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?”

  • Maureen

    I’m so happy to have found this topic. Thank you so much Ari for all the advice you are providing.

    I am driving myself crazy trying to decide what lens to choose. I got a second opinion and received conflicting advice. I have excellent distant vision, but need glasses for mid and near vision.

    I am 53 with starburst cataract in non-dominant eye dealing with halos and glare. I have cataract in other eye as well, but it is not impacting my vision yet. Of course I’d love to go without glasses entirely, but am willing to use them for reading, if necessary. I’m not willing to sacrifice my distance vision as I am able to ski, hike, drive and watch TV without glasses.

    My fear with multifocal lens is that it would make impact my distance vision, halos, and night driving. I tried a multifocal contact lens to simulate the effect and did not like what it did to my distance vision at all.

    I have been trying contacts in my non-dominant eye to see if I am a candidate for monovision. I seem to be doing well with +1.25, but it’s not quite enough to allow me to do computer work. When I try +1.50, it works well for near vision, but effects on my distance vision.

    If I go with monovision, is it safe to go with 1.50 assuming that my brain will continue adjust?

    If I go with multivision, is Crystalens a better option than ReStor? If I understand correctly, it doesn’t cause halos and would not be an issue having it in one eye until my cataract in the other eye needs surgery.

    I thought Crystalens was supposed to best mimic the natural eye; that the lens adjusts in response to the eye muscles that focus the eye. One of the dr’s I spoke with dismisses the Crystalens; he says he doesn’t believe they work over time and doesn’t use the product.

    I’d like to hear thoughts from others…

  • janet Cohen

    I”m 67 years old, and only started wearing glasses after 40. I adjusted immediately to progressive glasses, and was thrilled to get rid of either wearing glasses on a string around my neck – not such a great look – or stocking every draw with readers.
    I was diagnosed with cataracts in both eyes a couple of years ago, but right now it seems my glasses are not improving my vision, and night driving has become more difficult, so I will be having cataract surgery.
    My opthamologist said I was a good candidate for multifocal lenses, that would allow me to “lose” my glasses. I’ve had mixed feelings about them and after reading and checking out this board, I think I’ve decided to go with the monofocals.
    The statistics of 25%, that’s one out of four people still needed glasses for close work, is a pretty high price to pay for a “hopefully.” I am an avid reader and knitter, and need the best vision for all that close work. Also if there are halos at night associated with multifocals, and I’m one of the ones who sees them, then what have I accomplished for my difficulty with night driving?
    Reading between the lines, though there are many people happy with their multifocals, I think many eye doctors if being perfectlly honest would agree that the prudent choice would be monofocals.
    Also, not the least…..glasses, sitting on the bump on my nose, give me an instant and very cheap nose job!

  • ari

    always always always get the implant that corrects astigmatism. why put in an implant, then wear the astigmatism on your nose, when you could’ve corrected it in the implant in your eye? its a no-brainer.
    the only question is whether to get the crystalens (trulign) or regular implant for astigmatism. the trulign’s ability to give you reading vision is not great. its best for intermediate vision, and even then it can be somewhat unreliable. monovision is not a bad idea, and most like it, but some patients hate it. but its cheaper than trulign.

  • Nelson

    Low, Moderate, High Astigmatism. What are the guidelines? Glare and Starbursts are becoming more noticeable because of my cataracts. 74 y/o male.
    I’m thinking that the Crystalens and the toric version, Trulign, would give me the kind of vision I want.
    My last exam, and pretty much all my eye prescriptions for the last 10 years or so, show me farsighted +2.50 and +2.75 Spherical Diopters and -1.25 and -1.00 Cylinder for astigmatism.
    Would Toric Lenses be preferred? Should I be looking at mini-mono/blended vision?

  • ari

    in routine surgery, vision should be clear in days. if surgery is long and difficult, it may take weeks. if you are still blurred, you need to have it checked out and get an explanation

  • One last question. I am scheduled to have surgery on my right eye in March. My left eye is still sometimes blurry. (I had surgery on it back in November). How long does it generally take for the eye to see clearly? I have heard that it can take 6 – 12 weeks. Can it take longer? Thank you, Dr. Weitzner.

  • ari

    implanting both eyes is more critical with restor lens, as there is a brain adaption issue. there is no grain adaption with crystalens, so implant the other eye as early or late as you like.

  • Karen

    Thank you for the reply Dr. Weitzner.

    Do you agree with the opinion that crystalens must be implanted in both eyes (within 2 weeks) due to visual imbalance that can result with one natural uncorrected eye and one artificial lens?

  • I had a Restor lens explanted, and it was discovered in the explanting of this lens, that the Restor was not properly anchored in my eye. There were missing zonule fibres. Whether they were already missing or went missing during the surgery, I have not idea, but the doctor never put a tension ring in to secure the Restor lens. Is this something the surgeon may not have seen? I could not see properly with this lens and perhaps it was because it was loose in my eye. Please may I see a response.

  • ari

    if you were happy with -1.25 before the cataract, then i would simply aim for that, but that prescription is better for arms length vision. not closer vision. there is no need for a second opinion- small changes in the prescription can occur as the lens settles in.

  • ari

    karen- the crystalens now corrects astigmatism. remember that crystalens is best for intermediate vision, not closer reading vision.
    the timng is based purely on your desire to fix the vision. you dont have to wait

  • Update:

    Yesterday, I sat down in my studio and found that detail work was much easier than last week.

    Today I went in for my 2 week exam and when I looked @ the eye chart found that my vision has changed substantially. My doctor says that my left eye is @ -2.00. Is that 20/40 vision?

    I am happy that I can see to do detail work close up and @ arm’s length, but am wondering if my vision will keep changing? My original prescription glasses that I brought to my pre op visit back on October 28th are -1.50 in the left and -1.25 in the right. Should I get a second opinion before going forward w/ cataract surgery in my right eye or are these kinds of experiences normal? I was happy several years ago with -1.50 in the left and -1.25 in the right.

  • Hi Dr. Weitzner!

    I am 53 years old and just had cataract surgery on my left eye two weeks ago. The cataract had become severe. I have a cataract in my right eye and have been given a -2.25 disposable contact to wear in it until my surgery.

    Before I went in to have my left eye corrected, I explained to my doctor that I have been near-sighted my entire life. I work with animals and I am an artist. In my free time I love to read, cook and work on the computer. In short, everything I love and indeed my very livelihood require excellent vision up close. I do not mind wearing glasses for far, but I do not want to spend all day wearing them. I have no interest in multifocal lenses as I was happy with my vision before the cataracts. After I explained this to my doctor during the consultation, I asked if I could bring in my glasses from about 13 years ago and have my eyes adjusted to wear that same prescription and she said I could.

    During the pre op visit. I brought the glasses. Her tech took them and made note of the prescription. A little later my surgeon entered the room and said, “We’re going to adjust your vision for far…” Before she could finish I said, “But doctor, I need to be nearsighted.” She looked surprised and said, “Oh, so you want your vision to be here?” And she motioned with her hand stretched out in front of her. I repeated that I wanted to be able to wear my old prescription so that I could work well up close and just use the glasses for driving and going to movies. She made a note and told the tech to adjust me for…And I could not hear the rest. I had the feeling that she did not remember our conversation about how important near vision is to me.

    I want to say that this is a surgeon who is very experienced and has been @ the same hospital since 1980. I respect her. And I am so grateful that when the bandages came off I could see. During my post op visit, I could read the 20/20 line on the chart. Her tech told me that the doctor had adjusted me to 20/30 because I wanted to be able to see close up…but here’s the thing…I can’t.

    When I put my old glasses on I can see far off just like I did before. Without my glasses I can work @ the computer and cook, but when I am @ my job working w/ animals, when I have to pull one up close, it is out of focus. When I read I have to hold my book @ arm’s length and in the grocery store I have to hold everything far away from my face to focus on it with the left eye. The hardest thing is when I sit @ my desk to draw or paint. I am not able to do detail work with any precision. I close the right eye (the one that still has a cataract) and try to focus @ arm’s length. Then I close my left eye and move in very close w/ the right eye which has a contact on it. I am able to compensate this way. However, I need a solution that is better than this. I plan on creating art for the rest of my life and I can not afford (nor would I ever want to) injure an animal.

    So here’s my question: What type of adjustment should be made on the right eye to get me where I need to be and how do I communicate that to the surgeon?

    I look forward to your response. Thank you!

    My next appointment with my doctor is in two days. What do you suggest that I

  • Karen

    Hi. I was just diagnosed with posterior capsule cataracts (although have never taken steroids or have eye trauma Hx) and am 39 years old. I have poor distance vision (approx -2.75 to -3.0). Left eye has small astigmatism right eye has no – slight astigmatism. There is a trace of PSC in the left eye and a level 2 in the right eye. Right eye corrected vision cannot get better than 20/30 currently. Reading vision is/was perfect (right is becoming degraded due to cataract). My career requires lots of screen time and some reading. Dr. has recommended crystalens, but we are monitoring it over the next 6 months to see if it worsens.

    I am wondering if this is a bad recommendation given the report that crystalens cannot correct astigmatism. Should I wait as long as I can to have lens replacement given my age? Any thoughts on possible/best course of action would be appreciated! Thank you.

  • Dr. Ari Weitzner

    crystalens wont work well with astigmatism, unless you are getting the new toric crystalens, or the surgeon is doing lri’s for the astigmatism.

  • Colleen

    I am more confused than before now. I am 46 and am a RN that works midnights at this time. I was dx with having cataracts due to steroids I was taking for PCOS. My Dr. is recommending crystalens implants for me but, I am worried about what my vision will be after. I am having the left eye done first because the cataract and vision are much worse than the right. I also have astigmatism in the right eye so am worried that the crystalens wont be right for the right eye. Please help any advice would be greatly appreciated.

  • ari

    every surgeon can break a capsule. every one. even me. it happens even to the best of surgeons sometimes. luckily its not common at all, especially for experienced surgeons. compromised eyes- like retinal detachment- are more prone to this complication. but if handled well, it often leads to no problems for the patient. breaking capsule is NOT malpractice.

    if the implant dislocated and caused an acute glaucoma, that is suspicious for an implant that was not implanted correctly. that never happens if the implant is in the correct position. so i suspect that the surgeon broke the capsule and the implant was not implanted correctly, or somehow the implant dislocated right after the surgery was over. of course, its hard for me to know for sure w/o examining you, but that is my suspicion.

    the possibility of this happening to the other eye is almost zero. this is an extraordinarily rare complication. so i would proceed with a regular implant in the right eye and go for like a -2.00 or -3.

  • Ling

    My story is different from any one of above. I am 62 years old. I had retinal detachment surgery for my left eye in Jan. 2012. I am nearsighted and both eyes used to be around -5.0. After the surgery, however, the left eye’s vision became -9.0. My optometrist couldn’t correct it to 20/20 which is what I could see before the surgery. I visited the retinal surgeon two months later and he told me the left eye got cataract caused by the retinal surgery and he suggested me to see a specialist for the cataract. In May 2012, I got cataract surgery and a mono focal IOL was implanted in my left eye. The doctor didn’t want to give me multi focal lens because I have retinal detachment history. My left eye was corrected to -2.0, he said that will help me for reading purpose. He gave me soft contacts to try for my right eye. In August 2012, he did YAG on my left eye to eliminate star bursts. That worked pretty well, the eye can immediately see much clearer and star bursts are totally gone. He told me to get new prescription from my optometrist. He asked me to see him in 6 months if in case my both eyes cannot get balanced with new prescription. Both my optometrist and I found it is very difficult to make my eyes work together, since each eye has different vision (-2.0 vs. -5.25), both eyes have astigmatism(not significant), byopia and prism. After trying all options and combinations, finally I use a hybrid contact lens for my right eye alone, that is something like monovision people talked about in here, however, I never feel comfortable with it because there is always some blurriness whether looking near or far.
    In Feb. 2013, I visited the doctor who did cataract surgery for me last year, he recommended to have cataract surgery on my right eye even thou the cataract in right eye is very little but he said because both eyes cannot work together and get balanced, I’m eligible for the surgery and the insurance will cover it. At this time he still doesn’t want to give me multifocal lens. He said multifocal lens for one eye may even cause more problems.
    I then went to another doctor for second opinion. My both eyes were dilated in that doctor’s office. In the evening of that day, I felt severe pain around my left eye and gradually the left eye lost vision. I called the doctor and he wanted to see him immediately. We met in his office and he found that the IOL in the left eye shifted forward to in the front of the eye, the lens blocked the way the eye fluid goes, that caused very high eye pressure (60, the normal is 8-16), it’s just like glaucoma, and he said if it is not fixed immediately the entire vision of the left eye could be permanently lost next day. So he used laser to punch 4 holes in my eye to reduce the pressure. In about 30 minutes, the pressure was down to 40, the pain was reduced and the vision came back. He told me that because my capsule was broken, it cannot hold the IOL properly, when the eye is dilated, it gives the lens a chance to move forward. That was Friday night, so he told me to see him Monday morning, he would try to make the lens go back to right position. What he did in Monday morning is to let me lie down and dilate the left eye trying to let lens go back, it never worked, even worse, the lens flipped upside down. It seems surgery will be the only choice to fix the problem. He referred me to a retinal surgeon for the surgery. The surgery is scheduled to be done on 4/12/2013. The surgeon said the first option is to flip the lens and put it back to posterior chamber where the IOL used to be. If it’s not successful, the second choice is to replace the lens, but the new lens will be put in anterior chamber (the new lens is specially designed for this purpose).
    After the horrible experience above, I’m so worried about the outcome of the coming surgery. I’m very angry for the surgeon who did cataract surgery on my left eye, though non of the doctors wanted to tell me the truth why or who broke my left eye capsule, I’m sure he did.
    Mr. Ari, have you ever heard anything like this? If the outcome is good for the left eye surgery this time, what type of IOL you will suggest for my right eye in future? I appreciate your opinion.

  • ari

    if you are not a good candidate for multifocal, you should thank him for being so honest.
    either get corrected for distance, for reading, or do monovision- 1 eye for each. if your eyes are otherwise healthy, you shoud see very well either with or without glasses, depending on what prescription you choose.

  • I am a 58 years old nearsighted person with -9 for the right eye and -8 for the left one. A cataract have been developing in my right eye since more than one and half year and now started to interferes with my daily life activities specially night driving. Today I visited my eye Dr. Specialist who suggested to have the cataract surgery and to implant a mono-focal IOL for both eyes and he mentioned that a multi-focal lens is not suitable for me and he mentioned that I have to have an eye glasses for readings but he mentioned that even with the eye glasses I have to expect a difficulty in reading and see things clearly in short distance. Can any one of the forum participants comment and suggest better alternatives.