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Thread: ReStor lens for cataract surgery

  1. #1
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    ReStor lens for cataract surgery

    My Mom is scheduled to have cataract surgery next week. The Dr. is recommending the ReStor lens. I had not heard of this lens before today. Does anyone know anything about it? Any stories of it good or bad?

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    she has obviously opted for an 'accomodating' IOL, which attempts to lessen the need for reading glasses after surgery.

    two choices that are popular now are Crystalens and Restor.

    The crystalens appears to be better for distance and intermediate, while the Restor is a bit better for near, OK for distance, but not great for intermediate.

    She might want to make sure her surgeon offers both so that he/she is not simply putting her into the one that he offers.

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    He does offer both Crystal lens and ReStor. She was planning to go with Crystal lens after talking with the tech there. The doctor recommended the Restor because her close vision is very important to her. She does use a computer, but she figures she can keep a pair of glasses by the computer if she needs to.

    Her distance vision is also very important. The doctor assured her that her distance vision would be as good with ReStor as with Crystal lens but that she might have some glare with night time driving.

    I am concerned that you said the ReStor gave okay distance vision. Are there problems with it other then glare with night time driving?

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    it appears that many people need, say, a pair of -0.50s for night driving or driving in general. as the surgeon said, the main advangtage of the restor is the better near vision.

    there are other variables as well, however, including the power of the implant. the power makes a huge difference for how the crystalens performs. the higher the power, the better the reading vision.

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    Pupil size.....is the answer to success for any accomodating IOL as well as LASIK. It should never be under estimated in different lighting . Complaints center around problems in dim light if the pupil is larger than the diffractive zones. Another problem with glare is from certain types of haptics in IOL's

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    Always learning OptiBoard Bronze Supporter
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    Quote Originally Posted by Happylady

    "close vision is very important to her"

    "Her distance vision is also very important".
    She should use a standard IOL if she wants the best possible vision.

    Halos at night are a real concern with the Restor IOL.

    Some surgeons "over sell" these products. Get all the information you can get your hands on. Postpone the surgery until you have enough info to make an informed decision.
    Robert Martellaro
    Roberts Optical Ltd.
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    www.roberts-optical.com
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    She did consider the standard IOL but she was told that she would need glasses for both close and distance. She wears progressives, but is able to remove her glasses for extra good close vision. She wouldn't be able to do this.

    From what I read the problems with glare at night is about 5%. She has glare and halos from the cataracts now.

    I am concerned about distance vision other then night time driving. I understand that with this lens the person is actually seeing through both the distance and near portions of the lens at the same time and "blocks" the blurry image.

    I know I tried this with multifocal contacts and it blurred my distance vision. I could see 20/20 but it was ghosty and not sharp. The doctor assures me this IOL is different, but I am concerned. It is much easier to put a contact on and off then to redo a IOL.

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    Always learning OptiBoard Bronze Supporter
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    She did consider the standard IOL but she was told that she would need glasses for both close and distance. She wears progressives, but is able to remove her glasses for extra good close vision. She wouldn't be able to do this.

    That's not true. They can order an IOL that will come very close to providing the same RX that she wears now.

    From what I read the problems with glare at night is about 5%. She has glare and halos from the cataracts now.

    Right. The statistics are generated from test subjects who already have compromised vision. Try a multifocal IOL on a person with healthy eyes (this is being done outside of the US) and you will get lots of complaints from halos and blurred vision. Keep in mind the FDA trial subjects are risk takers to start with, hand picked, using surgeons who were extensively trained by the IOL manufacturer.

    I am concerned about distance vision other then night time driving. I understand that with this lens the person is actually seeing through both the distance and near portions of the lens at the same time and "blocks" the blurry image.

    Yes, it's a multiple ringed IOL.

    I know I tried this with multifocal contacts and it blurred my distance vision. I could see 20/20 but it was ghosty and not sharp. The doctor assures me this IOL is different, but I am concerned. It is much easier to put a contact on and off then to redo a IOL.

    All you have to do now is to convince your mother that her doctor might not be making a recommendation based on her best interests. Might be a tough nut to crack with that generation. Good luck.
    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    “Science is a way of trying not to fool yourself"
    -Richard Feynman
    ~~~~~~~~~~~
    A mime-free zone.

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    We were told that because of her astigmatism that with standard IOLs that she would still have some distance correction. I asked about leaving her nearsighted about a -3.00 so that she could wear progressives and take them off for near if she wanted. I was told that even if she was left nearsighted that the way the standard IOls work that she would not be able to see up close without correction.

    Her glasses have are about -3.75-1.50, but I don't know what the new correction they came up with yesterday is. The doctor told me that the astigmatism would not be a problem with the ReStor.

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    If the astigmatism is corneal, I would think she would have a diopter and half cyl post-op. Ask the doctor about "Limbral Relaxing Incisions" that might substantially reduce the cyl correction. This would be done at the same time as the IOL. Also ask about clear corneal incisions and topical anesthesia.

    Regards,
    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    “Science is a way of trying not to fool yourself"
    -Richard Feynman
    ~~~~~~~~~~~
    A mime-free zone.

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    Alot of times the cataract it self is the cause of a larger degree of correction for astigmatism. Ask if the astigmatism is corneal or cataract lens induded. Robert mentions one way to reduce it another is with LASIK post-operatively.

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    The majority of post op compaints my patients have are from multifocal IOLs and the newer accommodation IOLs. They have small optic zones and do create some glare and halos in those with larger pupil.

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    I'm annoyed by the surgeon in this case. He claims that the standard IOL not produce good distance vision and blames it on astigmatism, but the two accommodating IOL's do not correct astigmatism, so he must be performing limbal relaxing incisions but only if you get the accommodating IOL.

    Realize that the accommodating IOL's are not covered by insurance and that some (hopefully not all) Ophthalmologists are pushing these to receive more money from the patient and be more profitable.

    Realize nothing will "restore" vision back to how it was in her 20's and 30's, and some can actually cause problems if you're sensitive to some of the side effects that others have mentioned here. Explanting an IOL isn't really a great option to deal with this stuff either, and of course you won't get your money back if you don't like them.

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    I think the Restor lens is pretty good. I have taken the certification course and, as of now, have followed one patient with the Restor lens. That was a 72 year old who ultimately saw 20/20 and J1. How many 50 year olds can say that? Limbal relaxing incisions are certainly advisable for anyone with over 1 diopter of astigmatism. Night glare and halos probably occur in 5-10% but are not disabling. Unless you're a professional driver or trucker it was not a serious problem in the studies to date. Overall, having seen this lens personally and spoken to a number of colleagues I am fairly impressed.

    Ilan Hartstein, M.D

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    Think and research real hard before going with Restore Lens

    I made the mistake of my life going with Restore lens. I had one cataract and had both the lens in my eyes. Theproblem started when after the first one was inserted . A day before the second one was to be surgically placed my Physician says OOPS I didnt know that ALCON did not make a lens in the strength that my eye required! He said that he would have to perform Lasik to bring my eye up to the tight prescription. So now I have to go under the knife(laser) again. How in the world can a professional goof up like this on the second patient in his practice to have this new lens. Where are the office protocols? I would have thought that there would be a check list that would be checked at least twice to make sure everything is in place. I am not sure if it is because I do not have the right strength lens in but my vision stinks. I cannot read a newspaper unless I have a high powered light shing on me and my intermediate vision is horrible. This product has been way over sold and patients need to step back and really make a conscious decision and decise if they want to go with this new technology. I honestly now think it is all about the money. I read all the clinical trials and how 90+% of the patients loved this lens. I would like to meet these so-called happy people and ask them some questions. BTW I am only 53

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    I am sorry you are having problems with this lens. My Mom had her left eye done with it 8 days ago. At first her vision was blurry, but now she says the distance is sharp. The near is getting sharper, but is still not perfect. The doctor told her it could take a couple of weeks for the near vision to clear up.

    She goes back in 5 days to have it checked and if all is well will have the right eye done the next day.

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    [QUOTE=jmbeam]I made the mistake of my life going with Restore lens. I had one cataract and had both the lens in my eyes. Theproblem started when after the first one was inserted . A day before the second one was to be surgically placed my Physician says OOPS I didnt know that ALCON did not make a lens in the strength that my eye required!

    I'm not exactly understanding what you're saying. It sounds as if you had the first Restor IOL implanted in one eye and that went OK. Then you needed it in the second eye and they did not have a lens available in that power? If you don't mind my asking; what is your prescription? Unless you have an extremely long or short eye the Restor lens should be available. I am, therefore, assuming that you must have an extreme prescription for which Restor is not available. If that's the case then I agree that they should have known that before. However, I have a feeling that you will be very satisfied after the Lasik. We are beginning to realize that a good percentage of Restor patients may need to be supplemented with Lasik to get the really perfect results. Most Restor surgeons (such as myself) are mentioning this upfront and offering a sharp discount in the Lasik if it is absolutely neccessary postop. I am hoping that most of my patients will be perfectly happy without the neccessity of additional Lasik; however, it is only fair to warn them upfront.

    By the way: Restor is not about the money. Even though there is more money involved it is mainly about offering multifocal vision to patients. I have seen the look on patient's faces when they can see distance and near without glasses after 50 years of dependence. I think that's it's the next evolution in the IOL.

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    After reading all these posts I have some doubts. If the MD would answer some questions for me. I am having surgery in about two weeks on my left eye. My night vision is scary!! My right eye with my glasses on is just great. I think the Dr. said I had a +.75-2.00 in this right eye. He wants to wait a week after the first to do a second cataract surgery on the right. He says I have a small cataract on it as well. My question is if it is not ready yet why do it?

    As far as the IOL standard my parents had theirs done in their 60's. They are both very happy with this plan. They still wear eyeglasses for reading. Only one problem my dad had was after awhile I do not remember the time frame he had to have a lazer on one eye because he saw cloudy. They fixed that. Of course they did not have the MF implants then. I was looking at a article on the web and it said that some patients wanted the MF removed and the standard put in because of multiple images at night. So why are the doctors pushing a lens that would cause problems when the standard is okay? I for one like to wear glasses. My MD told me I would have to wear sunglasses anyway!

    What is the cost difference for a standard implant vs. the MF implant?
    :)

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    I think this is very similar to the contact lens options. Robert Martarello made some excellent points concerning the use of clinical trials to support Restor and other multifocal IOLs. You have to look at the patients in the trial. Many have other pathology such as macular degeneration. Also, many have reduced demands. For a 75 year old with a less demanding lifestyle, they may be ok. But, my observation, based on feedback from real patients is that they may be able to perform relatively well on Snellen acuity tests, they are not very happy. Again, just like the multifocal contacts, Snellen doesn't fully measure quality of vision. I see lots of patients read 20/25 or 20/20, but state "it just doesn't look clear". When I ask them if they would go that route again, they generally say no. "I would rather just use reading glasses".
    I'm a very active 51 year old myope. I've tried the various contact lens options and there is no way I could live with the compromises of the multifocal lenses.
    The bottom line is that this technology just isn't ready for widespread use. With carefully selected patients and adequate pre-op discussion there is a place for them, but the technology is far from mature.
    For now, conventional implants are the best bet for a more active, demanding patient in my opinion.

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    The trials only include patients without pathology. this is why sometimes they may be BETTER than what the clinicals find

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    After a cataract procedure I was told that at times a capsule forms on the eye that creats havoc with ones sight. This condition can be easily taken care of with a Yag laser. Is this true and if this occurs in my eye is it a condition that a Physician really has to look for to see it or is obvious? I am concerned for a couple of reasons. Thanks for any input on the subject.

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    Be of Good Cheer.

    Usually the patient notices the vision going South, similar to cataract development (sometimes misnomered as a "secondary cataract). If no the practioner will catch same during routine follow-up or yearly exams. This occurs in 50% of cataract patients. And be not dismayed the laser zaping takes about 5 min, no recovery time and you walk out of the office seeing again.

    Chip

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    Quote Originally Posted by chip anderson
    Usually the patient notices the vision going South, similar to cataract development (sometimes misnomered as a "secondary cataract). If no the practioner will catch same during routine follow-up or yearly exams. This occurs in 50% of cataract patients. And be not dismayed the laser zaping takes about 5 min, no recovery time and you walk out of the office seeing again.

    Chip
    Does the patient need to have his/her eyes dilated for the MD to be able to see this?

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    I doubt dilation is needed but it would give the doctor a much clearer view of what he was looking at. What difference does it make if the doctor needs to dilate him or not, dilation is not major invasive surgery.
    Chip

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    Does anyone know how much a cataract surgery costs? I have no insurance and I am too young for medicare!
    :)

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