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Facing cataract surgery, need feedback, help deciding on lenses
I read feedback on Crystalens and Restor lenses, but still cannot make a decision. The first doctor I saw said that he would not recommend any accommodative lenses. He would not implant them in his parents' eyes. That's a strong statement and surely most folks would not question it or look beyond.
I have been wearing glasses for many years now and have 8 different pairs, bifocals, progressive, reading, glare preventive and what nots. I spend good $800 a year on new glasses. My vision worsened this year terribly with the growing cataracts. I am afraid to drive anymore, I need new computer glasses already (just had new correctives 6 mos ago). The glare from the computer hurts my eyes and I have to close one eye to read.
When I did research on the accommodative lenses I clinged to Crystalens and wanted to hear from folks that have them. Then I saw this website postings and discovered Restor. Naturally, I want the best possible solution to my dilemmas, cataracts and poor near, intermediate and distance vision. I am 52.
I only have one "good" eye, my left eye was diagnosed with "lazy eye" condition since birth and has almost no vision. I have cataracts in both eyes and need surgery in both. Ideally, I would want accommodative in both eyes, if no contra-indications. I can always decide on my worse eye down the road, but are there any considerations I should be aware of?
Most importantly, which of the accommodative lenses should I choose? It seems that doctors specialize and recommend one type only and that makes it more difficult for patients to decide.
I have been wearing glasses for many years now and have 8 different pairs, bifocals, progressive, reading, glare preventive and what nots. I spend good $800 a year on new glasses. My vision worsened this year terribly with the growing cataracts. I am afraid to drive anymore, I need new computer glasses already (just had new correctives 6 mos ago). The glare from the computer hurts my eyes and I have to close one eye to read.
When I did research on the accommodative lenses I clinged to Crystalens and wanted to hear from folks that have them. Then I saw this website postings and discovered Restor. Naturally, I want the best possible solution to my dilemmas, cataracts and poor near, intermediate and distance vision. I am 52.
I only have one "good" eye, my left eye was diagnosed with "lazy eye" condition since birth and has almost no vision. I have cataracts in both eyes and need surgery in both. Ideally, I would want accommodative in both eyes, if no contra-indications. I can always decide on my worse eye down the road, but are there any considerations I should be aware of?
Most importantly, which of the accommodative lenses should I choose? It seems that doctors specialize and recommend one type only and that makes it more difficult for patients to decide.
Thank you for your recommendation for Dr.Herman. I will keep him in mind for fututer issues.I have decided I am not having lasik so I won't see him right away. I going for the Lens Exchange option (I have been told it ideally needs to be done in first month). My surgery date is 1/16/06 which is 35 days after the original surgery. I am hopeful the power on this second bounce will be "spot on" -+0 but I must admit I am not totally confident my Dr.(#1)can pick the right power based on his first try.
My current optical prescription for the left eye that will undergo an exchange is :sphere +3.50 cyl -2.50 axis 177.
The original Restor lens used that got me to this farsighted condition was 17.5 D. What "ballpark" Restor power would you use to get me back to "0" or slightly nearsighted? I am only looking for your best guess here.
I will get one extra and possibly two independant power selections next week.
I would appreciate any other thoughts you have on my selected course of action.
My current optical prescription for the left eye that will undergo an exchange is :sphere +3.50 cyl -2.50 axis 177.
The original Restor lens used that got me to this farsighted condition was 17.5 D. What "ballpark" Restor power would you use to get me back to "0" or slightly nearsighted? I am only looking for your best guess here.
I will get one extra and possibly two independant power selections next week.
I would appreciate any other thoughts you have on my selected course of action.
Lots of questions. There are three lenses right now considered in the refractive catagory. The ReZoom, ReStor and Cyrstalens. The Cyrstalens is the only accomodating meaning that it moves back and forth to give you the different focal points. Since it does not have defocused images, it would not have the halos. But it is a first generation and there are more in the works and it might not move as much over time. You would get great distance and some intermediate and little near. The ReStor gives you great near provided the they hit the right power and you don't have to hold it too close to read, but it lacks in intermediate and there does seem to be more questions arising about distance acuity not being as sharp. That could be due to optic design or getting great near sacrifices distance or contrast loss. The Rezoom will give you great distance, good intermediate and good near with a full range of focus. You can still have halos but you adjust over time and the good usually outweights the bad. The Tecnis multifocal has been in trials in the US over one year. I am not sure when approval could be. I would guess around the first or middle of 2007. The Tecnis is different from other monofocal IOL's and is probably one of the more studied monofocal iols. Go to www.tecnisiol.com to learn more. You can also go to www.visioninfocus.com to learn about ReZoom.
As far as determing the power of the lens to implant there are a couple of methods. The IOL master is one and an A-scan is the other. Immersion A-scan is more accurate than hand held. The doc will use a machine to measure the steepness of your cornea to get K readings which the horizontal and vertical axis of your cornea and for astigmatism. He will then use an A-scan or IOL master to measure the length of your eye. He will take this information and input it into a third generation mathematical formula to come up with the right power for the desired refraction. Depending on the amoung of astigmatism you have, they can operate of the steep axis to reduce it or perfrom limbal relaxing incisions at the time of surgery or later in the office. Lasik can be also used to correct more astigmatism. You will probably have to be out of your contacts and just wear your glasses for a period of time to let your cornea resume its natural shape. Most surgeons will personalize their surgeon factor over a series on the monofocal counterpart of the multifocal lens platform and the companies require them to do this to be certified. By doing a series of 25 or more lenses, they will come up with their own a-constant to be more accurate which they input into the formula. This has just gotten better and more accurate over time with immersion biometry and the IOL Master. Some will use both in your workup. As far as the silicone versus acrylic with the Tecnis, it becomes surgeon preferece and with any designs and materials there are pro's and cons that can be debated all day long but there have been millions of both implanted and silicone has actually been implanted longer than acrylic. My mother and stepmother have silicone monofocal lenses and my dad has silicone Array lenses. The ReZoom is an improved acrylic version of the Array lenses which has had over 7 years experience implanted in the US. It replaced the Array. I hope this helps as there are many opinions and you are in a great area with some very well known surgeons who are nationally and internationally respected. But they all have their favorites just as you probably do in things you work with and like. The most important thing is to look at your life style and what you do from your work to hobbies and the state of your eyes and then try to match the best thing for you. Some surgeons even have used a blended vision of different IOL's to give you near with one and better distance and intermediate with the other. You can imagine all of the possibilites as your research this more. As far as night driving, if you have posterior subcapsular cataracts that is when it will bother you the most as light hits and scatters from headlights. Hope some of this helps.
As far as determing the power of the lens to implant there are a couple of methods. The IOL master is one and an A-scan is the other. Immersion A-scan is more accurate than hand held. The doc will use a machine to measure the steepness of your cornea to get K readings which the horizontal and vertical axis of your cornea and for astigmatism. He will then use an A-scan or IOL master to measure the length of your eye. He will take this information and input it into a third generation mathematical formula to come up with the right power for the desired refraction. Depending on the amoung of astigmatism you have, they can operate of the steep axis to reduce it or perfrom limbal relaxing incisions at the time of surgery or later in the office. Lasik can be also used to correct more astigmatism. You will probably have to be out of your contacts and just wear your glasses for a period of time to let your cornea resume its natural shape. Most surgeons will personalize their surgeon factor over a series on the monofocal counterpart of the multifocal lens platform and the companies require them to do this to be certified. By doing a series of 25 or more lenses, they will come up with their own a-constant to be more accurate which they input into the formula. This has just gotten better and more accurate over time with immersion biometry and the IOL Master. Some will use both in your workup. As far as the silicone versus acrylic with the Tecnis, it becomes surgeon preferece and with any designs and materials there are pro's and cons that can be debated all day long but there have been millions of both implanted and silicone has actually been implanted longer than acrylic. My mother and stepmother have silicone monofocal lenses and my dad has silicone Array lenses. The ReZoom is an improved acrylic version of the Array lenses which has had over 7 years experience implanted in the US. It replaced the Array. I hope this helps as there are many opinions and you are in a great area with some very well known surgeons who are nationally and internationally respected. But they all have their favorites just as you probably do in things you work with and like. The most important thing is to look at your life style and what you do from your work to hobbies and the state of your eyes and then try to match the best thing for you. Some surgeons even have used a blended vision of different IOL's to give you near with one and better distance and intermediate with the other. You can imagine all of the possibilites as your research this more. As far as night driving, if you have posterior subcapsular cataracts that is when it will bother you the most as light hits and scatters from headlights. Hope some of this helps.
Hello again. Having spent several more hours searching the net, I now have additional questions. What factors are involved in accurately determining the power of the IOL? Is it easier to get this power right if one is implanting a monofocal IOL vs a multifocal or the crystalens accommodating IOL? Are there differences between various brands of monofocal IOLs? What are the tests and/or instruments for assessing power that provide the best restult? Is it dependent on surgeon's skill in implanting? Is it dependent on the age of the patient? Could it be dependent on the contact lens history of the patient, eg, hard or gas perm contacts which may be "molding" the shape of the cornea? How does one know if the cornea has reached stability following ceasing wear of the contact lenses? I have been told that Lasik can be done following cataract surgery to correct for astigmatism; can the Lasik procedure also correct for refractive error of the IOL, independent of astigmatism? If Lasik is used to correct for refractive error for distance visual acuity, will it make the near/intermediate acuity any worse? Is there a laser type of procedure that could be performed following implantation of a monofocal IOL (for distance visual acuity) which would correct for presbyopia (near/intermediate)? If that were the case, I'd go that route (tecnis monofocal IOL) in a heartbeat. Also, as relates to tecnis IOLs, their latest iteration (Z9003), fall 2005, is an acrylic platform, vs. their earlier silicone platform lenses. Does anyone know what the advantages of acrylic are? Felt more by the surgeon, or the patient? Thanks again, all.
Hi all. I'm new to this forum. Minneapolis area, female, age 51, bilateral posterior sub-capsular cataracts, have not had cataract surgery yet, still correctable to 20/20 DVA, but have been told that the surgery is likely in my near future. Moderately near-sighted (-5.50 R and -5.75 L), mildly astigmatic in one eye (don't know the measurement), need +2.25 for reading. Mostly I now wear multifocal gas permeable contact lenses, which give me "pretty good" acuity at full range (have worn some type of contact lens for 35+ years, ranging from the old "hard" to soft, to this gas perm). Also have progressive spectacles, which I tend to wear in the evenings only after removing contacts. Biggest problem right now is night driving (seems to be with either my contacts or my spectacles).
Have talked to three surgeons so far, one of whom implants restor, rezoom, tecnis monofocal, and crystalens. He also is in FDA trials for tecnis multifocal. I don't know how far out FDA approval of that IOL is. His study group is full; I am not eligible to get the tecnis multifocal. His recommendation is for me to wait a bit until I am not correctable to 20/20 DVA, and, assuming this is within the year or so, then to implant the crystalens, and do lasik (?) to correct any bothersome astigmatism. He says that he sees me as a "refractive patient". Could someone explain that term please? I had tried monovision correction with contacts some years ago, and I was never really happy with that.
It sounds to me from reading these posts that restor is problematic with the night driving halos, etc, and the lack of crisp acuity throughout the whole range. I've also heard (from doc #2) that the crystalens hinging mechanism fails in as little as three years, rendering it essentially a monofocal IOL. Further, it sounds like the reading capability of the crystalens would not be enough reading for me. This leads me to prefer the tecnis monofocal IOL, and just put up with glasses (or contacts, maybe?) for near and intermediate. However, if I could do this without glasses, that would be my preference. Still young and active (ski, golf, drive my 14 year old kid around, etc.). Can anyone speak to how the crystalens compares to the tecnis IOL in terms of "functional vision" and contrast sensitivity? Those seem to be the biggies for folks complaining of night driving difficulties. Does anyone know how soon the tecnis multifocal will be available, and if it is any better than the restor with respect to halos? Is the improved functional vision that is touted with the tecnis monofocal also a selling point for the tecnis multifocal? If I opt for tecnis monofocal, can I wear some kind of contact lens which would be "blank" for distance, and only correct for intermediate and near?
Also confused by conflicting (?) reports on the UV blocking capability of the crystalens. These two sites both indicate that the crystalens does not have UV blocking capability: http://www.agingeye.net/otheragingeye/crystalens.pdf http://www.crystalens.com/crystalens-physician-labeling.pdf
This site seems to indicate that it does have (some? but not sufficient?) UV blocking capability:
http://www.eyeonics.com/Product.html
I'm trying to do my homework now, so that when the time comes, I'm ready to pull the trigger. Would appreciate any help, personal experiences, etc. Thanks.
Have talked to three surgeons so far, one of whom implants restor, rezoom, tecnis monofocal, and crystalens. He also is in FDA trials for tecnis multifocal. I don't know how far out FDA approval of that IOL is. His study group is full; I am not eligible to get the tecnis multifocal. His recommendation is for me to wait a bit until I am not correctable to 20/20 DVA, and, assuming this is within the year or so, then to implant the crystalens, and do lasik (?) to correct any bothersome astigmatism. He says that he sees me as a "refractive patient". Could someone explain that term please? I had tried monovision correction with contacts some years ago, and I was never really happy with that.
It sounds to me from reading these posts that restor is problematic with the night driving halos, etc, and the lack of crisp acuity throughout the whole range. I've also heard (from doc #2) that the crystalens hinging mechanism fails in as little as three years, rendering it essentially a monofocal IOL. Further, it sounds like the reading capability of the crystalens would not be enough reading for me. This leads me to prefer the tecnis monofocal IOL, and just put up with glasses (or contacts, maybe?) for near and intermediate. However, if I could do this without glasses, that would be my preference. Still young and active (ski, golf, drive my 14 year old kid around, etc.). Can anyone speak to how the crystalens compares to the tecnis IOL in terms of "functional vision" and contrast sensitivity? Those seem to be the biggies for folks complaining of night driving difficulties. Does anyone know how soon the tecnis multifocal will be available, and if it is any better than the restor with respect to halos? Is the improved functional vision that is touted with the tecnis monofocal also a selling point for the tecnis multifocal? If I opt for tecnis monofocal, can I wear some kind of contact lens which would be "blank" for distance, and only correct for intermediate and near?
Also confused by conflicting (?) reports on the UV blocking capability of the crystalens. These two sites both indicate that the crystalens does not have UV blocking capability: http://www.agingeye.net/otheragingeye/crystalens.pdf http://www.crystalens.com/crystalens-physician-labeling.pdf
This site seems to indicate that it does have (some? but not sufficient?) UV blocking capability:
http://www.eyeonics.com/Product.html
I'm trying to do my homework now, so that when the time comes, I'm ready to pull the trigger. Would appreciate any help, personal experiences, etc. Thanks.
Jim,
Go to Wes Herman in Dallas. He does lasik, has Array's in his own eyes and will do the right the thing if he can help you. 214-361-1443. See him and no one else. He has the experience. He has done both ReStor and ReZoom. The Array is the predecessor to the ReZoom. Let me know what happens.
Go to Wes Herman in Dallas. He does lasik, has Array's in his own eyes and will do the right the thing if he can help you. 214-361-1443. See him and no one else. He has the experience. He has done both ReStor and ReZoom. The Array is the predecessor to the ReZoom. Let me know what happens.
I am stil looking forward to hearing your thoughts on my Restor predicament. Thanks....Jim in Fort Worth
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