Mono- or Multifocal

[Occupant]

I am 70 years old and have cataracts in both eyes. I initially decided to go with the Restor lens from Alcon - but it's not available. I need 8.5 to 9.0D and I also have some astigmatism (don't know what it is). By now I have been waiting for over a year and my vision gets progressivly worse. I am now using my driving glasses to do close up-work. I don't mind wearing glasse, but could never get used to bifocals. The only thing I am really concerned about is the Depth of Field issue, e.g. I want to be able to see (in focus) my speedometer and the road ahaed of me without having to switch glasses. Any help would be appreciated.

[Susan12345]

Well, those were the statistics this doctor quoted me.  I don't know where he got them from.  If those are his personal statistics, I guess I need to find another doctor. I'm not sure how. Susan12345

[JodieJ]

IMO, the notion that one out of every 1000 cataract surgeries results in total blindness is total **** ****.

[Susan12345]

Jodie, the  doctor said that there was a 1 in 1000 chance of total blindness in that eye ANY time you went into an eye for surgery, even regular cataract repair.  The additional risk of retinal detachment with an explant is just when doing the surgery, above the  lifetime risk, because of the risk of capsule rupture.   Plus there was a list of additional risks like corneal decompensation, which I didn't really understand, but I'm sure it's definitely not good.  Plus, if I do decide to have it done, I've got to figure out whether this guy is really the best one to do it and I just don't know how to determine that.  

Blue, what tests did Dr. Waltz do to determine that your IOL was positioned incorrectly that the previous doctors didn't do?  I've been told by 3 doctors now after dilated eye exams that my IOL"s were centered perfectly, but it sounds like you were told that by several doctors as well.  Good luck on your surgery.

Susan12345

[JodieJ]

blue92--Your post is testimony to belief that resourcefulness  and a positive attitude can pay off.  Please let us know your outcome--I'm anticipating a very good report.  (And thank you, eyecu, for posting Dr. Walsh's name on this forum.)

Susan--What's this about blindness?  From the info you posted, your chances of experiencing a retinal detachment are less than 1.5 percent if you explanted your "horrible" lenses.  That's really not much different from your chances of retinal detachment if you don't explant your ReStors.  But even in the extremely unlikely "worst case scenario," having a retinal detachment doesn't make you blind (unless you decide not to treat it).  Retinal surgeons repair detachments every day.  One of my coworkers has had two retinal detachment and currently enjoys good vision.

Susan, in your case, it doesn't really matter why your ReStors don't work for you.  You've found a surgeon who can exchange them for lenses that will make your life easier and potentially more satisfying.  Go for it!

[blue92]

A while back I wrote describing my visual problems with the Rezoom lenses. My problems were ghosting, double vision and no decent intermediate vision. Close vision was good and distance vision was good except for the ghosting. I developed severe dry eye after the surgery and the aberrations were mainly blamed on the dry eye. Fortunately, my dry eye is subsiding (finally), but the visual aberrations have not. I have been to a number of doctors for a second opinion. I realize that most doctors do not really understand the mechanics of the lenses and the critical items that must be considered for a successful outcome.

Somebody posted a successful Restor explantation done by Dr. Kevin Waltz in Indianapolis so I decided to make an appointment with him and took the trip to Indiana to see him. Dr. Waltz was able to diagnose the problem within minutes and confirm my hunch that the lenses were displaced in both of my eyes after a thorough examination. I was actually able to see the decentralization of the Rezoom lenses in the photographic pictures he took of my eyes and could see the refractive misalignment in the digital printout after a test for refraction was done.  The pictures told the whole story. I always suspected that there was something wrong with the placement of the lenses but no one was able to pick up on this. They all blamed the problems to adaptation, dry eye, astigmatism, etc.

Surgery to reposition the lenses is scheduled for late December for the right eye and 3 weeks later in January for the left eye. The procedure for repositioning is less traumatic and safer than removing the lenses and I have full confidence that Dr. Waltz will resolve my problem. Dr. Waltz is an Array lense implantee himself and I was amazed to see how well he could see in all light levels. I will keep you updated and let you know the outcome of my repositioning surgery.

The moral of the story, is keep looking for someone who's qualified and understands the technology..

[Susan12345]

Unfortunately, I just don't have a clue whether I'd be in good hands with this surgeon or not.  How do you decide?  He was in the "Best Doctors" list, but so was my other surgeon.  He didn't have anything to say about why my ReStors didn't work except that my eyes are strange.  Of course, like the 1st cataract surgeries, it'll be done one at a time, so if something goes wrong I'd only be blind in one eye.  But I pretty much have to emotionally  commit to having both done, because it'll make me nearsighted again.   I know, from the 5 weeks between my 1st and 2nd ReStor surgeries that having one eye corrected for distance and one for near wouldn't work for me and I'd rather be corrected for near and wear glasses for distance than vise versa.   Susan12345

[JodieJ]

I think you'd be in very good hands with your new surgeon.  Do you currently have better vision in one eye than the other?  You could start by explanting the ReStor in your "bad" eye, without committing to any procedure in your other eye.  I predict that you will be so pleased with the results of the explantation that you'll be eager to schedule the second procedure.

I'd be interested in knowing your doctor's opinion about why the ReStors didn't work for you.

[Susan12345]

Betting odds, maybe, but if I had good luck I wouldn't have had the problems I had with the ReStors in the 1st place.  If it were only one eye that had the problem it might be easier to make the decision, but 2 more surgeries....it's so terrifying.    One really strange thing, the doctor said that on my corneal exam I had zero astigmatism, my surgeon HAD corrected it 100%, but on my refractive tests I do still have significant astigmatism in my right eye.  I asked him how that was possible and he didn't know, said maybe it was in the lens but didn't have the time/inclination to speculate.  That is so weird.   Susan12345

[JodieJ]

I hope you decide to get "those stupid, horrible lenses" explanted.  They've made you miserable for long enough.  And unless I've miscalculated, your probability of retinal detachment is less than 1.5 percent.  Sound like betting odds to me.

[Susan12345]

Jodie, I had my appointment with the most recent doctor on Friday, and he said the astigmatism is not the problem, if it were I would be able to see fine with glasses.  He says the only solution is explanting the ReStors.  At least he believed my complaints and didn't dismiss them as being tired like the doctor who put them in.  But I am just so terrified of the risks of more surgery.  He says it can be done, outlined the risks, 15% chance of the capsule rupturing with a 5 to 10% chance of retinal detachment if that happens.  All because I had these stupid horrible ReStor lenses.   Susan12345

[K-D]

Jodie, I am not patient. I am a coward. Your info gives me hope though.  Thanks so much!

[JodieJ]

You're so much more patient than I am--I'd probably already have my appointment set up for 4 weeks from now.  (Patience is not my virtue.)  I don't think a vitrectomy would be very risky.  And it's been reported that with the new sutureless vitrectomy equipment, recovery is extremely rapid.  (One doctor reported that the day after the vitrectomy, it's often not apparent which of the patient's eyes had the surgery!)

[K-D]

Jodie, the retinal doc said that in four months the floaters would fall below the line of vision, go to the side, or the brain would tune them out.  I have only 4 weeks to go and I do not see any of that happening,  other than a small lightening of the floaters.  Dr. Prince mentioned 9 months.  So, I am going to wait until then.  I have a doctor lined up.  A doctor that I go to had it done by this doctor and is very pleased with the results.  It just helps to know that something can be done.  It is weighing the risk against the constant aggravation.  I think that if things remains this way in another 6 months, I will be ready to take the risk.  Thanks for your concern! Kady

[JodieJ]

You're saying that the floaters are causing you constant anxiety and driving you crazy.  (I'd probably feel the same way.)  What does your retinal doctor say about the probable time table for improvement?  At what point might you consider surgery in the event that your situation doesn't improve?  Maybe you could use another opinion.  Having information doesn't commit you to a course of action, but it's usually helpful for reducing anxiety.

[K-D]

Thanks for the info Jodie. Am going to take your advice.  Not ready for the big step yet.  But if this stays the same after a year, will consider it.  This is too annoying. Yes, it is a small problem. But it causes constant anxiety. And it is impossible to get the mind off of it because of the blur and black floaters that are constantly floating in the line of vision.

[K-D]

With my Rezoom, the middle of the lens in for distance.  So, when I am outside, my pupil is constricted around the center of the implant, and so the middle of the lens for distance is in play.  When in the dark, my pupil dilates and the next ring on the lens is in play.
I was told that with the Restor, the middle is for close, opposite of the Rezoom.

[JodieJ]

I don't know whether vitrectomies are commonly done to treat floaters.  I'm guessing that the degree of risk would depend on the condition of the eye (in your case, probably healthy), the reason for the surgery, and the skill of the surgeon.  Yes, it can be done with local anesthesia and no sedation (mine was), although local anesthesia and IV sedation is the norm.  My surgery was painless.  There is new vitrectomy equipment available that doesn't require sutures and significantly reduces recovery time.  For the type of surgery I had, the risk of retinal detachment was about one percent.  The highest risk was developing a cataract, which can't happen if you already have an implant.

I can certainly understand why you want to get rid of those floaters.  If I were in your situation, I'd schedule consultations with one or two of the best retinal surgeons in my area to get their opinions about a surgical solution.  (Try asking other ophthalmologists who they'd send a family member to.)  That should give you more information for basing a decision as to how to proceed.

[Susan12345]

K-D, i still don't get how the ReStor is supposed to work. How do your eyes and brain "know" to read with the center of the eye and look at distance with the outside and what is the part you're not using supposed to be doing?  Although I was never able to adjust to bifocal glasses there IS basic logic in how they're supposed to work, the top for distance and the bottom for close.  But I don't understand the logic behind the ReStors at all.

Sorry about your PVD, hope it improves.

Susan12345

[K-D]

Susan you are not kidding.  I was scheduled for surgery on my second eye many months ago. No mention of destorded vision, or any problem was mentioned.    Then after the study report was in, it changed to, " risky destored vision and eye surgery before cataract surgery, and months of healing".  It is hard to know who to trust.  This was definately financially related to me. Study over.  No need to finish the reduced rate patients, in my opinion.
Jodie, Can you tell me about your vitrectomy?  Is it really that risy?  My floaters are not improving from the PVD and I don't want to live the rest of my life like this.  But I read many times how risky a vitrectomy(sp) can be. Can it be done while awake?  Does it increase risk of a retinal detachment? I am just going into my 4 month after the PVD, but very little improvement.  If after a year things do not get better, I was thinking about seeing a doctor for this procedure.  Can you give me your opinion?  Thanks much!

[Susan12345]

Computers are considered intermediate?  I would have guessed intermediate was like 4-6 feet.  I just measured and my computer screen is about 20 inches from my eyes.  I wear my reading glasses on the computer but with bigger print and some strain I think I could use the computer without glasses-using the computer is much less difficult than reading a book, probably because the light is so good on the screen.  It's too bad books don't light up.  

Dr. ReStor told me that he might not be able to correct my astigmatism 100% and that's why I might have to wear reading glasses after surgery "for small print".  That's why I thought the 20% were wearing reading glasses.  At the time that seemed perfectly reasonable, I was already wearing reading glasses, for READING,  as a nearsighted person since childhood I had no concept that it was possible to not be able to take your glasses off and see the buttons on the microwave and of course no clue of the fluttering I get as my eyes try to adapt from far to near.  He certainly never mentioned  before or after surgery any further surgery to correct the astigmatism more.  I suppose because he knew that my HMO wouldn't cover it.  They covered the 1st astigmatism surgery because it was done at the same time as the cataract surgery, all I had to pay was $2100 extra for the ReStor lenses.  The money was definitely never the issue for me though.  I would NEVER have had multifocal IOL's if I had thought there was any chance of needing more surgery.  It was scary enough knowing that you had to have both eyes done if you had multifocals, but I told myself, the 2nd cataract will have to be done eventually, I might as well get them both done and not have to worry any more.     HA!!!!!!      

I don't know why he didn't tell me all this.  He's certainly not hard up for business, it takes months to get an appointment.   Though he was new to my HMO at the time, one of the other eye doctors I consulted before him told me how incredibly lucky my HMO was to get him,  so maybe he wanted to make the HMO didn't regret the huge salary I'm sure they're paying him.  I don't know.  Doctors are a  bizarre species.    

Susan12345

[JodieJ]

The 20% who wear glasses with ReStor need them for intermediate vision.  That's the weak point of ReStor.  (Actually, some reports state that it's more than 20% who need a low prescription for intermediate tasks, like doing computer work.)  ReStor is basically a bifocal lens, with near and distance portions.  Most people with ReStors have close to 20/20 vision for distance and near--that's why they were willing to pay extra for a premium lens.  No one with ReStors should need +2.50 readers for near vision--unless they have the wrong power lens.

I got the info on retinal detachment rates when I was researching "clear lens exchange".  The rate of detachment declines after age 70, and it is higher for males than females.  Myopia isn't much of a risk factor unless it's worse than -8 diopters.  I had vitrectomy surgery, which does adds a little to my risk.  I got a cataract as a result of the vitrectomy and did a clear lens exchange in my other eye.

I can understand your reluctance to trust doctors.  Last year I developed double vision related to monovision contact lens wear--a fairly rare occurrence.  I had several worthless, frustrating consultations with optometrists and ophthalmologists who had no idea what was causing my problem or what to do about it.  I started doing my own research by typing "double vision" in Google.  Once I understood my problem, I had a better idea of what would help.  I ended up referring myself for strabismus surgery.  Now I try to research medical issues BEFORE I see the doctor.  It gives me a basis for knowing which doctors to trust--and which ones to run away from.

[Susan12345]

Just curious, Jodie, where you read about being female and older decreasing the retinal detachment risk.  I couldn't find anything related to gender related risk, but everything I've read says that getting older increases your risk.  (Except for trauma related detachments, where of course daredevil young men would likely have the edge.)

Are you saying that most of the 20% of people who still need glasses after ReStors wouldn't if their doctors had done their measurements correctly?  That's a lot of bad doctors!  Given my level of trust in the medical profession, I can believe it, and yet, knowing how greedy pharmaceutical companies are, you'd think they would be doing a LOT more thorough training before giving doctors access to the ReStors if that were the case.  Granted, the Alcon Co. gets paid for the IOL whether it works or not, but bad publicity is eventually going to decrease demand.

Anyway, thanks for caring.  I have a 2nd appointment with the new doctor Dec. 8, if I'm able to get my medical records by then.  I haven't a clue whether he's trustworthy or not and feel like there's no reliable way way to find out about him or any doctor until it's too late.  All I know is that he (like my ReStor doctor) has been approved by the Alcon Co. to install ReStors and he (like my Restor doctor) has been on my local "Best Doctors" list.  

Susan12345

[JodieJ]

You may not have been the best candidate for ReStor, but that determination was your doctor's responsibility (not yours).  IMO, the best thing about ReStor is the sharp reading vision it provides.  You reportedly need +2.50 readers for near vision, probably because your doctor implanted lenses in the wrong power for you.  Your surgery results are WAY below the standard of what someone has the right to expect after paying for a premium lens, yet your doctor has consistently ignored your legitimate complaints.  It's understandable why you have a hard time trusting doctors.

BTW, did you know that being female significantly lowers the risk of retinal detachment?  And your risk is quite low to begin with--actually much lower than mine.  And getting older lowers our risk.

Susan, I hope you're able to stop blaming yourself for the mistakes of others, and you can then re-focus your energy on making your situation better.  I'm so glad to learn that you've been referred to a doctor outside your HMO who is reviewing your case and making recommendations.  Best of luck to you, and keep us informed.

[Susan12345]

I don't need reading glasses for distance vision, just for reading, though I wear them most of the time inside my apartment because I can't stand not being able to see things close like when I was nearsighted.  (I take them off to watch TV).   I wear bifocals outside mainly so I can read labels in stores and to protect my eyes from the wind outdoors, and probably because I feel less vulnerable that way. I know I'm already high risk for retinal detachment because of myopia, diabetes and cataract surgery, so I certainly want to know how much more risk I'm facing.  I'll ask the new doctor how much more risk I'm facing in his opinion when I see him for my next exam.  Percentages don't really matter though, if something  goes wrong for me it doesn't matter how many other patients had spectacular results.    No doctor can guarantee success. I already have drusen which is an early sign of macular degeneration, and while I don't have any diabetic retinopathy I know it could come at any moment.  I've NEVER been able to understand how anyone can stand to go on living if they're blind.  I know I should just think, well at least I'm not blind now, live in the moment, but thinking about surgery and having to make a decision fills me with panic.  This new doctor is the one my HMO refers complicated cases too, he's on the "Best Doctors" list too, like the one who did my ReStors and the orthopedic doctor who messed up my knee surgery, so obviously that means nothing, but I don't know how you know who to trust.  Or how to live with this kind of fear.    Susan12345