Multifocal lenses cataract surgery

Hi. I am 53 years old and have Posterior cataracts. I am sceduled next week to have Restor put in one eye and Rezoom in the other two weeks later . I don't know which is my dominant eye, or how to figure that out. I am concerned with drawbacks with these lenses, and maybe my expectations are too high. I read about new lenses awaiting FDA approval. One is the Tecnis ZM900. Does anyone know when it should be available?  Is it worth waiting for? I don't know how much longer I can wait because I am having trouble driving and my eyes are bothering me. Can I have one eye done and wait longer for the other?

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

Hello Lisa

I have answered questions on both the AAO Eye Forum and the Patient Eye Forum for over 6 months. There are a huge number of unhappy multi-focal IOLs patients. Use the Archives and review previous posts to just how big of a problem these IOLs are compared to single vision IOLs.

Perhaps some of the unhappy folks will take the time to let you benefit from their experience.

The major disadvantages of the multifocal IOLs are: greater price, greater complexity of surgery with higher chance of complicatons, much higher incidence of IOL removal/exchange, under/over correction of expected refractive error, disabling night vision with glare, flare, ghost images, rays, arcs, very long time to learn to use the IOLs (neuroadpation takes up to one year), trouble with the eyes working as a team with the fellow eye with or without a cataract and most of even the "happy" patients use glasses up to 20% of the time.

In terms of which is the best ( and I use that term in a relative not an absolute manner) of the multifocal IOLs available in the USA  #1 Crystalens best at distance and mid range # 2 Restor best for near and mid range  #3 Rezoom Good for nothing in the opinion of most of the posters on these forums.

I don't think given the complexity of the FDA anyone can tell you when the Tecnis ZM900 IOL will be available.

Don't say you weren't warned. By far the highest satisfaction are monofocal IOLs like the Tecnis and use of glasses for some or most things post op.

In 2007 the technology of multifocal IOLs is far exceeded by patient expectations. It will not make your eye work like it did when you were 16.

JCH III MD

[JodieJ]

At your age, we're talking about your vision for the next 30+ years.  I strongly suggest that you re-consider your plan.  (Read through the archives of the eye care forums.)  I've found aspheric monofocal lenses to be totally problem-free from day one.  Please take a look at the patient education video at www.tecnisiol.com before you decide to go with a ReStor/Rezoom combination.  BTW, aspheric IOLs like the Tecnis monofocal can be set for monovision (if you're a good candidate) or "blended vision" (described by the forum M.D.s elsewhere on this forum).  The results with either would probably exceed what you'd get with multifocal lenses, without the surcharge or the problems, frustration, and anxiety.  (And from what I've read elsewhere, the Tecnis multifocal has many of the same problems as Rezoom--also from AMO).

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

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[hootgibber]

I am 42, and just had the Tetraflex IOLs implanted for severe bilateral PSC cataracts. They are really great, no halos, no wasted light from the multiple images, no confused brain over which image is in focus. I found a superb consulting eye surgeon in London, Mr. Jeremy Josephs (Spire Bushey Hospital), who did an exceptional job. I took a medical holiday in London for 3 weeks, and got it done and a final ok to travel. Insurance paid for most of the surgery, the out of pocket for surgery itself was actually less than here in the US.

These lenses are still in clinical trials in the US, (and the enrollment is almost complete) if you look up on the website, they are still enrolling patients at some of the 7 centers, but I was disqualified due to 3d astigmatism OS. The max astigmatism is 1d. One of the great things about these lenses is that if they fail (accomodation fails to finction properly) you have monofocals. Also, if you are diabetic and concerned about imaging the fundus later on, these are perfectly clear and do not impair that in the slightest. If they work correctly you have great distance vision, and a month after, I am reading all but the tiniest type. I tested 20/12  and J4 just 7 days after, and 20/15 J2 or J3 just 30 days after. I do have some 1x readers for the little stufff, or for when my eyes are tired after a long day, but generally functioning w/o glasses of any sort for most activities.

You will find cataract surgeons are careful about patient selection for surgery because expectations often exceed the limits of the technology. I say it is OK to have high expectations, but be prepared to live with the results even if they are not perfect. The surgeon will do their best, but independant physiology of each of us is a real wild card that is difficult to control for. Aim high. Best luck.

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

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[yatriwalli]

hi-
i have had the amo technis multifocal lenses implanted and i dont know what the end result will be, the first eye was done october 6 and the second november 5. but i do suspect that it isnt a good idea for anyone unless they had severe defects in their vision before the cataracts. in my case, i had poor depth perception and contrast sensitivity, night vision, etc. i already saw haloes and glares, so i didnt have a lot to lose. i had worn glasses since the age of 5 and never had good vision no matter what prescription was given to me. i had no astigmatism. i dont know what it was that caused my poor vision or what it is in the lenses that have helped me so much, but they are like a miracle for me. i had been told at the age of 28 that i needed bifocals, and ultimately they only worked for close vision-my natural lenses apparently could not focus at different distances, and i would have needed four pairs of spectacles for different tasks. obviously i could not drive, and it was difficult to see the number on the bus until it was close enough to hit me.

i agree there is a neuroadaptation, but i am having fun with that-many people would be annoyed, but i am retired and nothing i do is important, so i can spend all day experimenting with different tricks, and i believe the more i do the better the eyes work together...so far.

so my advice would be to stay away from the multifocals unless you are already a hopeless case.

[Restornomore]

Hello Lisa,

I can only echo the comments of Dr Hargan and JodieJ.  Dr's summary of the drawbacks of multifocals pretty well covers it.  I am one of the unfortunates who was conned into multifocals, and it was the worst decision of my life.  I had two Restors explanted and monofocals put in, and I am *delighted* with the results despite ongoing problems due to the amount of surgical intervention I have suffered (an apt phrase, believe me). Please click on my username for my posts on this subject - they contain a lot of detail about the multifocal and monofocal experience.

Even though your poor vision is frustrating (I was nearly non-functionally blind, and that alas distorted my judgement) please do defer your decision and do some further research.  As Jodie points out, you are looking at the next 30 years of your life, so what's another month or two?

Yatriwalli is also offering you very good advice.  The patients most satisfied with multifocals are easygoing persons who typically had very bad pre-cataract vision.  All the best to you Yatri, I do hope you get to enjoy your vision more and more as you adjust to it, and that you experience the freedom from glasses you have never had.  It is quite true that multis are not for everyone.

Don't be afraid to cancel surgery out of any misguided sense of obligation.  Think of the next 30 years - you will be living with this decision for a very long time.  If you are pressured or hassled in any way, your best interests are not being considered.

All the best, whatever you decide.
Regards, Restornomore

[OldNavy966]

I wouldn"t go for a "premium" IOL if I were you.  I did.  Now I wish I hadn't.  I mean REALLY wish I hadn't.  That's my two cents.  Good luck.

[caren123]

Hi.  I'll add my voice to the nays.  I was debating for about a month between the two types of lenses that were suggesed, the old fashioned ones, and the crystalens.  My surgeon had no advice and said it was my decision.  I spoke to one of his crystalens patients who was happy.  Then I asked the surgeon if there were more risks to getting the newer lenses, and he said it was the same. (I don't believe that statement was true).  Depending on that last statement, I took the plunge and decided to pay the fee in hopes that I would not have to wear glasses at all if I was lucky, or maybe only for reading. The literature/advertisements  looked good .  As it turned out - his measurements were off and my lens is the  wrong strength.  (It may also be stuck in a forward position but I am not sure) Even with a contact lens I cannot see.  These lenses I think are trickier for the surgeon to handle.  And, unfortunately, the surgery caused complications to an already compromised retina.  Could this have been forseen?  If so, the surgeon never  mentioned it.  I have not been able to use that eye since.  I don't know if/when all of my problems will finally be resolved. It will take 2 more surgeries I think.   I only wish I had found this website before making my decision. In my opinion, these new lenses have too many possibilities of things going wrong.   I wouldn't do it over again the way I did..