Decision time for ReZoom implant

[wishfuleye]

I had a ReZoom implanted in my dominant eye eight months ago.  The results are disappointing to me as I still require glasses - the distance vision is almost OK, but the intermediate and close are about where they were before the surgery.

I've lost some confidence as the surgeon's thoughts on a solution have drifted from lasik tweaking, to "it will be better when we get a ReZoom in the other eye", to "may be macular edema", to currently "maybe monofocal would be best for you, and it looks like you'll just have to wear glasses".  I will have my last post-op appointment next week, and I don't know what to ask or do at this point. I don't want to proceed with another surgery without understanding more about why this one didn't work.

He had mentioned that if he had it to do over again, he would have used different diagnostic equipment, so I can't help but think that I may simply have the wrong lens.

Would I be able to find out from a different doctor with different equipment if the problem is the implanted lens, and if it is, is another exchange possible?  We did a lens exchange in the week following my surgery, and I have had a YAG, and I understand that these activities may present difficulties with another implant surgery.

My glasses prescription over the ReZoom is Sph +050, Cyl -075, Axis 050 and +200 Add.  I can live with this result but I wouldn't do surgery on my cataract eye for the same result.  How can I determine whether it's a lens selection problem, or if I'm just one of those statistics where the multifocal just doesn't work. Any thoughts appreciated.

[Forum-OD-MP]

"Would I be able to find out from a different doctor with different equipment if the problem is the implanted lens, and if it is, is another exchange possible?"

yes, yes, and yes.  you can always find another doctor.

"and I have had a YAG, and I understand that these activities may present difficulties with another implant surgery."

yes, that makes lens exchange more difficult

"How can I determine whether it's a lens selection problem, or if I'm just one of those statistics where the multifocal just doesn't work. Any thoughts appreciated."

there is no great way to determine that.  its not going to be easy for you or any doc you see to figure that out...

[K-D]

I am trying to find out the exact same question.  My doc also went from twicking, to monofocal in the other eye, to wear glasses. What happened to seeing near, far, and in between?  I can only see 20 inches in front of me from the Rezoom eye, when inside, but outside is` good.  Have to always wear readers, which I would have had to do with a monofocal, but would not have had halos. Yet, the solution I am now getting from the office is to come in and be fitted for glasses.  And oh yes, an additional fee to be fit.  At this point I wish I never heard to this doctor or the word multifocal.  I never wanted a multifocal to begin with.  I never ever heard of the word when going for cataract surgery.
I am not an eye expert, but it seems to me that if the problem with my being unable to see clearly with the Rezoom when inside, and yet if I look through a small opening and things become completely clear, it could not be a pupil problem,  but a astigmatism problem. Dr. Price could you please comment on this for me?  I have been trying to find the answer for almost a year now.  If things are blurry and I can make them totally clear by looking through a small opening, is this not an astigmatism problem that can be corrected, or is it truly a pupil problem that cannot be corrected with a Rezoom?

[Ag-i-doc]

"I am not an eye expert, but it seems to me that if the problem with my being unable to see clearly with the Rezoom when inside, and yet if I look through a small opening and things become completely clear, it could not be a pupil problem, but a astigmatism problem."

no.  its not a pupil problem.  its not nearly that simple.  any and every refractive problem can be made better by looking thru a small opening.  this is called the "pinhole effect".  its a complicated optics lecture, but basically by eliminating paraxial (off-axis) light rays, vision improves.  any/all vision improves with that method.  but is not a practical application in real life b/c it too-severely reduces peripheral vision.  literally every refractive problem can be improved with the pinhole effect, EVEN PROBLEMS THAT ARE NOT FIXABLE WITH CURRENT TECHNOLOGY like chromatic aberration, or coma, or spherical aberration, or corneal distortion, or irregular astigmatism, etc etc ad nauseum.

so the short version is...even if you see better when you look thru a small opening, that does not mean your problem is fixable, nor does it mean its a "pupil" problem.  you couldnt make your pupil small enough to get that effect, its impossible.

i feel bad for you restor/rezoom failures, but fixing the optics problems is usually way more complicated than one would think.  if it was as easy as "making your pupil a little smaller", that would have probably been mentioned to you already.  fixing this is not going to be easy, and it may just be impossible.

[JodieJ]

It's obvious to anyone who has been reading this forum recently that implanting multifocal lenses is extremely delicate surgery, and the possible problems involved can challenge even highly skilled surgeons.  Wishfuleye, it's likely that your surgeon doesn't really know what's causing your ReZoom problems or how to fix them.  You need to consult another doctor who has more experience/expertise with ReZoom.

K-D, you seem to be so "20/unhappy."  Have you considered finding a doctor who could safely explant your ReZoom and replace it with something you'd be happier with?

There have been a couple of people posting here recently about Dr. Kevin Waltz of Indianapolis, who was able to safely explant mulifocal lenses and to solve ReZoom ghosting problems that had perplexed other experienced surgeons.  If I lived anywhere near Indianapolis and was having similar problems,  I'd definitely consider a road trip to Indianapolis.  Eyecu, I believe that it was you who provided this valuable referral source.  Any other referrals of this nature would definitely be appreciated by readers of this forum.

[K-D]

Thanks much for the`info. Jodie after the PVD, I am too frightened to have the Rezoom explanted.  I do have an appointment with another doctor.
After 8 months, I was so happy that my halos have` decreased tremendously. But I just now realize it is because of my unoperated eye becoming dominate.  Ok for now. But real problem when that eye goes.

[wishfuleye]

Let me be a little more specific with my questions.  You say I can always find another doctor - can you give me some help with what diagnostic equipment I should expect the doctor to have and the best way to ask (interview) the doctor about his inclination to evaluate the lens selection of another doctor?

You confirm that the YAG makes lens exchange more difficult and I understand that there are risks to every surgery, but is there a conventional wisdom or statistical probable outcome for an exchange after a YAG and eight months of implantation?

This forum has been a great help in understanding concerns that don't appear in "official" publications availble to the general public.  I've gotten much more information here than from my doctor.  

Is there any "support group" out there, maybe similar to this forum, specifically for multifocal lens implants, or more specifically for ReZoom issues?

[Ag-i-doc]

"Let me be a little more specific with my questions. You say I can always find another doctor - can you give me some help with what diagnostic equipment I should expect the doctor to have and the best way to ask (interview) the doctor about his inclination to evaluate the lens selection of another doctor?"

not really.  i'm not a surgeon.  every IOL surgeon has an ultrasound and a pachymeter and a topographer, etc etc.

"You confirm that the YAG makes lens exchange more difficult and I understand that there are risks to every surgery, but is there a conventional wisdom or statistical probable outcome for an exchange after a YAG and eight months of implantation?"

NO.  no such luck.  not common enough of a problem for me or anyone else to have LOTS of experience with it.

"Is there any "support group" out there, maybe similar to this forum, specifically for multifocal lens implants, or more specifically for ReZoom issues?"

dont know.  if there is, i havent heard of it.  if you find one or start one, please please please post the link here b/c at least 1/3 of the questions posted here are questions about or problems with multifocal implants.

[JodieJ]

I'm glad to hear that you'll be consulting another doctor.  That's what I'd do in your place.  It's too bad, though, that your original doctor is getting off the hook so easily.  In several threads on this forum, you've very articulately described your justifiable frustration and anxiety at being talked into getting a ReZoom lens in one eye (which you hadn't wanted in the first place) when participants were needed for a research study about multifocals, only to later be told that you had "too much astigmatism" for a second multifocal lens once the study had ended.  Since it's the general consensus that having only one multifocal doesn't produce good results, your original doctor certainly has left you in a bind.  I've been trying to imagine how that doctor would react if you went back and told him everything that you've posted here about your experience and the feelings it caused. (Would he become defensive?  Embarrassed?  Apologetic?)  You might even ask how he'd react if his wife/sister/close friend had a similar experience, and what he'd suggest for them at this point.  It would certainly be an interesting scenario, even if it stays a fantasy.

[K-D]

Jodie, it has been almost one year of anxiety, frustration, and depression, regarding this lens.  I suspect the doc knows what I write on this board, because shortly after my posting here, he told me that a Rep from Rezoom that monitors this board, called him regarding my posts. It put a real strain on the doctor patient relationship.  At this point I don't care if the Rep reports my posts or not.  I am not going back to this dctor.  I do not believe that he put my best interests first and left me in a real bind.  I will let you know if I get any encouraging news from my up coming appointment. Jodie, thank you so much for your kindness and concern.  It is very much appreciated.
Kady

[JodieJ]

I'm just a former cataract patient who's done a lot of reading, but I believe that the "diagnostic equipment" referred to is what the doctor used to determine the power of your ReZoom lens.  From your post, it sounds like the second attempt to get the right power for you was still a little off--you seem to have very mild farsightedness and astigmatism.  This should be easy to correct with laser vision or CK enhancement.  But whether this will solve all of your ReZoom problems is uncertain.

Your best bet would be to consult other doctors, preferably those who are very experienced with multifocal lenses.  If you post your location, readers of this forum might be able to suggest experienced surgeons in your area.  You could also try posting a question on the Google group sci.med.vision.  When I posted a question there awhile ago about an unrelated eye problem, I received valuable information from optometrists, opticians, a board-certified surgeon and some very knowledgeable patients.

[Judy2]

I had the rezoom implant procedure done in my left eye on Dec. 14th, 2006.  I am scheduled to have my right (dominant) eye done on Jan. 25, 2007. Right now it seems my peripheral vision has closed in on me a little. I am also still seeing alot of 'flickering' of light(left eye.)  I wonder if these two problems will eventually go away.....and if having the other eye done will help to improve those problems.  I can definitly see much better with the lens though.  Thanks.

[K-D]

Judy, I can tell you that changes go on for a long time with a multifocal.  They seem to improve.  I had horrible glare for 3 months; now mostly gone.  I had disabling halos for 8 months; now almost completely gone.  So, you are in your infancy with the implant.  Many changes to take place. You have a long time to improve still. Best wishes.

[wishfuleye]

I too am noticing the loss of peripheral vision with my surgery eye (eight months after surgery,left, dominant).  I am really not conscious of the loss other than things surprise me from the left, and I seem to bump my left knee into things that I would have noticed if they were on the right side.  I hope that someday I'm not surprised by a semi entering my vision from the left at 60 mph.

I've also noticed that my reading vision is sharp for a width of only about two or three inches in the middle of my focus and the line blurs out to the left and to the right. When I close my cataract eye (my "good eye" for reading), I must move my head to scan a page. This is at odds with my doctor's diagnosis of macular edema, which he says should cause blurring at the focus point and clarity toward the edges.

[NutDriver]

I happened onto your website and I thought I might tell you about my ReZoom situation. I am nearsighted and had glasses for 40 years (am now 48). Near vision was getting fuzzy for years and I opted for Rezoom vs Lasik. I am truly disappointed! First eye was done Oct 1st and immediately noticed not halos around any light source, but rather cotton balls-big cotton balls. Doc said it will go away. Came back for 2nd scheduled eye one week later and commented to nurse that I didn't want 2nd eye done if this is what I will expect from ReZoom. She said I had to get 2nd eye done and problems will go away. Now after over three months, cotton balls are still there. Day vision on bright days is good, reading vision comes and goes from a clarity standpoint, but I feel unsafe driving at night because my vision is blurry. I noticed that sometimes when a car approaches that has a certain type of headlight that, while the lights are approaching, my vision becomes perfect and there are no cotton balls. Right after the car passes me, the cotton balls come back. This happens 1 out of every 50 or so cars. As I approach a stoplight from several blocks away, the cotton balls change to halos, but they are multi-ring halos-small one in the middle with 3 or 4 larger ones going out like a bullseye. As I approach nearer, the halos change to a starburst and when I am finaly right up close, the light has only a small blurr. There has been no real change since the first 2-3 weeks after surgery. Doc said we could remove ReZoom and put in mono, but I don't want another surgery and would like to keep ReZoom. However, I need to see clearly at night. I will wait if there is hope that it will get better, but so far it hasn't. I am getting upset and depressed with these results as I was not expecting to lose my night vision by having surgery to improve my eyesight, esp after dropping $6k. Any thoughts or comments would be greatly appreciated, esp the kind that can help provide a clear vision result to my dilema.

[K-D]

My psychedelic halos only started to decrease starting the 8th month. Halos are almost gone now.  I had no hope after the first couple of months.  These multifocal lense results are very personal and complicated.  Changes go on for a long, long time.  Best wishes.