Eyeworld Supplements

M any patients appreci- ate the increased freedom that comes from multifocal lenses that give them more than one focal length in focus. The ideal reading distance is moving out farther as more patients desire vision at the distance of a computer screen or a tablet. The +4.0D add multifocal IOLs provide high-magnification reading, but relatively close to the patient at about 13 in., which is closer than most patients typically want to read. This distance makes the computer screen particularly difficult to read. As a result, +4.0D add multifocal lenses, like the ReSTOR +4.0D (Alcon, Fort Worth, Texas), have had very good reading at 13 in. but are only 20/40 at intermediate distance (see Figure 1). While this is acceptable for some patients, there is no question that our society is becoming more computer distance-oriented. In comparison, the ReSTOR +3.0D supports reading at more typical distances. This moves the sweet spot closer to the intermediate zone, which is important to many patients. As a result, the ReSTOR +3.0D has an average visual acuity at intermediate distances of around 20/25, which is generally more acceptable to patients than the 20/40 vision achieved in the ReSTOR +4.0D. Another advantage of the ReSTOR platform is that it features an apodized structure. In normal lighting, half of the light is allocated to the near image and half of the light is allocated to the distance image. However, when the patient's pupils become larger, a growing percentage of the light is directed to the distance object. The lens was designed this way to reduce the potential for nighttime glare and halos. This feature should be appreciated by patients who spend more time out at night. Another key feature is that ReSTOR lenses are made of the same material as the other AcrySof lenses, so the haptics are soft enough that the lens can be moved and centered where you desire. The AcrySof material adheres to the posterior capsule, which helps it remain in place. These features help the surgeon to better center the IOL. I was involved in the FDA trial for the ReSTOR +3.0D lens, and in that study, patients were random- ized to receive either the ReSTOR +4.0D in each eye or the ReSTOR +3.0D in each eye. They were not told which lens they had. I implanted lenses in two separate patients on a Tuesday, and the next morning they came in for their 1-day postop visit. These two patients struck up a conversation with each other while they waited for their exam. As they talked, they figured out that both were in the trial and both had surgery on their first eye the day before. One patient was a pharmacist and the other was a dentist, and as they started talking about where they could see in the distance and where they could read, they figured out that one of them clearly had the ReSTOR +3.0D and the other had the +4.0D. They later told me their conclusions, and while I was not allowed to confirm this, I knew they were right. There is a noticeable difference in moving the focal length of the +4.0D lens out to the focal length of a +3.0D lens where patients read and see intermediate more comfortably. Last week, I implanted a +3.0D in the second eye of a woman who had come to see me with a specific desire to be less dependent on glasses after her cataract surgery. We reviewed all of the lens options available to her, studied her lifestyle, and concluded that the ReSTOR +3.0D was the lens that was most likely to give her the near, interme- diate, and distance vision that she desired. I called her a couple of days ago, and she said she was elated with her vision at all distances. Dr. Foster is a cataract and laser eye surgeon in Fort Collins, Colo. He can be contacted at FosterClinic@EyeCenterNoCo.com. EW Boston 2014 5 ReSTOR +3.0D offers excellent computer distance vision by Gary Foster, MD Gary Foster, MD " The ReSTOR +3.0D supports reading at more typical distances. This moves the sweet spot closer to the intermediate zone, which is important to many patients. " Figure 1

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