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Medical Forum / General / Vision / November 2005

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Multifocus IOL

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Earl Hendrix - 15 Nov 2005 21:18 GMT
I am planning to have cataract surgery in the near future. Does anyone have
any experience with the new AcrySoft ReSTOR multifocal IOL made by Alcon
inc. If so I would like to know your experience with vision clarity,
adjustment period, night vision problems, etc. Thanks.

Earl
SiG - 16 Nov 2005 13:16 GMT
Earl,

I had both eyes ReSTORed last summer without regret.  For starters, the best
hard info I've come across is at the FDA site,
http://www.fda.gov/cdrh/pdf4/p040020.html

Vision Clarity:
While it's claimed that 80% never need glasses, my own estimate is that I don't
need glasses 80% of the time.  The current physician lore is to target plano to
0.5D hyperopic (Alcon says plano).  This puts the best reading distance at 30-40
cm.  Without correction, my binocular vision is 20/25.  Corrected with optimal
lighting, 20/15.  For driving safety, I always wear glasses, although state law
requires but 20/50 for one eye.  For TV, sometimes, if I want raster-line
resolution.  For reading or computer, never.  For real closeup work, e.g.
modeling, Walmart's readers are useful.

Adjustment Period:
I didn't get the 24 hour golly-gee experience.  After a week, vision settled
down pretty much to what it is now.  The literature is quite ambiguous about as
to the details of novel visual effects you'll encounter, leaving you to wonder
if something's gone astray.  The expected effects can be rationalized by the
dual image planes created by the lens.  My computer's desktop is a night star
pattern, and the brighter stars are all surrounded by halos about 3mm across
(slightly tear-shaped) due to the out-of-focus distant image.  For dark text on
a white background, the effect is reduced contrast.  It's not a problem with a
LCD monitor, but newsprint requires better lighting than before.  I used to be
3-4D myopic and, when print appears blurred, I have the habit of bringing the
page closer.  Unfortunately, this no longer works as near vision depth-of-focus
range is nonaccomodative.

Night Vision:
Day or night, high-intensity headlamps at several 100 meters, look like a pair
of glowering owl eyes with rings and radial streaks, presumably due to the out-
of-focus near image.  Fortunately, the angular size of the effect doesn't change
with distance and, as the vehicle closes, the halo size becomes that of the lamp
itself.  Unless I were facing a battery of such cars, I wouldn't feel
overwhelmed and, in any case, it's not nearly as blinding as my preoperative
cataracts would have been under identical conditions.  Red tail lights also
create unexpectedly strong halo effects.  As to true night vision, there're a
lot more stars overhead than there were last year.

Finally, there are always issues that can arise unrelated to the IOL itself.  
Although refraction for my left eye came out closer to plano than the right eye,
the latter is 1-2 lines sharper when corrected and I'm unsure as to what exactly
is restricting the former to 20/20 corrected.

SiG
Dick Adams - 16 Nov 2005 14:46 GMT
responded to Earl:

> I had both eyes ReSTORed last summer without regret.

> [ ... ]  (click on news ID above for details)

I had Allergan silicone IOLs, Model SI40NB during the recent
several months.  Those are NOT multifocus, whatever that may be.

For distance, my prescription now is:
-0.50 -0.50  90
-0.25 -0.50  75

I see quite well for most things.  Need Walgreens 1.25D for reading
and computer.  Have ordered some prescription readers, add 2.0, but
don't think they'll make much difference.  Definitely need eyeglasses
for night driving (well, if I want to read signs and license plates, etc.),
but for TV at 10 feet, not really.  

Attested by O.D. to be 20/25 one eye, 20/30 the other, and 20/25
both, for DMV, so eyeglasses requirement for driving is dropped.
(Used to have more than -8D w. -1.25D cyl.)

With glasses, can now see the 20/15 line on the chart (either or both).

Since, my wife heard about Multifocus IOLs, and is sure I made a
mistake by not getting those installed, instead the ones I got.  She
will definitely need them, she says, when her time comes because
she needs to see everything and cannot be bothered with eyeglasses.

I am quite unclear on how the Multifocus jobs are supposed to
work.  I have looked at the blurbs, but they do not make any sense.
Perhaps having been a student of optics has distorted by perspective.

--
Dicky
 
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