Restor lens vision issues

I had Restor lens implants put in both eyes seven months ago. My distance vision is great, my middle-distance less so. But the biggest problem I'm having by far is in working at my desk and at my computer, and in reading. The doctor told me before the surgery that I "might" have to use reading glasses for these activities, but he apparently had no idea how difficult these activities were going to be. I definitely need the reading glasses and have been getting them at the drugstore, but I cannot find one pair that works for everything. Currently I'm using 1.75 for computer work and 2.50 for reading a book or newspaper. It's very awkward shifting back and forth like this. Can anyone who may have had a similar experience offer me any advice? Does anyone know where I could go in New York City to reliably get a pair of customized, post-cataract-surgery reading glasses made? Thanks in advance for any help--I have to do a great deal of reading and computer work and am having a hard time of it right now.  

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

No single vision pair of glasses no matter what the price is going to suffice for your multi-distance needs. You should resign yourself to the physics of optical systems and get a pair of custom (for you) pair of no-line progressive bifocals.

JCH III MD

[Focis]

Thanks for the advice. I'm going to look into that. I actually went about three months after the surgery without any glasses at all, because my doctor had told me to try it, but eventually my eyes started burning and feeling sore all the time, and I had to resort to the drugstore glasses. I couldn't see into the next room before I got the Restor lenses. Now I can see a freckle on a nose in the next county, but keyboards, check writing, computer screens, a good book--these things are problematical. Thanks again.  

[JodieJ]

The ReStor lens is essentially bifocal in design, with distance and near vision segments.  Intermediate vision is its weakness, and many (but not all) people with ReStors reportedly need weak readers for using the computer and other intermediate vision tasks.  However, needing +2.50 readers for near vision is not usual, and you don't seem to be gaining any benefit at all from your "premium" lenses.  (I have two monofocal lenses set for plano and need +2.25 readers for tiny print.)  Perhaps your lenses are slightly decentered, or mild astigmatism may be impairing your near vision; both of these problems are correctable.  In any case, I certainly think that it would be worth your time to get a second opinion from a surgeon who is very experienced with ReStor.  Best of luck!

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

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[Focis]

Thank you, Jodie. It may be that I am overdoing it with the 2.50's. Those glasses sure do give words on a page a crispness and a clarity that lesser powers don't, but then again, so would a magnifying glass. Perhaps to a certain extent I have managed only to confuse myself, and my eyes, by so much tinkering. But there are so many variables at play. For instance, how far from one's eyes should the computer screen be? Mine is currently about 32-33 inches away, but would it be better if it were the same distance as, say, a book or a newspaper is when we're sitting in a chair reading? And should the reading glasses be worn on the tip of the nose (which was the advice I got), so one can easily see over them, or should they be pulled all the way up? I am hoping I can sort all these things out on my own before going back to the doctor. Thanks again for your help.      

[JodieJ]

I think it would be a big mistake for you to assume that your near vision problems with your ReStors are in ANY way your fault.  Good near vision (without any reading glasses) is supposed to be the strong point of the ReStor IOL.  (Take another look at your ReStor literature.)  The fact that +2.50 readers make things crisp and clear for you suggests that there is a major problem in the way your lenses are working.  The way I see it, you paid good money for multifocal IOLs, and you essentially ended up with lenses that perform like standard monofocals.  Unfortunately, I don't think that your problem(s) with your ReStors are something that you can fix on your own.  If your doctor can't identify the reasons for your poor near vision (which weren't caused by your tinkering--you've been tinkering BECAUSE you've had difficulties), then you'll have to consult other experienced surgeons.  However, at the very least, your doctor can give you a prescription for progressive glasses.
  

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

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[Focis]

Thanks again! I can read without any glasses at all, but the typeface on the page is pale-looking, not black and crisp, and the words swim a little and blur over, and all in all reading is laborious. In situations of lower light it becomes quite impossible. If I cover my right eye and read only with my left, I can still read, but if I cover my left eye and try to read only with my right, I can't make out a single word. Only when I kick up to 2.50 can I relax and read without even thinking of my eyes.

I also have considerable trouble when, for instance, I'm in the aisles at the drugstore, looking at the products on the shelves, or in the library looking at the books on the shelves. In both cases the objects I'm looking at are quite blurry, though I can eventually make them out with an effort. One question I have about the Restor lenses is: At what approximate measurement in feet does the problematical "middle" zone begin and end?    

Anyway, you've motivated me to make an appointment with my surgeon. I'm grateful for your knowledge and insights.    

[JodieJ]

The fact that you can read better with your left eye than your right suggests that your difficulties  might relate to issues (e.g., wrong IOL power, mild astigmatism), which can be addressed with laser vision enhancement.  (Do you know your distance acuity with each eye?)

I sometimes wear bifocal contacts, so I understand the problem you have reading the titles at the library.  I think that improving your near vision in each eye will help a lot with the "middle" zone, but you'll have to experiment to find the optimal viewing distance for many tasks.  I suspect that the "middle" zone varies from person to person; ask your surgeon.

I think that you can look forward to some improvements in your vision.  Best wishes and happy holidays!