The ReSTOR Lens Implant

Dr. Gary Foster – Fort Collins & Loveland, CO

ReSTOR multifocal intraocular lens and ReSTOR Cataract Lens from Gary Foster MD

ReSTOR

The ReSTOR lens implant is one of the types of multifoal intraocular lenses (IOLs) used for eye lens replacement after cataract surgery that gives more than one area of vision in focus to increase your freedom from glasses.

I met one of its inventors in Seattle last year while speaking at a conference and it was interesting to hear him talk about all the effort and science behind the ReSTOR lens.

How does the ReSTOR Lens Implant work?

The ReSTOR lens implant contains a series of rings that focus light.  Some of the rings focus for distance and others for nearer vision.  The height of the rings near the center are taller than those further out.  This is called apodization.

In bright light, the ReSTOR lens implant gives both distance and near vision.  In dim light, the lens focuses most of the light for the distance image.  This cleaver engineering decreases the amount of nighttime glare and halos making this the best multifocal intraocular lens for night driving.

Apodization makes it easier to see and walk around in dim light, but on the other side, it would be harder to read in dim light.

Ideal Candidate for the ReSTOR Cataract Lens?

I recommended the ReSTOR multifocal intraocular lenses for my father when he flew up for his cataract removal procedure.  He is in his 70’s, spends time on the computer, jogs, and still refs high school basketball and volleyball games.

With his lifestyle, he and everyone he refs for wanted him to have good distance vision.  In addition, he wanted to be able to see the scorecards and felt it would be better to do all of this without the hassles of glasses.  After considering his lifestyle and specific visual needs, we both felt the ReSTOR cataract lens would be the best of the multifocal intraocualr lenses for him.

He can both ref his games and fill out the scorecards without glasses.  He does notice some halos at night that don’t affect his driving.

Most ReSTOR lens patients (80%) don’t need glasses for anything.

My father sees very well without glasses, but has elected to get a thin pair that he uses when he wants to make his good vision great.  He loves his ReSTOR lens and says his eyes, “are the part of my body that works the best now.”

Ideal ReSTOR lens candidates want good vision, but don’t need perfect vision to be satisfied.  They place a high value on freedom from glasses.  They have otherwise healthy eyes and don’t drive at night for a living.  If this sounds like you, then the ReSTOR lens may be the best eye replacement lens for you.

ReSTOR lens and reading without glasses

The Joy of Reading without Glasses

Side Effects of the ReSTOR Lenses

Multifocal intraocular lens implants give more freedom from glasses with some increase in night halos and a slight decrease in contrast for distance vision.  Some see a shadow around letters when they read.  If you have very dry eyes, retinal trouble, or corneal problems then a multifocal intraocular lens may not be the right choice for you.  In addition, those that require optical perfection or who are long-haul nighttime truck divers usually are better served with single vision lens implants.

What are ReSTOR Lens Problems?

In the FDA trial, 94% of patients with the ReSTOR lens implant were happy with their lenses and stated that they would choose the same lens all over again if they where given the chance.  This is a very high rate of satisfaction for a medical procedure.  This section is written for the other 6% that were not has happy with their lens choice.  In the FDA trials, we were not able to do other surgeries to make these patients happier until after the study concluded.

ReSTOR Lens Problems for ReSTOR Cataract Lens

Laser Eye Surgery to Correct Refractive Error

I have loved the ReSTOR lens have placed it in many of my patients over the years but it is not perfect.  Prior to surgery I tell my patients that we do not have a perfect implant.  It doesn’t exist in the world, but what we do have is pretty spectacular.  All of the implants have pluses, minuses, and quirks.  The goal is to find the IOL that is strong in the areas that matter most to you and weak in areas that aren’t that important to you.

Success with the ReSTOR lens requires that we get very close to the refractive target.  The biggest ReSTOR lens problem is to end up a bit near or farsighted or have some uncorrected astigmatism.  This would cause blurry vision for both far and near vision.  The near vision is more sensitive to this.

When this happens we can either use glasses, contact lenses, laser eye surgery, limbal relaxing incision, or exchange the IOL to solve this ReSTOR lens problem.

Dry eye causes blurry vision.  When we read, we don’t blink as many times per minute because we don’t want to loose our place.  This makes dry eye and blurry vision even worse when we read.  The multifocal intraocular lens is particularly sensitive to this.  If you are having trouble reading after ReSTOR lens placement, then you may need to treat your dry eye more aggressively.

About 20% of all cataract surgery patients develop a cloudy capsule (PCO) behind their intraocular lens regardless of they type of IOL they have chosen.  This causes blurry vision and glare.  This is corrected by polishing an opening in the capsule with a yag laser.

Treating residual refractive error, PCO, and dry eye will solve most of the ReSTOR Lens problems.  A small percentage of patients do not like multifocal intraocular lenses and they have to be removed.

Types of ReSTOR lenses

The ReSTOR lens implant is the only U.S. multifocal intraocular lens that offers both UV protection and high energy blue protection which protect the retina and decrease night glare.  The ReSTOR 4.0 gives distance vision and close, strong near vision.  The ReSTOR 3.0 is preferred by more patients as it gives distance and good near with pretty good intermediate vision.

We anticipate the release soon of the ReSTOR 2.5 which gives distance and good intermediate with pretty good near vision and the ReSTOR 3.0 Toric which will also correct astigmatism.  I was in the first to implant the ReSTOR 4.0 in Colorado and was involved in the FDA trials for the ReSTOR 3.0 and 2.5 so I have used these lenses for a long time.

How do I choose an Experienced ReSTOR Surgeon?

The multifocal lenses are more exacting than standard lens implants so find a great ReSTOR surgeon is important. Start by asking your eye doctor who in the region is a great ReSTOR surgeon. You can call ophthalmology offices in the area and ask if any of their surgeons do a lot of ReSTOR lenses. The answer to these questions will help you narrow the search down right from the start. In some circumstances you will need to travel to find the right one. We have an executive/celebrity cataract program to make it more time convenient for those traveling from distances or requiring greater discretion.

It is ideal if your surgeon uses a laser to help with the surgery and the ORA system for greater accuracy.  Using these technologies demonstrates a commitment to excellence.  In addition, it is helpful if your surgeon also performs laser vision correction in case any touch ups are needed to refine your vision without glasses.

Finally, there needs to be a good fit personality wise with your doctor.  There are some doctors that are great surgeons, but not very personable while others are very friendly, but lack the expertise or hand skills that you would consider important.  When it comes to your eyes and your healing, it is reasonable to insist that your surgeon has both.

ReSTOR Cataract Lens

The ReSTOR cataract lens has a long track record.  The apodized diffractive pattern minimizes the night halo issues and the yellow chromophore decreases night glare and minimizes high energy sunlight damage to the retina.  In many ways it is a triumph of modern innovation, and yet it is not perfect, as we have discussed above.  

If I can help answer any other ReSTOR lens questions for you, please schedule an appointment to visit with me or post a comment.

Comments

  1. Is it possible to get a Restor IOL lens implanted on a person who has amblyopia?

    • It is possible but requires extra consideration and discussion. When the Restor is in just one eye you have a 64-67% chance of reading without glasses. When it is in both eyes you have a 94% chance. If a patient has significant amblyopia in one then he/she is mostly relying on one eye so their chances of reading without glasses is lower.
      The next important consideration is that we don’t want to take any unnecessary risk in the good eye. Sometimes after cataract surgery we do touch ups to get a more accurate result if needed. I don’t like doing touch ups and taking risk on the “good eye”
      Finally, glasses with safety glass protect your good eye from injury so getting someone with amblyopia out of glasses is not always a good thing.
      In the end it depends on the amount if amblyopia along with a number of other factors you will need to discuss with your doctor.
      Generally I discourage multifocal lenses in the face of amblyopia.

      • I live in colorado, and I am thinking of coming in for a consultation. However, before I do that is there any possible lense implant for amblyopia that you would recommend, or would I be wasting my time. I just have the one bad eye.

        • The answer to your question depends on the amount of amblyopia that you have. The first question I ask my patients is, five years ago, before you developed a cataract, if you covered your good eye could you drive and do your job with your amblyopic eye?
          If the answer is no, then generally, it is a good idea to take a conservative pathway with both eyes to minimize risks.
          If you can tell that the vision has worsened in your amblyopic eye, then removing the cataract would usually reclaim the vision that has been lost over the past five years.
          In addition, removing the cataract in the amblyopic eye would allow you to balance the prescription needs between the two eyes. Most have both eyes repaired a month or so apart, while some only have cataract surgery on the good eye and leave the amblyopic eye until the cataract is noticeably worse.
          If the amblyopia is mild and you would have been able to drive with the amblyopic eye alone, then a wider variety of intraocular lens options become reasonable.

          I hope this helps
          Gary Foster

  2. I had ReStor multifocal lenses implanted in 2011. Since then I not only have halos but circles around traffic signals at night plus super large starbursts from oncoming headlights. I was informed I probably would not need glasses at all – possibly reading glasses. All distances are fuzzy, there is a blur in the middle of my left eye with floaters. I’ve been told I have a lot of debris with floaters in the back of my eyes. Glasses prescriptions seem to keep changing. What does all this mean? Previously, I was very near sighted; now I can’t even see my eyebrows to pluck them. These implants are terrible!

    • Caroline:
      Sorry to hear you are having troubles. Haloing is more common in multifocal IOLs. The ReSTOR is the multifocal lens I use most commonly because it has the least night haloing of all the multifocals. In the FDA trial 2 out of 3 didn’t see halos or called them mild, but 1 in 3 called them moderate or severe.

      The haloes do tend to decrease over time and go completely away for many, but not all. If a patient havs residual refractive error (near sighted, farsighted, or astigmatism) then this would increase their haloes and make their vision blurry at all distances. If a patient has been given glasses, it often indicates they have this problem. Glasses and contact lenses are good options, but if they are specifically trying to not need glasses, then laser eye surgery or LRIs are often preferred options by patients to achieve good vision without the glasses.

      Glasses changing frequently is not common after surgery. This could be a sign of dry eye, which could be treated, if present, by an eye doctor. It would be important to accomplish this before any consideration of a long-term solution for visual problems. Dry eye could cause blurry vision at all distances, make haloes worse, and cause glasses prescriptions to vary.

      Usually, decreasing refractive error and treating dry eye helps patients become very satisfied with their ReSTOR IOL. In addition, some patients develop posterior capsular opacity with can be easily corrected for most and have a big impact on the quality of vision and satisfaction with an IOL.

      Floaters are largely a separate issue from the type of IOL you choose. If these floaters are extremely problematic, patients can seek the opinion of a good retinal surgeon in their area to find out if removing the floaters is advisable.

      I have had a very good experience with the ReSTOR lens and it often is the best option for those that want both distance and reading vision without glasses. I have participated several of the FDA trials for the ReSTOR lens and 94% of patients in the study said they would choose the same lens all over again if they had a chance to remake the decision. This outstanding and one of the highest satisfaction rates achievable with an elective medical product. Having said that, it means that 6% would have made a different choice in hindsight.

      I have had around one out of every 250 patients that didn’t like multifocal vision. In these patients, I have removed the IOL and replaced it with a different style of IOL. Good medical consultation with a surgeon that works frequently with these IOLs helps in deciding which approaches would be the most helpful.
      All the Best
      Gary Foster, MD

  3. I love to shoot pool. Which ReStor lens would work best for me, the 3.0 or 2.5?

    • Josh
      As a general rule, the 2.5 ReSTOR would give better intermediate vision and pool mostly lives in that distance. A single vision lens with glasses for intermediate would probably make the edges of the ball a bit more crisp, but I believe the ReSTOR 2.5 would do a good job with this. Since it is not FDA approved yet and I was an investigator, I cant release any non-public data. Once it is approved, I could call a couple of my friends that were in the study to find out if they play pool and query them about their performance with the lens.
      All the Best
      Gary

      • Thanks for the info! He is scheduled for surgery in a couple weeks. Am I right in assuming the 3.0 would be much better than the 4.0?

        Thanks for your all you help!

        Josh

        • The ReSTOR 3.0 gives near vision further out than the ReSTOR 4.o. Glasses may be needed with the 3.0 or 4.0 for some distances with pool, etc. that are visual targets further out into the intermediate range.
          Gary

  4. Mohamed El-Gindy says:

    I did ACR Sof IQ ReSTOR Multifocal Toric IOL Implanation in Both eyes from 15 Days, i had astigmatism CYL -3.00 in both eyes. Now i am having a huge difficulty in reading.
    The readings after syregery showed that i have -1 SPH and -1 CYl in my right eye and that i need +2.75 near vision for the reading glasses. What shall i do? please help

    • Mohamed:
      Residual myopia and/or astigmatism in the amounts your describe cause blurry vision for both distance and near objects with a multifocal intraocular lens like the ReSTOR. If the refractive error is corrected, then most patients achieve good distance and near vision.

      Options for correcting residual myopia and astigmatism include glasses, contact lenses, exchanging the IOL for a different power to correct the myopia and doing a limbal relaxing incision to reduce the astigmatism, or doing laser vision correction, which can treat the myopia and astigmatism at the same time.

      A careful discussion of all these options with your surgeon to consider the best plan to improve your vision will help you decided how to best improve your result.

      All the best,
      Gary Foster

  5. Hello, I am 54 years old and have a cataract in each that is very small. I have some glare at night and in bright light because of the cataracts therefore my eye doctor said he would do surgery. I have an astigmatism in each eye caused by the cataracts so both eye doctors I went to for 2 opinions said almost all of the astigmatism would be removed with surgery. One doctor likes the crystalens accomadating lenses and said he would rather see me with that lenses versus the restor 3.0 because of halos however he will do which one I want. The other doctor is the same way however
    he thinks I should wait until restor 2.5 gets approved hopefully this year. My astigmatism is in the cataract from what they are telling me and would be corrected when they remove the cataract.
    Please respond. Bobby

    • Bobby:

      We do not have a perfect intraocular lens. As a result, we need to find the lens for our patients that will best fit their needs. Both the Crystalens and the ReSTOR 2.5 are IOLs that tend to give good intermediate vision with less impressive reading. I like both IOLs if matched with the right patient.

      Only about half of Crystalens patients can read without glasses no matter what the brochure says. Of the half that can read, many cannot sustain it for long as it feels like work. As a result, I recommend the Crystalens for patients that want distance and intermediate vision but are fine wearing reading glasses. If they get reading, it is a bonus.

      If you desire to increase the chances of reading with the Crystalens, you could consider mono vision where one eye is set for distance and the other is left a bit nearsighted.

      The ReSTOR 2.5 probably gives reading more often than the Crystalens, but we are waiting for the official data to be released. I did have a good experience with the lens in the FDA trial.

      Both the Crystalens and the multifocal lenses give more nighttime haloes than a standard IOL. I feel the multifocals have more of this than the Crystalens. In the FDA trials, two out of three patients called the multifocal haloes mild. Of those that are more troubled by the haloes, most adjust over the first six months and they disappear for many. I have never removed an IOL for haloes but this has happened in the U.S. I don’t put this in patients that are occupational nighttime drives.

      If a patient wants to be able to read at the book distance without glasses consistently, the ReSTOR 3.0 is often the ideal choice. It works best for those that aren’t on the computer all day as intermediate is its weakest zone.

      The fact that both doctors have recommended intermediate dominate lenses may indicated that you spend most of your time on the computer and little reading at the book distance. If this is accurate, then they are attempting to match the IOL to you needs. If not, then it may be helpful to explain more carefully to them how you use your eyes.

      I hope this helps
      Gary Foster

      • Dr Foster,
        Can you speak to the differences in low contrast between the ReSTOR 2.5 and 3.0?
        And does the 2.5 provide less potential for visual disturbances (glare and halos) compared to the 3.0?

  6. Jeri Humphrey says:

    I have had the Restor lens for about a year and a half and I was very satisfied with them until I had the yag laser treatment on my left eye. Now I can no longer read ANY line on the eye chart with my left eye and I had cloudy vision when I look straight ahead (driving). It is not so significant when I look to the side. My major concern is not being able to read any line on the eye chart with the left eye. I would certainly like to have some input from others

    • Jeri:
      I am sorry to hear you are having trouble. It would be very unusual to develop blurry central vision after a yag. It would be important to make sure some other eye problem has not developed.

      A complete eye exam ASAP is important to check the position of the intraocular lens, the prescription of the eye, and the intraocular pressure/inflammation. Occasionally, the cornea is dry or scratched after the yag creating blurry vision and a foreign body sensation while you heal.

      About 10% of patients have a small change in the prescription after a yag. If vision is improved with a prescription then glasses, contact lenses, or laser vision correction could be considered.

      There are a number of conditions that can cause blurry central vision like retinal swelling, nerve problems, occluded blood vessels, or damage to the intraocular lens. If the cause of the central visual blurring is not immediately obvious, a second opinion with a retinal specialist or a neuro-ophthalmologist could be considered.

      God Bless
      Gary

  7. Virgil Dishongh says:

    I recently had a monofocal, AcrySofIQ, model SN60WF, lens implanted in my right eye which suffers from BRVO. I’m now scheduled to have the Restor lens implanted in my left eye in a few days. Reading on the Internet I see people saying that mixing the lens is not a good solution and some say that it is an acceptable solution. My ophthalmologist says that I would have a good chance to be “glasses-free” with the Restor and he has had a lot of success in mixing these lenses. Any thoughts?

    • Virgil
      64% of patients could read without glasses in the FDA trial when they had the ReSTOR only implanted in one eye. 94% could read without glasses with the ReSTOR implanted in both eyes.

      Since you would only have the ReSTOR in one eye, you would have around a 64% chance of reading with the lens in only one eye. This means there would be a 36% chance of paying the extra money and not getting the reading you desire. On the other hand, if a single vision lens is placed in the final eye there would be a 0% chance of being able to read without glasses.

      I have chosen a more conservative pathway in the circumstance you described. I usually recommend that my patients match the lenses so that they are the same. Occasionally, a patient will push back and express above average desire for glasses independence. In these more highly motivated patients, I do implant a ReSTOR in the second eye and have had a good experience with the practice.

      God Bless with your surgery
      Gary Foster

  8. david andrews says:

    Hello Gary
    I would be interested in your views.
    I am a 58 year old male, tradesman, enjoys outdoor activities, golf in particular.
    My job has me spending quite a few hours a day on my mac air laptop, and general reading reading of books, manuals etc….and of course general industrial electrical activities.
    I apparently have a astigmatism in the left eye and cataract in both.
    Require glasses for reading everything and have a few pairs of 3x magnifiers at the office , car and home.
    and also a pair of multifocal prescription glasses.
    I find my eyes getting worse for driving and distance, and increasing the reading magnification.
    I have been told that I require the restor IOL’s in both eyes with a toric in the left eye with the astigmatism.
    Problem is, I do read of the negativity, including intermediate vision, which I am concerned will effect the hitting of the golf ball, general tv viewing.
    Your thoughts on the above regarding the effect regarding golf, and if the restor is the correct way to go?
    cheers

    • David
      I can only comment generally on the lifestyle you described, as I have not examined your eyes. There is not a perfect IOL for all of the activities you described. The ReSTOR does a good job for most of what you have described. Most ReSTOR patients have good getting around distance vision and can read with good lighting. The average intermediate vision was 20/25 in the FDA trial for the ReSTOR 3.0. Because a lot of your intermediate vision is with a laptop, you can move that a bit closer so it is near the sweet spot for the ReSTOR.

      Most of the golfers I know feel the IOL performs well for the ball on the T. I have had some feel it is harder to pickup the ball as it travels down the fairway. In addition, I picture an electrician as having to work in poorly lit environments on occasion. It would be likely that you would need glasses for near tasks when that happens.
      All the Best with your surgery
      Gary Foster

      • david andrews says:

        Hello again Gary
        Just another question and concern with the restor.
        I currently do have some multi focal glasses, which have 3 levels, to read, then approximately 6 or 7 feet away fro tv and supposedly longer distance for driving.
        I rarely ware them , as I prefer the magnifiers, as I find the multifocal hard to adjust to, and in particular when walking, where there appears to be distortion.
        Driving also is hard because the vision outside the glasses is hard to adjust to.
        I am assuming the restor IOL’s will not give the distortion feeling, and feel of short legs when I look down, and as they cover the complete eye, feel more real like?
        Or will it be a similar feeling?
        cheers
        david

  9. Bobby Troxler says:

    Hello Dr. Foster,

    Has the FDA finally approved Restor 2.5 and if so have you been doing surgery with this new lenses?

    Cheers, Bobby Troxler

  10. Bobby Troxler says:

    Hope all is well with you also Dr. Foster.

    God Bless you and your business.

    Regards,

    Bobby Troxler

  11. I’m a young (mid 30s) patient with a cataract in my right eye (and newly discovered one in my left eye). I’m a software developer, on my computer 9 hours a day. I’m also a an avid tennis player (4-6 hours a week), and read on my iPad daily. I don’t drive at night often. I have never worn glasses or had any eye issues until this was discovered a few years ago. I have some astigmatism in both eyes (between 1 and 2 D).

    One doctor is recommending a monofocal lens and suggests I wear glasses daily. Another recommends ReStor 3.0 following up with LASIK to correct the astigmatism. Remains to be seen what to do with the other eye as it is not a problem yet.

    I understand there is no perfect lens, but what would you recommend? Should I wait for the ReStor Toric (and any idea when that will be available)? Should I get the procedure done in Europe where that lens is available? If I waited for the 2.5, would I wear glasses while playing tennis?

    I obviously have a lot of working years ahead of me, so being able to work at my desktop monitor 20″-24″ is important. I’ve never work glasses so I don’t know if wearing them 9+ hours a day to compensate for poor intermediate vision is reasonable.

    • Jay: A standard monofocal lens will not help decrease your astigmatism whereas a toric monofocal lens would. If you choose a distance target, you would need near glasses for the computer and reading. The ReSTOR with followup LASIK is another option or waiting for the ReSTOR toric which should be available late this year or early next year. The ReSTOR 3.0 is OK but not great for the level of detail a programmer would probably require at the computer distance. If you leaned in closer to the screen you would hit the sweet spot for near vision, but it is not practical to lean into a screen for the 9 hours/day you spend at the computer. It would be most likely that you would choose to wear glasses for that distance with a ReSTOR 3.0 lens given your profession. The Crystalens is another option. The Trulign version of the Crystalens corrects astigmatism depending on the specific power your eye needs. It tends to give good distance and computer vision for most patients (90%). About half can read without glasses for near reading. It is also a good tennis lens for many patients. If computer vision is more important to you than near reading tasks, then there is a chance that the Crystalens is better fit for your lifestyle. If you discuss this with an eye surgeon that does both ReSTOR and Crystalens that has examined your eyes, you could get a more accurate read on which approach would be best for you.
      God Bless
      Gary Foster

    • Jeri Humphrey says:

      One thing that I have noticed with my Restor lens is that I can see well enough (though not perfect) when I am looking straight on but when I am looking at angles, my vision is very impaired. I think they would work prefect for you at the computer but I am not sure about tennis since you are looking at various angles and needing to focus quickly. I am wishing I had researched the lens more before making the decision to get them. At this point I am reasonably sure I would not have gotten them if I had understood their short comings.

  12. Randy Linton says:

    Dr. Foster,

    I have an astigmatism in both eyes. I am also very nearsighted. I cannot see at all without my contacts. Do you recommend the ReSTOR impant?

    • Randy:
      I use a number of factors to help me decide whether to recommend a ReSTOR lens or not like the health of the cornea and macula, the amount of astigmatism, and how a patient uses their eyes. If the astigmatism is mild to moderate, I can usually treat the astigmatism with the LensX laser at the time of cataract surgery. If the astigmatism is quite elevated, then I can’t fully treat it with the LensX and they will require a second surgery with LASIK or PRK to decrease the astigmatism. This adds to the complexity and expense of the surgery. Hopefully, the toric ReSTOR will soon become available in the U.S. so we can offer this option to those with higher astigmatism.
      God Bless,
      Gary Foster

  13. Carole Brown says:

    Hello Dr. Foster – I had a ReStor multifocal lens (10.5 + 3.0 add) implanted in my left eye (dominate) March 2014. Day of surgery, intraocular pressure rose into the 40’s; my eye was tapped & I was started on glaucoma meds. My eye was tapped five times the first week. It was difficult to evaluate my vision the first week until my pressure was under control due to cloudiness & rainbows. My eye pressure never went back to my pre-surgery level of 18. I’ve been told my current level is “high Normal” (low 20’s)
    My vision usually measures between 20/25 & 20/30 but not as sharp as my right eye (20/30) & somewhat hazy. Near vision is very blurred – I use +250 for reading in my left. Night vision is blurred, somewhat greasy with glaring halos, concentric circles & starbursts around headlights.
    My left eye constantly tears during my waking hours & always seems to be in a state of irritation. It sometimes feels like I have an ill-fitting contact lens or foreign body in my eye. I use “Thera-Tears (individual vials) several times a day.
    I was supposed to have my right eye done two weeks after my left eye. My right eye cataract is small & not causing any visual problems at this time. I decided to wait until my left eye was seeing better.
    My surgeon said he would exchange the left ReStor lens for a monofocal standard lens, states he has done this before with success but there are no guarantees. After he told me the risk factors, I’m afraid to have the exchange done for fear of an unsuccessful outcome, further damage & more surgery. Also, he stated the eye pressure problem could happen again – another added risk factor. I’ve gone for two second opinions & was told to return to my original surgeon as neither could detect a problem upon examination.
    I’m trying to talk myself into living with it but not sure I can. (Better the devil you know, than the devil you don’t)
    I would appreciate any advise you give me.

    • Carole:
      It is difficult to separate out the root of the visual troubles you are having. Eye irritation and watering often result from eye surface problems like dry eye/allergies. These cause blurry vision. It is often helpful for patients to have their eye doctor focus on this problem and resolve the issue. This fully solves visual problems for many. If the eye irritation/tearing is completely resolved and the visual problems persist then the next step is to understand a patient’s residual refractive error. If there is some left over glasses prescription, then it would cause visual blur. If the visual problems are resolved while looking through the glasses machine or while wearing a temporary pair of glasses or contact lenses, then resolving the residual refractive error with laser vision correction, LRI’s, IOL exchange, glasses, or contacts are potential solutions.
      If a patient’s distance vision is good after these steps, but they can’t read without glasses then they would be part of the 6% that cant read without glasses after a ReSTOR lens. A lens exchange would often not be worth it since they would still need reading glasses with a standard lens.
      If the distance vision is not good with a normal tear film and temporary glasses, then an IOL exchange could be considered if a patient does not think he/she will adjust to the multifocal vision.
      If a patient has high eye pressure after the first surgery, it is much more likely that they would after any other eye surgery, but a surgeon could anticipate this problem and start the pressure lowering medicines at the time of surgery and check a patient’s pressure several hours after surgery rather than waiting until the next morning to decrease the chances of problems.
      God Bless,
      Gary Foster

  14. Had restor multifocal lens implants in both eyes in May of this year. My optometrist said that i will need yag laser procedure as the left eye is 90% occluded (blurred) and the right eye is 40%. He stated I was a very aggressive healer and this may be due to this. He suggested i wait at least six months to have the yag procedure as it may cause retinol detachment. Will I need the yag laser again in the future to “clean out the debris”? Do they typically do yag on both eyes at the same time? Is this typical that my eyes have debris so soon? Dr Gary you are so right in choosing the right surgeon, My surgeon is well noted in this area and really good but his personality “bedside manner” is horrible. Getting the right mix is very important and sorry his is not, but willing to go back for the yag with him because he is good at what he does. I am happy with the lens i have chosen but now a little concerned and worried about the yag procedure.
    Thank you
    Susan

    • Susan:
      The yag only needs to be done once per eye for 99.9% of patients. I usually do them on separate days, one week apart. About 20% of patients develop enough clouding of the posterior capsule that they need a yag. It is not uncommon for it to form in the first year if it is going to form.
      God Bless,
      Gary Foster

  15. Nancy Sizeland says:

    Hello Dr. Foster- I’m having Cataract surgery Dec. 11 -2014 I only have sight in one eye ! I was born with a scare on my right eye !! I’m still debating if I should go with a the lens RE STOR I want the best vision possible ! PLEASE GIVE ME YOUR OPINION ! Is there less risks with a regular lens? Thanks for your help. Nancy

    • Nancy:
      I generally discourage using a multifocal in patients that only have one good eye for several reasons. First, in the FDA trial for the ReSTOR lens, 94% could read without glasses if they were in both eyes, but only 64% could read without glasses when it was only implanted in one eye. Second, we try to avoid elective surgery in patients with only one good eye to avoid any undue risk. If an enhancement or adjustment is needed, or if you do not like multifocal vision, it could create a circumstance where additional surgery would be needed. Finally, glasses offer some protection from trauma, especially if they are made from safety glass. I usually recommend that my patients with one eye wear glasses, even if they have good vision without them. For all these reasons I would discourage a multifocus lens in one eyed circumstances and favor a single vision lens.
      God Bless,
      Gary Foster

  16. Dr. Foster,

    I would appreciate you opinion. I’m 59 in very good health. Work for a major company outside sales representative. Drive several hours per day, continually on iPhone, iPad, computer and normal exercise. Have done monovision for years. I’m looking as Restor Multifocal. Only a little astigmatism in left eye which will be the first one done. My right eye moderate astigmatism and currently distant vision. Yes i’m looking for the most I can get distant, reading and intermediate. Which Restor would you recommend? Currently have tear plugs and that works for dry eyes. Thank you for your help!

    Nancy

    • Nancy:
      Most good monovision patients choose monovision with standard implants or the Crystalens with their cataract surgery since it is a glasses freedom system that they already know works for them. In addition, the multifocal lenses don’t perform as well in patients with significant dry eye.

      If you choose a multifocal lens, the ReSTOR 3.0 gives better intermediate vision than the 4.0 and it looks like your lifestyle is much more intermediate that near, if I have understood correctly. The 2.5 is still not FDA approved if you live in the U.S.
      God Bless,
      Gary Foster

  17. I had ReSTOR3 implanted in my left eye, while having cataract removed, operation was 8 days ago….We cancelled the same operation on right eye since, after 8 days now, the eye is still unable to focus …long or short distance…; I had thought it would only take 3 or 4 days for the new lens to “start up”…..my great surgeon said sometimes it takes a little longer for the newly implanted ReSTOR3 to “live up to it’s reputation”..Of course, I will refuse the surgery on the right eye until the left, with ReSTOR3 , gives me the results that I expect….no glasses for far and distant sight……it’s been 8 days since that first operation (left eye)……..the right eye surgery is scheduled for next Tuesday……is it a good assumption that my left eye will have improved enough….(13 days between surgeries) to go ahead and schedule the right eye surgery…?????? don’t want to walk around with 2 less than ‘perfect’ eyes……..Comments? MANY
    THANKS……..

    • B.G.
      If the issue is a bit of remaining corneal edema, then a short wait longer would clear the edema and improve the vision. If the problem is that you have some residual refractive error then waiting may improve the vision as the IOL locks into position. The longer you wait, the less likely that changes can occur. If the eye doctor has you look through the glasses machine and shows you the best correction possible and the vision is amazing, then the problem is residual refractive error. This could be fixed by glasses, contact lenses, laser eye surgery, IOL exchange, or possibly an LRI (limbal relaxing incision). If you wait until the healing is completed and your vision is not acceptable even when you look through the glasses machine with the best possible correction, then it is possible that you are one of the rare patients that don’t adjust well to multifocal vision. In some patients this is troubling enough that they decide to have the mutlifocal removed and a standard distance lens placed.
      God Bless,
      Gary Foster

  18. Bobby Troxler says:

    Dr. Foster:
    Do you have any news in ReSTOR 2.5 yet? I thought for sure it would have been approved and released on the USA market by now.

    God Bless,
    Bobby

  19. Claire Shaw says:

    Hello, could I ask what iol you recommend for me as I’m overseas and rather confused for my best options.
    I had retina surgery due to a detached retina( right eye) and tear in left , which has left me with cataracts, terrible glare ( cannot drive at night) and a water cleft , plus a macular pucker in right eye, left suffers from floaters and( I’m not finished with my tale of woe) awful dry eyes.
    I used to run and love the gym but am struggling now, I’m 48 and it’s been a huge shock .
    I know the pucker /floaters can be treated if necessary with a vitreoctomy but which lens would you recommend for me in the UK ?
    Thank you in advance, your website is really fantastic, great information!

    • Claire:
      There are some lenses available in the UK that are not available here in the U.S. like the M+ or the PhysIOL which have some intriguing features, but both are multifocal lenses and I generally do not recommend multifocus lenses for patients with macular puckers and or awful dry eyes. Generally standard lenses or a toric lenses are the more ideal choice for patients with retinal problems.
      God Bless,
      Gary Foster

  20. Deb Miller says:

    Dr. Foster
    I would very much appreciate your opinion. I had the ReSTOR lens implanted in my right eye in July 2014. I am 46 years old and had been on long term steroids for an autoimmune disease. Was suppose to have the left eye done in August. The day after my surgery I could see everything clearly, near and far. As the days and then weeks went by my vision decreased. I did not have the left eye done for fear that I would not have good vision in either eye! Today I still cannot read, or see well close up, or far away with that eye. My intermediate vision seems to be the best. My Dr. currently has me wearing a +2 contact in that eye which seems to help a bit with close up vision. He keeps telling me that there is nothing that he can see wrong with that eye. Trying to read is very frustrating. Blurry, almost double vision, but not quite. Also seems to be lots of fluctuation in my vision. Why is it that only 64% can read with one replacement lens but that goes to 94% if both are replaced? I would try that, and get the other eye done with ReSTOR if that might be the case, but what are the chances that the left eye would be the same as the right, and not see well?? That I CANNOT have happen! So what are the percentages that may happen? And then what? At this point I am thinking about getting the ReSTOR removed and put a monofocal in, but I too am afraid of what that might bring with it. This has been a very frustrating experience all the way around!! Sorry I even did it! I could see better with the cataract. Any thoughts?

    • Deb:
      Sorry you are having problems. The fact that you could see clearly for both far an near vision early on would usually signify that you are a good multifocal patient and that as the implant locked into place it found a position that left you a bit near or farsighted or with a bit of astigmatism. Your doctor could determine this by confirming the lens is well centered and checking your glasses prescription. If you look through the glasses prescription and your distance vision is clear, then you could discuss long term options for obtaining that type of vision like glasses, contact lenses, laser vision correction, IOL power exchange, or LRI’s.

      There have been times when there has been some astigmatism causing the problem that I could not find using standard methods that was detected by a wavefront exam.

      If everything is perfect with the IOL and you are not happy with your distance vision when you look through the best glasses prescription possible, then it could be that you are not a good multifocal candidate (which would be curios since you were at first. ) Having the second eye done would not probably improve the way you feel about your distance vision if that is the case, unless the first eye done has some other problem, like it has been a lazy eye since birth.

      Most patients that are happy with their distance vision but not reading well, gain the ability to read without glasses when the ReSTOR is implanted in the second eye. This is because both eyes now contribute information about the near image and the brain processes both to create an understandable image for reading. However, there would be some risk that you are the 6% that can’t read with the ReSTOR, even when it is in both eyes.
      God Bless,
      Gary Foster

  21. I just want to share my experience. I´n 2009 I got Restor 3.0 lenses implanted. I have expearanced all the side effects that you can read about, difficult ro read in dim light, bad intermediate, halos etc.
    Most if them was on an acceptable level after 12 month. What really amazes me is that the brain adopts many years after the surgery. I have expeararenced improvments for up to 4 years after the surgery. Today I only see halos when I want to see them. I never use any reading glasses. The intermediate vision is better but not perfect. I still find it difficult to stand behind someone trying to show me something on a computer screen.

    So my message is. Do not give up if you have problem adopting. Adoption will go much faster if you do not focus on the problems. Today I´m a 100% happy Restor user.

    • Roland:
      Thanks you so much for sharing your experience! I’m sure it will help many in the healing and neuro-adaptive phases. The brain is amazing in its ability to adapt to the complexities of life. Most adapt almost immediately to multifocal vision, but some require an extended period of full benefit from the lenses.
      God Bless,
      Gary Foster

  22. My situation sounds completely identical to what Carole Brown is experiencing with a few additional factors. My surgery was done on my left eye Nov.3,2014 and I’m holding off on my right eye until my left eye is up to what they say it should be. I’m also experiencing frequent dull pain in my eye as well as twitching of my eyeball when I read a book, phone or look at my computer screen. no one can seem to explain this but offered the theory that sometimes in patients with light eyes their pupils dialate more letting more light in possibly causing the twitching. I am 57 years old and am very active. i drive a school bus and a motorcycle as well as work in an office all day. I’m wondering if the Restor is right for me or should I have gone with regular accomodating lenses after my cataract surgery.

    • Lynn:
      I have not heard of twitching being related to any type of implant in general or to the multifocal implants in particular. Twitching after surgery is rare, and usually only temporary. Yours has already gone on longer than the norm. Some patients have a long-standing condition where the eye moves back and forth when the other eye is covered called nystagmus. It is possible that because you are only reading with one eye it is unmasking nystagmus. Your eye doctor could check for this specifically at your next postoperative exam.
      Careful treatment of dry eye will usually help with the ache you are describing.
      God Bless,
      Gary Foster

  23. Shahzad Khan says:

    Dr. Foster,

    I am a 46 years old patient with cataract in my both eyes. I am diabetic with no major complications. I am a software developer and spends 9-10 hours a day on computer. I wear reading glasses when I work on computer. I don’t drive at night that often.

    My Dr. is suggesting ReSTORE. Any suggestion please?

    • Shahzad:
      The ReSTOR 3.0 is built for the normal book reading distance. It gives OK vision at the computer distance, but that is further away than the ideal focus zone for the lens. If I implant the lens in a patient on the computer as much as you are, I tell them that they will likely need computer glasses. Those on the computer for shorter times usually do fine as they can move the computer screen closer or lean in a bit, but you can’t lead forward for 9-10 hours per day. The 2.5 ReSTOR is still not FDA approved in the U.S. It is designed to give a better focus at the computer distance. You may live in an area where this is already available. Many doctors are hesitant to implant multifocal lenses in patients with advanced diabetic issues, but you indicated that you do not have this problem.
      God Bless,
      Gary Foster

  24. I am a 59year old that has recently been diagnosed with cataracts in both that require surgery. I am diabetic but it is well controlled and there is no neuropathy. My left pupil is larger than my right and I have mild dry eye. My goal is to be able to see the golf I hit, play platform tennis where the ball comes back at very fast from 25 feet away and drive at night without halos and reduced vision. I am considering mono vison IOL lens set for distance or a Restor 3.0 multi focal. My opthamologist has had a bad experience with Crystalens so no longer recommends them. Bottom line , I’m having a very tough time deciding what choice is best for me. Please give me your thoughts.
    Thanks.
    Bruce

    • Bruce:
      I can only speak to the general principles of choosing an IOL since I have not had the opportunity to examine your eyes.

      Monovision: I like this option in patients that have already been successful monovision wears prior to developing cataracts. I am leery of giving patients permanent monovision if they have not proven they are among the 50% that can stand it and the 10% that prefer it. If cataracts are mild, a patient can do a trial prior to cataract surgery to gain confidence. If cataracts are more advanced, the vision is often too limited to conduct a proper trial.

      The ReSTOR lens might work great for you, but there are several above average strikes against multifocal success in your situation. This does not mean you wouldn’t love the lens, it just means there are some reasons to think you have a lower than normal chance of loving the lens.

      Multifocal lenses do not perform as well in patients with dry eye (which you have) and significant pupil size differences (which you have). Some golfers (which you are) don’t like the multifocals, feeling like it is harder to pick up the ball in flight than with a standard lens. On average the multifocals do not give as good of night driving vision as a standard IOL, but it is a more than acceptable trade to get the reading for most patients, but you have expressed a particular aversion to any compromise with night vision. You will have to weight your lower than average chance for multifocal satisfaction against the strength of your desire for more glasses independence.

      Most patients do not have dry eye, drive a lot at night, have abnormal pupils, and love golf, but you do.

      I have found the Crystalens more likely to give good intermediate vision than the 3.0 or the Rezoom but less likely to give reading without glasses. It has its problems, but is more forgiving of dry eye. There is room for debate on the question of night driving, but overall, most feel night driving is, on average, better for those with normal size pupils with the Crystalens than for a ReSTOR and better with a ReSTOR than with a Rezoom lens. However, you have one pupil that is larger than the other. You will need to find out if the larger pupil is too large for a Crystalens since it is only a 5 mm optic while most other lenses are 6 mm. With a larger pupil size, some patients can see the edge of the optic at night.

      If the risks of all of these end up feeling larger than the potential benefits, some patients elect to have a standard lens and count on the known issues of glasses for near vision as opposed to the potential issues of some of the advanced technology lenses.

      I work with these lenses a great deal and have a very high success ration of great satisfaction with my patients, but the lenses and my track record are not perfect and it is important to carefully understand the lenses strengths and weaknesses and how well those match up with your desires and lifestyle to give you your highest chance for happiness and success with your precious eyes. Even then, we are taking percentages not guarantees as some that are poor candidates absolutely love the multifocals and some that are perfect candidates with what appears to be a perfect outcome dislike them. In the end, 94% in the FDA trial for the various multifocals said they would choose the same lens all over again if given the opportunity to re-choose. This is amazing, but it also means 6% would have made a different choice if given the opportunity. We can do touchup to improve success that were not allowed in the FDA trial, but even with these we do not achieve 100% satisfaction and some need to have the IOL exchanged, and I view an IOL exchange as bit riskier in one with diabetes.
      Not an answer to your question, but food for thought.
      God Bless,
      Gary Foster

  25. Hello,

    I had both eyes done with the RESTORE 3.0 implants, the second about six weeks ago. Unfortunately, my night driving is much worse; I see multiple circles around all lights, including colored traffic and tail lights. Oncoming traffic is unbearable.

    Also, I still need glasses for reading a book, which is another unexpected outcome. My follow-up appt. isn’t until 5/4, and I’m not sure what to think. Is neural adaptation a possibility for the night vision to improve? Any feedback would be most welcome.

    Thanks,
    Cal

    • Cal:
      In the FDA trials, around 2 out of three patients didn’t notice night vision issues with the ReSTOR or called them mild. 1 out of three called them moderate or severe. The good news is that these symptom do decrease through neuro-adaptation for most patients over the first 6-12 months. Most feel like their night driving is better with the multifocals than it was with their cataract before, but so far, this is not your experience.

      I have implanted hundreds of these lenses and I have never had to take one out for night driving problems because our bodies are amazing and this neuro-adaptation tends to work. I had one patient that loved the reading with the lenses but was quite bothered by his night driving, to the point that he was seriously considering having it exchanged for a standard lens at six months post op. When he returned two months later, the symptoms had completely disappeared and he was totally satisfied.

      Even though most do fine at night with the lens right away and the majority get there if given enough time, I discourage the lens in patients that are required to drive frequently at night, especially if they are occupational night drivers like long haul truckers. If they happen to be the very rare person that can’t adapt, the impact on their life and even the potential wait to find out if they would neuro-adapt would be too difficult.

      There is a neural training program, RevitalVision, that has shown success in helping patients adapt if their progress stops that your eye doctor could introduce you to if that becomes necessary, but most ultimately adapt on their own.

      Neuro-adaptation is not the only consideration with night driving problems. If you have residual refractive error, dry eye, or the lens is not properly centered, it would make your symptoms worse. There are good treatments for all of those problems that could be considered in the meantime.
      God Bless,
      Gary Foster

  26. Shelley Lapkoff says:

    Dear Dr. Foster,

    I need cataract surgery. In researching lens, I see that there is an “accommodating lens” that is flexible and works with the muscles of the eye to provide vision both near and far. My understanding is that this is fundamentally different from the multifocal lens that have halo problems. It is my understanding that the crysalens is an accommodating lens and perhaps now the Restor as well. Is that correct? Do you do surgeries with the accommodating lens? If so, about how many have you done? (Tens, hundreds, thousands?) Thanks! Shelley

    • Shelly:
      The Crystalens is considered an accomdating lens while the multifocals are not. I have a blog post on the Crystalens http://www.garyfostermd.com/crystalens-accommodating-intraocular-lens-iol/.

      If your eye muscles can move the crystalens then it can focus back and forth. 50% can focus back and forth from distance to reading with the lens. Compare that to the restore where 94% can read without glasses. 90% of those with the crystalens can see far and compture. I tend to recommend the Crystalens to those that want distance and intermediate and are fine with needing glasses for near since they spend their day on the computer or a nook but not so much with close work. I tend to recommend the ReSTOR for patient that want to be able to read at the book distance without glasses since the multifocals have a much higher success rate for that task. Around 10% of patients can’t move the Crystalens at all and can only see distance and need glasses for both computer and reading distances.

      I implant 4-6 Crystalens per week and have been implanting them for years. Many surgeons don’t do enough lenses to be comfortable with both platforms. I have found it an advantage to have extensive experience with both platforms since they each have different plusses and minuses. This allows me to recommend the lens that will best fit my patients’ lifestyle needs. In a perfect world, we would have a perfect implant that would solve everyone’s issues, but that is not the current state of technology.

      There Crystalens doesn’t tend to cause halos as much as the multifocal lenses, especially in patients that have normal nighttime pupil sizes. The optic of the Crystalens is 5mm while the optic on the ReSTOR is 6mm. In patients while larger than normal pupils, some have night issues with the Crystalens if the pupil is so large they can get glare arcs off the edge of the implant optic.
      God Bless,
      Gary Foster

  27. Dr. Foster,

    I had the ReStor lens ,model SN6AD1, power 22.0 D +3.0 ( length 13.0mm, optic 6.0mm) implanted on 12/16/14. I have been having trouble with reading and seeing far away. Makes it terrible to try and golf as it is my right eye which is my dominate eye. My physician has given me a prescription for bifocal glasses. Does this sound like something that can be corrected so as not to need glasses for both far and near ? Really confused. Never had to wear glasses to golf in my life, and now after spending all this money I need to ??
    Thanks,
    Dan

    • Dan: If you are pleased with your distance vision when you put on the glasses then your issues come from a refractive problem, meaning that if your prescriptive error where corrected, you would see fine. This is good news.

      Glasses, contact lenses, LASIK/PRK, piggyback lenses, IOL exchange, or Limbal relaxing incisions are options to correct refractive problems. Which of these solutions would be the best for you would depend on the health of your eyes and your motivation to be more glasses independent.

      If you ask your surgeon what non-glasses options are available to improve your vision and then ask what the risks, benefits, and alternative are to those solutions you will be in a better position to make long term decisions. I employ one of these non glasses solutions in at least 10% of my ReSTOR patients to help them go from good to great or neutral to happy with their investment in their vision and view it as part a commitment to help them reach their goals. Some surgeons have these enhancements built into their original price for a certain period of time while others provide them at an additional expense.
      God Bless,
      Gary Foster

  28. Vicki cook says:

    I had both eyes done less then a month ago, the last three days I’ve had a little headache… also I see halo around lights?
    tyvm

  29. Katrena Jackson says:

    I’ve had restor lenses in both eyes. I have blepharitis and follow the cleansing routine religiously but the left eyes (which was also worse for bleparitis) has gotten worse. My doctor keeps saying how good my eye looks but last visit, I insisted he listen to my comments on how bad my left eye was watering. Plus I have major eye discomfort. He told me to start using the Genteal ointment more than at night and to increase to eye drops (genteal) to four times a day and that is helping a little. I am also taking an antihistamine as I think some of the problem might be allergy related. Any suggestions

    • Katrena:
      Sorry you are having this battle. Don’t give up!

      You will not achieve your best vision or eye comfort until the tear film improves for your eye. There are a number of treatments your eye doctor could recommend like taking fish oil pills, restasis (the prescription tear drop), temporary steroid drops, lipiflow treatments, antibiotic/steroid ointment, plugging the tear duct. If your eye doctor seems stymied by the process, you could ask if there is a dry eye specialist in your area. Often there is an optometrist in each area that is putting extra attention into treating these types of issues. If you live in the Colorado area, my partner Dr. Marske is quite good.
      God Bless,
      Gary Foster

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