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    Clinical experience with AcrySof ReSTOR lens in refractive patients


    Francesco Carones, MD

    *Off-label use of product in the United States; on-label use in Europe, for treatment of aphakia

    Refractive lens exchange has become the procedure of choice for correcting high ametropia in the presbyopic patient. From the refractive surgeon's perspective, the AcrySof® ReSTOR® lens is a wonderful option for refractive lens exchange. It is safest in eyes without high or excessive axial length. Until recently, the only implants available for refractive lens exchange were monofocal intraocular lenses (IOLs). These provided patients with a single focal point, either for reading or for distance. The Array® multifocal IOL became available several years ago, but my experience, and the collective experience of many other surgeons, was that this zonal refractive, multifocal IOL did not provide a satisfactory result for most patients.

    I began implanting the AcrySof® ReSTOR® lens in refractive patients a year ago. Since then, I have operated on 38 eyes of 19 patients, all of whom were refractive patients who received the AcrySof® ReSTOR® lens. These patients had clear lenses and no contraindications for lensectomy; all had very high motivation not to require any kind of spectacles in the postoperative period. I employed a standard lensectomy technique: a 2.8-mm clear corneal incision, a 5-mm capsulorrhexis, and the Monarch® cartridge as the lens delivery method. At last follow-up, all 38 eyes were within ±0.62 D spherical equivalent after surgery. At distance, all eyes were 20/25 or better without correction. At near, all patients could see J2 or better for reading, and with 1 exception, all could see at least J3 at 60 cm (computer distance) without correction. With correction, all were 20/20 or better and J1 or better.

    Feedback from the patients was highly satisfactory. These patients were mostly hyperopic before surgery, so having high-quality near vision without spectacles is what they had "dreamed of" for a long time. The intermediate vision was reported as good. Patients do note some visual complaints, specifically at nighttime, during the first postoperative week. But these complaints—typically halos and light rings—fade during follow-up and tend to disappear totally. This is probably due to the very effective wavefront this lens is able to provide.

    Still, as with all refractive surgery, patient selection is crucial for best results. I select patients based on motivation. Optimistic patients are ideal, because these patients can assess and accept the various slight compromises that necessarily accompany any type of refractive surgery. And again, hyperopes are much better candidates than myopes, because they have reached the myopic age, and they have already experienced the benefits of getting such effective near vision without compromising far distance vision. Since I began implanting the AcrySof® ReSTOR® lens in presbyopic hyperopes, my laser-assisted in-situ keratomileusis (LASIK) practice has shrunk by 70% in this population. It makes good sense to me to provide those patients with both distance and near vision. Also, these patients are so grateful that they become a marketing tool, sending many more patients to your practice.

    Table 1. Contraindications to Use of the AcrySof® ReSTOR® Lens
    There are very few contraindications to refractive lens exchange with the AcrySof® ReSTOR® lens (Table 1). However, highly demanding patients, hypercritics, should be avoided with this and probably all refractive procedures.

    I generally exclude people who wear multifocal spectacles in a satisfactory way, because they don't have a real need for this device. Additionally, monovision patients, patients with amblyopic eyes, and those who are poorly cooperative are not the easiest to manage.

    I suggest motivating your AcrySof® ReSTOR® patients to get the most from the lens by explaining to them that the best postoperative experience may require time—the brain has a learning period in which to reduce the various slight side effects that the lens may produce. And as with other refractive procedures, AcrySof® ReSTOR® patients must be trained to use light appropriately to get the best from near or distance vision.


    Dr Francesco Carones
    Francesco Carones, MD, is medical director of the Carones Ophthalmology Centre, Milan, Italy. He may be reached be E-mail: ...

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