multifocal lenses

[susannahe]

which is better, crystalens, rezoom or restor?

[JodieJ]

The short answer is that depends.  Multifocal IOLs like ReStor and ReZoom tend to be associated with night vision problems (glare, halos, starbursts), a loss of contrast sensitivity, and a lengthy adaptation time.  (It's been reported that up to 10 percent of the recipients never neuroadapt to multifocal vision.)  ReStor provides the best near vision, but intermediate (computer) vision is lacking.  And ReStor is associated with more complaints of "waxy" vision.  Problems with ghosting are most common with ReZoom, and near vision is generally not very good.  (It's been stated elsewhere on this forum that ReZoom is the worst option and should be avoided.)

The previous version of the Crystalens generally provided the best distance and intermediate vision, but just about all recipients needed readers.  The newest Crystalens model reportedly provides improved near vision, which would make it the best bet of the three.  But the Crystalens is hardly problem-free, as the archives of this site demonstrate.  Some recipients (particularly those with small pupils) have had terrible problems with glare.  The Crystalens provides no UV protection, and it may not be a great choice for people with significant astigmatism or a history of retinal problems.

My choice for the best chance of a problem-free outcome would be aspheric monofocal lenses set for monovision (if you're a candidate) or modified monovision.  My mother's friend (aged 80) who has monovision never wears glasses--and she can read the newspaper and drive at night.  My friend with modified monovision only needs drug store readers to see small print.  Both saved thousands of dollars in "premium" lens fees.  

[Michael J Kutryb, MD]

Thanks.

MJK MD

[susannahe]

Thank you so much for the information. Actually I'm definitely not going to get monovision because there is no way I'm going to remove my natural lens from my right eye. I had cataracts in both eyes but the lens they put in my left eye is so terrible that I would  never do it to the right eye.That eye would have to be pretty much blind first. I'm 36 and my cataracts are genetic. They were diagnosed when I was 10. My vision really wasn't the bad.  My quality of vision in my left eye is much worse than it used to be now that i have the iol in it. It's an acrysof and it has square edges. I have terrible negative dysphotopsia. It's basically like being part blind in that eye.  I am supposed to be getting the lens replaced with another lens and I am trying to get the best one possible. I understand that it should be 6mm, silicone and round but I am trying to find out if I can possible get a lens that isn't monofocal.  Unfortunately, the doctor didn't tell me ahead of time that the unnatural lens doesn't have the ability to focus like the natural lens does.  I really miss the way things use to look and when I cover up my left eye and look through my right I can again see all the wonderful depth of vision. It's very sad and depressing. As far as contrast goes this iol has way too high of contrast and now everything is lacking in the more subtle colors. I have always loved nature and now with this fake lens it doesn't even look very beautiful to me anymore. It's the same with beauty. I can't even see my children's beautiful faces like I could before. I think that maybe if I had a multifocal lens I might get some of this sight back. Everything is so flat,shiny, shaky and fake looking now.  It's almost as if it's see-through, like it has no substance.

[indi1664]

I dont fully understand your condition....I will inform you of wht I know....I was very nearsighted (-20 both eyes)...I have recently had blended vision monofocal Alcon implants...is my vision perfect?...No...RE +0.75 LE -1....but i am able to almost live without glasses accept for reading and computing...yes losing the initial closeup vision...after first Eye Op (+0.75)..was dissapointed...but got the balance back with 2nd Op RE -1....otherwise no complaints....yes it could have been better but given the current technolgy...this is Excellent for me...what I am saying is if you can get good result SAFELY...and have to wear glasses or contact lenses ...than this not so bad...Importantly a Good friend (Eye Surgeon)..advised me to specifiaclly ask for Acrylic lens...pls ask yr surgeon why he has suggested silicone....Good Luck

[JodieJ]

Acrylic IOLs are generally preferred for people with a history of retinal problems or who are at higher risk for retinal problems.  (My retinal specialist told me to get any IOL as long as it was acrylic.)  However, susannahe got an acrylic IOL made by Alcon and now has terrible negative dysphotopsia.  So in her case, replacing it with a silicone IOL makes sense.  Susannahe, possibly the latest model Crystalens would work for you.  But I'd strongly suggest that you follow your surgeon's advice in choosing an IOL at this point in time.  When all goes well, color perception is not affected by cataract surgery.  Hopefully, an IOL exchange will resolve all the problems you've been having.  

[2ndsight]

FYI Crystalens is a 5mm lens, even the newest model

[susannahe]

Thank you guys for the advice. I actually have an Acrysof lens implanted just to let you know.  Does Tecnis tend to be the best round, silicone monofocal lens to have put in after negative dysphotopsia in the eye?

[JodieJ]

Tecnis (by AMO) comes in a silicone version.  Most of the latest IOL models do have a square edge--this feature reportedly helps to prevent post surgery PCO, which would require a YAG.  In your place, I would let my surgeon choose my IOL.  I know that AMO makes round-edged, silicone models.

Given the poor results of your first surgery, I'd be inclined to see a different surgeon for the explant.  I'd definitely want a doctor who is experienced at explanting and replacing an IOL.        

[John C Hagan III, MD, FACS]

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