Best options for Multifocal & Premium IOL's in cataract surgery

Multifocal IOL's and Premium Lens Implants offer distinct advantages for patients and here is a guide how I am currently approaching them.

Reading Speed: my personal bias is the ReStor reads quite quickly, especially with better light. If dim light is common environment for the patient, then the ReZoom near reading speed is perhaps better but distance night glare might be a concern, in my opinion.

Night Drivers: I offer the Crystallens first, the ReStor Second, and the ReZoom Last. I think night glare with Crystallens is negligible, but in the FDA trial, the ReStor had 4% of patients with severe night glare, and 16% with moderate night glare. This is acceptable to me for most patients with good patient education and modest night driving demands. The ReZooms biggest concern for me is night glare.

Long Armed People: I offer the ReZoom or Crystallens first, and I avoid the ReStor in very tall people, they simply have to hold things too close. Average height, 6 feet and below, are less an issue for reading distance for any of the lenses.

Computer Users: I think the Crystallens and ReZoom do well here, and the ReStor requires some extra time to explain that intermediate vision improves monthly and intermediate can be quite good at 6 months post IOL implantation.

Patients with High Astigmatism: for now, I do laser vision correction to get astigmatism for anything over 1.5 diopers of astigmatism or cylinder. I think the Toric ReStor by Alcon when approved by the FDA will be my IOL of choice for astigmatic patients, given that the Toric IOL by Alcon is already such a phenomenal and predictible IOL in my experience.

Golfers: Some of our most observant patients with high expectations. Here the main outcome is excellent distance vision, which means getting the focus right and rid of any remaining astigmatism. Probably any of the 3 IOL's work well in this setting if the refractive outcome is nailed.

Patient satisfaction: all different for different people. I prefer the ReStor in patients with round corneas as it has excellent near and distance vision when astigmatism is controlled. I like the ReStor and ReZoom's predictibility in refractive target, and I think controlling for the Crystallens slightly more variable refractive outcome by doing the non-dominant eye first for nearer vision is a good idea.


Another Way to Approach this:
ReStor: great for patients who want excellent near and distance vision, and my best outcomes are those with very spherical corneal keratometry readings. These come out 20/20 and are the happiest in my opinion, even patients with very high expectations ~ if their corneas are already close to very spherical.

ReZoom: great IOL for those who do not night drive and want a range of distance, intermediate, and near vision.

Crystallens: great for patients who do not want any aberrations causing reduced contrast sensitivity, such as diabetics, glaucoma patients, and those with subtle macular disease. Also if intermediate is their concern and the patient accepts that near vision is not the true goal of this IOL, then more realistic and they will be happier.

It is fun to see patients appreciate and enjoy their refractive outcome, and this may mean a different IOL depending on the patients lifestyle. I have learned it is very hard to predict what is the right IOL for a patient, but when the different aspects of the IOL's are discussed, they tend to migrate to the best lens option for them. If I don't think the patient will be happy with that IOL then I tell them it not a great option for them, and discourage that choice, based on what they tell me about their expectations.

I tell all patients that even though there is a good chance they may not need glasses, almost all the IOL's do better with night driving with glasses as this reduces defocus and astigmatism, and secondarily reduces glare. Additionally, using glasses is still common for activities that require long periods of concentration, such as heavy reading, golfing, anything where residual defocus bothers them. Reducing dependence on glasses is usually achievable, but completely eliminating glasses might not be.