Gordon,

I recently explored the multifocal area and created the following
report for my sister - who ended up not risking it. I didn't happen
across your particular brand, but here's some places you might
explore:

-----
<http://www.informedconsent.org/cataract.html>
(Quotes...)
Multifocal Lens Implant: Today you have a choice of the monofocal or
the multifocal implant. The monofocal implant provides good focus at
one distance, requiring glasses to focus sharply at other distances.
The multifocal implant provides good focus over a range of distances
helping you achieve less dependence on glasses, though you may want
glasses at times for the sharpest possible vision for critical tasks.
You are a good candidate for the multifocal implant only if you plan
to have the multifocal in both eyes. The eyes cannot work together
well with a monofocal in one eye and a multifocal in the other.

The multifocal lens has five concentric zones similar to a bull's eye.
The lens is designed to use 100% of available light, approximately
half of light is distributed for distance vision (50%), one third to
near vision (37%) and the remainder to intermediate vision (13%),
which enables the lens to focus over a range of distances.

There is a trade-off for choosing the multifocal lens over the
monofocal lens. You may experience halos around lights at night (15%
chance compared to a 6% chance with the monofocal lens), glare (11%
chance compared to a 1% chance with the monofocal lens), less color
contrast because only part of the light goes to a particular focus
point, and a decrease in sharpness of vision.

According to the multifocal implant manufacturer Allergan, Inc., you
have a 92% chance of achieving 20/40 (legal driving vision) or better
without glasses, and a 97% chance of achieving 20/40 or better with
glasses. With the monofocal implant, you have a 50% chance of
achieving 20/40 or better vision without glasses and a 99% of
achieving 20/40 or better with glasses. If you have the multifocal
lens in both eyes you have: an 8% chance of "always" wearing glasses
compared to a 34% chance with the monofocal lens; a 51% chance of
"occasionally" wearing glasses for fine detail work compared to a 54%
chance with the monofocal lens; and a 41% chance of "never" wearing
glasses for distance or near, compared to a 12% chance with the
monofocal lens. With the multifocal implant, you have a 30 % chance of
not being 20/20 with glasses, compared to 1% of not being 20/20 with
glasses and a monofocal implant.

According to Allergan, Inc., less than 1% of patients ask to have the
multifocal lens removed and replaced with the monofocal lens. If your
job requires night driving, or very fine close work, or halos/glare
would not be acceptable, you may prefer the monofocal lens.

You are eligible for the multifocal implant if you have little to no
astigmatism and if you are planning to have the multifocal implant in
both eyes. You cannot use both eyes together with a monofocal in one
eye and a multifocal in the other.
(End Quotes...)

<http://www.eyecarectr.com/index.cfm/procedures/prelex>
Has some illustrations of the effects of multifocals. The two rows of
eye charts are interesting - If you look at the big C you might say
they work pretty well. But if you look at the small letters, they are
only improved at the closest distances, and are much worse at
infinity. There is no free lunch, the multifocal does not focus
selectively, you have no control over it. It smears some light into
close focus, and some into far focus, and both are there all the time.
That's why you get the "halos" at night. Mouse over the night scene -
I would rather have fixed focus at infinity (and pretty good focus to
about 4'), and put up with reading glasses.

<http://www.optometric.com/article.aspx?article=71468>
It looks like there really is an accommodating implant - see the photo
section just below halfway down the page.

"The crystalens (Eyeonics Inc.) is the first pseudoaccommodating
implant approved by the FDA. It is designed to correct distance,
intermediate and near vision through movement of the optic via a
hinged design. The implant requires the removal of the natural
crystalline lens (through a 3.5mm-scleral tunnel incision) as in
cataract surgery. The lens is designed with two hinges attached to the
optic, which allows the lens to move from a posterior vaulted position
to correct distance vision, to an anterior vaulted position to correct
near vision."

<http://www.crystalens.com/>
Now this sounds like something that could really work. The action of
your existing focusing muscles moves the implant to change its focus.
At worst you'd have vision as sharp as a monofocal implant at
distance. [Read on below for caveats about both of those statements!]
With some learning you could extend the range of sharpness to nearer
objects. Their reported percentages sound much better than the
multifocal. Seems like your doctor would have used the trade name if
this was really what he was talking about...  

<http://www.findarticles.com/p/articles/mi_qa3921/is_200306/ai_n9279565>
There is at least one competitor (near the bottom of the page).

"The other accommodating lens is the HumanOptics Akkommodative 1-CU.
The design features a central optic zone surrounded by a ring of
silicone. The 1-CU works by the contraction of the ciliary muscle
releasing the zonules, thus allowing forward movement. In a
head-to-head study of the 1CU and CrystaLens, investigators found
1.50D to 2.00D of accommodative capabilities with both."

Hmmm...  2.0D doesn't sound like much range! Better than none, but not
like the 12D or so a young natural eye can do.

<http://www.crstoday.com/PDF%20Articles/0704/crst0704_F7_dick.pdf>
Size: 39 KB (39,252 bytes)
This PDF lists a third accommodative implant, still experimental.
Their test results on all three were more like 1/2 diopter - which
seems hardly worth bothering with, though people who have a lens
fetish worry about 1/8 diopter errors.

They cite what sounds like a real problem with all these implants -
they only come in one size! If the size happens to match your lens
capsule, they work properly. If not, they may actually work backward:

"Surgeons must be cautious in how they present
the technology to patients, however. It may not be
fair, for instance, to tell them that, if an accommodative
lens does not restore accommodation, then they will have
the equivalent of a standard monofocal lens."

<http://www.la-sight.com/LS_reading_closeFocus.asp>
An overall good presentation of all the alternatives, including
monovision.

<http://www.la-sight.com/LS_how_maturing.asp#monovision>
"If a group of people (all appropriate candidates with equal
prescriptions) are given a chance to try monovision correction with
soft contact lenses, roughly a third will like it and desire to adopt
monovision. About a third will find it uncomfortable, unbalanced or
otherwise unacceptable, and will prefer having both eyes corrected
equally (for distance). The remaining third may grumble about
monovision with the same intensity that they would lament the
shortcomings of bifocals, and will be ambivalent about any long-term
commitment to monovision."

"The best way to know if you will like monovision-type correction ...
is to experience it first in contact lenses."

Anyway, there are some search terms and sites...  Hope this helps you
find answers to your questions. I ended up feeling I wouldn't want any
of the multifocal or pseudoaccommodating implants - even at no extra
charge.

Loren

Loren wrote an excellent treatise on this; I'll just briefly answer the
questions below, having gone through the process myself in Jan.

Because they cost way more than standard IOLs, and they have not become
the "standard of care" for cataract patients.

I don't think so, depending on how you define "success". I don't think
the optics of ANY multifocal or focusing IOL are as good as a standard
IOL, especially if the standard IOL has prolate optics.

See the treatise.  Cameras don't use them because people like their
photos to be clear. Exception to this is the crystalens which does
purport to work like a camera lens, but in practice does not deliver
much, if any, focussing ability.

I am definitely in the con camp.  I did not want the bad optics put in
my eyes, that's for sure. I like my Technis IOLs and have what I call
modified or partial monovision.  One eye is in focus at infinity, the
other at about 40 inches.  But then I also don't mind wearing glasses,
so would have been happy with full distance in both eyes...

w.stacy, o.d.

We kicked this around a bit in a thread I initiated on 30 Sept last,
titled:  Some Cataract Questions.  You might look for it.
I came away from that and some separate message contacts with
respondents with a firm idea to NOT use them.
First, in research, I found that a small percent of the folks who
receive them ask to have them removed.  It was only in the multfocus
type of lens that I found such a statistic.  I was advised to do this
and did:  Ask your eyedoc if he will remove them and replace them with
single vision lenses, at his expense, if you can't adapt to them.
Further, I was advised that only if I had some overiding consideration
that dictated that I could not/would not wear glasses should I
consider them.
I am not adverse to wearing glasses, therefore, after I have the
single vision lenses "installed" if I have to wear them. fine with me.
Right now I'm wearing tri-focal.
Go back to meyedoc Tuesday to determine "when"
LOL, YMMV
   Roy

Thank you all for your appends, which have really helped!

For the past week or so, the San Jose Mercury News has
been running a 5.5 x 9" ad captioned with six highly visible fonts:
"New Breakthrough Eliminating the Need for Vision Corrective
Glasses of Any Kind."  The doc claims to be a "UC Berkeley,
UCSF trained surgeon."  And for the worriers, the ad includes
this reassuring testimonial from a Mr. David Barton:  "Having
the cataract surgery with the ReStor lens put in, was as easy
as going to the barber shop."  My last trip to the barber shop
took me to Fort Campbell, Kentucky -- and it lasted eight weeks.  :-)

Fortunately our ophthalmologist, described as "best student
ever" by his/her Stanford ophthalmology professor, is merely
offering the multifocal repair for our consideration.  "60%" is the
stated patient satisfaction rate within the practice.

Patient satisfaction figures probably have positive biases.  Some
patients cannot admit a mistake, some are happy to have dramatic
even if suboptimal improvement of vision, some are too depressed
to provide feedback, and others are thrilled mainly to be rid of their
glasses.  Therefore, we are using a multifocal satisfaction rate of
50% in deciding.

Another question:  Can one predict what power of reading
glasses one will need after two successful monofocal implants
for distance (infinity)?

Thanks again, Gordon