Mixed vision after Rezoom implant

[K-D]

Hello,

I had a Rezoom implant in my left eye,  27/Feb/2006.
I had immediate clear, near, and intermediate, vision on my follow-up visit, the following day. My left pupil was very dilated and so I thought that was the reason my distant vision was so blurry.  Also, I was told about the halos at night. But I am seeing more than halos.  It looks like I am looking into a kalidoscope at night.  My concern is that if I can see so clear, near, and intermediate, I may have a wrong distant prescription. Have you had any patients that could see clearly near, and intermediate, but blurry distant, which eventually cleared up?  Am very anxious and do not see the doc for another couple of days.  Thanks much for any info.

[Forum-OD-MP]

6 days is not enough time.  cant make any vision judgement yet good or bad.  could still easily go either way

[eyecu]

6 days is not enough as the doc says. Also, when you go out into bright light and your pupil comes down, what is your vision? Pupil size does matter but you are still very early out.

[K-D]

Actually when I go outside the problem remains the same.  Very clear intermediate vision.  Blurry beyond 5 feet.  It seems like it is getting worse. I have three different eye drops that I put in 3 times a day.  One is Predisone.  All I ever heard is that cataract surgery is nothing.  For me, it has been a hugh deal.  Spent months deciding what lens to get.  Got a top doc.  And everyone that I know that had the Traditional lens saw clearly immediately.  I would have gladly put up with readers but was told by my doc  that vision with Traditional lens is blurry for 30 inches.  Now that is all I can see is about 30 inches and have halos, starburst and glare.  Very upsetting to say the least.

[eyecu]

Usually at about three weeks you are close to your final refraction. Most surgeons will use an antibiotic drop, a non steriod anti-inflammatory and a steriod drop such as Pred Forte. They will taper off the drops over time. I wonder if you might be a little over minused so that you have great near and intermediate at the expense of distance. The one thing the ReZoom gives you is excellent distance vision so something is going on. It sounds like you have an experienced surgeon and I feel you will have an answer here within a couple of weeks.

[K-D]

I agree.  Great doc but he did not do the tests, just the surgery.  Everywhere I read, the Rezoom is great at distance.
I saw the doc today and he said my eye is healing very well with no swelling.  He said to maybe put a Rezoom in my other eye for distance.  But that is not my dominant eye and I would want distance in my dominant eye.  I don't know how to approach the subject.  But I do think the lens were not calulated correctly.  And at night I see a hundred circles that look like pinwheels.  It is impossible for me to drive safely.  I have to hold the eye shut with the Rezoom..  Can this lens be taken out.  If so, does the doc usually charge a high fee.  How dangerous it is to be taken out.  I appreciate the intermediate vision, but not at the expense of distance and psychodelic night vision.  Feel just awful and do not know what to do.  Thank so much for your advise.

[eyecu]

K-d: sounds like you understand it. You can get unwanted visual images from all lenses, even monofocals. It is usually at night with a larger pupil and direct headlights etc. Some people notice them more than others and they usually subside through neuro adaptation. Or you can even get your doc to give you some diluted piolcarpine to constrict that pupil when you drive but it sounds like distance vision is your concern. You might also try some artificial tears to make sure you don't have dry in that eye which can cause problems since the cornea refracts the majority of the light. Plus, do you have any astigmatism from the surgery. I think you have to just keep hounding him on the distant vision until you get an answer. Having your second eye done should help as well, if you have a cataract in that eye. You need to find your post op refraction but probably need another week to see where it settles. Exchanging the lens is not that hard early on but there is always a risk when you go in to do another surgery but there are lots of lens exchanges done mainly due to the wrong power. No matter how hard you try, it just happens. You have the right to be happy but just like anything else, you have to work in an amenable fashion with both parties. Communication is what it always gets down to.

[K-D]

Eyecu,

Thank you so,so much for all your support.  However, yesterday for the first time, I was seen by an OD. He did not calculate the lens before surgery, a tech did.

I could not read the chart from far away.  When I asked him about it, he said , "Oh the lens was set to see intermediate and the next one will be set for distance."  I do not believe this.  If this was the case, a person would not  have a multifocal put in.  They would have a monofocal for distance and one for near, without the unbearable halos. Even if all lens have halos, what I am seeing is disabling.   I feel they are trying to solve the problem with another Rezoom lens by setting it for distance. But the whole point of this Rezoom was that I was told I would see close, imtermediate, and distance.  I would have never agreed to this situation.  Again, thank you so much for your support.  I should be paying you.  You give more information than anything I am getting from the office.

[eyecu]

Hard to believe you saw an OD and not the surgeon. There is actually a monovision done with the ReZoom to give you an increased depth of field but it definitely sounds like you are over minused which would enhance the halo effect at night and cut down on your distance vision since you had such great near and intermediate right off the bat. Usually your distance and intermediate is good off the bat and the near comes in over time. What city are you located in?

[K-D]

EyeCu,

I live in St. Louis, Missouri.  I did see the surgeon too yesterday.  But saw the OD for the first.  The surgeon wants to put another Rezoom in my right eye for the distance.  But I am not comfortable with this.  At night, it is just a horrible sight.  I cannot live like this but I don't know what the risks of removing the lens is, if the doctor will do it, or if my insurance will cover it and then  what to put in it's place.  Since the near and immediate is so good right off the bat, I really feel that if my lens was the right prescription, I would not be having these problems.  But I don't know.  I just know that I cannot see past a couple of feet see great near and intermediate  and the night time is a psychodelic experience.  I just don't know what to do. I can't continue to live like this. Thank you so much for you concern.  I appreciate it so much!!!

[Bill in JAX]

Sorry to read about your problems with the ReZoom IOL after your surgery.  You can be assured of one thing and that is all advise and information you receive from eyecu is the best and most professional you can get.  Also, I may be of some assistance to you as I have just completed cataract surgery on both eyes and had ReZoom IOLs implanted in both.  First, are you completely sure that you received the correct ReZoom IOL? After surgery, did the surgeon give you a Patient Lens Implant Card from AMO?  Does the back of the card reflect the implant date, Model Number such as NXG1, Diopter Number such as 19.0D, And a ten digit SN such as 4109700512.  Also the card should  reflect and OT and OB MM #s such at 13mm and 6mm?  Eyecu is correct in that if you had a true ReZoom multifocal IOL implanted your distance vision should have been excellent a few days after surgery without and major complications. Reading and near usually take and 6-12 weeks to really kick in. After my first implant I was set back about a full week due to an abrasion on my cornea from the surgery.  After a week of meds such as Nevanac, Pred Forte, Cosopt and Muro 128 my vision came around and there have been no problems since.  My second eye was done 10 days ago and everything is fine. Still on meds Nevanac and Pred Forte. Driving at night was problematic at first with all the halos but night vision is getting better every day.  Suggest you meet with your surgeon to determine what type and strength IOL you received.  Eyecu will help you through this mind field.

[K-D]

Hi Bill,

What kind people to even care what problem I am having.  Thank all of you!  Yes, Bill I have the card you asked about. ANO Diopler 17 OD t 13mm and B6mm.
Nothing is changing for me.  Great near and intermediate vision.  No distant vision and huge pinwheels at night.  Not just annoying but disabling.  Last night coming home from a friend's that I have been visiting for 10 years, ended up in a very bad part of the city.  Just could not make things out.  Like the 4th of July coming at me.  Am suppose to have a Top Doc. Just so very, very, upset.  I spent months deciding on the lens and the doc because I had an aunt who lost a eye due to cataract surgery.  I just do not know what to do because I cannot stay like this and yet, I sure don't want it to become worse with another surgery. Wish I would have gone with a Traditional or Crystalens.  Still, I think that an OD should have done my prescription for the lenses and a tech did.  Yet, this is a very well know place for cataract surgery and everyone else in the office seemed thrilled with their results. I was better off with the cataract.  I could not hardly see.  But I did not have the crazy night vision either.  A real mess.  And no solution that I can see.  Thank you again for your concern.  It is greatly appreciated!

[John82207]

KD-  I am an eye surgeon and use alot of REzoom implants.  It sounds like you are actually slightly nearsighted in the eye that you had surgery on. This would explain your current vision as you describe it AND the worse night vision.  The selection of implant power is NOT and exact science and many things play in to your final refraction.  Having said that there are a number of ways to alter your presumed nearsightedness in the post op period. 1)Excimer laser surgery 2)even RK is used by doctors inasmuch as the nearsightedness is usually minimal and generally can be corrected with just two small incisions- not a common approach but it is being used 3) Piggyback intra-ocular lens implantation- works well despite sounding "weird" to the average patient.  4)Rezoom implant exchange.  Which method is used on you if you are nearsighted will depend on which method your surgeon feels is the safest and that he has the most experience with.  Generally the REzoom is an "upgrade" in cost over an above what insurance pays for.  In our office this "includes" post operative procedures that are necessary because of a residual refractive error.  If you feel unsure about the whole REzoom concept altogether ask to have a soft contact lens placed on your operative eye that "corrects" your nearsightedness so you can experience vision as it was intended with the Rezoom.
                           Good Luck    Doctor JOhn

[K-D]

Thank you so much Dr. John.  Actually I had to pay $895 above what my insurance would cover for cataract surgery because it was a multifocal. It was suppose to be $3400 above what my insurance would cover but I was eligible for a research program comparing different lenses and so was charged the $895 instead of the $3400. If it is not too unsafe, I would perfer to have the lens removed.  I am just miserable with it. Yet, I fear the risks of another surgery.  Just unsure as to what to do.  Thank you so much  for telling me my options.  Again, greatly appreciated.

[Supard]

I'm looking for an experienced surgeon for ReZoom implant. Could you email me your office address? My email is ***@****

Thanks.

[K-D]

Ok.  Now I am really upset.  I called the office in the am and told them I could see only to arms length, then blurry,  and impossible to drive at night due to hugh circles with startbursts in different colors..
I asked if there could be an error in the refraction.  I was told that the doctor looked over my chart and said, No! that I should come in and be fit for mono vision glasses.  I never wore glasses in my life.  And to see distance means that I will need them all the time compared to readers. Am I missing something here?  Surely, he cannot think that this is the solution. No mention of anything else.  Just wear glasses.  And I got into this situation in the first place because he said I would not be able to see the first 30 inches without wearing glasses.  Now, not being able to see past 30 inches without glasses does not seem to be a problem to him. Am I missing something here?

[Eagle eyes]

Try to find out exactly what your refraction in the post op is and post it for us to see. It is very common for some patients to experience the nighttime visual sensations you are describing, ESPECIALLY Before the 2nd eye is done. Once you have the 2nd eye done, your brain will then be balanced again and start to "neuro-adapt" to your new vision. For most patients, it is just like wearing a watch. When you first put one on, drives you crazy because it feels heavy, once you get used to it, you don't even notice it. It definitely sounds like to ended up near-sighted though. Which means you would have more halos at night. Therefore, it makes sense that your doc recommended setting the 2nd eye for distance, to assist in the distance vision. Again, find out your "post op refraction".

Good Luck.......

[K-D]

I am going to ask for my refraction this Tuesday Eagle Eyes.  But I see more than halos.  Yikes,  It is the fourth of July at night.  Impossible to drive.  And my eye that has the Rezoom is my domimate eye. So, I do not feel comfortable having my non dominate eye set for distace.  I am afraid to even think about another Rezoom because when I go into darker lighting, total blurr.  With both eyes this way, I would be almost blind. And I want distance in my dominate eye. I wish I would have gone with the Traditioal lens.  This is just too, too much to deal with to avoid reading glasses.  But I was told that I would need bifocals.  If I was told that all I needed was readers, I would have never gone with the multifocal.Your concern is very much appreciated Eagle Eyes!

[eyecu]

Dr. John summed it up. I would still consider having the second eye done the more I read what you are telling me. It sounds like your surgeon has experience and a plan. By having your second eye done with more of a plano target, he is giving you a full range of vision. Once your second eye is done, the halo effect should diminish and your distance should kick in and you should be happy. Right now you are going crazy with just one eye done which is not uncommon with any multifocal implant. He was going to give you glasses for your ReZoom eye to bring it closer to your other eye's distance correction until you had your second eye done from what I can tell. Based on that, I would follow his plan and give it some time. If you still have some halo effect in your first eye(although I think it will diminish), then you could have laser correction to remove the myopia. But I still think you could end up fine.

[K-D]

EyeCu,

Thank you again so much for your kindness and support.  You are right on target.  I saw my doctor today and I am soooooo happy.  I was given a temporary soft contact lens, which I cannot even feel, and I see PERFECTLY!!!!!  Like a miracle!!!!
Very kind TALENTED man, and spent a lot of time explaining why I was having the problem with distance. Evidently  lens are based on calculations. I am a 0.75 refraction. The lens may not always be your  exact calculation and also cannot predict where the lens will settle.  But, it can be corrected.  The temporary contact that I received is giving me perfect vision, and cut down on the night problem by 60%, which will probably be even better when the next Rezoom is implanted.  No psychidelics now.  Halos.  But very small compared to before the contact. Can night drive now with no problem. And would certainly choose to have these halos to have  the near and intermediate vision.  What made me the happiest to hear is that I would be having the same distant problem with the Traditional  lens but would not have my clear, near and intermediate vision which I had from the beginning with the Rezoom.  This was new to me.  I will certainly have a Rezoom in my other eye. It is wonderful to see up close and intermediate, but of course not at the expense of not seeing at distance. But the Rezoom was not the problem and gives me wonderful near and intermediate vision and now great distance .  And I have a Top Doc who can correct permanently any problem with the distance.  So, I have so much to be thankful for today.  And that includes all of you, for all your support.  Thank you all and wishing you all the best possible outcomes regarding your eye surgeries!!!!!.

[Eagle eyes]

Good For Y O U!!! This is why I asked about the refraction, which now tells us why you were having 4th of July in March. HA! Your surgeon can better select the IOL power for the 2nd eye and get you even better. Plus your brain will then better adjust (neuro-adapt, as your surgeon calls it)...and will be even better. Congratulations!!! Keep us posted on your results after 2nd eye is done and settling in...

[K-D]

I certainly will keep you posted Eagle eyes. And thanks so much for your support and concern.  Thank all of you, Eyecu, Dr. John, Bill, everyone.  You were so comforting to me during a very rough time.  Cannot thank you enough!
Am seeing clear, and sharp, and perfect with the contact.  What a difference. And hopefully with the next Rezoom things will get even better. Will let you all know.  Thank you all again!!!