Cataract IOL Recommendation

[EyeWannaKnow]

My mother has to have cataract surgery and is unsure of whether to go with a monofocal or multifocal IOL. She doesn't care for the fact that with the monofocal she would still have to wear glasses for near vision but she's not totally comfortable going with the multifocal since they are fairly new and there is a greater chance of halos. After doing some research it seems most people are happy with the ReZoom multifocal and that the risk of halos is very small. The monofocal lenses that a few local surgeons go with are the Clariflex, the Bausch & Lomb, or the Alcon AcrySof. I've also read that some surgeons recommend going with one type of lens in one eye and a different type in the other eye such as ReZoom & ReStor. I've read a lot of negative side effects of the Crytalens.

My questions are:
Can anyone recommend which IOL my mom should go with?
Has anyone had experience with using 2 different types of IOL's?
Is it better to go with a multifocal in one eye and the Crytalens in the other - or a multifocal in one eye and a multifocal in the other  - or a multifocal in one eye and a monofocal in the other?
If my mom decides to go with a monofocal, can anyone recommend which one to go with as I haven't found much information comparing the different brands.
My mom lives in Kansas City, MO. Can anyone recommend a surgeon either in the Kansas City area or Overland Park, KS area?

I really appreciate any & all advice from anyone. Eagle Eyes - I would love to hear from you. Thanks everyone.

[Eagle eyes]

It is always reassuring and comforting to hear your surgeon tell you things look fine. Could be the flickering is from the brain or just catching a glimpse of light and the edge of the lens picking it up. Most people find their brain get used to these sensations and learn to ignore it. I wouldn't worry if your doctor isn't.

Probably just the imbalance of the two eyes. Normal to have that dizzy sensation until both eyes are balanced again. The lens may move (wiggle or jiggle or seem like it is, but that is ok. It is not going anywhere and all IOLs are very stable unless there is some rare occurence usually due to trauma or surgical complication, which isn't your case.

If placing the book vertically makes things more comfortable for you, do it. You can not harm your eyes by using them computer, keyboard, distant objecs, etc. When your eyes feel tired or strained, take a break. Don't rub them or get in dirty water, perspiration in eyes, etc, but using them to see is not a problem.

Gravity is not a problem for any IOL, unless you have just had retinal detachment surgery and told to lie face down. Again, not for you to worry about.

Have a nice weekend and remember, if you just had shoulder surgery, you wouldn't be pitching a baseball game right now. Give your eye time to heal completely and know these things will pass (:>)

[Eagle eyes]

Boy.....tough one.....
Well, does your doctor do LASIK? If so, it may be possible for you to have the standard IOL then have a LASIK enhancement to tackle the astigmatism. You don't mention your age, but in general, yes, ReSTOR and ReZoom are not so good for people who will have more than 1.00 Diopter, really even more than 0.50 Diopter of astigmatism post op.

LRI...might get some (maybe half of it, but for you that really isn't going to be option either, most likely.

There are some MDs that use a standard or even premium IOL in the bag and then a STAAR toric in the sulcus with success. Perhaps Hud will comment on the Alcon toric. I have no experience with it, yet. I do have experience with the STAAR toric, again as a piggyback with multifocal and standard lenses in the bag. I would still find out if LASIK or PRK enhancement is an option for you. If so, it would be best to make the decision before surgery, so the correct power of IOL could then be selected to leave you a bit nearsighted to better correct the astigmatism with the laser. If your chosen surgeon does not do LASIK, then ask if he -co-manages with a LASIK surgeon.

Do you have that much astigmatism in both eyes and are both eyes being done in this tight time-frame you referenced?

[Eagle eyes]

Hi Tommy,

What you are seeing (the whiteness and blueness)is perfectly normal after IOL surgery. Your night visino not being very good is a fairly common observation with patients that receive the SN60. Would your surgeon consider a different IOL for the 2nd eye? Tecnis aspheric IOL or even a standard non yellow IOL? Most likely the Tecnis would sharpen your nighttime vision as well as crisp daytime vision. Since you were highly near-sighted prior to PRK, you should be a good candidate for Tecnis, pending an exam by the surgeon for final recommendation.

The flickering you describe.... is it a "feeling" or a flicker that you "see"? If it is feeling....then that could be related to stress and tiredness while eye is still healing/changing. (nothing to worry about, most likely) If it is something you see, then look at pupil size at night....you may be catching a glimse of the edge of your IOL which can cause a flickering. If you do "see" it, where is it? (top(superior), bottom (inferior), nose side(nasal), or ear side (temporal). This would be helpful to know as well...

Regarding the dryness and discomfort....tell your doctor. It should be addressed there. If the dryness or discomfort has worsend then a drop change or deletion may be warranted. Again, have surgeon carefully check cornea and tear film, etc to make recommendation for you and your comfort. Perhaps an artificial tear (over the counter) may soothe.

Cataract/ IOL surgery is elective, so you get to decide when it is done. When it bothers you or affects your daily tasks, you will know and can proceed then.
Floaters are very common for someone as near sighted as you. The flickering should also be checked (dilated retina exam - if you are seeing the flickers. Again near-sighted, very near-sighted people in particular are more prone to retinal tears, holes or detachments. so be aware of the symptoms and warning signs ---seeing flashing lights , seeing hundreds of tiny spots, new or different floaters, and sudden curtain coming over vision are the most common. Again, talk to YOUR doctor about these things.

Best of Luck to you...

[LLGirl]

I'm 37 years old with a posterior subcapsular cataracts, both eyes - set to have cataract surgery in July. The doctor recommended multifocal lenses.... either Rezoom or Restor, my choice- she will not recommend one brand over the other.
I am confused on whcih to choose. I work in an office - i am on the computer all day, and also reading small print all day long. Also a big movie buff, so i watch a lot of TV at night. I guess with Restor the near vision ( is that up to 24 inches?) is better so that would be for reading, but with Rezoom they say the intermediate is better ( for computer and tv watching?). My computer monitor at work is pretty close, about 12-14 inches (so that i can see it with my cataracts!) and my computer monitor at home is about 24 -28 inches away.
All the seats in my living room are approx. 10-13 feet from my 27" tv ( maybe i will have to buy a big screen now!).
I understand that i might have to wear glasses for either near or intermediate...
I am also worried about halos and poor night time driving... the doctor said one of these lenses had a history of more halos, but i can not remember which she mentioned.
Any advice?

[Eagle eyes]

Many people adjust to "monovision"- one eye set for distance, the other for near. It varies as to how long it takes to adjust. She could have a trial in the office to get a feel for what it would be like by placing a contact in one eye or having monovision simulated in "trial frames/glasses" in the office. It is not 100%, but still gives some idea.

Is the vision good at all ranges? well, if she adjusts to it, yes for the most part. The main times it might not be favorable is when she would be driving, especially at night, or engaging in activities such as tennis or golf. If she enjoys much reading, then she would probably be very happy.

[EyeWannaKnow]

Thanks for your response. My mom is going to go with the monofocal lenses. Do most people get used to having one eye for distance & the other eye for near? How long does it usually take to get used to? My mom was near sighted in both eyes but has adjusted to not being able to see out of her eye that has the worst cataract so I'm thinking she'll probably adjust fine to the lenses. Since she's getting one lens for distance & one for near vision, is the vision at all ranges good? Thanks a lot!

[Eagle eyes]

As for dominant vs non-dominant eye....ReZoom is a distance dominant lenses so you should do well since your dominant eye is the one to have the surgery. Many patients as you have witnessed on this website are doing well with the combination. SEe comments made by eyecu stating Frank Bucci, MD sharing data at a recent meeting for eye surgeons. He started off with ReZoom in non-dominant eye, but has switched to ReZoom in dominant eye now. At the most recent big meeting for eye surgeons (ASCRS in March 2006), other MDs had reported doing the same. Starting with ReZoom or doing ReZoom in dominant eye when possible. Either way, having one of each should give you really great near with ReSTOR and really great distance and intermediate with ReZoom. No doubt, after refractive surgery (RK, PRK, LASIK, etc) it is always more challenging to accurately predict the IOL power needed, but can be done. Best of Luck to you!

[EyeWannaKnow]

Thanks for your response. My mother is 64 years old. Her dominant eye is her right. She has cataracts in both eyes. The eye that is really bad (she can't see out of it) is her left. Distance, intermediate and comfortable close vision are most important. She would be okay with wearing reading glasses but prefers not to.

I spoke with Dr Cokington's office, Dr Cavanaugh's office & Dr Hunkeler's office and they all said that they do not measure the size of pupils in different lighting for cataract surgery.

After speaking with 3 different technicians my mom is leaning toward getting monofocal IOL's in both eyes - the right (dominant) eye for distance & the left eye for near vision. She doesn't want to risk having halos with a multifocal.

Do you know if this is hard to get used to & how good vision would be at different ranges - distance, intermediate, comfortable close, near near?

Thanks for your help from both me & my mom. She said to tell you that she's blind in one eye and can't see out of the other. Ha!

[Eagle eyes]

Hi,

Great questions. In addition to an eye exam to determine eye health wise she is a good candidate...for deciding which IOL itt all depends on the following to best predict if she should do well. I will divide it up by numbers.
1. age
2. which eye is dominant / non-dominant
3. size of her pupils in bright light, dim light, pitch dark.
4. What does she do all day
(CLOSE READING or NEAR NEAR as it is called: very fine print like Wall Street Journal stock prices,medicine label, needlepoint, jeweler, etc) (COMFORTABLE CLOSE:reading further away than 6 inches from your nose out to arms length,normal reading of various size fonts from newspaper to books to articles, etc.) INTERMEDIATE WORK: computer, cell phones, PDAs, artist that painting, musician playing instruments, plumbing, shopping, cooking,golfing, play cards/dominoes,etc) DISTANCE: tv, outdoor activites such as walking, driving,etc. Most likely several if not all of these "ranges" are important. Pick which are the most important whether it is NEAR NEAR, COMFORTABLE CLOSE, INTERMEDIATE, or DISTANCE.

[Forum-OD-MP]

I'm sure Eagle will respond.  

but to answer one of your questions, there is no "better" option for every patient.  every patient is different and every eye is different.  beware anyone who recommends one method or iol brand/type to every patient (not saying anyone here does that).  i know that sounds like a cop-out, but if there was one product that was obviously better than the others for all patients, then we'd all recommend that product.  you have to choose the product/surgery that you feel is right for YOU...

[rmt01]

Thank you both for the recommendations.  I think the aspheric (if I can get it) or a standard IOL seems to be the choice for me.  

I've been wearing progressive lenses since adding the bifocal four years ago. I'm required to wear safety glasses at work.  And I've been wearing Transitions or Photogrey lenses for so long I don't what's it's like to go outside and not have them.  Therefore, it looks like the aspheric or standard IOL would be a easier transition for me.

The lure of the new tech IOLs and their promises of no glasses is attractive, but it looks like there's too much downside for me.  I guess that's why there are so many choices out there now.

[JodieJ]

I really appreciate your help.  I only have a cataract in one eye, so I began by checking out doctors who specialize in both cataract surgery and laser vision correction (for my noncataract eye).  It seems like most docs here only use Alcon lenses, and some don't even use aspherics.  Not good for consumers, but I suppose that most of their patients never know what their missing.  BTW, who woudn't be a candidate for an aspheric IOL?

[Eagle eyes]

With your lack of motivation to be without glasses and your moderately high amounts of astimgatism, I say no premium IOLs for you. Go with a standard... You could check to see if you are a good candidate for aspheric IOLs like Tecnis. About 96% of the population are candidates for aspheric IOLs.

Good Luck!

[Eagle eyes]

I will check wiht my boss and see who of his colleagues in Chicago are doing Tecnis. I know some docs there that are excellent, but not sure which aspheric IOLs they are using. I will get back to you in a day or two, for what it is worth.

[JodieJ]

Based on my research, you'll get the best visual acuity and contrast sensitivity from an aspheric IOL.  Worn with progressive glasses, you should get excellent vision at all distances.  (You might also consider limbal relaxing incisions to reduce your astigmatism if you'd like to go without glasses for distance vision only.)  Multifocal IOLs might allow you to lose the glasses for most activities, but your vision/contrast sensitivity won't be as good, and you'd probably experience visual aberrations (halos, starbursts) under some conditions.  Residual astigmatism might also be a problem with a multifocal.

The Tecnis lens from AMO (an aspheric lens in either silicone or acrylic) impresses me as being the Cadillac of IOLs.  Everything I've read about this lens has been very positive.  Unfortunately, I've been having problems finding a doctor who uses them.  Alcon seems to control the market here in Chicago.

[rmt01]

Along the same lines as the other questions in this thread:

I am 43, mature subcapsular cataract in right eye (almost no vision), cataract beginning in left eye but no effect on prescription at this time.

Last year's prescription was as follows:

DV OD Sphere -2.25, Cylinder -2.25, Axis 150  NV +1.75
DV OS Sphere -3.00, Cylinder -2.50, Axis 10   NV +1.75

So basically, moderately nearsighted, astigmatic, reading vision going with age.

So I too am looking for recommendations.  Liked the idea of the multifocals (ReStor, ReZoom, Crystalens), but looks like the astigmatism might not make me a candidate for these.  I have just recently learned about the torics.  Are these a better choice for me?  My optometrist thinks so, but recommends I talk with the optomologist first (appt on 7/17).  BTW, no one in the area (Charlottesville VA) that I know of doing any of the newer IOLs, so I might have to go out of town (1 hr) to get this done.

Or should I just go with a standard IOL?  I've worn glasses most of my life (30 yrs), so going glasses-free is not high on my list of objectives.  A good full range of vision with glasses is my major goal.  As an electronics engineer, I need good close up vision, good intermediate vision (computer reading), and for driving/etc. good distance vision.

Appreciate any feedback.  Thanks.

[hud]

sorry, but I am a ReSTOR patient and have no experience with the Alcon Toric implant. My take is that every astigmatic patient will get some level of benefit with a toric implant that does not rotate, as the history of Alcon AcrySof lenses have proven. Even if your 4.5D of cylinder is reduced by 2.0D with the implant, (and possibly more reduction with additional treatments), you would have better vision that with a standard monofocal lens.

[Tommy2006]

Thank you so much for your reply. I visited my Doctor again.
He said the operation looks quite good, the eye looked just fine. He can't explain the flickering. He said it is probably
caused by the Brain, as the operated eye now is slightly (I think 1.5) Far-sighted while the un-operated eye is 2.00 near sighted.

Every time when I look down at a book, or the prints on a bottle
I feel dizzy, and the lower exterior (ear side) side of my right
eye(the operated eye) flicks. Seems that the lens inside is making numerous adjustments and that makes me dizzy.

( It seems better If I place the book vertically at eye level).
It is OK if I look at the computer, or the keyboard or distant objects.

Is Gravity a problem for this IOL?

Thanks for taking the time to answer my question.

[Eagle eyes]

Yes, in general I would agree. Let's see what HUD has to offer. He seems very knowledgable about Alcon products. Again, we have no experience with the Acrysof toric, so I won't comment. Perhaps you could go back to hard lenses after your IOL surgery and healing to correct just the astigmatism if you need it. That is unless there is some reason why you could not do so later. Just having cataract surgery itself, should not be a contradindication once the eye is completely healed.

Keep us posted!

[tslight]

Thanks for your comments.  I'm 56 and the right eye with the cataract has 8.75D (not sure what the tech term for nearsightedness) and my left eye is 9.0D (don't know the astigmatism of this eye.) I don't plan to do both eyes  by Sept.

I have talked with my surgeon since posting question.  He is not a fan of the Staar Toric due to the problem of "slippage" in the older version.  I have been reading that the newer Staar Toric doesn't seem to have that problem, but my doc doesn't want to use Staar.  

Yes my doc does do LASIK, but didn't want to subject me to possible multiple procedures.  I'm in excellent health generally, but I don't know how that might affect my eye recovery.

Bottom line, my doc's view is to take the conservative approach.  He feels that whether I have the standard IOL or the Toric, I will still have to wear glasses or contacts...so why not do the standard procedure. He says that the Acrysof IOL will only correct 2.0D of my 4.25D of astigmatism.  Do you have any different knowledge concerning the Acrysof Toric's performance?

I didn't mention that before the cataract, I have been a hard contact wearer for 44 years.  Boy do I miss them.  I've been in glasses for the last 6 months to allow my eyes to "unmold".

Thanks again for your perspective Eagle Eyes.

Hud - are you out there?

[tslight]

Well this certainly seems like a lively forum.

I need to make a decision in just 2 days about an IOL choice!  I have 4.25 astigmatism in the eye that needs surgery.
First my doc suggested just a "regular" lens as I was probably not a candidate for the Restore or Rezoom due to the astigmatism.

Research on the internet for the last 4 days has both answered a lot of questions and raised even more.  

My doc had mentioned the newest IOLs call toric for astigmatism correction  As far as I can tell there are two primary manufacturers.  The Staar Toric and the Alcon Acrysof Toric.  My doc nor any of the other 8 docs in the practice has implanted a toric IOL.  
Here are some of the parameters that I'm working with.  First I NEED to get the procedure done and back in the working world by the last week in August.   The doc said that it might be another month before he can order the IOL and get certified in the implantation.  That puts me back to the end of my recovery time.  I have confidence in the doc, but of course don't want to his "first".  

However, IF I go ahead with just a regular IOL in two days, I will be ready to go my my cutoff time, but may have lost out on a chance for better vision without supplemental correction.  Any thoughts?

[LLGirl]

Thanks for the input... have an appt today to get my eye measured, and i have to give them my decision on what lens i have chosen.  Still wondering if multifocals are worth it, since we hear/read about so many problems, and do not hear much from the people that are happy with them!  Maybe it is easier to get monofocals and just wear contacts!  
HOwever, since i am 37, my doctor thinks i should take advantage of the newest technology available. She says i will no longer be able to see at all in 2 years or less, so i shouldn't bother waiting for the next available technology.  And she says that monofocals will give me the eyes of a 70 year old, and i probably would not be happy.

I usually hold items that i am reading from about 1 - 1 1/2 feet (at most) from my face.   i think i am already used to getting fairly close to things to see better.  I am just worried about not adjusting to seeing through multifocals, or seeing two images... or things like that.  I think that a lot of the problems that people have might come from lack of surgeon skill in placing, or putting in the correct power?  My doctor is considered one of the top 3 in the nation, and usually takes patients that other doctors have not had luck with or made mistakes on, so she oviosuly has the skill.  i am sure that any multifocal i choose, i will be able to see fine, just do not want to be disapointed after spending $4000.00 for the lenses out of pocket!

thanks for all the help!

[Eagle eyes]

I apologized for the metal hinges in a previous thread.

The improved night time vision is based upon 2 FDA claims. I thought the Tecnis was made by Pharmacia, prior to AMO acquiring the company, and the FDA claims were then made?

I am aware of NTIOL status for Tecnis in February and Alcon IQ in May of this year. I think that is great for all. If there are FDA claims on SN60WF ,other than the NTIOL status I am not aware of it, but would welcome the information.

[hud]

Dear Mister Metal Hinges:
Do more research, rather than having beers with your AMO buds. Alcon's SN series is the most popular implant platform in the world. Its use outnumbers all your AMO designs COMBINED, across the world. If the retina protection of the UV and blue filter was a detriment, it would not be so popular.
As you are consistent in promoting one company's products over another, I must offer fair balance.
The Tecnis apheric lens established the New Technology IOL category with Medicare for improved contrast and night vision for the additional reimbursement. Bravo, great for patients and the industry. Alcon applied the SN60WF for inclusion in the same class, where the criteria was to MATCH OR EXCEED the performance of the Tecnis data. Bingo. SN60WF is now a NTIOL. You were caught again with a falsehood when you stated that Tecnis gives better nighttime vision. Not according to the Medicare wonks who are not in the financial position to grant frivilous inclusion that is going to cost them millions.
Oh yeah, you are the expert who knows IOLs, and stated that crystalens was made with metal.