Crystalens or Restor as a Multifocal IOL After Cataract Surgery?

April 1, 2010

I am 40 yrs old and in need of cataract surgery. I have taken prednisone and inhaled steroids for asthma, which may have contributed to the formation of cataracts.

I knew nothing of monofocal or multifocal IOL’s when I started to suffer degraded vision in my left eye. I received opinions from 2 optometrists. One was for Restor and one for Crystalens. It may have just been the $3000 extra per eye over a monofocal IOL, but my initial impression was that the multifocal lenses were some sort of shady up-sell.

Now after thinking about it, I really do not want to have to rely on 2-3 pair of glasses and feel the extra $$$ might be worth it. I have worn glasses or contacts since grade school and am a pretty active guy. I set my mind on getting a multifocal lense after my second opinion (better bedside manner). This second optometrist recommended Restor, while the first optometrist had recommended Crystalens.

I am all bet set to get this done next month, but I am second guessing now. Can you recommend some impartial reading on the subject? My right eye is supposedly about a year behind in needing surgery.




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146 Responses to “Crystalens or Restor as a Multifocal IOL After Cataract Surgery?”

  • Ben (Gatineau, Quebec, Canada)

    Thank you for your comments.

    I have to go before February 11th to pay for my first len, before the surgery. I will inform the doctor about my choice (Monofocal) and ask her about what you suggested, -1.50 in the non-dominant eye.

    As for the second eye surgery, it is only due to delays due to long waiting list. For the first eye, I was told in October that the waiting was approx. 4 February. I could have had surgery in November 2010 if I would have went private (Lasik MD), however, insurance wont cover, and it’s $2400 each eye.

    Thanks again for your input.

  • ari weitzner

    i think you made a very wise, informed decision.

    since you are so young, give serious thought to making the non-dominant eye a little near-sighted (about -1.50)- this way, chances are high you can do a lot of computer/reading work w/o glasses. otherwise, you will be completely dependent on reading glasses when you work. it is a proven, well-tolerated strategy. if the -1.50 bothers you when you drive, it’s a simple matter to buy a pair of glasses for driving to make the non-dominant eye equally sharp.

    by the way, there is no reason to wait 2 months between operations. i typically wait 1 week.

  • Ben (Gatineau, Quebec, Canada)


    My cataract surgery is supposed to be in February 2011. I am 43, never had glasses, contacts. Vision problems started in Summer 2010. Had my eyes checked in October 2010 and was told left dominant eye has cataract, ready for surgery and my right eye has a beginning of cataract.

    I am suppose to get the Monofocal Tecnis IOL. Of course I have to make a decision if I want the Multifocal instead…and after reading a lot online on the pros and cons of both lenses…I believe I will stick with the Monofocal suggested by my doctor. Cheaper also, ($260 CDN out of my pocket) compare to almost $1000 CDN out of my pocket for Multifocal) but money was not the factor.

    I am very active, I am driving at night very often (and now it is very bad), so it is very important for me not to have the Halos and other side effects of the Mutifocal.

    Reading Forums like this and having the advice of Doctors, really helps in making such an important decision.

    So, left dominant eye in February 2011and right eye two months or so later. I will write again to let people know how my experienec went.

    Note: I believe I have read that it is suggested to have one eye done for distance and one eye done for close-up? Is the info correct or is it case by case and as per the doc?

    Thank you all!

  • Tom Kogan

    Let me explain further. I lived in Western Maryland prior to buying a condo and moving to Florida when I was 68.. My eye doctor in Cumberland Md. diagnosed me with glaucoma, but when I went to the Eye Centers of Florida, Dr. Brown told me that I did not have glaucoma and discontinued the drops, and since I am not a Doctor.. I believed him. On a later visit, he “recommended” that I have the Crystalens implants. The left eye went well, except for a “mid vision” problem, later when I thought I was getting a Crystalens in the right eye, he put in a Restor lens and I knew immediately something was wrong. The next day, everything that was supposed to be green was “red” in the right eye. In the meantime, I came back to Maryland. It never did clear up and later when I went back down and the lens was “changed out” the problem got worse. That’s when he told me that the glaucoma had come like “a thief in the night” and walked out. It has been a “nightmare” every since. I am now 74 years old, and my present Doctor in VA. finally got tired of me asking him if there was something he could do for my right eye, he said “look Tom, the doctor in Florida broke your capsule, the bad thing is, he was not up front with you”. This hit me like a ton of bricks. I could never understand what happened up to that point. Now I am furious at the Doctor in Florida for damaging my eye and then lying about it, and there is nothing I can do but “live” with this mess for the rest of my life.

  • Dr. Ari Weitzner

    you make an an excellent point. a well-known surgeon- i forget his name- is a big advocate of monovision and feels it is superior to the premium iol’s, and at zero cost. patients should definitely ask about this option.

  • vivian mower

    Too many problems with multifocal and even Cyrstalens. I am so glad I chose monofocal with blended monovision. I can see so much–distance excellent, also car dashboard, applying make-up, watching TV, much more, even most restaurant menus, etc. Many ophthalmologists focus the patients’ attention on the premium IOLs only; thus the patients assume ,they must choose a premium IOL. Beware of “eye centers” which show promotional videos on premium IOLs, recommend the premium IOLs and don’t discuss the advantages of the standard monofocal IOL. Vivian Mower

  • ari

    i am surprised you were given a multifocal in only 1 eye- those lenses really only work well when both eyes are implanted. you may be happier with both eyes implanted. hard to say what to do here- you may still be stuck with suboptimal near/intermediate

  • Kim, Akron Oh

    wondering if you’ve had your surgery yet?? I am 39 y/o and had cataract surgery over a year ago on my right eye. Prior to that I never wore glasses or even had an eye doctor. It was suggested by my eye surgeon to go with the multifocal (Restor) lens since I had never wore glasses and also might have a hard time adjusting to a single vision lens. My experience with the mutifocal has been good and not so good. My distance is great; however I am wearing readers as I am typing. My intermediate vision is very poor, which I was not expecting and I also have severe halos around lights at night.

    I am due to have my left eye done next month and am considering a single vision lens but am concerned about how both eyes will work together with two different types of lenses.

    Anyone out there with the same experience??

  • ari weitzner

    you are right about everything except the monovision- i wouldn’t blow it off so fast. try asking your eye doctor to put disposable contact lenses on you to simulate monovision for a couple of weeks. to have one eye slightly myopic- –about -1.50— is really not bad, and will allow you to use a computer w/o glasses. worst case scenario- you wear some glasses. honestly, as an ophthalmologist, thats the way i would go for my own eyes.

  • Atif

    Hi everyone, I am a 25 year old male (in uk) about to get surgery in both eyes for cataracts. I know I’m very young to have them but i have been given 3 options: monofocals, multifocals or crystalens accomodative lens.

    I cannot get monovision since i have been told that i may never adjust due to never requiring glasses before now.

    Can anyone advise on what they suggest i should opt for? i dont want to be dependent on reading glasses forever which is why i am swaying away from monofocals, and due to the negative press about multifocals, I am considering crystalens accomodative lens but have heard that they don’t really work either and are just a fancy monofocal?! I am getting a 2nd opinion but any advice here would be very much appreciated thanks.

  • ari weitzner

    yeesh. when i have a patient who comes for a second opinion, i always tell them exactly what i find. usually, the surgeon is not at fault, and i explain that, too. if the surgeon is at fault, then i am honest about that as well. breaking the capsule happens to every excellent surgeon, esp. in tricky cases like replacing an implant. breaking the capsule can cause cme- fluid builds up in the back of the eye and blurs the vision. i dont know what the story is with glaucoma in your case. that should be something that should be detected prior to surgery unless the cataract is very advanced and the view of the optic nerve is difficult. damage to the vision from glaucoma takes many many years to occur- it makes no sense to me that no glaucoma was suspected prior to surgery, yet somehow you lost vision to glaucoma after the surgery.
    re: not getting a refund on the second implant–that’s a tough one. the surgeon cannot get a refund for that lens from the company. when you paid for that lens, i think it should have been explained to you that if it doesn’t work out, you dont get a refund. thats what i do with my patients. if the capsule did not break, the surgeon would probably had given you a crystalens free of charge as a courtesy. since you did not get that crystalens, maybe the doctor would be willing to negotiate a partial refund. maybe you can call alcon (they make the restor lens) and tell them your story. maybe they will give you a refund? i am sure they dont want miserable patients bad-mouthing restor!

  • Tom Kogan

    When I was 68 years old and an active private pilot, my doctor in Florida recommended that I go for the Crystalens. He placed the lens in my left eye (price $1500.00 over medicare) and a few weeks later he placed a ReStor lens in my right eye, (I thought he was putting in a Crystalens.) and it was also $1500.00.
    When I came back to Maryland, the right eye (with the ReStor lens) was blurred, so I went back to Florida and told the Doctor that something was wrong, at first, he told me to take some drops, and I said can you just remove the ReStor lens and put in the Crystalens, and he replied, well o.k. if I can get it out. Now the vision in my right eye was almost destroyed and went back had he walked in and said well, you have glaucoma, it’s like a thief in the night and that is what happened to your right eye. I went to six different eye doctors after that and they all just put me off like they did not know what happened, I could not even wear glasses because none worked. It became a nightmare scenario. After four years of trying new doctors and new glasses, I finally had one of them tell me. Tom, he broke the capsule. I did not know what he was talking about. He explained that in rare cases, the doctor breaks the capsule. So, after four years and numerous doctors and glasses, I finally found out what happened. Now it is too late to do anything about it and I have to live with this “messed up” vision the rest of my life, and to add insult to injury, I found out that he had replaced the ReStor lens with a regular lens and never refunded the $1500.00 dollars that I paid for the ReStor lens.

  • Please note that none of the previous respondents mentioned Fuchs’ as one of their issues. We have a large group of over 2200 Fuchs’ Dystrophy patients on line and we have noticed two major issues with multifocal lenses of any type.

    Neither Medicare, Medicare Advantage (private insurance that ‘replaces’ Medicare) nor non Medicare patients’ major medical insurance covers any lens other than the standard lens. Multifocal lenses seem to run over $3000 each and that’s a whopper of non covered cost for patients.

    Of possibly 30 of our members or more who have had a multifocal lens installed have had strong complaints about glare and other issues. For many the problem was intolerable and they paid to have them removed. Removal is problematic because the natural lens capsule tends to grow around the plastic centering/retaining springs which can break during removal and pierce the lens capsule and fall into the main eye globe where they may cause damage to the retina or other parts.

    The number 30 is approximate but the complaints were from all but one individual.

    We are in constant contact with a large number of surgeons who specialize in Fuchs’ Corneal Dystrophy all of whom discourage their patients and our members from having multifocal lenses installed.

    Robert Bellizzi, Executive Director
    The Corneal Dystrophy Foundation

  • Mitch

    I started this string asking for help. Thanks for the responses. I am still on the fence. I just read an article about NanoFLEX IOL which is considered an FDA approved standard IOL that has shown more focusing ability than other standard IOLs, showing near and intermediate vision comparable to premium lenses. Currently they are seeking approval as an accommodating lens, until then, Medicare reimburses full cost. Has anyone heard anything on this lens?


  • Amy

    monovision happens to be a very good option, and there is no extra charge. a well-known surgeon (his name escapes me) advocates it strongly over multifocals. he shoots for about -1.50 in the non-dominant eye, and his patients are very pleased.
    btw, multifocal’s side effects are unrelated to how near-sighted you are.

  • ari weitzner

    mick- your reasoning is excellent. you touch on all the legitimate concerns about multifocals. patients need to be very motivated to be spectacle-independent in order to be happy with these lenses and to tolerate the side effects. if one picks the right patient population, the satisfaction rates are very high- 95% or so.

  • Mick

    There are advantages and disadvantages to both types. Monovision is good for range and quality of vision, but depth perception is reduced because your eyes are working independently to each other and a minority of people do not adapt. In my case, I had contact lenses previously set to monovision with +1.00 in my left eye about 2 years ago, to help with reading without glasses. It took about a week for me to adapt and worked well for a year, but presbyopia got worse and I needed reading glasses in the 2nd year. I think that +1.50 in your non-dominant is a good target to aim for, I have seen various research supporting this view, and this is what I went for.

    I am pleased that I didn’t go for multifocals in the end – not sure how I would have got on with the possibility of glare/halos/starburst, reduced contrast sensitivity at night, weak intermediate vision with diffractive lenses etc. I have none of these problems with my monofocal at the moment and don’t expect to. There appear to be more cases of explants with multifocals as opposed to monofocals and is not something you would want to go through in my opinion.

  • ari weitzner

    monovision happens to be a very good option, and there is no extra charge. a well-known surgeon (his name escapes me) advocates it strongly over multifocals. he shoots for about -1.50 in the non-dominant eye, and his patients are very pleased.
    btw, multifocal’s side effects are unrelated to how near-sighted you are.

  • ari weitzner

    restor is much better for close reading than crystalens. crytalens and restor may be about the same for intermediate (arm’s length). restor has higher risk of halos/sunburst, esp during night driving- crystalens has almost zero risk. i think restor is much more popular than crystalens at this time. from what i hear from experts who do alot of these implants, restor is better overall. there is some controversy about crystalens- whether it really works at all (it works by being pushed forward by your natural focusing muscles, but some studies suggest it doesn’t move at all. the restor doesnt move- it has like a bullseye pattern of circles that create multiple images simultaneously, and your brain kinda automatically focuses on the clear one at any given time depending if you are looking far or near).
    if you do a lot of night driving, be very careful about the restor.

  • Mick

    There is some interesting discussion on the MedHelp website which helped a lot to formulate an opinion for me.

    I am a 51 year old male in the UK and had cataract surgery on my non-dominant left eye last Friday. My prescription was -8.00 in my right eye, -6.50 in my left, with about +1.5 of presbyopia. I was advised by my surgeon not to go for multifocal implants given my short-sightedness, as they would most likely cause unacceptable glare and halos, which is well known as their achilles heel due to design. I decided to go for monovision using monofocals – with the non-dominant set for near, and dominant right-eye set for distance. I am happy with the results so far but it will take several weeks to fully adapt.

    I would advise reading up as much as possible before surgery. Unfortunately, you will find there is no perfect solution for your vision. Just aim for the best compromise depending on your lifestyle.