ReStor lens for cataract surgery

[jsan123]

I recently put off the Restor cataract operation because my Dr. indicated that my eyes are quite long and require 7 - 7.5 Diopter correction and the proper Restor lens is currenlty not available to provide this. Had I gone ahead, I would have not achieved the desired acuity and remained somewhat nearsighted as I understand it.

Does anyone know of any plans by the vendor to provide this higher correction?

What are the general thoughts about using Lasik to compensate for the lack of power in the Restor lens?

[William Stacy O.D.]

I recently put off the Restor cataract operation because my Dr. indicated that my eyes are quite long and require 7 - 7.5 Diopter correction and the proper Restor lens is currenlty not available to provide this. Had I gone ahead, I would have not achieved the desired acuity and remained somewhat nearsighted as I understand it.

Does anyone know of any plans by the vendor to provide this higher correction?

What are the general thoughts about using Lasik to compensate for the lack of power in the Restor lens?

I think all of the complex IOLs are bad. I include in this the Crystallens, the Restore, the Rezoom, all of them. The good ones are simple IOLs, single focus ones, the best ones are prolate surface single vision. It is all hype and pseudoscience and marketing. My recommendation is to get the sharpest optics you can get at distance (or near if you must), and wear glasses for the other distances. All the complex IOLs have fuzzy optics or do not perform as promised, or both. Sure you will hear testamonials here and there, but the fact is that if you have more than one focus in a lens, and your eye is looking through both focuses at once, less than half the incoming light will be in the focus plane that you want. So sure, turn up the lights and maybe they'll get 20/20. But put them on a dark road at night, and have more than 50% of the available light be OUT OF FOCUS, and have you done them a favor? I think not. (The Crystallens is an exception, but it doesn't move anywhere near enough to do any good, so it's just as bad).

[William Stacy O.D.]

What are the general thoughts about using Lasik to compensate for the lack of power in the Restor lens?

That's like putting sawdust in a bad transmission. It might sound better, but it won't work very well.

[jbrazell]

I am one of the 5% who can't drive at night because of glare from Restor lens. Unless your mother is too old to drive at night anyway, she should give that some thought. It really makes you feel handicapped when you have to hurry & get home before it gets dark because the glare is so bad you think you might have a wreck. Other than that, I love the Restor lens. I have 20/20 reading & 20/30 to 20/35 distance. I can see the t.v. really well. I can also see the computer & I work on the computer every week day. I had to pull the monitor a little closer than I used to have it, but can see fine to do my work. My distance is the worst. He is going to do some sort of laser surgery to correct my astigmatism & that might help my distance & maybe the glare. I'm hoping so. Still, even with not being able to drive at night, I love the Restor. My eyes aren't as good as when I was young, but they're close. I think I had eagle eyes when I was younger, so it's hard to get that back.

[DragonLensmanWV]

I am one of the 5% who can't drive at night because of glare from Restor lens. Unless your mother is too old to drive at night anyway, she should give that some thought. It really makes you feel handicapped when you have to hurry & get home before it gets dark because the glare is so bad you think you might have a wreck. Other than that, I love the Restor lens. I have 20/20 reading & 20/30 to 20/35 distance. I can see the t.v. really well. I can also see the computer & I work on the computer every week day. I had to pull the monitor a little closer than I used to have it, but can see fine to do my work. My distance is the worst. He is going to do some sort of laser surgery to correct my astigmatism & that might help my distance & maybe the glare. I'm hoping so. Still, even with not being able to drive at night, I love the Restor. My eyes aren't as good as when I was young, but they're close. I think I had eagle eyes when I was younger, so it's hard to get that back.

You might want to check the post date at the top left of the post. This thread was from 2005. Welcome!

[jbrazell]

Oh, sorry I didn't check the date of the post I was answering. Still, it might help someone else who is considering Restor.

[Happylady]

I'm the original poster and my mother passed away more then 3 years ago. Knowing the outcome and with more knowledge about these implants I think my mom would have been happiest if she had been left a -3.00. She missed her excellent close vision and had never had a problem with wearing progressives or distance glasses.

[jbrazell]

I'm so sorry about your mother. I should have looked at when your original message was posted. I'm new on here & didn't notice the date. I apologize!

Jan

[allanon]

They changed the ReStor after she had the implant... the add was too strong, so they dropped the number of rings to bring it down to an effective +2.50. I personally would rather be left at a -2.00 monofocal.

If you get the night glare from a Restor, try a drop of Alphagan ~30mins before going out at night. The manufacturer also recommends turning on the dome light in your car :)

[ilanh]

Even though it's an old thread I'll throw in my two cents worth. As a surgeon who does a lot of implants I'm still not 100% sold on the multifocal implants ie: Restor, Rezoom, Crystalens, Technis MF. I offer them to patients who are VERY motivated to be completely spectacle independent and I thoroughly explain the potential downsides. The Restor lens is probably the most popular lens out now and has been greatly improved by the +3 add rather than the +4 add that it used to have. Patients are reporting that the distance is the same but intermediate vision is much better. Reading is as good as it always was but you can move the print a little further away. Due to the nature of its apodized surface and its rings, reading is difficult in low light and there are some halos at distance at night. Overall, however, the apodized lenses all involve somewhat of a compromise ie: the total available light entering the lens is split into the component focused at near and the one focused at distance. This means that your vision is always using less light that the total available and that may affect contrast, sharpness, brightness etc. Even though patients are happy to be spectacle independent I don't get quite the WOW factor that I expected. I suspect that it's secondary to the above mentioned compromise. I do get quite a WOW factor with my monovision monofocal IOL strategy which is vaguely similar to Contact lens monovision but much better in every way. It too involves a compromise but I feel that the compromise is less and is also physiologically easier.

[Uilleann]

About ten years ago, I remember reading about a lens that was either in or just about to go to clinicals. If memory serves, it was a gel based implant that was supposed to completely fill the capsule. Being gel, it was also soft, and therefore was thought to afford some of a patients natural accommodation back. The doc would take the standard A's and K's, and then order the lens power needed. It would ship to the surgeon in a rod form, roughly 1 X 10 MM, something akin to a clear pencil lead was the image I seem to recall. As it was inserted into the eye and capsule, the patient's body heat would soften the lens, and it would regain it's lenticular form in about 20-30 seconds or so.

I never hear about it now, so I'm guessing the design was a failure. But the concept - a lens as close to a natural human lens as possible - seemed a very cool thing. Anyone know if this just flopped or what might have happened? I can't remember who was manufacturing it, or it's name at the time unfortunately.

Bri~

[Bill West]

I think every MD who does mono vision or multifocal implants on an unsuspecting victum should have to have the same thing done to them. It's always about money $$$$$$$. Just because the patient is ignorant as to what they are getting into does not mean the Md or, more than likely, the assistant should not tell them the truth. How about creating the effects of looking through an over plused lens at night and show them what they will really see. I am just an ole country boy but nobody will be allowed to screw up my vision. Gimme a good distance vision job and I'll take it from there. DISTANCE ONLY PLEASE.

[jbrazell]

My insurance paid for a standard cataract surgery with standard IOL. I had to pay $2500 for each eye in order to upgrade to Restor. Also, I can't drive at night. I must be one of the 5% who ends up with halos, glare, starbursts so bad that I can't drive. I am going to have a second opinion and see if there's anyway to correct this or exchange lenses. I do love my new eyesight, though. No glasses at all. I'm 64.

[ilanh]

jbrazell,
I am an ophthalmologist and have implanted many Restors. Therefore, I identify with your concerns and would like to provide some advice. Many patients find that the symptoms get a lot better with tincture of time. In fact, this is very common and can sometimes take as long as 6 months to a year for the symptoms to improve. However, there are some caveats: for example, if you have opacified capsules behind the Restor lenses this can be easily rectified with a Yag laser capsulotomy and can be very helpful. The other issue to keep in mind is that if you do decide to remove the IOL's it is better to do it sooner rather than allow them to fibrose into place. I realize that this point somewhat invalidates my earlier "tincture of time" advice but it's a decision that you alone can make. If you ultimately decide that you cannot live with the Restor lenses then I would find a surgeon that is experienced with removing IOL's (it's not always easy and it's not devoid of risk). You can opt to convert to a Crystalens (which has no glare issues but allows accomodation for reading), or you can opt for monovision IOLs (which corrects one eye for distance and one for near). Lastly, you can opt for distance in both eyes and simply wear reading glasses as needed. One other thought: if your initial correction was not accurate ie: you were left with a residual prescription, then this also can account for glare. This type of error, however, does not neccessitate removing the IOL's since the issue can be resolved by lasik or spectacle wear. Hope this helps.

[Geirskogul]

After a lot of thought, and reading the opinions about MF IOLs here and other places, I think I would prefer to be corrected to a -2.00 or so and have to wear glasses for distance activities rather than try these out. I do hope that in 40 years or so there will be better solutions, but if I were to get a traumatic cataract tomorrow I'd opt for the -2

[jbrazell]

ilanh,
Thanks for the information. It does help. I know I do have the opacified capsules because the surgeon told me I did, not too long after the cataract surgery. I chose not to have the Yag at that time because I read that it was harder to explant the lenses after having that. Now it is starting to affect my vision some, so I am considering it. However, I feel like I'm between a rock and a hard place. If I get the Yag done and that doesn't help the glare, then it's going to be trickier, if not impossible, to explant the Restor lenses. I have an appointment to get my eyes checked by the original surgeon's office and then next month I'm having a second opinion to see what I should do. I picked both of these surgeons out of "The Best Docs in Fort Worth" magazine, so they should be good ones. Doctors are the ones who vote. I know my surgeon did a good job. I had another eye surgeon who was learning to do botox and was using me to practice on, & he told me the surgeon did a good job, just from looking in my eyes without any office equipment or anything. I feel like he did do a good job, but I also feel like I was not really warned how bad this glare thing could be. I went back and re-read the literature I was given and it said "you can expect some mild glare at night". Before my surgery I thought "So, I already have that". I actually expected it to be better than before my surgery. It was at least three times worse, if not more. I really think eye surgeons should emphasize the fact you might not be able to drive at night anymore. Then, when this happens, they say your brain will adapt, so you give it time to adapt. Then they say they don't like to explant the lenses after so-and-so amount of time, so you are just stuck with it. It has been since November 2009 when I had the first eye done. It is not any better that I can tell. Still can't drive at night. Evidently, my brain doesn't know it's supposed to adapt.

Thanks!

jbrazell,
I am an ophthalmologist and have implanted many Restors. Therefore, I identify with your concerns and would like to provide some advice. Many patients find that the symptoms get a lot better with tincture of time. In fact, this is very common and can sometimes take as long as 6 months to a year for the symptoms to improve. However, there are some caveats: for example, if you have opacified capsules behind the Restor lenses this can be easily rectified with a Yag laser capsulotomy and can be very helpful. The other issue to keep in mind is that if you do decide to remove the IOL's it is better to do it sooner rather than allow them to fibrose into place. I realize that this point somewhat invalidates my earlier "tincture of time" advice but it's a decision that you alone can make. If you ultimately decide that you cannot live with the Restor lenses then I would find a surgeon that is experienced with removing IOL's (it's not always easy and it's not devoid of risk). You can opt to convert to a Crystalens (which has no glare issues but allows accomodation for reading), or you can opt for monovision IOLs (which corrects one eye for distance and one for near). Lastly, you can opt for distance in both eyes and simply wear reading glasses as needed. One other thought: if your initial correction was not accurate ie: you were left with a residual prescription, then this also can account for glare. This type of error, however, does not neccessitate removing the IOL's since the issue can be resolved by lasik or spectacle wear. Hope this helps.

[Barry Santini]

[QUOTE=ilanh;113889]

. 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.

It's attitude's like these regarding the issue of eyewear *dependence* that are our worst enemy.

I have seen him. I have met him. And it is us!

Must surgeons should have some training about their own prejudices regarding eyewear and the *best* vision possible.

B