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Monofocal IOL's
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Monofocal IOL's

The surgeon who I have consulted with on my future cataract surgery only discussed implantation of the crystalens IOL with me. After doing a great amount of research and reading in this website I am leaning heavily toward having the aspheric monofocal IOL implanted in my eyes because of all of the  complications with halos, glare and other conditions many persons have experienced with the crystalens IOL.  When I called my surgeon's office to ask whether he implanted that kind of IOL the technician who guides patients through the surgery process said that while my surgeion did do monofocal IOL implants that I should be aware that they were "government issued' and that she could guarantee me that I would have to wear glasses later to correct not only  near vision but also  intermediate vision and possibly astigmatism. She seemed to denigrate the monofocal IOL as an inferior IOL and discourage me from considering it over the crystalens IOL.

Her comments have puzzled me and made me wonder  whether this surgeon and his staff are "pushing" the crystalens IOL because they are much more costly than the monofocal IOL. When I questioned her about calling the monfocal IOL "government issued" I did not get a satisfactory explanation from her. Are the monofocal IOL's government issued? Are they inferior to the crystalens IOL's?
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517208_tn?1211644466
Dear Art0512,

Each lens option has potential benefits and risks. If you are not getting your questions satisfactorily answered, seek the care of another eyeMD.
13 Comments
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Avatar_f_tn
By "government issued," I believe that the staff person meant "paid for by Medicare" (as opposed to paid for by YOU.)  Implanting the Crystalens (or the ReStor) can be very profitable for the surgeon; implanting aspheric monofocal lenses are not very profitable.  However, as evidenced by the reports of many patients, the surgical outcomes for the so-called "government-issued lenses" may actually be far superior to what you get with the so-called "premium" lenses.

When I was contemplating cataract surgery, I had a consultation in one office where the surgeon and staff had attitudes similar to what you encountered.  I couldn't wait to flee, knowing I would never be back.  In my mind, this surgeon's highest priority was her bank balance (not my well-being.)
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Avatar_f_tn
Hello Art,

I second Jodie's comments.  If I were you, I would flee this particular surgeon.  It is characteristic behaviour for profit-seeking lens touts to denigrate the excellent aspheric monofocals.  If you do have astigmatism, this would need to be corrected anyway for the best results, regardless of the type of lens implanted (unless a toric, but that's another matter).

There is no lens available that will guarantee you will never need glasses, and well placed monofocals are the tried and true solution.  Crystalens may not be as bad as the unspeakable multifocals, but it does have its own problems (do a search on this site).  The quality of your vision with aspheric monos will be the best current technology can offer, but you will need glasses for at least some things.  Click on my username for a multifocal catastrophe.

Hi Jodie - my post-explant traumas are seemingly endless, and I would have been **so** happy if I'd had my monos in the first place.  Still glad I had the explants though. - A.

All the best to you Art,
Restornomore
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Avatar_f_tn
Hi, Restorenomore--sorry to learn about your ongoing explant problems.

It enrages me to hear that state-of-the-art aspheric monofocal IOLs are being called "government issued lenses" by greedy surgeons and their staff.  With a mini-monovision correction, monofocal IOLs can provide results at least as good as the Crystalens, without all the post-surgery problems associated with the so-called "premium" lenses (and without the big out-of-pocket surcharge for the patient.)
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574673_tn?1234129578
I weigh in in favor of Jodie J and Restornomore. I am also a restor explant patient now with blended monovision. I had a torric IOL implanted instead of my dreadful Restor. I can read in bright light with no glasses, and use progressive readers for computer and reading other wise. Good intermediate and great distance vision. Please consider the monofocals. I believe you would be highly satisfied and much less prone to problems.
Good luck,
londonbridge
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Avatar_m_tn
Thanks to all of you for sharing your experience. It really helps to hear from real people with real life experiences who don't have an agenda. I am becoming quite leery of believing eye surgeons who push a particular IOL. I hope to find some who will honestly and objectively will lay out the options and their fact based opinions of the pros and cons. And since my cataracts are not that bad yet I am going slow and doing my homework before making a decision on which is the best option for me. At this point I am still leaning heavily toward the aspheric monofocal IOL's. Can anyone share their view on whether there are any significant differences between the various brands of this IOL? I have read on this site that the Tecnics are good. Thanks.
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Avatar_f_tn
There is probably not much difference between brands.  I got Alcon's AcrySof IQs because my surgeon only used Alcon lenses.  The new one-piece acrylic Tecnis model is supposed to be excellent, and it does have one advantage over the IQs.  Unlike some other acrylic IOLs, the newest Tecnis lens is not supposed to glow in your eyes.  In some lighting situations, my IOLs do glow--something like the eyes of those alien kids in "Village of the Damned."  (Or maybe I should say that they have that "youthful" glow.)  
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Avatar_f_tn
I answered your post of January 14th.  My surgeon told me nothing about the monofocal lens.  I was told that I was lucky to be able to have the multifocal lens available to me and this was the only way to go. I completely trusted him.  I did not know before I had the surgery that there was more to cataract surgery then he led me to believe. He claimed that the price he was charging me was the actual price he had to pay and did not make anything from it.  I learned differently. He made a lot. He thought more of the money than me.  Had the ReStor horror explanted by another surgeon and the Tecnis aspheric monofocal exchanged.  Both eyes are now done and I am in vision heaven!  I  only need glasses for small print. ( I would have had a nervous breakdown if that lens was not removed.)

Hey, JodiJ, Londonbridge and Restornomore.    Thanks for all your help.  I don't know what I would have done without you! Waiting to get my final check-up next month and will post a full report.  As you have read, I am doing great.  Thanks again.  Disappointed66

art0512 As I said before, the multifocal lenses are overpriced and over-rated.  I definitely recommend the Tecnis aspheric monofocal.   As one of the doctors has said, if he had to have  cataract surgery, he would not even cionsider the multifocal.   Best wishes
disappointed66  (not disappointed any more)
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Avatar_m_tn
Thanks for your candid and informed comments.. Very very helpful.
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Avatar_f_tn
Hi Art,

I have one AcrysofIQ (like Jodie) and one Tecnis (like disappointed66).  Long story!  From a purely *visual* point of view, I would vote for the Tecnis because it offers a slightly "lighter" colour spectrum, and is just a little better at night.  I really do notice the slightly "darker" Acrysof world, and thought the same thing when I had two of the vile Restors (also by Acrysof).The Acrysof does some filtering of certain spectra of blue light supposedly to avoid macular degeneration and this *may* account for the difference, I don't know.  Noone else seems to to particularly mention this darkening effect and there are many happy AcrysofIQ recipients.  All and any flaws in a particular lens are most noticeable in artificial and dim light - I see no difference at all in bright sunlight.

Example - Acrysof whites have a slight creaminess or yellowing compared with Tecnis.  Acrysof reds are a little darker - my shocking pink Tecnis dressing gown
shocks a little less with Acrysof.  The many greens of nature are deeper and greener with Acrysof and I like this effect, and dislike most of the others.  These observations are "subtle" if you like, both lenses are good.  The intensity of the effects vary a lot with the type and quality of lighting.  (I was on the train one evening peering with alternate eyes at a man and woman who had red and green shirts respectively. I had sense enough to stop before they called for the guard.)

It is very important with any lens to lessen glasses dependency that the Dr hits the refractive target, esp for distance.  I have an **idea** that technically this may be easier with some lenses than others - don't quote me, do ask an experienced and honest surgeon, and good luck finding one!  My explant surgeon gave me an Acrysof, and when that worked well, gave me a Tecnis in the second eye - so it may be that Acrysof is better in difficult cases, though that may not be so for first-time surgery.

If it's viable to do so, while your sight is still reasonable you might try simulating mini-monovision with contacts, ie one eye set for perfect distance, the other set to the equivalent of a closer focal point to improve your intemediate vision.  Or you can try a double-distance rig like mine.  Jodie has often recommended this trial, and it would give an idea of what to aim for with your surgery, though the outcome is never guaranteed to be identical.  I like double-distance myself (I suspect a minority view), but am more dependent on glasses at closer ranges than someone with mini-monovision would be.  You can also get different test lenses at an Optometrists and parade around outside in their gear for a quick peek if they allow it.

Beware of your sight going rapidly downhill, as is often the case with younger cataract patients.  I too was taking a leisurely approach, then suddenly went almost blind in the course of months, which frightened me more than I was prepared to admit at the time, and led to the worst decision of my life.

I echo Jodie's rage at the dishonest downplaying of monofocal lenses.  If any surgeon does not even mention this option, just flee!  There are $$$$ in pushing so-called premium lenses.  My mistake was to trust the word of a highly reputed surgeon, when alas a used-car-dealership approach would have been more realistic - this in Australia.  (Second thoughts - I take back the insult to used car dealers, at least they don't destroy people's lives and some of them would have a grain of human decency and compassion).

So for what it's worth, I reckon if you need surgery in the next couple of years, go mono, trial your options, and get a good surgeon (the hardest job of all).  Whatever your decision, please post on this forum so others may have the benefit of your experience.

Regards, Restornomore
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Avatar_m_tn
While I have received several comments from laypersons on my questions and concerns I have not received any from this website's doctors and  I would appreciate their  perspectives  Thanks.
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Avatar_f_tn
I would recommend you give your message a catchier, more specific title than 'Monofocal IOL's,' and that you address your question directly to either of these doctors on this forum:

John C Hagan III, MD, FACS

Michael J Kutryb, MD
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Avatar_m_tn
The surgeon who I have consulted with on my future cataract surgery only discussed implantation of the crystalens IOL with me. After doing a great amount of research and reading in this website I am leaning heavily toward having the aspheric monofocal IOL implanted in my eyes because of all of the  complications with halos, glare and other conditions many persons have experienced with the crystalens IOL.  When I called my surgeon's office to ask whether he implanted that kind of IOL the technician who guides patients through the surgery process said that while my surgeion did do monofocal IOL implants that I should be aware that they were "government issued' and that she could guarantee me that I would have to wear glasses later to correct not only  near vision but also  intermediate vision and possibly astigmatism. She seemed to denigrate the monofocal IOL as an inferior IOL and discourage me from considering it over the crystalens IOL.

Her comments have puzzled me and made me wonder  whether this surgeon and his staff are "pushing" the crystalens IOL because they are much more costly than the monofocal IOL. When I questioned her about calling the monfocal IOL "government issued" I did not get a satisfactory explanation from her. Are the monofocal IOL's government issued? Are they inferior to the crystalens IOL's?
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