Farsightedness and New Lenses

[Hoddy44]

I am 60 year old and have an approximately +7 prescription.  I have some small cataracts.  I've seen alot of post about folks who are nearsighted, but how have the results been with IOLs and farsightedness.  From what I've read I've read, I might be interested in a Restor/Rezoom combination or one of the new asphericals such as the Tecnis Z9001. Of course with the Tecnis, I would not have all vision ranges corrected and would probably have to depend on reading glasses for the 0-14" range.  I believe it would be worth the trade-off if would get the increased quality of vision (contrast, night driving, low light improvement, lack of halos, etc.) that the aspherical lenses supposedly provide.  I would appreciate any commments/experiences.  Also, is the issue of potential decentralization really an issue with the Tecnis lens.  Thanks.

[Forum-OD-MP]

dont know.  hopefully someone who does know will respond.  i dont have enough experience with high plus Rx's and multifocal implants...

[The Queen]

You would be better served having the crystalens implanted in both eyes.  However, the mixing strategy of Crystalens/ReSTOR has been very well received.  You get superb distance and intemediate vision from the crystalens and the added bonus of good near vision from the ReSTOR.  

[One Eyed Jack]

I think you would be better off with the traditional IOL. It provides great vision and the trade off of having to use reading glasses is worth it. A big problem with the ReStor lens is the near distance is approx 12 inches which makes using computers and viewing auto dash frustrating. I can't think of any reason why any type of IOL works better if you are farsighted or nearsighted. More and more people with high prescriptions of any type are opting to have cataract surgery (or clear lensectomy if no cataracts are present)to be able to see without glasses. For example, sometimes it is a better option compared to lazer vision correction.

[hud]

I strongly disagree with the suggestion of a crystalens. Most surgeons have abandoned it, as the outcomes are variable. It is a monofocal lens, and all dr.s that still use it make it "work" by implementing monovision. You would save a lot of money using a monofocal like the AcrySof IQ or Tecnis with the same outcome. These forums highlight anecdotes, your best bet is to consult a couple of MD's about your particular vision needs.

[Ag-i-doc]

crystallens is not technically a "monofocal" lens...its an "accommodating" lens...

[hud]

I was near sighted before surgery, and had experienced halos early post-op, but not debilitating. Now I don't notice halos unless I focus on them. Then, they are minimal.
You probably notice halos now with your presbyopia and/or cataracts. After talking to dozens of ophthalmologists, and attending the professional meetings, my take is that standard government-issue implants have a small incidence of halos, followed by Restor, but the Rezoom seems to have more persisent halos than all. So the bottom line is that you can't lump all multifocals in the same basket.
As far as intermediate vision, it is the weakest part of the system with Restor, but certainly functional, as I am writing this at my desktop now without glasses. About 10-20% of Restor patients report that they use glasses only for this distance, say a computer job, and then it is only a pair of +1.00D full frame readers at the work station. But for the rest of your lifestyle, you can leave you glasses at your desk, because the near vision is superb. The low-light issue is managable- again, I remember all my life before eye surgery that if the light was too low to read, that I would position the paper to reflect the most available light. Not much difference with Restor. Rezoom has confused the marketplace by naming their product closely to the market leader (REstor), when in fact, their submission for FDA approval is for "Array 2". Restor has been a trademark for at least 15 years for Alcon, and Array is known as a multifocal flop.
Regarding the crystalens: it is technically classified as an "accomodating" lens, however, it is a monofocal optic with very flexible haptics. It has been on the market for a full year before ReSTOR and Rezoom, but has lost its appeal due to performance. Alcon's AcrySof lens series has been implanted in over 25 million patients, and the one-piece monofocal design with flexible haptics has been documented to provide accomodation in 25% of their cataract patients..........and then it diminishes after time. Alcon, and others have known this, and that is why most doctors have shunned crystal. Don't get me wrong, there are happy crystalens patients out there, but it is anecdotal and we'll see how long they last. The clue is in the professional articles about crystalens when you read the statement "proposed method of action". The researchers themselves don't even know how it works. As of June, ReSTOR commanded 75% marketshare of all the presbyopic implants, with Array, Rezoom, and crystal splitting the rest.
I'm a tad biased. Good luck on your decision.

[votglo]

I just had a Rezooms lens in my left eye on 7/26/06 and now realize I did not do
enough research after reading comments on the forum.  I didnt realize it would take
3-6 months for my eye to adjust.....so my BIG concern (other than night halos) is
it normal that I need my regular glasses to see at night?  
I am not seeing well during the day......everything is clear but I cannot read signs
when I drive unless I wear my glasses....is this normal?

[hud]

your pre-op near- or far-sightedness makes less difference after you have lens surgery. The surgeon will choose the lens power prescription based on the desired result. A monofocal implant is generally targeting best vision at distance. Intermediate vision is  usually regarded as arm's length. You may need glasses for sharpest vision at this distance with any implant.
If you don't mind wearing reading glasses for near work, a monofocal implant would do well. The Tecnis aspheric lens is a good choice, but you should also consider Alcon's AcrySof IQ. This aspheric monofocal is the most used in the US, and was just recognised by Medicare for meeting or exceeding the performance of Tecnis to gain the NTIOL status. (New Technology Intraocular Lens). You would be most dissapointed with a Rezoom lens, which performs poorly in patients with small pupils who spend $8K for a multifocal lifestyle.

[gbakes]

I just had a monofocal lens implanted on 7/31 and tested 20/15 the day after for distance.


re: your list... Driving is a joy because everything is crystal clear.  I imagine sporting events would be amazing, too, but I have yet to attend one with the new eye.  And watching TV and going to the movies is also crystal clear.  

But, as far as your #1 and #2 concern... I posted to another thread that my vision begins to get blurry around 4 feet.  And that is SO SO SO SLIGHTLY blurred at that distance, I can hardly tell.  Then it goes from there to blurry up close.

Typing on the computer I can see the words, tell what they are but they are blurry.  My cell phone is blurry so imagine a PDA would be  the same.  In fact, the purple line of text after the  "Forum OD" post is pretty small right?  Looking through the monofocal right eye only I can acutally read it if I squint.  Books I can see the words and barely make them out - but glasses make it SO SHARP!

Monday I get the second lens put in then I'm going to get PROGRESSIVE LENSES.  They will have no Rx at the top and progress to computer distance then down to reading.  From what I've heard they take a little getting used to but the transition is smooth and seamless.

Because I can't have acrylic I went with a silicone lens (because of my job) so my Dr used the Bausch & Lomb lens.

I'm very pleased.
  

[gbakes]

Also, my night vision is perfect with NO halos or starbursts of any kind.  And walking around the house with little light is fine, too.

[hud]

You've got my curiosity- what about your job precludes you from having an acrylic implant?

[gbakes]

I'm an actor and the fear was the "glint" or reflection that sometimes happens with acrylic lenses might look strange or too noticeable on camera.

[K-D]

Many people here are trying very hard to decide on what lens is right for them to choose for their cataract surgery.  So many things to consider.  It is a very hard decision to make; it certainly was for me.  I am concerned, however, in your bias when posting on this board.  I understand you have an interest towards the Restor lens, as it relates to your work.  However, please keep in mind that not one size fits all.  You commented that Rezoom lens would be the most disappointing.  Maybe for you.  But not for me  (Did have a rocky beginning, not relating to anything but my healing and focusing ability).  I personally would rather have clear vision uninterrupted.  Seeing clear distant, then not as clear, and then very clear again, as described with the Restor lens, would be a problem for me.  So, I prefer the Rezoom lens where the clarity is smooth. However, I realize that for many people, seeing very clear in the distance, and very clear to read, is more important than the intermediant vision.  
I traded  halos for no glasses.  Many people would not want to do this.  But it was right for me.
I post to help people with information that they may want to know, not to promote a product.  I give my cataract experience as it was, in hopes of helping those with initial poor results, hope of great vision with time.  Point being, people here do not want a salesman.  They want feedback from people that have had, or will have, cataract surgery, and are trying to decide what lens is best for them. Or informaton concerning initial problems that cataract patients may have had that cleared up.
I am in no way promoting the Rezoom lens because I would not want to be responsible for anyone getting something they did not like.  I am only reporting that I got a Rezoom lens last Feb.  Had clear vision to arms length initally.  Was a wreck because blurry vision after arms length.. Had and still have severe halos at night only, slight edge reflection at night  and slight glare  from overhead lights at night, that are decreasing with time. But my vision with time, at least a couple of months, became very, very, clear.  And so that is what I write. I in no way want anyone to go with the Rezoom lens because of what I write.  I have no financial interest in the Rezoom lens. But I am very happy with this lens and believe that your statement of it being the most disappointing lens is not only bias, it is inaccurate.
Reading on this board you will find many happy people with the Restor, Rezoom, Crystalens, Traditional, and Monovision. You will also find people that are very unhappy with each of these lenses.  So, sharing information ( which you do, thank you,) and experiences, is the key here, not salesmanship.  Just my opinion.

[K-D]

Hi Hoddy.  I have no weaker intermediate vision.  My vision is very clear from distant, better than 20/20 right up to reading fine print in bright light.  Then in very bright light, or fine print,  I  have to wear readers.  In dim light, like in a restaurant, or in a Church, my reading is perfect.

[K-D]

Here is my unprofessional opinion:

If wearing glasses was not a problem for me, I would have gone with a non-multifocal or  non- accomodating lens. No night aberrations or hinges to worry about.
If you want a multifocal or accomodating lense, to avoid glasses in most circunstances,  where the reading vision is better than the computor vision,( intermediate vision) go with the restor.
If you want vision that gives great distant, and intermediate, and reading only under certain lighting, go with the Rezoom. If hinges do not concern you, but halos do,  the Crystelens may be an option, although you are not guaranteed no halos with any lens.
The multifocal may have night aberrations that the traditional do not have. They can be severe.
The accomodating has a hinge to consider.
So, they all have their advantages and disadvantages.  The choice is a very difficult and personal one to make. Best wishes.

[K-D]

Hoddy, I don't know anything about the Tennis lens.  I have read where some people really like the combo lens that you were referring and some do not.  I believe that one is refraction and one is defraction. Restor/Rezoom. I do not know if the Crystalens is refraction or defraction. Some people adjust fine with the different systems and others do not. Same as with the monovision.  Some people like it.  I had contact monovision lens and could not adjust at all.  Depth perception was a real problem for me.  Going down stairs was weird.  Regarding halos, that too varies from person to person.  Since I have astigmatism, I thought it would be no problem at all to adjust to the halos.  And really the halos are no problem for me.  But I see more than halos at night.  I see large circles around anything that shines, lights, cars, reflectors in the road, parked cars, etc.  This does not mean that you would.  Just want you to know that I thought the halos would not be a problem either but see more aberrations at night than halos and just wanted to let you know.

[hud]

I am with a Wall Street firm with a focus on ophthalmology, devices  especially. I am not a salesman, anymore than anyone else who is happy with their personal implant choice. However, it is clear that I do know more about the technologies than most who post. No brag, just fact.When I see patients asking about the Tecnis lens, it is clear that many don't know there is a monofocal version available in the US in acrylic and silicone. But they may be asking about the Tecnis multifocal, which is being talked about, but won't be available in the US until 08.
Most posters are inquiring about the best technology available today, as they have immediate needs, and they may have to pay a premium for their choice. I want to inform all interested parties that in my opinion, Alcon continues to be the market leader in technology. The latest market share data through June shows that Alcon dominates the premium IOL market place with about 75% share. They have always had just acrylic foldable lenses. Now every manufacturer is transitioning to that material for the clinical benefits. AMO discontinued the silicone Array, and now promotes the acrylic Rezoom. Alcon perfected the diffractive nanotechnology of apodization in the Restor lens, now AMO is playing catch-up with its Tecnis multifocal diffractive lens. I'll bet that most patients don't realize that all implants filter UV, but Alcon offers the choice of Restor lens that filter  just UV, or both UV and harmful blue light. Why do you care? The data shows a huge incidence of macular degeneration after cataract surgery, with genetics, lifestyle, and exposure to harmful wavelengths being possible causitive factors. Know anyone with MD? I'll bet you do. AMO is again playing catch-up with this added level of protection, but first, their paid consultants are bad-mouthing the feature, but you'll see in a couple of years, it will be standard. Regarding Bausch and Lomb implants, they are out of the game. Their model LI61U is popular with surgeons who own their own surgery center, as this is the cheapest implant available for the non-discrimnating patient.
gbakes: you will do fine with your silicone lens, but the Alcon acrysof lens was modified some time back to address the telltale surface "glint" that was not very popular in Hollywood.Current models have a 3:1 convexity ratio, meaning that most of the curvature is on the front of the optic. The original Acrysof lens was reverse, with a very flat front surface that could be detected by others in certain conditions.
Some days I say I am going to quit this forum, as I don't beleive that patients should get their medical information from faceless strangers. And then I can't help myself when I see partial information put there. Plus the socialogical factor of those who post- extremely happy or extremely unhappy- how can anyone decide  rationally?

[hud]

The Tecnis multifocal, in my opinion, will be better than rezoom, but not Restor. One advantage with the Tecnis platform is the aspheric optic, which helps if you have positive aberrations in the cornea as most people do as they age. This is a minor enhancement, but the big drawback to the Tecnis MF is it has diffractive rings all the way to the edge of the lens, creating more unwanted nighttime effects. It will still be a bifocal, which Restor and Rezoom are both. If the surgeon is spot-on with your lens power calculations, and you don't have more than 0.5 diopter of astigatism, you are guaranteed sharp near and far vision with Restor. The arms'length vision will be functional, but not as sharp. With the Rezoom, you don't get as sharp with any distance, and you will more than likely need reading glasses for your best near vision. The intermediate is touted heavily from the makers of the lens, as that's as good as their near vision gets. You decide what you want to give up with all the choices out there. Unfortunately, there isn't one optic that can do it all. Most surgeons that I have talked to say that about 90% of their Restor patients are spectacle-free after surgery. The Rezoom lens is getting a little better than their published 42%, but it still is used mostly in mismatched eyes, as your doctor suggests. It does not perform well enough to stand on its own two feet, so to speak. You might be fine with mismatched eyes, if you want a chance to have it all, but it is off-label, and according my sources, the jury is still out on this approach. Ask your doctor how many he has mismatched, and with what results. Good luck, and let us know.

[JodieJ]

I hope you don't quit this forum, even though I don't agree with everything you say. The practice of cataract surgery is currently in a state of change, and many doctors are apparently still on the learning curve with regard to the new IOLs.  Although having two healthy eyes seems to be a prequisite for successful multifocal use (and the absence of astigmatism also appears to help), some doctors are apparently implanting these IOLs in patients who don't even have two seeing eyes.  People like you, Eagle Eyes and others have been very helpful in advising unhappy multifocal recipients as well as people just seeking information.  Hud, your bias toward Alcon isn't exactly subtle, but your knowledge of Alson's products is an asset to readers of this forum.                  

[K-D]

You stated, " somedays I say I am going to quit this forum as I don't believe that patients should get their information from faceless strangers.  And then I can't help myself when I see partial information put there.  Plus socialogical factor of those extremely happy or extremely unhappy.  How can anyone decide rationally" ?

Hud, doesn't that include you?  Are you not a faceless stranger who is extremely happy with his Resor lens????

And whatever the market place , or how much technology you know about lenses, I still think many people appreciate hearing from those that have had the surgery, and share their experiences without a bias point of view. I know I do.  A bias point of view, in my opinion, makes it more difficult for anyone to decide rationally. Just my opinion. No offense intended.

[JodieJ]

K-D, you're a multifocal success story after only one implant (with even better vision days to come), and you provide invaluable info about what to expect after surgery.  It's too bad that many doctors aren't currently giving more of this type of info to their patients.  For me, people like hud are great about providing more technical info about specific products.  (You just have to factor out his Alcon bias.) It's so hard for us cataract patients to navigate all the variables, i.e., which doctor, which IOL, what to do about astigmatism, what measurements, what will post-surgery vision be like?  After three surgical consultations to date, I'd definitely think that the patient needs to have good information BEFORE seeing the doctor.  And I strongly believe that many doctors need to have a better understanding about which patients are NOT candidates for multifocal IOLs.  One of the three docs that I've seen so far actually recommended the Restor for me, although he was aware of my astigmatism and recent retinal surgery.  That's why this forum is so valuable.

[K-D]

Jodie, so agree!

[K-D]

Jodie,

Believe me, I was not happy after my cataract surgery.  I was a wreck.  I never dreamed my vision would become so crystal clear after time.  And then factor in the new lively night show I see due to my astigmatism with the THEN blurry vision. Anxiety with a capitol A. The, "why did I go with this lens?,"  "I should have done this", or "I should have chosen that"." "Should I have this lens removed", " What are the risks of removing a lens"?, Oh, I can so relate to the fear and anxiety that I hear on this board, especially one man that posted and  has never posted again.  I hope he is doing ok.  But I post because I have been in the exact same position that many on this board are experiencing.  The delema of chosing a doctor.  What lens to choose? What about the halos?  What will they look like?  If I get the traditional lens, will I just need readers?  What if I get a multifocal and do not like it.  Can it be removed?

I have no bias regarding lenses.  Everyone on this board wants their precious eyesight back!!!!!  For some it is more important to not want to have to wear glasses all the time, and for others that is not a big problem.  My doctor implants all the lenses.  He gives the plus and minuses regarding all the lenses.  I appreciate that.  As I have said before, it is more important for me to see clearly in a steady fashion.  Therefore, I do not think I would have been happy with the clear, not so clear and very clear again Restor.  But many people are very happy with the Restor.  It is just that I think it is important to hear all of the advantages and disadvantages of all the lenses before choosing a lens. It is such a personal decision to make because so many factors are involved. I know that if I would have found this board before my surgery, I would have been very influenced with what one poster posts, and that choice would not have been right for me. He makes an excellent point about the UV rays, and it is important after cataract surgery, to wear eye protection against the sun, with lenses that do not protect all the rays, to prevent macular degeneration.  I hope that whatever anyone chooses, they get the absolute best outcome, because we all are in the same boat.  We have cataracts and want our vision back.  I just try to share some of the things that I think may help someone reading this board.  Example, my vison was very blurry after arms length, after my cataract surgery, and after several months,  my vision became crystal clear. And I did not know that the halos would include circles on everything that shines.  I did not expect circles on the reflectors on the road or parked cars that catch the light, or clipboards in a office, or circles on someone glasses, or ring or watch. The inside aberration are decreasing.  I just wanted to give a heads up to people so that by halos, they  realize it may be more than they expected. Then again, they may not have any, or just slight aberrations.  Still, I would choose my lively night show because of the advantages that I have with my lens, and I do not do much night driving.  Best of wishes to you Jodie.  Hoping for 20/20 vision for you, with no aberrations.

[gbakes]

Hi all - Yesterday I got my L eye mono IOL implanted and my vision is GREAT!  I made the mistake of reading Hud's post that Bausch & Lomb is "behind the game" moments before walking out the door to go get a Bausch & Lomb lens put it.  (Reserving nasty comment for the biased one)

After the surgery my vision was extremely blurry and milky-white.  This was frightening after having the R eye done just 7 days prior and vision was near perfect on the ride home.  But, after about 6 hours and a nap - all cleared up perfectly.

Today I got tested: R 20/15 L 20/15 almost 20/10!

I can even read the newspaper print sitting on the car seat next to me!  I feel great & the world looks great.  Last night I took a drive and NO HALOS - nothing.  Absolutely crystal clear.  Astonishingly clear.  So much for Bausch & Lomb, huh?  (Anyone with any financial interest in any company can and will find a way to "spin" data to fit their needs.  I think Hud is very knowledgeable but would caution against the clearly biased posts.  I don't think this is the place for it.)

Anyway, I just want to say that my 2 MONO IOLs (focused for distance) are doing great, I wouldn't have changed a thing.

I'm not "selling" my lens - I just hope it helps people who choose OR can't get a MULTI lens to feel good about their decision.  This forum has helped ease my fears... except for yesterday. :-)


I'll need glasses to work for long periods of time at the computer - but can actually do e-mail and such w/o them.  It's a little blurry, but I can still see the e-mails.

[gbakes]

Quick response!

>>What activities do you feel are limited by monofocals:
   - reading: YES
   - using cell phone/pda: YES
   - reading a menu: PROBABLY
   - seeing the dashboard: ABSOLUTELY NOT
   - see shopping labels: PROBABLY
   - shaving: NO

>I'm assuming that if I get monofocals I'll be able to basically >function without glasses except for reading? Is that consistent >with your experience?

Again, I could read newsprint when the paper was sitting on the passenger seat in my car.  I was shocked!

Right now I'm typing at the computer and it's 95% in focus.  Glasses make is SHARP but I can still see the text just fine.

I believe that anything within arms reach is SOMEWHAT readable - but made perfectly clear with glasses.  I'd never worn glasses before and was NOT HAPPY about the idea of wearing them.  But the HALO / GLARE / reflective issues kept me away from MULTI.

The thing that impresses me is that everything, I'd say, 4 feet+ is ASTONISHINGLY CLEAR.  with NO HALOS or artifacts of any kind.

Soon I'll be getting progressive lenses that will correct all my computer / reading issues.

((I don't know what forum protocol is but if you want to e-mail me directly or talk on the phone I'd be ok with that.  But, I do like keeping the info available to all.  ***@****))

[gbakes]

Best of luck, my friend.  In the end it's not as bad as looking through the nasty fog of cataracts.  I'm pleased and soon so will you.   Keep us posted.
GB

[K-D]

I have a big smile on my face right now.  I am so happy for you! And when I hear the no halos, I shamefully have to admit a bit envious.

Kathy