Monovision IOLs vs multifocal IOLs

[Kara96]

I need cataract surgery in one eye and will soon in the other.  I'd like to have the eyes does a week or two apart.  I am doing research online and have spoken to my optometrist of 30 years, as well as asking others about their satisfaction with their surgeries.

I have worn monovision contacts for over 20 years and have never had the problems that make this treatment unworkable for some.  My husband has one older IOL and one reSTOR lens; he thinks I'd be mistaken to have monovision IOLs, although I notice that he doesn't like to drive at night, anymore.  I have heard about the haloes and glare that can be a side-effect of reSTOR lenses, although he insists he has neither of these problems.

I had a detached retina in my left eye, about ten years ago, which was banded and stabilized at Duke Eye Center.  My optometrist says that laser surgery would not be a good idea for me, as it increases the interocular pressure, and I should not risk that, even though I've had no signs that my right eye, the dominant one, might develop a detachment.

I want to be able to drive at night.  I am a newspaper and book reader, as well as a daily computer user for work and personal finance purposes, and don't want to compromise any of my close- or middle-distance vision spheres. Are there any general recommendations that would help me make a decision?

[Roy S Rubinfeld, MD]

You ask well informed questions. I believe the key to finding the right options for you is to visit a surgeon experienced in multifocal IOLs (there are now 3 of them available), and laser vision correction. Often laser can be used to fine tune any IOL result and I do not believe you are likely to be out tof the ballpark for that simply because you had a retinal issue years ago.
Different IOLs have different risks of halos and different focal distances. Find the right surgeon, ask your excellent questions and you'll find the best options for your needs.   -RSR MD

[JodieJ]

If you consult a surgeon who specializes in multifocal/accommodating lenses, don't be surprised if that is what is recommended for you.  (I was told by one surgeon that I was the "perfect candidate" for ReStor, despite my slightly damaged retina and astigmatism.  All the ReStor literature in the waiting room should have tipped me off.  Fortunately, I had scheduled other consultations and had already done some research.)  Please read through both eye care forums; you'll find many, many unhappy people with multifocal lenses.  Besides, it seems that the aging process alone has a negative impact on night vision--do you really want lenses that make it even worse for you as you grow older?  For an alternative, take a look at the patient education video at www.tecnisiol.com.  Aspheric monofocal lenses have worked very well for me from day one, and they can be set for monovision.  Best wishes for successful surgery.

[Kara96]

I am impressed with these answers, and I'll move ahead on the suggestions.

Jodie, I've had the same feeling from the beginning of my enquiries.  If an advocate believes in something, or  had the procedure and must defend it, or is pushing it for any reason (financial or referral,) then that opinion must be discounted.

RSR-MD, what do you mean by:  there are three surgeons so experienced?  In this forum?  I live near Duke University and have access to Duke Eye Center, where a well-known surgeon, Alan Carlson, does these operations.  I want to be informed before I meet with him.

[foureyes]

No he meant there are 3 types of multifocal IOLs (Crystalens, ReZoom. ReStor). These aren't just different brands, they use different methods to give a range of foci.

[Kara96]

Thanks, foureyes.  I should have read the post again before asking my question.

I have printed out dozens of pages, from different sites, about the three multifocal IOLs and am beginning to get an idea of how they differ.  There is always the mention of possible halos and glare with ReZoom and reSTOR but not with Crystalens, (an IOL that has other possible negatives, I read.)

I am trying to find out what possible negatives there would be to permanent monovision, as opposed to the contact-lens monovision that I've used for decades.  Over the years, and as I aged, my optometrist had to work hard to get my monovision balance right...good or adequate distance vision plus being able to read fine print.  I used driving glasses for years and then ended up driving with my progressive spectacles. My advancing cataracts further clouded the issue.

I guess the only answer to this is a face-to-face interview with a surgeon who has enough time to consider a patient's personal needs.

[Kara96]

I pulled this comment off a webpage titled Multifocal versus monofocal intraocular lenses after cataract extraction [Cochrane Review] by Leyland M, Zinicola E


Sender Howard Savage
Sender Description ophthalmologist
Sender Email howard.***@****
Sender Address 2150 Pennsylvania Ave, NW Wash., DC 20037
Date Received 15/11/2004 19:20:37

The conclusions of the review abstract suggest that multifocals improved quality of near vision over the monofocal IOL, however in several studies noted (ie: Javitt & Steinert the refractive error targeted with monofocal IOLs is not mentioned. It is thus assumed that emmetropia was the goal, rather than monovision. A better question is how do patients with monovision IOL implants function compared to those with the Array. In my experience, patients prefer monovision! There is no glare or halo, and the quality of vision is sufficient for most to function unaided, including night driving.

HIS

I certify that I have no affiliations with or involvement in any organisation or entity with a direct financial interest in the subject matter of my criticisms.

[geb1]

I had IOL replacement surgery in 2001 with a standard monofocal lens and July 2007 with a Crystalens.  I have 20/20 distance vision with the standard lens and J1 with the Crystalens. Dx with Crystalens is reported by the Drs office to be 20/30, but to me it is not that good.  With the standard lens I cannot read.  So basically, I have a modified monovision. I have some abberations with both the standard lens and the Crystalens. This may not be ideal, but it is a lot better than cataracts.  It  has worked pretty well for me, as I rarely wear glasses - just for fine print.  I am also in the RDU area.  There are many eye surgeons in the area that do tradtional lens implants.  There are several that do Restor, but as far as I know it is very limited with Rezoom and Crystalens.
You can read more details about my lens implant experience at the following medhelp posts:
http://www.medhelp.org/posts/show/311691
http://www.medhelp.org/forums/ophthalmology/messages/54.html

[Kara96]

Thanks, Geb.  I'll pull up your links.  I have some questions about your post but perhaps they are answered in the linked sites.