multifocal contact lenses after cataract surgery

[orbit7]

I have catatacts in both eyes, I am 56 and have a active lifestyle and so have worn contact lenses for many years. I am trying to decide between having multifocal IOLS implanted with the aim of not having to use spectacles for near, intermediate or distance vision after the surgery versus having monfocal lenses implanted (focused on distance) and then using multifocal contact lenses afterwards so as not to need spectacles for near and intermediate vision.
I've been able to find out information about the disadvantages of multifocal IOLs eg risk of halos, glare, reduced contrast sensitivity and know that spectacle independence cannot be guaranteed. However, I have also read that using 2 different brands/models of multifocal IOLs (eg one thats better for near vision and the other that has better performance at distance) can improve the likelihood of spectacle independence. However, I can't get much information on the pros and cons of using multifocal contact lenses after having standard cataract surgery to be able to decide which option to take. Eg if my IOLS are monfocal and fixed for distance, are there multifocal contact lenses that provide strong enough near vision correction?

I'd be very grateful for advice on this. By the way, the approach of setting one eye fro near and the other for distance doesn't work for me.

Many thnaks

Cathy

[yarrow]

With swiftly worsening cataracts this last winter, I had to make a choice about lens implants if I wished to continue doing the things I enjoy, which include both near activities like sewing and distance activities like birdwatching.  For several decades, I had been wearing various strengths of reading glasses and contacts in a vain attempt to deal with my declining vision, so in a sense I was used to having some kind of lenses in front of my eyes most of the time.  Never liked wearing them, but that's the way it goes, and in exchange for decent sight through cataract surgery, I was perfectly prepared to wear glasses as least part of the time afterward.

My doctor, whom I like and respect, but who never 'pushes' a product or procedure, said that since I've always been hyperopic (far sighted) with 'short' eyeballs, I was a very good candidate for the newest reStor lens.  I did a lot of research here and at other sites, reading all the horror stories and so on; I pestered my doc with a LOT of questions (about the horror stories, the conditions and costs for explantation, and so on); told him what kinds of activities I used my eyes for; and ultimately decided that his years of familiarity with my eyes and his long years of surgical experience would be my best guide.  I consider this 'informed trust rather than blind trust (so to speak) since we really covered all the issues.  

In addition, he used several devices to assess the state of my retinas and to get good internal measurements of the interiors of my eyes--said he didn't want any unnecessary surprises when he got in there.

Although it would have been nice not to have to use glasses of any kind afterward, I understood that in general there was about a 20% chance that I would need them to some extent, and I was OK with that.  Heck, it would be terrific to see ANYTHING well at this point!

The surgery was uneventful, except that I didn't get the miraculous perfect sight some describe at once, but it did in fact happen overnight:  The next morning, I reached for my wristwatch and as I was reaching for the glasses wherewith to read the watch, I noticed that I could see those teeny little numbers WITHOUT glasses.  Whoa! And it just got better and better.

A month later I had the second eye done, and it went the same way.  I really had new, bionic eyes, the eyes of a young person.

Now, five months later, I do not wear glasses at all, except for reading newsprint at night if the ambient light is very low.  I sew things close to my face and I clearly see things far away, all without any other aid.

Yes, I do see some halos when driving at night, but they are not troublesome and seem to depend on the intensity of the particular lights.  In the case of oncoming headlights, they fade the nearer the car gets.  Even with these smallish halos, my night vision is so much better than it was that it's hard to describe.  I am a much safer night driver now, and I can see both the dashboard numerals and things way out in the distance.

Ultimately, I think it boils down to doing your research, finding a knowledgeable, experienced doctor you trust (I've known mine for twenty years), and keeping your expectations reasonable.  My doctor says his success depends on 'patient selection.'  He doesn't offer multifocals to all patients--just to those he feels are physically and psychologically suited to them.  And that may just be the key factor.

[Sandy Feldman, MD, MS]

Dear Orbit7,

Your questions are good. This is actually complicated and based on your goals and desires to be glasses independent and your personality. Not everyone is a candidate for a multifocal IOL or contact lenses.  Sometimes, accommodative implants, or monofocal implants with reading glasses works better.  To determine what is best for you, your eyeMD needs to assess your visual needs, medical cataracts as well as personality. He or she will be able to advise the best option for you.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[Restorsucess]

Well the ReStor worked great for me.  But I say "for me".  Multifocals do work well for many people.  The best advice I can give is:

Perhaps get several doctor's opinions on the choice that is best for you, when you have the surgery, get a surgeon with the most experience with the lens that works best with your eye and lifestyle (whether it be multifocal, accomodating or fixed focus with monovision), and understand and accept that there is a chance you will need glasses for something occasionally after the surgery.  Of course everyone would like to be glasses free, but it's better to resolve to yourself before surgery that there is that chance.  That way you will be ecstatic if you don't need any, but won't be so dissappointed if you do need them from time to time!

I don't know where you live, but I had Dr. Stephen Dudley.  He has MUCH experience and also, He's my hero!  Good luck!

[londonbridge]

Personally my experience with Restor, multifocals was very bad and I had an explant.
The technology is still developing and the most promising seem to be the accomodating although the comment from buttercup109 shows these are not always great.

Here is one option to ask your surgeon about. Having monofocal lenses set for blended vision. You could do a combination of intermediate/distance and only theoretically need glasses for fine print. That is what I did. Or you could do close/intermediate and only need glasses for distance i.e. driving/ movies etc. The quality of the vision will be great and the technology is tried and true. You could experiment prior with two different contact lenses to see how you adapt.
londonbridge

[BUTTERCUP109]

I can't offer any help with your initial question, however, I essentially have IOLs fixed for distance. (technically, I have Crystalens, so-called accommodating IOLs, but they are fibrosed in place such that they function as fixed focus.) Anyway, I have experimented with multifocal contact lens prescriptions, but never could achieve adequate near vision to read without readers. Have you had any experience with multifocal contacts already and if so what is your current degree of nearsightedness. It seems logical that if you slightly undercorrected your distance vision with the IOLs, perhaps to mimic your current vision, then the type of contacts you have been using should give you similar result. Does this make any sense? I really don't know anything about optics, just a thought. One piece of advice I have is to make an attempt to create a trial of the vision you would have after the IOLs with contacts before any surgery.