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

  1. ari on January 9th, 2012 10:09 am

    floaters, especially after surgery, are normal as we get older and get slowly better over months/years. we dont treat them.
    why are you having your implant replaced?? you think it causes the floaters? the implant has nothing to do with floaters.

  2. Jack on January 14th, 2012 6:02 pm

    Aloha all.
    I’m going to have my first cataract removed in Feb and like a LOT of peeps I’m still debating whether to pay the extra $2,000+ per eye for multifocals.
    I’m pushing 73 but still active flying RC planes, deep sea fishing and need GOOD distance 3D vision.
    I also still work as a woodturning artist and close good vision SURE would be nice also.
    My surgeon normally uses Tecnis IOL’s.
    After a LOT of surfing the internet I’ve yet to see anyone saying how GREAT multifocals are.

  3. ari on January 15th, 2012 12:03 pm

    Multifocals may not be for you. they require a tolerance for some side effects and drawbacks. i think you would be better off with monovision if you are really motivated not to wear glasses. I’d advise to get a few different opinions.

  4. Caroline on February 3rd, 2012 5:51 am

    I had ReStor multifocal lens in right eye July 2011 and left eye November 2011. I
    have pain in the left eye with a blur in the middle. I will need 2.75 reading glasses,
    computer screen is fuzzy and so are words on the television at 10 feet away. I
    might as well get progressive lenses glasses. Not what I expected. Used to see halos at night around traffic signals but now I see a bunch of graduated circles and cars headlights are now huge starbursts.
    Hopefully, others have better results.

    02-03-2012

  5. Jodi on February 3rd, 2012 6:32 pm

    I’m am 51 and scheduled for surgery on my right eye, w/ cataract (camera eye) I’m a photographer, on Feb. 21. then on my left eye, no cataract March 6. I am -5.75 in both eyes now wearing mulitfocal contacts. The halos and blurry lights are a bother to me with these contacts and I would rather not have to deal with that after my surgery. My question is, since I already wear the mulitfocal contacts, would I adjust to the monofocal implant lenses? Also, would the monofocal lens still cause the halos and light blurriness at night? Any other advice would be appreciated if
    needed.

  6. Christine on February 7th, 2012 10:11 am

    My right eye was corrected, with monofccal iol goal of intermediate vision, and the result came out distance. 20-25. My left eye, which is dominant will be done in next couple of monhts. I hate not being able to see the computer and things close to me such as peoples’s faces, my phone, those things within 3 feet. My left still has a little ability to see close, but it has a cataract and well there is blurriness.
    My qyestion is: Why does the dominant eye always have to have long distance vision ? Has any had their dominant eye corrected for near vision? Why couldn’t I get mutlifocal for left dominant eye?

    My corrected right eye doen’t seem to have any problems, I already see much better in distance with both eyes.

    I work as a dentist, and when I work I use Loupes and vision is good because of the magnification of 3X . It’s so frustrating to take off Loupes and notl being able to read the charts without glasses.

  7. ari weitzner on February 8th, 2012 4:06 pm

    there is no hard and fast rule. you could do near vision for the dominant eye if you wish. consider having the iol replaced in the right eye, or do lasik in that eye. a multifocal in only 1 eye is not typical, and you may not like it- the multifocals work best when done in both eyes, but some surgeons have had success with only 1 eye. consider crystalens in left eye- gives good intermediate vision.

  8. Ed on February 19th, 2012 3:59 pm

    I am 57 yr who has cataracts in both eyes. I use glasses for reading and computer but not for driving or TV. My vision for TV and driving is not as good as it used to be, but not enough for glasses. As I age, my visoin has slowly deteriorated so I expect that to continue. My Dr. recommended that I remove the cataracts and install crystalens.
    Are the benefits of crystalens worth the extra cost?
    I am avid tennis player so I want the best choce for that and I do not mind reading glasees, but the thought of no glasses really appeals to me.
    My sister-in-law had monovisons installed recently at Mass Eye and Ear and was told that the benefits of multifocal did not justify the cost so they stopped recommending them. Not sure whether to believe that.
    Any advice?

  9. ari on February 20th, 2012 4:30 pm

    monovision and crystalens both good options, but mono is free. crystalens not so great for reading- better for intermediate (like computer distance).

  10. John on February 28th, 2012 11:50 am

    I am 65 yrs old. I have significant near sightedness along with some astigmatism. My last visit to my optometrist indicated that I have a very slight cataract beginning in my left (dominant) eye. For most of my life I have worn eyeglasses. For the last (approximately) 20 years I have worn progressive lens eyeglasses for developing presbyopia. I can see pretty well with my eyeglasses but naturally I would like to both eliminate the chance of further development of cataracts and if possible, have excellent vision without eyeglasses. Let me qualify the eyeglass issue.

    I am ok with eyeglasses for closeup work I think. I do a fair bit of computer work but because of my age I think that this will become less and less with time. In any event, I consider it to be no problem to have glasses sitting close to the computer – ready for use with the computer.

    My value rankings for the various risk factor issues are:

    I only want to do the surgery once. Surgery of any kind scares me, so I want to reduce the chance of the problem having to be revisited – to as close to zero as possible.

    I value distance vision highest, along with excellent night vision. (I live at a latitude that has long winter nights, with driving necessary at times.

    I think my values point me to monofocal lenses. Can these correct for astigmatism. Is the Toric lens simply monofocal with astigmatism correction?

    Ari, you are a great resource. Thank you for your input.

  11. Nancy on March 5th, 2012 1:08 pm

    I am 67 and had perfect vision until my 40’s, at which time I added reading glasses. In my 50’s, I added computer glasses. Now my cataracts, both eyes, right eye dominant and worse, are causing glare and night driving issues, and reading glasses dont work, so i read everything on an ipad. One ophthalmologist is recommending Crystalens HD, another Tecnics, of course for a lot more money. I’m considering Crystalens, but wonder if I should just go with monofocals. I’m OK with reading glasses, but hate the glare. I’m also concerned with depth perception, as I have balance issues as well. I’m told I am a good candidate, no glaucoma or diabetes, very slight astigmatism. What do you think, Ari?

  12. ari on March 5th, 2012 11:05 pm

    if you are concerned about depth perception, then monovision may not be for you. crystalens has the fewest side effects like glare, but you may need to use reading glasses more than you might like.
    not sure why you have so much glare problems with reading glasses. i really dont think its the glasses- i think the glare is the cataract. good quality reading glasses should give you little glare trouble. so since you are ok with reading glasses, my feeling is go with regular implants.

  13. Nancy on March 6th, 2012 10:58 am

    Thanks Ari. The glare is there with and without glasses, it is the cataracts. So long as i wouldn’t need to wear glasses for intermediate vision, I think I’ll go with the regular implants. I just wouldn’t want to need glasses for other activities.

  14. ari on March 7th, 2012 12:11 pm

    ask the doctor to make you a litle near-sighted in one eye- like -1.25. it will give you good intermediate vision. i think you will be happy with that and with the overall vision

  15. Dev on April 12th, 2012 5:19 pm

    Hi,
    My Dad needs to get a surgery for cataract. I am doing my part of research to find the best lens available for it. Are there any one who is really very happy with multi–focal lens. Reading all about it, it seems to be that this is still not completely evolved and I should stick to mono focal lenses..
    Can someone suggest what are the different make available and which one is better… Something like if you need table you think of ipad, so if someone thinks for lens what should be there idle choice..
    Thanks in advance..
    Dev

  16. Greg on April 30th, 2012 6:41 pm

    Ari, I am really intrigued by your response above to Nancy…about asking her surgeon to make one eye a little nearsighted. This sounds like something I would like. If I could achieve good distant and intermediate vision with monofocal lenses…and then rely on reading glass for near vision, I think I would be a happy camper. Is what you suggested to Nancy true monovision…or more of a “compromise” somewhere between monovision and all distant (or all near). I hope that makes sense. I have some concerns about monovision and whether or not I could adjust…but your suggestion to Nancy sounds reasonable to me…and I want to find out if it would work for me.

  17. ari on May 2nd, 2012 2:52 pm

    we typically dont go for the full monovision- the asymmetry would be too much for most people. getting 1 eye to about -1.25 seems to be ideal monovision. good luck!

  18. Tina on May 27th, 2012 10:08 pm

    I am 50 and have cataracts in both eyes (left has more). I have worn glasses and contacts since I was 10. I am near sighted; -7.75 in my left and -7.50 in my right; I wear soft contacts the majority of the time. I work on the computer and have to wear reading glasses. I would like to be able to see without glasses even readers. Which would give me the better chance for that multi-focal or mono-focal with the least amount of side effects?

  19. ari on June 5th, 2012 8:22 pm

    monovision would give you least side effects, but vision may not be as good as the multifocal. its a hard call!

  20. Mary C on July 5th, 2012 9:20 pm

    I am 68 years old and need cataract surgery in both eyes. I am nearsighted since 4th grade, wore glasses and contacts, both hard and soft lenses, then permeable, then contacts with monovision. I now test -4.00 both eyes. I had lasix done about 10 years ago and was corrected to 20/20 vision. It was like a miracle. I could see close up and far. The last 5 years my nearsightedness came back. I can still see close up (love it) without glasses. Within the last 2 years, I went from -2.00 to -4.00, both eyes. I read a lot, am on the computer a lot, watch TV and, of course, drive. I have had halos around lights at night ever since the lasix, but have adjusted until recently when it got worse. My doctor has suggested Crystalens, but it is $2600 per eye. What to do?

  21. Mary C on July 6th, 2012 2:49 pm

    I have fine tuned my question to this. Should I get Mono-focal which Medicare covers or Crystalens? Most frequent activities include lots of reading, computer work, watching TV and I have to drive, too (and pass the driver’s test). What are most people happier with?

  22. ari on July 7th, 2012 9:40 pm

    not easy to get the right power of the crystalens implant, esp. after lasik– so good chance you will need touch-up with lasik after the crystalens to get 20/20. also, the accomodative ability of this lens can be unreliable. some swear by it, some dont. consider monovision, if cost is an issue.

  23. Neha on August 3rd, 2012 12:45 pm

    Hi, My mother has got cataract in both eyes with more snowy vision in the left eye. She is 61 yrs old and has been wearing glasses for more than 15 yrs both for distance and reading. She uses bifocal glasses at times and at times wears them separately as per her convenience. In all she owns 3 pair of glasses.
    Which lens she should go for – mono focal or mulltifocal or Crystalens? Is the extra money for crystal lens worth it? Please advise. She has not yet been tested for astigmatism or undergone any retina test.

  24. ari on August 3rd, 2012 4:32 pm

    depends on her motivation to be less dependent on glasses. crystalens can be unpredictable, and is better for intermediate vision. multifocal more predictable and better for near, but has some side effects. monovision is often a good compromise and has no extra cost. you really have to sit down with the surgeon and discuss all the options.

  25. CM on August 21st, 2012 9:16 pm

    Regarding Crystalens….
    I had my surgery in March 2012 for my right eye. I am one of those people who does not do well with this lens. I have been searching out more doctors to see if there is a solution for my problems. So far no answers. The problems are as many people have written. I have horrible night glare, halos, stars, and circles of light rushing at me when I drive past street lamps. It’s more noticeable at night due to the contrast of light and dark. Anytime there is a light source off to the side or top of the lens, it refracts and causes rays of light across my vision. I have asked the Dr to shine his little flashlight from the side of my face to prove to him it creates rays of light. Many times it’s like the prism effect, rainbow colors. He still has no solution. Needless to say, this is very, very depressing. So with this experience, I write to warn people to consider the mono lens and not the Crystalens.

  26. Simran on August 22nd, 2012 12:46 am

    Hi! I am 24 and had steriod induced cataracts in both the eyes. I have undergone surgery on 25th April 2012 and doctor has implanted multifocal restor lens in my right eye. After my surgery I have excellent distant vision, good near vision. But now I have joined my office after 15 days of rest, I am facing problem of darks spots around my eye while I am doing the computer work or sometimes I feel it in sunlight too. Now, I have to undergo left eye surgery on 31st August, after 1 month of previous surgery. Wanted to know would that dark spots reduce or it would increase. I dont have any problems with Halos while driving at night. But I think that gave me better vision.

    Please tell me about this dark spots or blurry spots around my right eye?? and should I go ahead with the left eye surgery using multifocal lens or any other lens??

  27. ari on August 22nd, 2012 2:03 pm

    it may be related to the edge design of the implant. doing the other eye wont make a difference,. the restor works best when implanted in both eyes.

  28. ari on August 22nd, 2012 2:06 pm

    i dont understand your symptoms CM. it may be that the crytalens is de-centered? i have never heard of these symptoms in crystalens- only restor. i advise strongly a second opinion, as i suspect something else is going on.

  29. CM on August 22nd, 2012 7:42 pm

    Ari,
    I have seen 2 other doctors for second opinions and will see another one in Sept. They all say it looks perfect. The last one said the same thing; that these symptoms are usually with the Restor. I have hopes for the doc #3 as he told my friend he has heard of these problems. I’ll keep ya posted. Meanwhile, doc #2 is sending my reports to specialist in other states who deal with cataract surgery problems. I have not heard back from him.

    I see your advise to not mix the Restor with another lens. What do you think about using a basic (mono) lens with the Crystalens? I still have to do the left eye at some point but I am afraid to use aonther Crystalens.

  30. ari weitzner on August 23rd, 2012 8:14 am

    considering your problems, i would go with standard iol for 2nd eye.

  31. Simran on August 26th, 2012 11:34 pm

    The main problem is that I had one eye operated and other eye is suffering still from cataract.. Sometimes I feel there are black spots in front of eye. But when I am comparing the vision of both the eyes it feels that my right eye (implanted with restor lens) doesnot have much problem and left eye can see more black dots in front of the eye. Can you please elaborate the reason behind this. My doctor is saying that your eye is 100% perfect. Is the reason is coz of left eye which is not yet operated as of now.

  32. ari on August 28th, 2012 8:52 am

    so…if the operated eye feels fine, and the symptoms are in the eye with cataract, and your eye doctor says nothing else is going on besides the cataract, what is the issue here?

  33. Susan on September 18th, 2012 11:29 am

    I’m due for cataract surgery and on a waiting list so it could be anytime soon. My concern (like several people here) is whether to go for Crystalens or mono focal lenses. My doctor suggests getting the Crystalens for both eyes as he says I’m still young (I’m 57 yrs. old) but I’m extremely myopic -10 and -11. What would you suggest I do? I’ve worn monofocal contact lenses since 16 and done very well with them. I’m ok with reading glasses but want to be able to watch TV and drive without issues during the day and night. My gut says to go with the standard monofocal lenses but am looking for some advice. My ophthalmologist cousin in India says not to go with the Crystalens since they lose their accommodating flexibility and hinging after some time. Is this true? She feels it’s simply a moneymaker.
    Thanks in advance.

  34. Susan on September 18th, 2012 11:31 am

    One more thing I wanted to mention is that I use an e-reader and can read without glasses with an increased font.

  35. ari on September 19th, 2012 9:27 am

    crystalens, when it works, will give you greater range, so you can have some intermediate vision as well as distance. but its not so predictable as restor. i am not aware of reduced effect over time.
    again, it all depends on how motivated you are not to wear reading glasses.

  36. Susan on September 19th, 2012 9:54 am

    Thanks for your response. Restor has not been offered to me as an option. I live in Canada – does that make a difference? I have only been told about Crystalens and was given a brochure to read about it. When you say that it would be a better option for me, does that mean that with monofocal lenses, I would have trouble seeing long distance? I certainly don’t want any dependency on glasses at all, if possible. However, I would prefer not to pay $3000.00 extra for both eyes, if possible.

  37. ari on September 21st, 2012 10:11 am

    monofocal simply means clarity at 1 distance- either near or far. all lenses give good far. the q is near. crystalens gives you some intermediate, but it can be unpredictable. it all depends on how motivated you are to be free of glasses.

  38. CM on September 29th, 2012 10:11 pm

    Susan,
    I would not reccomend the Crystalens. I have one in my right eye and I am on the verge of having it removed. It does not fit my eye and causes all sorts of star bursts and halos of light especally at night. I do feel that they do not give all 3 stages of vision (upclose – mid -distance). My vision has no up close which means I can’t see my face in the mirror or read a book. My mid and distance vision had gotten worse. All of this has been with in 6 months. It’s very upsetting to say the least. I would go with the standard lens.

  39. CM on September 29th, 2012 10:15 pm

    Ari,
    What do you know of the risks of removing the Crystalens and replacing it with a standard lens? It’s been 6 months and I want to have this done in the next month or two. I am very scared about it being worse. I have read that the sac could tear. Would this cause blindness?

  40. ari on September 30th, 2012 1:56 pm

    replacing an implant can be tricky and can tear the capsule due to adhesions between the capsule and implant, which can lead to blurred vision or difficulty placing a new implant. ask your surgeon if he has some experience with this, and if not, would he mind referring you to someone who does more of these kinds of cases to reduce your risk. its not a common operation, so it may be hard to find another surgeon in your area.

  41. ari on September 30th, 2012 1:58 pm

    as i mentioned before, im not sure why you are having so many side effects from the crystalens- unless the position of the implant is poor. ordinarily, one does not see these side effects from crystalens. the poor intermediate/near vision is a more common problem/complaint.

  42. CM on October 3rd, 2012 3:39 pm

    Ari,
    The position of the lens is correct. Four Dr.s have looked at it. The one who has done the most explants said that perhaps due to the square edge of the Crystalens, it catches the most light. I don’t know if my astigmatism has something to do with it or not. He wanted to correct this eye before putting a standard lens in my left eye but now after consulting with the other 2 docs it seems that they want me to do the left eye first to see how my brain sorts it all out. I really hope that I can handle a standard lens as I certainly do no want two bad eyes. I am waiting a call from him to see what changed his mind and to ask more questions.

    Do you know how people fair with one standard and one Crystalens?

  43. ari on October 4th, 2012 11:00 am

    mixing implants typically not a problem, esp with crystalens.
    if then problem is the edge, you need to choose an implant with a difft edge design. the astig only causes blur- not halos/starburst/double/ghost vision.

    i would go ahead with the second eye with a standard lens with difft edge design, (if you have astig, get toric lens) then see if you might be satisfied with that

  44. George on October 4th, 2012 5:01 pm

    My situation is a little unique. I am 40 years old and very mypoic (-17.5).
    About 3 years ago a had a retina detachment in my left eye which was repaired via laser and a schleral buckle.
    In my right eye I had laser to repair some minor tears.
    For the past year, i noticed my vision getting worse. After seeing my optometrist I was diagnosed with cataracts in both eyes. The left eye being more advanced than the right. My retina surgeon did warn me that this would happen.
    Now my optometrist has referred me back to my retina specialist to have the cataracts removed and have IOLs.
    I am uncertain as to what type of IOLs someone in my condition should proceed in regards to what type of lenses would be right for me.
    I trust my retina specialist who is well respected and a top doctor.
    I am willing to sacrifice wearing reading glasses for better distance and intermediate vision.
    I have been wearing high prescription glasses and contact lenses my entire life so wearing reading glasses would be a very small price to not have to wear what I have been since 4 years old.

  45. ari on October 6th, 2012 8:55 pm

    my feeling is that you would be happiest with regular implants, aiming for like -2.00 or so, which would give you comfortable reading vision w/o glasses, and at -2.00, your distance glasses would be normal thickness. if you are very motivated to reduce your reliance on glasses, make one eye plano and the other at -2.00. a very myopic eye that underwent laser/surgery is not the ideal eye for premium lenses.

  46. George on October 8th, 2012 9:48 am

    Tank you for the respons ari.
    By regular implants, do you mean monofocal?
    Your advice does seem sound and does confirm my research.
    Do you now if there is a cost associated with thes lenses in Canada.
    By “make one eye plano” do you mean correct it perfectly? I have not heard of that term before.
    Like I mentioned, wering light prescription glasses for reading and/or distance vision would not be too big of a deal considering how I have been seeing my entire life which has always been difficult. Soft contact lemses do not offer as clear as vision as hard lenses but I found hard lenses very irritating. Everything is a sacrifice I suppose.
    My optometrist does agree that they will most likely opt for regular implants. Regular implants is how he put it as well. Just wondering if that means Monofocal.
    He also assures me that despit needing reading glasses or distance glasses to compensate for any adjustments to my vision, that I will see better than ever befor, assuming all goes well of course.
    Would this be your opinion as well with people like myself.

    Thank you once again for your feedback. I just want to be as informed as possible before desisions are made on my behalf and understamd what is being done.

  47. ari on October 10th, 2012 9:13 am

    yes- monofocal is regular
    yes- plano means zero prescription for distance
    as i said, considering how awful your prescription has been for most of your life (-17 is really, really bad), you will be ecstatic with regular (monofocal) implants with a prescription of -2.00, and you therefore dont need to spend money on premium lenses.
    good luck!

  48. George on October 10th, 2012 9:58 am

    Thanks again Ari,
    Very encoraging. I am actually looking forward to it.
    Would you happen to know the recovery time?
    I do computer work. Would I be able to start working in a couple of days?
    What would I need to keep in mind in regards to short term recovery and long term lifestyle?

  49. ari on October 11th, 2012 11:02 am

    recovery is very short- day or two. until the second eye is done, you will be in limbo with 2 very difft eyes, so it may be hard to do prolonged work. you cant hurt or strain the eyes, so feel free to go back to work asap.

  50. George on October 11th, 2012 11:25 am

    Than you for the info and advice.
    I very much appreciate your responses and clarification to my questions.
    I feel much more informed now.

    If I can trouble you with one more question.
    As I have some astigmatism as well. Would it be advisable or a good option to have a toric IOL.
    My understanding is that a toric lense is a monofocal lense that corrects astigmatism as well.

    Would this be riskier? Would it be preferable to allow glasses to do the correction, the IOLs or laser?

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