distance vision. The highest step is 1.2 microns, the lowest step is 0.2 microns. (Human hair is about 60 microns thick). This apodized diffractive portion is what Alcon, the number one implant manufacturer in the world, has been working on since it acquired the technology from 3M about 15 years ago. No other technology will allow you to read your cellphone without glasses, use the TV remote, read your prescription bottle, check price tags, inspect your grandkids scraped elbows, tie fishing flies, etc. spectacle free. As your pupil enlarges beyond the 3.6mm portion, say, in a darkened bedroom, a higher percentage of the light is for distance vision, so you don't trip over the dog.
The category that is recognized by Medicare is called presbyopia-correcting lens implants. There are three brands available today that have varying degrees of efficacy. No matter what your lifestyle or career is, your best chance of spectacle freedom will be with ReSTOR. Don't find out too late.
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Hud...please stop cramming ReSTOR down people's throats. ReZoom gives people these same benefits that you mentioned and oh by the way, helps them to see things at arm's length better (known as intermediate vision) with ReZoom. Also, in dim light such as a restuarant on a Saturday night, guess which gives better menu reading? ReZoom over ReSTOR. ReSTOR is great for up close, really strong, often "too strong/too close for comfort" near vision. In the bright light outdoors, ReSTOR loses some of the sharpness at distance. ReZoom does give excellent distance vision, and intermediate vision, and good near vision. We have several ReZoom patients that are surgeons, 2 that are private pilots and have no problems with instumentation flying day or night! We have a pharmacist, a plumber, a preacher, several attorneys (Lord knows they did their homework before choosing ReZoom), and several physicians all of whom love their ReZooms. Our ReSTOR patients that are the happiest are those that really desired up close reading such as jewelers, and people that don't drive much or at all, but love to crochet, and work puzzles alot, etc. Again all of these lenses have their strengths and weaknesses. My suggstion as a nurse, as a patient with a cataract needing surgery and trying to decide which is best, someone who works for ophthalmologists for years and sees all of these lenses everyday.......is for people to ask questions, see for themselves the attributes of all the technologies available. Let's keep this website honest and helpful, not a commercial for one company.
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I am 46 andhad cataract surgery on my left eye 3 weeks ago.  Doctor convinced me that Restor was the way to go.  Currently have contact lens in my right eye.  I have been quite diappointed with the resluts.  Need readers except for black on white under the best light.  Suregeon now wants to do the other eye indicating that I should experience significant improvement.  Has anyone had them done weeks apart and noticed improvement when second eye is done.  I am also concerned about how doing the other will impact my nighttime driving.  At this point if I don't do the other I am contemplating taking out the lens and going back to bifocals.
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Night time driving can always be a challenge even without an implant as we age. YOu are young at 46 and also should be fairly adaptable. Any multifocal lens can cause some halo or glare at night due to the defocused near image and due to the fact you have a larger pupil at night in the dark. I don;t think you would have to back to bifocals. The Tecnis monofocal actually can help with night time driving and dusk condtions because it improves contrast. You would still need readers for reading but should have great distance vision. You are just three weeks out which many surgeons feel is the time for a final refraction. Others would still say that 6 weeks is better. The decision is yours and you do not have to have the surgery. You can wait a few more weeks and see what happens. Do you have a cataract in the other eye as well? Most surgeons do surgery about 1 to three weeks apart. I would suggest that you also seek a second opinion aas well. I noticed that some patients on this board have seen up to three surgeons before making up their mind. It never hurts. its your vision. I would give it some more time and see another doc. The second eye being done can help bring things in for you but if you are not really happy and not sure about it, check it out a little further.
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eyecu:

Thank you for your response.  I guess my real concern is that my right eye has a samll cataract but nothing that would require surgery at this time. (the vision is -6).  I am not overly comfortable with my Mutifocal in one eye and the contact len in the other.  My amin concern is to restore my ability to read up close and small print particularly in less than ideal lighting.  At this point I feel I have but 2 choices:  have my right eye done or switch out the mutlifocal for a single vision in my left eye at -3 and go back to my bifocals.  I got a few opinions.  They all said that what I was told by my eventual surgeon was correct and truthful but that he was taking a more aggressive approach than they might (suggesting that I do both eyes in order to get the full benefit from the lens).  I plan on acting soon do to my discomfort with my current situation
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If you are a minus six than your doc is giving you an implant for up close reading which is what you want. The lighting situation is a different animal though and you would have to explain the lighting conditions and your work or hobby to your surgeon. He could do some pupil testing in the lanes under various lighting conditions to see how you fair. Some surgeons are also using a multifocal in one eye and monofocal in the other. Kind of a monovision. One for reading and one for distance. But that is up to your surgeon. I would still give a few more weeks to see if you adapt and than proceed. Talk to your doc, he does want the best for you. We all want everyone to be 20 happy.
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Last month in Sydney Australia I had cataract surgery and restor lens implanted in both eyes with a two week interval between the operations.The first eye (right) result was very disappointing initially....very sore with blurred and glary vision that gradually improved to an acceptable degree within two weeks. The left eye was a better result and my bi-lateral vision has now improved so that glasses are not needed at all. Close up vision still has some astigmatism and distance vision is not sharp, the 'halo' effect when night driving was alarming at first but it is becoming less a problem now. On my billing I noticed a charge for 'corrective corneal incisions'. My surgeon did not discuss this procedure with me at all before the operations. I did some research and learnt that this was in fact a procedure called LRI (Limbal Relaxing Incisions) to help correct corneal shape distortion and reduce astigmatism. Why he did not see fit to discuss this procedure with me prior to surgery I can only guess, I'm none too pleased that this was done without my consideration even though it was most likely the correct surgical descision to take.
I have another three weeks to go before my next visit to the Surgeon where he said he will treat any residual problems with laser correction. We will be having a discussion on the LRI procedure....
I will post the results in one months time.

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I had surgery about 4 months ago.  If I had known that near vision meant 12" focal point, I would not have gone with the reSTOR lens. I work on a computer all day and ended up with computer glassess.  Reading at 12" is not a big deal, but requires bright light. I wish I knew about the reZOOM lens, but I think they just came out when I got my first eye done.  

Pre-surgery: both around -6D.

After surgery: distance vision is good (20/25, 20/20) and near is similar.  However for near vision you must have bright light.  Going into a dark resturant, you will not be able to read the menu.

Recommendation:  Look into the reZOOM lens, get hard facts such as acutal focal point for near/intermiedate distances.  Think about getting standard IOL and wait for better overlay/secondary lens options (.i.e. reSTOR is comming out with a secondary lens that overlays the standard IOL for near vision).

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utica-I could not have said it better.
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Where are all the positive "I love it" comments from the restor or crystalens.  We have placed a 100 of these in our practice and I'm still waiting.  Rezoom?  Been there done that.  Gave up.
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ReZoom has not really been out there to been there done that and gave up. Array maybe. You don't say much about Tecnis. Have you tried it in your practice?
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Why do we trust Doctors SO much??? I had a Restor lens implanted
in the summer of 05'...either I was told or I just wanted to beleive I could see better with the lens; WRONG!! Before surgery
I had some vision problems, essentially I could just move my head
around to "see" around the obstruction, but could read a paper
without glasses. Since I got up off the operating table, 7+
months ago, I can only see colored light. No reading anything. No
correcting, apparently. The surgeon immediately backed off and
gave me to her associate. He has already injected meds into my eye hoping to "re-shape" the retina...the only part that is known
to be uninjured. Sure seems like the implant, maybe even the surgery was defective and now they're into CYA mode, trying to get something to put the blame on besides themselves!!Make the Doctor explain the odds of unfavorable outcomes...make them know
you hold them accountable for poor outcomes...especially if they
are the ones promoting the lens...they're NOT promoting it for free!!!
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I recently had both eyes done with ReSTOR.  Right eye needs lasik for final improvement.  Left eye works as advertised or even better.  If the lasik corrects the vision in my right eye I will be extremely pleased, since my vision is now better than it has been for the previous fifty years.  Patients must all sign documents confirming we have been informed of what might go wrong.  When it does we sue.  It's the American Way.
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blind in one eye-It sounds to me like you are a myope or nearsighted and could read without glasses. You developed a central posterior subcapsular cataract so you could move your head and read around it. After the surgery you developed some cystoid macular edema which is fluid on the macula and it is effecting your vision. I do not think it is the implant. The surgeon is treating you to with injections to relieve the swelling which can take some time to heal. Myopes are also a higher risk with any surgery due to a long eye. They can develop retinal detachments easier etc. My uncle is a high myope and ended up with a retinal detachment after surgey and a sceral buckle or band to compress the retina back to the choriod or its life supporting layer. He has adjusted. He knows its not perfect but he realizes things happen and he was more susceptable to it and feels lucky it is not worse. Work with your doc and ask him why he is injecting meds and what he is doing it for and what your long term prognosis might be. There are always risks.
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How will the lasik improve your Restor vision?  I see fine close with my Restor, but the distance vision is not that great.  Will the lasik change your close vision?
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bjfinfl-which implant do you hae. Do you have a Restor and a Rezoom?
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I am a 68 yr.old illustrator with cateracts in both eyes.  I've had several cycles of going from near sighted to far sighted over past 20 years.  I'm now near sighted and have severe glare problem at night.  I can participate in a MUSC blind study of Restore/Rezoom
lens, but my regular doctor recommends monofocal distance lens in one eye and slightly near focal in the other.  Until about a year ago I had used reading glasses (150)for some years and Im not uncomfortable with that but want to make right decision.  Anyone have experience with that combination of monofocal?
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Touche' to Eagle Eyes!  Sorry for getting on late but every single thread regarding presbyopic IOL's gets an advertisement by this "hud" fella.  Obviously, an Alcon employee.  I'll be honest and tell you that I worked for Alcon AND for Advanced Medical Optics.  Currently, the later.  BOTH the ReSTOR and the ReZOOM are excellent products - you won't hear that statement from "hud" or any Alcon clone.  The best lens for the patient is governed by the lifestyle of the patient.  if you want good J1 vision (threading a needle), then ReSTOR is your ticket.  If you want a good intermediate/distant dominant lens (computer work)then ReZoom.  Too much conjecture on Crystalens to call.  I do have to ask "hud" though - what about all the problems with "waxy" vision that is coming out on your beloved ReStor?  And don't claim to have intermediate vision because you don't.  Leaning closer to the computer and flipping on the lights isn't intermediate accomodation friend.
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Hi! I am new to this forum. I have been wearing contacts for the past 16 years. I am 36 and having nucleus cataract in both eyes with the right eye being bad. As expected reading and night driving are a big pain. I work daily for about 7 hours with computers, drive at the speed of 45 mph for about 90 minutes a day (with abt 45 mins in the night) and am also required to attend presentations and seminars (a deadly mix of requirements eh!!?)

I have consulted two surgeons. Both are more or less against multi-focals IOLs and say that they are not yet perfected and would come with a cost in terms of contrast (because the light is distributed). One of the surgeon (an experienced one) though suggested that I can go for Crystalens (the accomodating type with UV protection). The possible escape chute with that is that IF IT WORKS, then well and good (until my cillary muscle is able to pull it off) with minimal correction. IF IT DOESN'T, then it would be just like any other monofocal lens and I will have to use progressive glasses over it. This way I can hope to escape the perils of diffractive multi-focal lenses while having a 60% chance of getting all their benefits.

Just out of curiosity, will the ReZOOM help in this case?

Does anybody have any suggestions on using multi-focal contact lenses over mono-focal IOL? Not a bad idea at least in theory to correct astigmatism and be free from glasses for the better part of the day.
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Yes, experience with multifocal CLs with our patients. Trouble with contact lenses is you still have to deal with the contact lenses, plus they can get blurry at times due to external elements such as climate, environment, plus movement on the eye and fit. I would like to hear more about your lifestyle, your activities beyond computer. Are you active outdoors? drive alot at night? If you had to wear glasses for some distance, which would be the place ? for reading, for computer, for night driving. Crystalens is so very unpredictable. It only works about 20% of the time. If you are in that group great, but if not you will be stuck with needing glasses or contacts. ReZoom is better for computer and distance.
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Thanks for the reply Eagle Eyes.
As for my lifestyle.....

1) I like playing outdoor games like cricket where you have a red cherry hurtled at you at 50 to 60 mph and you have to focus on it fast (pretty much like baseball) to hit it correctly. I also like swimming, table tennis, badminton, walking, etc.

2) I drive about 45 to 60 minutes in the night everyday back from work. It involes a lot of city driving so the oncoming lights might pose a problem to me (halos) in case of diffractive multifocals. I also prefer to drive on the highways during the weekends and while on vacation

3) As I mentioned, I work with computers 7 to 8 hours a day

4) I also need good and clear distance vision as I need to attend seminars/presentation and sometimes need to deliver one of these myself. Hence, you need clear vision to make good eye contact with you audience.

As far as use of contacts post surgery is concerned, I don't mind dealing with (multifocal) contact lenses during the day (for outdoor activities) as I have been doing that for the past 16 years. I also don't mind wearing progressive multifocal glasses during the evenings as I also do that right now after removing my contacts.

Hence, if Crystalens does not work, then I dont mind ending up with glasses/contacts BUT the catch is that if it works in one eye and not in the other, it will surely be a disastrous situation.

A third doc I consulted is also personally against any kind of multifocals and said that if I want crystal clear vision, then I should go for mono-focal IOL with progressive glasses (and MF contact lenses). He said that he suggests MF IOLs for patients who were old and who did not require driving or other outdoor activities at night. He also said that these days we have very good quality progressive glasses available to achieve good vision post surgery. He also suggested use of hydrophobic acrylic material (Acrysof) is better (than silicone) as instances of posterior capsular opacification are less with these IOLs. He was against Crystalens for that fact that if in the future I wanted a Refractive Lens Exchange, the Crystalens in a relatively difficult candidate to explant.

I hope I was able to provide relevant info to you.
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The ReZoom is acrylic as well and meets your distance needs as well as your athletic needs since it provides a full range of focus. It also addresses your computer needs. You will see halo at night but it tends to diminish over time as you adjust. They provide better vision than contacts as they are stable within the eye. I disagree with that multifocal lenses are for older patients who are not as active. There are many younger patients with multifocal lenses because they actually tend to adapt faster than the older ones. You need to see a surgeon who does both refractive and cataract surgery and has experience over the past 7 years with the Array as well, if you can find one in your area.
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To NewEyes - you're probably not a really good multifocal IOL candidate.  You're expectations or hopes are going to be hard to fulfill.  I see several red flags.  If you indeed have a significant cataract and need cataract surgery - you might consider the TECNIS for distance and get used to reading glasses afterward.  In summary, at least you'll have excellent uncorrected distance vision.  If you want perfect eyes at near and distance without glasses - it may not be in the cards for you unless you want to take a little bit of a chance with a multifical IOL (take your pick.) I wouldn't necessarily be interested in doing your case.
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Follow up on my Restor experience:

I had my right eye done and then my left lens re-centered.  Prior to the re-centering I could not read well at all.  On the 2nd day after the re-centering surgery my reading kicked in and I am reading even the smallest print (in good light).  The computer screen is less clear and I do wear cheaters when I have long work to do.  But overall I went from -6 to no glasses (no glare at night while driving!!)  Was not happy at first but after the long haul I am quite satisfied with the Restor - particulalry my reading.
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Dr MJ, Thanks for your comments on my case and your constructive criticism is also welcome. Like everyone, I also want the best possible outcome for myself.

If TECNIS (aspheric) can give me uncorrected crystal clear distance vision, I would be more than happy with it wearing progressive glasses or readers. I am -8 in left eye and -10 in the right. All the surgeons I consulted said that I would still end up a bit myopic (-1 to -1.5) and (funnyly) they would intentionally keep me that way as I was used to that condition. This approach is very difficult for me to comprehend as I would expect zero or minimal correction for distance. This might improve my near vision slightly but disturb my distance vision which I am not happy with.

Tomorrow, I am going for an A-scan and that would help the surgeon pinpoint how much correction I would need for distance post surgery with a mono-focal IOL.

I am sure you guys will help me decide on the best possible option by wednesday.

Cheers !!
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Dr MJ, Thanks for your comments on my case and your constructive criticism is also welcome. Like everyone, I also want the best possible outcome for myself.

If TECNIS (aspheric) can give me uncorrected crystal clear distance vision, I would be more than happy with it wearing progressive glasses or readers. I am -8 in left eye and -10 in the right. All the surgeons I consulted said that I would still end up a bit myopic (-1 to -1.5) and (funnyly) they would intentionally keep me that way as I was used to that condition. This approach is very difficult for me to comprehend as I would expect zero or minimal correction for distance. This might improve my near vision slightly but disturb my distance vision which I am not happy with.

Tomorrow, I am going for an A-scan and that would help the surgeon pinpoint how much correction I would need for distance post surgery with a mono-focal IOL.

I am sure you guys will help me decide on the best possible option by wednesday.

Cheers !!
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NEWEYES-  look for your doc to do a ZEISS IOLMaster or Immersion Ascan to get the best A-scan.  Also Holladay IOL COnsultant software to pick the IOL power.  Go for the gold and try to get as close to 20/20 uncorrected in at least one eye.  Consider leaving the second eye at -0.5 to -0.75 or -1.00 myopia to read at least a little bit with.  Bausch and Lomb also has an aspheric implant the LI61AO or "advanced optic" it is close to the Tecnis in theory.
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any more details on how to correct astigmatism after IOL implant?

I am considering either mono or multifocal implants (to correct cataracts) but with minus 2.50 astigmatism correction, I understand I will still need glasses or surgery to get clear vision. I am myopic (-6.0) and presbyopic (2.50)

my aim is to do away with glasses in all but few cases

thanks for yr thoughts
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A related discussion, ReStore Implant was started.
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A related discussion, CRYSTAL LENS was started.
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A related discussion, sucess with one eye restor and other traditional lens was started.
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A related discussion, choices was started.
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