My Ophthalmologist says that multifocal lenses are rubbish! Is he right?

[hondaboy2001]

Hi Guys

I'm 37 and have a sever cataract in my left eye.  I've been referred from my optician to Moorfields hospital in London to see a cataract specialist.

He was very nice and told me a lot about the condition, but when the subject came up of which IOL I should have, he told me that multifocal lenses are all **** and I must, must, must have a monofocal lens.  He says that he'll use an acrylic lens that he's been using for the past fifteen years with good success.

I talked to an Ophthalmologist in Florida, who said that I absolutely should have a multifocal lens if at all possible.  He went on to say that he wouldn't let anyone near his eye with a lens that's been around for fifteen years.

I really don't want to lose my near and intermediate vision, but am very confused.  

Would anyone here go for (or have gone for) a monofocal lens over a multifocus one?

[Forum-OD-MP]

many have.

what you're finding out is that there are no rules, and there are as many opinions on who needs surgery and who doesnt and what kind of implant to use as there are doctors.

if you get a monofocal distance-vision lens you absolutely will lose your intermediate and near vision.

[JodieJ]

It's been my experience that many cataract surgeons are extremely conservative in their approach.  I had to argue with my surgeon in order to get aspheric IOLs--he strongly preferred the conventional monofocal lenses.  (He did use ReStor, but only because the market demanded it.)

If I were 37 years old an needed cataract surgery, I'd definitely want either monovision or multifocals IOLs (even though they're not perfect.)

[Dr. EIZenhower]

My friend you sound like a perfect candidate for the crystalens but I don't think its available in the UK.

[hondaboy2001]

Thanks everyone, for your commments so far.

My surguen said that he has implanted Crystalens, but said it was **** (his exact word).

The Ophthalmologist I've been speaking to in Florida, says that he finds most success with Restor (which he uses wavefront to fit...whatever that might mean).  He says he gets a success rate of about 50/50 with Crystalens.  He doesn't rate Rezoom at all.  He did say that there is a new version of Crystalens out now, but he hasn't tried it yet.  Anyone have any experience of this?

Has anyone used Technis multi-focal, which is available here in Europe, I believe?

[Dr. EIZenhower]

Your surgeon obviously doesn't speak the "Kings English". Best of Luck....EIZ

[Mosesandre]

I recently had been diagnosed as having cataracts and had a Rezoom lens implanted in my right and dominant eye and a Restor implanted in my left eye.  The doctor who originally told me that I had cataracts scheduled me for surgery involving standard monofocal lenses,  She said nothing about there being multifocal lenses that might give me independence from glasses.  I only learned about the multifocal lenses after searching the internet.  I then found several doctors in my area who implanted multifocals and quickly canceled my surgery for the monofocal lenses.  I told my original doctor that I was very disappointed that she failed to mention the possibility of getting multifocals.  I even asked her technician if such lenses existed and was told that monofocal lenses were the only ones that they would implant.  After having a frank follow-up conversation with my original doctor, I discovered that she was fully aware of the multifocal lenses and planned to start implanting them sometime in the future.  Imagine how I would have felt after getting the monofocal lenses and then discovering that multifocal lenses existed.  Pretty unethical in my view.

After I found out about the multifocals, I read what I could find about them and spoke to many doctors, including some in other states.  I also read the information available in this forum.  My choices among multifocal lenses included Crystalens, Restor, and Rezoom.  Initially, I was impressed with Crystalens, but decided against them based on the range of accommodation and safety factors related to the hinge design.  I was told that the surgery for the Rezoom and Restor is very similar to surgery for the standard monofocal lenses.  All of these lenses are easier to extract if changes need to be made later.  I learned that many doctors were going with a combination of Rezoom and Restor lenses in an effort to take advantage of the strengths of each.  A newer multifocal similar to the Crystalens but without the hinges called Tetraflex is currently being field tested in Europe.  This was not an option for me as I live in the U. S.  In England, this might be an option if you can contact the right people.

One potential drawback to the Rezoom and Restor lenses is halo effects.  Other issues are cost, pupil size, and the effects of astigmatism.  I personally have had no serious problems with halos, and these problems are supposed to abate over time anyway.    I have had to pay an additional $1800 per eye beyond insurance coverage for the multifocals, but this cost includes follow-up Lasik surgery for astigmatism.  Small pupil size can undermine the effects of the Rezoom lens for intermediate and near vision.  Vision with multifocal lenses at all distances also can be significantly compromised by astigmatism. The best way to correct astigmatism is via Lasik surgery after lens implantation.  I had to learn all of this information on my own.

Right now, my vision is not perfect at all distances.  I have very good (20/20) distance vision in my right eye and better distance vision in my left eye than before lens replacement. Vision at other distances is coming in slower.  I can read a book in good light without glasses but not at a 20/20 level yet.  I have noticed gradual improvement at closer distances, and my doctor is confident that the Lasik surgery will remedy most if not all of my current deficiencies.

Overall, I'm glad that I had this surgery and anticipate that I will be glasses independent eventually.  You just have to be patient.  I recommend reading through the archives in this forum.  There is a lot of discussion about the pros and cons of multifocal and monofocal lenses.

[JodieJ]

Have you considered the accommodating Tetraflex lens?  It's available now in the UK but not in the USA.  Somebody from the UK posted a very favorable report about that lens recently--and it doesn't produce halos.

[hondaboy2001]

Hi Guys

Thanks for mentioning this Tetraflex lens.  I've never heard about it, but will check it out.

[Tony12]

I had Tetraflex Accommodative lenses put in both eyes a few weeks ago and am just amazed how good my vision is now. I don’t need glasses at all for driving or computer work. I can read really small print like on the back of shampoo bottles which I haven’t been able to do for years although the light must be good. For poor light I use just bog-standard magnifier glasses as it’s less strain. I still have some glare in my right eye but so do many people in the first few months after cataract surgery.
Although Moorfields is one of the best eye hospitals in the world, if you are referred there under the NHS then they will only give you Monofocals as they consider anything else a “luxury”. For me it was really important to have good reading and computer vision as I just hated being dependent on glasses. I had 3 different pairs and was constantly losing them or treading on them! If you can afford it, or have insurance, then I think Tetraflex are the best around at the moment (in the UK anyway – they’re not available yet outside Europe). It cost me £2250 for each eye which is loads of money but at least you get to choose the best surgeon around - unlike the NHS. Mine was recommended by my optician and has done over 7000 cataract operations. He only uses Tetraflex lenses now mainly because they give less problems and you don’t get those horrible night halos that people constantly mention. I’ve read some really bad reports about the Crystalens so I’m surprised that Dr. Eizenhower recommends it – I guess he’s probably just a rep. Do some research on the internet and I think you’ll be impressed. Also get opinions from different opticians and definitely AVOID all those eye clinics springing up all over the place – make sure you choose the surgeon not the clinic.

[hondaboy2001]

Hi Tony

Thanks for the advice.  Could you tell me who your surgeon is and how to contact him?

I've got private insurance through work, so it should pay.  However, I see in the US, insurance companies will only pay for monofocal lenses as well. So, I guess I might have to top it up.  We'll see.

I've read some reports this afternoon that suggest that Tetraflex stops focusing after about six months.  Did your surgeon ever mention this, or is it just a rumour?

[Susan12345]

I agree with the surgeon who said multifocal IOLS are rubbish!!!!!!!!!!!!  I had the ReStor lenses in both eyes and it was a huge mistake. Apparently some people have good results but others can never adapt to them.  Unfortunately the doctors don't tell you this in advance, and now I have to risk going blind by having them explanted or live the rest of my life with the visual problems I got from them.  I would NEVER NEVER NEVER have had them if I'd known the risks.    Susan12345

[hondaboy2001]

Hi Susan

Sorry to hear about your problems with your multifocals.  I realise that this is a big risk and that multifocals are not a great solution.

That's why I'm seriously leaning towards the Tetraflex.

[Tony12]

His name is Mr Jeremy Joseph M.D., F.R.C.S., F.R.C.Ophth. Consultant Ophthalmologist and his private secretary is on 020 8901 5561 or mobile number 07956 503 134. He works in the NW London area. Good luck and let me know how you get on.
As for that rumour (I think it is) where did you hear that?  Everything I’ve read has been positive. Could it be just one person’s bad experience? I think that because the Tetraflex is not available in the USA we don’t yet read the bad experiences on this forum, and I’m sure in years to come it will also have its fair share of complaints. In my opinion the Tetraflex is better than the Restor & ReZoom purely because of the halo problem and this is what most people complain about. There’s still a 10-20% chance of still needing glasses with the Tetraflex, but that’s still better than monofocals where it is 100% you will still need reading or computer glasses. Sometimes people get a bad surgeon or they have other eye problems, so getting the best surgeon possible is the most important thing in my opinion. I read on another forum that a woman lost her sight in one eye completely after a monofocal implant and that was from an infection that she just ignored. There will always be risks.

[hondaboy2001]

Tony

Thanks for the info, I really appreciate it.

I'll let you konw how I get on.  I've passed a message on to my Ophthamologist to explain that I want the Tetraflex lens, so I'm just waiting to hear back from him.

I live in Reading, so NW London is ideal.

I'll let you know how I get on.

[hondaboy2001]

My Moorfields surgeon, said that he didn't have any experience with Tetraflex and so, wouldn't implant it.

Subsequently, I've talked to loads of people about the Tetraflex lens, including your surgeon, Mr Joseph.  I'm seeing him on 5th Jan. He thinks I'd be perfect for the Tetraflex (providing there's no physiological problems, of course).

I'll let you know how I get on.

[Dr. EIZenhower]

Dr. Eiz back on this thread, want to assure Tony 12 and hondaboy not a company shill.  Just can't imagine a 37 y/o having multifocals, makes nooooo sense.  Tetraflex is a copy of the crystalens for all pratical purpose, so my original suggestions stands, accommodating lens for a 37 y/o is completely logical

[hondaboy2001]

Hi Dr Eiz

I absolutely agree with you about the accommodating lens for someone my age.  I can't see how I can lose, really.  The worse case scenario is that it will only act like a mono, which means I would be no worse off.

I did look at the Crystalens, but from my research, the optics are too small, creating edge effects in patients with large pupils.  Tetraflex has much bigger optics, so this doesn't happen.  Also, it’s not hinged, so can't move backwards.

It won't be as good as the lens in my right eye, but I think it will be better than a mono.

[Dr. EIZenhower]

Good luck, I'm sure your going to see like an eagle.  EIZ

[Tony12]

Good luck Honda Boy and keep us all posted. I'm glad to have helped.