Question: I have cataracts and need cataract surgery but have been given three different opinions of the type of lens implant that I should have and am now confused. Two cataract surgeons suggested not having Crystalens®, while one did. One suggested a toric lens implant and the other a ReSTOR® IOL. The eye surgeon who recommended the Crystalens® explained that my astigmatism is very small and may be corrected to a great degree by the natural lens removal. The cataract surgeon who recommended the ReSTOR® IOL also would use LenSx® femtosecond laser to do the cataract removal and make any correction for the astigmatism. The other two doctors do not feel laser use is necessary. The ideal of a multifocal lens implant appeals to me, especially if I can obtain very good vision without glasses. My current refraction is OD: -9.00-1.00 x 141 Axis and OS: -8.00-.075 x 048. I do have a +2.25 add for both eyes for reading using progressive lens. The question is how does one determine what to choose? Do I continue to seek more suggestions? I went to the 3rd eye surgeon when I received two really different recommendations. Now I have three different options.
Answer: Indeed this can be confusing when there are multiple opinions on lens implants from the various Cataract Surgeons. First, let’s consider the astigmatism. It is not completely possible to tell from information provided without knowing the corneal topography measurements, but it is reasonable to think that the astigmatism is at least in part due to the changes in the crystalline lens itself and would be reduced or eliminated by the cataract surgery itself or could be quite well managed by the planned placement of the cataract surgery incision or a laser LRI if needed. Based on this one would believe that a toric lens implant is not necessary. Now, regarding the use of either an accommodating lens implant such as Crystalens® or a multifocal lens implants such as ReSTOR®, technically either of these could assist you with being less dependent or independent of glasses after cataract surgery for most activities. Generally, those patients who like to have crisper clear near reading vision do much better with ReSTOR®. In fact there is significant bias among the Cataract Surgeons we queried that suggested NOT opting for Crystalens® for a number of reasons. The use of the LenSx® femtosecond laser does appear to offer some advantages for some patients, but is really a decision made by the individual Cataract Surgeon.
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