Cataracts and IOLs

[call me al]

Hi,
Well, that time in my life has come where it is necessary to replace my natural lens due to detiorating vision as a result of cataract formation. Beside a monofocal lens, an option for an IOL is a new class of IOLs that correct for multiple fields of vision. One brand is the Alcon ReSTOR; another is a lens called Crystalens. They are two different technologies with different emphasis: ReSTOR has two fields, distance and reading, but no intermediate, and has some issues with glare during night time driving. The Crystalens is newer, and "adjusts" over a period of time for good intermediate and poorer near. Of course, a proven monofocal lens is an option with glasses for intermediate and near vision.
Do any of you have experience with these products, either personal or with a patient?
Thanks

[William Stacy O.D.]

Hi,
Well, that time in my life has come where it is necessary to replace my natural lens due to detiorating vision as a result of cataract formation. Beside a monofocal lens, an option for an IOL is a new class of IOLs that correct for multiple fields of vision. One brand is the Alcon ReSTOR; another is a lens called Crystalens. They are two different technologies with different emphasis: ReSTOR has two fields, distance and reading, but no intermediate, and has some issues with glare during night time driving. The Crystalens is newer, and "adjusts" over a period of time for good intermediate and poorer near. Of course, a proven monofocal lens is an option with glasses for intermediate and near vision.
Do any of you have experience with these products, either personal or with a patient?
Thanks

Both. As an o.d. who had bilateral implants last year, and whose interest in the subject has blossomed, I can tell you to opt out of any multifocal OR focusing iol. Instead, get the best optics you can (preferably one with PROLATE optics like the ones I got (Tecnis)) in single vision lenses. Go for best vision at about 20 ft in both, or a little closer on one eye if you want to be able to go without glasses part of the time, but expect to wear glasses for some activities. Most importantly, chose a surgeon who takes less than 30 minutes per eye, one who uses stitchless incisions, and who will do it without retrobulbar anesthesia. And one who does more than 1 per week. (the crystalens does not work as advertised, and the multifocals give less than perfect vision at all distances).

[Ory]

Keep in mind that you are not guaranteed a perfect refractive result, but most of the time the surgeons come close. Cataracts can interfere with the measuring equipment and give misleading results, you may have corneal astigmatism that isn't corrected for (or induced by the surgeon), or the lens may not sit exactly as planned in the eye.

Following the advice of William above makes the most sense. The results from clinical tests of multifocal lenses are not promising enough to compromise your best possible acuity.

[Happylady]

My Mom wears the Restor. She has had no problems with glare at night. She used to be nearsighted and now needs no glasses for distance. She can read well with no glasses if the light is good, but in poorer light she wears a progressive with a +2.50 add. The problem with the close vision could be her age, she is 82 and is getting some "cell changes" in her retina.

[William Stacy O.D.]

My Mom wears the Restor. She has had no problems with glare at night. She used to be nearsighted and now needs no glasses for distance. She can read well with no glasses if the light is good, but in poorer light she wears a progressive with a +2.50 add. The problem with the close vision could be her age, she is 82 and is getting some "cell changes" in her retina.

Of course the promoters of restor will blame it on anything but their lenses. The fact is, no more than half of the light reaching the retinas is in perfect focus at any distance. Some people can "get by" with only half of the available light being in focus, but I'm not one of them.