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.

[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.

[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.

[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.