# Optical Forums > General Optics and Eyecare Discussion Forum >  ReStor lens for cataract surgery

## Happylady

My Mom is scheduled to have cataract surgery next week. The Dr. is recommending the ReStor lens. I had not heard of this lens before today. Does anyone know anything about it? Any stories of it good or bad?

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## chamilun

she has obviously opted for an 'accomodating' IOL, which attempts to lessen the need for reading glasses after surgery.

two choices that are popular now are Crystalens and Restor.

The crystalens appears to be better for distance and intermediate, while the Restor is a bit better for near, OK for distance, but not great for intermediate.

She might want to make sure her surgeon offers both so that he/she is not simply putting her into the one that he offers.

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## Happylady

He does offer both Crystal lens and ReStor. She was planning to go with Crystal lens after talking with the tech there. The doctor recommended the Restor because her close vision is very important to her. She does use a computer, but she figures she can keep a pair of glasses by the computer if she needs to.

Her distance vision is also very important. The doctor assured her that her distance vision would be as good with ReStor as with Crystal lens but that she might have some glare with night time driving.

I am concerned that you said the ReStor gave okay distance vision. Are there problems with it other then glare with night time driving?

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## chamilun

it appears that many people need, say, a pair of -0.50s for night driving or driving in general.  as the surgeon said, the main advangtage of the restor is the better near vision.

there are other variables as well, however, including the power of the implant.  the power makes a huge difference for how the crystalens performs.  the higher the power, the better the reading vision.

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## Bev Heishman

Pupil size.....is the answer to success for any accomodating IOL as well as LASIK. It should never be under estimated  in different lighting . Complaints center around problems in dim light if the pupil is larger than the diffractive zones. Another problem with glare is from certain types of haptics in  IOL's

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## Robert Martellaro

> "close vision is very important to her"
> 
> "Her distance vision is also very important".


She should use a standard IOL if she wants the best possible vision. 

Halos at night are a real concern with the Restor IOL. 

Some surgeons "over sell" these products. Get all the information you can get your hands on. Postpone the surgery until you have enough info to make an informed decision.

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## Happylady

She did consider the standard IOL but she was told that she would need glasses for both close and distance. She wears progressives, but is able to remove her glasses for extra good close vision. She wouldn't be able to do this.

From what I read the problems with glare at night is about 5%. She has glare and halos from the cataracts now. 

 I am concerned about distance vision other then night time driving. I understand that with this lens the person is actually seeing through both the distance and near portions of the lens at the same time and "blocks" the blurry image. 

I know I tried this with multifocal contacts and it blurred my distance vision. I could see 20/20 but it was ghosty and not sharp. The doctor assures me this IOL is different, but I am concerned. It is much easier to put a contact on and off then to redo a IOL.

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## Robert Martellaro

She did consider the standard IOL but she was told that she would need glasses for both close and distance. She wears progressives, but is able to remove her glasses for extra good close vision. She wouldn't be able to do this.

That's not true. They can order an IOL that will come very close to providing the same RX that she wears now. 

From what I read the problems with glare at night is about 5%. She has glare and halos from the cataracts now. 

Right. The statistics are generated from test subjects who already have compromised vision. Try a multifocal IOL on a person with healthy eyes (this is being done outside of the US) and you will get lots of complaints from halos and blurred vision. Keep in mind the FDA trial subjects are risk takers to start with, hand picked, using surgeons who were extensively trained by the IOL manufacturer.

I am concerned about distance vision other then night time driving. I understand that with this lens the person is actually seeing through both the distance and near portions of the lens at the same time and "blocks" the blurry image. 

Yes, it's a multiple ringed IOL.

I know I tried this with multifocal contacts and it blurred my distance vision. I could see 20/20 but it was ghosty and not sharp. The doctor assures me this IOL is different, but I am concerned. It is much easier to put a contact on and off then to redo a IOL.

All you have to do now is to convince your mother that her doctor might not be making a recommendation based on her best interests. Might be a tough nut to crack with that generation. Good luck.

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## Happylady

We were told that because of her astigmatism that with standard IOLs that she would still have some distance correction. I asked about leaving her nearsighted about a -3.00 so that she could wear progressives and take them off for near if she wanted. I was told that even if she was left nearsighted that the way the standard IOls work that she would not be able to see up close without correction.

Her glasses have are about -3.75-1.50, but I don't know what the new correction they came up with yesterday is. The doctor told me that the astigmatism would not be a problem with the ReStor.

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## Robert Martellaro

If the astigmatism is corneal, I would think she would have a diopter and half cyl post-op. Ask the doctor about "Limbral Relaxing Incisions" that might substantially reduce the cyl correction. This would be done at the same time as the IOL. Also ask about clear corneal incisions and topical anesthesia. 

Regards,

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## Bev Heishman

Alot of times the cataract it self is the cause of a larger degree of correction for astigmatism. Ask if the astigmatism is corneal or cataract lens induded. Robert mentions one way to reduce it another is with LASIK post-operatively.

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## Rophod

The majority of post op compaints my patients have are from multifocal IOLs and the newer accommodation IOLs.  They have small optic zones and do create some glare and halos in those with larger pupil.

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## snowmonster

I'm annoyed by the surgeon in this case.  He claims that the standard IOL not produce good distance vision and blames it on astigmatism, but the two accommodating IOL's do not correct astigmatism, so he must be performing limbal relaxing incisions but only if you get the accommodating IOL.

Realize that the accommodating IOL's are not covered by insurance and that some (hopefully not all) Ophthalmologists are pushing these to receive more money from the patient and be more profitable.

Realize nothing will "restore" vision back to how it was in her 20's and 30's, and some can actually cause problems if you're sensitive to some of the side effects that others have mentioned here.  Explanting an IOL isn't really a great option to deal with this stuff either, and of course you won't get your money back if you don't like them.

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## ilanh

I think the Restor lens is pretty good.  I have taken the certification course and, as of now, have followed one patient with the Restor lens.  That was a 72 year old who ultimately saw 20/20 and J1.  How many 50 year olds can say that?  Limbal relaxing incisions are certainly advisable for anyone with over 1 diopter of astigmatism.  Night glare and halos probably occur in 5-10% but are not disabling.  Unless you're a professional driver or trucker it was not a serious problem in the studies to date.  Overall, having seen this lens personally and spoken to a number of colleagues I am fairly impressed.

Ilan Hartstein, M.D

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## jmbeam

I made the mistake of my life going with Restore lens. I had one cataract and had both the lens in my eyes. Theproblem started when after the first one was inserted . A day before the second one was to be surgically placed my Physician says OOPS I didnt know that ALCON did not make a lens in the strength that my eye required! He said that he would have to perform Lasik to bring my eye up to the tight prescription. So now I have to go under the knife(laser) again. How in the world can a professional goof up like this on the second patient in his practice to have this new lens. Where are the office protocols? I would have thought that there would be a check list that would be checked at least twice to make sure everything is in  place. I am not sure if it is because I do not have the right strength lens in but my vision stinks. I cannot read a newspaper unless I have a high powered light shing on me and my intermediate vision is horrible. This product has been way over sold and patients need to step back and really make a conscious decision and decise if they want to go with this new technology. I honestly now think it is all about the money. I read all the clinical trials and how 90+% of the patients loved this lens. I would like to meet these so-called happy people and ask them some questions. BTW I am only 53

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## Happylady

I am sorry you are having problems with this lens. My Mom had her left eye done with it 8 days ago. At first her vision was blurry, but now she says the distance is sharp. The near is getting sharper, but is still not perfect. The doctor told her it could take a couple of weeks for the near vision to clear up.

She goes back in 5 days to have it checked and if all is well will have the right eye done the next day.

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## ilanh

[QUOTE=jmbeam]I made the mistake of my life going with Restore lens. I had one cataract and had both the lens in my eyes. Theproblem started when after the first one was inserted . A day before the second one was to be surgically placed my Physician says OOPS I didnt know that ALCON did not make a lens in the strength that my eye required! 

I'm not exactly understanding what you're saying.  It sounds as if you had the first Restor IOL implanted in one eye and that went OK.  Then you needed it in the second eye and they did not have a lens available in that power?  If you don't mind my asking; what is your prescription?  Unless you have an extremely long or short eye the Restor lens should be available.  I am, therefore, assuming that you must have an extreme prescription for which Restor is not available.  If that's the case then I agree that they should have known that before.  However, I have a feeling that you will be very satisfied after the Lasik.  We are beginning to realize that a good percentage of Restor patients may need to be supplemented with Lasik to get the really perfect results.  Most Restor surgeons (such as myself) are mentioning this upfront and offering a sharp discount in the Lasik if it is absolutely neccessary postop.  I am hoping that most of my patients will be perfectly happy without the neccessity of additional Lasik; however, it is only fair to warn them upfront.

By the way: Restor is not about the money.  Even though there is more money involved it is mainly about offering multifocal vision to patients.  I have seen the look on patient's faces when they can see distance and near without glasses after 50 years of dependence.  I think that's it's the next evolution in the IOL.

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## acredhead113

After reading all these posts I have some doubts. If the MD would answer some questions for me. I am having surgery in about two weeks on my left eye. My night vision is scary!! My right eye with my glasses on is just great. I think the Dr. said I had a +.75-2.00 in this right eye. He wants to wait a week after the first to do a second cataract surgery on the right. He says I have a small cataract on it as well. My question is if it is not ready yet why do it?

As far as the IOL standard my parents had theirs done in their 60's. They are both very happy with this plan. They still wear eyeglasses for reading. Only one problem my dad had was after awhile I do not remember the time frame he had to have a lazer on one eye because he saw cloudy. They fixed that. Of course they did not have the MF implants then. I was looking at a article on the web and it said that some patients wanted the MF removed and the standard put in because of multiple images at night. So why are the doctors pushing a lens that would cause problems when the standard is okay? I for one like to wear glasses. My MD told me I would have to wear sunglasses anyway!

What is the cost difference for a standard implant vs. the MF implant?

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## EdWhite

I think this is very similar to the contact lens options.  Robert Martarello made some excellent points concerning the use of clinical trials to support Restor and other multifocal IOLs.  You have to look at the patients in the trial.  Many have other pathology such as macular degeneration.  Also, many have reduced demands.  For a 75 year old with a less demanding lifestyle, they may be ok.  But, my observation, based on feedback from real patients is that they may be able to perform relatively well on Snellen acuity tests, they are not very happy.  Again, just like the multifocal contacts, Snellen doesn't fully measure quality of vision.  I see lots of patients read 20/25 or 20/20, but state "it just doesn't look clear".  When I ask them if they would go that route again, they generally say no.  "I would rather just use reading glasses".  
I'm a very active 51 year old myope.  I've tried the various contact lens options and there is no way I could live with the compromises of the multifocal lenses.  
The bottom line is that this technology just isn't ready for widespread use.  With carefully selected patients and adequate pre-op discussion there is a place for them, but the technology is far from mature.
For now, conventional implants are the best bet for a more active, demanding patient in my opinion.

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## chamilun

The trials only include patients without pathology.  this is why sometimes they may be BETTER than what the clinicals find

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## jmbeam

After a cataract procedure I was told that at times a capsule forms on the eye that creats havoc with ones sight. This condition can be easily taken care of with a Yag laser. Is this true and if this occurs in my eye is it a condition that a Physician really has to look for to see it or is obvious? I am concerned for a couple of reasons. Thanks for any input on the subject.

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## chip anderson

Usually the patient notices the vision going South, similar to cataract development (sometimes misnomered as a "secondary cataract).  If no the practioner will catch same during routine follow-up or yearly exams.  This occurs in 50% of cataract patients.  And be not dismayed the laser zaping takes about 5 min, no recovery time and you walk out of the office seeing again.

Chip

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## jmbeam

> Usually the patient notices the vision going South, similar to cataract development (sometimes misnomered as a "secondary cataract).  If no the practioner will catch same during routine follow-up or yearly exams.  This occurs in 50% of cataract patients.  And be not dismayed the laser zaping takes about 5 min, no recovery time and you walk out of the office seeing again.
> 
> Chip


Does the patient need to have his/her eyes dilated for the MD to be able to see this?

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## chip anderson

I doubt dilation is needed but it would give the doctor a much clearer view of what he was looking at.  What difference does it make if the doctor needs to dilate him or not,  dilation is not major invasive surgery.
Chip

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## acredhead113

Does anyone know how much a cataract surgery costs? I have no insurance and I am too young for medicare!

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## chip anderson

A lot less than trying to make a living blind.

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## acredhead113

FUNNY! Seriously do you know the amount?




> A lot less than trying to make a living blind.

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## acredhead113

> FUNNY! Seriously do you know the amount?


Hey Chip. Just thought you would like to know. I am no longer unable to see with my left eye. I see great! The out of pocket cost for the procedure was $825. I have no insurance and I have no medicare benefits since I am underage!

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## chip anderson

Look I just paid $8000.00 for shoulder surgery.  Why because I need my right arm to make a living and for other things.  It's a lot of money but I would loose a lot more not useing my right arm.

Since when do we have to have some third party paying all our bills.  $825 is what 10 days pay?  And you don't have to go through rehab for a cataract.

If you had insurance you would have paid a lot more for the premiums, so pay for the surgery.  Unless of course you don't really feel seeing is important.

Chip

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## acredhead113

[QUOTE=chip anderson]Look I just paid $8000.00 for shoulder surgery. Why because I need my right arm to make a living and for other things. It's a lot of money but I would loose a lot more not useing my right arm.

Chip:

I really am saddened that you had to have shoulder surgery! I hope you will recover soon!

Since when do we have to have some third party paying all our bills. $825 is what 10 days pay? And you don't have to go through rehab for a cataract.

I think our insurance programs are overrated!! Yes I would rather pay it out of my pocket. It is less!!

If you had insurance you would have paid a lot more for the premiums, so pay for the surgery. Unless of course you don't really feel seeing is important.

The most important thing is seeing do'nt you think!! Good luck on your recovery

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## Happylady

I thought I would post an update on my Mom's surgery. She had the left eye done with the Restor lens 4 weeks ago and the right eye 2 weeks ago. She is seeing 20/40 in the distance and that is probably about as good as she will be able to see. The doctor found some cell changes in her retina and can't correct her vision any better. However she is seeing better without glasses in the distance then she saw with glasses before.

She can read without glasses, but small print is blurry and she needs a good light. She got a prescription today for glasses with a +2.50 add. I am surprised at the add. The distance is
right eye -1.00 +1.00
left eye   +.25  +.25

I am going to make her a pair of progressives this week.

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## chip anderson

Add means that the implant is not working as a bifocal.  +2.50 is pretty standard for all aphakic patients without macular problems.  20/40 ain't bad, you can get a driver's license most places with this.

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## Happylady

> Add means that the implant is not working as a bifocal. +2.50 is pretty standard for all aphakic patients without macular problems. 20/40 ain't bad, you can get a driver's license most places with this.


Yet she CAN read with no add. She can read J2 on the card at the doctor's office, she read the menu at a restuarant the other day without any correction. I showed her some small print and she read it to me.

She says that the reading card the doctor uses is very black and white and books and newspapers are more gray. She is also trying to read with a 100 watt lightbulb in a lamp with a medium brown shade. She scoffs at me when I suggest she get a stronger lightbulb. I think I will just buy her one!

She used to be about a -3.75 and is used to be able to see very well up close without any correction.

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## chip anderson

From what you say so far, it sounds like the doctor checked distance only, didn't remember the new implant was supposed to be bifocal and just prescribed +2.50 std. aphakic reading addittion.   If she can read with nothing, and does not require a minus distance Rx, she sure doesn't need a +2.50 near.


Chip

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## Happylady

> From what you say so far, it sounds like the doctor checked distance only, didn't remember the new implant was supposed to be bifocal and just prescribed +2.50 std. aphakic reading addittion. If she can read with nothing, and does not require a minus distance Rx, she sure doesn't need a +2.50 near.
> 
> 
> Chip


My Mom told them she was having problems seeing small print. They had her look through  +1.00 readers but she said it wasn't strong enough. They gave her another pair to look through and she said it was better, it was a +2.00. Then the doctor wrote the rx for +2.50. 

I bought her a 150 watt repose light bulb and she says it is better. She can read, but really likes the add better.

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## ilanh

The Restor lens provides a surprisingly high add (around +2.5).  Actually, the add is less of a problem than the distance.  The distance can be subjectively diminished because of the diffractive zones, night halos etc.  However, the reading vision is turning out to be rather good.  Therefore, it's not feasible that after surgery a patient would be given a +2.50 add with a Restor lens.

Calculations for the IOL implant have had to change somewhat with the Restor lens.  Traditionally we calculated on the minus side so that if we got a minus "refractive surprise" then at least the patient could read.  For example, if we would up with -1.00 instead of plano, the patient would still be happy because they had good, uncorrected intermediate vision.  Likewise, if they wound up -2.00 they would have good close vision.  However, winding up on the plus side would leave them without distance OR near vision.  The Restor lens, however, is changing this.  If you plan for the minus side they can wind up with near vision so strong that it involves moving the print to an uncomfortably close distance.  We are therefore targeting now on the plus side so as to avoid this.  This, ofcourse, leaves us in the uncomfortable position of winding up with +1.00 or more which can cause distance blur.

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## Spexvet

> I thought I would post an update on my Mom's surgery. She had the left eye done with the Restor lens 4 weeks ago and the right eye 2 weeks ago. She is seeing 20/40 in the distance and that is probably about as good as she will be able to see. The doctor found some cell changes in her retina and can't correct her vision any better. However she is seeing better without glasses in the distance then she saw with glasses before.
> 
> She can read without glasses, but small print is blurry and she needs a good light. She got a prescription today for glasses with a +2.50 add. I am surprised at the add. The distance is
> right eye -1.00 +1.00
> left eye +.25 +.25
> 
> I am going to make her a pair of progressives this week.


Was your mother's ReStor lens covered by insurance?

Does anyone know if United HealthCare (or any other ins. co.) covers ReStor lens and/or surgery?

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## Happylady

> Was your mother's ReStor lens covered by insurance?
> 
> Does anyone know if United HealthCare (or any other ins. co.) covers ReStor lens and/or surgery?


She had to pay $1,950.00 per eye.

The doctor I work for says it is possible that my mom is getting glasses with a +2.50 add is because she has pre or early macular degeneration. The doctor saw some cell changes in the back of her eye and they can only correct her to 20/40.

I only know this because I went in with her for her first follow up. I am sure she wouldn't have told me, she is very close minded about stuff like that.

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## acredhead113

I have a optical question! Since my operation on my left eye the doctor said it was ok to use my old glasses. 

My right eye I can use for reading up close. My left eye I see very clearly for distance.

Is there any problem using my glasses like this until I get my new RX?

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## chip anderson

Your doctor said it was OK, don't you trust him?   It's fine unless you plan to wait an extremely long time to have new Rx filled.

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## acredhead113

> Your doctor said it was OK, don't you trust him? It's fine unless you plan to wait an extremely long time to have new Rx filled.


I am a opend minded person. I like to ask other people's opinion then make a decision I can live with! 

Kind of like reading the newspaper. Do you believe everything that is printed?

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## fjpod

I predict that we will see problems with these IOLs similar to those seen with multifocal CLs.

Most of my post op cataract pxs see surprisingly well with a non-accomodating IOL if their distance is plano.  If their distance is -1.00 they think their near is great, and they don't notice distance blur because they are seeing so much better than they were before the surgery.

You all realize that eye surgeons are asking over $2000 over the medicare fee, per eye for these lenses as they are not covered.;)

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## ecsoptical

The reason MD's are asking so much now is b/c this is thie most expensive iol they've had to buy (couple of hundred vs almost a thousand). but unlike a standard IOL more testing is involved (refractions, orbscans, wavescans) more time is spent talking to and training the person. It is not the standard sx then back to your optom.  When we started using the Restor, we thought we might do 4-5 a month, we are doing 4-5 a day.  Cost is what peolpe are willing to pay.  Hopefully though after a while the IOL will come down, Or Insurances will cover the presbyopic portion of sx.

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## acredhead113

> The reason MD's are asking so much now is b/c this is thie most expensive iol they've had to buy (couple of hundred vs almost a thousand). but unlike a standard IOL more testing is involved (refractions, orbscans, wavescans) more time is spent talking to and training the person. It is not the standard sx then back to your optom. When we started using the Restor, we thought we might do 4-5 a month, we are doing 4-5 a day. Cost is what peolpe are willing to pay. Hopefully though after a while the IOL will come down, Or Insurances will cover the presbyopic portion of sx.


I was offered the standard IOL or the new MF implant. After doing research on the internet and asking questions on this board I came to the conclusion that the standard was the right option. 

At first when I found out the cost was just a bit more I would take the new model. But after asking questions the money was not the issue. The way I want to see after the surgery is more imortant to me.

My surgery with a stitch to correct for not having to use glasses all the time only reading glasses came to a grand total of $920.

I am under the medicare age so I paid for it out of my own pocket. Seems like when they know you have insurance the price goes way up. Sounds like you need to do some negotiation on how much you are willing to pay!

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## optical sam

Just wanted to thank the forum participants for this thread. As a cataract surgeon who is not currently using the restor, I am struggling not to get caught up in the excitment. If someone is paying 1900 to 2000 dollars more for the procedure with a multifocal/pseudoaccomodating intraocular lens (IOL) we need to be careful that the results support the cost/effort. 

TO date in my own practice, i target between -1 to -2 in the non dominant eye with a monfocal implant to provide the patient with solid near. The dominant eye is targeted for plano. Even patients that settle in the lower myopic range ---0.5 to -1.0 can read a clear j3 on the near card. -1.50 to -2.0 will net j1+. A little trial with monovision contact lenses if the cataract is not too bad is helpful. I have also suggested some trials with multifocals in select patients but my colleagues do not necessarily agree that this is a good test model. Some patients LOVE multifocal contacts, others do not. If in the best hands the acceptance rate is 75 to 80%, how could it be any higher with a multifocal IOL? 

Today oct 2005 for my eyes i would still lean towards a mild mono in the non dominant eye and perhaps a wavefront (low spherical aberration) optimized IOL for the dominant eye. I would wear a nice light single vision for night driving and extreme visually demanding distance tasks. If i were retired like most of my patients who only day drive and rarely night drive, i would rarely wear glasses at all. 

THis discussion is probably the most honest, straightforward, optically based information exchange I have read to date on this IOL.

Sam

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## ecsoptical

Thank you Sam for your comments.  In the practice I work at, until the Restor Iol came out, we shot for around -.75 ou to help with accommadation and adjusting more or less with the second eye if the pt wanted more near or far. Most peolpe are perfectly ok with that ,and like you, may only wear glasses for somethings some or the time, but glasses were almost 100%  for somethings.  So far, If you believe the liturature, 80% never have to wear glasses for anything. And our practice is finding close to FDA trial numbers. Call it vanity or whatever, but glasses and reader have a stigma to them about being old.  And if someone wants the best chance and not needing glasses at all, then Restor is for them.  Most of uor agruements between is one lens better or anthor is mute.  As with frames and lenses and contacts, our job is to present the facts and help the pt come to a decision best for their life. For some money may be an issue (i know it is for me).  If not for working in this practice I couldn't afford Lasik but it has been the best thing I have ever done. It's expensive, but to have a chance not to wear glasses peolpe do it. Restor is a choice, people with the will and the means have anthor option

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## Happylady

My Mom got her progressives with the +2.50 add and is happy again. She CAN read with her Restor lens with a very good light and if the print isn't too small. She is much more comfortable with her progressives. I think she will probably wear them almost all the time.

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## chip anderson

Happy:  Most aphakic patients can read quite well with a 2.50 add in any kind of lens, so what is the restore lens doing for her?

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## jmbeam

Hello again, I am gun shy with my surgeon who placed the retor lens for me. She erred after the first eyr was done by not realizing that Alcon did not make a lens strong enough for me. She had to put in the strongest one Alcon had but it was still not strong enough. Sorry she said(What ever happened to crossing or T's and and dotting our i's?) She said no problem I can touch it up with Lasik. I am not seeing well, I am seeing OK distance wise until it gets dark and if I dont put on my 2.5 glasses I cannot drive at all at night. My intermediate vision stinks(this is a point that patients should be concerned about before having this procedure. They do not emphasize this enough how affected intermediate vision becomes) and my reading is not good either. I was also told by another surgeon that I have a secondary cataract growing which my original surgeon did not notice. So you see why I am hesitant in going back to her. My question is  Could the reson why my vision is not up to par even with glasses is because the fact that I have a wrong and weak prescription Restor lens in my eye that this is affecting all the parameters of my overall vision? DO the MD's on this forum think that if I correct my etes with Lasik that it will affect the Restor lens positivly and all facets of my vision will improve? I am also thinking of having the Restor taken out and just go with basic lens. I feel that they over promoted this Restor lens. Currently I have to use a 30" computer monitor with large font to use a computer.  I still want to kick myself because my vision was pretty good before even with my one Cataract. It just seemed to good to be true to be able to have the cataract fixed and then not having to wear eye glasses again. I also used to like to be able to take my glasses off and look at things very close. Imp[ossible to do that now. Now I am constantly switching glasses. I cant wear them when using the computer and for intermediate viewing. Need to put them on for driving but they still feel over powered. I am so confused and don't know who best to trsut to steer me in the right direction.

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## Happylady

> Happy: Most aphakic patients can read quite well with a 2.50 add in any kind of lens, so what is the restore lens doing for her?


Ha, Ha....well it does help at near. She was wearing a +3.25 add before and still removed her glasses to see small print. She used to wear more then a -4.00.


We went out to breakfast on Sunday and she easily read the menu without any correction. The light was good and the print was very black against white. With a standard implant there is no way she would have ANY close vision. In the real world newspapers tend to be gray and light is not always good.

She is wearing her glasses all the time and is happy with them.

She is having no problems with her night time vision with this lens.

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## ilanh

Regarding JMBeam and his problems following the Restor lens.  Some of your complaints are due to a misunderstanding of what the lens is supposed to do, but some may indeed be due to a basic weakness of lens design itself.  The Restor lens does do a good job at correcting near vision and generally provides a high near add in the range of +2.5.  Consequently, intermediate vision is not ideal with this lens even though it is a multifocal lens.  People who see ideally for a particular range of vision before refractive surgery must always be prepared to possibly lose this postop.  For example, the -3.00 myope who sees perfectly at near without glasses prior to Lasik may lose this ability postop if they're in the presbyopic age range.  Therefore, they've traded perfect uncorrected distance vision at the expense of uncorrected near vision.  The Restor lens is also in the same category.  People with good intermediate vision preop may lose some of that postop.  However, distance vision is a different problem.  If you have a resultant postop refraction and are able to see well at distance with that refraction then it is true that a Lasik "touch up" will solve the problem.  However, if you are unable to see well at distance no matter what prescription you wear then the problem will be one of three things.  You could have a capsular membrance behind your lens implant which will need removal with a Yag laser (a quick and easy procedure).  You could have cystoid macular edema or some other retinal problem which is limiting your vision.  Or you could have a problem with the multifocal lens itself ie: the concentric zones are decreasing contrast sufficiently to affect you.  The first two conditions are easy to rule out.  If the third is the case then you will have to have the Restor lens explanted and replaced with a monofocal lens.  You will not be the first to have this done (it's unusual but it happens).  Good luck,

Ilan

----------


## acredhead113

> Just wanted to thank the forum participants for this thread. As a cataract surgeon who is not currently using the restor, I am struggling not to get caught up in the excitment. If someone is paying 1900 to 2000 dollars more for the procedure with a multifocal/pseudoaccomodating intraocular lens (IOL) we need to be careful that the results support the cost/effort. 
> 
> . 
> 
> TO date in my own practice, i target between -1 to -2 in the non dominant eye with a monfocal implant to provide the patient with solid near. The dominant eye is targeted for plano. Even patients that settle in the lower myopic range ---0.5 to -1.0 can read a clear j3 on the near card. -1.50 to -2.0 will net j1+. A little trial with monovision contact lenses if the cataract is not too bad is helpful. I have also suggested some trials with multifocals in select patients but my colleagues do not necessarily agree that this is a good test model. Some patients LOVE multifocal contacts, others do not. If in the best hands the acceptance rate is 75 to 80%, how could it be any higher with a multifocal IOL? 
> 
> Today oct 2005 for my eyes i would still lean towards a mild mono in the non dominant eye and perhaps a wavefront (low spherical aberration) optimized IOL for the dominant eye. I would wear a nice light single vision for night driving and extreme visually demanding distance tasks. If i were retired like most of my patients who only day drive and rarely night drive, i would rarely wear glasses at all. 
> 
> THis discussion is probably the most honest, straightforward, optically based information exchange I have read to date on this IOL.
> ...


Optical sam:

I had my left eye operated on about a month ago. The MD told me I could have either. It was my choice. The MF cost more. After looking on this board and reading more about it on the internet I told him I wanted the standard IOL implant. I am 57. I still work. I still drive at night. I still do all the things that most people like to do. My Dad is 82 this month. He has had implants in both eyes. He agrees with me. He wants to be able to see the best that he can for at least 18 more years. He said new is great as long as it takes into consideration the needs and wants of the patient. You see my Dad thinks he is still young and wants the same as us younger people, just plain good vision for everything. If this new Restor lens does not meet all his requirements they need to improve it instead of trying to sell people on a bad idea.

----------


## fjpod

FWIW...I'm an OD with 27 years experience of managing post-op cataract care.  Compared to the days when we fit aphakic spectacles and CLs, today's posterior chamber IOL patients generally get 20/25 BVA with no glasses...and if we can get one eye to come out at -.75, the patient has J2 + near VA with no spectacles at all.  

Most patients (who had cataracts bad enough to warrant surgery) are THRILLED with this.  Of course if their VA wasn't so bad in the first place, ( and this is a big if) and their IOL calculations or lens placement is off a bit, they can be very unhappy.

I really don't see what all the "excitement" is over accomodating IOL's.
I haven't had a patient complain to me yet about having to wear glasses for reading or driving after surgery.

I saw one patient recently that I did not comanage.  He was a 58 year old who had a unilateral cataract removed and replaced with an accomodating IOL.  He was upset that he had to still wear reading glasses for the other eye which was no where near developing a cataract.  He was wondering ( and so was I) why he was talked into it in the first place.    

I really don't feel that it's OK to tell these accomodating IOL patients, "well, you have to be ready for a little LASIK if the IOL isn't perfect"

----------


## ilanh

Most people who get the Restor lens done are encouraged to get it done on both eyes.  It works best that way.  The few that I have seen so far are literally thrilled.  I examined a 75 year old patient a few weeks ago who saw 20/20 for distance and J1 for near, all without correction. He never wears glasses anymore for anything.  He had previously been a hyperope and had spent his entire life in glasses.  I am 45 years old and do not have the uncorrected vision that this elderly gentleman has.  I do not want to go on record saying that everything is perfect with this lens because we are still working on some issues.  For example, there is still the glare at night issue which appears to trouble some people.  The official word from the company is that this occurs in about 5% of people.  Other studies have shown that initially it may occur in a lot more but that it comes down significantly once the brain has adapted to the concentric zones and apodized surface.  Also, the vast majority of patients are experiencing excellent uncorrected distance vision, but there are some who have unexplained loss of best corrected visual acuity (some of these patients have had the lens explanted).  Overall, you have to view this a little bit like Lasik.  Most Lasik patients are thrilled but there are definite side effects that causes some griping in the minority.

-I think that we need to pick better candidates ie: no lasik patients, unilateral cataracts etc.  
-We need to inform patients that distance and near vision will be better than intermediate (ie: eliminate folks who depend a lot on interm vision)
-Eliminate truck drivers and other night vision dependent people (ie: people whose job depends on night driving and may suffer as a result).
-For now don't do this on pilots, police officers, fire fighers etc

I believe that the future is rosy for this lens but would still counsel nervous nellies to wait another year before getting it.

----------


## fjpod

Usually you do have to dilate to get a good perspective on whether there is a secondary cataract, and to what extent it may be causing a reduction in VA. The density of the cataract and the VA reduction must make sense. You also have to rule out any other potential internal problems before engaging in the treatment such as macular edema and optic atrophy.

----------


## acredhead113

> Usually you do have to dilate to get a good perspective on whether there is a secondary cataract, and to what extent it may be causing a reduction in VA. The density of the cataract and the VA reduction must make sense. You also have to rule out any other potential internal problems before engaging in the treatment such as macular edema and optic atrophy.


I have a question: I had cataract surgey one month ago on my left eye. I think at the same time he did lasik surgery to correct for my astigmatism. I have had two appointment or consultants with him and he keeps telling me he is going to remove the stitch from my eye. I feel something in my eye. It feels like water or just something is there. What is it?

----------


## ilanh

> I have a question: I had cataract surgey one month ago on my left eye. I think at the same time he did lasik surgery to correct for my astigmatism. I have had two appointment or consultants with him and he keeps telling me he is going to remove the stitch from my eye. I feel something in my eye. It feels like water or just something is there. What is it?


What you had was a limbal relaxing incision (LRI) which is often done at the time of cataract surgery.  Relaxing incisions are made using a diamond blade at the steep meridians of the eye to decrease astigmatism.  Usually the relaxing incisions cause a foreign body sensation that lasts a few weeks.  Although many of us do sutureless cataract surgery it is possible, however, that your surgeon used a corneal suture and that indeed may be what you feeling.  If he told you that he placed a stitch then it's most likely that the sensation that you are experiencing is the suture and it will go away as soon as he removes it.

----------


## acredhead113

> What you had was a limbal relaxing incision (LRI) which is often done at the time of cataract surgery. Relaxing incisions are made using a diamond blade at the steep meridians of the eye to decrease astigmatism. Usually the relaxing incisions cause a foreign body sensation that lasts a few weeks. Although many of us do sutureless cataract surgery it is possible, however, that your surgeon used a corneal suture and that indeed may be what you feeling. If he told you that he placed a stitch then it's most likely that the sensation that you are experiencing is the suture and it will go away as soon as he removes it.


Thank you for the explanation.

What type of procedure is required to remove the stitch? Does it hurt? How long does it take?

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## jasonmiller

Check out http://AccommodatingIOL.com

Has some decent info about the topic

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## jsan123

I am a 58 Y/O myopic male and with an immature cataract in the left eye.  I am considering the Restore procedure, with refractive correction for the right eye.

While I am not a fighter pilot or a truck driver, one of the reasons I am doing this is for sailing/cruising. I need to have 20/20 acuity. I have worn monocular contacts for most of my life but as I age I find that my acuity has been reduced. 

My OD says that it may require post op lasik to get to 20/20 which he is willing to do as part of the (considerable) price. Does anyone have comments on the success of this, please?

----------


## QDO1

> I am a 58 Y/O myopic male and with an immature cataract in the left eye. I am considering the Restore procedure, with refractive correction for the right eye.
> 
> While I am not a fighter pilot or a truck driver, one of the reasons I am doing this is for sailing/cruising. I need to have 20/20 acuity. I have worn monocular contacts for most of my life but as I age I find that my acuity has been reduced. 
> 
> My OD says that it may require post op lasik to get to 20/20 which he is willing to do as part of the (considerable) price. Does anyone have comments on the success of this, please?


be prepared to wear spectacle while it all gets sorted out - post op, pre lasik.  This procedure potentially seems quite surgical.  the last laser clinic I worked in listed recent ophthalmic surgery ad a contra indication to Lasik...

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## chip anderson

I know I am gonna get accused of O.D. bashing again but last I heard they couldn't do catract surgery or lasic at any price.

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## Happylady

My Mom  who had Restor lenses put in when she had catarat surgery is not thrilled with her close vision. If the light is great and what she is looking at is dark letters against a light background then she can read with no glasses.

If the light is poor or the reading material doesn't have good contast then she needs glasses. Her progressives have a +2.50 add but the other day in a restaurant she had to use a magnifying glass to see a menu with poor contast. even wearing her glasses.

We are going to do a refraction on her this week and I think a stronger add will make her happier.

----------


## fjpod

> I know I am gonna get accused of O.D. bashing again but last I heard they couldn't do catract surgery or lasic at any price.


Maybe jsan is mistaken and means OMD.  Or maybe his OD performs pre and post operative care which is within his scope of practice.

Why assume that an OD is performing cataract surgery illegally?

Someone's gotta keep you honest, Chip.

----------


## chip anderson

The patient pretty well stated the O.D. was going to do lasik "at a conciderable fee."

My biggest problem is that I am honest.

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## fjpod

> The patient pretty well stated the O.D. was going to do lasik "at a conciderable fee."
> 
> My biggest problem is that I am honest.


Doesn't matter whether he is charging a fee or not, the patient may be mistaken, or the OD may be in partnership with an OMD, and just like an optician who owns an optical practice may say " We can examine your eyes" when he really means that the OD he employs can examine his eyes, the OD may have been referring to his OMD partner or employee.

Why do you automatically assume the OD is practicing illegally?

I think your biggest problem is you think you are the only one who is honest.

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## chip anderson

I didn't I assummed the patient didn't know the difference between an O.D. and an Opthalmologist.

Twas you who assumed the worst.

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## fjpod

> I didn't I assummed the patient didn't know the difference between an O.D. and an Opthalmologist.
> 
> Twas you who assumed the worst.


Ah!  So you were couching your thoughts and hiding your true analysis of the subject.  

Sounds a little dishonest.

By now the whole board is annoyed with us for carrying on off the topic.  So, why don't we move any further discussions like this to threads with appropriate titles like honesty, ethics, situational analysis, etc.?

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## jsan123

You are quite right, I did not understand the distinction. This particular Dr. is a board certified Opthamologist with a specialty in cornea issues I believe.He comes highly recommended.  Regards this error,  my old boss used to say "Do not rule out the possibility of incompetence."

But back to the point of my initial inquiry. After the Restore implants and the Lasik "touch up" am I going to see 20/20 at distance to see that bouy at the channel entrance?

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## fjpod

> But back to the point of my initial inquiry. After the Restore implants and the Lasik "touch up" am I going to see 20/20 at distance to see that bouy at the channel entrance?


jsan,

Really only your eyecare professional, in this case your ophthalmologist, can give you assurance.  Make sure he/she is someone you have used in the past, and someone you trust.  But, I don't think anyone can "promise" you 20/20.  They would be foolish to do so.

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## jsan123

The Doc was pretty clear in setting my expectations.  He indicated that the results have been 20/25 to 20/40 but then said that with Lasik should be able to get to 20/20. I am looking to find out what others, either professionals or patients have experienced with this new technology. As I said before if I am going sailing, I need to hve good vision, both near and far.

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## chip anderson

JSAN:  No one can predict with 100% certianty the out come of any surgery.

As to sailing just remember what a cute little little redhead once told me: "You don't have to see to have fun."
Of course, I never got to find out exactly what she ment.

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## Robert Martellaro

> I am a 58 Y/O myopic male and with an immature cataract in the left eye. I am considering the Restore procedure, with refractive correction for the right eye.
> 
> While I am not a fighter pilot or a truck driver, one of the reasons I am doing this is for sailing/cruising. I need to have 20/20 acuity. I have worn monocular contacts for most of my life but as I age I find that my acuity has been reduced.


If updating the Rx and/or lens design proves unsatisfactory, I would strongly consider a fixed focus monofocal IOL. I've heard of very good results with Tecnis's prolate silicone IOL- good vision and contrast sensitivity. Most folks would agree that multifocal and accommodating IOLs at their best can only approach the quality of distance vision of traditional IOLs.




> My OD says that it may require post op lasik to get to 20/20 which he is willing to do as part of the (considerable) price. Does anyone have comments on the success of this, please?


In some cases 20/20 says more about the quantity of vision and less so for the quality of vision. 

Regards,

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## ilanh

The Restor IOL should only be used on patients who place a high premium on getting around without glasses.  In my practice I would not even offer it to anyone who is happy with their reading glasses or "feels naked" without glasses.  This lens is for highly motivated people only.  It will get about 80% away from glasses as advertised.  There may be some adjustments to make ie: near vision may require you holding the print a little closer than you are otherwise used to (since the add power is somewhat strong).  Also, intermediate vision is not stellar with the lens and may require additional glasses just for the computer (or adjusting your distance from it).  Finally, there may be slight halos at night around lights (although the majority of patients have not complained too much about this).  In fact, most cataract patients have suffered from halos around lights just due to the cataracts (Restor halos are milder).  About 5-10% of people may require a lasik touch up following the procedure to take care of residual astigmatism or to finalize the prescription.  Some surgeons are bundling this in with the cost of the procedure.  There is nothing wrong with this and it is logical.  The bottom line is that the vast majority of patients will be very happy with their final vision and will not regret having gone this route.  If you want to play it absolutely safe you can wait for another few years until the technology is perfected (then again, you can say this about a lot of things.)

Ilan Hartstein, M.D

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## ecsoptical

Very well put, thank you

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## jsan123

I recently put off the Restor cataract operation because my Dr. indicated that my eyes are quite long and require 7 - 7.5 Diopter correction and the proper Restor lens is currenlty not available to provide this.  Had I gone ahead, I would have not achieved the desired acuity and remained somewhat nearsighted as I understand it.

Does anyone know of any plans by the vendor to provide this higher correction?

What are the general thoughts about using Lasik to compensate for the lack of power in the Restor lens?

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## William Stacy O.D.

> I recently put off the Restor cataract operation because my Dr. indicated that my eyes are quite long and require 7 - 7.5 Diopter correction and the proper Restor lens is currenlty not available to provide this. Had I gone ahead, I would have not achieved the desired acuity and remained somewhat nearsighted as I understand it.
> 
> Does anyone know of any plans by the vendor to provide this higher correction?
> 
> What are the general thoughts about using Lasik to compensate for the lack of power in the Restor lens?


I think all of the complex IOLs are bad.  I include in this the Crystallens, the Restore, the Rezoom, all of them.  The good ones are simple IOLs, single focus ones, the best ones are prolate surface single vision.  It is all hype and pseudoscience and marketing.  My recommendation is to get the sharpest optics you can get at distance (or near if you must), and wear glasses for the other distances. All the complex IOLs have fuzzy optics or do not perform as promised, or both.  Sure you will hear testamonials here and there, but the fact is that if you have more than one focus in a lens, and your eye is looking through both focuses at once, less than half the incoming light will be in the focus plane that you want.  So sure, turn up the lights and maybe they'll get 20/20. But put them on a dark road at night, and have more than 50% of the available light be OUT OF FOCUS, and have you done them a favor?  I think not. (The Crystallens is an exception, but it doesn't move anywhere near enough to do any good, so it's just as bad).

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## William Stacy O.D.

> What are the general thoughts about using Lasik to compensate for the lack of power in the Restor lens?


That's like putting sawdust in a bad transmission.  It might sound better, but it won't work very well.

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## jbrazell

I am one of the 5% who can't drive at night because of glare from Restor lens.  Unless your mother is too old to drive at night anyway, she should give that some thought.  It really makes you feel handicapped when you have to hurry & get home before it gets dark because the glare is so bad you think you might have a wreck.  Other than that, I love the Restor lens.  I have 20/20 reading & 20/30 to 20/35 distance.  I can see the t.v. really well.  I can also see the computer & I work on the computer every week day.  I had to pull the monitor a little closer than I used to have it, but can see fine to do my work.  My distance is the worst.  He is going to do some sort of laser surgery to correct my astigmatism & that might help my distance & maybe the glare.  I'm hoping so.  Still, even with not being able to drive at night, I love the Restor.  My eyes aren't as good as when I was young, but they're close.  I think I had eagle eyes when I was younger, so it's hard to get that back.

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## DragonLensmanWV

> I am one of the 5% who can't drive at night because of glare from Restor lens.  Unless your mother is too old to drive at night anyway, she should give that some thought.  It really makes you feel handicapped when you have to hurry & get home before it gets dark because the glare is so bad you think you might have a wreck.  Other than that, I love the Restor lens.  I have 20/20 reading & 20/30 to 20/35 distance.  I can see the t.v. really well.  I can also see the computer & I work on the computer every week day.  I had to pull the monitor a little closer than I used to have it, but can see fine to do my work.  My distance is the worst.  He is going to do some sort of laser surgery to correct my astigmatism & that might help my distance & maybe the glare.  I'm hoping so.  Still, even with not being able to drive at night, I love the Restor.  My eyes aren't as good as when I was young, but they're close.  I think I had eagle eyes when I was younger, so it's hard to get that back.



You might want to check the post date at the top left of the post. This thread was from 2005. Welcome!

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## jbrazell

Oh, sorry I didn't check the date of the post I was answering.  Still, it might help someone else who is considering Restor.

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## Happylady

I'm the original poster and my mother passed away more then 3 years ago. Knowing the outcome and with more knowledge about these implants I think my mom would have been happiest if she had been left a -3.00. She missed her excellent close vision and had never had a problem with wearing progressives or distance glasses.

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## jbrazell

I'm so sorry about your mother. I should have looked at when your original message was posted. I'm new on here & didn't notice the date. I apologize!

Jan

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## allanon

They changed the ReStor after she had the implant... the add was too strong, so they dropped the number of rings to bring it down to an effective +2.50.  I personally would rather be left at a -2.00 monofocal.

If you get the night glare from a Restor, try a drop of Alphagan ~30mins before going out at night.  The manufacturer also recommends turning on the dome light in your car :)

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## ilanh

Even though it's an old thread I'll throw in my two cents worth.  As a surgeon who does a lot of implants I'm still not 100% sold on the multifocal implants ie: Restor, Rezoom, Crystalens, Technis MF.  I offer them to patients who are VERY motivated to be completely spectacle independent and I thoroughly explain the potential downsides.  The Restor lens is probably the most popular lens out now and has been greatly improved by the +3 add rather than the +4 add that it used to have.  Patients are reporting that the distance is the same but intermediate vision is much better.  Reading is as good as it always was but you can move the print a little further away.  Due to the nature of its apodized surface and its rings, reading is difficult in low light and there are some halos at distance at night.  Overall, however, the apodized lenses all involve somewhat of a compromise ie: the total available light entering the lens is split into the component focused at near and the one focused at distance.  This means that your vision is always using less light that the total available and that may affect contrast, sharpness, brightness etc.  Even though patients are happy to be spectacle independent I don't get quite the WOW factor that I expected.  I suspect that it's secondary to the above mentioned compromise.  I do get quite a WOW factor with my monovision monofocal IOL strategy which is vaguely similar to Contact lens monovision but much better in every way.  It too involves a compromise but I feel that the compromise is less and is also physiologically easier.

----------


## Uilleann

About ten years ago, I remember reading about a lens that was either in or just about to go to clinicals.  If memory serves, it was a gel based implant that was supposed to completely fill the capsule.  Being gel, it was also soft, and therefore was thought to afford some of a patients natural accommodation back.  The doc would take the standard A's and K's, and then order the lens power needed.  It would ship to the surgeon in a rod form, roughly 1 X 10 MM, something akin to a clear pencil lead was the image I seem to recall.  As it was inserted into the eye and capsule, the patient's body heat would soften the lens, and it would regain it's lenticular form in about 20-30 seconds or so.

I never hear about it now, so I'm guessing the design was a failure.  But the concept - a lens as close to a natural human lens as possible - seemed a very cool thing.  Anyone know if this just flopped or what might have happened?  I can't remember who was manufacturing it, or it's name at the time unfortunately. 

Bri~

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## Bill West

I think every MD who does mono vision or multifocal implants on an unsuspecting victum should have to have the same thing done to them. It's always about money $$$$$$$. Just because the patient is ignorant as to what they are getting into does not mean the Md or, more than likely, the assistant should not tell them the truth. How about creating the effects of looking through an over plused lens at night and show them what they will really see. I am just an ole country boy but nobody will be allowed to screw up my vision. Gimme a good distance vision job and I'll take it from there. DISTANCE ONLY PLEASE.

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## jbrazell

My insurance paid for a standard cataract surgery with standard IOL.  I had to pay $2500 for each eye in order to upgrade to Restor.  Also, I can't drive at night.  I must be one of the 5% who ends up with halos, glare, starbursts so bad that I can't drive.  I am going to have a second opinion and see if there's anyway to correct this or exchange lenses.  I do love my new eyesight, though.  No glasses at all.  I'm 64.

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## ilanh

jbrazell,
I am an ophthalmologist and have implanted many Restors.  Therefore, I identify with your concerns and would like to provide some advice.  Many patients find that the symptoms get a lot better with tincture of time.  In fact, this is very common and can sometimes take as long as 6 months to a year for the symptoms to improve.  However, there are some caveats: for example, if you have opacified capsules behind the Restor lenses this can be easily rectified with a Yag laser capsulotomy and can be very helpful.  The other issue to keep in mind is that if you do decide to remove the IOL's it is better to do it sooner rather than allow them to fibrose into place.  I realize that this point somewhat invalidates my earlier "tincture of time" advice but it's a decision that you alone can make.  If you ultimately decide that you cannot live with the Restor lenses then I would find a surgeon that is experienced with removing IOL's (it's not always easy and it's not devoid of risk).  You can opt to convert to a Crystalens (which has no glare issues but allows accomodation for reading), or you can opt for monovision IOLs (which corrects one eye for distance and one for near).  Lastly, you can opt for distance in both eyes and simply wear reading glasses as needed.  One other thought: if your initial correction was not accurate ie: you were left with a residual prescription, then this also can account for glare.  This type of error, however, does not neccessitate removing the IOL's since the issue can be resolved by lasik or spectacle wear.  Hope this helps.

----------


## Geirskogul

After a lot of thought, and reading the opinions about MF IOLs here and other places, I think I would prefer to be corrected to a -2.00 or so and have to wear glasses for distance activities rather than try these out.  I do hope that in 40 years or so there will be better solutions, but if I were to get a traumatic cataract tomorrow I'd opt for the -2

----------


## jbrazell

ilanh, 
Thanks for the information.  It does help.  I know I do have the opacified capsules because the surgeon told me I did, not too long after the cataract surgery.  I chose not to have the Yag at that time because I read that it was harder to explant the lenses after having that.  Now it is starting to affect my vision some, so I am considering it.  However, I feel like I'm between a rock and a hard place.  If I get the Yag done and that doesn't help the glare, then it's going to be trickier, if not impossible, to explant the Restor lenses.  I have an appointment to get my eyes checked by the original surgeon's office and then next month I'm having a second opinion to see what I should do.  I picked both of these surgeons out of "The Best Docs in Fort Worth" magazine, so they should be good ones.  Doctors are the ones who vote.  I know my surgeon did a good job.  I had another eye surgeon who was learning to do botox and was using me to practice on, & he told me the surgeon did a good job, just from looking in my eyes without any office equipment or anything.  I feel like he did do a good job, but I also feel like I was not really warned how bad this glare thing could be.  I went back and re-read the literature I was given and it said "you can expect some mild glare at night".  Before my surgery I thought "So, I already have that".  I actually expected it to be better than before my surgery.  It was at least three times worse, if not more.  I really think eye surgeons should emphasize the fact you might not be able to drive at night anymore.  Then, when this happens, they say your brain will adapt, so you give it time to adapt.  Then they say they don't like to explant the lenses after so-and-so amount of time, so you are just stuck with it.  It has been since November 2009 when I had the first eye done.  It is not any better that I can tell.  Still can't drive at night.  Evidently, my brain doesn't know it's supposed to adapt.

Thanks!




> jbrazell,
> I am an ophthalmologist and have implanted many Restors.  Therefore, I identify with your concerns and would like to provide some advice.  Many patients find that the symptoms get a lot better with tincture of time.  In fact, this is very common and can sometimes take as long as 6 months to a year for the symptoms to improve.  However, there are some caveats: for example, if you have opacified capsules behind the Restor lenses this can be easily rectified with a Yag laser capsulotomy and can be very helpful.  The other issue to keep in mind is that if you do decide to remove the IOL's it is better to do it sooner rather than allow them to fibrose into place.  I realize that this point somewhat invalidates my earlier "tincture of time" advice but it's a decision that you alone can make.  If you ultimately decide that you cannot live with the Restor lenses then I would find a surgeon that is experienced with removing IOL's (it's not always easy and it's not devoid of risk).  You can opt to convert to a Crystalens (which has no glare issues but allows accomodation for reading), or you can opt for monovision IOLs (which corrects one eye for distance and one for near).  Lastly, you can opt for distance in both eyes and simply wear reading glasses as needed.  One other thought: if your initial correction was not accurate ie: you were left with a residual prescription, then this also can account for glare.  This type of error, however, does not neccessitate removing the IOL's since the issue can be resolved by lasik or spectacle wear.  Hope this helps.

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## Barry Santini

[QUOTE=ilanh;113889]


> . I have seen the look on patient's faces when they can see distance and near without glasses after 50 years of dependence. I think that's it's the next evolution in the IOL.


It's attitude's like these regarding the issue of eyewear *dependence* that are our worst enemy.

I have seen him.  I have met him.  And it is us!

Must surgeons should have some training about their own prejudices regarding eyewear and the *best* vision possible.

B

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