Facing cataract surgery, need feedback, help deciding on lenses

[cataractx2]

I read feedback on Crystalens and Restor lenses, but still cannot make a decision. The first doctor I saw said that he would not recommend any accommodative lenses. He would not implant them in his parents' eyes. That's a strong statement and surely most folks would not question it or look beyond.

I have been wearing glasses for many years now and have 8 different pairs, bifocals, progressive, reading, glare preventive and what nots. I spend good $800 a year on new glasses. My vision worsened this year terribly with the growing  cataracts. I am afraid to drive anymore, I need new computer glasses already (just had new correctives 6 mos ago). The glare from the computer hurts my eyes and I have to close one eye to read.

When I did research on the accommodative lenses I clinged to Crystalens and wanted to hear from folks that have them. Then I saw this website postings and discovered Restor. Naturally, I want the best possible solution to my dilemmas, cataracts and poor near, intermediate and distance vision. I am 52.

I only have one "good" eye, my left eye was diagnosed with "lazy eye" condition since birth and has almost no vision. I have cataracts in both eyes and need surgery in both. Ideally, I would want accommodative in both eyes, if no contra-indications. I can always decide on my worse eye down the road, but are there any considerations I should be aware of?

Most importantly, which of the accommodative lenses should I choose? It seems that doctors specialize and recommend one type only and that makes it more difficult for patients to decide.

[Forum-OD-MP]

the fact that most surgeons prefer& use one lens or the other does make it more difficult.

do not be scared of an accommodating iol, even if you do only have 1 eye.  

I personally like the restor a little better. i'll copy some ext from a website about it:

"The most remarkable statistic from that study is that 80% of the patients in whom the (ReSTOR) IOL was implanted bilaterally reported not needing spectacles for any activities after the surgery—not for distance, near, or intermediate vision tasks," Dr. Mackool said.

He observed that result compares very favorably against outcomes associated with the Crystalens accommodating IOL (eyeonics) and the Array multifocal IOL (AMO), for which reported rates of complete spectacle independence were 26% and 40%, respectively.

"The ReSTOR IOL is truly a revolutionary implant," Dr. Mackool said.

Four hundred sixty-five patients received bilateral ReSTOR implantation during the FDA trial. Of these, Dr. Mackool implanted 43 lenses. The average patient age was about 65 years.

In that study, the vast majority of patients (84%) who underwent bilateral implantation with the ReSTOR IOL had a distance visual acuity of 20/25 or better and a near visual acuity of 20/32, or J2, or better without correction compared with 23% of patients who received conventional or monofocal correction."

http://or-live.mediwire.com/main/Default.aspx?P=Content&ArticleID=155761

[sjnuss]

Hello to all,
I am in a somewhat similar situation to the initial poster but with slight differences. I am 50 and only the right eye needs surgery at this time and although I still have relatively good vision in the left eye but it will need surgery at some point. My optomistrist has said the same thing: "I would not put the multifoacl IOL in at this time". I must add that I am photographer so I am used to good, sharp vision (and that is what I want to have after surgery). Although it would be nice not to have to wear glasses that is not the most important issue. I want the best possible vision after surgery that I can possibly have and if the IOL/glasses combination will give that to me then that is fine. I have my opthalmology appointment tomorrow so I will get his side of the story then.

Thanks to all who may have any additional insight.

[Ag-i-doc]

the way i understand it, the restor lens is a multifocal lens.  it will most likely NOT give anyone the absolute CLEAREST vision at all distances...but it is much more likely to keep someone from needing glasses after the surgery.  i guess it depends on your preferences.  if you want SUPER CLEAR vision, i would say go with a traditional IOL and glasses.  if your goal is to be less dependent on glasses, and you dont mind seeing a *little* blurry in order  acheive that, then the restor is probably a good option.

[cataractx2]

Thank you for your responses and taking the time to give me more food for thought. Why can't I have it all? To have a SUPER CLEAR vision without glasses in this day and age of technology seems not too much to ask.
I am wondering what is the expected corrected distance acuity of the conventional monovision IOL?  Obviously, no one wants a little "blurry"  vision at any distance. If I have to use glasses to work, so be it. I am afraid though that fixed focus lens with distance correction means needing one pair of glasses to work on computer at 2-3 ft. Then another pair to walk around to see people at 4-10 ft. Another pair to drive and see street signs at 15 ft with the car instruments bifocal reading. Maybe no glasses to see well beyond 20 ft, but when this circumstance really happens? Possibly, when I am on vacation, sightseeing? Not in every day life. My fear is that I will end up with similar amount of pairs of glasses I have now if I choose monovision lens. If I have to have the surgery anyway, I might as well improve the quality of my life as well as my vision all in one shot if that is possible with minimal exceptions. I am assuming that Restor can be corrected with glasses if necessary to perform certain activities like computer work.

[Ag-i-doc]

no, right now i dont think you can really "have it all".  this is an area of our profession where significant research is being done, but IMO it is certainly not perfected yet.

if you go with a "traditional" single focus iol, you will likely need multiple pairs of glasses, or at least glasses with multiple rx's in them (bifocals, trifocals or "progressives").  if you go with the restor, you will likely need fewer pairs of glasses, but you will also likely be slightly BLURRIER all the time and at ALL distances, both with Rx glasses on AND without glasses on.

"monovision" means correcting one eye for one distance, and the other eye for a different distance...usually the dominant eye for farter than 20 ft and the non-dominant eye for 16-18".  when you use the word "monovision" while talking about cataract surgery, you are implying using one single-focus IOL for one eye to see at great distances, and using a different power single-focus IOL for the other eye to see well up close.

[sjnuss]

I had my appointment today and was given three options: 1) do nothing at this time and wait 2)RESTORE lens w/LASIK to correct for astigmatism or 3) traditional IOL w/glasses. I chose door #3! Although I probably could get by a while longer I am really bothered by a number of vision issues. Number 2 did not sound enticing as one procedure seems to be enough. So I decided to go the more tradtional route and hope that it all works out in the end.

Thanks again.

[cataractx2]

Just want to thank you all again for your help. I kept forgetting that I only have one good eye and someone reminded me of protecting it at all times. Therefore, glasses in my life are necessary anyway and so I cannot have it all.

I also read that in all multifocal or accommmodative lenses the optimal vision results are achieved when implants are bilateral. Not having this luxury with my bad eye, I am opting for the best clear vision I can get with the traditional method and glasses to correct all other distances. I also have endured enough "blurr" in the last few years with my cataracts and cannot bear the thought of dealing with it for the rest of my life (if I want to avoid risky replacement surgeries down the road) because I chose the wrong lens. I guess my cataract did not come in an opportune time when technology could provide "having it all".

[hmh]

I just had surgery and had the ReZoom lens in my left eye 3 weeks ago and my vision for distance in that eye is 20/20 and I can see inermediate fairly well and close is 20/30.  I just had my right rye done on Monday, Dec. 5 and had a -.5 for it.  I am very encouraged and am hoping that I will be able to see close and intermediate in a few weeks.  My right eye is a bit swollen, so I believe it will only improve.  I was not able to see distance with corrected contact lenses and could hardly drive at night.  My doctor said that I would not be able to pass the driver's test next year.  I am only 62 and am very excited about my long distance vision and if my near vision isn't as sharp as I would like (wanting the perfect lens)I sure don't mind wearing readers.  Will keep everyone posted.

[eyecu]

go to www.visioninfocus.com
and wwww.tecnisiol.com

The ReZoom gives you a full range of vision from near to far and 20/20 distance. The only accoomdating lens in the Crystalens since it is supposed to move back and forth. The others are bifocal or multifocal. The ReZoom is a true multifocal. The Tecnis is a monofocal but is different. It has two FDA claims of improved night time driving and improved functional vision so it is better than the average monofocal lens. There are quite a few one eye patients that are doing will with the Array lens which was the predecessor to the ReZoom. But if you are leary look at the Tecnis.

[thewind]

I had a Restor lens installed in my right eye five days ago (12/12/05.  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 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.

[eyecu]

Five days is not too long. Things can get better as the capsule contricts aroundt the implant to stabilze the lens better. You can also have the lens exchanged if it continues to bother you. You could have little corneal edema or swelling from surgery or macular edema. Give it some more time. If it still bothers you at three to six weeks, than you can discuss your options at that time.

[thewind]

I had a Restor lens installed in my right eye ten days ago (12/12/05)at Victoria Eye Center, Texas. I had a follow-up exam 12/18 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. She also said more time was required for healing and "setteling in."  More follow-up postings describing my results over time to follow.

[Bill in JAX]

I'm 63 and have been diagnosed with cataracts in both eyes.  I recently had a complete evaluation at the Jacksonville Eye Center and the surgeon has recommended ReZoom IOLs for both eyes over the Crystalens and ReStor at a cost of 2,700 each. Another highly recommended surgeon in JAX is recommending the ReStor at 2,800 and does not offer the ReZoom as an option.  An evaluation has not been done yet with this surgeon. Would like some feedback on ReZoom vs Restor from all with any suggestions or those with recent implants.

[eyecu]

The ReZoom will give you a full range of vision from near to far. It is a second generation IOL with 7 years previous experience behind it. It is an improvement over the Array. It uses 100% of light and light is redistributed at night to cut down on the halo effect. The results have been better than expected. It gives you an edge on computer vision and better contrast and reading in low light. Go to www.visioninfocus.com.
It is a more forgiving lens than the others.

[Jim in Fort Worth]

On 12/12/05 RESTOR NIGHTMARE...I had cataract surgery and a Restor lens was implanted in my left eye. A significant overcorrection occurred leaving me at a +2.00 farsighted. Both distane and close vision are bad. My right eye is nearsighted at a -1.75.I have had my eyes refracted on two occasions since 12/22/05 and 12/27 and the vision does not seem to be shifting much. Thus,my eyes are 3.75 diopters apart -- which is not good. My right eye also has a cataract but surgery on it can be put off indefinitely. With this botched Restor lens power selection I now have an extreme form of monovision.
I am seeking a second opinion on 1/3/05 to determine what to do:
1)Have a lens exchange to better fit the left eye with the proper power.
2)Live with left Restor lens and have lasik to correct the remaining astigmatism and hypeopia caused by the wrong power on the Restore lens.
I am particularly interested in hearing IF the knowledge of the wrong power of the Restor lens I now have will help in getting a very good power prescription for a second lens exchange. Having two botched lens power selections is NOT something I want to endure.
Also,I am concerned how long I have to get the lens exchange before the Restor lens "settles in."
I want to get the left eye issues resolved before I tackle the right eye.

[eyecu]

I would opt for an exchange. You are not that far out and if you know you have the wrong power than go ahead and get it exchanged. They should have learned more off the first eye to be more accurate for the exhange. You definitely want to have the first eye corrected before preceeding to the second. If your doc doesnt want to do it, find someone that will. I am not wild about lasik and messing with the cornea because the power was off. You can also have a monofocal lens placed behind the pupil in the sulcus in a very low power or minus 2 to offset your missed lens power if you cannot safely remove and replace the ReStor.

[Jim in Fort Worth]

Thank you for your advice. I was already leaning toward the lens exchange approach before seeing your response. I did forget to mention that in 1997 I had successful lasik in both eyes that were previously approximately -6.0 nearsighted. I knew going into the Restor surgery that the power selection is harder if a patient has had lasik -- I just didn't expect to end up +2.0 farsighted. I am hopeful the power selection will be more managable on this "second bounce" in spite of my previous lasik (that is my doctor's excuse for his first miscalculation). So with this additional background I hope you STILL feel accuracy is attainable.
I will see 2 new doctors on 1/3/06 along with the doctor that did the surgery on the left eye and I will update you following.

[eyecu]

You are doing the right thing by talking to your surgeon and getting another opinion. What you forgot to post is very important. Since you had previous lasik, it is always tougher to hit the right power. Kind of a **** shoot. You do your best and hope you get close. You should have been prepared for this prior to surgery and gone in knowing that a lens exchange was highly probable. It sounds like you were. There are also differing opinions on whether previus lasik pateints should opt for a monofocal due or a multifocal and you will hear it both ways. You are a good candidate for the newer lens becuase you had lasik in the first place which means not having to wear glasses is something that you want. Let us know what they say and how it turns out.

[thewind]

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 recently 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, few if any  have posted in these related sites 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.

[eyecu]

How much astigmatism do you have? As far as the 80 and 90% promises, it is always better to underpromise and out perform. They take that from clinical studies but you have to look at the clinical studies and how they were performed. Get a second opinion. Take a trip to Corpus and talk to Dr. Dugan.

[Jim in Fort Worth]

I saw two new doctors for second opinions yesterday(plus my original doctor)and I am nowhere closer to deciding what to do. It appears my stituation is rather complicated.
Dr. #1 is a respected Ophthalmologist at Southwestern Medical Center. He says the cataract removal has left me with high order abberations and significant astigmatism. Oddly the astigmatism wasn't remarkable before the surgery.He says a lens exchange would not solve my astigmatism problem and suggests lasik or surface PRK to correct both astigmatism and hyperopia. He says he would attempt to lift my 8 year old lasik flap(yikes!)and failing that,do surface PRK. Apparently cutting a second flap is not a good thing to do.
Dr. #2 is a young Ophthamologist in Fort Worth.He said he had never seen post surgery astigmatism like I have.He says a lens lens exchange is a better route(than lasik)but says he would bail on Restor and use a monofocal lens. He says getting the power closer to -+0 ,rather than farsighted,is not an unreasonable/unattainable goal. Both #1 and #2 said contact lens could be considered as a "status quo approach."
I also saw Doctor #3 who did my cataract/Restor surgery on 12/12/05. Doctor #3 is a young doctor who does lots of Restor work. He sides with Dr. #1 but said he did not do lasik himself anymore.He thought the contact lens idea was worth trying.
Assuming I went with a lens exchange he did NOT like the idea of a monofocal rather than a second Restor. He seemed interested in dismissing me -- and said he would see me in 3 months.
Here is my take today:
1)The status quo seems like a dead end because I don't like the idea of a far-sighted astigmatic left eye while the right eye remains nearsighted. Wearing glasses with a 3.75 diopter differnce is not really doable. Realistically I expect to need glasses for golf and reading no matter what route I take.Contacts might allow the "staus quo approach" to work but I see this as a longshot.
2)I don't like the idea of raising the 8 year old lasik flap.It is interesting that the doctor with the most experience and a prestigous background came up with this aggressive approach.
I would want to know a lot more about raising a flap and current surface/PRK techniques before going that route.
3)The right eye can't be overlooked. If I stay with status quo (farsighted Restor)in left eye then am I bound to target a similar outcome for the right eye so they will "match?" (lessen the diopter difference). Again,I am thinking about the ease of wearing glasses ultimately.
4)I will try contacts right away.I have an excellent Theraputic Optometrist who will give me my best shot at contacts.
5)I will get at least one more opinion and try to get further clarification from Drs. #1 and #2 after better outlining my concerns to them.
I WOULD BE MOST INTERESTED IN YOUR THOUGHTS. I am now 23 days out from my cataract removal.If you have a suggestion for a doctor in Dallas/Arlington/FW for my 4th Opinion I would be appreciative.

[eyescared]

I am 62 years old with early cataracts. I am choosing to do refractive surgery and have an IOL lens implant.  I have prebyopia and am nearsighted.  My reading is about a 3.75 with my distance about 2.75. I live in Sarasota and have been to 2 doctors. One recommended a monofocal, and the other restor lens. Now I am thinking of going to a third doctor who does rezoom lenses.  They charge $4900 per eye which sounds very high based on other postings. Also, I am totally confused about which lens to get.  I also have an astigmitism which the last doctor said he would correct during this surgery before putting in the lens.  HELP!

[eyecu]

Sarasota-go see Randy Burke or Tommy Schwartz or both and see what they say. $4900 an eye is steep and must include lasik touch up if necessary. Surgeons who do these lenses should do lasik or have someone in their practice that does if they are a large group. You can correct astigmatisn at the time of surgery with LRI or AK cuts. Surgey can also induce astigmatism but usually that works itself out because it should not be that much with todays tecniques and lenses. Fort Worth, I will get back with you. I need to read your history a few times and speak with some of my lasik people.

[eyescared]

I am confused by your answer. Are you recommending Lasix surgery because I want cataract surgery with the insertion of an IOL, but I am confused over restor, rezoom , etc. Which do you recommend for me. I do not want to wear glasses for distance and expect to wear some glasses for occasional near work. I have read on this sight that restor gives you fuzzy vision afterward.lack of acuity.

[eyecu]

Sorry for the confusion. Sometimes lasik is used in combination with implants to correct astigmatsim. Based on what you are saying I would recommend the ReZoom. It is designed to give you 20/20 distance vision, intermediate and 20/30 near vision. It utilizes 100% of the light which helps with contrast and night vision. You might have to wear glasses when reading very small print or when reading for long periods of time but then again you might not. Go to www.visioninfocus.com and it might help answer more of your questions. It is designed for what you are looking for.

[Jim in Fort Worth]

I am stil looking forward to hearing your thoughts on my Restor predicament. Thanks....Jim in Fort Worth

[eyecu]

Jim,

Go to Wes Herman in Dallas. He does lasik, has Array's in his own eyes and will do the right the thing if he can help you. 214-361-1443. See him and no one else. He has the experience. He has done both ReStor and ReZoom. The Array is the predecessor to the ReZoom. Let me know what happens.

[bbd]

Hi all.  I'm new to this forum.  Minneapolis area, female, age 51, bilateral posterior sub-capsular cataracts, have not had cataract surgery yet, still correctable to 20/20 DVA, but have been told that the surgery is likely in my near future.  Moderately near-sighted (-5.50 R and -5.75 L), mildly astigmatic in one eye (don't know the measurement), need +2.25 for reading.  Mostly I now wear multifocal gas permeable contact lenses, which give me "pretty good" acuity at full range (have worn some type of contact lens for 35+ years, ranging from the old "hard" to soft, to this gas perm).  Also have progressive spectacles, which I tend to wear in the evenings only after removing contacts.  Biggest problem right now is night driving (seems to be with either my contacts or my spectacles).  

Have talked to three surgeons so far, one of whom implants restor, rezoom, tecnis monofocal, and crystalens.  He also is in FDA trials for tecnis multifocal.  I don't know how far out FDA approval of that IOL is.  His study group is full; I am not eligible to get the tecnis multifocal.  His recommendation is for me to wait a bit until I am not correctable to 20/20 DVA, and, assuming this is within the year or so, then to implant the crystalens, and do lasik (?) to correct any bothersome astigmatism.  He says that he sees me as a "refractive patient".  Could someone explain that term please? I had tried monovision correction with contacts some years ago, and I was never really happy with that.  

It sounds to me from reading these posts that restor is problematic with the night driving halos, etc, and the lack of crisp acuity throughout the whole range.  I've also heard (from doc #2) that the crystalens hinging mechanism fails in as little as three years, rendering it essentially a monofocal IOL.  Further, it sounds like the reading capability of the crystalens would not be enough reading for me.  This leads me to prefer the tecnis monofocal IOL, and just put up with glasses (or contacts, maybe?) for near and intermediate.  However, if I could do this without glasses, that would be my preference.  Still young and active (ski, golf, drive my 14 year old kid around, etc.).  Can anyone speak to how the crystalens compares to the tecnis IOL in terms of "functional vision" and contrast sensitivity?  Those seem to be the biggies for folks complaining of night driving difficulties.  Does anyone know how soon the tecnis multifocal will be available, and if it is any better than the restor with respect to halos?  Is the improved functional vision that is touted with the tecnis monofocal also a selling point for the tecnis multifocal?  If I opt for tecnis monofocal, can I wear some kind of contact lens which would be "blank" for distance, and only correct for intermediate and near?  

Also confused by conflicting (?) reports on the UV blocking capability of the crystalens. These two sites both indicate that the crystalens does not have UV blocking capability: http://www.agingeye.net/otheragingeye/crystalens.pdf  http://www.crystalens.com/crystalens-physician-labeling.pdf

This site seems to indicate that it does have (some? but not sufficient?) UV blocking capability:
http://www.eyeonics.com/Product.html

I'm trying to do my homework now, so that when the time comes, I'm ready to pull the trigger.  Would appreciate any help, personal experiences, etc.  Thanks.

[bbd]

Hello again.  Having spent several more hours searching the net, I now have additional questions.  What factors are involved in accurately determining the power of the IOL?  Is it easier to get this power right if one is implanting a monofocal IOL vs a multifocal or the crystalens accommodating IOL?  Are there differences between various brands of monofocal IOLs?  What are the tests and/or instruments for assessing power that provide the best restult?  Is it dependent on surgeon's skill in implanting?  Is it dependent on the age of the patient?  Could it be dependent on the contact lens history of the patient, eg, hard or gas perm contacts which may be "molding" the shape of the cornea?  How does one know if the cornea has reached stability following ceasing wear of the contact lenses?  I have been told that Lasik can be done following cataract surgery to correct for astigmatism;  can the Lasik procedure also correct for refractive error of the IOL, independent of astigmatism? If Lasik is used to correct for refractive error for distance visual acuity, will it make the near/intermediate acuity any worse?  Is there a laser type of procedure that could be performed following implantation of a monofocal IOL (for distance visual acuity) which would correct for presbyopia (near/intermediate)?  If that were the case, I'd go that route (tecnis monofocal IOL) in a heartbeat.  Also, as relates to tecnis IOLs, their latest iteration (Z9003), fall 2005, is an acrylic platform, vs. their earlier silicone platform lenses.  Does anyone know what the advantages of acrylic are?  Felt more by the surgeon, or the patient?  Thanks again, all.

[eyecu]

Lots of questions. There are three lenses right now considered in the refractive catagory. The ReZoom, ReStor and Cyrstalens. The Cyrstalens is the only accomodating meaning that it moves back and forth to give you the different focal points. Since it does not have defocused images, it would not have the halos. But it is a first generation and there are more in the works and it might not move as much over time. You would get great distance and some intermediate and little near. The ReStor gives you great near provided the they hit the right power and you don't have to hold it too close to read, but it lacks in intermediate and there does seem to be more questions arising about distance acuity not being as sharp. That could be due to optic design or getting great near sacrifices distance or contrast loss. The Rezoom will give you great distance, good intermediate and good near with a full range of focus. You can still have halos but you adjust over time and the good usually outweights the bad. The Tecnis multifocal has been in trials in the US over one year. I am not sure when approval could be. I would guess around the first or middle of 2007. The Tecnis is different from other monofocal IOL's and is probably one of the more studied monofocal iols. Go to www.tecnisiol.com to learn more. You can also go to www.visioninfocus.com to learn about ReZoom.

As far as determing the power of the lens to implant there are a couple of methods. The IOL master is one and an A-scan is the other. Immersion A-scan is more accurate than hand held. The doc will use a machine to measure the steepness of your cornea to get K readings which the horizontal and vertical axis of your cornea and for astigmatism. He will then use an A-scan or IOL master to measure the length of your eye. He will take this information and input it into a third generation mathematical formula to come up with the right power for the desired refraction. Depending on the amoung of astigmatism you have, they can operate of the steep axis to reduce it or perfrom limbal relaxing incisions at the time of surgery or later in the office. Lasik can be also used to correct more astigmatism. You will probably have to be out of your contacts and just wear your glasses for a period of time to let your cornea resume its natural shape. Most surgeons will personalize their surgeon factor over a series on the monofocal counterpart of the multifocal lens platform and the companies require them to do this to be certified. By doing a series of 25 or more lenses, they will come up with their own a-constant to be more accurate which they input into the formula. This has just gotten better and more accurate over time with immersion biometry and the IOL Master. Some will use both in your workup.  As far as the silicone versus acrylic with the Tecnis, it becomes surgeon preferece and with any designs and materials there are pro's and cons that can be debated all day long but there have been millions of both implanted and silicone has actually been implanted longer than acrylic. My mother and stepmother have silicone monofocal lenses and my dad has silicone Array lenses. The ReZoom is an improved acrylic version of the Array lenses which has had over 7 years experience implanted in the US. It replaced the Array. I hope this helps as there are many opinions and you are in a great area with some very well known surgeons who are nationally and internationally respected. But they all have their favorites just as you probably do in things you work with and like. The most important thing is to look at your life style and what you do from your work to hobbies and the state of your eyes and then try to match the best thing for you. Some surgeons even have used a blended vision of different IOL's to give you near with one and better distance and intermediate with the other. You can imagine all of the possibilites as your research this more. As far as night driving, if you have posterior subcapsular cataracts that is when it will bother you the most as light hits and scatters from headlights. Hope some of this helps.

[Jim in Fort Worth]

Thank you for your recommendation for Dr.Herman. I will keep him in mind for fututer issues.I have decided I am not having lasik so I won't see him right away. I going for the Lens Exchange option (I have been told it ideally needs to be done in first month). My surgery date is 1/16/06 which is 35 days after the original surgery. I am hopeful the power on this second bounce will be "spot on" -+0 but I must admit I am not totally confident my Dr.(#1)can pick the right power based on his first try.
My current optical prescription for the left eye that will undergo an exchange is :sphere +3.50 cyl -2.50 axis 177.
The original Restor lens used that got me to this farsighted condition was 17.5 D. What "ballpark" Restor power would you use to get me back to "0" or slightly nearsighted? I am only looking for your best guess here.
I will get one extra and possibly two independant power selections next week.
I would appreciate any other thoughts you have on my selected course of action.

[eyecu]

Jim, seeing Dr. Herman has nothing to do with lasik. You do not need lasik. Your refraction right now is at +2.25. You have 2.5 diopters of astigmatism. I would be interested in seeing what you pre-op refraction was to see how much astigmatisn was induced by surgery. I have not idea without a lot more information about your pre-op work up what power you would need. Off the bat right now, I would  guess it would be around a 19.5 but you are dealing with astigmatism that needs to be corrected. Multifocal IOL surgeons want to shoot for around half a dioper of astigmatism to provide the full benefit of the lens.

[bbd]

First of all, thank you to eyecu for your helpful comments.  I'm still trying to make sense of all I'm reading and hearing from docs.  

At this point, I'm planning to wait, maybe till next fall (when the nights get longer and night driving becomes more of an issue because, well, there's more night!), and go with the tecnis monofocal.  I'm thinking about an a la carte approach now, rather than one IOL and one surgery which will do it all.  Accounts of restor implants make me kind of leary.  

Anyway, after the tecnis monofocal surgery recovery period, I believe that I could consider contact lenses again (I've worn them now for years and years; they are my primary means of correction now anyway), with "blank" for distance, presuming they've gotten the IOL power correct, and only correct for intermediate and near with the contacts.  I'd really like to hear from anyone who has tried this approach.  

If the distance does not get corrected to 20/20 with the tecnis monofocal, I also believe that lasik would be an option (also had one doc say that he could do the limbal relaxing incisions at time of IOL insertion for the astigmatism) to correct distance VA only.  Then, perhaps years down the road when there are solid surgical tecniques for presbyopia correction with IOLs, I could pursue that.  

My biggest problem now with my posterior sub-capsular cataracts is the loss of acuity for night driving (I'm still legal, though).  The tecnis monofocal addresses this issue particularly.  If people's experiences with that IOL are living up to the claims, then it would certainly seem to be a prudent, conservative, and appropriate choice.  If I could hear of some living proof of contact lenses following tecnis monofocal insertion, I'd really find that helpful.  At 51, and with my long history of contact lens wear, I guess I could be comfortable doing it for another 10 or 20 years.  And in that time, who knows what surgical procedures for near and intermediate correction may be present?  This demographic will certainly be driving innovation in this field in the years to come.

I do have another concern about just how they go about measuring for IOL power.  One doc has told me that his practice uses the IOL Master.  I've read some stuff about that, and wonder if it is perhaps not the best with posterior sub-capsular cataracts in particular?  Is immersion A-scan more accurate with this type of cataract?  Is it more invasive?  IOL Master looks pretty simple and non-threatening.  

All this having been said, I do still sort of wonder about the coming (hopefully) tecnis multifocal.  Does anyone have info about what this IOL will be able to claim?  Same superior contrast sensitivity as the tecnis monofocal?  Reduced incidence of halos and other night time disturbances, compared to present multifocal technology?

Thank you all, and good luck to everyone grappling with this issue.

[beyes]

I am 43 years old and I recently had cataract surgery on my right eye.  I have congenital cataracts on both eyes.  My question is if anyone has experienced any side effects from the surgery resulting in blurring vision at night. I just had the surgery on December 13th.  At first I saw great and was very excited with the results.  Over the last week I have noticed that I am having an after image that really washes out colors and makes lights at night seem like blobs instead of the halo effect that they talk about.  It is almost like someone flashed a camera at me and I am seeing blocked vision from the flash.  I am scheduled to have my second surgery on the 24th of this month.  I do have an appointment this Friday hoping to find some answers to these occurences.  Has this happened to anyone else out there?  Thanks!

[eyecu]

Beeyes, what style lens did you have implanted?

[beyes]

They gave me an Intraocular lens that is supposed to enhance my distance vision.  When I have the other one done it will be for close up vision.  I don't know what type but my card says it is Amo Z9001 +25.5D.  I hope to get some answers at my appointment.  Thanks.

[Jim in Fort Worth]

Monday I go in for a lens exchange with my original doctor (#1). Doctor #1 conferred with the doctors at the SW Med School in Dallas and arrived at a lens power selection of 21.0 D. The other doctor (#3)independently suggested 19.0 so as you can see this is not a precise process. Since the lasik or PRK approach does not appeal to me I am going forward with a lens exchange-- primarily so I won't have to have two farsighted eyes. I am hoping to end up -+0 to slghtly nearsighted and use glasses and possibly contacts to correct the astigmatism and myopia. Then my right eye can be targeted for a similar result,eventually. Down the road Plan B can be the lasik/PRK option I suppose.Thanks for all your help. I will update in week or so.

[eyecu]

Jim, sounds like you are on the right track and they are zeroing in on the appropriate power which is the best way to go, I think.

[eyecu]

Beeeyes, you have a monofocal lens. The halo effect is not usually an issue as you are not dealing with multiplfe or defocues images. YOur doc should help you clear some things up tomorrow. You might have some macular edema or which is some fluid on the retina or swelling that can be treated with drops but I don't think it is a lens issue. He will check you out tomorrow and let you know. I would be curious to hear what he says.

[eyecu]

bbd, a LRI or limbal relaxing incision should take care of your astigmatism due to the fact that it does not sound like you have much and the procedure is simple performed at the time of surgey or even in the doctors office. The IOL Master and immersion biometry are both good ways for measuring the eye. They just use a different form of measuring. The IOL Master uses interferometry and A-scan use ultrasound. They measure the axial length of your eye and some docs use both of them and even compare. Immersion is not invasive. It is more accurate than hand held with a probe. It uses a solution placed in a small type of cup on the eye and since you are not contacting the cornea there is less chance for compressing the cornea so it give you a more accurate measurement. Even thought Dr. Hill is a ReStor guy, you can to his web site at www.doctor-hill.com if you want tp beat yourself up and read more about measurments.Most docs are up to date on this today but it never hurts to be sure. You have some great docs up in Minnesota, Dr. **** Lindstrom and Dr. Ralph Chu should be able to work with you on what you need. The more you find out the better informed you are from listening to the different opinions but it can also drive you crazy as you over analyze it. You said you saw a doc that was in the study on the Tecnis Multifocal. That's who you need to talk to about what he or she thinks in comparison with other lenses. Most of the data is out of Europe and it is promising but it could be a year or longer before we have it in the US. I am not sure anyone knows at this point.

[bbd]

eyecu, thanks for your continued dialog.  I've actually seen Dr. Ralph Chu, and was quite impressed.  Of course, these additional questions surfaced after my appointment with him.  His feeling, as to my options, was to wait, which I'm inclined to do.  I hope to push this out at least several months, during which time I can continue to research (or drive myself nuts), and perhaps wait for yet another IOL, the tecnis multifocal, to add to the mix and confuse me further!  I did talk again to my original doc, who implants either restor, rezoom, or acrysof monofocal IOLs.  His feeling was that there were three or so monofocals presently in use out there, including the tecnis, and another from AMO, and that they were all about the same.  Interesting coming from someone who does not implant the tecnis monofocal?

I really am interested in experiences of folks who've worn contact lenses (multifocal, with "blank" for distance) following monofocal IOL implants.  Maybe this a la carte approach will be the best way to get the best of everything, albeit, having to wait who knows how long for solid surgical enhancements for the presbyopic part.  On the other hand, I don't want to pin my hopes on that route (contacts) if there are compromises I would find unacceptable.

Thanks again, and good luck to all.