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Cataract Surgery-ReStor lenses
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Cataract Surgery-ReStor lenses

I had cataract surgery with astigmatism repair and ReStor multifocal lenses on my left eye 5 months ago and on my right eye 4 months ago. The ReStor lenses were a complete failure, did not help my near vision at all and I still must wear reading glasses and bifocals.  I was very nearsighted before surgery and while my distance vision without glasses is of course much better than it was without glasses before surgery, it is worse than it was with glasses, even with cataracts before.  I HATE the loss of near vision, being nearsighted, before surgery I could always take my glasses off to see something up close and now of course can no longer do this, basically I wear my reading glasses all the time inside, and try to function with bifocals outside, I have gone to 3 different optometrists trying to get glasses that will help.  The worst part by far however, is that my eyes do not seem to focus as well together, there is an unpleasant, headache inducing "fluttering" sensation when reading (with my reading glasses, I cannnot read without them). My eyes are also very dry and tire easily when reading.  Is there anything that can be done for these problems?  I have actually started thinking about having the horrible ReStor lenses removed and replaced by regular IOL's, though I am terrified of more surgey.  How dangerous is this?  I have read that once too much scar tissue forms it can no longer be done.  I am furious that these ReStor lenses were ever approved and VERY frustrated.    Susan12345
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Avatar_n_tn
not an easy fix for this.  if multiple glasses rx's have not yet worked for you, they likely never will.

more surgery may be the only fix.  you'll have to decide if its worth it or not...
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Avatar_n_tn
Susan, I am so, so sorry to read your post.  Can you get a second opinion from another doctor?  I believe the Restor site has a list of names of doctors, in all the cities, that deal in Restor. One of those doctors can tell you about correcting or removing the lens.  Wishing the very best outcome for you. I would not let anymore time past though.
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Avatar_n_tn
I agree. You need another opinion. The Restor lens is doing what its supposed to do, but your spherical and/or cylindrical power is not matched with the implant prescription. Your dry eye condition also exacerbates the situation. I have spoken to several surgeons who have dealt with scenarios like yours, from other surgeons' work, and have been able to explant/exchange lenses and treat any residual power issues. Dr robert Cionni in Cincinnati has reported that he has exchanged Restor lenses as far out as 12 months, with no complications. It is the last resort, as there are risks involved whenever you have to go back into the eye. Barring any contra-indicating pathology, you should have excellent vision with Restor.
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Well, I DEFINITELY wouldn't have the ReStor lenses replaced with another set of ReStor lenses!!!!!!!!!!!!!    If I were brave enough to go through 2 more surgeries I would have plain old-fashioned single vision IOL's, set for near vision and wear glasses for distance.  But I guess this is just fantasy, as long as I can still see, even if not as well as previously, I doubt I would be brave enough to try again.  Something else would go wrong, I attract bad luck like a magnet.   I just constantly keep kicking myself for being stupid enough to have these horrible ReStor lenses installed.  I've never been able to read with bifocals, so was so frustrated constantly switching glasses.  And though the ReStor advertisements said 20% still need reading glasses, I thought big deal, I already wear reading glasses.    They don't tell you about the other complications,  like the fluttering focusing problem or that's it's one thing to wear reading glasses for reading the newspaper and another when you can no longer see the buttons on the microwave without your reading glasses.  The fluttering comes and goes, the glasses I ordered from the 3rd optometrist have a different astigmatism prescription (it seems to keep changing) and expensive anti-reflection coating, maybe that will help, though most likely not, the problem's coming from the IOL, not the outside.    I'm just so angry, at myself, at my doctor for not recognizing that I was not a good candidate for multifocals and at the ReStor company.  I don't think my doctor did anything wrong technically.   But I'd be interested to learn if other people who have had difficulty with bifocal glasses are more likely to have problems with multifocal IOL's.  If so, they should be warned BEFORE they go through the trauma and expense of surgery.         Susan12345
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Avatar_n_tn
Susan, please get a second opinion from the best opthamologist in your city.  Do not let anymore time pass.  Do you have a teaching Medical School in your city?  If so, that is a good place to get a referral. As Hud said, lenses can be removed.  What City do you live in?  Hud can maybe recommend a doctor in your City.  If you still want them removed, it would still be better to go to a doctor that has experience with the Restor, I would think.  My thoughts are with you.
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Avatar_n_tn
Susan, I just did want to mention that if you have your Restor exchanged for the Traditional lenses, if you have the Traditional set for near, you will need glasses all the time for most things in daily life.  Where as, if you have them set for distance, you will need glasses only for things near.  Of course the most important thing is what you are more comfortable with. Best wishes.
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Avatar_f_tn
Please stop blaming yourself for your vision problems.  They are NOT your fault.  I disagree with your statement that your doctor did nothing wrong technically.  I think hud's right--your IOLs are the wrong power, and they may also be improperly implanted.  (It requires greater skill to implant a multifocal than a conventional lens.)  Please go for a second (or third, if necessary) opinion.  I think that a surgeon who is experienced with ReStor would be best for identifying the sources(s) of your difficulties and providing you with treatment options. Maybe hud can recommend a good surgeon if you tell us where you live.
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Avatar_n_tn
Yes, Jodie J.  I agree.  I read where someone on the board posted that the doctor that does cataract surgery is not important, because it such a routine operation.  I could not disagree with this opinion more.  And I have a hunch that all Opthamologists who do cataract surgery would also disagree.
There is much that goes into the right eye measurements for the patient.  And the skill of the surgeon is of the upmost importance to me.  Yes, I guess cataract surgery is one of the most common surgeries performed in the world. But the outcomes can vary greatly, depending on the surgeon performing the operation.
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Avatar_f_tn
I think that multifocal IOLs are much more demanding in terms of the surgeon's skills.  Measurements have to be exact, and the lens has to be precisely centered in order to get good results.  Some docs are still on the learning curve.
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Avatar_n_tn
I don't know how you ever really know if a doctor is any good.  The one who did my eye surgery was listed in a local magazine as one of the best doctors in his specialty (as selected by the magazine surveying doctors about who they'd send a family member to).  He has both an MD and a Ph.D.  I was told by other doctors how lucky my HMO was to get him. He's the only one at my HMO who does mutifocal surgery, so I'm looking at about $20,000 out of pocket if I were to have the Restor lenses removed.  I don't mind wearing glasses, I chose the ReStor because I was so sick of switching glasses constantly because I could never read with bifocals.  I was fine with glasses until the middle-aged presbyopia set in.  I had a large cataract in my left eye and a small one in the right, if I'd had regular cataract surgery I'd just have had to have my left eye done; the right might not have needed surgery for years.   But because I stupidly chose the ReStor lenses, I had to have them both done, and now my vision is so much worse than before.  I don't understand what people mean when they say the doctor must have installed the wrong size implant.  The Restor people say flat out that 20% will still need glasses, so I accept that.  My main problem is the fluttering focusing problem and that seems to me to be intrinsic to the design of the ReStor.  The web site mentions glare and halos and I guess this is an extreme form of this.  Believe me, if I had had ANY idea it would be like this I would have NEVER have had it done.     Susan12345
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Avatar_n_tn
Susan,

I would think that any correction that you needed due to your poor outcome would be covered by the surgeon that did your surgery.  What does he say about your poor outcome?  What reason does he give for your poor present vision?  How much did he charge for your surgery?
Was the magazine that you saw his name in, an advertisement paid by him? This is your life. Don't blame yourself for this situation. You are in no way to blame for anything.  Don't let anymore time pass.  Go to the Restor site and put in your city and get other opinions from doctors  that show up on the Resor site that practice in your city, using the Restor lenses.  This does not mean that you want other Resor lenses.  But someone that deals with Restor, will be able to pin point the problem more accurately than someone that does not use them.   Get another opinion from a reputable doctor before anymore time passes.
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Avatar_f_tn
I'm a cataract patient myself, not an eye care professional.    Based on everything I know about ReStor lenses, your outcome suggests that something has gone very, very wrong.  And I don't think that your inability to adjust to your bifocal glasses pre-surgery has anything to do with the problems that you're having now.

If your ReStors were the correct power for your eyes and were properly implanted (not tilted or off-center), you should have good distance and near vision.   You might need glasses for intermediate vision tasks, like using the computer.  You might also experience halos/glare in some lighting situations, which would probably diminish during the months following your surgery.  Take a look at the new post (8/20/06) about ReStor lens problems.  ReStor lenses aren't perfect, and these are the type of complaints that you might have.

Your situation with Restor lenses is very different.  It's as if you're wearing glasses in the wrong prescription, and the frames are battered so the lenses are loose and out of alignment.  Maybe other factors (significant astigmatism?) are contributing to your woes.

I think it's common for people (especially us women) to blame themselves when things go wrong.  But your current vision problems are absolutely not your fault, and that kind of thinking is going to prevent you from getting your HMO to make good on their responsibility to you.  You need an evaluation from a doctor who is experienced with Restor in order to identify exactly what's gone wrong and how it can be fixed.  Keep us posted about your situation.

        

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Avatar_n_tn
Excellent post!!!!!!!!
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Avatar_n_tn
Well, it really doesn't matter whose fault it is, I'm the one who will go blind if further surgery makes it worse.  Regular cataract surgery would have been covered in full by my HMO, I paid $2301 extra for the ReStor lenses and the astigmatism repair which was necessary for the ReStor to work.  My astigmatism wasn't corrected 100%, but supposedly enough that the ReStor should have worked.  But I know my HMO wouldn't cover anything if I used a doctor outside , and I doubt they even would if the doctor who did the 1st surgery did a repair, since I don't have cataracts anymore.  My surgeon gets back from vacation Aug. 28, I wasn't able to get an appointment til Sep. 21, but I plan to be on the phone Aug. 28, begging to be seen to see if there is anything that can be done.  No, the doctor review article wasn't an advertisement.

My prescriptions before surgery:

OD: -400 -275*032
OS:  -525 -200*159
Add: +2.50

Latest (after several prescription changes)

OD; +1.00 -1.75x047
OS: +0.50DS
Add: +2.50

So the reading vision is on paper exactly the same before and after, in reality it's MUCH worse, since I can no longer bring things up to my nose to read without glasses the way nearsighted people do.   No longer nearsighted, but still some astigmatism.  But it's whatever's causing this fluttering sensation that drives me nuts!  When I try to describe it to the optometrists they have no clue.  The last one talked to me about needing to move through the stages of grief.  He was the one who ordered the last prescription, with the anti reflection coating, so when those glasses get here I'll see if they help at all.  I suppose I could experiment too by covering the right eye, the one with the worst astigmatism, and see if that's causing the fluttering.   Though it feels like it's coming from both eyes.   I hate it!   I'm definitely still in the anger stage!      Susan12345
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Avatar_n_tn
Susan, it really is summed up by the Forum O.D.  However, myself, I would most certainly get a second opinion from another Restor doctor, no matter if my HMO paid for it or not.  And I would do it before it became too late for correction, should that be the route you decide to take.  Good luck to you, no matter what you decide to do.
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Avatar_f_tn
Based on your latest script, you're a little farsighted with significant astigmatism in your right eye.  This could be corrected by Lasik/PRK enhancement (usually included in the multifocal surcharge), but I don't think that it would even come close to resolving your current vision problems.

I suspect that most of your ReStor problems (including the fluttering) are happening because your surgeon didn't implant the lenses correctly.  (Eyecare professionals, please speak up if I'm mistaken here.)  The center portion of the ReStor lens is for near vision.  Because your near vision is poor even with a 2.50 add, I don't think that you're able to access the center of the lens with either eye.  I'm also guessing that both lenses are tilted (probably at different angles), which is why it's more difficult for you to focus both eyes together than it once was.  It's astounding that your surgeon would leave you in this awful state!

In your place, I'd get an appointment with a different ophthalmologist at your HMO, preferrably a doctor who also does cataract surgery.  I'd claim that my headaches had become too severe for me to wait until the September appointment with the original surgeon--I needed to be seen this week!  I'd bring a written list of all the problems and issues mentioned in your posts to the appointment, so that everything would get documented in my medical record.  I'd certainly ask for the doctor's opinion about what needed to be done (at the HMO's expense, of course) to correct my vision problems.

ReStor lenses are made by Alcon.  Their website has an 800 number.  Perhaps an Alcon consumer rep could refer you to another surgeon in your area for an additional opinion.  It would be probably be worth the money.

BTW, was it Castle Connolly who named your surgeon a "best doctor?"  



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Avatar_n_tn
Sorry, I don't have any idea who Castle Connolly is.

I talked to my surgeon's office today and begged them to have him give me a call as soon as he gets back, apparently he will be back Aug. 23, not Aug. 28.  He's the only one at my HMO who knows anything about the multifocal lenses, the other cataract surgeons, wisely, just do the regular ones.  I called the eye clinic at my local medical school, but they can't get me an appointment any sooner.  I told them who my surgeon was and they said he was wonderful, used to work for them.   Like I said, I just attract bad luck like a magnet.....I had knee surgery from another "best doctor", which made my knee a lot worse.  Or maybe the "best" doctors get careless after a while because they think they're so good.  I don't know.  If my eye surgeon weren't  a 2 hour bus ride away I'd go camp out in his office until I got him to see me.  Though actually I think he has 3 different offices.   Anyway, anybody who's thinking of having a multifocal IOL, think again.  They definitely haven't been perfected yet, in my opinion, and I E-mailed both the FDA and the Alcon company to give them my opinion.    Susan12345
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Avatar_n_tn
I looked up Castle Connolly and it looks like my local magazine's list of "best" doctors may have some association with them.  Is that good or bad?  Well, obviously it was bad in my case, but how ARE you supposed to find a good doctor??  

When I had my stitches out my doctor said my IOL's were in the right position. My near vision wasn't any better then, but I wasn't having this fluttering sensation.  If the IOL's have moved out of position since is there any way to fix it without removing them?  And WHY would they move out of position?  A lot of cataract surgeons boast about "no stitch" surgery, but mine said he did use them just to prevent that kind of problem.  They tell you not to bend over for 2 weeks after surgery, and I was so worried I accidently would, but my doctor said, that was exactly why he used stitches, to prevent any problem if someone accidently bent over.    Susan12345
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Avatar_f_tn
I don't think your vision problems have anything to do with possible defects in your ReStor lenses.  From what I've read, most people are pleased with their ReStors.  The center portion of the lens is for near vision, with distance vision in the outer ring.  It seems like you're only able to access the distance portion of the lens, and even then your vision is variable and has problems.  I believe that an optometrist could tell if your lenses were properly centered.

A list of Castle Connolly "best doctors" appears in a local magazine here in Chicago.  I've actually had two eye surgeries (eye muscle and retinal) done by docs on that list, both with excellent results.  However, one of the previous "best docs" (not an ophthalmologist) was a joke in my office.  (I work in a health-related field.)  A few years ago this doctor lost his medical license as a result of his unorthodox practices.  He was also sued successfully for very large amounts.  Last I heard, he was arrested in another state for practicing medicine without a license.  So it's hard for medical outsiders to know who is really good.
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Avatar_n_tn
I had restor lenses implanted in July.  Is it possible for a lens to be perfectly centered the day after surgery and slightly off center 4 weeks out?  I can see up close better with the right eye, which my optomitrist said is perfectly centered.  The left eye, which she said is slightly off, has some shadowing on close reading.
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Avatar_f_tn
I defer to the professional opinion of your optometrist.  I've read that it takes a week or more after implantation for an IOL to be securely in position--but I'm not an eyecare professional.
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Well I was able to get my surgeon to examine my eyes.  (Three hours each way on 4 buses to one of his distant offices).   He said everything looked fine and my IOL's are centered  in exactly the right place.  He has no idea what's causing the fluttering,  never had a patient who complained about it before, suggested maybe it was from not getting enough sleep.  What???!!!!  I'm in my 50's, I never had this fluttering until getting the ReStor.  Does he think for the 1st 50 years of my life I always got adequate sleep?  I suppose it could have nothing to do with the ReStor, maybe it's a brain tumor or some other horrible neurological problem, something else to worry about.  But I think it's the ReStor.   It's just too confusing to the brain to be trying to see both near and far at the same time.  Apparently most people adapt, but then most people can adapt to bifocals too.   I HATE THE RESTOR!   I HATE THE RESTOR! I HATE THE RESTOR!!!!!!!!  But it definitely sounds like it's too risky to remove.  He did say there isn't a set time when it's too late to remove an IOL, he once removed one after 10 years, obviously not a ReStor, they didn't exist then.  But that there really wasn't any difference between 4 months and 4 years in terms of safety, the biggest problem is that the IOL is put in folded in to a tiny incision and once it's unfolded you need a much bigger incision to get in out.  So basically,  I'm stuck.  I know getting angry at myself, my surgeon, or the Alcon Company changes nothing but it's just so incredibly frustrating.  I really thought I had researched this thoroughly beforehand.  I certainly didn't go to one of those discount Lasix surgeons that advertise every week in the Sunday comics.  But I might as well have.  I just didn't know the right questions to ask.   I want to tell everyone, if you have trouble with bifocals a multifocal lenses may not work, and if you're very nearsighted  and the near vision part of the multifocal doesn't work, your near vision will be much worse.   Also if you have astigmatism repair as part of your surgery your eyes may be dry and sore forever.  I HATE THE RESTOR!!!!!!!!!!!!!!!!!  Susan12345
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Avatar_n_tn
Susan,  I am so sorry to read your post. If there is any consolation at all to derive from your visit, it is that you are not under the gun to make a decision to have them removed now.  I believe, because usually they are preferred to be removed before the 3rd month.  Yes, very, very, hard decision to make. But at least he has done it before.  And evidently it was successful. It is at least an option.  Risky yes.  But it would be harder for me to hear that they could never be removed. The option, risk and all, would be a better scenario for me to hear, than, "nothing can be done". Best wishes.
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Avatar_f_tn
It's obvious that your current vision problems are having a extremely negative impact on your quality of life.  You're going to have to channel your energy into finding a way to improve your vision.

You have already seen (literally) what your current doctor can do.  It's time to consult someone else.  I suggest that you start with another ophthalmologist at your HMO, preferrably a doctor who also does cataract surgery (even if s/he doesn't do multifocals.)  Bring a list of all your problems and complaints to the appointment, so that everything can get documented in your medical record.  Ask your new doctor about the options for improving your vision.  (Do you know what your current visual acuity is for near and far?)  You will probably have to go outside your HMO network to resolve your problems, but there's a good chance that your HMO won't complain about paying for everything.

BTW, I've known several people who claimed that they couldn't adjust to their bifocal glasses.  In every case, these people were able to easily adjust to different bifocal/progressive glasses made at a different lab or in a different style.
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There's no point in asking any of the other cataract surgeons at my HMO about my problems, they know zip about multifocal lenses and would just tell me to ask my surgeon.  I know full well my HMO would never pay for anything outside the network unless it was something like a pediatric heart transplant that no one inside could do. I guess it wouldn't hurt to make an appointment for a self-pay exam with someone out of network, though probably all the ReStor specialists in my area were trained by my doctor. As far as my doctor thinks, my results were excellent.  Certainly I'm less nearsighted, and have less astigmatism, and he doesn't see the near vision thing as a big problem, after all everyone over 40 has presbyopia and the ReStor people say that 20% will still need glasses.  He tells me that I try to read too close and if I hold things farther away and squint til my head is ready to explode I get better results on the reading chart, so it all looks good on paper, but there's certainly no pleasure in reading that way and I HATE that feeling of not being able to see close; I wear my reading glasses all the time inside my apartment.  He's never had a patient complain of fluttering before so it must not exist.  I know I'm making him sound terrible and actually he was very nice, examined my eyes thoroughly and took an unusually long time talking to me.  He just doesn't know what to do and doesn't think my problems are anything that would merit having the lenses taken out.  And after he discussed the risks, I'm far too afraid, it's not just the surgical risks but much increased risk afterwards of retinal detachment, which I'm already at high risk for anyway due to nearsightedness, cataract surgery and diabetes.  Hopefully it will improve a little, or I'll get more used to it.  I'm just so frustrated that this wasn't some awful accident, I actually CHOSE to have it done.

Unfortunately not everyone can adjust to bifocals.  I tried so many different kinds, regular with the reading spot in different places, various kinds of progressives.  I finally settled on an expensive brand of progressive that didn't make me feel like I was going to fall over, but I don't think I really was ever using them as bifocals, I think I was just looking through the top part and and taking off my glasses or looking over them in order to read. I work in a health care field and twice people mentioned my doing this to my supervisor.  Because I was nearsighted,  I could read fine doing this,  I certainly wouldn't have continued working if I couldn't, but it LOOKED like I couldn't.   This was one of the biggest reasons I wanted a multifocal,  though ironically now I'm retired anyway due to knee problems made worse by another doctor's surgery at my lousy HMO.    Susan12345
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