ReStor, ReZoom or Monofocal?

Since I have been diagnosed with cataracts in both eyes, and am scheduled for surgery on the left non-dominant eye on Nov. 7, I am faced with deciding between the risks / costs associated with multifocals vs. tried and true monofocals. The tipping point is..well HOW bad will my intermediate vision be with a monofocal? I'm 45, and have only needed weak drug-store reading glasses - until recently. I can deal with wearing reading glasses for closer stuff, but would be more unhappy if I needed glasses all the time for intermediate ranges like computer work, or working on my tractors. My Doc wants to do Restors, but I hear the ReZoom is better intermediate. However, I do alot of night driving in the winter and I would be concerned about Halos. (Incidentally, could someone who has multifocal describe the halos to me? Maybe they are not as bad as the fuzzy blobs of glare I'm seeing now.)So, my basic question is, can I get decent intermediate vision with monofocals, or will they take so much of my near/intermediate vision away, that multifocals would be worth the risk?

[Forum-OD-MP]

"HOW bad will my intermediate vision be with a monofocal?"

if both eyes are monofocal distance-vision, then your intermediate vision w/o readin g glasses will be terrible.  you would definitely need reading glasses for computer work.  both restor and rezoom have halo problems.

no, you cannot get decent intermediate vision with monofocal iols.

[Dr. EIZenhower]

The crystalens is a monofocal that provides the best intermediate vision of the three premium IOLs. EIZ

[DianeAllen]

After some careful consideration & research online, I decided to pay an additional $3,000 to have ReZoom multi-focal lenses instead of the standard monofocal ones covered under OHIP, the Ontario (Canada) Health Insurance Plan. The operation was a breeze, but the period since has not been without its problems in terms of my eyesight, glasses & halos. Be sure to have the surgery when you don't absolutely have to work fulltime b/c it will slow you down visually for a few wks till you recover & reach full capacity again.

I was told Rezooms would give me a 90% chance of not needing glasses at all - an amazing offer to someone who had worn them since age 4 (now 60) & had to use 2 sets of bi-focals (desk/computer, distance/closeup). I had to change my glasses dozens of times/day -- whenever I got up from my desk or someone came into my office. My bifocals were progressive & had a mid-range for the computer screen, but it was so narrow that I just couldn't hold my neck at the necessary angle for long. (Many people have told me the same thing). I was told that ReZoom offered the best solution to those who use computers & need intermediate vision.

The 1st lens gave me near perfect distance vision in that eye, but I still needed minor correction for reading & computer. The doctor then chose a slightly different prescription for the 2nd
eye in the hope of compensating for this & having me not need glasses at all.

The period after surgery was VERY awkward because:
* my old glasses no longer worked (since I had corrected vision in the eye operated on)
* it takes a while for the vision in that eye to clear up
* it takes at least 6-8 wks, sometimes longer, for your vision to really settle down to the point where new glasses can be prescribed if necessary
* the halos were bad enough to prevent me from driving at night, & made it difficult even walking around my neighbourhood. They form a wide band around every light, the same colour of the light - porchlight, car head or tail light, streetlight, illuminated sign, you name it. 4 mos have now passed & the halos have lessened significantly but are still present.
* going any place - store, office - that has fluorescent lighting is still very difficult. At 1st, it seemed like the lights were vibrating & I'd have to leave; even now I still don't see well in these places.

*** I absolutely would have had to take an extended leave of absence if I'd had a job requiring me to drive after dark or work in under fluorescent lighting. ***

In the 2 wks between when the 1st eye then the 2nd was done, I managed by:
* having that lens in both pairs of bifocals replaced by clear glass; this worked for driving/walking/etc but I couldn't read with them
* covering the clear glass lens in my computer/reading glasses & just using my unoperated-on eye & its prescription lens to read/work on computer (very slow & tiring)

After my 2nd eye was operated on (2 wks after the 1st):
* my distance vision was now fine w/o glasses - I can drive/walk around, & see people in the room clearly
* for a few days, I used my husband's computer glasses for reading/computer (they have just a little magnifcation).
* Once I could drive, I got my own drugstore glasses for this interim period, until it became clear whether I will still need RX lens for computer/reading.

I had migraines for 5 days straight afterwards; I think this may have been caused by my eyes/brain trying to adjust; the migraines were in a different place -- right between my eyes -- than usual (top of my forehead) ones which only come 1x/mos

It's been 4 mos now since my surgery. I still can't use the computer or read w/o glasses, & I don't have good intermediate vision for preparing food at the kitchen counter, reading the dial on the washer, etc. It is frustrating to have to always carry around reading glasses which inevitably are in some other part of the house from where I am when I need them.

Therefore, I plan to buy 2 different pairs of bi-focals (desk/computer, reading/distance) as before, only:
* I can still go w/o glasses to drive, walk etc if I want
* the new glasses will be much thinner/lighter than my old ones

I don't regret having paid the $3,000 for the Rezoom lenses, even tho finances are very tight for us, because it was worth the gamble & I still have the freedom to walk/drive w/o glasses.

[JodieJ]

Thank you for posting your detailed, very interesting account of your experience with ReZoom.  I've read that it takes 9 months before your brain has fully adjusted to multifocals, so you may experience further improvement in your vision during the coming months.

I had no idea that the adjustment to multifocals was so challenging.  You've really kept a positive attitude!

[K-D]

Jodie, that is so true.  It is 8 months since my Rezoom implant and just recently I noticed that my halos are getting smaller.  It would be so helpful if doctors would stress this adjustment period.  Most people are left with the idea that the result is immediate with the multifocal lens. My halos used to cover a whole car coming towards me.  Now the very large halos are in the distance. At first the tail light of the car in front of me covered the whole car.  Now the tail light is normal in the car in front of me but the further away, the larger the halos.  It is now manageable to drive.  Initially I could not drive safely at night.  Now I am beginning to believe that they may even get smaller with time. Multifocals definately take a long adjustment period for some people. And if this was stressed more, people would not be so alarmed. The problem is that when you see such aberrations and are very upset, you have a short time to safely explant and that is the delema. Waiting to see if things improve makes it less safe to explant should that be your decision.

[janjan99]

HI - Just my experience...I have monofocal lens and my intermitamt vision is just fine. I read most everything that except newspaper fine (use cheap drugstore glasses), work at computer, and watch tv without any problems and no glasses....My lens are 13.5d amd 13.0d and they work for me...I use my glasses for night driving because they make everything look sharper, but I have no halos..hope this helps

[kckc007]

Hello
Just saw your comments and I was wondering which doctor are you using and how do I contact them. I have been trying to look for doctors that specialize in multi-focal IOL in Ontario. Any help you can give me is greatly appreciated. Thx

[K-D]

Boy are you fortunate.  Sounds like you can see better than some with the multifocal and without the problems or expense.

[janjan99]

I didn't realize this was not the norm....I am 48 yrs old and my surgery was done at Kaiser Hosp. in Los Angeles.  90% of my day I do not use any glasses.  My vision about 20/500 before surgery, and couldn't function without glasses extreme myopia.  After surgery I was about 20/40 at 6 weeks, and now can see 20/30 and the last surgery was performed in June of this year.  Recovery was very easy.  Hope this helps.  Jan

[Felis]

I had cataract surgery in this summer. After lots of research, I wanted to set my vision for 20/40 with Alcon monofocals. Now, I can do pretty much everything without wearing glasses (reading, computer, driving, etc). The only time I wear glasses is when driving at night.

There's no magic here. With 20/40, you have distance vision good enough to pass the DMV test and excellent intermediate vision. I can read pretty much everything at 20 inches.

I am not saying that my choice was better than the Restore/Rezoom. I wanted to go with the safest route (my surgeon said the monofocal procedure is almost perfected that it can't go wrong) and made a decision. Except initial minor flickering vision, my recovery was ultra quick and smooth.

20/40 may not be acceptable for someone who's not myopic at all. But to me, as we age, being a slight myope does have benefits.

[HamiltonGuy]

Thank you all for taking the time to post such detailed comments. You all are very kind and extremely helpful. I guess there are more satisfied monofocal recipients out there that I thought. I've interviewed a couple of folks I know with monofocals, and they were happy. Right now, I'm leaning toward monofocals for two reasons: 1) There appears to be less risk. I'm guessing that monofocals are more forgiving concerning the measurements that are taken. (My doc says that multifocals have to be "dead-on" correct & perfectly centered). 2) I am very concerned about the night halos.  That seems to be a constant in every post or conversation I've had about multifocals. I know they are supposed to go away over time as the brain adapts, but there are too many people saying that they still have them in a significant way 6-8 months down the road.

I know with this decision that I must be prepared to lose some intermediate range. Still, there may be ways to minimize that. I'm new to all this, so I'm just going to have the work the problem. You folks are a great help.

So, I guess now I'll have to find out about what types of monofocals are out there and what spherical vs aspherical means!

[K-D]

Had I found this board before my surgery I would have gone with the 20/40 vision monofocal lens.  I have always had 20/40 20/200 vision and never wore glasses.  So, that would have worked fine for me.  Best wishes for you HamiltonGuy!

[janjan99]

I too wanted the best possible outcome..I researched the multifocal lens, but did not want to risk the halos at night (that what prompted me to have surgery).  I am very happy with monofocal and the cost difference was not worth the risk hoping not to wear glaseses at all.  It was approx 10,000 for both eyes for multi vs $100 for monofocal.  My insurance covered cost for monofocal but not multifocal.

I can say I am truly happy with my results, and hope you experience the same....Good Luck and let us know how you come out.

[JodieJ]

My distance vision was 20/40 with monovision and a macular pucker in one eye.  I could drive but I couldn't read the road signs.  I couldn't find what I was looking for in the supermarket because I couldn't read the overhead signs at the ends of the aisles.  And I couldn't see what the cashier was ringing up on the register.  I probably unintentionally snubbed people because I didn't recognize them.  If your standard is 20/40 and 20/200, then you're REALLY going to appreciate your upgraded vision when you get your second multifocal.

[K-D]

I hope so Jodie.  I read how happy the people are with the traditional lens.  And now since I had my wits scared out of me by the doc telling me that a second multifocal could give me distored vision, which was never mentioned for 7 months prior, it puts me in a very nerve wrecking position.  And especially since I did not go into the office for multifocals.  I  said I did not mind wearing reading glasses.  And that seems to be what the posters with the traditional lens experience. But I am not going to have multifocal and traditional. And as I said previously, that only became the suggested route after the results were in from the lens comparison program that I was in.  Cannot help but think that the suggestion of the traditional with the multifocal was not in my best interest, especially since at the beginning of the program, I was told that my eye measurements were in line with all three of the new lenses.  My eye did not change shape after the report was in. But I was left with a unexpected delema and expense concerning the second implant.

[JodieJ]

I don't see why a second multifocal would cause "distorted vision" if your relatively low (1.5 D) astigmatism was corrected with LRI's and/or laser vision correction.  From what I've read, getting your second eye done would improve your vision by at least a line on the eye chart and reduce your visual aberrations at night.  As I said before, you have a lot to look forward to.

[K-D]

Jodie can you tell how much astigmatism I have in the left eye by the numbers I posted in a previous post?  I do not understand the numbers and was wondering how great the astigmatism was in the unplanted eye. So it is 1.5?

[JodieJ]

Based on the numbers you posted, you have the same amount of astigmatism as I did--enough to interfere with your vision with a multifocal but not really all that much. If you're lucky, limbal relaxing incisions at the time of surgery would eliminate all of it.  If not, a laser vision touch up would eliminate the residual.  I read that ReStor (plus laser vision correction) is now recommended for people with up to 4 diopters of astigmatism--and you have only 1.5 diopters.

[K-D]

Thanks Jodie.  Makes me even more convinced that the change from the doc from multifocal to monofocal for my second eye implant,  after comparison study was in, was not in my best interest.  Distorted vision was never mentioned until report was in and I was scheduling for my second Rezoom. This should  not have  been a problem for a doctor voted Top Doc, to deal with.  Disappointing.

[frogman]

I am a 69 yrs old male in BC Canada, with left eye cataract surgery and single vision implant completed a year ago. Set for distance vision, results are great but for close-up (and uncorrected right eye vision) I still rely on glasses.
Now scheduled for surgery on the right eye, Dr. recommends ReStor multifocal implant with stated 85-90% success in his practice. It should let me function without glasses except for extended periods of reading when cheap reading glasses would work. I tend to trust his recommendation but reading the almost completely negative comments in this and other forums, I am concerned about the results as well as the $1500 cost of ReStor not covered by Medicare. I am wondering if all the comments posted are from the unfortunate 10-15% of people who are in the group with expected unsatisfactory results. Supposedly the majority of applications are more than satisfactory so why isn't anyone with good results post a comment? Is this another case of the "silent majority"?

[JodieJ]

I've read many posts on this forum and elsewhere from people who are very pleased with their multifocals.  However, the multifocals are designed for bilateral implantation.  From what I've read in the professional literature, having only one multifocal IOL produces less satisfactory outcomes.  In your place, I'd probably prefer monovision (or modified monovision) with a second monofocal lens if near/intermediate vision were a concern.  Has your doctor discussed this alternative with you?

[frogman]

Thanks for your comments Jodie. My Dr. is of the view that one eye with mono and the other with multifocal implant is the best of both worlds, i.e good distance and reasonable close-up vision that may need reading glass supplement for extended or fine print reading. We have discussed the choice of mono or multi i.e. "up to me" but the multi would allow me to deal with routine reading without grabbing for glasses.
I don't know what to believe.

[JodieJ]

Why don't you get a second opinion from another surgeon.  It's your vision, after all.

[K-D]

Some doctors refer to a feeling of imbalance when having only one multifocal. This may not be a problem for you.  I have only one multifocal and do feel a bit imbalanced. ( only one eye operated on at present) It is not a huge problem.  Just feel like one eye is not exactly working with the other eye. Speaking for myself, I prefer the same system in both eyes. But everyone is different.  And outcomes are so hard to predict.  Wishing you the best in your decision.

[iowamichael]

I would like to know if anyone has had the Crystalens adaptive multifocals put in. How do they compare to existing multifocals and monofocals? What are the negative/positives?

I am 43 and was recently implanted with a monofocal in the right eye, which was 20-200 w/o cataract. Since my left eye is ~20/60 I have been doing monovision pretty successfully since the operation, however small left eye cataract will likely grow problematic as I age, and will also need to be operated on at some point.

Like many who commented here, my distance vision is excellent but intermediate vision (computer monitor and tennis ball-contact point) is not good in the operative eye. I was surprised at this, because when choosing monofocal vs. multifocal the literature and Doc said choose monofocal if you do a lot at midrange, so I expected better.

Michael

[K-D]

The Crystalens is an accomodating lens with hinges.  It is to work with the eye muscles in your eye.
Multifocal are put in like the monofocal but have different points of focus on the lens, trying to give you near, far, and in between vision.  The Rezoom is generally better at intermediate and the Restor is generally better with reading. All have good points and bad.  Crystalens hinges can become stuck in a forward or backward position.  Thereby giving you one focal point of vision, which could be anything depending upon which way it is stuck. Also, harder to exchange if necessary. Generally has fewer problems with halos.
Multifocal does not depend upon the eye muscle to work.  But halos can be debilitating. Also, if the exact measurement is not obtained, vision will not be clear. Multifocal is for near, far, and intermeidate vision.  But generally with the Rezoom you may need glasses for reading and with the Restor you may need glasses for computor.
Monofocal lenses give you only one focal point.  Confused as to why the surgeon told you Monofocal was good for intermediate unless he set the focal point point for intermediate.  Then you would need glasses for near and far. Monofocal generally are good for only one focal point but some very lucky people get more than one focal point with the monofocal. but it is not the norm. Most people have it set for distance and wear glasses for near and intermediate.
Generally monofocal with a accomodating or multifocal lens can leave you with a feeling of imbalance.  I know I have only one one multifocal lense implant and I do have a feeling of imbalance.  Good luck and best wishes.

[toma48]

I am 58 and have a cataract in one eye (non dominant). I use computers and read for hours a day for my work (atmospheric scientist).  The multifocal lens is attractive to me, but can I have just one ReSTOR or Rezoom implanted?  Thankyou.

[K-D]

Answer to your question is written above.  Best wishes.

[kpthestudent]

I plan on having my cataract surgery this March. Currently I am a college student and after graduation I will need to see up close for my job (chemist). Should I get my vision corrected to see up close? Another question is would I have to get bifocal contacts or can I just where a normal -# prescription contacts. Right now I have a +4.75 prescription in both eyes. The type of contacts I wear are hard to find in toric. It seems they make many options for -# prescriptions. I plan on having LRI's. Is there any way I can get monovison that does not effect my depth perception or increase the amount of migranes (migraines)?
I would like to read my paper and the computer and drive without glasses. I am still pretty young


P.S. I was told toric IOL's where not an option because of insurance.

[K-D]

I would never, ever, have my natural lenses removed to have the multifocal or accomodating lense implanted when you do not have cataracts.  You are so young and these lenses are very new.  Many problems for many people.  Get an opinion from different doctors. Once your lens is removed, you cannot get it back.  I think a pair of glasses would look very impressive on you, especially considering your Major.  And they are very reliable and accurate. New things are developed every year.  Those of us with cataracts had no choice but to have our natural lens removed.  You do not have to. Don't do something that you may regret and be unable to correct. Best wishes.

[K-D]

oops.  See you do have cataracts.  Sorry, I misunderstood.