Ashperic Restor vs. Monofocal for 33 year old eye?

[javadesigner]

Hi:

I am male, 33 years old, with bilateral (and growing) PSC cataracts. Also a huge (and growing number) of floaters as well. Have had many dilated eye exams from very good doctors and there are no retinal complications (although, there may be faint signs of PVD, but no retinal tears or detachment).

I've consulted with some doctors who have performed upwards of 25,000 cataract operations and several thousand Restor implants. (Dr. Christerbury in North Carolina, Dr. Mckool in NYC, some others in teaching hospitals)  

No one can really recommend a lens to me. They've all gone over pros/cons of monofocal (Alcon IQ aspheric, for example) and multifocal (Restor). They've all said that Restor has "good" performance but does leave halos around bright lights which will never go away.
No one is sure whether mono or multi is good for me, everyone has said that although most people are happy with restors, some people are never able to adjust.

Also restor is similar to Monofocal for distance but not great for intermediate vision.

I'm a computer programmer, heavy web surfing, cell phone, video game use. Reading finely printed computer manuals and switching back and forth from the manual to the screen is important to me. I've worn glasses since 14 and have -5.50D in both eyes.

So my questions are:

1) Does the Aspheric restor improve intermediate vision over the previous version ? Does this newer version make going with restor now, a no-brainer ?

2) I've read that with monofocals, vision is quite blurry less than 5 feet inwards. With monofocals, could I switch easily from keyboard, monitor, open manual etc with bifocals or would i have to keep switching glasses to read a monitor 22 inches away vs. a book 12 inches away ? IF this is possible with MONOfocals, then maybe they are a safer option ?

3) Having the ability to read my wristwatch when I get up in the morning or a book to fall asleep to would also be great :-)

4) What other advise would forum members give me ? I really need to get surgery in the next year or so (I have too much glare, halos, smudged vision as of now with PSC). I'm
generally quite fussy (a smudge on my glasses really bothers me) but as I grow older, I think I can learn to compromise/adjust better with whatever type of IOL I choose.

Thanks so much for all your advice and replies.

Best regards,
--j
***@****

[gobal]

I was the 72 year old with vision problem. After reading the various queries and comments I feel I should fill in more details of my problem , perhaps I might then get some help. I had cataract in both my eyes and had difficulty reading anything beyond 20 feet. I am shorted sighted and suffer from astigmatism, both the latter conditions since my early teens. I had cataract surgery done in my right eye in December 2007, but it was a failure. The posterior capsule got punctured during surgery. It was successfully corrected by another very capable surgeon in March 2008. In July 2008 I had a fall and hit the back of my head quite severely. After a couple of weeks after the fall I developed bleariness, especially the periphery  in my right eye. This was diagnosed as retinal detachment and by the time my surgeon who was on long leave saw me, the retina was 100% detached. It was corrected and I can now see quite well with glass, in fact better than the left eye. I need to change my spectacles now. I need advice as to what type of lens to obtain.  

[val42]

Thank you for your comments.  I have just about decided to forgo ReStor.  My doctor did not mention using Crystalens.  I plan to ask for the Blended Monovision (or is it Blended Monofocal??) -- anyway, the one with one eye far & the other intermediate.  I used to wear contact lenses years ago with one eye for near & one for far, so I think this will work.  I don't mind wearing reading glasses for small print or lengthy sessions.  I just don't want the glasses around my neck thing.
I do realize, as you have said, that results vary & there may be complications. I'm sure it will be just my luck to have to have him "tweak" the lenses afterwards with a laser because he charges $2100 for that!
Thank you again for the comments.  I will let you know what happens!

[ace399]

Val,
I have both the Crystalens HD and the newest Restor.  Although the new Restor is improved by extending the near to about 2 ft, the CL HD is still clearer from 2 ft to ~ 6 ft.

If you can get accommodation, the CL HD is a really good way to go.  However, you cannot determine pre-surgery whether you will get accommodation.  In my case, I had very limited accommodation with the CL HD after 1 week post op.  So my Dr. recommended the Restor for the other eye.

The Restor does allow me to read the computer screen and 11 pt type WORD doc's in good lighting without glasses, but I have to use reading glasses for news print and fine print books.

The CL HD gives really good vision from the start, but the Restor requires the brain to adjust.  It creates a near and far image, which the brain sorts out.  It's working out for me, but is definitely not for everyone.

Depending on how myopic you are, the monofocal IOL's can be an excellent way to go for really clear vision and no compromises in vision.  The only compromise is the use of eye glasses.  Multifocal IOL's are definitely more risky, with a much higher potential for a poor outcome.

[peakhope]

Your eyes are important enough to be worth a little embarrassment, if that's what it takes to get it right.

Monovision as suggested by Dr. Hagen works well for a lot of people, but for me it just sounded too weird. Plus I wanted full stereo vision at all distances. So I ended up with the Crystalens HD's myself. But for other people either monofocals set at one distance, monovision, or Restor lenses might be the right choice.

If your corrected vision is still good enough, you might try monovision contact lenses to see whether you like it or not before having it done in the form of permanent surgery.

Take your time, do your research, choose your doctor carefully, and realize that: 1) There is no single perfect lens yet, 2) regardless of any statistics, your outcome may be better or worse than you expected, and 3) with any medical procedure, things can go wrong that are nobody's fault.

[JodieJ]

Getting a second opinion might be a good idea.  But you shouldn't be embarrassed to go back to the first doctor for more information.  (He should be embarrassed for not informing you about all the options in the first place.)

I'm not an eye care professional--just a fairly knowledgeable patient who has had a few eye problems.  I think that the type of correction recommended by Dr. Hagan would be your best bet for a problem-free outcome.  But you would need glasses for prolonged reading and seeing small print (not that this would be so bad.)  Another good alternative might be the Crystalens HD.  Dr. Oyakawa has posted information about this option during the past few months.  If you do go for the Crystalens HD, it's important to have a surgeon who is experienced with it.

Best wishes for an excellent outcome.

[val42]

Thank you.  I know I should go back.  I will just have to get over my embarrassment.  I may go to a different surgeon as there is another practice here that I am familiar with.  
I will try to find the 2009 threads, but I am new at this.
I appreciate all the info because it is such an important decision and one that is not easily undone.
I had noticed a lot of comments from you & wonder if you are a medical professional?

[JodieJ]

If your doctor had given you more information about all your options initially, then you would not need to be going back to see him.  The option suggested by Dr. Hagan is excellent for many people.  My friend who has this type of correction only needs glasses for prolonged reading or seeing small print, and he had excellent vision from day 1 post-op (and no out-of-pocket surcharge to pay.)

This thread is about a year old, and there have been a few improvements in IOL technology.  There is now a new aspheric ReStor model offering some improvement in intermediate vision.  (If driving at night is important to you, the ReStor would probably not be a good choice.)  And many people posting here have been happy with their results with the new Crystalens HD.

I'd suggest that you do a little more research on this forum, focusing on the 2009 threads.  Make a list of your questions and concerns.  Then call your doctor's office to set up an appointment to discuss them with him and/or his staff.  It's your vision, after all.

[val42]

PS:  My surgeon said he was going to use ReStor & on the box it would say D-1
I can't find any listing like that to research.  I did find a study which said+ 3.0 D was better than +4.0 D, but this means nothing to me.  I emailed the surgeon's tech to ask which he was going to use, and she has not answered.  What does all this mean?

[val42]

I just signed up to get ReStor multifocal lenses in both eyes post cataract surgery for a total of $4500.  I am having 2nd thoughts, especially after reading the postings.  I like Dr. Hagan's idea of the -0.25 for far & -1.25 for intermediate, but I have been back to the doctor twice and don't have the nerve to go again.  He probably thinks I'm a nut for being so indecisive.  (The first time I just said OK to surgery, did not ask what kind of lenses, etc, so I assume they would both have been far vision with reading glasses, then I saw other choices on the internet & went back).  I don't mind wearing reading glasses, I just don't want to have to go around with a pair of glasses hanging from a rope around my neck!  If this forum is still going on, can you give me some advice?  Luckily, my surgery is not scheduled til April.

[72vo]

My cosultation with 2nd doc produced the following recommedation: Toric IOLs for both eyes eventhough I have astigmatism in right eye only.  He also recommends -0.75 difference between the two IOLs instead of the -0.25 and -1.25 you recommended for far/intermediate.  I have four questions: (1) Is Toric IOL better choice than limbal relaxing incisions for correcting aproximately 1D astigmatism? (2) Is there a better IOL alternative to Toric IOL for the non-astigmatic eye (doc claims it's best to use same IOL for both eyes)? (3) Why do you recommend -0.25 for far vision (I am assuming 0.00 produces optimal far vision)? (4) do you recommend UV filtering in the IOLs, and is this an option?
Thank you.
72vo

[JodieJ]

If you had strabismus, you would not need to check on this--you'd already know it.  So I don't think you need to worry.  Your doctor can see if you have a phoria (aka "latent strabismus") by covering one of your eyes and seeing if the other eye turns in/out, although this might not even be an issue with blended vision.  Dr. Burton Kushner at the University of Wisconsin is probably the worldwide authority in this area.

Best wishes for an excellent outcome.


  

[telya]

You are too fantastic to answer that question for me.  Thank you soooooo much more than I can tell you.
That gives me an idea ( I do realize it can be different for each person)
of how much difference I might expect between blended eye's night and distance vision and both set for distance.  Valuable info for me.
Now, can anyone tell me if I check with my doc and see whether I have ever had strabismus, let's say she says I have not, will I get it from blended implants?  It is a risk and if so, how big a % of a risk?
I think I read that it occurs more in strict monovision where one is set for distance and one for reading because there is such a wide setting between eyes but am not sure if that also applies to blended, one set for distance, one for intermediate since there is not as wide a difference?
So much to learn.
Thank you so much.

[JodieJ]

I have both eyes set for distance with aspheric IOLs made by Alcon.  I have a history of strabismus, so I wanted both my eyes set to the same focal point. One pair of progressive glasses gives me excellent vision at all distances.  I also have bifocal contacts.

Having both eyes set for distance will give you slightly better distance/night vision than if you had blended vision, but the difference probably wouldn't make much (any?) difference to most people.  The advantage of blended vision is the ability to perform intermediate vision tasks (and even some near vision tasks) without glasses or contacts.

If you have no history of strabismus, I'm sure you'll do fine with blended vision.  From what I've read, the SofPort is an excellent lens.  

[telya]

Thank you so much for your advice.
I checked and my right lens card they implanted says +16.5D.  That is my distance eye.
Does that sound odd?  I did have LRI to relax and correct astigmatism.
YOu all have been talking in say like -1.25, etc.
I am stupid about such things.

Anyway, I take it that I'd be ok then going with the other eye with SofPort also?
And that if I have it set for blended which would I assume be like intermediate vision, not
near (reading) then I'll have as crisp and far a distance vision without glasses for distance?
Sorry to ask to verify but I'm just so excited about seeing clearly again that I want
my distance vision and night vision to be the best it can be.

Straight to the point:  If I decide to have both lenses set for binocular distance, I'd be looking at (tell me if this is pretty much right on, please)  one set of glasses for the computer and one everyday all the time pair with intermediate on top and reading on bottom but I'd have absolutely(?) NO better distance vision and night vision than if I got the blended where one eye is set to intermediate?   If so, why would anyone have binocular distance vision ever?
What's the gain?  Why not blended for everyone?  Then just glasses for reading?
I cannot tell you how I am agonizing over the right choice here.
Is there any long term danger that you know of with either choice such as I read somewhere that strabismus experts feel one of these choices is a strain on the eyes and could cause some muscle damage.  NOT what I want after all this.  Which setting is that and what other dangers are possible for either choice?
Thank you again so much for your time.
I cannot get these questions answered anywhere else.
Bless you all.
I stress again, I want my driving distance and night vision to be good.
I want my choice to not cause my eyes any harm in the long term.

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

1. If you plan on wearing glasses most or all the time you probably won't notice much difference either way. Most people are happy with one eye distance and the other intermediate distance (about -1.25) that way they can see to shop, computers, read in good light, shave, put on make up all without glasses.
2. Most people get progressive bifocals with their custom RX in both lens. That way when they're "on" you have the best possible vision distance and middle and near.  The thing about lifing up the chin to see intermediate can be corrected with a second pair called "computer glasses" the distance vision is removed and the glasses only have intermediate and near. There is no chin lift at all for computer use.
3. You would want to use the Tecnis aspheric IOL  only if your surgeon is comfortable using it. Otherwise go with his/her recommendation. Do not expect your RX to change much after 6 weeks. If something does change then the changes are incorporated into new glasses.

JCH III MD

[telya]

I appreciate the info here so much.
I had my right eye cataract surgery on Wednesday of this week.
I am having the other eye done in about 10 days.
I am having so much trouble decifering the answer to help me choose.
I want the best distance vision I can get, the crispest and clearest.
I don't mind wearing reading glasses or even progressive glasses with
clear on top for distance and intermediate if I have to and reading prescription.  I have two questions please before next week.
1.  Is distance and contrast and clarity better in monofocals both set for distance vision or one distance and one intermediate?  How much do I give up on distance vision and depth perception and contrast to have one set for intermediate?
2.  If I need glasses for reading after having one set for distance and one for intermediate so all I need is a reading prescription, can I have them leave the tops of the glasses with no correction and have the reading inset
a bit higher in the glasses than usual so as to not have to tilt my head so far down to read?  My husband hates that he has to do that to read, hurts his neck?
3.  Ok, one more question, please.  I had the right dominant eye set for distance with the aspheric SofPort AO so if this Technuis lens is so great, can I have a monofocal Technis set for intermediate or distance and mix the lenes or is that bad for some reason?  Also, if I have one implant set for intermediate will that vision ever change and what do you do  then since it's an implant?

Thank you so much.
If you have any way to get this answered quickly, please so .  I have to decide fast.  Sorry.
I had forgotten how colorful the world is and am very grateful for the implant I just got.

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

You can get to work in a 2008 cadillac or a 2000 Chevy Nova. Newer is not always better, most expensive is not almost the best. The important thing is does it give good reliable, repeatable results.

Also even the most modern equipment is no better than the physicians or technicians using them. I would take a excellent technicians using an older IOL power instrument rather than a shoddy technician using a brand new IOL power instrument.

JCH III MD

[72vo]

My first eye doc claims he has the best equipment in the world to make the most accurate measurements for prescribing IOLs that yield the best acuity, contrast, etc., and that others in his business are using older, outdated equipment that is not a good.  What is the state-of-the-art equipment today?  Why is it better than older equipment?  I am seeing second Doc. tomorrow for his recommendations, and will let you know.  Thanks.
72vo

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

------------------

[JodieJ]

Astigmatism can be corrected with limbal relaxing incisions, a toric iol, or other refractive procedures (like LASIK).  If you have significant astigmatism, you won't see well without glasses/contacts at any distance.

IOLs are meant to last the remainder of your lifetime.  I wouldn't count on replacing them years into the future.  I seriously doubt that the Crystalens (or anything currently available) would give you everything you want.  However, you do have several options that will give you very good vision.  If you're at a point where your cataracts are an issue, why not schedule consultations with 2-3 experienced surgeons in your area to get their recommendations for you.

[72vo]

Besides my emphasis achieving the best distant vision possible, I am somewhat concerned about post-op near-vision acuity with monofocal IOL.  Even with glasses I don't expect to see as well as I see now with my myopic eyes sans glasses.  Should I consider Crystalens to give me everything I want, great acuity and great relative contrast at all distances.  I suspect this is a pipe dream after reading the postings here.  But I'm not sure in which situations Crystalens would diappoint me.  Given the expected compromises of each approach do you think I would be better served with monofocal Tecnis or multifocal Crystalens?  With my -3.5D, -5D with astigmatism, am I a viable candidate for Crystalens?

Another concerm is my right eye astigmatism, now corrected with Toric contact lens or refractive correction in glasses.  How will the astigmatism correction be implemented with either type IOL?  Is astigmatism correction, however accomplished, generally an added cost item?  

What is the expected useful life of the IOLs?  Do they yellow like most plastics from UV and aging?

Finally, when a better IOL becomes available that that is devoid of most present limitations, can the presently implanted IOL be easily (financially speaking) extracted and exchanged for the future IOL?  My doctor mentioned if laser is used to adjust vision, for example to correct for haloes after IOL is implanted, the IOL can never be removed.  Why is that?
Thanks,
72vo.

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

If you have confidence in your surgeon then you should probably let him/her use the MONOFOCAL IOL that he/she is most comfortable with. Our practice uses Tecnis aspheric IOLs, which we belive at as of 3/21/08 is the best monofical IOL on the US market.

you should consider about -0.25 for distance and about -1.25 for intermediate and you will need reading glasses.

JCH III MD

[72vo]

At 72 years I require cataract surgery.  I now wear contact lenses for physical activities like tennis and otherwise wear progressive lenses to correct 5D and 3.5 D myopia plus astigmatism in one eye.  I want IOLs that give me the best possible far vision with good intermediate vision and I don't mind wearing glasses for reading as long as I can also use the same glasses, if needed, for computer work.  I absolutely don't want to deal with halos when driving at night.  My doctor recommends Alcon AquaSoft monofocus IOLs.  Is this the best IOL choice for me?

72vo

  

[JodieJ]

I've read that people who have very small pupils have a wider range of focus.  Maybe that's your sister's situation.  But what makes for "great" distance and near vision may be relative.  If you're used to impaired vision due to a cataract, then maybe being slightly myopic post-surgery would seem "great" (and also provide functional vision at more than one distance).  I think that the two of us had very high standards for our post-surgery vision because our pre-surgery vision was already very good.

I don't know how you survived the three days without the contact before your second surgery.  My surgeon had initially wanted me to do the same, but then let me wear my contact until the day of my second surgery.  It would have been extremely hard for me to function without the contact.

I hope your astigmatism correction makes for a big improvement.  I think that you'll ultimately be satisfied with your vision despite the rough beginning.