21 and having IOL surgery

I’m 21 years old and I have to have cataract surgery (diabetes related).  I don’t know which multifocal IOL to choose.  Drs won’t give me a straight answer b/c they don’t want to seem bias one way or another so they just tell me positive things about them all—NOT helpful!  I’m leaning towards Crystalens, but I really don’t know.  I’ve heard a lot of bad things about restor and good things about rezoom, but I’ve heard bad things about rezoom from ONE optometrist.  I’m totally confused and don’t know what to choose.  Please, if you have any pro OR con experiences with ANY of the multifocal IOLs, let me know!

[John C Hagan III, MD, FACS, FAAO]

If you will take the time to look at the archives and use the search feature "multifocal IOLs" you will see that there is a large number of UNHAPPY PATIENTS  that have posted here with multifocal IOLs.

I would recommend to a diabetic your age in my practice to have a high quality aspheric monofocal like the acrylic Tecnis put in the eye and NOT a multifocal IOL. I would tell the patient that they would need progressive bifocals worn over the IOLs to get their best vision. A modified monofocal with a goal of -0.25 in the distance eye and -1.25 in the near eye would be the target post op refractive errors.

UNDER NO CIRCUMSTANCE WOULD I ALLOW A REZOOM IOL TO BE PUT IN MY EYE.

jch md  BOARD CERTIFIED OPHTHALMOLOGIST.

[young_with_eye_problems]

What's my best option if I really don't want to wear glasses (though I wouldn't mind having to use glasses for far distance, like for driving, but I definitely am NOT interested in wearing glasses for reading or computer.... and bifocals sound extremely unappealing)??

[cdn_glenn]

At the moment there is no perfect multifocal or accommodative IOL that will give you excellent close, mid and distant vision.

Multifocal IOLs should "mostly" deemed to be bifocal lenses where both near and distant light is focused on the retina at the same time and the wearer of the IOL needs to spit the two signals into usable near and distant information.  Multifocal lenses tend to have weak mid-vision -- somewhere between two and six feet.  The ReZoom mentioned above by Dr. Hagan does advertise that it covers all three near-mid-distant zones.  It does ... BUT NOT UNDER ALL LIGHTING CONDITIONS.  There have been too many reports of poor vision in dim light with only near items in focus.  Heed Dr. Hagan's advice and steer clear of ReZoom.

Accommodative lenses use the ciliary muscles of the eye to focus, hence mimicking the natural focus of the eye.  These lenses tend to have good mid and distant vision, but reading glasses will most likely be needed.  On the American market there is the new Crystalens HD which is supposed to give improved reading vision.  They were only released onto the market in July 2008.  There isn't much feedback, as yet, whether near vision has improved with this model.

With both multifocal and accommodative lenses there is some risk/probability of visual side effects.  Halos and ghosting are big issues with multifocals.  Glare has been reported in many instances with accommodative IOLs.  Though time takes care of a great deal of these issues, some visual aberrations may remain and the wearer will simply have to "live with them".

A very safe alternative -- not totally risk free, but certainly with the best track record -- is the aspheric monofocal lens.  Only thing is ... it's monofocal.  This is much better described by others on MedHelp:  you could have your non-dominant eye set for near/reading and your dominant eye set for mid or distance.  In this way you could be "mostly" free of glasses.

Good luck in your choices, and please take some time and read through the Eye Care Communities in MedHelp.

[John C Hagan III, MD, FACS, FAAO]

Better safe than sorry. Do your due diligence and read about the many problems with multifocal IOLs.  

JCH MD