monolense vs. multifocal

[mom206]

Help! I need your input and testimonies. Scheduled for cataract surgery on both eyes. Monofocal or Multifocal?? I am thinking about getting multifocal lenses at $5,000. sounds great. I am far sighted and near sighted and I can toss my glasses away. I am favoring "Crystalens" or "ReZoom".


This discussion is related to Which lenes? ,Crystalens, ReZoom or ReStor or nothing?.

[John C Hagan III, MD, FACS]

Take the time to use the search feature and archives to read the many, many unhappy postings here from patients that have had multifocal IOLs put in their eyes.

I would generally avoid multifocal and NEVER would I consider ReZoom   REZOOM = PROBLEMS.  

Personally I would suggest a monofocal aspheric IOL like Tecnis or Alcon or B&L. It is cheaper, safer and gives better vision.

JCH MD

[JodieJ]

I vote for aspheric monofocal IOLs, too.  However, the way the IOLs are set will also play a big role in your post-surgery satisfaction.  (Making IOL power predictions is not an exact science, but usually the results are fairly close to the target.)

If both of your eyes are set for distance vision (plano), you should have excellent distance vision but everything within arm's length will be blurry.  You would need glasses for reading, using the computer, applying makeup, cooking, etc.

With blended vision (distance vision in dominant eye, intermediate in non-dominant), you should have very good distance and intermediate vision.  With a little luck, you would only need glasses for prolonged reading or seeing small print.

With full monovision (distance vision in dominant eye, near vision in non-dominant eye), you should have pretty good vision at all distances.  Many people with monovision never wear glasses.  But some (a minority) of people cannot adjust to monovision, so it's best to do a trial beforehand with contact lenses (if possible).

There is NO out-of-pocket surcharge with aspheric monofocal IOLs.

  

[John C Hagan III, MD, FACS]

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[2ndsight]

there are MANY posts on this board from disappointed patients who were told by their doctors that they wouldn't need glasses after having a multifocal lens implant. You should expect to wear glasses after surgery for something, often reading, especially with Crystalens.

I would walk away from any surgeon who tells you that you will be able to "throw your glasses away," since this is not true for most patients. Check around and find a more reputable surgeon who will go over the risks and benefits of each lens with you in detail.

[John C Hagan III, MD, FACS]

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[bbuzz]

A friend of mine opted for the Restore mutifocal lens at $3,000 each.  One eye is good, but she is having trouble with the close vision in the other eye.  Her doctor assured her that she only recommended Restore lens for "chosen" people and my friend was one of the "chosen.  Now that the lens is not performing as expected, the doctor said she could "tweak" the eye for an additional $600, but couldn't guarantee that she would be able to see any better at close range.  (Her distant vision in this eye is good.)  I agree you should try the monovision IOL.  Hope this is not too discouraging.

[John C Hagan III, MD, FACS]

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[laker234]

I'm got opinion after having cateract surgery and had the monovision implants. I think people with moderate nearsightness and farsighted would have good results. But people with bad nearsightest I quess like anything over 20-300 will have more difficulty adjusting.That is just an opinion.my results i can see decent but still got glasses for driving,etc.My problem now having trouble with starbursts around lights,especially headlights,l try get things before dark.Using alphagan eye drops with some relief. Whatever  u choose good luck.

[Onnieellen]

I've read your comments about monovision and blended monovision.....Could you tell me a doctors proposed target for both techniques?...in acurity or diopters....I am +1 in my right (dominant) eye......What would a good target be for both techniques in the left eye? Thanks....

[JodieJ]

Dr. Hagan responded with the targets for blended vision yesterday.  Scroll down the Community Forum to the question titled "IOL power" by "bad eyes" posted on 9-23-08.  (It's currently on page 2, but this is subject to change.)  For a distance/intermediate correction, his targets were -.25D (dominant eye) and -1.25D (non-dominant eye).

I'm not an eye care professional, but I'm guessing that targets for full monovision would be about -.25D (dominant eye) and -2.25D (nondominant eye).

But you are already +1D in your dominant right eye.  I'll be honest--in your situation I'd either plan to wear a contact lens, or (better yet) I'd look into having a refractive procedure (whatever would work best) to bring me closer to plano.  I don't think that +1D would work well with either full or modified monovision (although it would probably work better with a very modified version, maybe -.75D.)

Dr. Hagan, if you are still monitoring this thread, please provide input.  Otherwise, Onnieellen, you might want to ask your question again in a new thread.

  

[John C Hagan III, MD, FACS]

I guess I don't quite have a full picture.
1. Have you had surgery in both eyes?
2. Do you have cataracts in both eyes.
3. Do you mean that you were left +1.00 AFTER cataract surgery?

JCH MD

[JodieJ]

Dr. Hagan, Onnieellen has posted here previously.  She is +1.00 post-surgery in her right (dominant) eye.  She is asking about the possible target for her left eye.  (I'm interested in reading your input, too.)

[John C Hagan III, MD, FACS]

It depends a great deal on Onnieelen's desire to reduce her need for glasses.

1. If you "don't care if you have to wear glasses" then you might shoot for -0.25  or -1.25  the first will give you best corrected vision without glasses the second some intermediate vision (computer, shop, shave/makeup).    Anytime the difference between the two eyes is over 2 diopters many people have trouble adjusting.
2. If you want to be as glasses free as possible then I think you are going to need to have something done to the +1.00 eye either CK or hyperopic lasik to reduce it down to 0.00   then you can do -1.25 in the unoperated eye and plan on glasses for reading.

JCH MD

[Onnieellen]

I didn't describe my situation clearly. I'm post-surgery left eye....probably between 1.50-2 diopters. (Implant moved) Right eye (dominant) is not progressed enough for surgery......Prior to surgery, my doctor suggested monovision and making me slightly nearsighted.....he didn't quote any numbers.... Now I'm wondering what his proposed target was ......Obviously my +1 eye doesn't figure in with your calculations.......I think my vision has cleared slightly.....will know more next week at appointment. When my right eye progresses to surgery, what would "your" proposed target be for the right eye? I prefer not to wear glasses for intermediate  vision and driving...Is there a way to accomplish this without laser procedure? Rather than wear a contact lens on the left (post-surgery) eye, would it be possible to wear glasses with a corrective lens for the left eye and a clear (non prescription) lens for the right? Or wouldn't that option work?  My doctor said I'm seeing at 4 feet. I assumed he meant I was seeing clearly 4ft and under.....some blur beyond. I feel I need some correction for driving... I have light flashes and blur in peripheral vision that causes me to be less confident while driving.  Under most situations, my vision is satisfactory..... Any suggestions? Thanks

[John C Hagan III, MD, FACS]

What is your glasses RX on the right eye?

JCH MD

[JodieJ]

Sorry I misunderstood your situation.  You are now between -1.50 and -2 for your nondominant eye (correct?).  Then target -.25 for your dominant eye (per Dr. Hagan's suggestion).  If all goes as planned, you will only need glasses for tiny print.  (No contacts needed.)  You could reverse the monovision for best distance vision with glasses.  

[John C Hagan III, MD, FACS]

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[Onnieellen]

I just returned home from my 4 week post surgery appointment. My left eye (post cataract) has gone from 20/25 day after surgery, to 20/60 week after, to 20/80 today. I realize worse problems can happen, but I'm feeling discouraged.....Doctor said my implant moved forward.....what exactly does that mean? Did it move down, rather than sideways, or isn't it fitting the curvature of my eye?, or what? He suggested three options for correction: Lens replacement, piggyback lens or laser correction. Which would you normally recommend for best correction with minimal complications? I also noted a couple weeks ago, a contrast decline on computer ......doctor verified clouding......I asked about glasses.....I'm +1 in non operated eye and -2.25 in post cataract eye. If I calculate properly, that's 3 1/4 diopters difference between the two. Thinking I might have more success with glasses, he decided to write the prescription for .50 diopter less in each eye. Present prescription is +0.50 + 0.50 +90 ; -1.75 + 0.50 + 98 + 2.50.  I'm to return in 3 weeks to see how I fare with glasses.

I'm having a difficult time understanding monovision and blended monovision.......
As I stated earlier,  I'm 2.25 in my operated eye......I see satisfactory for most  daily activities, but have lost confidence with driving.....I have alot of peripheral blur.....How can a -2.25 (in non dominant) and -.25 (dominant) coordinate and give me good  "all time" vision?  I'm not really satisfied with the -2.25 now....Sorry, I'm so thick....Also, I don't understand JodieJ's comment, "you could reverse the monovision for best distance vision with glasses...... Thanks to both of you for your patience and guidance.

[Onnieellen]

I just returned home from my 4 week post surgery appointment. My left eye (post cataract) has gone from 20/25 day after surgery, to 20/60 week after, to 20/80 today. I realize worse problems can happen, but I'm feeling discouraged.....Doctor said my implant moved forward.....what exactly does that mean? Did it move down, rather than sideways, or isn't it fitting the curvature of my eye?, or what? He suggested three options for correction: Lens replacement, piggyback lens or laser correction. Which would you normally recommend for best correction with minimal complications? I also noted a couple weeks ago, a contrast decline on computer ......doctor verified clouding......I asked about glasses.....I'm +1 in non operated eye and -2.25 in post cataract eye. If I calculate properly, that's 3 1/4 diopters difference between the two. Thinking I might have more success with glasses, he decided to write the prescription for .50 diopter less in each eye. Present prescription is +0.50 + 0.50 +90 ; -1.75 + 0.50 + 98 + 2.50.  I'm to return in 3 weeks to see how I fare with glasses.

I'm having a difficult time understanding monovision and blended monovision.......
As I stated earlier,  I'm 2.25 in my operated eye......I see satisfactory for most  daily activities, but have lost confidence with driving.....I have alot of peripheral blur.....How can a -2.25 (in non dominant) and -.25 (dominant) coordinate and give me good  "all time" vision?  I'm not really satisfied with the -2.25 now....Sorry, I'm so thick....Also, I don't understand JodieJ's comment, "you could reverse the monovision for best distance vision with glasses...... Thanks to both of you for your patience and guidance.

[JodieJ]

I think that I may be giving you too much confusing information.  With monovision, one eye is used for distance vision and the other is used for near vision.  It takes several days (or more) to adapt to it.  Most (but not all) people can adapt.  If you wanted to see how you liked it, you could try wearing a contact lens to correct your dominant eye to plano (and leave your non-dominant eye as is).  Glasses (worn over the contact) with lenses that are plano and -2.25 would give you distance vision in both eyes (reversing the monovision).

Given a choice between laser correction, lens exchange, and piggyback lens, probably laser correction would be the safest.  Which option is your surgeon recommending for you?  I think that your best bet would be to have your surgeon explain the pro's and con's of blended vision.  Most people prefer it to having distance vision in both eyes.  There have been several recent threads on this forum discussing it.




  

[me901]

Before surgery you should check my post entitled , cataract eye drops. these are working.
It is working for me so far. It is worth a try and better than surgery. Not the stuff they sell on the net that does not work. You need to get this from an osteopathic doctor. Natural remedies do work sometimes.

[Hoddy44]

I haven’t been on this board for a while but,  a couple of years ago I had a bilateral Restor.   My preop Vision was approximately +7 in each eye with a slight amount of astigmatism.  In other words, I was totally dependent on glasses for almost any activity.  My choices at that time if I wanted to try to become independent of glasses were basically the Restor,  the Rezoom, or a combination of the two.  I chose the Restor since I have small pupils that do not dilate well.
Two years later, I do not use glasses for any activity.  My near and distant vision are approximately 20/20 and my intermediate vision (computer length, etc.) is satisfactory.  I drive at night with minimal light effects.
Based on my experience, the Restors certainly have the ability to function properly.  I do feel that the path is more of a journey than a single operation.  The Restors alone probably have the capability to make your vision 20/20 or 20/25 in a controlled environment such as the doctor’s office.  However, satisfactory vision involves many different lighting situations and environments.  These conditions can create glare, shadowing, cloudiness, etc.  In order to alleviate these conditions,  a YAG in both eyes is probably necessary.  This is a general consequence of IOL surgery but it is probably even more important to be done with Restors.
There now seem to be more options available for eye glass independence.  These include a new variation of the Restor, the Technis multifocal, and the Crystallens HD.  My advice would be to find a doctor considerable successful experience with some of these lenses, have a preliminary evaluation, and discuss which option he feels is best for you and why.  I would then do this with two more experienced doctors.  After this, if I wanted to try for eyeglass independence,    I would go for it.

[val42]

It's me again.  I had just about decided to go for the monovision with one eye far & the other intermediate.  Then, I found more comments here including yours of 9/23/08 where you seem to be saying that the best is the full monovision with one for far & one for near.  So, I'm confused again.
I did wear this kind of thing with contacts lenses many years ago.  As I recall it was fine.  At least I know I did not have trouble adjusting to monovision.
I did hear back from the doctor's assistant, and she said I can take my time to decide (of course he prefers me to have the ReStor, I think).  
She is saying no guarantee any of them will leave you without glasses.  I do not care if I have to wear reading glasses.  I don't want to have to wear a pair around my neck for everyday use.  What do you think?  

[JodieJ]

Full monovision (distance/near vision) will give you a broader range of focus than "blended vision" (distance/intermediate vision).  Some people with full monovision don't ever wear glasses.  However, a minority of people cannot adapt to full monovision.  If it worked well for you with contacts, then it might be a better option than "blended vision."  If you don't want to wear readers around your neck post-surgery, don't have both eyes set for distance.

[val42]

I will have to think about it.  I am not sure which I want.  I had thought earlier, from Dr. Hagan's comments, that the blended was the best bet....

I am going on vacation this week & will deal with it when I get back.

At least the doctor's tech answered my email & said to take my time & make the decision that's best for me (whatever that is!).

I have completely ruled out ReStor & definitely know I don't want both set for distance.
You are always very helpful in your comments.  Thank you.

[val42]

Well, it has been decided.  I am going for one eye with distance & one for intermediate.  The lens he is using is the Tecnis Z2009.  I hope it works well.  The surgery is not til April.
Of course, I had to look up Tecnis on the internet & saw a couple comments from eye surgeons about capsular tears with this lens because of the injector device.  One more thing to worry about!  I'm sure my surgeon must be aware of this.  
Thank you so much for all of your valuable help.  You are a great resource.

[JodieJ]

You'll be getting the Cadillac of monofocals, IMO.  Check out the patient education video at www tecnisiol com.

[val42]

Thank you for saying that!  It's reassuring since you are so knowledgeable.
I did watch the video...