Restor Multifocal lenses

[Zell1]

I had cataract surgery just a week ago, Restor multifocal lens was implanted in one eye. Distance vision is 20/20 and I can read  the computer and fine print and I'm thrilled with that .My next surgery is in two weeks. I know that midvision with the Restor is not going to be wonderful and that it's supposed to improve some with time. My question is about blurry or unfocused near vision (to do makeup, nails, etc.). Also, I went into the book store today and titles on shelves all looked blurry (compared to my "old" eye with contact), but yet I could open the book and read the fine print with my "new" eye. I understand things will improve with the second implant and maybe six months time. I do see some "ghosting" reading, but I can probably live with that. I have been myopic all my life and knew going in that reading with my natural eye probably would be better than with the implant, but at least I can read and the distance vision is exciting. All would be great if I could see better in the mirror and close up. Why can I read small print with the Restor and not see clearer close-up otherwise? Maybe it just takes time or perhaps I'll need some "cheater" glasses for these tasks. I'd like your opinion. Thank you so much.

[Zell1]

Hi. I really do appreciate your input. I'm hoping I fare as well as you have. I can deal with the midvision, I think. My main concern is the close vision.  Now, I'm not talking about reading fine print, because I can do that fairly well so far, though there is some ghosting. What is bothering me is not seeing as clearly close up generally, like not seeing myself in the mirror close-up and things that are close not being sharp (sharp, I guess, is the word). It doesn't bother me generally just around the house or out and about until I really need the near vision. When you said your near vision improved, were you talking about near vision generally or just reading fine print?   My surgeon says I'm doing wonderfully....just wish I totally agreed with her at the moment!

I'm trying to be upbeat, and your comments have been a great help. When I made this decision, I was not sure I wanted to do monofocal for distance, though if I have to wear readers forever, I'm not sure what difference it would make. (sorry, don't mean to go into the "poor me" mode. ha) However, I'm hoping that, like you, that will improve. I thought about monovision since I'd been reasonably happy with monovision contact lenses; however, I have a friend who had monovision implants and said she was disappointed that she did not see as well as she had hoped.  Of course, we're all different and some can adjust better than others. Some of us may even have more talented ophthalmologists/surgeons than others, so there certainly are variables. I'm very grateful for your comments, Glenn, as it's good to hear from someone who has been there (and who seems pleased with the outcome). Your list of improvements is encouraging. Hope you don't mind if I "consult" you from time to time.  I'll let you know my progress.  I'm hoping there'll be two of us who can encourage others one of these days!  Thanks again.

[cdn_glenn]

You're very welcome.  It's only been a week since surgery and your eyes are still healing.   I expect your vision will improve greatly.

Things that improved for me in the first month:
1) adjustment to different light conditions -- very slow at first due to (I guess) swelling and other effects of surgery -- now normal adjustment time
2) near vision improved greatly from poor (very worried) to acceptable (some relief) to being able to read extremely fine type (yippee!)
3) the range of "acceptable" vision bordering near and distant vision increases, hence a lower reliance on reading lenses

It definitely looks like you've gained greatly as a result of your first IOL.  Regarding the choice for your second IOL, there are different schools of thought:

I personally feel that both eyes having multifocals is the way to go.  I've read many articles supporting this and my personal experience agrees with this.  (Note: As long as one of them isn't a ReZoom.  Search for other posts with ReZoom on MedHelp.)  The difficulty with multifocal lenses is that they WILL have a period for adaptation that may be 6-12 months, or longer.  They may have some degree of aberration, such as halos, starbursting or ghosting.  The odds are the patient will have to live with some degree of these aberrations for the rest of their lives or explant the lenses.  The difficulty for the practitioner is needing to either educate the patient about the initial outcome from surgery or face repeated reports of dissatisfaction from their patients.

Others would recommend monofocal aspheric IOLs in one or both eyes.  This option, by far, seems to be the "sure thing" -- at least the least probability of patient dissatisfaction after surgery.  Also, this has the least probability of having any halos.  The only thing is that the patient will either be focused for distance, near or monovision.  In the first two cases (distance, near) the patient WILL have to wear glasses for some part of their vision.  If they are comfortable with monovision they may be free from glasses.

I'd like to hear how your first eye has come along after a month.  I'm hoping it will be improved.

Good luck,
Glenn

[cdn_glenn]

I have two multifocal (Tecnis) lenses.  I have exactly the same loss of mid vision you describe.  You'll find that when reading anything still on the shelf you'll need to either get closer or step back to the far side of the aisle.  The alternative is to pop on a set of, in my case, +1.00 reading glasses.  This gives your mid vision priority.

I found my near vision improved greatly in the first month.  I wore my +1.00 readers to help with near vision.  After a while I no longer needed them.

Some of the ghosting goes away (Neuroadaptation) and some may stay.  I don't see ghosting on a printed page.  Hopefully this will pass.

Regarding the second lens I am very happy with two multifocals.  The one concern many people have reported regarding ReSTOR lenses is poor performance in low light situations.  Many people find that reading in dim light, such as reading a menu in a restaurant, is very difficult with ReSTOR lenses.  Others are fine with them.  Since you enjoy reading please test your ability to read under different lighting conditions.

Regards,
Glenn

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

You will likely need glasses for many things.  Your problem will need to be dealt with by the surgeon based on the readings of residual refractive error.

You might want to discuss "mix and match" such as putting a high quality monofical IOL like the Tecnis or the Crystalens in your other eye.

The tendency now is NOT to put two ReStor IOLs in one person. AND CERTAINLY NOT TWO OF THE REZOOM IOLS.

jch iii md

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

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[cdn_glenn]

I've done much reading on the Internet regarding mixing and matching IOLs.  Many surgeons mix IOLs as part of a strategy for blended monovision.  The advantages of one IOL in the dominant eye and the other IOL for different functions, such as reading in low light situations.  Other surgeons implant a different IOL in the second eye depending on the results of the first implanted IOL and the patient's needs.  Many surgeons do not advocate mixing IOLs at all.  It's a matter of experience with each practitioner.

If you're looking for an unlimited supply of articles on the topic try Google:

http://www.google.ca/search?hl=en&q=mixing+matching+IOLs&btnG=Search&meta=

Also, I should let Dr. Hagan answer for himself.  But he, along with many other good practitioners, offer their time to MedHelp -- often answering the same or similar questions over-and-over.  There are only three multifocal lenses approved in North America and a handful of monofocals.  You'll see certain lenses often mentioned, because they have a good success rate and high patient satisfaction.

Glenn

[BobbieB]

I had a ReStor lens put in on Oct. 15, 2007, and nothing about it has been good so far. Flickering as I turn my eyes or head. Always feels like something in my eye, like a contact is in there and folded over or something. I'm now wearing glasses, trifocal from my regular Dr. I wore monofocal contacts for many years, and liked them. Now, wondering if I will still have to have this ReStor replaced. I can't shop in stores in ease or even work in the garden which I usually do alot, now, I'm wondering if I'm totally ruined, which is what I feel like. I'm so afraid to have the other eye done now. I'm using a contact in it..same as before, it was my distant contact.     BobbieB   Feb. 04, 2008

[Zell1]

Thank so so much for your comments.  It's good to hear from someone who has actually been through this and seems happy with his multifocals (seems like a number of people aren't, but then happy people don't always seek out forums for advice I guess!) You give me hope that my eyes (and brain) just need more time to adjust.  I have read that things get better after both eyes are done. I am very happy with my distance vision and the fact that I can read small print. Actually today when I went out, I took my readers with me and found they did the trick when choosing some greeting cards.  It was just a bit of a shock to find that what I consider my near vision was not what I thought it should be.  Midvision seems to encompass more territory than I'd realized, as I had read and been told that midvision suffers with Restor. It's encouraging that you no longer need your readers. I hope that happens with me as I find this pretty frustrating.

I have noticed that light does have an affect on the  Restor lens, that it does need to be fairly bright. I can probably live with that.  I couldn't read a menu in a restaurant before Restor without readers, so that won't be a change unless I can't see at all in a dimly lit room. Many people with multifocals seem to complain about night driving and halos around stoplights, etc.  I had halos before the Restor, plus I couldn't see distance, so night driving is so much better now. On a recent night drive I couldn't see that I had any more problem with the Restor eye than with my "old" eye with contact on.

I truly appreciate hearing from someone who has good things to say about multifocals. I am determined to do my best to adjust to the multifocals and feel thankful the surgery went well. I hope that I will be as lucky as you seem to have been to have made such a wonderful adjustment. Thanks again for taking the time to respond.

[DNK]

Dear Dr. Hagan,

My Mother will be having Cataract Surgery Soon...

What has been your experience implanting the various Presbyopic Lenses?

Could you elaborate or explain data on why Mixing and Matching technology is recommended? Everything I have read from the manufacturers of these lenses suggests bilateral implants of the sametype. Please comment if this information is anecdotal, or from a  peer reviewed controlled study.

Also, do you or members of your practice have any "Financial Ties" to any of the products listed above?

Thanks,

D

[Zell1]

Thank you for such a quick response. I'm sorry I didn't find your site until after I had one eye done. I thought I had done considerable research before surgery. I'm tending to second-guess my decision, but am trying not to as I know I still have adjusting and healing to do. I had tho't about monovision lenses since I wore monovision contacts for many years, but for me that was a trade-off, too, as I couldn't read perfectly or see distance perfectly either. I changed to distance contact lenses as my eyes became progressively worse to see if they would help my distance sight though I'm not sure they did. I know there are concessions with whatever lens implant one chooses. I think I just hadn't realized that my near vision would not be good. However, I know i'm only a week out of surgery and need to adjust and see how my eyes progress. I will ask my surgeon about having a different lens in the other eye. Thank you so much for your input.