Mono- or Multifocal

[Occupant]

I am 70 years old and have cataracts in both eyes. I initially decided to go with the Restor lens from Alcon - but it's not available. I need 8.5 to 9.0D and I also have some astigmatism (don't know what it is). By now I have been waiting for over a year and my vision gets progressivly worse. I am now using my driving glasses to do close up-work. I don't mind wearing glasse, but could never get used to bifocals. The only thing I am really concerned about is the Depth of Field issue, e.g. I want to be able to see (in focus) my speedometer and the road ahaed of me without having to switch glasses. Any help would be appreciated.

[JodieJ]

I don't know whether vitrectomies are commonly done to treat floaters.  I'm guessing that the degree of risk would depend on the condition of the eye (in your case, probably healthy), the reason for the surgery, and the skill of the surgeon.  Yes, it can be done with local anesthesia and no sedation (mine was), although local anesthesia and IV sedation is the norm.  My surgery was painless.  There is new vitrectomy equipment available that doesn't require sutures and significantly reduces recovery time.  For the type of surgery I had, the risk of retinal detachment was about one percent.  The highest risk was developing a cataract, which can't happen if you already have an implant.

I can certainly understand why you want to get rid of those floaters.  If I were in your situation, I'd schedule consultations with one or two of the best retinal surgeons in my area to get their opinions about a surgical solution.  (Try asking other ophthalmologists who they'd send a family member to.)  That should give you more information for basing a decision as to how to proceed.

[K-D]

Thanks for the info Jodie. Am going to take your advice.  Not ready for the big step yet.  But if this stays the same after a year, will consider it.  This is too annoying. Yes, it is a small problem. But it causes constant anxiety. And it is impossible to get the mind off of it because of the blur and black floaters that are constantly floating in the line of vision.

[K-D]

With my Rezoom, the middle of the lens in for distance.  So, when I am outside, my pupil is constricted around the center of the implant, and so the middle of the lens for distance is in play.  When in the dark, my pupil dilates and the next ring on the lens is in play.
I was told that with the Restor, the middle is for close, opposite of the Rezoom.

[Susan12345]

Computers are considered intermediate?  I would have guessed intermediate was like 4-6 feet.  I just measured and my computer screen is about 20 inches from my eyes.  I wear my reading glasses on the computer but with bigger print and some strain I think I could use the computer without glasses-using the computer is much less difficult than reading a book, probably because the light is so good on the screen.  It's too bad books don't light up.  

Dr. ReStor told me that he might not be able to correct my astigmatism 100% and that's why I might have to wear reading glasses after surgery "for small print".  That's why I thought the 20% were wearing reading glasses.  At the time that seemed perfectly reasonable, I was already wearing reading glasses, for READING,  as a nearsighted person since childhood I had no concept that it was possible to not be able to take your glasses off and see the buttons on the microwave and of course no clue of the fluttering I get as my eyes try to adapt from far to near.  He certainly never mentioned  before or after surgery any further surgery to correct the astigmatism more.  I suppose because he knew that my HMO wouldn't cover it.  They covered the 1st astigmatism surgery because it was done at the same time as the cataract surgery, all I had to pay was $2100 extra for the ReStor lenses.  The money was definitely never the issue for me though.  I would NEVER have had multifocal IOL's if I had thought there was any chance of needing more surgery.  It was scary enough knowing that you had to have both eyes done if you had multifocals, but I told myself, the 2nd cataract will have to be done eventually, I might as well get them both done and not have to worry any more.     HA!!!!!!      

I don't know why he didn't tell me all this.  He's certainly not hard up for business, it takes months to get an appointment.   Though he was new to my HMO at the time, one of the other eye doctors I consulted before him told me how incredibly lucky my HMO was to get him,  so maybe he wanted to make the HMO didn't regret the huge salary I'm sure they're paying him.  I don't know.  Doctors are a  bizarre species.    

Susan12345

[Susan12345]

Just curious, Jodie, where you read about being female and older decreasing the retinal detachment risk.  I couldn't find anything related to gender related risk, but everything I've read says that getting older increases your risk.  (Except for trauma related detachments, where of course daredevil young men would likely have the edge.)

Are you saying that most of the 20% of people who still need glasses after ReStors wouldn't if their doctors had done their measurements correctly?  That's a lot of bad doctors!  Given my level of trust in the medical profession, I can believe it, and yet, knowing how greedy pharmaceutical companies are, you'd think they would be doing a LOT more thorough training before giving doctors access to the ReStors if that were the case.  Granted, the Alcon Co. gets paid for the IOL whether it works or not, but bad publicity is eventually going to decrease demand.

Anyway, thanks for caring.  I have a 2nd appointment with the new doctor Dec. 8, if I'm able to get my medical records by then.  I haven't a clue whether he's trustworthy or not and feel like there's no reliable way way to find out about him or any doctor until it's too late.  All I know is that he (like my ReStor doctor) has been approved by the Alcon Co. to install ReStors and he (like my Restor doctor) has been on my local "Best Doctors" list.  

Susan12345

[JodieJ]

The 20% who wear glasses with ReStor need them for intermediate vision.  That's the weak point of ReStor.  (Actually, some reports state that it's more than 20% who need a low prescription for intermediate tasks, like doing computer work.)  ReStor is basically a bifocal lens, with near and distance portions.  Most people with ReStors have close to 20/20 vision for distance and near--that's why they were willing to pay extra for a premium lens.  No one with ReStors should need +2.50 readers for near vision--unless they have the wrong power lens.

I got the info on retinal detachment rates when I was researching "clear lens exchange".  The rate of detachment declines after age 70, and it is higher for males than females.  Myopia isn't much of a risk factor unless it's worse than -8 diopters.  I had vitrectomy surgery, which does adds a little to my risk.  I got a cataract as a result of the vitrectomy and did a clear lens exchange in my other eye.

I can understand your reluctance to trust doctors.  Last year I developed double vision related to monovision contact lens wear--a fairly rare occurrence.  I had several worthless, frustrating consultations with optometrists and ophthalmologists who had no idea what was causing my problem or what to do about it.  I started doing my own research by typing "double vision" in Google.  Once I understood my problem, I had a better idea of what would help.  I ended up referring myself for strabismus surgery.  Now I try to research medical issues BEFORE I see the doctor.  It gives me a basis for knowing which doctors to trust--and which ones to run away from.