rezoom, restore or mono lens??? HELP

[milehighmommy]

I am a 36 year old mom just diagnosed with cataracts (why i got them so young - i have NO idea~~) Anyhoo, i was told to choose between rezoom for distance and intermediate vision (possibly need reading glasses) or Restore for distance and near vision (possible blurry intermediate vision-ie computer. )  this is a tough decision. anyone with any experience or know how -  i would value the input. also wondering if the multifocal is even worth the extra money over the monofocal traditional lens.....???? will I ABSOLUTELY need reading glasses with a traditional monofocal?

[lksa]

I just realized that I have my terminology mixed up. What is the difference in Monofocal and Multifocal?
I assumed that monofocal was different lenses in each eye, and multifocal is the same in both eyes. Is that correct?

[margareta]

A related discussion, astigmatism was started.

[pica314]

Thanks, Jodie. I will try to explain his comment about a second monovision implant.  My 2nd eye still has accomodation and focus power even with the cataract. With a fixed focus lens, say at 16", I will lose some of the clarity I now have for distance as my second eye will be nothing but a blur for distance. Currently, even imperfectly my second eye is still involved. With the ReStor, I get help with distance and I still have the ability to read. The most difficult part according to my MD is that the brain is receiving both near and far images at the same time and must learn to chose which to use. That is one of the reasons the intermediate vision is slow to clear with ReStor. My MD is part of the FDA study for the new ReStor (a 15 " lens for computer work)  and has done hundreds of them, even designed a machine to take the most accurate measurements. He also said that since I am already accustomed to monovision, my brain may adjust faster to the image selection process of a Restor even in only one eye. My original opthamologist also mentioned I could lose some depth perception with a fixed focus reader in the second eye. He recommended another distance lens and glasses. Sorry for the layman's terms.

[Marv20/20]

I am 69 years old and had Rezoom lenses implanted both eyes 4 & 3 weeks ago. After wearing tri-focal glasses for 35 years, I no longer need any glasses. The only exception is reading small type for an extended period. I use +1.00 drugstore glasses to prevent eye strain. There are some problems, but overall my vision is highly functional. I can do everything I need to do.

Night driving is still a bit of a  problem. I am confident enough to drive at night, but there are ghosts and halos to contend with. This has been getting better.  My doctor said these effects will diminish over the next few months, but won't disappear completely. I can live with that.

Overall, I am happy with the Rezooms. I don't have to wear or carry glasses any more. I leave some reading glasses at home and at work in case I need them, but rarely need them. I do carry a plastic magnifying card in my wallet if I have to read something under poor conditions, such as the fine print on a menu in a dark restaurant. I spend much of my day on a computer, and have never needed glasses there.

This is not a recommendation,   I am just sharing my experience. I have complete confidence in my doctor and he said the Rezoom lenses would work very well for me. After a great deal of research I decided the Rezoom offered exactly what I wanted. So far, so good.  One thing which stood out in my research was people either love or hate multifocal lenses.

Good luck to you whatever you choose.

[Barbara M]

First thing I want to say is that the most wonderful thing in the world is to be rid of your cataract. I received the wrong lens recently. It is not one that is easily removed so we chose not to go that route.  If money is not abundant people should not consider a premium lens. There seems to be a greater risk of additional problems . My doctor has been great. All follow up work has been free.  But there are always other charges such an anesthesiologist, equipment, facility and missed work, that will come out of your pocket. I've worn glasses as long as I can remember. I'm not sure what possessed me have something I've never had. But once you start you will continue to not waste the original money invested. You become trapped.  If you have time, test monovision with contacts or glasses to see if you can adjust to it. It is an individual thing that each person needs to test for themselves. There are lots of great results with all the lenses and if money is not a question most problems are fixable.

[JodieJ]

I disagree with your doctor's comment about it being "uncommon" to implant a reading lens in the 2nd eye.  Monovision (or modified monovision) with monofocal implants is very common.  Because you did very well with monovision in the past, I'd say that you are excellent candidate for monovision with IOLs.  On the other hand, ReStor is hardly problem-free, and there is reportedly an even greater probability of problems with ReStor in only one eye.  The bottom line:  It seems to me like a good idea for you to get a second opinion from another surgeon.

[pica314]

I had my first cataract done 5 years ago with a distance lens. I was in my early 40s and did great with monovision  (with nothing in my second eye). Then my second cataract, as well as aging, began to impact my close-up and I needed progressively more correction- with reading glasses constantly on my head for whenever I need to see close, then pulling them off to see anything else. My Dr. suggested another distance lens for the 2nd. I would always wear glasses for reading and computer. He said it is not common to implant a reading lens for the 2nd eye, it seems that it doesn't work as well. I went to a specialist in RESTOR and am going for surgery in 2 weeks. I had halos with my first  lens for over 2 years- they eventually went away. So I am not worried about that.
I hope it is the right decision.

[John C Hagan III, MD, FACS, FAAO]

A "mono-focal" intraocular implant (IOL) is the standard IOL used in most surgery. It has a fixed focal length. At the focal length things are generally quite clear (unless there is a large amount of astigmatism or severe eye disease).  Closer or farther than this focal length things are blurry and glasses (often progressive no-line bifocals) are used to help the eye see at those distances.  Many people with monofocal IOLs have excellent distant vision or excellent near vision or excellent mid-range vision without glasses. If one monofocal IOL has a focal length of infinitity (distance) and the other a focal length of 20 inches and the person uses one eye for distance and the other for reading and doesn't wear glasses that is "Mono-vision".

A multifocal IOL or Premium IOL or Accommodating IOL are new, used in a small number of cases and have variable focal lengths due to the way the implant is made (mutifocal or apodized IOLs) or the implant actually bends and moves in the eye and focus's light (accommodating IOL).  

Premium IOLs cost more, the costs are often not covered by insurance, the procedure is more difficult and complicated, complications are mor common, IOL exchanges and explants are much more common, night vision is often a problem and 20-30% of patients still require glasses for some or most visual tasks.

Our eye care forums are not a place where happy Premium IOL patients often come to crow about their successes, consequently unhappy premium IOL patients greatly outnumber "happy" premium patients.

I have said before that if I was going to have cataract surgery on myself at this time I would not choose a Premium IOL.

JCH III Eye Physician & Surgoen

[lksa]

Hi!  I was so glad to read about your explantation. I didn't know they could do that. Although it's only been two weeks, i am miserable since I go the ReZoom in my left eye. I was supposed to get ReStor in both eyes, but without telling me, the doctor put ReZoom in the left eye. I have had a really bad headache since the second surgery, and mt visioin has not improved. With the Restor I could read pretty good. The doctor said distance was not as good as he had hoped, but it could be "tweaked" (Whatever that means!) if the second ReStor didn't improve it. Then, without my input he substituted ReZoom.Now I need glasses for the computer and reading a newspaper, and get the bad headache. And distant visioin has not improved. I would have told him that I never got used to Mono-contacts. I really think that if I could get ReStor in the left eye, too, it will be better, but I wonder if I should give it more time. (I assume I won't have to pay for the explantation since it was his mistake.) It cost $6,000 and insurance didn't pay!
The headache is constant, though, so that's hard to take. Ibuprofin doesn't help.

[janjan99]

Yes - My intermediate vision is fine.  Like I said I function most of my day without glasses..  I work on computer and can see the screen just fine.  Actually I ended up with 20/25 vision i both eyes after the surgery.  I used to wear thick coke bottle glasses.  This is a blessing to me.  I can even put on makeupand watch tv without glasses.  I have some problems in very dim light conditions, but I just pop on my glasses and everything is fine.  Keep me posted...Jan

[John C Hagan III, MD, FACS, FAAO]

A recent medical journal article on "premium intraocular lens" has this statement: ..... expectations of the post-operative results with multifocal and accommodating implants have far exceeded present technology".

JCH III MD

[John C Hagan III, MD, FACS, FAAO]

Hi. you don't have to have either.  if you don't mind the idea of reading glasses you can choose distance vision for both and it will normally be covered by your insurance.  you can also choose monovision, also at no additional charge, where one eye is set for distance and the other for reading.  if your cataracts aren't too bad, this can be simulated with trial glasses in the office or even with a contact lens in one eye to see how you handle it.  it also never hurts to get more than one opinion as this can be an important decision so take your time.
JS MD

[blue92]

I had Rezoom lenses implanted and eventually explanted. I had so many aberrations that it prevented me from driving at night. Along with halos and ghosting, my intermediate vision was poor. I made the decision to have the lenses explanted after one year of trying and waiting . I'm very happy with the monofocal lenses that I now have. They were set for modified monovision  (one eye set for close up and the other for distance; 20/20 right eye and -.75 left eye) giving me a high degree of freedom from glasses. I use +.75 readers in low light indoors conditions and reading, however, outdoors and well lit places I function very well without glasses. The best part is that the lenses are aberration free. My intermediate and distance vision is excellent. For outdoor activities and sports my vision is great without glasses.

As for multifocal lenses, you need to be very careful and understand that you'll have some aberrations such as halos, starburst and perhaps compromised vision at either close, intermediate or distance. Ghosting can also be a debilitating problem. Bottom line, the two people I know that have done well with multifocal lenses and are happy with the results have small pupils. (During the day - 2mm and at night 4mm.) Other people that had multifocal lenses had severe problems. Three opted for explantation including myself, a couple others wish they had the means (money) to have the procedure done. The rest (5) have learned to live with the lenses, but are not really happy with the results. I guess among all the factors involved in adjusting to multifocal lenses, pupil size does matter, however, please keep in mind that smaller pupils doesn't guarantee positive results either. There is a lot more involved in the adjustment and satisfaction process.

Please talk to your doctor and see if monovision or modified monovision will work for you. It is much more predictable and safer. I don't imply that you are not a good candidate for Restor or Rezoom, but I truly believe the odds are against you. Remember, changing lenses at a later time comes with some risks (retina detachment, PVD, floaters, etc) and most doctors are not willing to do the procedure.

Finally, all I can tell you is that if I had to do it all over again, I would have monofocal lenses implanted. The Rezoom journey has been a nightmare and I'm so glad and blessed to have put it behind me. I wish you the best of luck and I hope you take the time to further investigate the outcomes and not rush into it like I did. Because there was an up charge for the premium lenses, my doctor was more than happy to recommend them. He should have taken into account my large pupil size, but didn't. After the surgery and during my ordeal, they were very cynical and indifferent. They just wanted to wash their hands from my problems. Thank God I found an excellent doctor in Indiana who was willing to do the explantations and did a great job.

[milehighmommy]

thank you JS also, now I understand what you are referring to. I am going to do the demo with my dr.  and You are right jodie, money shouldn't matter, but for some of us, it does lean the scales a little when making decisions. I am just saying that if a monofocal lens will be sufficient, and I may need glasses with a multifocal, is it really worth it?

[milehighmommy]

I appreciate that Jan!  I am reading so many SCARY stories on these forums on the multifocal that i am beginning to wonder why dr's suggest them at all if the monofocal work fine.  I also wonder if i still wil have to use reading glasses with Rezoom. why not just avoid all the problems and just go with the standard lens?  IS your intermediate vision fine Jan? did you have any astigmatism

[janjan99]

oops - meant to say without my glasses.  sorry jan

[janjan99]

I have monofocal lenses implanted last year and I love it.  I didn't have the difficulty adjusting that a lot of people seem to have with the multifocal lenses.  I spend about 85% of my day with glasses.  I can see the computer and read without any aid.  I need glasses for night driving and reading very small print.  I didn't have a serious halo or starbursing problem that most seem to have with multifocal lenses.  Hope this helps

Jan

[JodieJ]

Forget about the money for now; we're talking about the quality of your vision for the next 40+ years.  I think that the question you should be asking is:  "Would the potential benefits of a multifocal/accommodating lens outweigh the risks for me?"  In order to answer that question, you need to have more information about the benefits and risks of all the available options.  The post I mentioned above has several links to the type of information you need in order to make a good decision.  There is also a wealth of information on this website.

I suspect that you've already seen a cataract surgeon, who suggested either ReStor and ReZoom.  Some people who have received these implants are very happy; others have had terrible problems with their vision.  I think that Dr. Salz' suggestion that you get second opinion from another doctor is an excellent idea.

    

[milehighmommy]

oops, i guess i had my terminology incorrect. I didn't mean to say mono lens as in one eye would be treated. Both eyes contain cataracts. I was actually asking if the multifocal lens is really worth the money over the traditional cataract implant. ???

[James J Salz, M.D.]

Hi. you don't have to have either.  if you don't mind the idea of reading glasses you can choose distance vision for both and it will normally be covered by your insurance.  you can also choose monovision, also at no additional charge, where one eye is set for distance and the other for reading.  if your cataracts aren't too bad, this can be simulated with trial glasses in the office or even with a contact lens in one eye to see how you handle it.  it also never hurts to get more than one opinion as this can be an important decision so take your time.
JS

[JodieJ]

Your question was recently answered.  Scroll down to the next page and find the post dated 9/14/07 by scams ("Multifocal lens--which one?")  You can find even more information by searching the archives for "multifocal," "ReZoom," "ReStor, "Crystalens".

This is a very important decision for you, so please do enough research before surgery so that you're satisfied with your choice.  BTW, if you got monofocal lenses set for monovision (and monovision worked for you), you probably wouldn't need reading glasses.