Crystalens VS ReStor

[mkmr]

Dear All

   I am planning to do a cataract sugary for my right eye very soon, I am 35, and I have to work in front of computer all day long at work. My eye doctor recommended me to use Crystalens, but I also worried since this lens can move inside of my eye, what happened years after and one day it gets stuck and can not move again. Will that happen? Should I go for ReStore?  By the way, I also have astigmatism since my childhood. Doctor says he may reduce half  of it during the sugary, and the other half may need Lasik to get rid of it. Is that normal for cataract sugary? I am reluctant to have two sugary to fix one eye.
I am in Houston, TX, the eye doctor I went is Berkeley eye center
Thanks for any recommendations.

[John C Hagan III, MD, FACS]

There are different answers for different people. If you do decide to have a multifocal IOL Crystalens is the best available now in the US with the ReStor second. Crystalens best for distance and intermediate and ReStor for near. I would advise you to stay away from the ReZoom IOL since we have tons of unhappy patients with that IOL here in the eye forums.

Even with accommodating IOLs you should plan on wearing glasses some of the time for some things.

The standard way of fixing the eye would be use a high quality non spheric monofocal IOL like the Tecnis and set one eye for distance -0.25 and the other for intermediate -1.25 and plan on wearing no line bifocals for reading and when you want your best vision (night driving, sporting events).

JCH III MD

[mkmr]

Hi John,

  You mentioned “Crystalens best for distance and intermediate and ReStor for near”.

I am a computer programmer, have to look at computer all day long, will Crystallengs perform well in arm distance?

Thank you for your reply

[John C Hagan III, MD, FACS]

Can't generalize. Sometimes yes, sometimes no. Read the many posts about the pros and cons of these IOLs.

JCH III MD

[mkmr]

I went to see another doctor this morning, he suggested that I should use ReZoom. (First doc recommended Crystalens).

Now I just cannot decide which one to use.

Lots of people in this forum like ReZoom, not that many like Crystalens.

I have 2.5 astigmatisms plus 3 near sighted.

Can you tell me what your think which lens I should use?

Many thanks

[John C Hagan III, MD, FACS]

You are NOT looking at the forums correctly. There are far more unhappy people on these two forums with ReZoom in their eyes than Crystalens.

I posted that in January 08 I went to a two day seminar on cataract surgery. In a poll of over 200 surgeons the Crystalens was the overwhelming choide of the surgeons when asked what IOL they would want put in their own eyes (IF THEY WANTED A MULTIFOCAL IOL).

There was not a single surgeon that raised her/his hand in answer to "Would you have ReZoom IOLs put in both of your eyes".

I personally would not want a ReZoom in my eye or any patient that I have to take care of. Our practice uses mostly Crystalens and using "mix and match" some Crystalens for distance and ReStor for near.

JCH III MD

[mkmr]

Hi John,

  You are right; I read some more posts these two days with my half blind eye, found out that there are only a few cases here complaining about Crystalens.

  I also found out on Crystalens website that their latest release is 5.0, should I ask my doctor if he is going to use this “version” or I can expect taht they will always use the latest release of Crystalens by default?

  Thanks again John

[JodieJ]

You have significant astigmatism, which will impair your vision at all distances with the Crystalens.  Be certain that your surgeon will be doing some type of refractive procedure to reduce/eliminate astigmatism before you pay the surcharge for Crystalens.  Another possibility for you would be toric IOLs (to correct astigmatism) set for modified monovision.

[mkmr]

Accroding to the doc, he says he can do some kind of procedure during the cataract surgery to reduce about half of the astigmatism, and few month after Crystalens installed, he will do a Lasik to get rid of the rest astigamatism. I am not sure if this is usually what they do to treat patient with high astigamatism or not. but it sounds reasonable.
The Crystalens is about $2200, it include a lasik surgery. I don't know how much it cost to do the cataract surgery and astigmatism reduce procedure yet, but will know next monday. I am sure it's going to cost me a fortune.

thanks for your response.

[JodieJ]

It sounds like your doctor has a good plan.

If you have cataracts, your insurance should cover the cost of your cataract surgery (less the surcharge for the Crystalens).

[John C Hagan III, MD, FACS]

--------------

[eyecu]

I would go to the Heights Eye Center in Houston and get a second opinion about the ReZoom lens. If you saw the recent Masters tournament and watched Gary Player play in his 51st Masters, then you saw a bilateral ReZoom patient who was so ecstatic with his vision he became a spokesman for the lens. My sister in law is bilateral with ReZoom lenses and passed her drivers test for the 1st time in her life not needing glasses. Mixing the ReZoom in the dominant eye and the ReStor in non dominant eye is also a widley accepted practice because it gives you range of focus in all lighting conditions. I am truly surprised that since the computer is important to you the ReZoom lens  was not mentioned as it should be your first choice. Yes, there are halos associated at night with multifocal lenses but glare is a by product of the Crystalens since it only has a 5mm optic. Look on the labeling. Plus it does not have even the minimal UV protection that most standard lenses have. Get all the facts which is what you are doing.

[John C Hagan III, MD, FACS]

Again use the search feature here an read all the bad posts on ReZoom. In a large group of active eye surgeons they would use only Crystalens and ReStor in their own eyes.

JCH II MD

[eyecu]

The meeting was a Crystalens user meeting so I would say the answers are a little biased. This board is not a scientific sampling. Any complaint does not mean it is a lens problem. It could be a surgical problem, astigmatic correction problem, target refraction could be over plus or minus, adaptation  problem etc. The ReZoom's strength is distance and intermediate vision. There are also J1 ReZoom patients so it is the only lens that gives you a chance at a full range of focus. It is a 3rd generation and does have some asphericity to it which the Crystalens does not. The ReZoom patient gets better over time as halo's diminish through neuroadaptation as they do with ReStor. Crystalens data on the 5.0 is just now approaching one year out so we will start seeing what long term outcomes with that product are and if does stop moving etc. as MKMR is worried about.

[JodieJ]

I agree that surgeons' opinions at a Crystalens user meeting might be biased sample.  However, when surgeons attending the ASCRS 2007 Symposium were polled as to which of four multifocal/accommodating lenses they would want in their own eye, the ReZoom lens also placed last.  In this forced-choice situation, the results of the polling were as follows:  43% of the surgeons chose Crystalens, 33% chose Synchrony (not available in the US, possibly a protest choice), 16% chose ReStor, and 8% chose ReZoom.  Since these surgeons are privy to  "inside information" about how well these lenses actually perform, these results are hardly a vote of confidence for ReZoom.  

[mkmr]

I just had Crystalens installed in my left eye two days ago on April 16th.
Now I noticed that I have some glare when I am indoors, especially form the ceiling lights; I don’t see any glare when I was driving at daytime in the sunlight. And the distance vision at daytime is excellent.  When I drive at night, the street lights give me circling glares from small to large and fly away from my eye when I pass it. This is kind of annoying.

Will this glare go away after a few days or weeks?

My arm distance vision is very blurry, I can not read from a computer monitor unless I set the resolution to 800x600, but when I put a 1.25 reading glass on, it becomes very clear.  I don’t know what’s going on. Will I be able to gain the close vision in the future? Should I keep using the reading glass I just bot? I wife suggested me to train my eye to read in arm distance by staring at the monitor very hard, she thinks using a reading glass at the age of 35 does not make much sense.

Any suggestions appreciated.
Many thanks!!!

[mkmr]

I just found a picture that can best descript what I have in my eye when I am approaching a light, it is not that intensive like the picture, but it more spread out. Not that strong like the picture. When I look directly at the light source, I don’t have any glare or flare.

http://upload.wikimedia.org/wikipedia/en/a/a6/Rainbow_flare.jpg

[lsnstr]

From a former Rezoom implant (had them explanted) I can tell you in no uncertain terms that the Rezoom lenses are a piece of junk. It is not only the halos you need to worry about, it is poor intermediate vision, ghosting, etc. I can't believe there are doctors still implanting those useless lenses!
Eyecu, are you a Rezoom salesman?

[JodieJ]

Based on her responses to previous posts, I believe that eyecu does work for AMO, the manufacturer of ReZoom.  She is very knowledgeable about many aspects of cataract surgery involving multifocal lenses.

Lsntr, based on what I've read about ReZoom, I share your sentiments.  However, I've seen a number of posts from people who are pleased with their vision with a combo of ReZoom/ReStor.  It's an open question as to whether these same people would have been even happier if they had gotten monofocal aspheric lenses set for (modified) monovision.

Mkmr, your eye is still healing.  What does your doctor tell you?  In your place, I'd wear the +1.25 readers if I needed them to read my monitor.  
  

[lsnstr]

I have modified monofocal vision and I'm very happy with the results. I was inspired to have the Rezoom implants removed based on the successful procedures and positive results shared by others in this forum.

[mkmr]

I did an eye exam the day after surgery, but my eye was still dilated at the time, so I don't see any glare/flare,
I will have a another follow up exam early next week.
Hope this glare/flare will be gone when my eye is healed.but until now this morning, I can still see them.

[eyecu]

My sister in law is a very happy ReZoom patient. Every patient out there has experienced trouble and has had lenses explanted whether it is ReZoom, Crystalens or Restor. That is the whole point. There is not perfect lens. And if you had poor intermediate vision than your surgeon missed their refractive target or did not know what they were doing. I am just looking for balance. If the Restor or ReZoom was perfect they would have never been mixed in the first place. There are Crystalens patients who have had low diopter Array lenses implanted or piggybacked so they could have near vision. ReStor patients also experience poor distance vision like looking through wax paper. Surgeons can be polled and say they would have or prefer a particular lens and they have never even implanted any of the three. The cream will rise to the top and the good news is that technology is being driven to find a better mousetrap.

[mkmr]

update
I had my second post surgery exam this afernoon. doctor says the glare is normal, the lens is perfectly aligned with pupil. it will either go away or my brain will filter it. I told the doctor the vision I have for crystalens is fine, even I can not read from the computer monitor.
The only problem right now is all these glares that bothers me most. and these ray like glares sometimes can occupy most of my eyesight if the light source is at certain angles. and doctor says he did not get that complains very often, most people only complain that they have glares occasionally. he asked me to come back to check again two weeks later, I asked what's my options if this problem continues. he answered "lens exchange", they do that a lot few years back when they had wrong power of lens installed. I asked what's the risk for exchange, he says the risk is just like to put the first lens in.
I hope these glares will go away, because even for a lens exchange, I have no idea what lens I can use. people in this forum get glares/flares from all three lens, crystalens,restor,rezoom. Maybe a monofocal one does not have glare.

[2ndsight]

I had a Crystalens implant 1 day after yours, 4/17. Right now I am using 1.25 readers for the computer, I have very little glare just a few reflections here and there. In my reading about how the Crystalens works I understand it should take a little time for the lens to be accomodating to intermediate and near vision. I have the impression that I can see well at all those distances (everything except fine print)  but there is actually still some blur. The Bausch & Lomb website I think says somewhere to allow 4-6 weeks for adjustment.

[2ndsight]

p.s. have you tried polarized sunglasses for the glare

[mkmr]

I am using 1.25 readers too. I can not wear sunglass at work since I need the reader to see the monitor. but I do wear gunglass when drive at daytime, I can not use it at night because it will be too dark for me.

For the vision part, I think we are almost the same, some good distance vision, pretty bad arm distance vision. but it seems to be I am getting more glares.

Do you have a lot of ceiling lights at your work place and home? I get glares from them a lot. sometimes these ray like, spider web like glares can be really large in the center of my eye if the light souce is at certain angles.

Do you see glares from your edge of nose and face when you look straight?

[2ndsight]

I am not having too much problem with glare, not like what you describe. I see a bit of reflection from light coming through windows and the TV, but very little. I have not driven at night yet, but looking outdoors at night I do see a lot of glare-halos-etc from street and car lights and things/objects seem darker than normal.

My eye has been dilated all week - at the post op appointment on 4/18 the dr put a drop of atropine in it - it has only just started going down. Did you have this? Supposedly the Crystalens is not supposed to move/accomodate in your eye while it heals and the atropine keeps the eye muscle from moving while dilating the pupil. This could be partly why you have glare...so it may subside in another week or so.

My biggest issue is my intermediate ( 2-20 feet) vision is a little distorted, not exactly blurry but as if my two eyes are not focused the same. It is most noticeable for instance in a room. Driving this is not too noticeable except when I have to negotiate a closer space, like parking, or pulling into the garage. This might also be just an adjustment from my previous vision. Time will tell...

[mkmr]

My dilation lasted for two and half days, at the post op on 4/17, dr did not give me any eye drops. They only checked the eye pressure and since I can hardly notice anything unusual with my dilated eye, I was out of there without talking too much to the dr.

I don't have the distorted thing you mentioned, but I do have the focus problem, I guess the eye and the brain are still adjusting.

I think your intermediate vision will improve since that’s what Crystalens good at, distance and intermediate vision, but not sure about the arm distance vision, like read from a computer monitor or a newspaper.

I see glare, halos too at night, and you are right, things are darker than normal at night.

Lets keep each other posted for any update.

[2ndsight]

yes I will post again in a few days. I keep forgetting to mention that I have a friend my age (50s) who got 1 ReStor and 1 ReZoom a year ago and she CAN NOT READ with either eye, must use readers and bifocals, even to see things on the grocery store shelf. So I think you made the right decision and hopefully the glare problems will subside

[bstaggs]

At the age of 42 I had surgery on my left (dominate) eye to remove the cataract and implant a Crystalens IOL. (3/25/2008) (Posterior Polar Cataracts )

On 4/22/2008 I had a Restor lens implanted in my right eye.

The first 3 to 5 days after the Crystalens surgery was bad. Halos, glare, starburts. But after the mediation wore off it got much better.  Now (4.5 weeks after) I have glare when I am indoors under certain lighting.  It is glare on my lens itself and not on the light source. If that makes an sense? It is almost like having a drop of water on my eye.  And I also have "ray" like or "spider webs", particularly when I am under a recessed lighting. It does seem to be getting better, so I am hopeful that it will subside in time.

The Crystalens gives almost surreal clarity at intermediate distance. I could see 20/15 at intermediate distances on my second post op visit.  Distance is also good with the Crystalens (and Restor) @ 20/20.  However I can not focus up close well at all with the Crystalens. Which is why my doctor advised going with the Restor in the right eye. And it appears to haved worked, becuase I am not wearing glasses at all.  I can even read fine print with the restor. The two lenses seem to complement each other very well.  I can see at any distance and I don’t give any regard to which eye is carrying the load. And I can drive day or night without problems.

So yes I have glare from the Crystalens and halos from the Restor, but considering how degraded my vision was to begin with, I am very satisfied

[mkmr]

Hi bstaggs

  Glad to hear your vision is good for all distance, my Crystalens is so so for distance and middle, pretty bad for arm distance.

  Can you tell me which one gives your more glare? I mean between Crystalens and Restor.

  I may have to do the other eye in a year or two, just want to make sure I am not getting more glare than what I have now from Crystalens.

Thanks

  

[bstaggs]

Which one gives me more glare?  The Crystalens for sure.  While I have only had the Restor lens for 6 days now, I don't recall getting any glare from the Restor lens. Halos yes, glare no.

The glare does seem to be getting better all the time though and I am hoping that it will go away altogether.  I have been wondering if maybe the glare could be coming from the astigmatism treatment and not the Crystalens itself.  I had astigmatism relieving incisions (not sure correct term) done on my Crystanlens eye and not the Restor.  ?? Didn’t you also have this done?

[mkmr]

Yes, the doctor also did astigmatism incisions on me.
But that glare should be create by the lens, not the incisions, I think. Not very sure.
I feel I am getting better too with this glare. but I can still see them when the light is at certain angle. Maybe it's just I pay less and less attention to them.

[vivian756]

Re Multifocal lens implants--lots of reports of multifocal patients having to use glasses for intermediate/near tasks.  Why, then, does the IOL Counselor, now being used in many ophthalmologists' practices, show perfect distance, intermediate and near vision for multifocal patients, and blurry vision for intermediate and near tasks.  Sales of multifocal lenses in practices using the IOL Counselor have jumped 50-80 percent, according to the IOL Counselor inventor, Robert Watson.      Linda Breen

[2ndsight]

interesting that you & bstaggs both had the incisions and encountered the glare - maybe there is in fact a connection...

I elected not to have the incision when I had my Crystalens implanted 4/17 since my astigmatism is very mild, and I have not had much glare at all (although I did start noticing the effect from overhead lights you mentioned it is only very slight with me)

my issue which has to do with focus at certain distances being or seeming out of whack is improving a little each day - I notice it is worse in direct sunlight - as if my eye is having more difficulty accommodating in bright light - but I do see progress...

[Mukobi]

Hi there,

I came across your posts and just thought I'd chime in.  I'm 37 years old and had the Crystalens 5.0 implanted 11 days ago (4/21/08), and still cannot see anything clearly up close or at arm's length.  Distance was 20/30 at my 2nd post op yesterday, but they have no explanation why I cannot see up close and intermediate.  I also see the "edge" of what looks like the left side of the lens when I look toward any light.  In addition, when I am under recessed lighting in our kitchen and other areas, I also get the spider web image where the light is divided into many rays that branch out.  I had extreme glare, halos, ghosts, etc. for the first 5 days after surgery, as my pupil was still dilated from the atropine, but now there isn't that much glare except for certain light angles (which can be quite distacting).  Anyway, they may cancel my second eye surgery that is scheduled for May 12th if the first eye does not accommodate.  I'm very worried I have the wrong power implanted, even though the computer that measures your eye got very close readings on two separate occasions.   I'm hoping the machine was at least calibrated correctly!  Any input you have would be greatly appreciated!

Thanks!
Kimberly

[bstaggs]

Hello Mukobi

The distance and intermediate has been really good pretty much from word go on my Crystalens eye.  The intermediate really starts working just a few inches past arms length.  I find myself leaning back in my chair when using the computer, rather than pressing my face to the screen as I did before the surgery.  I have kind of a dead spot where the Crystalens starts to fall off and before the Restor close up starts working of about 12” or so, but it is workable.  

The close up vision on the Crystalens has not been good at anytime.  It is an improvement over my cataracted lens but I would defiantly have to wear reading glasses were it not for the Restor lens.  Between the surgeries I attempted to read without my glasses as I was told this would perhaps train my eye to move the lens. To date I have seen no indication that the lens is “accommodating” at all. Assuming that close up vision is the measure for accommodation in this case. Since I can see both distance and intermediate does that mean that the lens is moving some?  

Don’t know if that helps any?

bstaggs

[Mukobi]

Thanks for your reply.  I'm glad you can see the computer with the Crystalens because I cannot see it at all, even if I lean back in my chair.  I have to either wear strong reading glasses (+3.0) or close the eye and use the cataract eye (which sees the computer and reading fine, but still has the very cloudy lens).  If I don't close the Crystalens eye, I'm dizzy from the overlap of clear and cloudy (left) and the extremely blurry (Crystalens).  My eye doctor has no explanation except maybe some inner part of th eye is still responding to the atropine.  But since the eye could accommodate just fine prior to surgery, I'm beginning to wonder if she might have accidentally cut the fibers that control the ciliary muscle that makes the eye accommodate.  I don't know if that's possible or not, but it would explain things.  I have not been given the option of the Rezoom or Restor because I also have retinopathy from diabetes and was told they would not work.  It's very frustrating, though, because there are no answers.  The spider web glare from lights is also very distracting, so I hope that will go away at some point.  Do you still experience that?

Thanks again,
Kimberly

[bstaggs]

Yes, under certain lighting conditions I still get the ray/spider webb glare thing.  Although it does seem to be getting better, or perhaps I am just getting used to it.  

bstaggs

[mkmr]

UPDATE

Same as bstaggs. plus halo from my nose and cheek at daytime outdoors.

--------------------------------
by bstaggs

Yes, under certain lighting conditions I still get the ray/spider webb glare thing.  Although it does seem to be getting better, or perhaps I am just getting used