A related discussion, IOL explant / replacement was started.

I just saw your post and hope you're still reading this forum.  I'm glad to hear that your retinal surgery was successful; I also had successful retinal surgery.  Unfortunately, high myopia and a history of retinal disease place us both at higher than average risk for future retinal problems.  Hopefully, this won't ever happen, in which case it wouldn't matter which IOL we had.  But we don't know what the future holds.  In an older  thread, Eagle Eyes (6/25/06) describes how silicone IOLs can become foggy, which might impair a surgeon's visualization of the retina and negatively impact the surgical outcome.  In addition, silicone oil (frequently used in retinal detachment surgery) can't be used with a silicone IOL installed.  You can find a reference for this info at www.evrs.org/pages/meetings2/22.htm.  (The speaker, a retinal surgeon, seems to believe that NOBODY should get a silicone IOL, but I think that's a pretty extreme position.  When I asked my retinal surgeon about IOL selection, he told me to avoid the ones made of silicone.  However, he probably never would have said anything about this if I hadn't asked.)

There's a discussion by/for cataract surgeons about Crystalens at www.eyetowncenter.com.  Apparently, getting good results with this IOL requires a very skillful surgeon.  A history of retinal disease is listed as a contraindication.

I have a question to JodieJ, on a comment that was posted in May. I just joined this forum today, and I could not find the exact thread but found JodieJ on this thread. To JodieJ I ask--What do you mean that crystalens is contraindicated for someone with retinal detachments? Could you please cite some references for this. I have had retinal detachments as long as 15 years ago and they were fixed perfectly by William S Tasman of the Wills Eye Hospital by scleral buckling. I understand that the scleral buckling procedure involved sewing a sicilone band on the back of my eyes to create scarring and to fix the break. I had numerous laser procedures as well as a retinopexy and that didn't work- finally I was referred to Dr. Tasman and he gave me what must be the gold standard procedure of scleral buckling.  

Anyway, why is silicone-based lenses contraindicated? By the way my vision in my left eye is -14.50 and my right -10.50.

I just went to the eyeonics website. I see the hinges are listed as flexible, not metal.

Who is the medical monitor? I know of one prominent, world renown surgeon who recommended that when the crystalens is to be explanted to cut the optic and leave the haptics/hinges in place to cause less trauma to the eye and maintain the capsular bag. I was under the impression he was the medical monitor. Perhaps I was misinfomred. Perhaps you could set comment here, since you seem to be so high on crystalens. I would be most interested in learning what you feel is the best way to explant a crystalens? What do you recommend when the crystalens serves as a monofocal providing excellent distance but no intermediate or near?

If you read all the threads, you will see that I have recommended all the premium IOLs. Why are so you so biased against ReZoom? My comments are based on facts, anecdotal information, and personal experience with many cataract and refractive patients who have received all types of IOLs including crystalens, ReSTOR, and ReZoom, as well as corneal refractive surgery.

Dear uniformed eagle eyes.

You are right when you say that the ReZoom is more predicatable, it is, you can predict that it will provide you increased glare and halos, and limited intermediate vision. It is the Array lens with the rings re-arranged, there was no FDA study performed on the ReZOOM, the labeling cites Array data.  

You elude to the fact that the Crystalens is harder to manage, causes Z syndrome and has metal hinges - Oh please, get your facts right - Z syndrome has been around for years, first documented in the early 90's, so it is not specific to the crystalens.  Metal hinges, hardly, suggest you log on to www.crystalens.com for the real scoop - Your quote regarding the crystalens medical monitor is ridiculous, he has never explanted a crystalens !  

Patients need to make an informed decision about which lens is right for them.  At least give them the truth!!!!

Dear EE,  

My dad has a crystalens, good memory.  I am a mechanical engineer and studied carefully the mechanism of action of all the lens available.  Optics are my hobby.

Some of the statements you make are incorrect and I really think you show a bias toward the ReZoom lens?  Why is that?  I'm sure the ReZoom lens is a fine product, but no need to degrade other technology while making your point.

Its my guess that every patient presents a different lifestyle, different geometry of the eye, and other factors that an ophthalmologist would understand and then select the best lens accordingly.  Not one of the current crop of presbyopic IOL's is the perfect solution.  Statements to make any lens stand out as the "only" solution might be harmful to people reading this page who are trying to make an informed decision about their surgery.

While I'm at it, I must point out that you are just flat out wrong about:
A) Crystalens having "metal" hinges, that is proposterous!
B) I am completely aware of the Z phenomonon with the original crystalens,  My dad has a crystalens SE which has eliminated the problem.  SE stands for square edge, apparently this blocks irregular capsule contractile forces that were causing the "Z".

EE, Do you work for the company that makes ReZoom??????

Jesse Optics

Hi

Crystalens works well as it did for you, if my memory serves me correctly. It is just that it is the most difficult of the three to use with great success. It has a much smaller optic 4.5 mm vs 6 for ReSTOR/ ReZoom. It has metal hinges, so it is virtually impossible to remove, should it need to be. Even the medical monitor for crystalens, recommends leaving the haptics in place if the IOL needs to be removed so it does not tear out the bag or do more damage. A condition called Z phenemenon can occur. Sometimes, it does not "accommodate" like it is designed to do, so patients end up very angry that they did not "get their monies worth.

Most of the Europeans have completely stopped using this IOL.

ReZoom is easier to implant, works more consistently, more reliably, and more predictably.

When it works, it works. It gives the best distance vision with fewer halos. It gives the best intermediate (which is it's strongest point) it gives the worst near.

I am thrilled that yours is doing the job for you.

I thought that you were an Alcon insider....you neither confirm nor deny...

My eye surgeon told me on 4/10/06 that Alcon has a new, improved ReStor lens currently in "bench study", not yet tested in humans, designed to capture more of the intermediate range vision, but that it was at least 9 - 12 months or more away from release to the public.  

Because of the uncertain timing of development and release to market, he did not think that I would want to wait that long to explant my original left eye ReStor lens.  He never mentioned that waiting that long could be a problem in the physical proces of explanting; just that he thought that I would grow even more impatient with my current intermediate range vision woes while waiting.  And he is right.  

That's all I know.

Please explain the release of an "improved" ReSTOR lens. I have direct contact inside Alcon and have not heard of such a project. You may be thinking of the Tecnis diffractive multifocal, but it will come with the same 4 diopter add as ReSTOR next year from AMO, not Alcon.

Dear Eagle Eyes,  You comment that the multifocals are "more forgiving" than the crystalens.  What do you mean?  JO

Thank you and the other folks for some very supporting, encouraging and helpful comments.  You are giving me the info I need to discuss with my surgeon.  He never once indicated that 8 months out would be a problem, not even when rejecting (as impractical) the option of waiting for Alcon to release the improved ReStor lens in 9-12 months (or more).  I cannot believe that when I ask him about risk of vitreous, fibrosis or other problems if we wait(ed) too long to explant, that he will slap his forehead and say "Oh wow, I never thought of that."  My surgeon is too good, reputable, and renowned to make a bonehead mistake like that.  Like you have said, HE is looking at the chart and at my eye, so he and I will have to decide if this is feasible or not.  Trust me though, if he hesitates or even hiccups when I ask about the timeline, I will walk away from explanting.  Only if he is certain of his succuss will I proceed with explant.  Thanks.

We are seeing more and more MDs both in the US and certainly in Europe mix and match. The brains are adjusting just fine. It all depends on this -->

An eye exam to determine eye health wise for good candidacy. Plus:

1. age
2. which eye is dominant / non-dominant
3. size of pupils in bright light, dim light, pitch dark.
4. What does one do all day
(CLOSE READING or NEAR NEAR as it is called: very fine print like Wall Street Journal stock prices,medicine label, needlepoint, jeweler, etc) (COMFORTABLE CLOSE:reading further away than 6 inches from nose out to arms length,normal reading of various size fonts from newspaper to books to articles, etc.) INTERMEDIATE WORK: computer, cell phones, PDAs, artist that painting, musician playing instruments, plumbing, shopping, cooking,golfing, play cards/dominoes,etc) DISTANCE: tv, outdoor activites such as walking, driving,etc.

Most likely several if not all of these "ranges" are important. Pick which are the most important whether it is NEAR NEAR, COMFORTABLE CLOSE, INTERMEDIATE, or DISTANCE.

Pupil size may be one of the biggest reasons to mix and match, if the pupils are small, very small.

The Queen makes some good comments. In simple terms, it is very unpredictable as to how successful an explant/exchange will go. No way of knowing for sure until the surgeons gets in there. Having said that, there are some things that make for success with an exchange. No doubt, sooner rather than later is easier. (especially within first several weeks. The problem is with "giving it some time" to heal and see if it gets better, the weeks drag out and then months have gone by. If a YAG has been done, definitely harder to do and more risky--as the vitreous (jelly in back of eye) can be exposed and may come out wtih the IOL causing other problems that need to be addressed. Also, centration of premium IOLs in particular is crucial. After an exchange if there is a comprimise to the capsular bag or zonules, an IOL can be decentered. This causes pther problems like double-vision, ghosting image around image, etc.

The other factor is surgeon experience with any one issue. If you have to have an IOL exchange, surgeon experience is key. There are silicone, and acrylic IOLs and acrylics are inarguably more challenging to remove than silicone. There are special instruments and techniques, so again, the surgeon needs to be totally informed on the latest "how-to" to be good at it.

In general, explantation rates are around 1%. For standard IOLs. We found this to be true with the old Array - 1st generation multifocal. Now with ReZoom and ReSTOR....more explants are occuring-even moreso with ReSTOR...why?
1. More MDs are using these IOLs, may of which are new to multifocals so there is a learning-curve for them to know who and when to use in the first place. Then if there are problems, sometimes they tend to yank it out as opposed to be patient and work with the patient. ReZoom is more versatile, and more forgiving than ReSTOR. They are both more forgiving than Crystalens. Ask all the questions you want of your surgeon. You deserve to know the answers. Get as many opinions as you need to so that you are comfortable with the recommendations.

You will hear many opinions on what works and what doesn't.  The mix and match may work perfectly for you, but it could be a nightmare having two different optical systems in your eyes. After all, the ReZoom is refractive and the ReSTOR is defractive. This differences alone can cause visual disturbances. Not to mention the fact that both lenses have these issues even when implanted bilaterally. A second, refractive, opinion may be the best thing for you.

With apologies, I may have mis-spoken about the 100 explants.  As I think further about what my surgeon told me, his colleague has done at elast 100 ReStor / ReZoom combos, some of which were explants, many of which were original procedures.  I do not know the breakdown.  I am sorry about the confusion and the "fire storm" I touched off with my hasty comments.  Please forgive.

I agree that I need a second opinion.  I am quite concerned about explanting this far (7 - 8 months) down the road.  I will start with my eye surgeon but also proceed from there.  Thanks.

Mike:
you need another opinion. Explanting a serious affair, and must be reported to the manufacturer and FDA by federal law. I seriously doubt that one surgeon has explanted 100 lenses of any brand without it hitting the news. Have you noticed that Bausch and Lomb had a handfull of contact wearers report infections, and the news hit the major wires? You should contact Alcon Consumer Affairs to report your concerns.

That's a great idea.  I will look into that.  I wonder if they would refer me to / validate my current eye surgeon??  I wouldn't be surprised if they did.  Thanks!!

Since Frank A Bucci Jr MD & Henry L. Milne MD are the leading proponents & most experienced with the Rezoom/Restor combo why not try to set up a consultation- phone or otherwise- with them regarding your unique situation. It seems like they perhaps would have some experience with the restor explant/rezoom implant procedure. Or could refer you to someone in your area of the country.

I just posted a message in a previous thread about ReStor woes in response to remarks by Dr. Michael Wong (posted by hud on 5/15/06).  I thought Dr. Wong's comments were totally outrageous, and they left me with the impression that the ReStor lens is an inferior product (and the doctor may have a sociopathic streak.)  I'm really curious about what others think about the doctor's remarks.

My eye surgeon first raised the prospect of explanting the ReSTOR and replacing it with a ReZOOM lens at the end of February 2006, which was already 3 1/2 months post-op for me.  He discussed it again at length with me on 4/10/06, or at 5 months post-op, which is when he told me that there was virtually no risk to him removing the ReSTOR and implanting the ReZoom lens.  He is aiming for the end of June 2006 to actually do it, which would be at 7 - 8 months post-op left eye.

As I noted in another thread, he is the foremost, premier Lasik / cataract / refractive lens implant surgeon in my area.  I trust that he knows what he is doing; I just need more information to satisfy myself in discussions with him, and I am seeking that via this forum---specific questions to ask him.

Oops, let me qualify that---most of that 100 would be explants, and some may be a ReSTOR / ReZoom combo from the start.  I do not know the breakdown.

Explanting any lens always comes with a risk.  Afterall, it is a secondary surgery.  If your capsule becomes ruptured, the lens would have to be placed into the sulcus.  Not the first place of choice.

It is more than likely that  capsular fibrosis is complete.  It would be very difficult to remove if you are 6 months post-op.  The window of opportinity for most patients is within the first 2 months of implant.

Is your information on 100 explants correct? - Seems to me that that kind of information needs sharing with the public.  Good Luck

Thanks for the tip.  I'm not sure that the information posted on this forum can be considered complete.  My eye surgeon has a colleague in Pennsylvannia who has explanted ReSTOR lenses in approximately 100 patients, and counting.

I will discuss it thoroughly with him at the next visit.  Thanks.

So sorry to read about your problems and frustrations.  If the info posted elsewhere in this forum is accurate, only twenty-something of those IOLs have been explanted.  Why don't you try contacting the manufacturer directly.  There has to be somebody there in Consumer Relations who can address your concerns or connect you to someone else who can.  The web site must have a phone number.