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Eye Care  (Expert Forum)
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Near Vision after First ReStor IOL implantation
Answered by
John C Hagan III, MD, FACS - Ophthalmology
Discover Vision Centers Kansas City - MO
Our Ask A Doctor Ophthalmology Forum is where you can post your question and receive a personal answer from physicians affiliated with the American Academy of Ophthalmology.
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MedHelp Member's Question

Near Vision after First ReStor IOL implantation

by Gichuki, May 19, 2007 12:00AM
Pre-cataract surgery I was near-sighted w/ mild astigmatism & steep corneas. Wore glasses for 45 yrs/alot of PC use/close work hobbies.
1 mo. post-dominant eye surgery I drive w/o glasses;can see PowerPoints in lectures;mo longer wear glasses. Night driving vision improved-fewer halos than before.
  Altho I'm pleased w/this distant vision, I am distressed my "second sight" cataract-caused vision in my eye w/cataract is superior to my near vision in my newly implanted ReStor eye. Yes my "second sight" will deteriorate/I will have to implant some lens in my 2nd eye. I am assured w/the 2nd ReStor implant my near vision will be better & my vision won't improve until I do get the second implant. It doesn't make sense that if I can't see up close now that I would see so much better up close w/ a 2nd ReStor implant. I can't "trust" my near vision will improve w/ 2nd ReStor. I wish no more surgery to get near vision back & I don't want to start wearing readers for up-close reading when I've not had to wear glasses for the last 2-3 yrs. I understood the ReStor's strength was near vision.
  I have difficulty reading my piano music through the blur; can't read blurry book page 8-10 inches from my eyes w/o aid of my original lens w/cataract. Using only the ReStor implanted eye,computer text is blurry.I have traded near-sightedness for far-sightedness. Thx for any insights to my near vision concerns.
Doctor's Answer

by John C Hagan III, MD, FACS, May 19, 2007 12:00AM
Intra-ocular implants (IOLs) that are multi-focal (can see distance and near and are so called 'premium IOLs', take longer to adjust to than regular single focus IOLs. One month is not your final result and most patients improve over subsequent months. Some patients that are ultimately very happy with their multi-focal IOLs take 6 months to fully adjust.  Also even with premium multi-focal IOLs surgeons cannot guarentee that patients will not need glasses for certain tasks (night driving, sporting events, computers, sewing, etc) to achieve the best possible vision.

Also with muti-focal IOLs 'rivalry' between the eye with the IOL and the eye still having a cataract is often more troublesome than in mono-focal IOLs. Your brain is being presented with two different images from each eye that differ in clarity, focus, color persception and with different glare disability and contrast sensitivity. This situation is not unlike having two different people talking to you at the same time. In this situation vision may seem better by closing one or the other eye.

Rivalry is often helped dramatically by surgery on the second eye. Also when the second eye is done your surgeon can 'tweak' the power of the multi-focal IOL to compliment the first eye for various tasks/distances.

In any case there's no reason to rush into a second procedure until you are satisfied with the results of the first procedure (provide your expectations are reasonable--a multifocal IOL is still nothing like a 16 year old eye with youthful focusing power).

Surgeons that use multi-focal IOLs have a wealth of experiences about the recovery period of their favorite IOLs. As such your best souce of information is your EyeMD (eye surgeon).

JCH MD
Member Comments (7)

by RHS, May 20, 2007 12:00AM
To: Gichuki
I share your pain. What ever you do next don't let the doctor stretch out your waiting period for your vision to improve. I have two Restor lense implants which are now  one year old. My vision was bad from the start and has never gotten better. I tried every thing that my doctor suggested to improve my vision. Contact lenses, laser surgery to correct my astigmatism, etc I can't see well at any focal length. Near vision: my two eyes do not focus at the same reading distance. They don't work at all in low light situations. Middle distance is non-existent in good light and poor light. Far distance works fairly well during a bright sunny day, however at night the rings and halos are so bad that I am unable to drive at night. To read this forum my head is plastered up to the computer screen to recruit my near vision blurry as it is.I am now scheduled to have my first Restor lense removed on June 20th by a different surgeon at my expense. The second will follow. What ever you decide to do, don't wait like I did. Basicly my life has been hell for 12 months. And to top that off I am not confident about the surgical proceedures I now face. It seems, by what I have read that if you choose to explant that you should do it withtin three months. By the way, my vision never improved once the second eye was done. I thought all along that it was the astigmatism but it was not.

Hopefully, some other people will respond to offer insight on our problems.

by JodieJ, May 21, 2007 12:00AM
To: RHS
If you check the archives of the Optometry forum, you will find several posts from people who have had their multifocal lenses successfully explanted (after several months to more than a year) and replaced with monofocal lenses.  It is now reported in the medical literature that a small percentage of people are never able to adapt to their multifocal IOLs.  Best of luck with your surgery.

by K-D, May 22, 2007 12:00AM
In my opinion, with the multifocal so new, many problems with multifocal lenses are not always apparent to the surgeons.

I had a Rezoom lense implanted 15 months ago.  It was 14 months of misery, because I could only see to arms length when inside a building.  I was told that my problem was because Rezoom was pupil dependent.
So, for months and months I went back and forth regarding an explant.  Then I developed the secondary cataract with the capsular bag and needed a YAG.  But I knew that if I received the YAG, I would be stuck with the Rezoom, because after YAG, it is hard to measure the eye for the correct lens implant.  So, after 14 months of misery, I decided, since due to the secondary cataract, and I had hardly any vision, and was too apprehensive about an explant, I went with the YAG.  I expected to live the rest of my live with the inside blurry misery, due to the Rezoom being pupil dependent.  However, I am still in awe.  It was not the Rezoom.  Since the YAG, for the first time since I had the Rezoom implanted 15 months ago, I can see inside as well as outside, and read without glasses.  I sought out another physician and a very simple procedure completely changed my vision.  Now the once hated Rezoom is very precious to me.  I still have halos, but with my clear vision, it is a small problem to me.  And I still have floaters which I am hoping will one day cease.  But the point is, a second opinion is so very, very, important.  My problem was misdiagnosed.  I have the same pupils, and can see so clearly, inside as well as outside.  Just so sorry that it took me so long to get another opinion.
WHen having a problem that is not addressed by your doctor.  It is time to seek another opinion.

by JodieJ, May 22, 2007 12:00AM
K-D, I'm very glad to learn about your improved ReZoom vision!  As you stated, the multifocals are new technology, and it seems like most docs are still on the learning curve.  I've read reports about a variety of procedures that have really improved the vision of some people:  laser vision correction, surgery to recenter the IOL, receiving a second multifocal implant, (and now) YAG.  But none of the above procedures have worked for everyone.  Within the past month, I've seen reports in Eye World and the EyeQ Report of the ASCRS 2007 Symposium stating that a small percentage of people never neuroadapt to the multifocals.  (Susan from Seattle, your intuition about your ReStor vision appears to have been right on target!)  RHS, you may be in this group, and I truly empathize with your misery and frustration over the past year.  On the positive side, there are posts in the archives (e.g., from Blue92) who obtained excellent vision when their multifocals were replaced with monofocal lenses (after more than a year of bad vision).