questions re multifocal lens for cataract repair

Since 2005 a new multi-focal lens implant has been available in USA
for cataract repair (name Acry Restor). Per the doctor, neither
Medicare
nor any other insurer covers the cost (approx. $2500 in Calif. Bay
Area).

Questions:

(1) Why does Medicare not cover this lens implant?
(2) Does it enjoy the same success rate as the monofocal IOL?
(3) How does it work? (Why don't cameras use a multifocal lens?)
(4) Does anyone have a heartfelt opinion pro or con?

Many thanks!
Gordon

 

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.

 

Loren Amelang wrote:

The problem with this is that you're talking about people who already
have very compromised vision, and contacts won't give them much
improvement at all due to their cataracts, so it's not a fair test.

I firmly believe that partial mono (one eye at about 1 meter) is going
to be well accepted by most, and that ANY residual hyperopia is not
acceptible, so that the first eye to be operated should be targeted at
somewhere between -0.50 and -.75. Any result within a half diopter
either way will be acceptible. Then the other eye can be more
accurately targeted at 0.00 or -0.25.

w.stacy, o.d.

 

I was very happy that my OD caught my cataract well before my vision was
"very compromised". My OMD was very good about explaining my options.
I was already wearing prescription reading glasses, and quite happy with
switching glasses all the time, so monovision wasn't a plan for me. If
I had wanted to try it, though, I think I could have gotten a good idea
whether it was for me.

 

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

 

Might as well get used to the idea now. If you currently wear
trifocals, you'll be wearing some kind of glasses. At a minimum, part
of the time. At worst, all of the time. One thing that you should
think about real hard is what strength IOL you want installed. If you
don't discuss this with your doctor, they may well make this decision
for you. This will probably be fine, but I'd rather make the choice,
even though my choice was exactly what the doctor would have done
anyway. Also be aware that the people on this group, including the
doctors, don't agree on this.

Of course, one option is just to continue wearing trifocals. I tried to
talk to a woman at work about these options. She cut me off. She wore
trifocals, she liked trifocals and that was that. That's what she
wanted, that's what she got and she was happy. The top segment of her
new lenses after surgery had no correction.

 

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

 

O.K. Please discuss with me some of the governing factors, or send me
please to some references on this. Is there a "Normal" or what
determines?
And while you're at it, is there a particular IOL brand you would
recommend; Why???
TIA - I see meyedoc again on Tuesday
Roy

 

In other words, fucking up is not entirely out of the question?

Residual error can be calculated into that.

 

MF IOL's are working very well these days. With a little adaptation,
you are free of glasses altogether and can enjoy great vision. It all
depends on pre-op script and your doctors skill.

dr grant

 

Some of us think that "normal" is correction at distance. YMMV.
Personal preference is what determines. If you are a little old lady
who does nothing but reading, tv, knitting and needlework, all while
constricted to a wheelchair, having your vision set to "near" might
make more sense. The once a week you get taken outside, you can either
not see (somebody else is pushing your wheelchair), or you can wear
glasses for distance.

I like to have some input into what is happening. I think that this is
pushing it. I take whatever my HMO is buying. No way do I have the
expertise to provide input into this.

Good luck. I would suggest a Google on this group. Some people here
have provided a lot of good information, much more than I could provide.

 

A great deal of significant work and innovation is done within arms'
reach. It's not all needlework, needlebrain! Some other people might
like to be able to see what their fingers are doing with their naked eyes.

Sometimes they lose their eyeglasses and go driving. It happens more
than one would anticipate. Cataract surgeons, take notice!

Is there no hope?

 

Like I said, personal preference. I would suggest a lot of careful
thought, but it's up to you.

Make up your mind! Are you pushing correction for near or far?

You snipped what I was replying to. The OP was asking what kind of IOL
to buy. What kind did you decide on?