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Avatar universal

Unsure about lenses

I was just told yesterday that I have cataracts which need to be removed.  I have noticed in the past few months that I've been having problems with my eyesight.  I thought I needed new glasses, but that will not solve the problem.  

I am 51 years old and a Dental Hygienist.  For my job, I need to have excellent near vision.  I wear progressive bifocals now, but I don't wear my glasses while I am working on a patient, since I see better without them.  I considered lasix a few years ago, and I was given one contact to wear to see if I could adjust to using one eye for distance and one eye for close up but it did not work for me.  I ended up not having lasix done because I did not want to sacrifice my near vision.  I also drive close to an hour to and from work in the dark.

What are my options for IOLs?  The Dr. I saw yesterday was talking about the multi-focal lenses being a possibility,  and that if I went with a standard lens I would have good distance vision but would need reading glasses.  I have a consultation appointment scheduled with the surgeon who has treated me previously, and I would appreciate any information I can get prior to my appointment.

I wouldn't really mind having to wear reading glasses, and I am very concerned about what I've been reading about the multi-focal lenses on these boards.
21 Responses
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Avatar universal
Physical address for Alcon reports that is.
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Avatar universal
Hadn't thought of filing a report with the Alcon Corp.  Does their website give the physical for such reports?
Helpful - 0
574673 tn?1234125978
Just to add my two cents. I currently have one monofocal  torric Acrysof IQ lens set for intermediate in my nondominant eye. I wear a contact lens in my other eye set for distance as the cataract is mild. If I have it done eventually I will set it for distance. This gives me good vision at most distances and I use reading glasses. ( I plan to get prescription progressives soon so that I don't have to take my glasses on and off all of the time at work) I debated about setting both eyes for distance and tried a contact lens to correct for distance and intermediate before my surgery and decided I would really miss having intermediate since so many things are at that distance.
I had a Restor lens in that eye originally and it was a complete disaster. I could not focus at any distance and glare, halos, ghosting, loss of contrast was debilitating. I can not imagine a lifetime of this vision and after much deliberation I had the Restor explanted one month ago. I cannot recommend this lens at all. If you don't mind wearing glasses for some tasks, I think the quality of your vision would be much better without a multifocal.
The FDA MAUDE website also allows for patients to file an adverse medical device report - that is what I did in addition to filing a report with the Alcon Corp.
Helpful - 0
Avatar universal
Thanks for clarifying your search details. My search that found 489 was product type IOL, product name Restor, dates since 2/1/01. It looks like the database records are missing some data, so slightly different searches that should produce identical results...don't.

To get the complete picture, you would have to do several searches for each product, merge the duplicates (including duplicates that come back from a single query), and eliminating any reports that might have been mis-identified. After that, ideally each record would be classified as to severity, outcome (was the problem solved to the patient's satisfaction), etc.

There is a lot of good data there, but a raw "number of reports" is just slightly better than meaningless.
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Avatar universal
FDA Maude website, I found 777 reports on the restor using year 2000-now. All I put in was Restor (Brand) and Alcon as (Mfg.
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Avatar universal
I had cataract surgery last Oct/Nov, with Restor lenses.  Like you I tried monovision contacts (at age 40, I am now 53) and never adjusted.  The distance part was fine, but I hated that I could read better without my contacts than with them.  

I have been nearsighted all my life and the thought of permanently not being able to see close up (without reading glasses) REALLY bothered me.

My surgeon recommended either modified monofocal or Restor lenses, but he told me there was no such thing as an artificial lens that would give perfect vision, at all distances, in each eye.  But I am glad I went with Restor, I can indeed read without corrective lenses, and I have 20/20 distance.  My intermediate vision is not as good, so I have cheap readers for working on the computer.  

I do see halos at night, not debilitating, I also face long commutes..on Los Angeles freeways (boy are there a lot of cars out there with halos! ) And I did have ghosting but that went away after a few weeks, it isn't a problem anymore.  Nothing was a surprise, the surgeon told me exactly what I could expect.

I think people who are generally happy with their cataract surgery don't post on this website, but all in all, I am glad I went with the Restor.  My second choice would have been to have both eyes set for close up vision, and wear glasses for driving.
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Avatar universal
This takes you directly into the Adverse Reports FDA search area. I put in Crystalens and no mfg. name.  You don't have to put in other info except date.  I ranged from 2000 to current date.  There were 795 reports there for the Bausch and Lomb Crystalens.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm

Be sure to use the www. in front as government sites are particular.
Helpful - 0
233488 tn?1310693103
MEDICAL PROFESSIONAL
Sometimes that means the manufacturer are doing a much more thorough job of looking for and reporting problems whereas others under-report problems. I agree that on this website and in the medical literature that Crystalens is the least problematic and ReZoom the most.

JCH MD
Helpful - 0
Avatar universal
The FDA "MAUDE" web site seems to be:
http://www.fda.gov/cdrh/maude.html

I see 104 Rezoom reports since 2/1/01, 745 for Crystalens, and 489 for Restor. Which makes me question the value of this statistic, since those numbers are almost the opposite of what I would expect.

Scanning the 10 most recent Crystalens reports, 3 of them are duplicates of one event, and 2 of them are duplicates of another. One report is of poor vision and watery eyes one week post-op, which is certainly not an unexpected side effect.

Clearly more study would be required to pull valuable information out of this raw data.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
What is the web address for that website?  How many are posted for Crystalens and ReZoom ?

JCH MD
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Avatar universal
I too worked in the dental field for several years. I'd worn progressive glasses and had cataract surgery with the Restor Multifocal IOL put in. It was horrible. I could not see good at any distance.  I have since had one lens taken out and put a distance vision IOL in.  I still wear progressives. Please do read the archives. There are over 777 adverse reports on the FDA Maude website on the Restor alone. My doctor didn't inform me of these reports even when I specifically asked about them.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
You're welcome.  I really couldn't handle monovision either.

You said, "I wouldn't really mind having to wear reading glasses ...".  I agree with peakhope's thought.  Do you really wish to perform your work using reading glasses?  You are used to wearing glasses for distance now.

Multifocal IOLs will give you both near and far (but not mid-vision), but you may risk seeing anomalies in your vision while doing your work.

Though positive, there has not been enough response regarding the accommodative Crystalens HD and near vision.  For accommodative IOLs it may take 6+ months to adapt to using them.  I don't believe we have anyone posting who has had them this long.
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Avatar universal
I had tried monovision several years ago, also early forties, at the recommendation of my optometrist.  That meant simply leaving out the contact in my non-dominant (but weaker) eye.  It didn't take me long to give up and replace the contact.  It was also before I understood what Presbyopia was.  I'm pretty sure I was in the earlier stages.  Now there are multifocal contacts, giving greater range.  They are regularly set for some form of monovision.  That would have given a better trial.

As I can see from your story you understand there is no "perfect" solution.  You have a Toric monofocal IOL in your non-dominant eye set for near vision.  Keep reading on MedHelp.  There haven't been many who were satisfied with a monofocal lens in one eye and a multifocal lens in the other.  There were a couple satisfied with a monofocal in one eye and an accommodative Crystalens in the other.
Helpful - 0
Avatar universal
I've actually had a neighbour have her monofocal IOLs set for near vision.  She still wears her "trademark" frames for distance, and she is very happy with this.

There has been a little discussion on MedHelp regarding patients receiving monofocal lenses set for distance -- the most common way.  Then they discover, having been nearsighted all their lives, they no longer have any near vision.  It's a reverse of how they had been seeing all along.  A few were very unhappy with this.

The Tecnis multifocal was recently approved by the FDA.  This is the type of IOL I have seen through for the past two years.  If a patient isn't suitable for Crystalens, this will give another alternative.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
You note that you couldn't adjust to monovision several years ago. I had the same experience back in the '80's when I was in my forties. Before having cataract surgery in December '08, I talked to many people who chose monovision and are quite happy with it. This encouraged me to experiment with monovision and "mini" monovision.

So, in December, I had my non-dominant eye  corrected to -1D (20/25) with a toric lens that also corrects astigmatism. My dominant eye remains at -6 and doesn't need cataract surgery at present. This is not perfect by any means but is do-able for using the computer, household chores, watching tv, dancing, exercising, reading in good light, handweaving (I am a fiber artist,) makeup, plucking eyebrows, etc. I haven't had headaches or balance issues.

I have a contact that corrects my dominant eye to 20/20 for distance viewing (day driving, scenery, movies, etc.) For night driving, I take out the contact and wear bifocals that correct my vision to 20/20 in both eyes.

In short, it may be worth the time and $$ to experiment with a contact lens and monovision one more time before you commit to cataract surgery. By the way, astigmatism complicates choosing an IOL, particularly a multifocal like ReStor or an accommodating IOL like Crystallens HD.

Helpful - 0
Avatar universal
Yes, monovision is what you tried with contacts. There is also mini-monovision that you might be able to adapt to...but it doesn't sound like it would really suit what you want either.

So your other options would be:

1. Both eyes set to distance, and you would need glasses for near (and some intermediate).

2. Both eyes set for intermediate or for near, in which case you would need glasses for the other distances. I'm not sure I have heard of anyone actually doing this, so I don't know if there is a reason it wouldn't work.

3. A multi-focal or accommodating IOL. In the US, your current choices are Rezoom (lots of problems), Restor (some problems), or Crystalens (some limitations).

Generally the Crystalens has not been recommended for people who need excellent near vision without glasses. The new HD model is better...but still might not be good enough for you. And Crystalens is tricky to install, so you would want an experienced doctor if you go that route.

You mentioned that reading glasses would be ok. Do you also mean that using glasses to do your work would be acceptable? Do you want/need excellent distance vision, or would "pretty good" be good enough?

Helpful - 0
233488 tn?1310693103
MEDICAL PROFESSIONAL
It's your call but take the time to look at all the postings from people with problems with multifocal IOLs.

If it were me I would have a monofocial aspheric IOL like B&L or Tecnis and a mini-monofocal post op refraction.
JCH MD
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Avatar universal
Thanks for your imput.  I am afraid of the monovision.  Isn't that what I tried a few years ago using the one contact lens?  I couldn't adjust to that when I tried it.
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Avatar universal
I've had multifocal IOLs for the past two years, and this is the first time I'm going to recommend NOT to get them.  I have excellent near vision up to about 18 inches, then it changes to (probably) 20/30 up to about four feet where vision is good again.  The reason I'm not recommending multifocals for you is the possibility of ghosting.  I notice ghosting only with strong contrasts, such as white-on-black titles at the end of movies.  I would worry in your case that, with the gloss from the white teeth and the background of the mouth, you would see a second edge of the teeth's surface.

The ReSTOR multifocal has been noted in many cases to result in poor night vision depending on pupil size.  I have Tecnis multifocals and do not have this problem due to their simpler design.  (ReZoom IOLs as mentioned in many posts appear to have the greatest number of problem of any multifocal.)

Though it's not what I usually say because I'm happy with my multifocal IOLs, either get monofocal IOLs set for near focus and wear glasses for distance or have the IOLs set for monovision.  Look up "monovision" with MedHelp's search engine, but basically it's having the dominant eye set for distance and and the non-dominant eye set for near vision.  Also note that some people do not adjust to monovision.
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