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The latest technological advance in lens-based surgery is the introduction of the apodized diffractive intraocular lens implant called the ReSTOR®.  This multifocal implant, when used with refractive lensectomy (also known as clear lens extraction), can greatly reduce or even eliminate the need for glasses, for both distance and reading! The topic of intraocular lenses (IOL) is a complex one, so let’s spend a little time going over the concepts.

Routine refractive lensectomy (without the ReSTOR®  implant) will not completely eliminate the need for glasses.  While distance vision can be made clear, reading vision is compromised (again, when a traditional intraocular lens implant is used).

In patients under approximately 40 years of age, the natural crystalline lens retains the ability to flex in a process called accommodation. This allows an individual to generate the extra focusing power needed to read up close. After 40, the ability to accommodate diminishes more quickly, which results in a person needing bifocals or reading glasses.  This need for reading glasses is “accelerated” by removal of the natural crystalline lens; for all purposes, the traditional intraocular lens implant cannot accommodate.  



The traditional monofocal intraocular lens implant only focuses at one point, either distance or near, or somewhere in between (intermediate), but almost never at two or all three points simultaneously.  Hence, the term monofocal or “one focus”.

With monofocal implants, one of three strategies can chosen, if both eyes are having surgery:
 a) Implant selection so that both eyes focused at distance.  While glasses may still be necessary for distance, they will almost certainly be necessary for reading and intermediate vision.
 b) Implant selection so that both eyes focused at near.  While glasses may still be required for reading or intermediate vision, glasses almost certainly required for distance.
 c) Implant selection so that one eye focused at distance, and the other eye for reading.
Glasses may still be required for both distance and near, but choosing this option can reduce overall dependence on glasses.  This is called monovision.  Monovision can work well but it is a compromise.  Decreased depth perception and difficulty with vision under dim lighting conditions (such as night driving) may occur.  Golfers and pilots may not like this.  People who drive at night extensively may not like monovision.




The multifocal implant is quite different from the traditional monofocal implant. One such multifocal implant is the ReSTOR® intraocular lens implant. (There are other brands of multifocal implants.) It is a highly sophisticated implant that produces two simultaneous focal points, for distance and near, almost like the lens of bifocal glasses. A patient unconsciously learns to switch between the two focal points, depending on what is being viewed. The benefit of using this implant is that each eye can see both distance and near. This is quite different than the monovision option (see previous paragraph) using the more traditional monofocal lens implant, where only one eye is focused at distance, and the other eye is focused at near. Vision with the ReSTOR® is arguably a more natural way of seeing. In a study of the ReSTOR®  implant for cataract patients (this study may not apply to patients undergoing refractive lensectomy),  92 out of 100 ReSTOR®  patients reported never needing glasses for distance, and 81/100 not needing glasses for reading. The ReSTOR®  implant is designed for clear reading vision at 14 inches. Reading material may need to be held closer than usual for some patients. Intermediate or computer vision, without glasses, is acceptable for a large number of ReSTOR®  patients (82/100 in above cited study).  ReSTOR®  patients may have to move closer to the computer screen or intermediate range targets, to see very clearly without glasses. Intermediate vision appears to improve over time. 
The best visual results are obtained when both eyes receive the ReSTOR® implant.  It is
not recommended that only one eye receive the ReSTOR® implant.  This is an implant
designed to be used in both eyes.   

The optimal result with the ReSTOR® implant requires getting as close to a “zero” distance prescription as possible.  A few patients who have refractive lensectomy using the ReSTOR®  implant, will require a "touch-up" procedure to realize the full potential of this lens implant.  In other words, to fine-tune the visual results, sometimes an additional procedure may need to be done afterward.  The additional procedure may involve correction of astigmatism with either a limbal relaxing incisions (LRI) or astigmatic keratotomy (AK), both of which can be done in the office. Another procedure which is sometimes used to refine the ReSTOR® results is laser vision correction, like LASIK, which is done at another facility. 

Are you a candidate for the ReSTOR® implant?  Only your ophthalmologist can tell you.  After a complete eye exam and additional testing, your doctor will be able to determine if you are a suitable candidate for ReSTOR®.  Your doctor will talk to you about the risks of surgery, and those specific to multifocal implants.  For patients who meet the criteria, the ReSTOR® implant can be a life-changing experience.

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