Would monofocal distance lens in dominant eye work with ReStor multifocal in other eye?

Two weeks ago I had ReStor multifocal lens implanted after cataract surgery in my non-dominant eye.   Daytime results are very good, although reading is still a little tricky because I am working without glasses and my dominant eye requires correction of approx. 2.00+.  Doctor checked me at 10 days and I have approx. 20/40 distance vision with the ReStopr but, for some reason, it is not correctable to 20/20 with glasses. I am supposed to have the same strength implant in my dominant eye in 10 days, but have decided to postpone the surgery because night driving is so difficult.   Not only do I still see radiating glare with the ReStor eye but now I also see superimposed on the glare 7 or 8 concentric circles around light sources, making the lights appear perhaps 4 or 5 times larger than I know they are.   On oncoming headlights, these concentric circles can overlap into a peanut shaped effect.   I understand ReStor IOLs work best when implanted in both eyes and my experience to date leads me to believe that my daytime results would be excellent, but right now I have less glare and no halos in my non-operated dominant eye and my vision in that eye is still correctable to 20/20 with glasses. despite the cataract.  Doctor says he would use same lens in the second eye (it's a quarter of a diopter off, whatever that means, and they used the "stronger" lens).     I am afraid that if I have the halos in both eyes,driving at night would be even more difficult and perhaps impossible, and the reason I had surgery in the first place was because of my concerns about driving safely at night.
   Since my second eye is the dominant one, I am beginning to wonder if I would be better off considering a single focus distance lens in that eye and wearing glasses for reading.  
  I was aware that there might be "halos or circles around lights" as the ReStor literature explains.   That wording is very misleading.   I thought they were talking about one halo or one circle around a light, not multiple halos and multiple circles around a single light source.
  Should I postpone the second surgery until the cataract is so bad that I can no longer get 20/20 vision with glasses, even though that's my dominant eye and it seems to be "fighting" the ReStor eye for control!!
  Whether now or later, should I go with the single distance IOL in the dominant eye? -  Would that eliminate the nighttime glare now caused by the cataract, or can you still have the same problem with any IOL?   Would a single focus distance IOL in my dominant eye "override" the halos my ReStor eye is seeing?
  I prefer not to consider explanting.  There are always risks to surgery   I hope I can, with practice, force myself to ignore or diminish the halo effect.  I just don't want a second implant to exacerbate the problem.
  Thanks for any advice.
Seeingisbelieving
  
      

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

There is a wealth of information on this website that you can access using the search and archives.  Hopefully you have the new ReStor IOL and not the "old" ReSTor.

I would consider waiting. Bilateral ReStor's are not an ideal mix. A Crystalens in your dominant distance and a ReStor in your reading eye is a often used combination.

I would get a second and third independent opinion before you do the second eye or decide to take the ReStor out of the operated eye.

JCH MD

[seeingisbelieving]

Thanks for suggestions. Yes, the ReStor is the most recent.  Dr. said it's been out just a few months.   Could you explain what "Bilateral Restors" means.  And, would the Crystalens  in the dominant eye be for distance only?
  Thank you.
Seeingisbelieving

[peakhope]

"Bilateral" just means "two sides", so doc was saying that 2 Restor lenses are not ideal (probably due to nighttime glare). Monofocal and Crystalens can have some glare problems in some patients, but most experience minimal if any glare with them.

Crystalens is an accommodating lens, which allows vision at multiple distances, using completely different technology from how the Restor works. The Crystlens HD generally offers very good distance vision with excellent intermediate, and some patients get near (<2') vision as well.

My doctor says he has had excellent results mixing Restor and Crystalens.  If you choose Crystalens, be sure to use a doctor who has implanted a lot of them, as they can be a bit tricky. (I have two Crystalens HD's by the way). Search this forum for problems and successes with Crystalens HD.

Waiting at least a while seems like a good idea. Before choosing a second lens, be sure you understand the likely outcome, as well as the best-case and worst-case possibilities. Think about how important it is to you to be able to see in the 2 to 6 foot range without glasses, as that would be the primary benefit of Crystalens HD over a monofocal lens. If really excellent (as opposed to good or very good) distance vision is critical for you,  a monofocal lens might do better than Crystalens.

There are no perfect IOL's on the market yet, and none that I know of on the immediate horizon (within the next year or two). So you will have to decide which features, limitations, and risks are most important to you, for your lifestyle.

P.S. I'm curious why your distance vision with Restor is not correctable better than 20/40. Did the doctor explain what is wrong? Perhaps it is just because the surgery was so recent, and will improve as your eyes recover and adjust.

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

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[cdn_glenn]

It sounds like you've received the ReSTOR 3.0 which is supposed to have better (more of the) mid-vision.  It still is a bifocal arrangement where both near and far images are focused on the retina.  In time your mind learns to separate the two images better.  That's called neuroadaptation.  Unfortunately it takes several months to endure and adapt.

I went through the same nighttime situation seeing concentric circles around lights.  At first the spaces between the circles were opaque and I couldn't tell what was behind the circles.  In months the spaces between the circles cleared.  I now see fine circles around halogen headlights, and still halos around distant lights.  What I am trying to say is that to some degree this will dissipate.  It probably won't go away.

I have bilateral multifocal IOLs (Tecnis not ReSTOR) with both good near and distant vision -- mid not so much, but workable -- and after time accepted them for the advantage they gave me.

If you're not happy now give some time for your eye to adapt a bit more.  Two weeks is barely enough time for your eye to have healed from surgery.  There are quite a few posters on MedHelp who have mixed Crystalens HD with a ReSTOR.

[seeingisbelieving]

Thanks - I'll check out the Crystalens for the second eye.  My doctor does implant them, but actually for me he recommended ReStor in both eyes, saying they work better when both eyes are implanted.   Vision in the one ReStor eye is really good by day, for near intermediate and far vision and I think it would be even better without "interference" from my unoperated dominant other eye.   It's just the night vision that's making me hesitate.  I'm concerned that having ReStor in both eyes will intensify the glare and circles. I'll give it a couple of weeks to see how I adapt to night driving and use the time to research other options.  Thanks for the help.
Seeingisbelieving

[seeingisbelieving]

Thanks for your comments.  Glad to hear that the circles and glare diminished over time in your experience.  I'm hoping that will happen for me or I can learn to ignore it.
  Did you notice a difference in the glare/circle effect between the first and second implants?   I'm concerned that the second implant in my dominant eye will intensify the problem.   Right now the dominant eye (albeit with a cataract) seems to "tone down" the images in the ReStor eye..  However, I keep hearing that ReStor lenses work better when implanted in both eyes.   I can tell that would be the case in daytime but.......nighttime driving?
  I'm not looking for perfection, just want to keep driving at night in safety.
  Seeingisbelieving

[cdn_glenn]

I had both eyes done at the same time, so I only have experience with both eyes having multifocal IOLs.  I can't say what will happen if you have a second ReSTOR implanted.  I know I really felt like I'd made a "boneheaded" decision at first.  In a few months things improved.

One thing that seems to be an issue with the previous version ReSTOR 4.0 is that it had a pupil size issue affecting night vision (smaller pupils are better).  I'm not sure if the 3.0 has the same issue.  Use the search engine in the upper right-hand corner of this page to research this and see if this is what you're experiencing.

Again, you take some time to see if you can adapt to the first ReSTOR you have.

[seeingisbelieving]

Appreciate your input.  I'm impressed you had both eyes done at the same time.  I had a hard enough time getting up the courage to get one done.  I think I'll wait a while to see how much the night vision improves.  Daytime vision in that eye is excellent and everything looks perfectly normal so no complaints there (although I was  hoping I could have used glasses to tweak the vision to 20/20 for driving).
Thanks again.
Seeingisbelieving