Scott Grealish M.D.
EyeHealth Northwest Deluxe Lens/Cataract Specialist
Portland, Oregon

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Results and Experience with the Alcon Restor Multifocal Lens Implant

Starting in 2004 the FDA approved a new class of lens implants that allow surgeons to offer patients a greater range of vision with less need for glasses after surgery. The first lens to receive FDA approval was the Crystalens, but the first lens to achieve widespread acceptance among surgeons was the Restor Multifocal. I was amongst the first surgeons to use these in 2005 right after FDA approval. The Restor quickly became the lens of first choice for the select group of surgeons who were early adopters of this new class of technology. Its ability to deliver good predictable results for any surgeon really opened up this market to a wider audience of surgeons and patients. The Restor is still the most reliable of the deluxe lens implants in my experience. I initially chose it over it’s competitors because it had the highest rate of achieving glasses free vision, even for reading, compared to any other implant on the market. Now, with the third version of the Restor, it is still the leader in providing the best chance of reading after surgery without glasses and simultaneously giving distance and intermediate vision.

Alcon, the company behind this lens, is the world leader in cataract surgery and lens implant technology, though their rivals would contest the throne. Having used their products for 15 years, I would say they are the standard against which others try to compete. From a surgeon’s viewpoint, going with the gold standard is always a safe bet. No matter which lens implant is used, I strongly counsel all patients to recognize that their own healing response to their surgery is a critical factor in what they may see after surgery, and that results to date are no guarantee of their particular outcome.

In my experience, the greatest advantage of the Restor over any other lens implant on the market in the US is that it offers the greatest chance of not needing glasses after surgery.

So why not use the Restor in every patient who wants a chance to see without glasses after surgery? The answer is that to achieve such excellent reading vision, the designers of the Restor had to use what we call a “Multifocal” approach. They very cleverly created two points of focus, one near and the other distance, in a single lens. Moreover, they brilliantly made the lens better for reading in bright conditions, and better for distance in dim conditions (think night driving). Unfortunately, such a design suffers from three predictable drawbacks that make it less than ideal for all patients.

The first is that many patients can perceive a “halo” effect around headlights at night. In my experience this occurs in at least 1/3rd of Restor patients when they are asked directly about their night vision. However, I have found only about 1% of Restor patients are truly bothered by this effect, and I have yet to have a patient insist of exchanging the lens for another (primarily due to the natural reluctance to undergo more surgery and the loss of reading vision they would likely experience). The catch, however, is that we currently have no ideal method to identify who will be the 1% that dislike the Restor “halos”. As a consequence, I ask all patients to clarify their visual needs at night and discuss the pros and cons of the Restor with every patient prior to surgery. Since most of us are not airline pilots or commercial truck drivers who must have the best possible night vision, in reality most people are excellent candidates for the Restor. I find this to be especially true in older patients who have typically lived with poor night vision from cataract for years (which usually causes far worse “halo” and “glare” than the Restor) and also tend to limit their night driving in general.

The second potential downside of the Restor is the need for bright light to read without glasses. If you recall, the lens designers actually built this feature into the Restor in order to maximize the ability to drive at night, a distance activity. They reasoned that most people read in the light and not in the dark. While a reasonable premise, in my experience I find some Restor patients have difficulty reading menus in restaurants without glasses (or better lighting). Since this effect is so predictable, I view it as an acceptable trade for the other benefits of the Restor, and counsel patients (and occasionally remind them after surgery) that it’s OK to use “readers” for some activities.

The third potential downside of the Restor has largely been resolved with the latest version of the lens that we now use exclusively. It used to be that Restor patients would have to get very close to their computer screens and hold reading material unnaturally close to get their best focus. Here is a great example of how a large company, Alcon, which created a very commercially successful lens (there have been hundreds of thousands of Restor lenses implanted since 2005 and they are still the market leader) went back to the lab and redesigned it based on surgeon and patient feedback to make it even better. Of course it didn’t hurt that their competitors (and there are many) were simultaneously creating better lens implants each year and raising the bar for best “Deluxe” lens implant.

So despite the fact that “better” implants are coming out almost yearly, for those who have a cataract now there is little reason to delay surgery; the current Restor is already excellent. Here is a brief summary of typical results from my practice based on the hundreds of Restor implant surgeries I have performed. I use an online database to compare these outcomes to many thousands of other surgeries performed by hundreds of cataract specialists around the US. This allows participating surgeons like myself to quickly learn which of the newest implants is performing the best for each of many criteria we use to judge vision. As a result, I can counsel patients quite accurately on even the latest cataract lens implant technology shortly after it reaches the market.

Restor results: What can you expect for your vision?

When reviewing the Restor results, it may be helpful to take a few minutes to look at the results I summarized for the Crystalens here. Now, compared to the Crystalens, the Restor has the following attributes:

Distance Vision (Driving)

On average, my Restor patients achieve about 10% less distance clarity than those patients who receive the Crystalens. Another way to say this is that the chances of seeing well in the distance without glasses after surgery is just slightly lower with the Restor than the Crystalens. I believe the results with the latest Restor will close this gap. Results nationally indicate excellent distance vision with the current Restor.

Intermediate (Computer/Shopping) Vision

The first two versions of the Restor, on which I have the greatest data, have almost 50% less clarity at an intermediate distance than the Crystalens. Hence the need for Restor patients to sit closer to their computer screens to see clearly without glasses. With the newest Restor, computer vision is typically excellent. I no longer counsel patients toward a particular lens based on their need to do intermediate work without glasses since all of the deluxe lens implants seem to do this quite well.

Near Vision (Reading)

The Restor seems to give about 25% better clarity at near than the Crystalens. This is reflected both in the measurements we take in clinic and in the 80-90% of Restor patients who state that they “never” wear glasses after surgery for any activities. Comparatively, about the same percentage of Crystalens patients say that they “seldom” wear glasses for any activity (typically if any glasses are worn they are for reading only).

Making the right choice for your vision.

So, now that we know the pros and cons of the Restor and have compared it with the Crystalens, we have on overview of the two “Deluxe” lens implants that virtually own the US market. So which is best for you? That decision is best made with the personal counsel of your experienced cataract surgeon who has the best understanding of your visual needs, desires, and willingness to compromise where necessary to achieve the best vision for you. To learn more about how I guide patients through the decision making process and an overview of these technologies, read my articles on “Choosing your Lens Implant” and “Realistic Expectations for Cataract Surgery with Deluxe Lens Implants”.