Ashperic Restor vs. Monofocal for 33 year old eye?

[javadesigner]

Hi:

I am male, 33 years old, with bilateral (and growing) PSC cataracts. Also a huge (and growing number) of floaters as well. Have had many dilated eye exams from very good doctors and there are no retinal complications (although, there may be faint signs of PVD, but no retinal tears or detachment).

I've consulted with some doctors who have performed upwards of 25,000 cataract operations and several thousand Restor implants. (Dr. Christerbury in North Carolina, Dr. Mckool in NYC, some others in teaching hospitals)  

No one can really recommend a lens to me. They've all gone over pros/cons of monofocal (Alcon IQ aspheric, for example) and multifocal (Restor). They've all said that Restor has "good" performance but does leave halos around bright lights which will never go away.
No one is sure whether mono or multi is good for me, everyone has said that although most people are happy with restors, some people are never able to adjust.

Also restor is similar to Monofocal for distance but not great for intermediate vision.

I'm a computer programmer, heavy web surfing, cell phone, video game use. Reading finely printed computer manuals and switching back and forth from the manual to the screen is important to me. I've worn glasses since 14 and have -5.50D in both eyes.

So my questions are:

1) Does the Aspheric restor improve intermediate vision over the previous version ? Does this newer version make going with restor now, a no-brainer ?

2) I've read that with monofocals, vision is quite blurry less than 5 feet inwards. With monofocals, could I switch easily from keyboard, monitor, open manual etc with bifocals or would i have to keep switching glasses to read a monitor 22 inches away vs. a book 12 inches away ? IF this is possible with MONOfocals, then maybe they are a safer option ?

3) Having the ability to read my wristwatch when I get up in the morning or a book to fall asleep to would also be great :-)

4) What other advise would forum members give me ? I really need to get surgery in the next year or so (I have too much glare, halos, smudged vision as of now with PSC). I'm
generally quite fussy (a smudge on my glasses really bothers me) but as I grow older, I think I can learn to compromise/adjust better with whatever type of IOL I choose.

Thanks so much for all your advice and replies.

Best regards,
--j
***@****

[JodieJ]

I have both eyes set for distance with aspheric IOLs made by Alcon.  I have a history of strabismus, so I wanted both my eyes set to the same focal point. One pair of progressive glasses gives me excellent vision at all distances.  I also have bifocal contacts.

Having both eyes set for distance will give you slightly better distance/night vision than if you had blended vision, but the difference probably wouldn't make much (any?) difference to most people.  The advantage of blended vision is the ability to perform intermediate vision tasks (and even some near vision tasks) without glasses or contacts.

If you have no history of strabismus, I'm sure you'll do fine with blended vision.  From what I've read, the SofPort is an excellent lens.  

[telya]

Thank you so much for your advice.
I checked and my right lens card they implanted says +16.5D.  That is my distance eye.
Does that sound odd?  I did have LRI to relax and correct astigmatism.
YOu all have been talking in say like -1.25, etc.
I am stupid about such things.

Anyway, I take it that I'd be ok then going with the other eye with SofPort also?
And that if I have it set for blended which would I assume be like intermediate vision, not
near (reading) then I'll have as crisp and far a distance vision without glasses for distance?
Sorry to ask to verify but I'm just so excited about seeing clearly again that I want
my distance vision and night vision to be the best it can be.

Straight to the point:  If I decide to have both lenses set for binocular distance, I'd be looking at (tell me if this is pretty much right on, please)  one set of glasses for the computer and one everyday all the time pair with intermediate on top and reading on bottom but I'd have absolutely(?) NO better distance vision and night vision than if I got the blended where one eye is set to intermediate?   If so, why would anyone have binocular distance vision ever?
What's the gain?  Why not blended for everyone?  Then just glasses for reading?
I cannot tell you how I am agonizing over the right choice here.
Is there any long term danger that you know of with either choice such as I read somewhere that strabismus experts feel one of these choices is a strain on the eyes and could cause some muscle damage.  NOT what I want after all this.  Which setting is that and what other dangers are possible for either choice?
Thank you again so much for your time.
I cannot get these questions answered anywhere else.
Bless you all.
I stress again, I want my driving distance and night vision to be good.
I want my choice to not cause my eyes any harm in the long term.

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

1. If you plan on wearing glasses most or all the time you probably won't notice much difference either way. Most people are happy with one eye distance and the other intermediate distance (about -1.25) that way they can see to shop, computers, read in good light, shave, put on make up all without glasses.
2. Most people get progressive bifocals with their custom RX in both lens. That way when they're "on" you have the best possible vision distance and middle and near.  The thing about lifing up the chin to see intermediate can be corrected with a second pair called "computer glasses" the distance vision is removed and the glasses only have intermediate and near. There is no chin lift at all for computer use.
3. You would want to use the Tecnis aspheric IOL  only if your surgeon is comfortable using it. Otherwise go with his/her recommendation. Do not expect your RX to change much after 6 weeks. If something does change then the changes are incorporated into new glasses.

JCH III MD

[telya]

I appreciate the info here so much.
I had my right eye cataract surgery on Wednesday of this week.
I am having the other eye done in about 10 days.
I am having so much trouble decifering the answer to help me choose.
I want the best distance vision I can get, the crispest and clearest.
I don't mind wearing reading glasses or even progressive glasses with
clear on top for distance and intermediate if I have to and reading prescription.  I have two questions please before next week.
1.  Is distance and contrast and clarity better in monofocals both set for distance vision or one distance and one intermediate?  How much do I give up on distance vision and depth perception and contrast to have one set for intermediate?
2.  If I need glasses for reading after having one set for distance and one for intermediate so all I need is a reading prescription, can I have them leave the tops of the glasses with no correction and have the reading inset
a bit higher in the glasses than usual so as to not have to tilt my head so far down to read?  My husband hates that he has to do that to read, hurts his neck?
3.  Ok, one more question, please.  I had the right dominant eye set for distance with the aspheric SofPort AO so if this Technuis lens is so great, can I have a monofocal Technis set for intermediate or distance and mix the lenes or is that bad for some reason?  Also, if I have one implant set for intermediate will that vision ever change and what do you do  then since it's an implant?

Thank you so much.
If you have any way to get this answered quickly, please so .  I have to decide fast.  Sorry.
I had forgotten how colorful the world is and am very grateful for the implant I just got.

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

You can get to work in a 2008 cadillac or a 2000 Chevy Nova. Newer is not always better, most expensive is not almost the best. The important thing is does it give good reliable, repeatable results.

Also even the most modern equipment is no better than the physicians or technicians using them. I would take a excellent technicians using an older IOL power instrument rather than a shoddy technician using a brand new IOL power instrument.

JCH III MD

[72vo]

My first eye doc claims he has the best equipment in the world to make the most accurate measurements for prescribing IOLs that yield the best acuity, contrast, etc., and that others in his business are using older, outdated equipment that is not a good.  What is the state-of-the-art equipment today?  Why is it better than older equipment?  I am seeing second Doc. tomorrow for his recommendations, and will let you know.  Thanks.
72vo