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Mono- or Multifocal

I am 70 years old and have cataracts in both eyes. I initially decided to go with the Restor lens from Alcon - but it's not available. I need 8.5 to 9.0D and I also have some astigmatism (don't know what it is). By now I have been waiting for over a year and my vision gets progressivly worse. I am now using my driving glasses to do close up-work. I don't mind wearing glasse, but could never get used to bifocals. The only thing I am really concerned about is the Depth of Field issue, e.g. I want to be able to see (in focus) my speedometer and the road ahaed of me without having to switch glasses. Any help would be appreciated.
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Avatar universal
um, dont know.  many variables here.  yes if your Rx is -9.00 or +9.00, that likely wont be available in a multifocal.

you'll need regular monofocal cataract extraction, and then after the surgery you'll likely need reading glasses...
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Avatar universal
IMO, the notion that one out of every 1000 cataract surgeries results in total blindness is total **** ****.
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Well, I really can't blame the doctor.  I chose him specifically because he does the multifocal IOL's and according to the other 2 docs I have seen they were placed correctly. It wasn't like he was begging me to do something I didn't want.  I just should have asked many many more questions before the surgery.  I just didn't know what questions to ask.  And even if I had, it probably wouldn't have helped, because apparently none of his other patients have had experiences like mine.  That's why I'm so frightened to even think of more surgery.  I feel trapped and terrified, worrying about this constantly.  Susan12345
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Avatar universal
Well, but I can't not read for 9 months. I do see the halos at night but don't find them any big deal.  But not reading would be a VERY big deal!!!
                                      
I went to another doctor to find out the risks of having the ReStors removed.  He wants to get my surgery records and examine me again.  I really doubt that I'll have the nerve to go through more surgery though.  Something else would go wrong.  The fluttering drives me nuts, but it's not all the time, worse with bright fluorescent lights like a grocery store or with reading for too long. At least I CAN see and read.  So it could be worse.   I'm TERRIFIED of going blind.

I asked this new specialist how the ReStors were supposed to work.  He said, frankly, he'd been trying to figure that out for a long time and still had no idea!  He does put ReStors in, and I asked him how many he'd taken out.  He said none.  I asked him how many IOL's of any kind he'd taken out and he said hundreds.   Which sounds like a lot, but from his age he's probably been doing this for 30 years, so that's maybe one a month.  Though they probably didn't do as many explants until the multifocals were invented.  When I see him again I'll ask him how many of the hundreds were successful.  

Anyone, I desperately wish I'd never heard of the ReStors!!!!!!!!!

Susan12345
Helpful - 1
Avatar universal
My second cataract surgery was completed over a month ago. I chose to have multifocal lens implanted. My surgeon uses one Resume and one Restore lens. My left eye - non dominate has the best close up vision. My right eye - the dominate one - has the best intermediate vision. I have 20/20 vision in one eye and 20/15 in the other eye. I didn't have a problem "seeing" after the first surgery (the better close vision), but I did use my old glasses for close reading for any length of time. The glasses are progressive and my doctor says the eye picks up the amount of help it needs. After I had the second eye done, I saw very well without glasses, but still needed some help for close up reading for any length of time. My doctor said it might take a while for my brain to get accustomed to the slight differences. I kept trying without glasses and found that getting a better reading light fixed that.

I notice halos, but they are not large and, unless they are halogen (those very white headlights), they don't bother me. I don't do much night driving anyway.

My doctor said that one multilens and one mono lens worked together, but one multilens and one uncorrected eye did not work that well together.

I can see the computer very well. I spend a great deal of time using the computer. I found that the lowest computer screen setting worked best for me. The one where the desktop icons are largest. When using programs, I use as is or adjust them within the program.

I find that I read better with a white background and black letters. Sufficient light is important. Polarized "driving" sunglasses (amber) have been very helpful to me as I am more sensitive to light than I was with cataracts.
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Avatar universal
You may always hate your ReStors, but I do have a suggestion for you which is guaranteed to improve your vision with them:  a laser enhancement.  (I think PRK might work better for someone with dry eyes.)  As I recall from your previous posts, your cataract surgery left you farsighted in both eyes with significant astigmatism (about 1.75 diopters, I believe).  This is WAY too much refractive error for any multifocal lens to perform well.  Most surgeons who use multifocals include a post-surgery laser enhancement in their fee.  (Actually, many surgeons would insist on a post-surgery enhancement for someone with your degree of astigmatism, because the ReStor lens is very sensitive to even a little astigmatism--and you have a lot.)  Correcting your farsightedness would improve your near vision with ReStor, and you wouldn't have to wear reading glasses for distance vision.

You are obviously a more tolerant person than me when it comes to your vision.  There is simply no way I would accept the vision you reportedly have.  First, I'd consult other surgeons familiar with ReStor.  If they thought laser enhancement would help, I'd do it.  Otherwise, I'd have the lenses explanted and replaced with something that would work better for me.
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Avatar universal
K-D
Susan, the way I understood it, the Restor is a defractive lens and the middle of the lens is for close vision.  The Rezoome is opposite.  It is refractive and the middle of the lens is for distance. They work differently and I guess that is why some doctors are mixing and matching. I am so sorry for all your anxiety concerning your outcome.  I experienced the same for 3 horrible, hopeless months.  Then the clear vision came in, and then the PVD, which again has caused so much anxiety and unclear vision.  Hoping things get better for both of us. Problems with sight cause such anxiety.
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Avatar universal
If you had trouble adapting to bifocal glasses DON'T go for a multifocal IOL.  I had ReStor IOLs installed and it was the biggest mistake  I ever made, I regret it daily. I asked the doctor before whether not being able to adapt to bifocals would have any effect on not being able to adapt to multifocal  IOL's and he said no, but he was clueless.  I'm still constantly switching glasses (I can't read with the ReStors's at all without reading glasses (same strength I had before surgery) so it's still back and forth switching glasses) and there is a frequent fluttering which drives me nuts as my eyes and brain try to catch up with each other.   I still haven't figured out HOW these are supposed to work, but they sure don't work for me.     Susan12345
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Avatar universal
K-D
Susan,

Maybe it would be better if you tried not to use the glasses.  I read that for some, it can take 9 months for the brain to adjust to multifocal implants.  I gave up on the halos improving after 8 months, and then to my shock, in the 9th month, they are getting smaller. Maybe using glasses is preventing your brain from adapting to the Restor.
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Avatar universal
Well, those were the statistics this doctor quoted me.  I don't know where he got them from.  If those are his personal statistics, I guess I need to find another doctor. I'm not sure how. Susan12345
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Avatar universal

Jodie, the  doctor said that there was a 1 in 1000 chance of total blindness in that eye ANY time you went into an eye for surgery, even regular cataract repair.  The additional risk of retinal detachment with an explant is just when doing the surgery, above the  lifetime risk, because of the risk of capsule rupture.   Plus there was a list of additional risks like corneal decompensation, which I didn't really understand, but I'm sure it's definitely not good.  Plus, if I do decide to have it done, I've got to figure out whether this guy is really the best one to do it and I just don't know how to determine that.  

Blue, what tests did Dr. Waltz do to determine that your IOL was positioned incorrectly that the previous doctors didn't do?  I've been told by 3 doctors now after dilated eye exams that my IOL"s were centered perfectly, but it sounds like you were told that by several doctors as well.  Good luck on your surgery.

Susan12345
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Avatar universal
Unfortunately, I just don't have a clue whether I'd be in good hands with this surgeon or not.  How do you decide?  He was in the "Best Doctors" list, but so was my other surgeon.  He didn't have anything to say about why my ReStors didn't work except that my eyes are strange.  Of course, like the 1st cataract surgeries, it'll be done one at a time, so if something goes wrong I'd only be blind in one eye.  But I pretty much have to emotionally  commit to having both done, because it'll make me nearsighted again.   I know, from the 5 weeks between my 1st and 2nd ReStor surgeries that having one eye corrected for distance and one for near wouldn't work for me and I'd rather be corrected for near and wear glasses for distance than vise versa.   Susan12345
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Avatar universal
blue92--Your post is testimony to belief that resourcefulness  and a positive attitude can pay off.  Please let us know your outcome--I'm anticipating a very good report.  (And thank you, eyecu, for posting Dr. Walsh's name on this forum.)

Susan--What's this about blindness?  From the info you posted, your chances of experiencing a retinal detachment are less than 1.5 percent if you explanted your "horrible" lenses.  That's really not much different from your chances of retinal detachment if you don't explant your ReStors.  But even in the extremely unlikely "worst case scenario," having a retinal detachment doesn't make you blind (unless you decide not to treat it).  Retinal surgeons repair detachments every day.  One of my coworkers has had two retinal detachment and currently enjoys good vision.

Susan, in your case, it doesn't really matter why your ReStors don't work for you.  You've found a surgeon who can exchange them for lenses that will make your life easier and potentially more satisfying.  Go for it!
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Avatar universal
A while back I wrote describing my visual problems with the Rezoom lenses. My problems were ghosting, double vision and no decent intermediate vision. Close vision was good and distance vision was good except for the ghosting. I developed severe dry eye after the surgery and the aberrations were mainly blamed on the dry eye. Fortunately, my dry eye is subsiding (finally), but the visual aberrations have not. I have been to a number of doctors for a second opinion. I realize that most doctors do not really understand the mechanics of the lenses and the critical items that must be considered for a successful outcome.

Somebody posted a successful Restor explantation done by Dr. Kevin Waltz in Indianapolis so I decided to make an appointment with him and took the trip to Indiana to see him. Dr. Waltz was able to diagnose the problem within minutes and confirm my hunch that the lenses were displaced in both of my eyes after a thorough examination. I was actually able to see the decentralization of the Rezoom lenses in the photographic pictures he took of my eyes and could see the refractive misalignment in the digital printout after a test for refraction was done.  The pictures told the whole story. I always suspected that there was something wrong with the placement of the lenses but no one was able to pick up on this. They all blamed the problems to adaptation, dry eye, astigmatism, etc.

Surgery to reposition the lenses is scheduled for late December for the right eye and 3 weeks later in January for the left eye. The procedure for repositioning is less traumatic and safer than removing the lenses and I have full confidence that Dr. Waltz will resolve my problem. Dr. Waltz is an Array lense implantee himself and I was amazed to see how well he could see in all light levels. I will keep you updated and let you know the outcome of my repositioning surgery.

The moral of the story, is keep looking for someone who's qualified and understands the technology..
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Avatar universal
Betting odds, maybe, but if I had good luck I wouldn't have had the problems I had with the ReStors in the 1st place.  If it were only one eye that had the problem it might be easier to make the decision, but 2 more surgeries....it's so terrifying.    One really strange thing, the doctor said that on my corneal exam I had zero astigmatism, my surgeon HAD corrected it 100%, but on my refractive tests I do still have significant astigmatism in my right eye.  I asked him how that was possible and he didn't know, said maybe it was in the lens but didn't have the time/inclination to speculate.  That is so weird.   Susan12345


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Avatar universal
I think you'd be in very good hands with your new surgeon.  Do you currently have better vision in one eye than the other?  You could start by explanting the ReStor in your "bad" eye, without committing to any procedure in your other eye.  I predict that you will be so pleased with the results of the explantation that you'll be eager to schedule the second procedure.

I'd be interested in knowing your doctor's opinion about why the ReStors didn't work for you.
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Avatar universal
I hope you decide to get "those stupid, horrible lenses" explanted.  They've made you miserable for long enough.  And unless I've miscalculated, your probability of retinal detachment is less than 1.5 percent.  Sound like betting odds to me.
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Avatar universal
Jodie, I had my appointment with the most recent doctor on Friday, and he said the astigmatism is not the problem, if it were I would be able to see fine with glasses.  He says the only solution is explanting the ReStors.  At least he believed my complaints and didn't dismiss them as being tired like the doctor who put them in.  But I am just so terrified of the risks of more surgery.  He says it can be done, outlined the risks, 15% chance of the capsule rupturing with a 5 to 10% chance of retinal detachment if that happens.  All because I had these stupid horrible ReStor lenses.   Susan12345
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Avatar universal
K-D
Jodie, I am not patient. I am a coward. Your info gives me hope though.  Thanks so much!
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Avatar universal
You're so much more patient than I am--I'd probably already have my appointment set up for 4 weeks from now.  (Patience is not my virtue.)  I don't think a vitrectomy would be very risky.  And it's been reported that with the new sutureless vitrectomy equipment, recovery is extremely rapid.  (One doctor reported that the day after the vitrectomy, it's often not apparent which of the patient's eyes had the surgery!)
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Avatar universal
K-D
Jodie, the retinal doc said that in four months the floaters would fall below the line of vision, go to the side, or the brain would tune them out.  I have only 4 weeks to go and I do not see any of that happening,  other than a small lightening of the floaters.  Dr. Prince mentioned 9 months.  So, I am going to wait until then.  I have a doctor lined up.  A doctor that I go to had it done by this doctor and is very pleased with the results.  It just helps to know that something can be done.  It is weighing the risk against the constant aggravation.  I think that if things remains this way in another 6 months, I will be ready to take the risk.  Thanks for your concern! Kady
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Avatar universal
K-D, i still don't get how the ReStor is supposed to work. How do your eyes and brain "know" to read with the center of the eye and look at distance with the outside and what is the part you're not using supposed to be doing?  Although I was never able to adjust to bifocal glasses there IS basic logic in how they're supposed to work, the top for distance and the bottom for close.  But I don't understand the logic behind the ReStors at all.

Sorry about your PVD, hope it improves.

Susan12345
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Avatar universal
K-D

Susan you are not kidding.  I was scheduled for surgery on my second eye many months ago. No mention of destorded vision, or any problem was mentioned.    Then after the study report was in, it changed to, " risky destored vision and eye surgery before cataract surgery, and months of healing".  It is hard to know who to trust.  This was definately financially related to me. Study over.  No need to finish the reduced rate patients, in my opinion.
Jodie, Can you tell me about your vitrectomy?  Is it really that risy?  My floaters are not improving from the PVD and I don't want to live the rest of my life like this.  But I read many times how risky a vitrectomy(sp) can be. Can it be done while awake?  Does it increase risk of a retinal detachment? I am just going into my 4 month after the PVD, but very little improvement.  If after a year things do not get better, I was thinking about seeing a doctor for this procedure.  Can you give me your opinion?  Thanks much!
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Avatar universal
You're saying that the floaters are causing you constant anxiety and driving you crazy.  (I'd probably feel the same way.)  What does your retinal doctor say about the probable time table for improvement?  At what point might you consider surgery in the event that your situation doesn't improve?  Maybe you could use another opinion.  Having information doesn't commit you to a course of action, but it's usually helpful for reducing anxiety.
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