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Ashperic Restor vs. Monofocal for 33 year old eye?

Hi:

I am male, 33 years old, with bilateral (and growing) PSC cataracts. Also a huge (and growing number) of floaters as well. Have had many dilated eye exams from very good doctors and there are no retinal complications (although, there may be faint signs of PVD, but no retinal tears or detachment).

I've consulted with some doctors who have performed upwards of 25,000 cataract operations and several thousand Restor implants. (Dr. Christerbury in North Carolina, Dr. Mckool in NYC, some others in teaching hospitals)  

No one can really recommend a lens to me. They've all gone over pros/cons of monofocal (Alcon IQ aspheric, for example) and multifocal (Restor). They've all said that Restor has "good" performance but does leave halos around bright lights which will never go away.
No one is sure whether mono or multi is good for me, everyone has said that although most people are happy with restors, some people are never able to adjust.

Also restor is similar to Monofocal for distance but not great for intermediate vision.

I'm a computer programmer, heavy web surfing, cell phone, video game use. Reading finely printed computer manuals and switching back and forth from the manual to the screen is important to me. I've worn glasses since 14 and have -5.50D in both eyes.

So my questions are:

1) Does the Aspheric restor improve intermediate vision over the previous version ? Does this newer version make going with restor now, a no-brainer ?

2) I've read that with monofocals, vision is quite blurry less than 5 feet inwards. With monofocals, could I switch easily from keyboard, monitor, open manual etc with bifocals or would i have to keep switching glasses to read a monitor 22 inches away vs. a book 12 inches away ? IF this is possible with MONOfocals, then maybe they are a safer option ?

3) Having the ability to read my wristwatch when I get up in the morning or a book to fall asleep to would also be great :-)

4) What other advise would forum members give me ? I really need to get surgery in the next year or so (I have too much glare, halos, smudged vision as of now with PSC). I'm
generally quite fussy (a smudge on my glasses really bothers me) but as I grow older, I think I can learn to compromise/adjust better with whatever type of IOL I choose.

Thanks so much for all your advice and replies.

Best regards,
--j
***@****

57 Responses
Avatar universal
Avatar universal
There is ample information in the archives of this forum about multifocal problems/issues.  According to the recent medical literature, the best results from a multifocal/accommodating IOL seem to involve the Crystalens, with ReStor second, and ReZoom last.  In your case, getting the Crystalens (set for slight monovision) makes sense to me, especially if you don't have astigmatism.  Frankly, since your work involves computers, getting bilateral ReStors sounds like a terrible idea to me; intermediate (computer) vision is the biggest weakness with this lens.

Getting aspheric monofocal lenses set for monovision or modified monovision (AKA "blended vision") might also be a good choice.  It would give you good vision immediately after surgery, and you'd probably need glasses only for a few activities (like reading small print for a long time.)

So my vote in your case would either be for Crystalens or aspheric monofocals, probably with blended vision.  I'd suggest that you see more than one experienced surgeon and get their recommendations.  
Avatar universal
Jodie:
Crysalens is out, it's too gimmicky and unreliable. I do have very slight (0.5) astigmatism.

I've gone through a lot of the forum archives and read all about the monofocal and multifocal pros/cons. I'm stil very confused and can't figure out what to do! Intermediate is awful with monofocals too (as with restor), so I'd have to wear glasses for computer work with both.

But I won't need glasses for near with restor whereas I would with monofocals. So are the halos etc., an acceptable trade off, especially as one gets older ? That's the question I am trying to wrestle with. Would restors or monofocals (perhaps with -0.5D) would be better to switch back and forth from books, finely printed manuals, cell phone and computer screen (all of which are varyingly situated between 6 inches and 24 inches away from my eye).

Avatar universal
I have multifocal implants (Tecnis not ReSTOR).

1) Does the Aspheric restor improve intermediate vision over the previous version ? Does this newer version make going with restor now, a no-brainer ?

With my lenses I have an area of "soft focus" between 18" and 4 feet.  I can read text on a computer screen in that zone, but with +1.00 readers I can see the screen and everything in my work area clearly.  For typing and reading copy I often take off my reading glasses.  I have my screen tucked up to the front of the desk (always had it that way).  I can both copy and screen with amazing clarity.  I believe the area of "soft focus" for the ReSTOR is closer to 6 feet, making them the multifocal IOL choice for computer work.

2) I've read that with monofocals, vision is quite blurry less than 5 feet inwards ...

I have quite a few neighbours with monofocal lenses focused for distance.  They need reading glasses for anything close, but can drive and see the speedometer, etc. clearly enough without glasses.  I have one neighbour who chose to have monofocal lenses focused for near vision.  Yes she can see clearly up close, but wears her familiar frames (with a different prescription) for distance.

Jodie's discussion of monovision / blended vision IOLs is workable and is a personal choice, as is selecting a multifocal IOL.  Not to be decided quickly.

3) Having the ability to read my wristwatch when I get up in the morning or a book to fall asleep to would also be great :-)

It's a joy to do this again after years of wearing bifocals.  I can read the morning paper on the train and glance around to see what's happening.  No glasses; no waiting to focus.

4) What other advise would forum members give me ? ...

I can only describe the experience of receiving multifocal IOLs.  Functionally my eyes are as good as they were twenty years ago (I'm 52 now).  I can read the finest of type and see distant objects clearly -- I think better than I could with glasses.  In practice there are some trade offs.  Halos is the big one.  Initially -- first three months -- they were unbearable.  Will these ever go away?  No they won't.  But they've become minimal due to Neuroadaptation -- the brain getting used to seeing through the lenses and filtering out unwanted information.  Halos mostly display at night around bright, distant lights.  It's very workable.  I certainly can operate better than I have for years.  But I'll never see exactly in-the-way I used to.  All said, it was an excellent choice.

Cheers,
Glenn
Avatar universal
I have monofocals.  I can read the computer screen without blur at 2 feet.  Within that distance, I use 1.0 readers.  The characters on the car's dashboard are very clear without glasses.   If I squint, I can read most nutrition statements on packaging at the grocery store.  Some of these are small print, but of course, the lighting is  very good in these instances.   I was told before the surgery that I am slightly nearsighted in one eye.
Keep in mind that with regard to cataract surgery, the phrase "Your mileage may vary" seems appropriate when anyone describes their results.
233488 tn?1310696703
MEDICAL PROFESSIONAL
If it were me. I would chose a monofocal aspheric IOL and set my dominant right eye at about -1.00 and my non-dominate left eye at -2.50  I would then expect to be able to read and use my computer nicely without glasses. With no line bifocals (the prescription would be RE -1.00  LE -2.50 and +3.00 Add) I would expect to have great night vision and excellent vision and depth perception to do surgery with.

If I wanted to emphasize my distance vision then I would ask the surgeon to shoot for -0.50 for distance and -1.50 for intermediate and wear glasses to read.

JCH III MD Eye Physician & Surgeon
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