ReStor Lens implants - in a month

[Eyeshy]

I have a very positive opthalmologist and have been convinced that this is the way to go; however, aftter researching some of the negative comments on line I am worried quite frankly.  I am 64 years old, a small cataract in my left eye and am considered to be a good candidate for the procedure.  To tell the truth, I would prefer getting this type of procedure done earlier in life than wait until I am older and have more physical ailments that would impede a recovery.  I just need reassuring I think at this point.

[CSBDR]

Couldn't agree more about being aware of bias in small, uncontrolled studies.  And although I do feel personality can play a role in neuroadaptation, refractive outcome and lack of pathology definitely trump it.

The Restor and Tecnis MF have a place in modern cataract surgery, but not as big of a place as some eyedocs (and unrealistic patients) would like it to be.

[JodieJ]

Thanks for info.  The closest I could find was an abstract involving patient satisfaction with the Array IOL (an older version of AMO's ReZoom), based on 1990's data from Germany and Austria.  It's my impression that the Array lens involved terrible glare and halo problems, and I'm not sure what (if anything) can be generalized from this data.

Unfortunately, single-practitioner studies (based on data collected from a surgeon's own practice) are bound to be subject to experimenter bias (i.e., the practitioner may be biased to blame dissatisfaction on the patient's personality.)

This thread was begun by a woman who was told by her surgeon that she was a "good candidate" for ReStor, but she was concerned about the poor outcomes of others.  CSBDR, you are probably in a better position than many surgeons to offer advice about who really is (or is not) a "good candidate" for Restor.  (One surgeon called me a good ReStor candidate, although I had pre-existing macular damage from an ERM.  Fortunately, I knew enough to flee that office.)  Your frank advice on this issue might help others avoid a lot of grief.    

[CSBDR]

Hey Jodie.  The study I've heard quoted several times, with at least somewhat objective personality assessment, came out of Germany in the late 90s I believe, I think through the International Society of Technology Assessment in Healthcare.  Don't quote me on that though.  Smaller, single practitioner studies have also been presented.  

[JodieJ]

I tend to be sceptical of conclusions drawn from all correlational research.  But I'd love to read the type A-personality/multifocality studies you mentioned.   (I'm a psychologist.)  Where can I find them?

[CSBDR]

I have not a rep and have no financial interests in the eyecare industry, but I am a fan of and understand all the available technology.

I am not trying to label anyone anything, there are studies (both in the IOL and contact lens worlds) showing that type-A personality tends to be less tolerant of multifocality.  Look them up, or talk to eye docs, they will tell you the same.

The "lousy vision" you describe is often one of two settings.  Surgeon not willing or able to get a pt at emmetropia, or other ocular pathology (tear film, macula, etc).  Believe it or not, there are literally thousands of people out there thrilled with their multifocal vision.

[JodieJ]

I agree with you about the importance of the wish to be free of glasses.  But I disagree about the personality factor.  It's just too easy to label someone "an obsessive engineer-type personality" when they repeatedly complain post-surgery about their (realistically) lousy vision.  That strikes me as blaming the victim.

CSBDR, you are obviously very knowledgeable about ReStor.  Are you an Alcon rep?  The manufacturer's reps who have posted on this forum seem to have an extremely good knowledge of their products.

[CSBDR]

Agree with JodieJ re: astigmatism, pupils, etc.  Personality is an equally important component, as is the will to become spectacle independent (which is more common with Restor than Crystalens).  Surgeon experience is actually more important with the Crystalens than Restor, where surgical technique is not the same as standard cataract surgery.  Dr. Kutryb and others are successful with the Crystalens because they are meticulous in technique, and select appropriate pts.  All these FDA-approved IOLs work in the right situations, but predicting those situations is not an exact science.

[JodieJ]

Most of the happy ReStor recipients have three characteristics:  no astigmatism, small pupils, and a surgeon who has LOTS of successful experience with ReStor.  Anyone without these characteristics is asking for trouble if they opt for ReStor (in my non-professional opinion).  And even those who are initially happy with their ReStors better hope that they don't develop a retinal condition in the future.  I agree with Dr. Kutryb--the Crystalens is probably a better bet if you want a "premium" IOL.

[disappointed66]

from disappointeed 66

I am sure  you will agree that everyone's concept of seeing well is different.  I am very particular and want to see crips and clear at all distances,near, far and in-between, even if it means wearing glasses.This is what I told my surgeon before I had the Restor explanted and exchanged with the tecnis monofocal.  Some of the things described by those  satisfied with  multifocal lens would Not be acceptable to me. So they may be happy and resigned to seeing rings and starbursts around light sources at night, but are okay with daytime vision  would not be good enought for me. and they still need glasses for small print!  And that is all I need glasses for.

So there is a lot to take into consideration.  And, as I said previous, I think multifocal lenes are over-rated and not as great as they make them out to be, not to mention the expense. It seems more people are not satisfied than are satisfied.  We all hope we are not in that 5% category.  But 5% of thousands of people are a lot unsatisfied. I personally think it is more than5%.  Is it worth the chance?  It wasn't for me. Also, many surgeons on this forum do recommend monofocal lenses.

And Good luck, Eyeshy. Whatever you choose, I hope you achieve the great vision you and all of us deserve.

D-66

[CSBDR]

I am not the surgeon who did my mother's eyes, but I do know many happy multifocal pts well.

Multifocal IOLs take a very bad rap on this website, mainly because of very vocal unhappy pts and surgeons who prefer pseudo-accomodating IOLs.  We all know there are limitations of multifocality, but there would not be thousands of multifocal contact lenses and IOLs utilized every year if everyone was disappointed.  

Everyone awaits truly accomodating IOLs with high amplitude, but that wait has no end in sight

[Michael J Kutryb, MD]

CSBDR may want to illuminate why he knows so many happy multifocal patients.  Perhaps you were the surgeon who put in your mom's lenses?  All I can say is that there is no way to try out this type of lens as you would be able to do with a multifocal contact lens or a pair of progressive glasses.  There can be some undesirable visual effects from multifocal IOL's and unfortunately there is no way to know if you will have them or be bothered until it is already done.  I'll leave it at that.  If you strongly desire to  to go with a presbyopia correcting lens, I personally feel more comfortable with the crystalens line of lenses.  They have less undesirable visual side effects but generally offer significantly less power for reading vision.  Surgical enhancement after cataract surgery could be needed in about 5% of cyrstalens patients.

[CSBDR]

My mother has Restors 3.0, and loves them.  Only uses reader glasses for dim lighting, and only for the finest of print then.  Know plenty of happy multifocal pts.

Realize this site tends to draw more unhappy pts, for a variety of reasons.  And multifocal IOLs are not for everyone, either due to conditions of the eye, occupation, personality, etc.  But if you have healthy eyes otherwise, are motivated to see without glasses, understand adaptation can take time, and don't mind the associated halos that typically diminish with time, you should do well

[disappointed66]

from disappointed66

I am 67 years old. I too thought that Restor was the only way to go because my surgeon advised and convinced me that this was the lens to have. He is an excellent surgeon   and I trusted him. Wrong. The surgeons make a lot of money on these lenses and I found out for a fact that this is true.  It was not a good decision.  I had the Restor explanted and exchanged for a monofocal lens and also had the other eye done with a monofocal lens.  (different surgeon)  I had a terrible experience with the Restor. as have many others.  Night driving was out of the question.  I am extremely happy with my monofocal lenses.  I Just need glasses for very small print .   Save your money.  My advice is to stay away from the Restor lens. It is not worth the extra money.
Do some more research. Check the archives on this forum.  Again, stay away from the restor and multifocal lenses and go with the monofocal lens to suit how you want to see.   From what I have learned even with multifocal lenses you still need to wear glasses for one thing or another. It is not worth the risk . Good  luck.