what is differenc n IOL's?

I am a candidate for the new AcrySof Toric IOL but since there is little info about patient satisfaction, I am loath to be a pioneer for it.  What is the difference between Restore, Rezoom & a regular IOL implant that Medicare covers?
I need big distance correction in right eye & intermediate distance in left eye & then astigmatism correction.  Would the regular IOL provide me with distance & intermediate distance? Then I would need to wear a toric contact + readers.  This would seem to be the most cost effective-but is it the best choicd?
THX

[Forum-OD-MP]

many people will post on this.  and there are already many threads on this.  but the MUCH ABBREVIATED version is:

regular iol is a monofocal.  would need reading glasses.

restor is a multifocal.  much more expensive, and obviously not covered by medicare.  would not need reading glasses, but would likely sacrifice some distance vision acuity to do it.  also more incidence of problems, especially halos at night.

rezoom i know less about.

if you think you may need a TORIC iol...then i doubt you can have a multifocal implant...

[JodieJ]

A traditional IOL could absolutely give you the distance correction that you need, but it would not correct your astigmatism.  You could get an accurate preview of what your vision would be like post-surgery by exchanging your toric contacts lenses for regular ones.  (If you have more than .75 diopters of astigmatism, you probably won't be very pleased with your vision.)  But if you were willing to wear toric contacts all the time post-surgery, you'd have about the same vision that you would with contacts and no cataracts.  However, few people would choose to do this if they can get the same results without wearing contacts all the time.

The AcrySof toric IOL is not "new technology."  There has been a silicone toric IOL around for of a number of years (made by B&L, I think.)  Some surgeons complained, though, that it tended to rotate in the eye, thereby negating some of the astigmatism correction.  The AcrySof toric lens uses the same one-piece design as several other AcrySof lens models, it incorporates the same UV and blue-light blocking features, and it is made of the same acrylic material.  It had to pass rigorous tests to be approved by the FDA.  During these clinical trials, it demonstrated the ability (according to surgeons' reports) to remain "remarkably stable" in the eye (a feature of the Acrysof design shared by several lens models), thereby providing reliable astigmatism correction.  From your perspective, it has the advantage of allowing you to toss your contacts after cataract surgery.

But there are other alternatives available to you if you don't want a toric IOL.  Limbal relaxing incisions at the time of cataract surgery is an easy, safe way to correct astigmatism--just a couple of little cuts at the limbus to flatten the cornea.  The problem with LRI's is that they are unreliable.  Sometimes they eliminate all the astigmatism, but on average they eliminate only about 50% of it.  (The AcrySof toric IOL does a lot better than this.)  But no method of astigmatism reduction is as reliable as laser vision correction (LASIK, PRK), which involves an additional procedure 2-3 months after cataract surgery.  The biggest down side of laser vision correction is the cost (not covered by insurance).  My surgeon charges more than $2K per eye.

In my opinion, the multifocal lenses truly involve new, evolving technology, and the recipients of these IOLs are real  pioneers.  These lenses are not problem-free and require a long (maybe 9-month) adjustment period, but many people feel they are worth the trouble and out-of-pocket expense of several thousand dollars.  (There's a recent post from a Canadian woman named Diane about the difficult adjustment needed for bilateral ReZooms.)  The multifocals don't work well with astigmatism, so you'd have to agree to have an additional laser vision procedure if you wanted to go this route.

Quill, I really urge you to do some of your own research.  Start by reading about different lens options at consumer-oriented cataract surgery sites.  For more advanced reading, try entire word combinations such as "toric IOL" or "cataract surgery astigmatism" into Google.  You'll get hundrds of hits, which will take you thousands of places, and you'll end up learning a lot.

[JodieJ]

BTW, results with the AcrySof toric lens are very much dependent on your surgeon's skills at determining the correct power for you and implanting the lens properly.  Other factors such as your eye's anatomy and how it heals are also relevant.  In this situation, the testimonials of other patients would really say little about how good (or not so good) your results might be.

[Quill]

Thanks Jodie for you help.  I have been doing a lot of reading on the matter.  It would seem at this point if I were to do the toric I would need to find a surgeon who has some experience with it.  The one I had seen-this would be her first one.  She does a lot of implants in my area & is considered very good.  But no experience with AcrySof Toric.   Any suggestions on how to find who has done this procedure?  I am close enough to Baltimore & to Philadelphia that it would not be a great distance to travel for the procedure.

[JodieJ]

There are several articles about the AcrySof toric lens in the May 2006 "Cataract & Refractive Surgery Today." (Go to www.crstoday.com and click "archives", then click May 2006 "Astigmatism Correction".  According to one author, the surgery involved in implanting an AcrySof toric lens is not much different from what's involved in cataract surgery with the other AcrySof lenses.  (The power calculations are just a little trickier with a toric IOL.)  I really think that any experienced surgeon would do a fine job, even with their first implant.

Except for those surgeons involved in the clinical trials, no one has much experience with this lens.  You might try to email the authors of the Acrysof toric articles for recommendations of surgeons in your area.  Or you could try contacting a customer service representative at Alcon.  Hud sometimes posts here; maybe he has some suggestions.    

[hud]

I don't know of an AcrySof Toric experienced surgeon in your area, but from what I've heard, it is somewhat a slam-dunk. It can treat patients with regular astigmatism as low as .75D to 2.0D or more, depending on where your steep axis is. I am aware of about a dozen different surgeons who have nailed it on their first try. And the nature of the AcrySof material makes it very stable, and less prone to rotate compared to earlier silicone designs. If you call around, I'll bet you can find someone capable, if you're not comfortable with your first choice.

[JodieJ]

Quill, I hate to think that I've caused you unnecessary aggravation.  I really believe that a skilled surgeon would have no problem implanting an AcrySof toric lens, even if s/he had never used the lens before.  My surgeon had an excellent reputation using traditional AcrySof lenses and the AcrySof ReStor.  Although he'd never used the toric model before, I would have been very comfortable being his first toric lens patient.  Unfortunately, the toric lens didn't come in the power I needed.  So I opted for the AcrySof aspheric lens and limbal relaxing incisions, with excellent results.  And it was my surgeon's first time implanting the aspheric IOL.