Multifocals

[Defy_John]

How come many surgeons around my area prefer to use the Restor multifocals even though studies and statistics say that the Tecnis multifocals have less complications and better outcomes? When asked, they say that they had more success with the Restor and have used the Tecnis in the past but many patients complained. However, larger studies say otherwise.

[rwbil]

I went with the Tecnis 2.75 when they 1st came out and in my area, like yours, everyone used the Restore.  I think that is just what they all had been using and never changed.  I actually had to talk my Ophthalmologist into implanting the Tecnis 2.75 and I was his guinea pig.  Now it is his MF lens of choice.

[JohnHaganMD]

=

[Defy_John]

I found a clinic here just like yours where they offer the Tecnis and the Crystalens. I was advised there that the Tecnis was preferred since it was easier for one to adapt to than the Crystalens.

The reason I asked about the Lasik was because I've been leaning toward a toric monofocal and that'd cause me to give up one focus. Being corrected to distance seemed to be the preferred.and being myopic all my life I was hoping to restore some near vision with future Lasik since a correction set for near during the initial cataract surgery was discouraged by surgeons because of it's limited extent of vision that'd it provide.

[JohnHaganMD]

I would suggest respectfully you read this article carefully TWICE:  http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ; If you are myopic and you are use to reading without glasses and things at near being clear like computer screen and writing you will likely be very unhappy if your post op refraction is 0.00 (plano) in both eyes even if you see 20/20  That is at 20 feet. If you watch TV 10 feet away from you its out of focus by 10 feet.  And you can forget reading, iphone, computer without glasses.  Also you can't "fix" that problem with lasik since lasik can't make you myopic so you cold read. Most myopes are happiest with mini-mono vision near bias -1.00 dominant and -2.00 non-dominant  If that didn't work the dominant eye could be lasiked to 0.00 and the reading to -1.00   I have never taken care of a myopic patient that could read or use computer without glasses that was happy with plano in both eyes even if 20/20

[Defy_John]

This was one of the first articles I believe I read when I joined the site. I have it bookmarked as well and I go back to it to review. Great to have.

I've been doing a lot of research and it seems that many doctors do either try to upsell IOLs or ignore the fact that I'm myopic and just recommend a distance correction.

To be sure I will need to talk to my surgeon regarding a mini-monovision because I don't think I could live with a full monovision so either a toric mini-monovision or a monofocal with an LRI for my astigmatism. If going for a premium I'd have to consider one of the Tecnis, I believe the +2.75 was the one that had the lower risks of glares/halos compared to the higher add Tecnis multifocals.

A nurse mentioned an extended range IOL that gives acceptable distance and anything within arms length would require glasses. They refused to tell me the brand or model of these IOLs and I have never heard of them. They just said it was an "extended vision lens". Any idea what it might be? I don't think it was the Crystalens. The only "extended" range IOL I heard of was the Symfony which is not available yet.

[Defy_John]

To clarify they called it the "custom single focus lens" I'm suspecting they would have customized it maybe kind of like a mini-monovision, but the degree wasn't discussed, was only given information on how it'd provide not as sharp vision as a monofocal but with a broader range around and limited intermediate or near.. I forget which.

[JohnHaganMD]

I want to repeat something I've said. Many offices of eye surgeons use huge coercive tactics to get people to upgrade to "premium" IOLs and technology. For most people it is an extra 2 to 9 thousand dollars extra. Most people don't need that technology. If you feel pressured or are not getting straight answers go somewhere else. There are many wonderful cataract/IOL surgeons that don't pressure people to spend extra every operation.  

[yaox127]

Hello there,

Just wanted to ask something reading this statement:

"if your post op refraction is 0.00 (plano) in both eyes even if you see 20/20  That is at 20 feet. If you watch TV 10 feet away from you its out of focus by 10 feet."

I am confused, if you are corrected to 20/20 , wouldn't you see clear at all distances except for close reading. As well as see very clearly at 10 feet and any other distance over close reading distance?

[JohnHaganMD]

No you clearly don't understand. 20/20 vision refers to vision at 20 feet or further because at that distance and further light rays enter the eye parallel. Anything closer the light rays are diversing and plus lens power is needed which the eye with a monofocal IOL cannot generate.  At about 7 feet away from a TV a plano need about +0.50 dioters to see clearly.  So plano 20/20 eye is clearer further than 20 feet (out to the resolution of the eye) while the closer things get the blurrier they are.

[Defy_John]

What is your opinion regarding the Restor vs. Tecnis multifocals? Or would you still prefer a monofocal?

Also if one was to choose to have a single focus correction, is it possible to have future accommodations such as LASIK to fix the uncorrected vision?

[JohnHaganMD]

I would still get a toric monofocal IOL. I've worn glasses forever and am use to them. Of the two I would choose the Tecnis. Lasik can make an eye less myopic fairly predictable but it can't make the eye my myopic and is not good at correcting farsightededness.

[Defy_John]

That's what I was told as well, they said they were contracted with Alcon and that it was easier to get the IOLs compared to the Tecnis. When asked about the Tecnis, they were telling similar stories of them having used it in the past; however, many patients were dissatisfied so they went back to the Restor. Some clinics said they had success with the Restor so they never bothered with the Tecnis. Seems like a more conservative approach of multifocals if just sticking with the Restor.

[JohnHaganMD]

It likely is a sampling error.  The IOL companies offer discounts to hospitals and surgicenters so they sometime go with whatever is the least expensive. Our clinic used Crystalens and Tecnis.  Not many ReStor.  Remember that the cost and complication rate are quite a bit higher with multifocal IOLs compared to monofocal IOLs.

[Defy_John]

I'm in Alabama. I was told the same thing from two different clinics, did more research/contacted other eye clinics in the area and was told the same thing.

[except]

I had this problem when researching doctors/lenses in my area. Hardly anyone offered the Tecnis lenses.
It appears Alcon spends much more money in recruiting doctors to use their products compared to Abbott. Also consider if your doctor uses an Alcon laser as this will usually play a factor. I agree with you that the Tecnis Multifocal Family is on another level compared to Alcon's but sadly money trumps all in these situations.

[JohnHaganMD]

I have no idea.  Where do you live?