Restor 2.5D Review and Comments

First, thank you very much to Sue.An and everyone else on this forum for the extremely helpful insight during this very difficult process. I’m going to apologize, in advance, for the length of this post.

I’m writing this because I had not found a single review of the newer, Restor 2.5D lenses online, just one or two complaints but the issues didn't seem to be related to the choice of IOL itself. This lens is a lower-add and re-designed (center-distance) version of the older Restor lenses. There are many older Restor posts online but many of these are quite old and, unfortunately, most patients don’t indicate which of the various Restor lenses they had. I had many questions about this lens such as the loss of contrast, nighttime halos, dip in vision between focal points, and similar and other than the company sponsored research and studies there was very little out there. Contrast this with Symfony where there are hundreds of personal reviews and comments. It’s an oddity as there are many, many Restor 2.5D’s being installed. I decided to write my in-depth thoughts and comments on this lens. My left is still unaffected by its cataract, so I think I can do a decent job of comparing the two eyes (which wouldn’t be possible otherwise). Hopefully this will help someone else in the future

BACKGROUND

I am a healthy male (just turned 51). I have cataracts in both eyes which were diagnosed about 2 years ago. There was nothing in my family history (or in my own) which would have put me at risk for early cataracts. At the time, a surgeon told me that it would probably be about 4-5 years before I’d need surgery. That turned out not to be the case although my right eye progressed much more rapidly than my left. I am near sighted and, until recently, have been wearing Acuvue Oasys weekly disposable contacts for ~20 years (-4.5L, -3.25R, although the right was the same as the left before cataracts developed). I have a very mild astigmatism in my right eye (approx 0.25D) which was uncorrected with lenses (and also not corrected during cataract surgery). With the lenses (and before the cataracts progressed), I could see about 20/13 in my left eye and 20/15 in my right eye. At the time of surgery, the vision in my right eye was down to about 20/50 to 20/40 (under perfect lighting conditions) and essentially nothing under other lighting conditions. My left eye is still at 20/13 (so the cataract is not yet an issue in this eye).

I have been using +1.25 readers for computers and +2.00 readers for extended cell phone/tablet use for the past 3+ years. My goal was to get back computer, tablet, and some cell phone reading without glasses. I was totally fine with continued use of readers for close-up work and extended cell phone use. I should mention that I am an engineer and electrical contractor and work extensively on the computer. I have a relatively large set-up with a 34” 21:9 and (2) 27” 16:9 monitors (all at 1440P). I sit between 24” and 30” from the monitors which makes text pretty small (and means I need pretty sharp vision). My office is the lowest level of my house, so if I may refer to home and office somewhat interchangeably.

One of the biggest problems with presbyopia correcting IOL’s is nighttime halos and other problems. Since the cataract is not yet causing problem in my left eye, I wanted to try to simulate these effects before surgery and I opted to test out some multifocal contact lenses. Ultimately, I was unable to find a lens that could duplicate the nighttime halos of a multifocal IOL. However, after two completely failed attempts, the third multifocal contact I tried (Cooper Proclear 1-Day Multifocal) was a complete success. I was able to achieve 20/13 distance and pretty good intermediate vision. Unfortunately, the cataract in my right eye was too strong and even with this lens in my left eye, I still needed reading glasses. The right eye just caused too much distortion to make extended reading/computer use possible. I tired a patch over the right eye but didn’t adjust to that either.

After much research, I chose to go with multifocal Restor 2.5D lenses. I was also considering monofocal IOL’s (set for distance) and Symfony. My surgeon uses both Restor and Symfony although he does 4X as many Restor lenses. Due to my personality, I ruled out any form of monovision. I know that quite a few patients are able to read with monofocal IOL’s set for distance but there are many factors in how well this works. In my case, with contacts set at perfect distance (and some accommodation left), near and intermediate vision are absolutely horrible. I can’t imagine that a monofocal with zero accommodation would suddenly give me great intermediate vision, so I ultimately decided that I would try one of the Presbyopia correcting lenses. Mainly due to this forum, I decided to trade off the extended focus range and lower incidence of nighttime halos with Symfony for the lack of concentric rings (which seem to affect almost everyone). Also, my surgeon’s familiarity with the lenses and the fact that he has not had a single explant ultimately led me to this decision.

Although these terms get somewhat interchanged, I’m going to use the term “Halo” to refer to one or more circular/rectangular rings centered around a light source, “Glare” to refer to a more diffuse “blob” of light around an object and “Starburst” to refer to fewer but long, spokes or vertical lines of light radiating away from the central source. When I’m mentioning Halos, I’m talking about artifacts specifically related to the design of the lens while I think most starbursts are artifacts caused by the capsule, scarring or similar and are mostly independent of the choice of IOL.

Day 1 (Thursday 2/8/18) – Surgery was at 10:30 AM. Femtolaser room was first, with no sedation, only numbing drops in the eye. I was nervous about this, but it did not hurt and it was over quickly (less than 1 minute). The machine has a suction-like device which helps greatly as you just have to stay “reasonably” still.

Once the femtolaser is done, they immediately started IV Sedation and wheeled me to the surgery room. I was pretty much out of it but did get some direction from the surgeon. There was no pain and I was on my way home by noon. My surgeon puts a dressing and shield over the eye for the first night (most surgeons seem to just use a clear shield), so I went home like this and had no idea if I could see at all. There was really no pain, but the bandage over my eye did itch and occasionally I would open my eye below the bandages and it would sting. The gauze itched my eyelid and the sides of my eyes. I would say that dealing with the bandage the first afternoon/evening was far worse than the surgery but it really wasn’t that bad.

Day 2 (Friday) – Doctor’s office at 9:30 AM.

My bandage was removed and the overall feeling was …underwhelming. I have read many comments on peoples’ first impressions about how everything was so clear and the colors so vibrant and I didn’t feel any of that. The cloudy “veil” was removed but colors looked pretty much the same as before and pretty much exactly like my left eye. This was likely due to the type of cataract I had which was a posterior subcapsular cataract. The surgeon also told me today that I would definitely need YAG within 3 months. He had told me ahead of time that YAG was likely going to be required but now it’s a certainty. I am hoping to see the benefits of the near focal point before we get to that point. At this time, I don’t feel my intermediate vision is good at all. We’ll see how this changes over time, though.

Day 2 (Friday) – Back home around 11:30 AM.

My vision is not very sharp but it is not horrible either, certainly much better than before the surgery. At distance, I am about 20/50 (I have a chart in my office set at the correct distance). At 6 ft, about 20/70 and at 21 inches (the near focus point for the Restor 2.5D) I am about 20/100 (14-pt font). For near testing, I am using a chart meant to be held at 31cm (which has conversions into metric and feet), but I am holding it close to the 53 cm (21 in) point for the Restor. This means that my actual vision would be a little better than 20/100 (because I am holding the chart further out). Nevertheless, I think it’s a fair measure to see what happens over time and I’ll be doing the same thing as I progress to see if it gets better or worse over time.

I tried small distance add glasses (-0.5D and -1.0D) as well as reading glasses (+0.75 and +1.25) and neither of these seemed to make any improvement which I’m hoping is a positive sign that I’m just feeling effects of the surgery itself and not a miss in the target. I am also seeing flashes of light which appear to be emanating from the outside edge of my viewing. They are not constant and the relatively large QTY of floaters I had prior to surgery seems about the same so the surgeon doesn’t believe that I have a retinal detachment.

Day 2 (Friday) – Mid-Afternoon

I wanted to take the day off, but I had to try to do some work. I got on the computer and forced myself to NOT use my normal +1.25 computer reading glasses. It took about 15-20 minutes but then my vision settled down and seemed to get better and better over the next few hours. I actually worked close to 4 hours without reading glasses for the first time in 2+ years! After this, I went outside to the back yard (it’s been over 70 deg F for the past week here in San Francisco) and lied down by my fire pit with my tablet for more than 2 hours. No reading glasses. I can also use my cell phone now without reading glasses. What I found is that the moderate improvement to my right eye from the new IOL coupled with the multifocal contact in the left eye creates some really impressive combined vision. I am really excited and happy about this.

Day 3 (Saturday) – Pretty much exactly 48 hours post-surgery

This morning, my distance vision has improved to 20/30 and my near (using the same procedure as yesterday) is up to 20/50 (8-pt font). With both eyes together, it is 20/13 distance and 20/25 near (4-pt font). However, I am noticing significant flickering at the right edge of my vision while my eyes are moving (mostly during reading). There is a very good (and long) thread on this forum regarding this symptom. With +2.0 reading glasses I was able to look into the mirror and see the implant itself move and kind of flicker while this happened. I’m hopeful that this condition will lessen as the lens gets held more firmly. Already, I can say that my brain is somewhat tuning them out as I don’t notice them all the time. I also see occasional flashes from an off-angle light source, although this is not frequent.

I walked around quite a bit last night and definitely see Halos around most light sources of differing intensity (depending on the light source). I am seeing pretty much exactly what is drawn by David Taylor’s son (Search for, “David Taylor my intraocular lens experience”) in his Restor ere image but WITHOUT the long starburst “spoke” lines (I just see the circles). They are very noticeable but also quite small relative to the size of the light source. The same sources through my left eye appear as slightly smaller and uniform, fuzzy “balls of glare” (probably the only visual evidence of my cataract in that eye). One difference is that with the Restor eye I can make out the actual shape of the light source clearly in the center. For example, a square LED light fixture across the street looks square and more sharp inside 3 or 4larger halo rings (with Restor) where it’s more of a single, diffuse blob with my left eye (and maybe a little smaller overall). Due to my research, this is exactly what I expected to see and while this effect should lessen over time, due to the relatively small size I don’t feel it will cause much of a problem in terms of driving. I may be wrong about this, so we’ll have to try it in a few days.

I also tried to see how much of a loss of contrast there is with this lens alternating back and forth between my two eyes. It was pretty hard to see much of a difference. However, in a very dark room I can detect a subtly better image through my left eye. Looking at my bedroom door, for example, I can just make out the hinge and door handle with my left eye but not with my right. I can also see some added detail looking at a power receptacle about 12 feet away whereas I can only see the outline with the Restor eye. It’s really a subtle difference however but I will make note of any differences I see in other situations.

I watched a movie and some TV last night in a completely dark room. I wanted to see if I’d notice halos around credits or other objects on the screen. This was a concern of mine as I like to play compute/console games and watch movies. I did not notice any artifacts from the Restor eye, but I will continue to do the left/right eye test on this over the next few weeks.

I also wanted to comment on the dropoff in vision that should be there between the two focal points (maybe around the 6 ft, 2m point). At this stage, I cannot notice this, but my vision isn’t sharp enough yet, so I will revisit this late on. This is another area where the Symfony should be superior.

Overall Summary and a Quandary

At this point my visual results (numerically) seem to not be optimal but they are improving and hopefully this will continue. However, my overall vision has improved so much over my pre-surgery condition that I am already very happy at this point while still expecting additional improvement. Had I done an RLE (clear lens exchange), I would probably feel completely different. With my two eyes together (RESTOR 2.5D + Multifocal Contact) my vision is now quite good. I can read my cell in to about 12”(with its default font size) and it’s the Restor providing most of the clarity at this distance. I’ve been able to use a tablet or computer for several hours without glasses. I have regained my depth perception and watching TV just seemed so much more clear and sharp.

The problem is that multifocal IOL’s supposedly work much better if implanted bilaterally and I am scheduled to have my left eye surgery in less than 3 weeks. I don’t know if I’m going to go through with it or delay it for a while. The surgery on my right eye was an easy choice – my vision was already poor – but that’s not yet the case with the left. I don’t know if I have another 2-3 months of clear vision or 2-3 years. Also, since I have a multifocal contact paired with a multifocal IOL, does this improve the performance of the IOL (relative to a standard contact lens) or does it mean the Restor side doesn’t improve to its full potential? I haven’t found a single comment or study about this as it’s probably an uncommon situation. I see the surgeon again on Wednesday and I am going to push for a delay on the other eye but I will report back either way.  Any comments or suggestions would be appreciated.

Finally, in case any contact lens wearers considering an RLE happen upon this post in the future I want to encourage you to exhaust every possible presbyopia curing contact lens option before getting an IOL implant. In my case, the first two multifocal contacts I tried didn’t work at all. I did get good intermediate vision, but my distance vision dropped below 20/40. With one lens, I could get the distance up to 20/20 only if I turned my head sideways and look back at a very sharp angle. On paper, the design of the lens that worked is very similar to the lenses that didn’t worked, but boy did lens #3 work for me. Just find an optometrist that will give you multiple trials of different lenses until you’ve exhausted every option. No matter how good your surgeon replacing doing an RLE will come with some sacrifices. Unfortunately, the contacts will only work for me for a limited time but they feel like magic to me.

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