AcrySof ® IQ ReSTOR ® +2.5 D IOL with ACTIVEFOCUS

I'm mid fifties and moderately active. I don't wear contacts or glasses. I have a cataract in my left eye that needs to be replaced. That eye has near vision only. My right eye sees mid and distance well but the lens will need to be replaced in a couple of years due to a cataract in that eye too.

I was looking at the Symphony but the doc suggested the ReStor instead saying you get less visual issues with that lens. I don't recall talking about main focal point setting. He just said this lens is better for active people and I won't get the spider webs like you do with the Symphony.

I'm 52 and I ended up choosing between this IOL and the Symfony too. Despite claims by MFG's that most people end up “tuning out” the side effects that come with these lens designs, I didn't expect that to be the case with me. I figured that if the IOL produced a halo or "spider webs" I would see it. It might not bother me, but I didn't expect it to disappear either.

I ended up deciding that I did want to feel completely safe driving at night and I felt that a smaller, brighter "halo" would be preferable to a larger, fainter series of concentric circles. I had my surgery in February, 2018 and I noticed the nightime halos immediately and I still notice them. I was correct though that they don't really bother me very much and they don't affect my vision at night. Here is a quick summary for me:

Positives

1. Fantastic distance vision. I went for plano (distance) and based on testing I'm probably about 0.5D over corrected. I notice no difference in sharpness or contrast in distance between the eye with the Restor 2.5D and the contact. I actually can’t imagine the distance vision being any better than it is now with another lens.

2. No noticeable change to colors - colors appear identical between my eyes.

3. Barely any reduction in contrast sensitivity. It's technically there, but very, very difficult to notice any difference between my two eyes unless I set up exactly the right test conditions.

4. Serviceable intermediate vision - At the "arms length" and computer range I can read comfortably. However, while very clear, I do see a haze around letters which I think of as a reverse halo (the out of focus distance point). It varies considerably depending on the color of the text and background. This is one "artifact" where my brain does tune it out. If I look at the same text with both eyes, the “haze” I mentioned completely disappears.

5. No starbursts, pain, or other issues and only occasional and moderate dryness. I’ll just say this is probably a combination of surgeon and good luck.

Negative

1)Somewhat narrow field of clear vision. This will differ from person to person, but I can start noticing some loss in clarity around 10ft to 12ft. In my case, this is partly due to slightly missing the target. If I wear a +0.5D contact, it improves vision in this range without affecting distance. Although I now have this option, I rarely wear a contact as the two eyes together work very well and I only notice this softness with one eye open. When I get closer, say 4ft to 6ft, my vision does drop into the 20/40 range and then it goes back up to 20/20 at around 3ft. This is one major advantage of the Symfony (you get a continuous, clear range of vision).

2)Some glare when light strikes my eye from the side. For example, while sitting at my desk working on my computer (with a window to the right), I’ll sometimes notice a spot of light on the desk. If I then look at it, it’s gone. I will acknowledge that this lessened greatly over the year since my surgery, but it still is there sometimes. It seems to be more related the edge of the IOL and not as much a function of the multifocal aspect of the design, but it can happen with this IOL.

3)I still need reading glasses for close work (inside 18”). I knew this going in and I’m fine with the tradeoff (to get smaller nighttime halos) but it is a fact that near vision still requires some help.

hi jeff looks like moderator still reviewing my link. May not allow it but it was a surgeon's review of Restor and Symfony.

I myself have 2 Symfony lenses. Diagnosed at 53 with cataracts. Like these lenses for clarity at all ranges. Need good lighting especially for reading but don't need glasses. Have a pair for fine print which I use rarely. What I like about the EDOF lenses is the seamless vision - no blur in between focal points. I do see the spider webs around certain lights though at night.

That is a tough question and could vary between people with even same lens.

I had strong glare first few months so much so in the beginning I never saw the spider webs/concentric circles. I found it difficult to drive at night then and would avoid dark unlit roads. Was easier driving on roads with streetlights overhead. Within 5 or 6 months glare diminished a lot. However I do see faint thin circles around sources of light (red stop lights - cars when brakes applied - certain LED porch lights). I like Derek don't believe these will ever disappear as my brain adapts. I had both eyes implanted with Symfony July and Aug 2017. I do drive at night and feel safe to do so.

There are others who are more bothered by Symfony lenses at night than I am and some will say they don't see the circles at all.

My own opinion (and it would apply to any premium lens) is it's crucial the power calculation is accurate and no significant astigmatism after surgery. The more those 2 things are off the more artifacts one will have.

My right eye can see 20/15 for distance and my left 20/25. i can read J1 at 11 inches. I love being able to do close work without glasses.

For me the trade-off of not having perfect night vision was worth it. I work still full time with computer and spreadsheets. Couldn't imagine wearing computer glasses and readers.

If you want least amount of night vision glare and halos a monofocal would be better choice. Some professions like pilots insist on monofocal lenses only. what many surgeons do is target one eye for distance and the other slightly nearer .50 / .75 diopter nearer to give more range of focus and one would only need readers. Alternatively one could choose to target intermediate a d near and wear glasses just for driving.

Many options each with their set of pros and cons. Think about your work, hobbies sports you enjoy and make the best choice for you.

Hopefully you have searched for a good surgeon. sometimes they recommend the lens they ate most comfortable with or have most experience with. So I assume yours prefers Restor so if it were me and I wanted this surgeon I would likely go with his recommendation.

My surgeon didn't push any particular lens bit when I settled on a premium lens he suggested Symfony to me.

Sue An is quite correct. Unfortunately, there isn't great way to simulate exactly what you'll experience through a particular lens and even the simulations/renderings that are available probably won't convey to you the actual feelings you will have once the IOL is in your eyes.

I can tell you that, since surgery, I've driven a lot at night in a very densely populated city where I'm constantly on the lookout for bicycles and people running out in from of the car (San Francisco), on freeways in the Bay Area and LA, on rural interstates from San Diego to Portland, on very dark deserted roads on Maui and the Big Island. I never felt my vision was compromised in any way just a little "different" due to the small halo around point light sources. I might have made exactly the same trips with Symfony and felt the same (no way to say). However, at no time did I think to myself, "I wish I had gone with a monofocal IOL" as the benefit of being able to also see in the intermediate range is huge to me.

I'll tell you one more thing you might be thinking about. I don't see any halos looking at stars, the moon, white movie credits on a black background, or really anything other than headlights, streetlights, tail lights, and similar sources. I design lighting layouts as part of my job and spend a lot of time looking at and adjusting lighting (post installation) and rarely ever notice halos in this type of activity.

I think that Sue An will tell you the same things about Symfony - it's not constant these "artifacts" only happen under certain conditions and those conditions don't add up to a lot of time relative to the total amount of time your eyes are open and you are looking through them.

I had one other thought for you. Since you noted your "good" eye has decent distant and mid vision, it sounds like you still have some accommodation left. Surgeons like to perform this surgery on both eyes pretty soon after each other. I'd advise you not to do this unless you aren't happy with the results of your first surgery and the doctor thinks the second will help. My surgeon scheduled me for both but the cataract in eye #2 isn't affecting my vision yet so I canceled the second one. I am very nearsighted in that eye and I do wear a contact. If I correct just for distance, I have no intermediate vision. While I can read and use the computer solely with the Restor, my eyes work much better if I use a multifocal contact in the "good" eye which gives me two eyes focusing on both distance and intermediate.

Jeff, I am sorry, but I missed your message above. You are correct, with Restor, there is a range between far and intermediate where I do not have 20/20 vision. It drops to maybe 20/40 and then gets clear again. You should have a continuous, clear range with Symfony.

Dave:

How is the vision in your other eye? I would advise you to delay the second eye as long as possible but your situation may dictate that you need both done. I have Restor in one eye only and it's great.

While Symfony and Restor both have night issue, the "issues" are quite different between the two and this is where you need to do the research, read patients comments and decide which of the two night issues you think will bother you less. With Restor, you will have relatively bright but small halos around point sources of light. If you are thinking of 2.5D vs 3.0D Restor, the halos will be smaller with the 2.5D. With Symfony, the issue would be concentric rings around a point light source. These will be fainter but much larger than what you'd see with Restor.

As I've said in my comments, the Restor 2.5D halos are quite small and because they don't extend out very far from the light, they don't impact my driving at all and they don't bother me at all. The dip between far and intermediate does bother me a little.

Hi Dave - there should be a minimum of 2 weeks between surgeries - my own wait was 6. How can adjustment be made to the other eye when the eye that was operated on is healing and settling. Target cannot be guaranteed (IOL shifts back and forth till it adheres and power can be plus or minus half a diopter.)

Both IOLs good options but as you are aware they each have their pros and cons. The Restor has a different halo at night than Symfony (symphony has concentric circles around certain light sources). I work full time in front of a computer for large portion of my day do went with Symfony. Amazingly I have great near vision and see distance and in between too. Don't wear glasses except in dim lighting. both my eyes were targeted for plano and RE achieved that see better than 20/20 - recent test i could read 20/15 line. LE has a bit of astigmatism and distance is 20/25. but with both eyes open i see well.

Get all the advice you can now and make the best decision given your own set of criteria. Wish you the best - keep us posted.

Thanks, Sue and Derek. I've read all of your threads in this forum. Derek, you said the RESTOR Dip is at 4-6 feet for you, but my doctor said lean forward to computer screen. The distance between my eyes and my 27" computer screen is 70cm (~2 ft). Why would my doctor said lean forward? The Alcon website chart show it's worst (20/50 for 2.5D) at 13 inches. So if I lean forward from 2 ft to 1 ft, it will get right into the bad zone.

Another concern is that I had LASIK 12 years ago, my doctor said the machine will calculate the prescription with error because of that. Although he said it can be corrected with postop LASIK, I really don't want to have that. If I can find out my prescription before the 12 year old LASIK, will that help the machine to be more accurate?

For night vision problem, I don't think I will care that much because I'm already seeing lots of starburst right now. How can it be worse?

You are correct if you can obtain your pre-lasik prescription the doc should be able to more accurately calculate the power.

In my opinion getting power accurate is very important when selecting premium lenses - due to the expense and expectation of glasses free (or at least less dependent on them).

I too experienced bad glare and starbursts due to cataracts when night driving. It is better now than prior yo surgery. Derek is correct that the concentric circles are big - noticeable but faint like a spider web. Got used to them and not afraid to drive at night. But if anyone tells you they disappear in time - that is not true.

Dave the other factor in all this is how large your pupil dilates. Younger patients will dilate more and if extend beyond edge of IOL (regardless of lens type as they all are about 6mm) this causes another unique annoyance.

If you are getting the 2.5D Restor, the "inner" focus point is optimized at about 53CM (21") assuming distance is set at plano, but the 3.0D will give you better vision closer than that (12" or 14").

Another thing to note is that the depth of field will vary between different people and how you use your vision. I'd consider my usable "near" vision range to be 18" to 24". You might see well from 14" to 36" with the same IOL. I'm using multiple high-density-computer screens with pretty small text, so I'll interpret text to be unreadable at a different point than someone who is looking at a computer where the fonts are 2X the size.

Also, if your doctor is considering the 3.0D Restor in one eye and the 2.5D in the other, then get the 2.5D first. It's design will definitely have fewer night-time issues. If you are fine with it, and think to yourself, "I'm willing to accept larger nighttime halos in exchange for being able to read a little closer" then they can install the 3.0D in the second eye. On the other hand, if you think, "I couldn't deal with any larger halos" then at least you will be able to get the second eye in a 2.5D or Symfony.