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?”

  • Kathryn

    I am scheduled to have a multifocal lens replaced in my left eye during my cataract surgery next week. I am having doubts about the multifocal lens, concerned that I will have trouble driving at night, and seeing contrasts. At 53, I have worn multifocal contact lenses for the past 10 years with great success. Do you think that monovision might be a good option for me to replace the multifocal lenses as scheduled?,

  • ari

    your vision will be excellent after surgery. the question only is- with or without glasses. you have to discuss at length the options, risks etc with your surgeon.

  • paula hendrikse

    hi there ,
    i am 43 and never had a problem with my eyes ,only the last month i noticed reading menus at night difficult ,i visted the eye hospital to be told i have cataracts in both eyes the right eye is blurry and the left still ok. i wonder what lens would be recommended as i paint a lot and would hate to be left unable to do that .also is it better to wait and see what happens my doctor was planning an operation for a week after the first meeting ,which i found a little scary because i need to think about lenses. any help ?

  • ari

    hard to say! restor works best when used binocularly, so you may want to try it. you could go back to the operating room a couple of weeks later to replace the iol- it should not be terribly difficult to replace before the iol scars in place. if you want to be conservative- choose near mono as you suggest.

  • Dorota

    Sept 30,2011 I am going to have my second cataract surgery done. By tomorrow I have to decide what kind of IOL- mono or multifocal I prefer. Since my first surgery 2 years ago, I really do not like all these side effects, what I was not informed about with my multifocal ReSTOR lens in my right eye. Halos and blurriness at night are really disturbing. I also have a grey shadow behind the letters with the close reading. However I have to admit, I have regained my ability to read without the reading glasses ( aprox 1.5 year after the surgery). I was told that the same ReSTOR multifocal IOL is recommended but I have a right of choosing otherwise. I am opting right now for monofocal IOL in my left eye for near vision with existing multifocal ReSTOR IOL in my right eye. Any suggestions will be really appreciated.

  • ari

    flomax makes it harder, with a slightly higher complication rate, but we have ways of dealing with it. leaving the cataract in the eye to get larger with time is the worst option.

  • don

    I have 2 have 2 cataracts done. Think I will go with mono lenses after reading comments. I take Flomax daily and my doc says not to worry. Is he correct. Can he do the surgery with no problems? Thanks.

  • Kathy

    July 6 had surgery on right (dominant) eye and August 3 on left eye. Crystalens in both. After first eye, I was skeptical about getting second eye done with Crystalens as believed I would have good far and mid vision, but didn’t. Because of the way the lens seated itself, I was left with excellent mid vision and very good near vision. Based on the outcome of first eye, dr. made adjustment to strength of second lens. I now have 20/20 in second eye for distance and fair mid vision. I am able to go without glasses entirely, although wasn’t exactly as planned. There are really no guarantees on the outcome no matter what you decide to go with. With each passing day, my brain is learning to adapt to my new eyes. Although I think we would all like perfection, I don’t think any lens will give you that.

  • Tom

    I AGREE..in fact, I am very pleased with the results! I see so much more at close range than I ever had and appreciate his decision. Perhaps patients hear about what others have and you wonder, but I appreciate your comments. Bottom line, I can see and that is all that matters!

  • ari

    a history of optic neuritis makes you a bad candidate for multifocal. the tissues of the eye (cornea, retina, optic nerve) have to be in near perfect shape in order to get the most of these lenses. your surgeon did you a favor- thank him!

  • Tom

    I have had cataracts for at least 10 years, but not enough to impair my daily living or warrant surgery. This year my new eyeglass Rx did not improve my vision, so it was time to go ahead and take care of the problem. My opthomolgist advised me to receive the best vision with my particular history, bilateral monofcals both set for near vision, was the way to go. I have had a past history of a couple bouts of optic neuritis and nearsighted since my youth.
    Does anyone possibly know the reason a multifocal lens implant would not be a viable option given my history?

  • Maggie

    Thank you Dr Ari. I am worried becaues now my dashboard is blurry completely and headlites are ery glaring again. I am due to have my other eye done this week. My doctor would always do what is in my interest and I have NO doubts of that. However, now that I have done my homework is it reasonable to cancel that second surgery and sit down and really discuss this fear and what I am doing?Thank you for your input.

  • Dr. Ari Weitzner

    you are not a good candidate for multifocal if you had optic neuritis. your surgeon did the right thing, but i suppose he should have discussed it further with you so it would have been clear prior to surgery.
    if a patient is really miserable and wants multifocal, the lens can certainly be replaced. but again, this would be rare, as doctors typically discuss the iol’s prior to surgery. on the other hand, a minority of patients (3% or so?) have the mulifocal removed and replaced with monofocal due to dissatisfaction with the multifocal.

  • Maggie

    I’m 61 and had a monofocal IOL implanted after cataract surgey this month and the other eye is going to be done next week. I have worn glasses since I was 8 yr old and I THOUGHT I was getting a multifocal. Now that I could not see distance as I thought I would the doctor said he used monofocal because my eye would not adapt to balance issues. I did have a bout of optic neuritis in the past and a neurological disease and am severely nearsighted. My doctor is the best and I trust him completely, but I feel like I never had input.

    Has anyone ever had the monofocal removed and replaced with a multifocal IOL?

  • ari

    great to hear such a satisfied patient!

  • Nasir Abbas

    By the way, halo is nothing compared to what I imagined and i find it not a problem at all. Night driving is in fact better than my pre-op vision.

  • Nasir Abbas

    It was very confusing to decide whether to have a mono-focal IOL or a multi-focal IOL implanted and if multi-focal then which brand? After comparing all options and considering that Restor is the most popular and my doctor was experienced with Restor I only had to decide one more thing. Mono or multi-focal. My biggest concerns were halo and night vision as well as the success rate of only about 80% in becoming completely glasses free meaning that I could be spending additional $5000 for nothing. My doctor was very straightforward and very neutral and honest in explaining the pros and cons of each choice I could make.

    Considering that I had many years of career remaining and the inconvenience of putting on glasses for working on computer and reading and also that this a choice that will affect rest of my life I decided to take the chance on multi-focal Restor.

    I got implant in my left eye on March 17, 2011 and in right eye on April 7, 2011. So far I am extremely pleased with the choice I made. I can already read fine prints in bright light which my 28 year old son says is not easy to read!. My distant vision is better than ever I can recall and my doctor says that it will improve further! I realize that I could end up in the 20% unfortunate patients but if I had to do it all over again I will not change a thing. After all it is a decision that affects the quality of my life for the next at least two decades I am expected to live. I am taking chances almost every day in my life with or without realizing it. Why not take a 80% chance for the betterment of life?

    I hope my experience will help someone else making his/her decision easier.

  • ari

    any ophthalmologist should be able to detect diabetic retinopathy prior/after surgery, unless the cataract is very advanced. instead, i would recommend a 2nd opinion- especially when the cataracts are not bothering you too much. true- removing a cataract earlier is sometimes better than later, but that typically applies to mature cataract, or if there are other conditions that make the surgery more risky, like pseudoexfoliation. it could easily take 5-10 years for an early cataract to become a problem for a patient, so no need to have it removed so soon- unless, of course, the patient is unhappy with the vision, where the cataract should be removed immediately. and yes- retinoapthy must be controlled prior to surgery, and may certainly get worse afterwards.

  • Judy in Texas

    I’ve not seen addressed here, something which I wish I’d known about. At 58, I was told I had cataracts in both eyes. I was surprised. The ophthalmologist said they should both come out, because they had learned it was much better to remove them early, as it became more difficult as they thickened. She gave options, but recommended the Crystalens HD, saying it had received great reviews. So, the plan was to put them in both eyes, a week apart. After putting one in my right eye, yes, I had 20/25 vision (compared to earlier 20/50); however, I also had halo’s, blurring, and loss of depth perception. Also, I had lost much of my peripheral vision, and it felt I was peering out from behind a black rim. They said the latter happened sometimes and YAG laser surgery was common to correct this. So, I had YAG. It helped for a wider view, and less black rim. But 4 months later, I still felt like I was looking out of a hole in the ground. They did some more YAG, and again, it did help my viewing area seem larger, but none of the other things changed, and in fact were getting much worse. They kept encouraging me to do the other eye (cataract surgery), as I’d put it off so fearful of a similar outcome.

    Now, 3 years later, and after going to about 5 doctors, I just went to a retina specialist 3 days ago. He doesn’t know why this wasn’t picked up on, but the blurriness, spots, lack of clarity, etc. are because I have diabetic retinopathy. He said the retina hemorrhages I have indicate I’ve had the problem over 10 years, and that due to my condition, I should have only had the cataract removal if it was entirely essential, because if you have retinopathy, having cataract surgery will most likely accelerate the problems with your retina.

    The retinal specialist said absolutely do not have cataract surgery on the other eye, in hopes we can get this under control some, plus that certain steps should be done before surgery if a person has the diabetic retinopathy. Keep in mind that on any blood tests, I “never” had a blood sugar reading A1C over 6.7, so was under the guideline of what was considered diabetic. I would suggest that anyone who has a lot of blurriness, or is over 50, have a good retina check before having cataract surgery.

  • Dr. Ari Weitzner

    oh- youre from canada- that explains the delay. here in the states, there is no delay.

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