questions re multifocal lens for cataract repair

Discussion in 'Optometry Archives' started by Gordon, Nov 25, 2005.

  1. Gordon

    Gordon Guest

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


    (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, Nov 25, 2005
  2. 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.
    William Stacy, Nov 26, 2005
  3. 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.
    William Stacy, Nov 26, 2005
  4. Gordon

    Dan Abel Guest

    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.
    Dan Abel, Nov 26, 2005
  5. Gordon

    Roy Starrin Guest

    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"
    Roy Starrin, Nov 26, 2005
  6. Gordon

    Dan Abel Guest

    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.
    Dan Abel, Nov 26, 2005
  7. Gordon

    Gordon Guest

    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
    Gordon, Nov 27, 2005
  8. Gordon

    Roy Starrin Guest

    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
    And while you're at it, is there a particular IOL brand you would
    recommend; Why???
    TIA - I see meyedoc again on Tuesday
    Roy Starrin, Nov 27, 2005
  9. Gordon

    Dick Adams Guest

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

    Residual error can be calculated into that.
    Dick Adams, Nov 27, 2005
  10. Gordon

    CatmanX Guest

    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
    CatmanX, Nov 27, 2005
  11. Gordon

    Dan Abel Guest

    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.
    Dan Abel, Nov 29, 2005
  12. Gordon

    Dick Adams Guest

    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?
    Dick Adams, Nov 29, 2005
  13. Gordon

    Dan Abel Guest

    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?
    Dan Abel, Dec 2, 2005
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