Facing cataract surgery, need feedback, help deciding on lenses

[cataractx2]

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.

[Forum-OD-MP]

the fact that most surgeons prefer& use one lens or the other does make it more difficult.

do not be scared of an accommodating iol, even if you do only have 1 eye.  

I personally like the restor a little better. i'll copy some ext from a website about it:

"The most remarkable statistic from that study is that 80% of the patients in whom the (ReSTOR) IOL was implanted bilaterally reported not needing spectacles for any activities after the surgery

[sjnuss]

Hello to all,
I am in a somewhat similar situation to the initial poster but with slight differences. I am 50 and only the right eye needs surgery at this time and although I still have relatively good vision in the left eye but it will need surgery at some point. My optomistrist has said the same thing: "I would not put the multifoacl IOL in at this time". I must add that I am photographer so I am used to good, sharp vision (and that is what I want to have after surgery). Although it would be nice not to have to wear glasses that is not the most important issue. I want the best possible vision after surgery that I can possibly have and if the IOL/glasses combination will give that to me then that is fine. I have my opthalmology appointment tomorrow so I will get his side of the story then.

Thanks to all who may have any additional insight.

[Ag-i-doc]

the way i understand it, the restor lens is a multifocal lens.  it will most likely NOT give anyone the absolute CLEAREST vision at all distances...but it is much more likely to keep someone from needing glasses after the surgery.  i guess it depends on your preferences.  if you want SUPER CLEAR vision, i would say go with a traditional IOL and glasses.  if your goal is to be less dependent on glasses, and you dont mind seeing a *little* blurry in order  acheive that, then the restor is probably a good option.

[cataractx2]

Thank you for your responses and taking the time to give me more food for thought. Why can't I have it all? To have a SUPER CLEAR vision without glasses in this day and age of technology seems not too much to ask.
I am wondering what is the expected corrected distance acuity of the conventional monovision IOL?  Obviously, no one wants a little "blurry"  vision at any distance. If I have to use glasses to work, so be it. I am afraid though that fixed focus lens with distance correction means needing one pair of glasses to work on computer at 2-3 ft. Then another pair to walk around to see people at 4-10 ft. Another pair to drive and see street signs at 15 ft with the car instruments bifocal reading. Maybe no glasses to see well beyond 20 ft, but when this circumstance really happens? Possibly, when I am on vacation, sightseeing? Not in every day life. My fear is that I will end up with similar amount of pairs of glasses I have now if I choose monovision lens. If I have to have the surgery anyway, I might as well improve the quality of my life as well as my vision all in one shot if that is possible with minimal exceptions. I am assuming that Restor can be corrected with glasses if necessary to perform certain activities like computer work.

[Ag-i-doc]

no, right now i dont think you can really "have it all".  this is an area of our profession where significant research is being done, but IMO it is certainly not perfected yet.

if you go with a "traditional" single focus iol, you will likely need multiple pairs of glasses, or at least glasses with multiple rx's in them (bifocals, trifocals or "progressives").  if you go with the restor, you will likely need fewer pairs of glasses, but you will also likely be slightly BLURRIER all the time and at ALL distances, both with Rx glasses on AND without glasses on.

"monovision" means correcting one eye for one distance, and the other eye for a different distance...usually the dominant eye for farter than 20 ft and the non-dominant eye for 16-18".  when you use the word "monovision" while talking about cataract surgery, you are implying using one single-focus IOL for one eye to see at great distances, and using a different power single-focus IOL for the other eye to see well up close.

[sjnuss]

I had my appointment today and was given three options: 1) do nothing at this time and wait 2)RESTORE lens w/LASIK to correct for astigmatism or 3) traditional IOL w/glasses. I chose door #3! Although I probably could get by a while longer I am really bothered by a number of vision issues. Number 2 did not sound enticing as one procedure seems to be enough. So I decided to go the more tradtional route and hope that it all works out in the end.

Thanks again.

[cataractx2]

Just want to thank you all again for your help. I kept forgetting that I only have one good eye and someone reminded me of protecting it at all times. Therefore, glasses in my life are necessary anyway and so I cannot have it all.

I also read that in all multifocal or accommmodative lenses the optimal vision results are achieved when implants are bilateral. Not having this luxury with my bad eye, I am opting for the best clear vision I can get with the traditional method and glasses to correct all other distances. I also have endured enough "blurr" in the last few years with my cataracts and cannot bear the thought of dealing with it for the rest of my life (if I want to avoid risky replacement surgeries down the road) because I chose the wrong lens. I guess my cataract did not come in an opportune time when technology could provide "having it all".

[hmh]

I just had surgery and had the ReZoom lens in my left eye 3 weeks ago and my vision for distance in that eye is 20/20 and I can see inermediate fairly well and close is 20/30.  I just had my right rye done on Monday, Dec. 5 and had a -.5 for it.  I am very encouraged and am hoping that I will be able to see close and intermediate in a few weeks.  My right eye is a bit swollen, so I believe it will only improve.  I was not able to see distance with corrected contact lenses and could hardly drive at night.  My doctor said that I would not be able to pass the driver's test next year.  I am only 62 and am very excited about my long distance vision and if my near vision isn't as sharp as I would like (wanting the perfect lens)I sure don't mind wearing readers.  Will keep everyone posted.

[eyecu]

go to www.visioninfocus.com
and wwww.tecnisiol.com

The ReZoom gives you a full range of vision from near to far and 20/20 distance. The only accoomdating lens in the Crystalens since it is supposed to move back and forth. The others are bifocal or multifocal. The ReZoom is a true multifocal. The Tecnis is a monofocal but is different. It has two FDA claims of improved night time driving and improved functional vision so it is better than the average monofocal lens. There are quite a few one eye patients that are doing will with the Array lens which was the predecessor to the ReZoom. But if you are leary look at the Tecnis.

[thewind]

I had a Restor lens installed in my right eye five days ago (12/12/05.  The results to date are poor.  Long distance vision is not good at all, near vision is so-so.  There is also glare and sort-of double vision. If it doesn't improve over time I will (1) regret the $2800 I paid beyond medicare cost and (2) go with a fixed-focus in my left eye and wear glasses.  I will make some follow-up postings describing my results over time.

[eyecu]

Five days is not too long. Things can get better as the capsule contricts aroundt the implant to stabilze the lens better. You can also have the lens exchanged if it continues to bother you. You could have little corneal edema or swelling from surgery or macular edema. Give it some more time. If it still bothers you at three to six weeks, than you can discuss your options at that time.

[thewind]

I had a Restor lens installed in my right eye ten days ago (12/12/05)at Victoria Eye Center, Texas. I had a follow-up exam 12/18 and the poor results were confirmed. The examining optomitrist said I still have astigmatisim that would require follow-up lasik surgery that should bring my vision to near normal. She also said more time was required for healing and "setteling in."  More follow-up postings describing my results over time to follow.

[Bill in JAX]

I'm 63 and have been diagnosed with cataracts in both eyes.  I recently had a complete evaluation at the Jacksonville Eye Center and the surgeon has recommended ReZoom IOLs for both eyes over the Crystalens and ReStor at a cost of 2,700 each. Another highly recommended surgeon in JAX is recommending the ReStor at 2,800 and does not offer the ReZoom as an option.  An evaluation has not been done yet with this surgeon. Would like some feedback on ReZoom vs Restor from all with any suggestions or those with recent implants.

[eyecu]

The ReZoom will give you a full range of vision from near to far. It is a second generation IOL with 7 years previous experience behind it. It is an improvement over the Array. It uses 100% of light and light is redistributed at night to cut down on the halo effect. The results have been better than expected. It gives you an edge on computer vision and better contrast and reading in low light. Go to www.visioninfocus.com.
It is a more forgiving lens than the others.

[Jim in Fort Worth]

On 12/12/05 RESTOR NIGHTMARE...I had cataract surgery and a Restor lens was implanted in my left eye. A significant overcorrection occurred leaving me at a +2.00 farsighted. Both distane and close vision are bad. My right eye is nearsighted at a -1.75.I have had my eyes refracted on two occasions since 12/22/05 and 12/27 and the vision does not seem to be shifting much. Thus,my eyes are 3.75 diopters apart -- which is not good. My right eye also has a cataract but surgery on it can be put off indefinitely. With this botched Restor lens power selection I now have an extreme form of monovision.
I am seeking a second opinion on 1/3/05 to determine what to do:
1)Have a lens exchange to better fit the left eye with the proper power.
2)Live with left Restor lens and have lasik to correct the remaining astigmatism and hypeopia caused by the wrong power on the Restore lens.
I am particularly interested in hearing IF the knowledge of the wrong power of the Restor lens I now have will help in getting a very good power prescription for a second lens exchange. Having two botched lens power selections is NOT something I want to endure.
Also,I am concerned how long I have to get the lens exchange before the Restor lens "settles in."
I want to get the left eye issues resolved before I tackle the right eye.

[eyecu]

I would opt for an exchange. You are not that far out and if you know you have the wrong power than go ahead and get it exchanged. They should have learned more off the first eye to be more accurate for the exhange. You definitely want to have the first eye corrected before preceeding to the second. If your doc doesnt want to do it, find someone that will. I am not wild about lasik and messing with the cornea because the power was off. You can also have a monofocal lens placed behind the pupil in the sulcus in a very low power or minus 2 to offset your missed lens power if you cannot safely remove and replace the ReStor.

[Jim in Fort Worth]

Thank you for your advice. I was already leaning toward the lens exchange approach before seeing your response. I did forget to mention that in 1997 I had successful lasik in both eyes that were previously approximately -6.0 nearsighted. I knew going into the Restor surgery that the power selection is harder if a patient has had lasik -- I just didn't expect to end up +2.0 farsighted. I am hopeful the power selection will be more managable on this "second bounce" in spite of my previous lasik (that is my doctor's excuse for his first miscalculation). So with this additional background I hope you STILL feel accuracy is attainable.
I will see 2 new doctors on 1/3/06 along with the doctor that did the surgery on the left eye and I will update you following.

[eyecu]

You are doing the right thing by talking to your surgeon and getting another opinion. What you forgot to post is very important. Since you had previous lasik, it is always tougher to hit the right power. Kind of a **** shoot. You do your best and hope you get close. You should have been prepared for this prior to surgery and gone in knowing that a lens exchange was highly probable. It sounds like you were. There are also differing opinions on whether previus lasik pateints should opt for a monofocal due or a multifocal and you will hear it both ways. You are a good candidate for the newer lens becuase you had lasik in the first place which means not having to wear glasses is something that you want. Let us know what they say and how it turns out.

[thewind]

I had a Restor lens installed in my right eye 12/12/05 at Victoria Eye Center, Texas. I have had two follow-up exams (most recently 12/29/05 confirming poor results. The examining optomitrist said I still have astigmatisim and other vision issues that would require follow-up lasik surgery that "should" bring my vision to near normal.

My current concern is that the outcome statistics offered by Victoria Eye Center for ReSTOR lenses is 80% of those with the lenses don't need glasses and 90% would do it again.  Yet, few if any  have posted in these related sites anything positive in their personal experiences with the ReSTOR lens.  I would welcome some positive comments from people who have had these lenses installed.  

More follow-up postings describing my results over time to follow.

[eyecu]

How much astigmatism do you have? As far as the 80 and 90% promises, it is always better to underpromise and out perform. They take that from clinical studies but you have to look at the clinical studies and how they were performed. Get a second opinion. Take a trip to Corpus and talk to Dr. Dugan.

[Jim in Fort Worth]

I saw two new doctors for second opinions yesterday(plus my original doctor)and I am nowhere closer to deciding what to do. It appears my stituation is rather complicated.
Dr. #1 is a respected Ophthalmologist at Southwestern Medical Center. He says the cataract removal has left me with high order abberations and significant astigmatism. Oddly the astigmatism wasn't remarkable before the surgery.He says a lens exchange would not solve my astigmatism problem and suggests lasik or surface PRK to correct both astigmatism and hyperopia. He says he would attempt to lift my 8 year old lasik flap(yikes!)and failing that,do surface PRK. Apparently cutting a second flap is not a good thing to do.
Dr. #2 is a young Ophthamologist in Fort Worth.He said he had never seen post surgery astigmatism like I have.He says a lens lens exchange is a better route(than lasik)but says he would bail on Restor and use a monofocal lens. He says getting the power closer to -+0 ,rather than farsighted,is not an unreasonable/unattainable goal. Both #1 and #2 said contact lens could be considered as a "status quo approach."
I also saw Doctor #3 who did my cataract/Restor surgery on 12/12/05. Doctor #3 is a young doctor who does lots of Restor work. He sides with Dr. #1 but said he did not do lasik himself anymore.He thought the contact lens idea was worth trying.
Assuming I went with a lens exchange he did NOT like the idea of a monofocal rather than a second Restor. He seemed interested in dismissing me -- and said he would see me in 3 months.
Here is my take today:
1)The status quo seems like a dead end because I don't like the idea of a far-sighted astigmatic left eye while the right eye remains nearsighted. Wearing glasses with a 3.75 diopter differnce is not really doable. Realistically I expect to need glasses for golf and reading no matter what route I take.Contacts might allow the "staus quo approach" to work but I see this as a longshot.
2)I don't like the idea of raising the 8 year old lasik flap.It is interesting that the doctor with the most experience and a prestigous background came up with this aggressive approach.
I would want to know a lot more about raising a flap and current surface/PRK techniques before going that route.
3)The right eye can't be overlooked. If I stay with status quo (farsighted Restor)in left eye then am I bound to target a similar outcome for the right eye so they will "match?" (lessen the diopter difference). Again,I am thinking about the ease of wearing glasses ultimately.
4)I will try contacts right away.I have an excellent Theraputic Optometrist who will give me my best shot at contacts.
5)I will get at least one more opinion and try to get further clarification from Drs. #1 and #2 after better outlining my concerns to them.
I WOULD BE MOST INTERESTED IN YOUR THOUGHTS. I am now 23 days out from my cataract removal.If you have a suggestion for a doctor in Dallas/Arlington/FW for my 4th Opinion I would be appreciative.

[eyescared]

I am 62 years old with early cataracts. I am choosing to do refractive surgery and have an IOL lens implant.  I have prebyopia and am nearsighted.  My reading is about a 3.75 with my distance about 2.75. I live in Sarasota and have been to 2 doctors. One recommended a monofocal, and the other restor lens. Now I am thinking of going to a third doctor who does rezoom lenses.  They charge $4900 per eye which sounds very high based on other postings. Also, I am totally confused about which lens to get.  I also have an astigmitism which the last doctor said he would correct during this surgery before putting in the lens.  HELP!

[eyecu]

Sarasota-go see Randy Burke or Tommy Schwartz or both and see what they say. $4900 an eye is steep and must include lasik touch up if necessary. Surgeons who do these lenses should do lasik or have someone in their practice that does if they are a large group. You can correct astigmatisn at the time of surgery with LRI or AK cuts. Surgey can also induce astigmatism but usually that works itself out because it should not be that much with todays tecniques and lenses. Fort Worth, I will get back with you. I need to read your history a few times and speak with some of my lasik people.

[eyescared]

I am confused by your answer. Are you recommending Lasix surgery because I want cataract surgery with the insertion of an IOL, but I am confused over restor, rezoom , etc. Which do you recommend for me. I do not want to wear glasses for distance and expect to wear some glasses for occasional near work. I have read on this sight that restor gives you fuzzy vision afterward.lack of acuity.