Focusing and multifocal IOLs

[William Stacy O.D.]

Has anyone around here ever seen any of the accommodating or multifocal IOLs in practice? If you have, please tell us which ones and any info you've learned about them.

If you have not, please tell us that, too, as this input may be more important than the above.

Thanks a lot.

(I'll start, to break the ice): I've seen one case of Crystalens, implanted monocularly, which I observed 2 weeks after implantation. The vision was good, 20/25 unaided in that eye, correctable to 20/20 with -.50. There was zero measureable accommodative amplitude. No other problems, and no advantages noticed.

[Happylady]

My mother was fit with the Restor lenses in September and October of 2004. She was hoping to have good close vision. She used to be nearsighted, about a -3.50 with some cylinder and even though she wore progressives she loved being able to remove them and have eagle vision up close.

She has no problems with glare at night. She was noticing that it took a second or two to focus on something in the distance like a street sign. I am not sure if she is still noticing this, I will ask her. Her distance is fairly good overall though I think they were only able to correct her to 20/40.

I went with her to one of her followups and heard the doctor tell her she had "cell changes" in the back of her eyes so I am thinking this is why her distance is not better. She is not very forth coming with imformation about her health.

Her main dispointment is her close vision. It is good only if the light is excellent. With normal light she would struggle to see a book or newspaper. I made her a pair of progressives with a +2.50 add and that works if the light is good. If the light is poor, like in a restaurant or the print is not dark enough on a light enough background then even that is not sufficient. She pulled out a magnifying glass to see a menu in a restaurant even with her progressives. She needs lots of light.

She misses her close vision. Even with her cataracts removed it is poorer then before.

[ecsoptical]

Wm Stacy, see post on accommidating IOL thread. In short, I work for a cataract specialist. We have seen excellent results, in house. We all have seen the pt that refract to 20/20 but upon getting glasses, can't see. I have heard back from patients, they they really like the Restor. That's the only one we use. We have found the percentages to be true that Alcon states. I really think good training, pt selection, and expectation make the happiest patient. Too many people think of the iol's the way they think of LASIK. snip, snip and I can see a fly at 100 yards.

[MrMotts]

Dr. Stacy,

In another post you said :

the crystalens does not work as advertised

Not that I am in a position to disagree, nor do I, I am just curious for your specific observations. What do you think of their new lens?

[Barry Santini]

Q: Why would *any* -2.50 to -4.00 myope want to get an implant that takes away their nearsightedness? For mono-pseudophakes, the eyewear is an easy, seemless adapt , and after the second surgery, they'll still be able to:

1. Read like a champ w/o eyewear...just like "the ol' days"
2. Still wear progressives and get all the UV/transitions benefits, along with *convenience*!!

I said I was an out-of-the-box thinker. I've advise many of my clients in this way for their implants, and all the ones who have followed my advice thank me every time they come in.

Glasses (aka eyewear) isn't soooo bad....

Barry

[Happylady]

Q: Why would *any* -2.50 to -4.00 myope want to get an implant that takes away their nearsightedness?

Barry

This sure is an old thread.

Yes, my mom was happier with her correction before she had Restor. She wanted to stay nearsighted but the doctor told her that it wouldn't work for some reason. He distance vision did stabilize and she was able to see 20/25 with a very mild correction. She missed her outstanding near vision.

In my other post I said my mom had no glare at night. I was incorrect, she told me later that she did have glare at night.

[Robert Martellaro]

Q: Why would *any* -2.50 to -4.00 myope want to get an implant that takes away their nearsightedness? For mono-pseudophakes, the eyewear is an easy, seemless adapt , and after the second surgery, they'll still be able to:

1. Read like a champ w/o eyewear...just like "the ol' days"
2. Still wear progressives and get all the UV/transitions benefits, along with *convenience*!!

I said I was an out-of-the-box thinker. I've advise many of my clients in this way for their implants, and all the ones who have followed my advice thank me every time they come in.

Glasses (aka eyewear) isn't soooo bad....

Barry

I like my myopia. If my doctor takes it away without asking there'll be hell to pay.

The surgeons can't quite grasp this, with their mind-set stuck on minimizing refractive error, instead of what would be best for the patient.

[chip anderson]

I'm not so sure that myopia is a good thing. I am quite sure that mono-vision is a bad thing. But I can see that a patient might be happy with undercorrection (-2.50) equal to his accomodation loss post cataract surgery. But it should be made clear that he really need to wear his distance glasses after surgery if he elects to have it done this way.
If he is corrected to emmetropia he will be free to see everything except reading distance without glasses and the reading can be corrected with a variety of spectacle options that need not be used when not reading or doing close work.


Chip

[Barry Santini]

I like my myopia. If my doctor takes it away without asking there'll be hell to pay.

The surgeons can't quite grasp this, with their mind-set stuck on minimizing refractive error, instead of what would be best for the patient.

Thank you, Robert! I see you agree!

Barry

[fjpod]

Darn right, a little bit of myopia is a good thing. (Try to tell that to a 40 something year old two diopter myopic yuppie that wants LASIK though.)

Anyway, I find multifocal and accomodating IOLs to be not worth it. The results I have seen are OK...but just OK. Actually, I have found a number of these patients to be uncorrectable to 20/25, and they should be. 70% of these people have to wear an Rx at least part-time, although most of them won't because they are in denial that they need them...after spending $X thousands on the Premium IOL.

All other things being equal, I like SV implants where the dominant eye is -0.25 and the left eye is -.75. These folks read 20/25 at distance and J2 at near. No multifocal can beat that.

Curious that this is such an old thread...but the results are coming in now as more people chose this option. To me it's just like multifocal CLs...ehh...they stink...too often (please don't be offended, Chip). Although MF CLs have two advantages. They can be tweaked and they can be removed. Try that with an IOL.

[Robert Martellaro]

Thank you, Robert! I see you agree!

Barry

I do. (see below)

Darn right, a little bit of myopia is a good thing. (Try to tell that to a 40 something year old two diopter myopic yuppie that wants LASIK though.)

I've done that a few times- keep your head down!

Anyway, I find multifocal and accomodating IOLs to be not worth it. The results I have seen are OK...but just OK. Actually, I have found a number of these patients to be uncorrectable to 20/25, and they should be. 70% of these people have to wear an Rx at least part-time, although most of them won't because they are in denial that they need them...after spending $X thousands on the Premium IOL.

That's pretty much what I tell my clients- If you want the best possible vision, stay with SV IOLs (aspheric when appropriate).

All other things being equal, I like SV implants where the dominant eye is -0.25 and the left eye is -.75. These folks read 20/25 at distance and J2 at near. No multifocal can beat that.

For some, the best solution. I lean towards the old school "get it as close as possible". However, Barry was saying that there's at least one more possiblity; keep the postop Rx the same for moderate myopes. For example, I'm a sph equiv. -3.75; I intend to keep the same Rx after cataract surgery. I really like being able to see very small objects and text without the use of a magnifier. I can read in bed without glasses. Life is good! Like Barry, I have told my clients that they have this option- some choose it, some don't. But not one of them knew that they had a choice.