Cataract surgery options

[FranAnn]

I am thinking of having ReStore lenses put in when I have cataract surgery.  I am very far-sighted.  In addition, I have one eye that was crossed when born and I the glasses I have worn all my life have corrected the crossed-eye (no surgery ever done as a child.)  Will my crossed eye respond to ReStore (multi-focal lenses) the same as when wearing glasses?  Should I be concerned about this?  I was told it wouldn't be a problem, but I'm still a bit concerned.

[Sandy Feldman, MD, MS]

Dear FranAnn,

If one is farsighted, the muscles that control the farsightedness also cause the eyes to cross.  If you are treated with glasses, contact lenses or an implant [and thus, the farsightedness is corrected], then the muscles relax and the eye may not cross.  It should not be an issue as long as it corrects with contacts as well as glasses.  

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[FranAnn]

Thank you so much.  I am much relieved. I indeed wore contact lenses for many years and my crossed eye was corrected by them.  FranAnn

[londonbridge]

I encourage you to read member's posts on this forum regarding Restor before making a final decision. While it is true happy Restor patients would not post, there are enough significant problems with multi focals that it is well worth considering the option for a monofocal seriously. Rarely do you avoid wearing glasses at all with mulitfocals and the quality of the vision can be compromised overall with many more side effects. Blended monovision with your eyes set at slightly different distances can work well in eliminating the need for glasses most of the time.
Also you may wish to get several expert opinions from qualified surgeons experienced with multifocals before considering options. I don't know if accomodating lenses like Crystal lens were discussed as that is a third option.
Good luck
londonbridge

[disappointed66]

I echo londonbridge. Check out  the post of others. Get expert opinions and do not make a hasty decision. Multifocal lenses are not all that great as they makle them out to be.  Best of luck.
disappointed66

[roncun]

Dear FranAnn,
I would also encourage you to read all of the posts on the ReSTOR IOL.  I had posterier subcapsular cataracts in both eyes and had ReSTOR multifocal lenses implanted in both eyes.  The first was implanted on 9-30 and the second on 10-7.  I have not experienced any problems so far.  However, I do not have astigmatism and my contact lenses were only 2.0 and 2.5.  There seems to be "issues" with the ReSTOR lenses when the patient has astigmatism and needs greater correction.  I would think that your best source of information would be your surgeon.  I believe that I'm the only poster that has had a favorable outcome.  At my follow up appointment this past Monday I tested 20/20 on both distance and close reading tests.  When my surgeon read the results of the eye exam he said that I have better vision than he does. The ReSTOR lenses are definately a good fit for me and I'm extremely satisfied with the results.  For someone contemplating surgery I would recommend getting as much information as possible. Obviously, this lens is not the best for everyone, but in my opinion, when conditions are right, the ReSTOR lens can be the best choice.  
Ron  

[londonbridge]

Roncon makes some very good points. I do believe that a stronger correction (my eyes were -7.5 and -8.0 with an astigmatism) can make a difference in results. The Restor lens was only recently approved for this level of correction when I had it implanted (later explanted and replaced with monofocal).
londonbridge

[JodieJ]

After reading this forum for awhile, there seems to be a few factors associated with a good outcome with ReStors:  an absence of even slight astigmatism, small pupils, healthy eyes, and an experienced surgeon.

According to what I've read in articles written for and by cataract surgeons, very farsighted patients make the best candidate for ReStors.  ("They're accustomed to having poor vision at all distances, so they tend to be happy with their surgical outcome.")  Second best are very nearsighted patients.  The worst candidates are said to be people who are mildly nearsighted.  ("Their near/intermediate vision may be significantly better before surgery than with ReStors.")

[Restornomore]

With the multifocal technology, regardless of the patient's individual characteristics, there is an inescapable tradeoff between clarity and acuity (quality of vision) and depth of focus.  

With two Restors I had supposed 20-20 vision, correctly positioned lenses, and also (I believe) small pupils and very healthy eyes apart from early cataracts, and the resulting vision was so substandard and unnatural that I undertook a bilateral explant at great heartache and risk.  I am so happy with the monofocal aspheric lenses that I will never regret that decision.  The original operations left me shortsighted for distance, but even with that corrected by glasses, the "special effects" associated with these lenses nearly drove me mad, and completely ruined my quality of life.  It was like having a maladjusted television set stuck in my head.  For the full catastrophe, click on my username for all posts.

Therefore, I would suggest to you Fran, if you have no objection to wearing glasses, have a fussy disposition and are intolerant of visual distortions, the monofocal lenses offer the best of current technology.  You may be one of the people who likes the multifocals, but it is an awful risk to take as a very significant percentage are unhappy with them.  My point is that you can have many of the factors other posters have indicated for multifocal success, and still hate them.

Apart from physical concerns, the requirements seem to be a flexible disposition, and poor pre-cataract vision.  I had excellent vision until a few years ago, and am about as easy-going as Hitler, so a very bad multifocal candidate!
I actually think the best multifocal candidate according to many unethical surgeons is one with two eyes and a chequebook.  There are big $$$$ behind the pushing of these things -drop in on some of the Opthamology journals and you will see some barefaced discussions to this effect.

Whatever you choose, a competent surgeon is a must.  Beware of those who tout via advertising and push "premium lens" barrows - your welfare is not their chief concern.  At the very least, the monofocal solution should be offered and explained to you, if not then information is not being divulged.  (I think the Tecnis monofocal lens is better than the Acrysof, having one of each, but both are good).  All the best with your decisions.

Regards, Restornomore

[JodieJ]

Unfortunately, your point about the best multifocal candidate being someone with a check book is well taken in some cases.  The article I was referring to was written by a cataract surgeon to be read by other cataract surgeons, and it was quite cynical.  The author stated that his ReStor patients have been a good source of revenue.  By "best" candidates, he meant "most likely to be happy with their ReStor outcome."  In his opinion, people who have had poor uncorrected vision at all distances for much (if not all) of their lives (i.e., the very farsighted) were the best candidates for ReStor.  Those who once enjoyed excellent uncorrected distance, intermediate, or near vision were the worst candidates.  ("They're going to complain about the quality of their vision and the glare and halos.  They'll require too much chair time after surgery.")  Yeah, that all makes sense to me.    

[disappointed66]

I cannot add much more to Restornomore then ditto! I thought I was going to have a nervous breakdown, especially because I was not able to drive at night because of the sunbursts from any light source. At least I stopped before I had the second eye done. I had the tecnis implanted in my left eye after the restore explant. I am very happy.with it and will be having the right eye done on Nov. 9h with the same lens.  Good luck with your decision.

disappointed66  (no more)

[disappointed66]

I am scheduled to have my right eye done on Monday Nov. 9.  I left you a message regarding this.  I just hapenend to see your post on having both eyes set a plano and I think that is what  I am about to have done.  I really don't  know.  I saw dr. today and I thought that I had made the right decision and now I am not sure. Please check your messages I will feel better if I get a reply from you.

Thanks Jodie