Crystalens, Restor,

I had RK done in 1989 when my eyes were -6.75 and -5.00
Now I wear reading glasses to see everything. Close up intermediate and distance...all problems resolve when I have my reading glasses on. They are +2 and that is my correct prescription.
I want and I need RLE and my surgeon does NOT use Crystalens.
He uses a plastic yellow IOL that I do NOT know the name of, and he uses Restor. I have not yet spoken with him as he is out of the country. I have had numerous conversations with the counsellor at the GEC and she refuses to tell me why he won't use Crystalens. My surgery is tentatively booked for 2 weeks from today IF he agrees to do it after going over my file.
She told me that if I chose the plastic yellow IOL my reading vision would probably become worse so that lens is out of the question. She also said that the majority of patients that get the Restor IOL hate it but she wouldn't tell me why.
If reading glasses cure my close up AND distance vision....WHY would an IOL not be the same if it was the same power? To say the least, I am very confused and quite upset.
I HATE glasses. If I was comfortable with them I would not have bothered to get RK done in 1989 when it cost $2500 per eye. What should I do?
I want to be able to read again, and I want to be able to see a reasonable distance but reading is the most important.
I cannot wear contact lenses because of my RK incisions. Overall, I was told that my eyes and lenses are very healthy. Someone please help me ( hopefully an opthamologist )
Thank You

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

I think the respondents have painted your option. You may want refractive lens exchange but you don't need it. Big difference.

Most surgeons are reluctant to put a accommodative or multifocal in a patient that has had RK because the corneal scars plus the dysphotopsia often associated with that type of IOL can be very debilitating.

Suggest you use the search feature and archives to read about all the problems with accommodative/multiofocal IOL before you spend the time and money and end up very unhappy.

JCHMD

[Restornomore]

Hello Scarletttt

I'm a RLE patient who had the surgery for severe cataracts - nothing optional about it.  The Restor lens is to be avoided because of the inherently poor vision the technology offers - ghosting at the edges of images, bleeding of contrasting colours, and halos around all light sources, esp at night.  Close up vision (in my experience with this lens) was nothing spectacular either.  Click on my username for further info, or use the search function on this site.  Crystalens has its own problems, and many dissatisfied customers - it can 'fail to adjust' and settle into an unpredictable position, and many patients report problems with very close vision - your stated priority.  Again, use the search feature for more info.  

With *any* lens exchange you may well need glasses at least some of the time.  The outcomes of surgery *cannot* be guaranteed, and are difficult to adjust or reverse, even an equivalent "power" of lens that gave satisfaction in the form of glasses is used.

You will not like this advice, but it is offered in good faith - forget surgery and learn to love your glasses.  If you have satisfactory vision with glasses and otherwise healthy eyes, then you are taking a great leap into the unknown - and may well end up less satisfied with your life than at present.  RLE surgery is *not* to be undertaken lightly.  

Consider this also, if reading is your priority, what's so bad about glasses - you are sitting down.  Wearing glasses in more active situations is indeed much more of a pain.

All the best with whatever you decide, but tread very carefully.  Once your natural lens is gone, it is gone forever.  I wouldn't go near RLE surgery with a bargepole unless blind with cataracts or the like - a personal opinion based upon some very bitter experience.

Regards, Restornomore

[scarlettttt]

Hello,
Thank you very much for replying. I noticed in your user profile that it appears you have had the Restors removed. What did you use to replace them?
My Uncle lives in Australia and recently had cataract surgery and he is just raving about how perfect ALL his vision is and how glad he is etc. I never thought at the time of our conversation to ask him what product was used on him.
As for using reading glasses.....I have to use them for EVERYTHING....reading, computer AND driving. The only time I don't wear them is when I'm working out at the gym which I do daily for 3 hours or when I go out in public.
I can see that I have a LOT of research to do and if any type of laser surgery was an option, that is what I would choose but unfortunately because of the incisions on my cornea from my previous RK surgery, laser surgery is impossible. It rarely gives good results anyway on farsightedness. Please tell me what you replaced your Restor IOLs with.
Thanks,

[londonbridge]

I agree with Restornomore.  I also had my Restor explanted and replaced with a monofocal IOL. It is set for intermediate distance in my non dominant eye and when I have my second eye done, which has a small cataract presently I will have it set for distance thus giving me "blended monovision". This means I would see well for distance and intermediate and need glasses for reading. Currently I have progressive perscription glasses over my one contact lens for reading/computer and to correct an astigmatism.
Honestly most people do require glasses for some tasks following any type of IOL replacement and the premium lenses, while they do work for some, have many problems for others that are just not worth it.
I would personally keep my natural lens for as long as possible and live with the glasses. I wish I had now but I was very lucky to have found a highly skilled surgeon who was able to remove the Restor and give me satisfactory vision.
At the very least please get several more medical opinions regarding your situation before making any decision at all.... you only have one set of eyes. They are worth the time.
londonbridge

[Restornomore]

The level of satisfaction people have with their post-RLE vision depends very much on how bad their vision was before - your Uncle probably had worsening vision (glasses or not) for many years before his surgery, and as cataracts mature, glasses can no longer help. Therefore, after cataract surgery (same as RLE) the vision *is* much improved - with cataracts you are peering through an increasingly dirty window.  If he's an older man he will definitely have monofocal lenses, probably set for different focal points - no lens presently available can give the full spectrum of vision without glasses.  Most people given monofocal lenses have this setup (as described by Londonbridge).  It can be very good but does represent a *compromise* as does every single lens or surgery option currently available.  

What pleases your Uncle (good luck to him) may not please you - what a pity we can't swap heads!  I agree with Londonbridge - you have *much* more research to do before making such an important decision, esp when there is no urgency and you can function perfectly well with glasses.  Whatever you do now will be with you for the rest of your life!

Be very way of any surgeon who tries to talk you into one of the so-called premium lenses, esp multifocals - to the extent that they "work" they involve considerable visual compromise, and "neuroadaption" (translation - ignoring the side effects of the lens technology).  Some patients can cope with this, others cannot.  There are $$$$ involved in pushing these lenses.

Lens technology is constantly evolving - why not love your glasses for a few more years, at least until you know everything there is to know about the pros and cons of each option.

I have monofocal lenses both set for distance. One AcrysofIQ and one Tecnis. (This is not a typical setup - most people get some sort of monovision, and the same lens).  The Tecnis in my opinon gives a better colour spectrum - some lenses filter for different spectra of light;  however some surgeons don't like it for technical reasons.  Like you I am very active, but prize distance vision (5 feet+) over all else, and consider I have the best that current technology can offer - I see beautifully from 5 feet to infinity, very natural good quality vision, quite well closer, but need glasses for reading, computer, peering into drawers and all sorts of situations where light gets a bit dim.  My night / dim-light vision is now noticeably inferior to what it was pre-cataracts (4 years ago).  My Dr says that even though modern monofocal lenses are very good, not all of the functions of the natural lens have been replicated.  There is a lot involved here!!

If you do go for surgery, I think a monofocal lens setup would give you the best >natural-quality< vision - your need for glasses would depend on your own eye setup and might be very different from what others describe.  Your surgeon should be willing and able to explain to you in general terms the sort of outcome you could expect after surgery, even though it's not an exact science, after all they are dealing with a bag of jelly.  When people say they "don't need glasses" we tend to think that the quality of their vision must be excellent - this is not necessarily the case.  I absolutely need glasses for close vision where I did not with the Restor, but my overall *standard* of vision with monofocals is far superior.  I am at peace with the world with my glasses, whereas the Restor nearly drove me mad.

Longsightedness and 100% glasses dependency is indeed a bugbear, but there are worse fates.  Most people you meet on these boards are those who have had bad experiences - we *do* know how serious eye surgery is, and how dreadfully your life can be ruined if outcomes are bad.  That's why we post.

Like Londonbridge, I say stick with your natural lens, at least until you get better informed.  You have already had one experience of surgery that made things more difficult further down the track.  Maybe you could try to track down some people who suffered from longsightedness and have had RLE - I'm not sure how you'd do this.

Hope this helps.

Regards, Restornomore

[BUTTERCUP109]

Aside from the problems associated with the IOL not providing the vision you hope for, is the risk of the surgery. It is far more risky than cornea-based refractive surgery because it is more invasive. And if you think that because thousands of 70 year old cataract patients do it that it must be simple and safe, that's what I thought too. The younger you are the higher the risks. If you are in your 40s or 50s, your vitreous may not have yet detached while in the senior population, if a vitreous detachment is ever destined to happen it likely has. What this means is that the very act of having your anterior chamber manipulated can trigger traction on the retina at a time of life when you are vulnerable for a retina event. I was 48 when my chain of retina problems started all because like you I hated glasses and monovision contact lenses. I had Crystalens RLE and wish I could undo that decision every day. I wish someone had warned me. Leave the lens replacements for the cataract population.

[Restornomore]

Hi Buttercup109
Your point about the risks of surgery is a good one.  I suspect bad outcomes and complications are more common than the public is lead to believe - how much followup is done, especially where private clinics are involved?

One possible outcome of interfering with the cornea (inherent in RLE) is ongoing maddening pain - like grit in the eye and/or a burning sensation.  That bodypart is sensitive and can be slow to heal.  Lasik patients can have this experience too.  I had ongoing pain for 3 months after the first lot of surgery, even before the explants, and believe me Scarlettt, you don't want to be one of the "lucky" ones there.

Regards, Restornomore

[scarlettttt]

Hi,
I'm leaning towards Tetraflex now as my surgeon uses these and NOT Crystalens.
At the Tetraflex website www.tetraflex.ca you can see colour comparisons between various IOLs  
It's really very interesting to see the subtle differences.

Regards,
Scarlettttt

[BUTTERCUP109]

Have you asked if your RK can be adjusted with another procedure like PRK and if so what did they tell you? You could try out monovision with a temporary pair of contacts which could later be acheived with PRK if your previous incisions do not prevent it.
What is your age? There are a number of complications to lens replacement surgery that effect younger patients such as posterior capsule opacification that can negatively impact the success of moveable IOLs.

[scarlettttt]

Hi,
I'm 43 and PRK is not an option for me because I was too young when I had my RK and my eyes kept bouncing back hence the 25+ incisions in my right eye. THAT is why my surgeon chose overcorrection, hoping that when it stabilized it would be where he wanted it to be. My vision ( after a 3 month recovery period of wearing sunglasses ALL the time and intense pain ) was absolutely better than perfect. I was a guinea pig for lack of a better term because back in 89 my surgeon was one of a handful in Canada doing the surgery. He apparently learned it in Russia and obviously he learned it very well. Laser correction is a poor choice for farsightedness as the results usually regress very quickly. That is what I was told by the counsellor at the Eye centre. The farsightedness affects my whole field of vision NOT just reading. Apparently RLE is my only chance of seeing normally again and after comparing every single option I have come to the conclusion that IF I have it done....I will choose Tetraflex.
Tetraflex.ca shows comparisons ( actual pictures of the differences in various lenses ) and the advantage it has over Crystalens is the superior intermediate vision. It's either intermediate or close up. I honestly can't remember but it's an accomodating lens that allows the recipient to see EVERYTHING at any distance. Eye exercises are required but for me that is no big deal as I have already started them.
IF Laser surgery or PRK was an option I would GLADLY go that route but apparently it isn't.  

[scarlettttt]

I wonder why posts are shown here that are over 4 years old.
No wonder people get mislead. It's difficult to make a decision when technology changes so quickly and people read 4 year old posts as *I* have and get confused.
I would suggest that anything over one year be put into an archives file which is where it belongs.

[BUTTERCUP109]

Thanks for the explanation. I have a hard time understanding the kind of farsightedness you have, especially the idea of wearing readers even to see far away. I'm sure that must be very difficult and I wish you the best of luck with your surgery. It seems you are determined to do it and I sincerely wish you the best. Just make sure you have the very best doctor available to you and get all your questions answered up front.
I would love to learn more about Tetraflex and how it works for you. I had such high hopes for Crystalens and was so deeply disappointed with the result. It is my dream to have an IOL exchange someday, although it may not be possible with the degree of fibrosis in my capsular bag. But one can always dream.
Good luck.

[Restornomore]

Hi Scarletttt,

What you are reading re the Tetraflex website is advertising material.  Bear this in mind. They are hardly going to tell you it's rubbish.  It would indeed be wonderful if this lens does what it says on the packet - a lens that gives the clarity of a monofocal but with focal accommodation is the holy grail of lens exchange surgery.  I remain sceptical and would stick by my original advice - wait for years if needs be for technology to improve before risking *optional* surgery - you have on average 40 more years to live with the results.

Like Buttercup109 I wish you all the best if you go ahead.  If you do, please post on this forum be the results good or bad so that others may benefit from your experience.

Regards and good luck,
Restornomore

[scarlettttt]

Last night on the evening news ( I think it was CBC ) there was a report about a 60 year breakthrough in IOLs. The story was about a lady in the U.K. that had just recently received what is referred to as a light accomodating IOL.
This lens can be tweaked AFTER implantation to a degree of .20 ( a fifth of a diopter ) to ensure perfect vision. The lady was obviously delighted with the results. It made ME more confused about what to do. Today was supposed to be the day I would find out about my upcoming surgery etc. 12 noon came and passed and still no phone call, so I called them. I was told that they were going over my chart in Calgary and I'd know the decision tomorrow.
At about 7.30 this evening the phone rang and it was Dr. G.
We discussed all the lenses and I told him about what I'd seen on the news and if he knew anything about it. I felt like a complete fool when he told me he was directly involved with that particular lens ( he mentioned he was a director or on the board or something....I really can't remember the specifics )
HE told me he would prefer to use that lens on my eyes and to keep in direct contact with his clinic and I would be first on the list to get it. He said that he thought it would be available here ( Canada ) in approximately a year or less.
I'm disappointed and excited at the same time. Disappointed that I have to wait up to a year and excited that my results will be far superior than anything he could offer me today, when I finally get the surgery.
He also told me to continue my eye exercises as doing so will improve my vision albeit a small improvement. I asked him if I could get a temporary lens like a monofocal until I was able to get this superior one and he said I could but recommended that I just wait and only have one surgery.
I'm just keeping you all posted as to what is going on.
Thanks for all of your support.