Visual acuity with cataract lenses

[VisualAcuity]

I am trying to select a cataract lens and am currently trying to choose between a monofocal lens and Restor. My question is: Shouldn't it be possible to chart my current visual acuity as a function of distance from either my current eye glass prescription which is for both near and far vision (crude) or from a series of tests (more accurately) and compare that with charts of visual acuity as a function of distance for each of the lenses that I am considering.

I realize that a new set of tests would have to be run on my non-cataract eye. But, since my vision was similar in both eyes, I would be ok with that.

I was quite happy with my vision before the cataract, even though I had to wear glasses for driving, and would be very happy simply to restore my vision to what it was without all the potential side effects of the new high tech lenses. I think that charts of visual acuity as a function of distance for my eyes and all the lenses I am considering would do more than any other single factor to help me select the right lens.

[Michael J Kutryb, MD]

A monofocal aspheric lens should be able to provide pretty good distance vision (provided you have an otherwise healthy eye and minimal astigmatism.)  The vision will usually be able to be fined tuned as well with a thin glasses prescription.  Reading vision will requre the assistance of reading glasses.  Your other option is use the same lens and remain a little nearsighted so you can read books somewhat without glasses but would definitely need fairly strong glasses to see to drive.  Finally, some people have one eye for near and one eye for distance.  

Regarding the Restor, you would get some distance and some reading vision, but a higher incidence of troubling glare and halos.  Driving at night might be very, very difficult.  Also, there is no way to "try out" the lens or get an idea what it might look like.  Taking out these type of lenses can be very involved and includes a list of possible complications as well.  If you don't mind wearing glasses somewhat, stay with the monofocal lens.  Also, you might want to speak with a couple of friends or people you know that have had the Restor lens.  Find out their experiences first.  I think that would be very helpful.

MJK MD

[londonbridge]

I am glad to be of help. I am only a patient like you, but I found this forum to have a lot of good information both from the doctors and caring folks.
One thing that you need to consider is how your two eyes will function together. I did not hear if you are planning/needing to have cataract surgery on your second eye. It has been reported that multifocal lenses work best when they are done in pairs (although in my opinion I would never chose them again). Generally if you choose either full monovision(one eye set for distance and one eye set for close up) or blended monovision(one eye set for close up and one eye set for intermediate - thus using glasses for distance or one eye set for intermediate and one eye set for distance - using glasses for reading) you would have your dominant eye set for distance (or intermediate in the first scenario). Most people can tolerate blended monovision easier than full monovision. One way to simulate this is by trying it first with contact lenses. You also need to keep in mind that IOL's don't generally correct for any astigmatism (either preexisting or created sometimes by the surgery itself). There are procedures such as laser, limbal relaxing incisions or just glasses to take care of this. Your astigmatism at -.75 is not that great and may not be a factor.
It is still my strong opinion that I would choose a monofocal lens (the newere aspheric have great reviews) over a multifocal hands down. You will have crisp vision at your chosen distance without most of the problems of glare, halos, problems with contrast, night driving issues (all problems with Restor). If you do not mind wearing glasses for some tasks ( and many multifocal lens wearer's need glasses anyway), you will be happier and not have the added expense of a premium lens.
Good luck, Do all the research and ask all the questions of qualified surgeons that you need too. A surgeon that truly cares about your satisfaction will by very willing to work with you.
londonbridge

[VisualAcuity]

Thank you very much for your comments.

My preference would be to get a near sighted monofocal lens but I would like to have
some idea of how bad my distance vision would be if I make this choice. My last prescription for my right eye (precataract) was -1.25-0.75 x 10 which is not very strong and I have never worn reading glasses.

I appreciate very much hearing about your experience londonbridge. I have a brother in law who really likes the Restor lens. However, I find that, when you talk to someone who really likes a particular lens, you eventually find out that they had terrible vision before the cataract, so anything would be a vast improvement. That is not the case with me and the Restor lens has a lot of undesirable side effects.

I have now had evaluations from 2 ophthalmologists and am going to have at least one more. The results are confusing:

OP1: Preferred Crystallens but said that, in my case, I could restore my vision to very near what it was before the cataract with a near sighted monofocal lens (I find this hard to believe - hence my questions about visual acuity as a function of distance)

OP2: Preferred Restor. Thought Crystallens had too many problems.

OP3: I have not had the evaluation but I know through a friend that this ophthalmologist prefers monofocal lenses

[londonbridge]

Please read my posts under londonbridge, regarding Restor. After months of miserable vision with my Restor, I had it explanted by an expert surgeon in MA and replaced with a monofocal set for mid distance. I still have a minor cataract in my right eye and so I wear a contact for distance in that eye. This gives me fairly good intermediate and distance vision and I need reading glasses for closer up. My Restor lens was terrible for driving at night (one of the main reasons, I needed to have my cataracts done in the first place!) the contrast sensitivity i.e. seeing things on a dark background was also bad. Added to my woes was the fact that my first surgeon measured wrong and I was left farsighted so I my vision was poor at all distances. Save yourself a lot of heartache and go with a monofocal. If you want the most crisp vision and don't hate wearing glasses for some tasks (depending on how you set your monofocal) that is what I recommend. 'The technology is simply not there yet for the high tech lenses. It seems that the direction is moving away from multifocal and more toward accomodating lenses like Crystalens that have hinges that move with your eye to change focal points. Good luck. Take your time, do your research and find the most qualified surgeon you can. It is your vision for the rest of your life and cataract surgery, while generally uncomplicated, is still surgery and is not just a simple process.
londonbridge

[Michael J Kutryb, MD]

One other thing. Please use the search medhelp feature on this page and enter Restor and read posts from other patients.

MJK MD

[MaryRoe]

You are so right in taking one's time and doing homework.  I am sure my surgeon placed the wrong lens in and also I aquired a PVD post-op from his inexperienced or careless hands. I am paying the price now and will live in the thrones of &*%^%& forever.  Not only does one want to seek out the best surgeon but talk to his patients.  See if his Tech's are good.  Mine were not all that great. It does not matter if the doc has Professor before his name....this means nothing if he cannot relate to the patient or recognizes a post-op problem and does not kick them out the door.  Eyesight is priceless. My best to all of you.