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Eye Care Archive (Expert Forum)
Mono- versus Multifocal
Our Ask A Doctor Ophthalmology Forum is where you can post your question and receive a personal answer from physicians affiliated with the American Academy of Ophthalmology.
Mono- versus Multifocal
by Occupant, Jan 13, 2007 12:00AM
Hi,
After more than a year of waiting for an Alcon Restor that still isn't available (-8 to -9D), my ophthalmologist called and said, that this year of waiting had at least shown to them that one out of four patients is unhappy with the multifocal lens and whether I would consider a monofocal. Can this be confirmed or does he just want to get it over with? After following this forum for a while, I have to admit, that I too have some concerns. Wouldn't the curvature of the lens in my case be greater than if I weren't so myopic and, therefore, even more sensitive to decentering and tilting?
After more than a year of waiting for an Alcon Restor that still isn't available (-8 to -9D), my ophthalmologist called and said, that this year of waiting had at least shown to them that one out of four patients is unhappy with the multifocal lens and whether I would consider a monofocal. Can this be confirmed or does he just want to get it over with? After following this forum for a while, I have to admit, that I too have some concerns. Wouldn't the curvature of the lens in my case be greater than if I weren't so myopic and, therefore, even more sensitive to decentering and tilting?
Doctor's Answer
by Forum-OD-MP, Jan 13, 2007 12:00AM
ha! yes confired just by the number of postings on this websitr alone. it certainly fails in some people and causes a lot of problems. may, many posts on here about this. read away.
"Wouldn't the curvature of the lens in my case be greater than if I weren't so myopic and, therefore, even more sensitive to decentering and tilting?"
hmm. more complicated than this. no, not necessarily.
"Wouldn't the curvature of the lens in my case be greater than if I weren't so myopic and, therefore, even more sensitive to decentering and tilting?"
hmm. more complicated than this. no, not necessarily.
its just that there are many, many people here struggling with this and MANY MANY people here who have major problems with multifocal implants.
it is my opinion that 25% number your surgeon threw out there is probably close. maybe even a little conservative (although i have no studies to back it up or anything, just personal experiences...)
There are also interesting comments by Dr. Michael Wong of Princeton in the archives of this site. Find the thread: "ReStor Intermediate Vision Woes" (5/14/06) and scroll down to the post by hud (5/15/06).
Multifocals obviously work well for many people. Does the profile of the successful multifocal patient describe you? (Having a very experienced surgeon undoubtedly also boosts the chances of success.)
nobody in their right mind should select a multifocal lens in my opinion. I don’t like 50/50 or even 40/60 chances and hoped that there might be some more reliable data out there, but then may be not.
@JodieJ: Thanks for your post. I wasn’t quite serious with my remark about getting it "over with", but if I were a surgeon and would have to field constant questions about when lenses would finally be available, "does it take so long, because they can’t their act together?" and "my eyesight isn't getting any better, you know" - I would react that way.
And then, I still have to wear glasses to read. And it seems that many people with the multifocals do still have to wear glasses, rezoom for reading, restor for computor.
Maybe you would love the multifocal. But if things do not turn out like expected, it is one very rough ride. One that you need to be prepared to take. I was not. Very best wishes to you. Good luck!
I really think that multifocal/accommodating IOLs will become excellent products, but perhaps the technology and surgeon experience isn't there yet. With aspheric monofocal lenses you could have super distance vision in all lighting situations without halos, ghosting or glare. And you wouldn't have to wait months to adjust to your new vision. (I was driving the day after surgery.) If you left one eye a little myopic, you'd probably only need glasses for reading small print. (Did you know that people wearing glasses are perceived to be more intelligent than people without them?)
Just to clarify. Alcon got FDA approval and launched the clear U.V. -only and the "natural" blue-filtering versions of ReSTOR on the same day. Doctors have always had their choice of Restor lenses, but since most lenses implanted today have the added feature of blue-light filtering, that is the way most have gone. Alcon tells me that every new lens model going forward will have this feature, except the phakic lens. This makes sense because the human lens already has the filter in it, so no need to double-filter.
In my opinion, Alcon management grossly over-estimated the market potential for Restor, as this is a new market in the Medicare segment. Surgeons tell me that the biggest deterrant to a qualified patient agreeing to choose Restor over a monofocal is the cost. Incredibly, most surgeons are not well versed in refractive surgery, which this technology requires. Seek out an experienced doctor and ask how many he /she has done, and then reduce by 20%. Maybe in time there will be a price correction. Overall, there has been plenty of experimentation with mixing and matching lens designs, but Restor appears to still lead the pack in hitting performance expectations. It sounds nice that different optics could be a ying and yang for each other, but in reality, it's all hype. Potential patients should do their homework, as clearly, you can't lump all multifocals together.