Presbyopia is the normal aging process that everyone experiences over the age of 40 which affects near vision. This usually results in the need for reading glasses or bifocals. The crystalline lens which is located behind the pupil is clear and flexible and changes shape to focus at near. As one ages, the crystalline lens loses its flexibility and cannot change shape and focus. At first, one may have to push reading material out to focus, but will eventually resort to wearing reading glasses. If one already wears spectacles for distance a bifocal would be necessary. If one wears contact lens for distance vision, then reading glasses are needed as well. Some people attempt monovision with contact lenses, where one eye is corrected for distance and one for near. Monovision is not extremely popular, there is little intermediate vision, and a tendency for visual imbalance. Presbyopia continues to worsen with age – even a watch, smart phone, or laptop computer becomes impossible to read without glasses. By age 50 even using a desktop computer require glasses. Lasik, which is a commonly performed vision correction procedure, only corrects distance vision, and does not correct near vision. The only current surgical treatment to correct presbyopia and eliminate reading glasses or bifocals is a multifocal intra-ocular lens, and the most effective is the ReSTOR®. ReSTORis a lens that is inserted in the eye that has a dual optic – one optic for distance and one is for near. It is permanent vision correction and need not be changed later in life. Restor also provides simultaneous distance and near vision without any head movement.
Replacement of the natural lens of the eye is called a lensectomy with intra-ocular lens implant. This is a similar surgery to cataract surgery, but less involved since a clear lens is removed and not a cataract. After ReSTOR, one cannot develop a cataract with age. The procedure can be performed in the office with mild sedation and topical anesthetic drops. Medicated eye drops are used for several weeks. Usually in three to four days one can read, drive a car, and return to work.
With ReSTOR, both eyes are corrected for distance, and both for near. The apodized optics of the multifocal ReSTOR lens allows for excellent distance, intermediate, and near vision. In the FDA clinical trials, 80% of patients stated they never wore glasses after ReSTOR, and in our experience at Christenbury Eye Center, 95% of patients do not wear glasses. ReSTOR allows vision from 8 inches, and then continuous out to 14 inches, or about arms length. This range of vision allows reading material and the computer to be in focus. Of the several multifocal lens implants available in the U.S., we believe the ReSTOR provides the best near, intermediate, distance, and night vision.
Most patients, after any lens implants, can notice glare or halos around lights at night, and ReSTOR is no different. These symptoms are generally transient and last the first one to two months, then seem to dissipate. The FAA has approved ReSTOR for private and commercial pilots. Of the few percent of patients with persistent halos at night, they seem to be mild, do not prevent night driving, and in the words of one patient “better than wearing reading glasses.” One will always read with better illumination with Restor, but most patients can read a menu in the average restaurant lighting. The ReSTOR provides “blue blocking” to protect the eye from ultra violet light, just like the natural lens of the eye.
The day before the procedure you will start an antibiotic drop, which will be continued for several weeks after the procedure. The day of the procedure you will be given a sedative and anesthetic drop. Most patients are not aware during the procedure, and have little or no memory of the procedure the next day. The procedure takes approximately 10 minutes per eye, and both eyes can be corrected the same day. This allows a quick vision recovery. One requires a driver companion the day of and the day after the procedure for the one day postoperative visit.
By utilizing a microscope, a 2 to 3 mm incision is made at the edge of the cornea. Then the ReSTOR lens is folded and inserted through a small tube and placed behind the pupil. It naturally takes its position based on your own pre-operative measurements, and it centers each ReSTOR lens that is custom designed for you. Since the incision is so small, it heals without any stitches! The procedure is associated with very little discomfort, and most patients take no pain medication except Tylenol if needed. You will notice vision improvement that same afternoon, and the next day. Most patients return to most normal activities in 3 – 4 days.
If you desire freedom from reading glasses and bifocals, have moderate to severe Presbyopia, and/ or have been told you have cataracts, you maybe a ReSTOR candidate.
If you are over 40, dependent on reading glasses or bifocals, and desire spectacle independence, you may be a candidate. ReSTOR can correct distance vision like Lasik, as well as near vision. If one has good distance vision, ReSTOR will maintain the distance vision and correct the near vision. The FDA recommends, and it is our experience that both eyes should be corrected with ReSTOR to obtain the best reading vision. We perform a comprehensive eye exam to determine that the eyes are healthy. If a cataract is present this can be removed at the time of ReSTOR, and the results are the same as lensectomy. If astigmatism is present, we correct as much as possible at the time of ReSTOR. For larger amounts or residual of astigmatism a follow up Lasik can be performed at two to three months, and this is included in the ReSTOR fee.
IF YOU DESIRE FREEDOM FROM READING GLASSES AND BIFOCALS, CONSIDER THE RESTOR PROCEDURE. IN OUR EXPERIENCE 95% OF PATIENTS DO NOT WEAR SPECTACLES NORREADINGGLASSES AFTER RESTOR!
- 1. American Society of Cataract and Refractive Surgery, San Diego, 2011.
- 2. American Academy of Ophthalmology, Chicago, 2010